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Pharmacology > COPD > Flashcards

COPD Flashcards

1
Q

COPD

A

chronic, obstructive pulmonary disease that is characterized by airflow limitation that is not fully reversible and progressive, associated with abnormal inflammatory response

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2
Q

Two subtypes of COPD

A

Chronic bronchitis and emphysema

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3
Q

Chronic bronchitis

A

cough and sputum production for at least 3 months of two consecutive years in absence of other bronchial disease; chronic cough, increased mucous, SOB, throat clearing

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4
Q

Emphysema

A

over inflation of distal airspaces with destruction of aveolar sacs and loss of stretch and recoil, trapped air worsens oxygenation; cough, SOB, limited exercise

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5
Q

Risk factors of COPD

A

smoking, occupation, environment, air pollution, nutrition, infection, socio-economic status, age

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6
Q

Anticholinergic long acting

A

umeclindiniu, (incruse), Aclidinium (tudorza), Tiotropium (Spiriva)

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7
Q

Anticholinergic short acting

A

Ipratropium (Atrovent)

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8
Q

Long acting B agonists

A

Salmeterol (Serevent), Formoterol (Foradil), Aformoterol (Brovana), INdacaterol (Arcapta), Vilanterol (only in combo)

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9
Q

Short acting B agonists

A

Albuterol (Proventil), Levalbuterol (Xopenex), Terbutalin (Brethine), Pirbuterol (Maxair)

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10
Q

Inhaled corticosteroids

A

Beclomethasone (Qvar), Budesonide (Pulmicort), Flunisolide (Aerospan), Fluticasone (Flovent)

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11
Q

Combined Products

A

Ipratropium/Albuterol, Fluticasone/salmeterol (Advair), Budesonide/Formoterol (Symbicort)

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12
Q

ADRs of COPD drugs

A

Very little concern because drug is inhaled and goes straight to the source

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13
Q

Bronchodilator highlights

A

short and long acting B2 agonist, anticholinergic agents, Methyxanthine-theophylline

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14
Q

Primary use of bronchodilators

A

symptomatic relief of SOB, may not increase exercise tolerance or improve FEV

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15
Q

B2 agonist bronchdilators MOA

A

Agonist at B2 receptor catalyzing ATP conversion to cAMP resulting in bronchial smooth muscle relaxation

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16
Q

Albuterol Pearls

A

DOC for rescue, always use albuterol first if using other inhalers, tachy most notable with high doses, tablets and syrups available, some therapy for hyperkalemia

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17
Q

ADR of LABA

A

headache, arthralgia, tremor, anxiety, palpitations, diarrhea, nausea, insomnia

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18
Q

LABA Pearls

A

Not for emergency, long duration and onset, used in combo with ICS or anticholinergics, may use in addition to albuterol,

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19
Q

What is the only LABA approved for COPD instead of asthma?

A

Aformoterol (Brovana)

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20
Q

Risks with LABA monotherapy

A

increased overall death, but not when used with corticosteroids

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21
Q

Anticholinergic Bronchodilators MOA

A

Inhibition of acetylcholine at muscarinic receptors resultin in bronchodilation, decreases respiratory secretions

22
Q

Short acting anticholinergic bronchodilators

A

Ipratropium (atrovent)

23
Q

Long Acting anticholinergic bronchodilators

A

Tiotropium (Spiriva), Umeclidinium (incruse), Aclidinium (Tudorza)

24
Q

Pearls of anticholinergic bronchodilators

A

Ipratropium DOC for inpt use, combo with albuterol, niche with asthma indication; longer duration, longer onset, restrictive price tag

25
Q

Ipratropium (atrovent) pearls

A

give multiple doses per day, combo for ease of administration, decrease cost

26
Q

Tiotropium (Spiriva)

A

Increased cost, long duration, once daily, decreased exacerbation, given in conjunction w/ LABA +/- ICS, can be used as mono therapy

27
Q

Theophylline (Theo dur) MOA

A

methylxanthine, PDE I, increases cAMP causes bronchodilator effect, less effective and tolerated than LABA

28
Q

Theophylline (Theo dur) ADR

A

tachy, HA, insomnia, restlessness, GI intolerance

29
Q

Theophylline (Theo dur) clinical use

A

primarily considered when pt cannot tolerate inhaled bronchodilators or have maxed out inhaled therapies, coupled with LABA to improve FEV

30
Q

Inhaled corticosteroids MOA

A

anti-inflammatory, immunosuppressive, antiproliferative

31
Q

Long term ICS use

A

only appropriate for symptomatic COPD pts w/ an FEV

32
Q

ADRs of ICS

A

Oral thrush, patients should always wash/rinse mouth after dose, HA, upper respiratory tract infection

33
Q

ICS drug type

A

Fluticasone (Flovent), Budesonide (pulmicort), Mometasone (Asmanex)

34
Q

ICS Pearls

A

usually combo, unfavorable benefit-to-risk ratio, short term improvement

35
Q

Combination products

A

ipratropium/ albuterol, salmeterol/ fluticasone (advair), Formoterol/ Budesonide (symbicort)

36
Q

Combo products

A

in absence of cost restriction these are most commonly used agents and way of future!

37
Q

Roflumilast (Daliresp)

A

PDE-I, treat sever to very severe, reduces exacerbations treated with ICS, LABA, only PO, ADR: poor appetite, N/V. diarrhea, do not give with theophylline

38
Q

Expectorants and mucollytics

A

Best option? acetylcysteine (Mucomyst), gaifenesin (mucinex)

39
Q

Antibiotics for COPD

A

severe exacerbations

40
Q

Non pharm options for COPD

A

pulm rehab, o2 therapy (stage 4), surgical intervention

41
Q

Guaifenesin (Mucinex)

A

mucolytic, cough expectorant, tablet and liquid, no ADRs or DI, take w/ lot of H2O

42
Q

Primary treatment goals of COPD

A

Relieve symptoms, prevent progression, improve exercise tolerance, improve health status, prevent complications, reduce mortality/SE

43
Q

Treatment of Mild COPD

A

active reduction of risk factors, vaccinations, Shortacting bronchodilators

44
Q

Treatment of moderate COPD

A

regular treatment with long-acting bronchodilators, pulm rehab

45
Q

Treatment of severe COPD

A

inhaled corticosteroids

46
Q

Treatment of very severe COPD

A

long term O2, systemic steroids, surgery

47
Q

Prevention and risk factor reduction

A

smoking cessation, influenza and pneumonococcal vaccine, pulmonary rehab

48
Q

5 A’s of smoking cessation

A

Ask, advise, assess, assist, arrange

49
Q

Smoking cessation options

A

gum, inhaler, nasal spray, transdermal patch, sublingual tablet, lozenge, prescription, E cigs

50
Q

Smoking cessation drugs

A

Varenicline (Chantix), Buproprion (Welbutrin, Zyban), Nortriptylline

51
Q

Treatment of COPD exacerbations

A

Bronchodilators (SABA DOC, anticholinergic), Corticosteroids, O2, mechanical ventilation, antibiotics controversial

52
Q

Must have following symptoms for antibiotic therapy

A

increased dyspnea, sputum volume, and sputum purulence

Pharmacology (61 decks)

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