COPD Flashcards
COPD
chronic, obstructive pulmonary disease that is characterized by airflow limitation that is not fully reversible and progressive, associated with abnormal inflammatory response
Two subtypes of COPD
Chronic bronchitis and emphysema
Chronic bronchitis
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
Emphysema
over inflation of distal airspaces with destruction of aveolar sacs and loss of stretch and recoil, trapped air worsens oxygenation; cough, SOB, limited exercise
Risk factors of COPD
smoking, occupation, environment, air pollution, nutrition, infection, socio-economic status, age
Anticholinergic long acting
umeclindiniu, (incruse), Aclidinium (tudorza), Tiotropium (Spiriva)
Anticholinergic short acting
Ipratropium (Atrovent)
Long acting B agonists
Salmeterol (Serevent), Formoterol (Foradil), Aformoterol (Brovana), INdacaterol (Arcapta), Vilanterol (only in combo)
Short acting B agonists
Albuterol (Proventil), Levalbuterol (Xopenex), Terbutalin (Brethine), Pirbuterol (Maxair)
Inhaled corticosteroids
Beclomethasone (Qvar), Budesonide (Pulmicort), Flunisolide (Aerospan), Fluticasone (Flovent)
Combined Products
Ipratropium/Albuterol, Fluticasone/salmeterol (Advair), Budesonide/Formoterol (Symbicort)
ADRs of COPD drugs
Very little concern because drug is inhaled and goes straight to the source
Bronchodilator highlights
short and long acting B2 agonist, anticholinergic agents, Methyxanthine-theophylline
Primary use of bronchodilators
symptomatic relief of SOB, may not increase exercise tolerance or improve FEV
B2 agonist bronchdilators MOA
Agonist at B2 receptor catalyzing ATP conversion to cAMP resulting in bronchial smooth muscle relaxation
Albuterol Pearls
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
ADR of LABA
headache, arthralgia, tremor, anxiety, palpitations, diarrhea, nausea, insomnia
LABA Pearls
Not for emergency, long duration and onset, used in combo with ICS or anticholinergics, may use in addition to albuterol,
What is the only LABA approved for COPD instead of asthma?
Aformoterol (Brovana)
Risks with LABA monotherapy
increased overall death, but not when used with corticosteroids
Anticholinergic Bronchodilators MOA
Inhibition of acetylcholine at muscarinic receptors resultin in bronchodilation, decreases respiratory secretions
Short acting anticholinergic bronchodilators
Ipratropium (atrovent)
Long Acting anticholinergic bronchodilators
Tiotropium (Spiriva), Umeclidinium (incruse), Aclidinium (Tudorza)
Pearls of anticholinergic bronchodilators
Ipratropium DOC for inpt use, combo with albuterol, niche with asthma indication; longer duration, longer onset, restrictive price tag
Ipratropium (atrovent) pearls
give multiple doses per day, combo for ease of administration, decrease cost
Tiotropium (Spiriva)
Increased cost, long duration, once daily, decreased exacerbation, given in conjunction w/ LABA +/- ICS, can be used as mono therapy
Theophylline (Theo dur) MOA
methylxanthine, PDE I, increases cAMP causes bronchodilator effect, less effective and tolerated than LABA
Theophylline (Theo dur) ADR
tachy, HA, insomnia, restlessness, GI intolerance
Theophylline (Theo dur) clinical use
primarily considered when pt cannot tolerate inhaled bronchodilators or have maxed out inhaled therapies, coupled with LABA to improve FEV
Inhaled corticosteroids MOA
anti-inflammatory, immunosuppressive, antiproliferative
Long term ICS use
only appropriate for symptomatic COPD pts w/ an FEV
ADRs of ICS
Oral thrush, patients should always wash/rinse mouth after dose, HA, upper respiratory tract infection
ICS drug type
Fluticasone (Flovent), Budesonide (pulmicort), Mometasone (Asmanex)
ICS Pearls
usually combo, unfavorable benefit-to-risk ratio, short term improvement
Combination products
ipratropium/ albuterol, salmeterol/ fluticasone (advair), Formoterol/ Budesonide (symbicort)
Combo products
in absence of cost restriction these are most commonly used agents and way of future!
Roflumilast (Daliresp)
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
Expectorants and mucollytics
Best option? acetylcysteine (Mucomyst), gaifenesin (mucinex)
Antibiotics for COPD
severe exacerbations
Non pharm options for COPD
pulm rehab, o2 therapy (stage 4), surgical intervention
Guaifenesin (Mucinex)
mucolytic, cough expectorant, tablet and liquid, no ADRs or DI, take w/ lot of H2O
Primary treatment goals of COPD
Relieve symptoms, prevent progression, improve exercise tolerance, improve health status, prevent complications, reduce mortality/SE
Treatment of Mild COPD
active reduction of risk factors, vaccinations, Shortacting bronchodilators
Treatment of moderate COPD
regular treatment with long-acting bronchodilators, pulm rehab
Treatment of severe COPD
inhaled corticosteroids
Treatment of very severe COPD
long term O2, systemic steroids, surgery
Prevention and risk factor reduction
smoking cessation, influenza and pneumonococcal vaccine, pulmonary rehab
5 A’s of smoking cessation
Ask, advise, assess, assist, arrange
Smoking cessation options
gum, inhaler, nasal spray, transdermal patch, sublingual tablet, lozenge, prescription, E cigs
Smoking cessation drugs
Varenicline (Chantix), Buproprion (Welbutrin, Zyban), Nortriptylline
Treatment of COPD exacerbations
Bronchodilators (SABA DOC, anticholinergic), Corticosteroids, O2, mechanical ventilation, antibiotics controversial
Must have following symptoms for antibiotic therapy
increased dyspnea, sputum volume, and sputum purulence
