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Pharmacology Exam 2 > COPD > Flashcards

COPD Flashcards

1
Q

CXR findings - COPD

A

hyperlucency (trapped air)
barrel chest
vertically oriented heart
flattened diaphragm

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2
Q

Normal decrease in FEV1 for non-smokers

A

25-30 mL/yr after age 35

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3
Q

Decrease in FEV1 for smokers

A

> 60 mL/yr

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4
Q

What scale can determine prognosis of COPD progression?

A

BODE

BMI
Obstruction (degree of airflow limitation)
Dyspnea
Exercise capacity (6 min walk test)

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5
Q

Goal of therapy for COPD

A

(NO CURE)

  1. symptom control
  2. prevention of exacerbations
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6
Q

What is the BEST intervention for COPD?

A

Stop smoking!

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7
Q

Anticholinergic Agents - MOA

A

acts on enzyme guanylate cyclase -> increases cGMP -> -> -> bronchodilation

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8
Q

What is the biggest issue with Ipatropium (SAMA)?

A

QID

MDI - need spacer or proper # of steps (harder to use)

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9
Q

Tiotropium - counseling for technique

A

pill form for inhalation…not for PO!

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10
Q

Tiotropium - class and indication

A

Long acting anti-cholinergic (LAMA)

COPD

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11
Q

Ipratropium - class and indication?

A

short acting anti-cholinergic (SAMA)

asthma exacerbation and COPD

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12
Q

ICS for COPD - who?

A

more severe patients (b/c higher risk of death and pneumonia)
GOLD 3 and 4 (FEV1<2L)

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13
Q

Roflumilast (Dalisresp) - class and indication

A 
PDE4-inhib
severe COPD (GOLD 3 and 4)
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14
Q

PDE-4 Enzyme Inhibitor (Roflumilast) - MOA

A

inhibits phosphodiesterase 4 (PDE4) which results in accumulation of cAMP in lungs –> anti-inflammatory, mild bronchodilation, remodeling

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15
Q

Roflumilast - ADE

A

weight loss - 20% lose 5-10%, 7% lose > 10%

this is a problem b/c already thin

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16
Q

Are the decreases in exacerbation from Roflumilast clinically relevant?

A

No.
Not a first line…add to other drugs.
Who is a candidate? severe patient trying to keep out of hospital and can afford.

17
Q

Are mucolytic agents recommended for COPD?

A

No

Doesn’t really help and has not been proven.

18
Q

Vaccines for COPD patients

A

Pneumococcal and influenza

19
Q

Supplemental home O2 - who can get?

A

PaO2 < 55 mm Hg (ABG) or SaO2 <88%
or
PaO2 56-59 mm Hg + (evidence of pulmonary hypertension or secondary erythrocytosis (Hct 55%) or right sided heart failure)

20
Q

*Drugs to use with caution in COPD

A 
Beta blockers
Respiratory depressants (opiods, benzodiazepines)
21
Q

*GOLD Guidelines: non-pharmacologic

A

A - smoking cessation + physical activity + vaccines

B - above + pulmonary rehab

22
Q

*GOLD Guidelines: First Line

A

A - SAMA prn or SABA prn
B - LABA or LAMA
C/D - (ICS + LABA) or LAMA

23
Q

Most common cause of COPD exacerbation

A

viral resp tract infection

24
Q

*COPD Exacerbation - DOC

A
  1. Albuterol + Ipatropium

2. Systemic steroids (Prednisolone 30-40 mg qd x 10-14 days)

25
Q

If a patient has fever, increased purulent sputum, dyspnea or mechanical ventilation, what should be added to the COPD regimen?

A

Antibiotics –>
Macrolide (azithro or clarithro)
3rd gen ceph
Resp FQ (Moxi, Levo)

26
Q

Desired O2 sats during O2 therapy for COPD exacerbation

A

88-92% (because used to being low)

in high 02 sat, brain will have less drive to breathe and will retain more CO2

27
Q

*Ipratropium - class?

A

SAMA (Anticholinergic)

28
Q

*Aclidinium bromide (Tudorza Pressair) and Tiotropium bromide (Spiriva) - class?

A

LAMA (Anticholinergic)

29
Q

Why are LAMAs associated with decreased COPD exacerbations compared to LABA?

A

Patients feel better probably because of easier technique for administration and more convenient dosing.

30
Q

What medication used for COPD is a SAMA + SABA?

A

Ipratropium + albuterol (Combivent)

31
Q

What PDE-4 Enzyme Inhibitor is used for severe COPD?

A

Roflumilast (Daliresp)

32
Q

COPD - classifications

A

1 - Mild, FEV1>80%, with or without symptoms
2- Moderated, FEV1 50-80%, with or without symptoms
3- Severe, FEV1 30-50%, with our without symptoms
4- Very severe, FEV1 <70%

33
Q

Can you give Ipatropium (SAMA) and Tiotropium (LAMA) together?

A

No because they have the same MOA…need to pick a short and long from two different classes.

34
Q

Can you given Ipatropium (SAMA) and Salmetrol (LABA) together?

A

Yes because they have different MOA (different classes).

35
Q

*Ipatropium vs Tiotropium dosing

A

Ipatropium 2 inhalations qid

Tiotropium 1 inhalation (cap) qd

36
Q

Preferred admin of inhaled bronchodilator and ICS

A

MDI with spacer - slows down med/gets deeper but bulky.

Pharmacology Exam 2 (9 decks)

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