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Pharmacology Test #3 > COPD > Flashcards

COPD Flashcards

1
Q

What is the goal of COPD therapy?

A

Relieve symptoms

Prevent disease progression

Improve exercise tolerance, QOL

Improve health status

Prevent complications and exacerbations

Reduce mortality

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2
Q

What are the short-acting bronchodilators used to treat COPD?

A

Albuterol

Levalbuterol

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3
Q

What are the anticholinergics used to treat COPD?

A

Ipratropium

Ipratropium/albuterol

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4
Q

What are SABAs used for in treating COPD?

A

Maintenance therapy

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5
Q

What are the long-acting bronchodilators used to treat COPD?

A

Salmeterol

Formoterol

Arformoterol

Indacaterol

Vilanterol

Tiotropium

Theophylline

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6
Q

Name the long acting beta agonists used to treat COPD, their duration of action and their dosage form

A

Arformoterol = 12 hr –> Nebules
(long acting)
Indacaterol = 24 hr –> Capsule for inhalation (1/day) (ultra long acting)

Vilanterol = 24 hr –> Capsule/blister for inhalation (1/day) (ultra long acting)

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7
Q

What is tiotropium?

A

Long-acting anticholinergic

Often seen as first-line

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8
Q

What is Aclidinium?

A

Newest long-acting anticholinergic

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9
Q

What is the mode of action of aclidinium?

A

Competitively/reversibly inhibits ACh action @ M3 receptors in smooth muscle –> smoother muscle relaxation = bronchodilation

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10
Q

What is a benefit of tiotropium over ipratropium?

A

More selective

Higher affinity for muscarinic receptor subtypes

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11
Q

What is a common side effect of tiotropium?

A

Dry mouth

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12
Q

When would you prescribe inhaled glucocorticosteroids for COPD?

A

Repeated exacerbations (3 w/in a year)

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13
Q

Which inhaled glucocorticosteroids are used for COPD exacerbations?

A

Salmeterol and Fluticasone combo

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14
Q

Why would you use a salmeterol and fluticasone combo to treat COPD exacerbations?

A

Decrease exacerbations

Improve health status scores

Improve FEV1

**all better than salmeterol alone

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15
Q

What is rolumilast?

A

Oral PDE-4 enzyme inhibitor

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16
Q

What does roflumilast do?

A

Reduces pulmonary inflammation

17
Q

What are the adverse drug reactions for roflumilast?

A

Headaches

Nausea

Diarrhea

Insomnia

Back pain

Influenza

Anxiety

Depression (caution pts w/ Hx of huicidal ideations)

18
Q

Which COPD pts should use oxygen as a long term treatment?

A

Stage IV COPD (PaO2 @/below 55 mmHg or SaO2 < 88%)

OR

PaO2 between 55 mmHg - 60 mmHg or SaO2 of 88% w/ evidence of pulmonary hypertension, peripheral edema (suggesting CHF) or polycythemia

19
Q

What is the primary goal of oxygen as a long term treatment in COPD?

A

Increase baseline PaO2 to @ least 60 mmHg

Increase SaO2 to @ least 90%

20
Q

How many hours/day do pts w/ COPD need to be on their oxygen?

A

15 h/day

21
Q

How else can you treat COPD?

A

Mucolytics

Antioxidants

Immunoregulators

Antitussives

22
Q

What mucolytics could you use to treat COPD?

A

Acetylcysteine

Ambroxol

Erdosteine

Carbosteine

23
Q

What are the nonpharmacologic treatments of COPD?

A

STOP SMOKING

Avoid Triggers (cold air/pollutants)

Filter Air

Adjust ADLs as needed

Diet-nutritionist

24
Q

What is the first thing used to treat COPD exacerbation?

A

O2! –> get SaO2 > 90%

SABA

25
Q

What are the 2nd line treatments of COPD exacerbation?

A

Short acting anticholinergic

Methylxanthines (aminophylline, theophylline)

26
Q

What is the systemic glucocorticosteroid used to treat COPD exacerbations?

A

Prednisone (daily for 7 - 10 days)

27
Q

When would you use a systemic glucocorticosteroid to treat COPD exacerbation?

A

FEV1 < 50% predicted

28
Q

When would you treat an COPD exacerbation with antibiotics?

A 
3 Cardinal Symptoms = Present
                Dyspnea
                Sputum Volume
                Sputum Purulence
OR

2 of 3 symptoms if purulence sputum = 1 of the symptoms

OR

Pt w/ severe exacerbation that requires mechanical ventilation

29
Q

What are the most likely microorganisms that cause a mild exacerbation?

A

H. Influenza

S. Pneumoniae

M. Catarrhalis

Chlamydia

Pneumoniae

Viruses

30
Q

What are the first line antibiotics used to treat a mild COPD exacerbation?

A

Penicillin

Amoxicillin

Doxycycline

Trimethoprim/Sulfamethoxazole –> Bactrim

31
Q

What are the alternative antibiotics for a mild COPD exacerbation?

A

Amoxicillin + clavulanic acid –> Augmentin

Macrolides –> azithromycin

2nd/3rd generation cephalosporins

32
Q

What are the most likely microorganisms that cause a moderate COPD exacerbation?

A

Same as mild exacerbation PLUS penicillin resistance

Enterobacteriaceae

33
Q

What are the first line antibiotics used to treat a moderate COPD exacerbation?

A

Amoxacillin + Clavulanic acid –> Augmentin

34
Q

What are alternative antibiotics used to treat moderate exacerbation?

A

Fluoroquinolones:

Levofloxacin

Moxifloxacin

35
Q

What are the most likely microorganisms that cause a severe COPD exacerbation?

A

Same as moderate

P. aeruginosa

36
Q

What is the first line antibiotics used to treat for a severe COPD exacerbation in a patient at high risk of an P. aeruginosa infection?

A

High Dose:

Ciprofloxacin

Levofloxacin

37
Q

What is the length of antibiotic therapy?

A

7 - 10 days

**macrolid/fluoroquinolone/cephalosporin data shows 5 day treatment is just as effective

Pharmacology Test #3 (6 decks)

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