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Pharmacotherapy > COPD > Flashcards

COPD Flashcards

1
Q

Symptoms of COPD

A

Shortness of breath

Chronic cough

Sputum

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2
Q

COPD risk factors

A

Tobacco

Occupation

Indoors and outdoor pollution

Host-factors

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3
Q

What is required to establish diagnosis of COPD

A

Spirometry

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4
Q

Dyspiea with COPD

A

Progressive over time

Worse during exercise

Persistent

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5
Q

Chronic cough with COPD

A

Maybe intermittent and unproductive

Presents with recurrent wheezing

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6
Q

Chronic sputum production and COPD

A

Any form may indicate COPD

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7
Q

Recurrent lower respiratory tract infection

A

Indicates COPD

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8
Q

History of Risk factors

A

Genetic factors

Congenital or developmental abnormalities

Tobacco

Smoke from other source

Occupational dust, fumes, gases, vapors and other chemical

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9
Q

Family history or childhood factors

A

Low birth weight

Childhood respiratory infection

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10
Q

Mild severity of COPD

A

FEV1 ≥ 80% predicted

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11
Q

Moderate severity

A

50% ≤ FEV1 ≤ 80% predicted

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12
Q

Severe severity

A

30% ≤ FEV1 ≤ 50% predicted

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13
Q

Very severe severity

A

FEV1 < 30% predicted

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14
Q

mMRC grade 0

A

Out of breath with strenuous exercise

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15
Q

mMRC grade 1

A

Speed walking on a leveled ground or walking up a slight hill

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16
Q

mMRC grade 2

A

Walker slower than age group because of breathlessness

Or

Stop to catch a breath when walking at pace on a leveled ground

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17
Q

mMRC grade 3

A

Catch breath after 100 meters or few minutes while walking on a leveled ground

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18
Q

mMRC grade 4

A

Too breathless to leave the house or depressing or undressing

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19
Q

0 or 1 hospitalization

mMRC 0-1

CAT < 10

A

Group A

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20
Q

0 or 1 hospitalization

mMRC ≥ 2

CAT ≥ 10

A

Group B

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21
Q

≥ 2 or ≥ 1 hospitalization

mMRC 0-1

CAT < 10

A

Group C

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22
Q

≥ 2 or ≥ 1 hospitalization

mMRC ≥ 2

CAT ≥ 10

A

Group D

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23
Q

What are the non pharmacological therapy for COPD

A

Smoking cessation

Vaccination

Pulmonary rehabilitation

Physical activity

Appropriate inhaler technique and adherence

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24
Q

Group A initial treatment

A

Bronchodilator

25
Q

Group B initial treatment

A

LAMA or LABA

26
Q

Group C initial treatment

A

LAMA

27
Q

Group D initial treatment

A

LAMA

or

LAMA + LABA

or

ICS + LABA

28
Q

What immediate relief therapy should all COPD Patient be offered

A

short acting bronchodilator

SAMA + SABA

29
Q

Group A explained

A

Few symptom and low exacerbation risk

Short or long acting bronchodilator offered and continued if benefit is observed

30
Q

Group B explained

A

More symptoms and low risk of exacerbation

LAMA or LABA

31
Q

Group C explained

A

Few symptoms and high risk of exacerbation

LAMA preferred

32
Q

Group D explained

A

Frequent symptoms and high risk of exacerbation

LAMA

If CAT > 20 LAMA + LABA

If eosinophils > 300 or history of asthma LABA + ICS

33
Q

SABA: Albuterol dosing

A

90 mcg

2 inhalation q 4-6 hours prn

Onset: 4-6 hours

34
Q

SABA: Levalbuterol

A

45-90 mcg

2 inhalation q 4 hours prn

Onset: 6-8 hours

35
Q

12 hours or twice daily dosing LABA

A

Formoterol

Arformoterol

Salmeterol

36
Q

24 hours or once daily dosing LABA

A

Indacaterol

Olodaterol

37
Q

SAMA

A

Ipatropium bromide

2 inhalation q 6 hours

Duration: 6-8 hours

38
Q

12 hours LAMA or twice daily dosing

A

Aclinidium Bromide

2 inhalation BID

Glycopyrronium bromide

1 capsule inhaled BID

39
Q

24 hours or once daily dosing LAMA

A

Tiotropium

Umeclidinium

40
Q

Antimuscarinic ADR

A

ANTI-SLUD

41
Q

True/False: LAMA and SAMA can be administered together

A

False

42
Q

Use of ICS-LABA has strong support for which group

A

Group D

History of hospitalization and exacerbation

≥2 COPD moderate exacerbation per year

Eosinophils > 300 cells/ul

History of asthma

43
Q

ICS-LABA should be considered for use in which patient group

A

1 moderate exacerbation per year

Blood eosinophils 100-300 cells/ul

44
Q

What patient group should not use ICS-LABA

A

Repeated pneumonia event

Eosinophils < 100 cells/ul

History of mycobacterial infection (TB)

45
Q

12 hours or twice daily dosing LABA + ICS

A

Symbicort

Dulera

Advair

46
Q

24 hours or once daily dosing LABA + ICS

A

Breo Ellipta

47
Q

24 hours or once daily dosing LABA + LAMA + ICS

A

Trelegy Ellipta

48
Q

Draw the follow up chart for COPD pharmacological treatment for exacerbation and dyspnea

A

On notability

49
Q

When do you discontinue inhaled corticosteroids in patients with COPD

A

Active or risk of pneumonia

50
Q

What is exacerbation

A

Acute worsening of respiratory symptoms that require an addition therapy

51
Q

How is mild exacerbation managed

A

Short acting bronchodilator

52
Q

How is moderate exacerbation managed

A

Short acting bronchodilator + antibiotic with or without oral corticosteroids

53
Q

How is severe exacerbation managed

A

Hospitalization

54
Q

What can trigger COPD exacerbation

A

Viral infection

Bacterial infection

Environmental factors

Ambient temperature

55
Q

Cord exacerbation characteristics

A

Increased sputum production ( Purulence and volume)

Increased cough

56
Q

Now Lang does exacerbation symptoms last

A

7-10 days

57
Q

How can COPD exacerbation be managed pharmacologically

A

Bronchodilators
• Increase doses/frequencies of SABD
• Combine SABA and SAMA
• Consider using LABD when patient is stable
• Use spacers/nebulizers when appropriate
• Use oral corticosteroids (5-7 days)
• Consider oral antibiotics when signs of bacterial infection present (5-7 days)
• Increased sputum production, increased sputum purulence, increased dyspnea
• Consider non-invasive mechanical ventilation (CPAP/BiPAP/etc.)

58
Q

What is Roflumilast

A

PDE-4 inhibitor

Dose once daily by mouth 500 mcg

59
Q

When is azithromycin used

A

Prevent COPD exacerbation

250mg daily or 250-500 mg 3x weekly

Pharmacotherapy (12 decks)

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