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Pharm I ( Melicia) > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD?

A

Inflammation affecting small airways:

  • predominance of neutrophils, macrophages and cytotoxic T lymphocytes
  • progressive narrowing
  • fibrosis, destruction of lung parenchyma, destruction of alveolar walls (emphysema)
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2
Q

COPD results in…

A

airway closure on expiration

air trapping and hyperinflation

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3
Q

COPD includes:

A

emphysema and chronic bronchitis

they are treated the same

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4
Q

Sxs of COPD?

A

Include: wheezing, pursed lip breathing, chronic cough, barrel chest, dyspnea, easily fatigued, freq. respiratory infections, use of accessory muscles to breath

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5
Q

Risk factors for development of COPD?

A

tobacco smoker, occupational dusts/chemicals, air pollution, genetic (alpha 1 antitrypsin), airway hyper responsiveness, impaired lung growth

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6
Q

Goals of COPD tx?

A

prevent disease progression, relieve sxs, improve exercise tolerance, improve overall health status, prevent exacerbation, prevent/tx comp. Reduce morbidity and mortality.

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7
Q

GOLD COPD classifications based on postbronchodilator FEV1:

A

1: mild= FEV1 80%
2: moderate= FEV1 50%-80%
3: severe FEV1 30%-50%
4: very severe FEV1 less than 30%

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8
Q

What are the COPD assessment questionnaires?

A

CAT

mMRC (modified medical research council dyspnea questionnaire)

CCQ

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9
Q

the mMRC assessment tool only assess..

A

breathlessness

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10
Q

Class A COPD? Tx?

A

0-1 exacerbations (not leading to admission)

mMRC 0-1
CAT <10

Tx: bronchodilator

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11
Q

Class B COPD? Tx?

A

0-1 exacerbations (not leading to admission)

mMRC >2
CAT >10

Tx: LABA or LAMA if persistent sxs–> LAMA + LABA

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12
Q

Class C COPD? Tx?

A

> 2 exacerbations or 1 or more leading to admission

mMRC 0-1

CAT <10

LAMA if still not better –> LAMA +LABA or LABA + ICS

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13
Q

Class D COPD? Tx?

A

> 2 exacerbations or 1 or more leading to admission

mMRC >2
CAT >10

Tx: LAMA –>
LAMA + LABA ot LABA + ICS –>

LABA + LAMA + ICS

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14
Q

What should be considered in class D COPD pts who are former smokers?

A

A Macrolide

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15
Q

Effect of albuterol in COPD pts?

A

response generally less than that is seen in asthma

only small improvement in FEV1

may improve respiratory sxs and exercise tolerance

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16
Q

ADEs of beta agonist?

A

sinus tachycardia, rhythm disturbances, skeletal muscle tremors can occur initially

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17
Q

Effect of long acting beta agonists and antimuscarinic

A

superior outcomes in lung func. (spirometry)

sxs including dyspnea

reduce in exacerbation freq.

improved QOL

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18
Q

Name 2 antimuscarinic (bronchodilators)

A

Ipratropium (short acting)

Tiotropium (long acting)

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19
Q

Ipratropium MOA?

A

bronchodilation by competitively inhibiting cholinergic receptors in bronchial smooth muscle

20
Q

ADEs of Antimuscarinic

A

dry mouth, nausea, occasional metallic taste

21
Q

What are the anti-inflammatory mechanisms of corticosteroids?

A

reduction in capillary permeability to decrease mucus

inhibition of release of proteolytic enzymes from leukocytes

inhibition of prostaglandins

22
Q

ADEs of corticosteroids

A

osteoporosis, muscular atrophy, thinning of the skin, development of cataracts, adrenal suppression with insufficiency

23
Q

What are some examples of LABA & ICS?

A

salmeterol + fluticasone

Budesonide + Formoterol

Mometasone + Formoterol

24
Q

What drug class is Trelegy Ellipta?

A

Combination of an inhaled corticosteroid (ICS), a LAMA and a LABA

delivered once in dry powder inhaler

25
Q

What is Phosphodiesterase 4?

A

the major phosphodiesterase found in airway smooth muscle cells and inflammatory cells and is responsible for degrading cAMP

26
Q

Name a phosphodiesterase 4 Inhibitor. Indication?

A

Roflumilast (Daliresp)

 adjunct to bronchodilator therapy in 
class C and D COPD pts and are not controlled by inhaled bronchodilators
27
Q

Roflumilast MOA?

A

selectively inhibit phosphodiesterase-4

anti-inflammatory effects

28
Q

Both….and Roflumilast have similar MOA through inhibition of phosphodiesterases

A

Theophylline

29
Q

ADEs of Phosphodiesterase 4 inhibitors

A

HA, dizziness, insomnia, diarrhea, weight loss,, nausea, decreased appetite, back pain

30
Q

Contraindication for phosphodiesterase 4 inhibitors?

A

hepatic impairment

31
Q

phosphodiesterase 4 inhibitors drug interactions?

A

Cimetidine and Ciprofloxacin both increase the concentration of Roflumilast

Roflumilast make increase the effect of immunosuppressants

32
Q

Indication of Alpha 1 antitrypsin replacement therapy

A

inherited AAT deficiency associated emphysema

tx is focused on reduction of risk factors such as smoking and sxs tx with bronchodilators

weekly infusions of pooled human AAT

33
Q

What is included in the 5 step strategy for smoking cessation program?

A

5As

Ask, Advise, Assess, Assist, Arrange

34
Q

First line Pharmacotherapies for smoking cessation?

A

Bupropion SR, Nicotine gum, Nicotine inhaler, Varenicline (Chantix)

35
Q

Common complaints associated with pharmacotherapies for smoking cessation?

A

Bupropion: insomnia, dry mouth

Nicotine (gum, inhaler, nasal spray, patches): sore mouth, nasal irritation, skin rxn, insomnia

Varenicline: nausea, sleep disturbances

36
Q

Cardinal sxs of acute COPD?

A

worsening dyspnea, increase in sputum volume, increase in sputum purulence

upper respiratory tract infection

37
Q

Staging of acute exacerbations of COPD

A

Mild (1): 1 cardinal sxs plus at least one of following:URI within 5 days, fever w/out explantation, increased wheezing, increased cough, increased RR or HR >20%

Moderate (2): 2 cardinal sxs

Severe (3): 3 cardinal sxs

38
Q

When can you give abx for acute COPD exacerbation?

A

if 2 or more:

  • increased dyspnea
  • increased sputum production
  • increased sputum purulence
39
Q

Therapeutic options for acute exacerbations of COPD?

A

Abx, corticosteroids, bronchodilators, controlled oxygen therapy, noninvasive mechanical ventilation

40
Q

When is Noninvasive mechanical ventilation not recommended for acute COPD exacerbations?

A

in pts with AMS, severe acidosis, respiratory arrest or cardiovascular instability

41
Q

Recommended abx therapy for uncomplicated COPD exacerbation in pt with less than 4 exacerbations per yr, no comorbid illness and >50% FEV1? `

A

likely pathogens: s. pneumoniae, H. influenzae, M. matarrhalis, H. parainfluenzae

Macrolide, 2 or 3 gen cephalosporin, Doxycycline

42
Q

Recommended abx therapy for complicated COPD exacerbation?

A

Likely pathogen: same as uncomplicated + drug resistant pneumococci, Beta lactamase-producing H. influenzae and M. catarrhalis

Amoxicillin/Clavulanate, Fluoroquinolone w/ enhanced pneumococcal activity

43
Q

Tx for complicated COPD exacerbation w/ risk of p. aeruginosa?

A

fluoroquinolone w/ enhanced pneumococcal and P. aeruginosa activity (levofloxacin)

44
Q

What puts someone at risk for p. aeruginosa infection?

A

chronic bronchial sepsis, need for chronic corticosteroid, resident at nursing home w/ > 4 exacerbations/yr

45
Q

Who should be given long term Oxygen therapy?

A

in pts with severe resting chronic hypoxemia

46
Q

Vaccinations recommended for COPD pts?

A

flu

pneumococcal

Pharm I ( Melicia) (18 decks)

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