COPD drugs Flashcards
FEV1
Forced Expiratory Volume in 1st sec
FVC
Forced Vital Capacity
FEV1/FVC ___
confirms diagnosis of COPD
<0.7
GOLD 1-4
GOLD 1 FEV1≥80%
GOLD 2 50%≤FEV1<80
GOLD 3 ≤30FEV1<50
GOLD 4 <0FEV1
Dyspnea mMRC score (0-4)
Score from 1-4 indicates dyspnea
CAT score (0-40)
Score > 10 indicates symptoms of COPD
Two categories of risk for COPD
Low risk - ≤1 exacerbation per year
2. High risk - ≥2 exacerbation per year or ≥1 leading to hospitalization per year
COPD treatment categories
Initial treatment:
Group A – bronchodilator
Group B – LABA/LAMA
Group E – LABA/LAMA, OR consider LABA/LAMA/ICS if eosinophils ≥300
Short-acting Bronchodilators
SAMA
ipratropium
Long-acting muscarinic agents (LAMAs)
Tiotropium
competitive reversible antagonism of acetylcholine at M3 receptors in bronchial smooth muscle leading to bronchodilation
Adverse effects of LAMA
Dry mouth – most frequently reported with tiotropium; rare with others as more selective for M3 receptors
* Nasopharyngitis, UTIs
* Constipation, urinary retention
* Headaches, cough
* QT prolongation
Long-acting beta-2 agonists (LABAs)
salmeterol and formoterol
comparing LAMAs with LABAs
which is effective
LAMAs appear to be more effective in reducing the incidence of acute exacerbations and hospitalizations
adverse effects of LABAs
Tremor
* Tachycardia, palpitations
* Headaches
* Cough (high rate of cough with indacaterol at 18%, esp. 1st week)
* Irritability/nervousness, insomnia, sleep disturbance
* Hypokalemia and hyperglycemia can occur with high doses
* QT prolongation
methylxanthine
Theophylline
Slow bronchodilator with anti-inflammatory effects
Roflumilast
Phosphodiesterase-4 inhibitor
Macrolides
azithromycin
current smoke : no effect
long-term prophylactic
need to monitor QT interval
Mucolytics
N-acetylcysteine
injection form
