COPD

Question 1

Beta2 Agonists

Answer 1

Mainstay of COPD therapy
SABA: Acute symptomatic relief
LABA: Monotherapy or combined therapy
No black box warning for COPD (vs. Asthma!)
May be prescribed alone or on combo

Question 2

Muscarinic Agents AKA

Answer 2

Muscarinic agents (anticholinergics) = inhaled anticholinergics = LAMA (long-acting muscarinic antagonist)

Question 3

Muscarinic Agents MOA

Answer 3

Prevents release of immune mediators from mast cells; blocks the contraction of bronchial smooth muscle; decreases mucous secretion
Ipratropium bromide (Atrovent): blocks muscarinic cholinergic receptors
Tiotropium (Spiriva): Inhibits muscarinic M3 receptors in smooth muscle of the lungs (bronchodilation)

Question 4

Muscarinic Agents Contra/Cautions

Answer 4

Contraindications/Cautions: 
Hypersensitivity
Soy or peanut allergy
Caution: narrow angle glaucoma/BPH
Adverse events
Cough (most common)
Dry mouth
Possible constipation/urinary retention

Question 5

Phosphodiesterase-4 (PDE-4) inhibitor

Answer 5

Roflumilast (Daliresp) is a new class of drugs used for COPD and targets PDE-4 receptors. PDE-4 is a cyclic AMP enzyme that is found in lung tissue.

Question 6

Long term oxygen therapy in COPD

Answer 6

Oxygen reduces right sided heart workload and mild bronchodilator

Question 7

COPD Group A Treatment

Answer 7

Bronchodilator -> evaluate effect -> Continue, stop, or try alternative class of bronchodilator

Question 8

COPD Group B Treatment

Answer 8

Long-Acting Bronchodilator (LABA or LAMA) -> persistent symptoms -> LAMA + LABA

Question 9

3 cardinal symptoms of COPD Exacerbation Requiring Antimicrobial Therapy

Answer 9

Increased dyspnea
Increased sputum volume
Increased sputum purulence

Question 10

Only 1 of the 3 cardinal symptoms

Answer 10

=Mild COPD Exacerbation

No antibiotics
Increase bronchodilators
Symptomatic therapy