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Pharmacology PaxFlan > COPD > Flashcards

COPD Flashcards

1
Q

what type of inhalers do you shake before use

A

MDI

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2
Q

SABA/SAMA use in COPD

A

“rescue” with occasional symptoms or on maintenance therapy

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3
Q

solo SAMA/SABA or SAMA+SABA

A

SABA+SAMA is more effective than either drug alone

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4
Q

ipratropium

A

SAMA - usually combined with albuterol for COPD + bronchospasm in the hospital

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5
Q

SAMA ADRs

A

dry mouth, pharyngeal irritation

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6
Q

best drug to prevent exacerbations in pts with mod-very severe COPD

A

LAMA > LABA

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7
Q

tiotropium

A

LAMA (QD)

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8
Q

umeclidinium

A

LAMA (QD)

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9
Q

revefenacin

A

LAMA (QD)

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10
Q

aclidinium

A

LAMA (BID)

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11
Q

glycopyrrolate

A

LAMA (BID)

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12
Q

list of LAMAs for COPD

A 
tiotropium (QD)
umeclidinium (QD)
revefenacin (QD)
aclidinium (BID)
glycopyrrolate (BID) 
(- ium and -late)
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13
Q

list of LABAs for COPD

A 
indacaterol (QD) 
olodaterol (QD) 
salmeterol (BID) 
formoterol (BID) 
arformoterol (BID) 
(-terols)
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14
Q

interactions of B-blockers + LABAs

A

historically were contraindicated; now are shown to decrease mortality & exacerbations

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15
Q

when would you use dual bronchodilator therapy with LAMA + LABA

A

moderate-severe dyspnea/symptoms & at risk for exacerbations & for those with persistent symptoms/exacerbations despite use of long-acting bronchodilator

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16
Q

steps of what inhalers you would give COPD patient

A

SABA –> LAMA –> LAMA+LABA (and still SABA, always)

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17
Q

when would you do an ICS/LABA combo

A

moderate-severe COPD who experience frequent exacerbations while on > 2 long-acting agents (LABA + LAMA)
or pts with mixed asthma - COPD phenotypes

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18
Q

ADRs of ICS

A

dysphonia, OP candidiasis, glaucoma, increased risk of thrush, more pneuomonia cases, increased risk of fracture

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19
Q

roflumilast MOA

A

selective inhibitor of PDE4 = increased intracellular [cAMP] = decreased inflammation

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20
Q

roflumilast indications

A

severe COPD associated with chronic bronchitis & history of AE-COPD

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21
Q

roflumilast ADRs

A

N/V/D, weight loss, insomnia, anxiety/depression

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22
Q

theophylline indications

A

pts with persistent symptoms despite tx with inhaled triple-therapy

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23
Q

GOLD group A treatment

A

SABA alone

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24
Q

GOLD group B treatment

A

SABA + LAMA

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25
Q

GOLD group C treatment

A

ensure on at least long-acting dilator (LAMA>LABA)
2 long acting bronchodilators
reserve ICS for severe disease or pts with asthma

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26
Q

GOLD group D treatment

A

ensure on 2 long acting meds, reserve ICS

managed by pulmonologist probably

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27
Q

why wouldn’t you want to give a pt a LAMA + ipratropium

A

both are muscarinic antagonists = more ADRs

use SABA + LAMA instead

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28
Q

steps to managing AE-COPD

A
  1. oxygen
  2. bronchodilators (all pts!) - albuterol +/- ipratropium
  3. systemic glucocorticoids (all pts!) - prednisone
  4. abx therapy? - if cough/sputum present
29
Q

what is the PaO2/POx goal during AE-COPD exacerbation

A

60-70 mmHg/ 90-94%

30
Q

how soon after giving O2 should you repeat and ABG

A

30-60 min

31
Q

abx for uncomplicated AE-COPD

A

cephalosporin, doxycycline, Bactrim

32
Q

abx for complicated AE-COPD

A

FQ (moxi or levo), amox/clav

33
Q

abx for AE-COPD if at risk for pseudomonas

A

levofloxacin, cefepime, ceftazidime, pip/tazo

34
Q

how often should pts use a reliever inhaler for AE-COPD

A

q4-6 hr until symptoms improve

35
Q

dextromethorphan for cough

A

not effective or safe in young children

36
Q

DM ADRs

A

CNS: confusion, excitement, irritability, nervousness
at high doses: N/V, HA
very high: robo-trip euphoria

37
Q

pharmacologic options for cough

A 
honey
DM
codeine/hydrocodone 
benzonatate (tessalong perles) 
guaifenesin 
decongestant/ antihistamines 
SABA/SAMA 
corticosteroids
38
Q

benzonatate

A

alternative to opioids for severe cough

dont use d/t risks

39
Q

guaifenesin

A

expectorant
considered safe
not recommended under <12 y.o

40
Q

how do antihistamines/decongestants work in cough

A

may reduce PND via antimuscarinic effects

41
Q

decongestant interactions

A

should not be used with or within 14 days of a MAOI

42
Q

phenylephrine drug class

A

decongestant

43
Q

decongestant ADRs

A

increase HR/BP
excitability, insomnia, HA, nervousness, confusion, dizziness
dry nose/throat

44
Q

SABA/SAMA use in cough

A

MIGHT benefit, cheap and well-tolerated

for cough that has a bronchospastic component

45
Q

corticosteroids use in cough

A

treatment of cough in pts WITHOUT asthma

46
Q

non-pharm options for cough

A 
saline nasal sprays
mist inhalers 
sialagogues
honey 
menthol or camphor rubs
47
Q

acute cough 2* to common cold/PND in adults treatment steps

A

1: antihistamine-decongestant combos
2: naproxen 200-500 mg TID
3: inhaled ipratropium if persisting for 3-8 weeks
4: ICS if ipratropium doesn’t work
5: DM or codeine IF ALL ELSE FAILS + cough persists for 8 weeks
(ANIID)

48
Q

acute cough 2* to common cold/PND in kids treatment steps

A

1: saline nasal sprays
2: topical antitussives (vaporub or babyrub if <2 yrs)
3: honey (0.5-2 tsp)

49
Q

who should not be given honey

A

infants <1 yr

50
Q

major complications of smoking

A

lung cancer, ischemic heart disease, COPD

51
Q

when do people ususally start smoking

A

18 y.o (80%)

52
Q

do men or women have greater risk for dependence and difficulty smoking

A

women

53
Q

what is the major neurotransmitter implicated in smoking/tobacco

A

DOPAMINE

54
Q

what is the main receptor that mediates nicotine dependence

A

a4B2

55
Q

nicotine withdrawl symptoms

A

“hangriness” - irritability, frustration, anxiety, depressed mood, difficulty concentrating, increased appetite, weight gain, decreased HR, insomnia

56
Q

5 As of quitting

A 
ASK 
ADVISE
ASSESS
ASSIST
ARRANGE
57
Q

short-acting smoking cessation nicotine drugs

A

gum, inhaler, nasal spray, lozenge

58
Q

long-acting smoking cessation nicotine drugs

A

nicotine patch

59
Q

what to put pts on interested in nicotine replacement products

A

patch to control sx throughout the day + short-acting form (gum, lozenge)

60
Q

when to start bupropion

A

started 7-14 days BEFORE anticipated quit date

61
Q

varenicline (Chantix)

A

blocks nicotine (Maureen) from binding (to Alec) & stimulates receptor-mediated activity (Paxton stimulating Alec), but to a lesser degree than nicotine –> stimulation

62
Q

when to start varenicline

A

a week BEFORE quit date

63
Q

who cannot use varenicline

A

pilots, truckers, bus drivers, air traffic controllers d/t dreams, suicide risk

64
Q

contraindications to varenicline

A

pregnancy/breastfeeding

65
Q

interactions with varenicline

A

ETOH can cause increased behavior, aggressive behavior, amnesia

66
Q

varenicline ADRs

A

dose-dependent nausea

black box warning of neuropsychiatric symptoms & exacerbations of pre-existing psych illness

67
Q

should we recommend e-cigs for smoking cessation

A

no or you are dumb

68
Q

are e-cigs FDA approved for smoking cessation

A

no

69
Q

preferred treatment for smoking cessation during pregnancy

A

counseling

bupropion, varenicline - category C

Pharmacology PaxFlan (12 decks)

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