COPD Drug Flashcards
what is the FEV1% for Gold 1
> =80%
what is the FEV1% for Gold 2
50-79%
what is the FEV1% for Gold 3
30-49
what is the FEV1% for Gold 4
<=30
Patient is a diagnose with Gold group A COPD. what do u give him?
Bronchodilators
SABA- Salbutamol (3-6h)
and/or SAMA - Ipratropium (6-8h)
Patient is a diagnose with Gold group B COPD. what do u give him?
LABA -Formoterol (12H) -Salmeterol (12H) - Indacaterol (24H) - Olodaterol (24H) LAMA - Tiotropium (24H) - Glycopyrronium (24H)
Patient is a diagnose with Gold group C COPD. what do u give him?
LAMA
- Tiotropium (24H)
- Glycopyrronium (24H)
Patient is a diagnose with Gold group D COPD. what do u give him?
LAMA or
LAMA + LABA
ICS + LABA
ICS given if EOS > 300
Can also add the following :
LAMA + LABA + ICS
Theophylline
Roflumilast
Azithromycin
List the Muscarinic Receptor Mechanisms, Use and Adverse Effect ?
SAMA - Ipratropium
LAMA - Tiotropium
Mechanisms of Action:
• Inhibit M3 receptor-reduce bronchoconstrictions
• Reverses vagal nerve-reduce bronchospasm & mucus secretion
Uses and Efficacy:
• First-line for COPD bronchodilation (especially for
GOLD Groups C & D)
Adverse Effects:
• Limited systemic side effects as not well absorbed
into systemic circulation when taken by inhalation
• Unpleasant taste
• Typical parasympatholytic effects:
• Dry mouth
• Urinary retention (especially in the elderly
What is the mechanism of action, use and adverse effects of SABA and LABA?
Mechanisms of Action:
• Help bronchodilation
• Increase in mucociliary clearance
Uses and Efficacy:
• Usually second-line for COPD bronchodilation
(although more likely to be used alone for GOLD Groups A & B)
• Combining LABA with glucocorticoid prolongs effectiveness
• Often combined: SAMA + SABA or Triple Inhaler (LAMA + LABA + glucocorticoid)
Adverse Effects: • Tremor • Peripheral vasodilatation • Palpitations & tachycardia • Hypokalaemia/Hyperglycaemia • COPD patients who also have asthma have β2-adrenoceptor tolerance
What is the mechanism of action, use and adverse effects of ICS?
Mechanisms of Action:
• Anti-inflammatory action
• Upregulate β2 adrenoceptor expression
Uses and Efficacy:
• Anti-inflammatory agents for more advanced COPD
• Combined with LABAs to counter downregulation of β2 adrenoceptors by LABAs
Adverse Effects: • Oropharyngeal candidiasis • Dysphonia • Cough / throat irritation • Adrenal suppression (e.g., fluticasone) • Easy bruising (especially in elderly) • cataracts • Osteoporosis
List down the factor to consider when using of ICS for COPD patient
a) Strong support
b) Consider Use
c) Against Use
Support - Hospitalisation history of exacerbations of COPD - >= 2 exacerbations of COPD per year - Blood eos >300 cell History of cocomitant , asthma
Consider Use
- 1 exacerbation of COPD per year
- Blood eosinophils 100-300 cell
Against
- eosinophils < 100cell
-bacterial infection history
-
What is the mechanism of action, use and adverse effects of Theophylline ?
Uses & Efficacy:
• Used as adjunct for more severe cases of COPD
Adverse Effects:
• Narrow therapeutic window (therapeutic range: 5-20 mg/L)
• Many drug-drug interactions: Caution for potential drug interactions
• Gastrointestinal: Nausea, vomiting, abdominal discomfort, anorexia
• CNS: Nervousness, tremor, anxiety, insomnia, seizures
• Cardiovascular: Arrhythmias
What is the mechanism of action, use and adverse effects of Roflumilast ?
it inhibit PDE4 to prevent breakdown of cAMP which
- reduce inflammatory cell activity
- inhibition of fibrosis
- Relaxation of smooth muscle
Uses & Efficacy:
• Reduces episodes of exacerbation
• Slows progress of fibrosis
Adverse Effects:
• Headaches, dizziness, insomnia
• Weight loss, diarrhoea, nausea, decreased appetite
• Rarely: anxiety, depression, and suicidal ideation
• Caution in patients with hepatic impairment
What is the mechanism of action, use and adverse effects of Azithromycin ?
- Antibiotic prevents bacteria from growing by interfering with their protein synthesis
- Anti fibrotic and airway smooth muscle relaxant
Adverse Effects: Many adverse effects including: • Common: Diarrhoea, nausea, vomiting • Severe: Cardiac arrythmia • Contraindicated history of cholestatic jaundice or hepatic dysfunction
