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Advanced Pharmacy Practice > COPD > Flashcards

COPD Flashcards

1
Q

LAMA

A

Long acting antimuscarinc agent: tiotropium

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2
Q

LABA

A

Long acting beta agonist: salmeterol, formeterol.

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3
Q

What is COPD?

A

Chronic Obstructive Pulmonary Disease:

Chronic bronchitis and Emphysema.

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4
Q

The biggest cause of COPD is:

A

Smoking.

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5
Q

What are the clinical features of COPD?

A

Exertional dyspnoea
Cough
Sputum production
Wheeze

*Symptoms are typically ‘fixed’ whilst the disease is progressive and relentless.

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6
Q

Why would we need to measure the post-bronchodilator spirometry?

A

To avoid missing a diagnosis of asthma.

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7
Q

What is bronchiectasis?

A

Disease in which there is permanent enlargement of the airways of the lung. Symptoms typically include a chronic cough, productive of mucus.
NOT THE SAME AS COPD.

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8
Q

In what patients would we consider a diagnosis of bronchiectasis?

A

In patients with a chronic cough and frequent infections: or evidence of permanent enlargement of the lung.

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9
Q

Why should we always consider a CXR before diagnosing new COPD?

A

There may be an alternative diagnosis, COPD is often misdiagnosed.

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10
Q

What are the aims of inhaler treatment of COPD?

A
  1. Reduce breathlessness

2. Reduce exacerbation frequency.

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11
Q

ICS/LABA inhalers have been associated with an increased risk of

A

pneumonia

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12
Q

ICS/LABA leads to adrenal _______, ______ risk of TB, ______ incidence of type ___ diabetes.

A

ICS/LABA leads to adrenal suppression, increased risk of TB, increased incidence of type 2 diabetes.

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13
Q

What are the four LAMAs licensed for COPD?

A
  1. Tiotropium
  2. Aclidinium
  3. (Glycopyronium)
  4. Umeclindinium
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14
Q

What is the brand name of tiotropium? what class of COPD treatment is it?

A

Triotropium = spiriva = LAMA.

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15
Q

What is the brand name of aclidinium? what class of COPD treatment is it?

A

Aclidinium = Eklira = LAMA

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16
Q

What LABAs are licensed for COPD?

A

Salmeterol
Formoterol
(Indacaterol)
(Olodaterol)

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17
Q

What ICS/LABAs are licensed for COPD?

A 
Fostair 
Symbicort
Duoresp
Seretide
Relvar
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18
Q

Salmeterol

A

LABA for COPD

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19
Q

Symbicort

A

ICS/LABA for COPD

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20
Q

Formoterol

A

LABA for COPD

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21
Q

Aclidinium

A

= Eklira = LAMA for COPD

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22
Q

Seretide and Relvar

A

Both ICS/LABAs for COPD

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23
Q

Tiotropium

A

LAMA for COPD

24
Q

Duoresp

A

ICS/LABA for COPD

25
Q

LAMA/LABAs for COPD

A

Anoro (umeclidinium + vilanterol)

Duaklir (formeterol + aclidinium)

26
Q

What is carbocyteine?

A

Mucolytic: 375-750 mgs tds

27
Q

A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally _______) and who present with one or more of:

A

A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with one or more of the following symptoms:

exertional breathlessness

chronic cough

regular sputum production

frequent winter ‘bronchitis’

wheeze

28
Q

Patients in whom a diagnosis of COPD is considered should also be asked about the presence of:

A 
Weight loss
Effort intolerance
Waking at night
Ankle swelling
Fatigue
Occupational hazards
29
Q

At the time of their initial diagnostic evaluation in addition to spirometry all patients should have:

A

CXR.
FBC.
BMI calculated.

30
Q

How does smoking status differ between COPD and Asthma patients?

A

COPD: Nearly all.
Asthma: Possibly.

31
Q

All COPD patients should be encouraged to stop

A

Smoking - if they do.

32
Q

How can COPD patients be aided in quitting smoking?

A

NRT, varenicline or bupropion, unless contraindicated.

33
Q

What should be the initial empirical treatment for the relief of breathlessness and excercise limitation in COPD?

A

Short-acting beta2 agonists (SABA) and short-acting muscarininc antagonists (SAMA)

34
Q

What are the side effects of inhaled corticosteroids that patients should be aware of?

A

Most important: non-fatal pneumonia

35
Q

People with stable COPD who remain breathless or have exacerbations despite using short-acting bronchodilators as required can be offered what?

A

OD long-acting muscarinic antagonist (LAMA) in preference to four-times-daily short- acting muscarinic antagonist. SAMA.

36
Q

What should be the maintenance therapy in pts with stable COPD who remain breathless etc. with FEV1 >50% predicted?

A

If FEV >50% predicted: LABA or LAMA.

If FEV <50% predicted: Either LABA+ICS or LAMA.

37
Q

In a pt with stable COPD but still breathlessness when would LABA+ICS be recommended as maintanence therapy?

A

When the FEV1: <50% predicted.

Could also use LAMA instead.

38
Q

In patients with stable COPD and an FEV1 >50% who remain breathless or have exacerbations despite maintenance therapy with LABA, what can be considered as further treatment?

A

LABA+ICS in a combinaton inhaler.

LAMA in addition to the LABA when ICS are declined/not tolerated/contraindicated.

39
Q

We should offer LAMA (in addition to LABA+ICS) to people with COPD who remain breathless or have exacerbations despite taking LABA + ICS irrespective of what?

A

Irrespective of their FEV1.

40
Q

In whom would maintenance use of oral corticosteroid therapy be found?

A

Those with advanced COPD.

41
Q

What must be considered in those on long term oral corticosteroid treatment?

A

Monitor for the development of osteoporosis. Those over 65 should be started on prophylactic treatment, without monitoring.

42
Q

In whom should mucolytic therapy be used?

A

Patients with a chronic cough productive of sputum.

43
Q

Before stepping up treatment what should be checked? [3]

A
  1. Inhaler technique
  2. Compliance with administration instructions
  3. tolerance of current device.
44
Q

A LABA and LAMA are recommended in what patients?

A
  1. Pts who remain breathless or have exacerbations despite;
  2. Using short-acting bronchodilators as needed and have
  3. FEV1 less than 50% of predicted and
  4. Have declined or cannot tolerated an ICS.
45
Q

When converting from IV aminophylline to the oral theophylline dose, the bioavailability and ____ ______ must be considered.

A

Salt factor for aminophylline is approx 0.8.

46
Q

The total daily dose of IV aminophylline is the same for _____ aminophylline.

A

IV same as oral.

47
Q

If IV aminophylline is changed to oral theophylline, then the total daily dose of IV aminophylline should be multiplied by

A

0.8 (salt factor)

Alternatively, multiply the hourly aminophylline dose by 10, to obtain the theophylline dose to be given every 12 hours.

48
Q

Normal control of COPD consists of

A

SABA + SAMA

Salbutamol + Ipatropium

49
Q

If COPD not controlled by SABA (Salbutamol + Ipatropium) and the FEV1 is <50% of expected what can be added?

A

LABA/ICS combination or LAMA.

50
Q

If COPD not controlled by SABA (Salbutamol + Ipatropium) and the FEV1 is higher than 50% of expected what can be added?

A

LAMA or a LABA.

51
Q

What is triple therapy?

A

SABA prn + LABA/ICS combo + LAMA

52
Q

What 5 things should be considered in the management of an acute exacerbation of COPD?

A
  1. Antibiotics (duration and 5 days post, oral when possible).
  2. Steroids (prednisolone 30mg 7-14 days + CONTINUE patients ICS if they have it) - this is based on severity, response and previous treatment. If patient has had a week post admission before maybe try two weeks).
  3. Bronchodilators nebulised driven by AIR (not oxygen) [STOP any tiotropium].
    Salbutamol 2.5mg 4 hourly + ipatroprium QDS [maximum] 500micrograms (write this in exam not ug)
  4. VTE risk assessment.
  5. Oxygen sats target lower than asthma at 88-92%.
53
Q

What needs to be considered when discharging a patient who has had a COPD exacerbation? [6]

A
  1. Carbocysteine - use if helps symptoms.
  2. Refer for pulmonary rehabilitation.
  3. Change medicines back to inhalers not nebs.
  4. 2 week follow up appointment with nurse.
  5. Rescue pack of oral steroids.
  6. Ensure vaccinations have been done and stop smoking.
54
Q

Managing COPD in hospital setting: antibiotics for how long?

A
  1. Antibiotics (duration and 5 days post, oral when possible).
  2. Steroids (prednisolone 30mg 7-14 days + CONTINUE patients ICS if they have it) - this is based on severity, response and previous treatment. If patient has had a week post admission before maybe try two weeks).
  3. Bronchodilators nebulised driven by AIR (not oxygen) [STOP any tiotropium].
    Salbutamol 2.5mg 4 hourly + ipatroprium QDS [maximum] 500micrograms (write this in exam not ug)
  4. VTE risk assessment.
  5. Oxygen sats target lower than asthma at 88-92%.
55
Q

Managing acute COPD in hospital: what steroids?

A
  1. Antibiotics (duration and 5 days post, oral when possible).
  2. Steroids (prednisolone 30mg 7-14 days + CONTINUE patients ICS if they have it) - this is based on severity, response and previous treatment. If patient has had a week post admission before maybe try two weeks).
  3. Bronchodilators nebulised driven by AIR (not oxygen) [STOP any tiotropium].
    Salbutamol 2.5mg 4 hourly + ipatroprium QDS [maximum] 500micrograms (write this in exam not ug)
  4. VTE risk assessment.
  5. Oxygen sats target lower than asthma at 88-92%.
56
Q

Acute COPD in hospital: what bronchodilators?

Driven by what?

A
  1. Antibiotics (duration and 5 days post, oral when possible).
  2. Steroids (prednisolone 30mg 7-14 days + CONTINUE patients ICS if they have it) - this is based on severity, response and previous treatment. If patient has had a week post admission before maybe try two weeks).
  3. Bronchodilators nebulised driven by AIR (not oxygen) [STOP any tiotropium].
    Salbutamol 2.5mg 4 hourly + ipatroprium QDS [maximum] 500micrograms (write this in exam not ug)
  4. VTE risk assessment.
  5. Oxygen sats target lower than asthma at 88-92%.

Advanced Pharmacy Practice (29 decks)

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