copd Flashcards
dx of copd fev1/fvc? fev1 predicted?
Assess spirometry (post bronchodilator FEV1/FVC <0.7 and FEV1< 80% predicted)
any meds to help progression of COPD? what helps?
No medication can slow the progression of COPD
Smoking cessation can slow progression and reduce mortality by 40%.
how does bronchodillators helps copd?
Improve airflow and hyperinflation, decrease work of breathing and improve exercise tolerance – reduce trapping of air
Do not slow the progression of COPD
eg of bronchodilators for copd? 2
Albuterol + Ipratropium SABA and SAMA
SE of ABA and AMA
Bronchodilator - Adverse effects
ß2-agonists
Tachycardia, palpitations, muscle tremors/cramping, insomnia (rhythm distubances in susceptible pts)
Hypokalemia, prolonged QT interval, hyperglycemia
Terbutaline offers no advantage to salbutamol
Different devices: Tubuhaler (terbutaline) vs MDI
Anticholinergics
Dry mouth, constipation, metallic taste, mydriasis if sprayed in eyes
Similar adverse effects with short- and
long-acting agents
consideration for LABA
Long-Acting β2 Agonists (LABAs)
No evidence of tolerance with regular use in COPD pts
No known difference in efficacy among agents (salmeterol- delayed onset; formoterol – quick onset)
Can use short-acting (anticholinergic) or beta2-agonist for relief of symptoms- best to use agent from different class
Limited evidence for choice between LABA or LAMA : LAMA may be better tolerated & better at reducing exacerbations
LAMA used for what type of copd pts
moderate to severe COPD
Tiotropium (Spirivia) 18 mcg has once daily dosing, 30 minute onset, duration of action > 24 hours In patients with moderate to severe COPD
Delayed time to first exacerbation (16.7 vs. 12.5 months) (29% ↓exacerb)
Reduced exacerbation days per patient-year (12.11 vs. 13.64)
Did not affect mortality
Limited evidence for choice between LABA or LAMA : LAMA may be better tolerated & better at reducing exacerbations Cochrane 2012(9): CD009157
Tiotropium vs. salmeterol
which combo therapy might provide best benefit?
risk with ICS?
Combining LABA + ICS with a LAMA might provide modest benefit (triple therapy)
pneumonia
genetic disorder test for Copd
alpha-one-anti-trypsin deficiency
what to do with acute exacerbation
Prednisone 40 mg daily for 5 days for acute exacerbations.
Corticosteroids may regulate 2 receptor function by increasing expression of the receptor, and inhibiting 2 receptor down-regulation
Mild exacerbation: no risk factors for poor outcome
Moderate exacerbation with risk factor(s)* for poor outcome
Severe exacerbation with risk factors for Pseudomonas aeruginosa
symptom tx, or
Amoxicillin, doxycycline, TMP/SMX, azithromycin, 3rd generation cephalosporin
Amoxicillin-clavulanate, levofloxacin, moxifloxacin
quins - Ciprofloxacin, levofloxacin (high dose)
copd cardial symptoms 3
risk factors of copd 4
dyspnea
cough
sputum
over 65
cardiac disease
2 or more exac/year
FEV1 <50% predicted
4 se of nicotine gum
contraindications of gum and patch
Burning
Upset stomach
Jaw pain
Hiccups
Contraindications: Recent myocardial infarction (2 wks) Unstable angina Severe cardiac arrhythmia Recent stroke Pregnancy and breastfeeding Patients < 18yrs of age
how does bupropion work?
se?
what other drug has bupropion? think antidepressant?
(Zyban)
Blocks reuptake of dopamine and norepinephrine
If also taking other nicotine replacement, monitor BP Adverse reactions: Insomnia Dry mouth Tremors Skin rash Serious allergic reaction Seizures 1:1000
wellbutrin
Contraindications of bupropion?
Current seizure disorder
Current or prior diagnosis of bulimia or anorexia nervosa
Use of another medication containing buproprion (Wellbutrin)
Undergoing abrupt withdrawal from alcohol or benzodiazepines
Current use of monoamine oxidase inhibitor antidepressants or within 14 days of discontinuation
Severe hepatic impairment
