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Intreventions 2 > COPD Medications > Flashcards

COPD Medications Flashcards

1
Q

Spirometry

A

Spirometry will assess lung function through measuring the volume of air that the patient can expel from the lung after a maximal inspiration

FEV1-how much air can you blow out in one second

FEVC-How much can you blow out in total

<0.7 FEV1/FEVC means COPD

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2
Q

Spirometry Criteria

A

Current and former smokers >40 years and answer yes to any one of the following questions

  1. Do you cough regularly
  2. Do you bring up phlegm regularly?
  3. Do even simple chores make you short of breath
  4. Do you wheeze when you exert yourself or at night
  5. Do you frequently get colds that persist longer than those of other people you know?
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3
Q

What can you use if the patient is SOB

A

Ventolin or Atrovent per as needed

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4
Q

What LABA is also a LAMA

A

Oxy

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5
Q

Pulmonary Rehabilitation

A

Pulmonary Rehabilitation should be added into self-management education because it will make more of a difference than any of the puffers will. So pulmonary rehabilitation should be done for everyone

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6
Q

Management of COPD

A
  1. Self Managment Education/Smoking Cessation
  2. Short Acting Bronchodilators
  3. Long Acting Bronchodilator
  4. Pulmonary Rehabilitation (this should actually be throughout the whole treatment
  5. Inhalaed Corticosteroids
  6. Oxygen
  7. Surgery
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7
Q

From early diagnosis to end of life care

A

Early Diagnosis (spirometry) and Prevention= Decreased FEV1

End of Life Care=Increased Dyspnea

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8
Q

Mild COPD Pharmacology

A

Begin with SABD prn

If there is still persistenet dyspnea then continue onto

LAAC + SABD prn

OR

LABA + SABD prn

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9
Q

Severe COPD Pharmacology

A

Severe COPD= Frequent AECOPD (> 1/year)

Begin with LAAC + ICS/LABA + SABA prn

If persistent dyspnea move onto

LAAC + ICS/LABA + SABA prn +/- Theophylline

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10
Q

Moderate COPD Pharmacology

A

Moderate COPD=Infrequent AECOPD (<1/year)

Begin with LAAC or LABA + SABA prn

If persistent dyspnea move onto

LAAC + ICS/LABA + SABA prn

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11
Q

Long Acting Muscarinic Antagonist (LAMA)

A

Spiriva® (Tiotropium)

Tudorza® (Aclidinium Bromide)

Seebri® (Glycopyronnium Bromide)

Incruse® (Umeclidinium) *Not on the market yet

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12
Q

Long Acting B2 Agonists (LABA)

A

Oxeze® (Formoterol)

Serevent® (Salmeterol)

Onbrez® (Indacaterol)

Streverdi® (Oladaterol)*Not on the market yet

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13
Q

LAMA/LABA

A

Ultibro® (Glycopyronnium/Indacaterol)

Anoro® (Umeclidinium/Vilanterol)

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14
Q

ICS (Inhaled Corticosteroids)/LABA

A

Symbicort® (Budesonide/Formoterol)

Advair® (Fluticasone Proprionate/Salmeterol)

Breo® (Fluticasone Furoate/Vilanterol)

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15
Q

Short Acting Bronchodialators (SABD)

A

Ventolin® or Airomir® (Salbutamol)

Bricanyl® (Terbutaline)

Atrovent® (Ipratropium)

Combivent® (Salbutamol/Ipratropium)

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16
Q

Spiriva Category

A

LAMA

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17
Q

Spiriva Devices and Cost

A

Handihaler (18ug/capsule – 1 inhalation via capsule once a day)

Respimat (2.5ug/actuation – 2 inhalations once a day (soft mist, no capsule needed))

  • Handihaler - $83.93/30 doses* – covered by Alberta Blue Cross.
  • Respimat - $83.30/60 doses* – Not covered by Alberta Blue Cross
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18
Q

Spiriva Generic Name

A

Generic Name: Tiotropium

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19
Q

Spirivia Side Effects

A

Dry Mouth, Urinary Retention, Constipation, Headache, Nasopharyngitis

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20
Q

Aclidinium Bromide Category and Generic Name

A

LAMA

Brand Name Tudorza

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21
Q

Aclidinium Bromide Device and Cost

A

Genuair - 400 mcg – 1 inhalation twice a day, no capsule

$70/60 doses – covered by Alberta Blue Cross

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22
Q

Tudorza Side Effects

A

Dry Mouth

Urinary Retention

Constipation

Headache

Nasopharyngitis

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23
Q

Glycopyronnium Bromide

Category and Brand Name

A

LAMA

Seebri

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24
Q

Glycopyronnium Bromide

Device

A

Breezhaler – 50 ug/capsule – 1 inhalation via capsule once a day

$70/30 doses – covered by Alberta Blue Cross

25
Q

Seebri Side Effects

A

Dry Mouth

Urinary Retention

Constipation

Headache

Nasopharyngitis

26
Q

Indacaterol Category and Generic Name

A

LABA

Onbrez

Note:Only indicated for COPD not Asthma, unlike other LABA agents.

27
Q

Indacaterol

Device and Cost

A

Breezhaler – 75ug/capsule – 1 inhalation via capsule once a day

$62.83/30 doses – covered by Alberta Blue Cross

28
Q

Onbrez Side Effects

A

Headache

Tremor

Increased Heart Rate

Muscle Spasm

29
Q

Glycopyronnium Bromide/ Indacaterol Category and Brand Name

A

LAMA/LABA

Glycopyronnium Bromide/ Indacaterol

30
Q

Glycopyronnium Bromide/ Indacaterol Device

A

Breezhaler – 50/110ug percapsule – 1 inhalation via capsule once a day

$44/30 doses – Special Auth

31
Q

Ultibro Side Effects

A

Headache

Tremor

Increased Heart Rate

Muscle Spasm

Dry Mouth

Urinary Retention

Constipation

Nasopharyngitis

32
Q

Umeclidinium/Vilanterol Category and Generic Name

A

Umeclidinium/Vilanterol

LAMA/LABA

33
Q

Umeclidinium/Vilanterol Device and Cost

A

Ellipta – 62.5/25ug – 1 inhalation once a day, no capsule

$160.19/30 doses – Special Auth

34
Q

Anoro Side Effects

A

Dry Mouth

Urinary Retention

Constipation

Headache

Nasopharyngitis

Tremor

Increased Heart Rate

Muscle Spasm

35
Q

Fluticasone Furoate/VilanterolCategory and Generic Name

A

ICS/LABA

Fluticasone Furoate/Vilanterol

Note:Only indicated for COPD not Asthma, unlike other ICS/LABA combos

36
Q

Fluticasone Furoate/Vilanterol Device and Cost

A

Ellipta – 100/25ug – 1 inhalation once a day

$103.48/30 doses – Special Auth

37
Q

Breo Side Effects

A

Oral Thrush

Hoarse Voice

Sore Throat

Headache

Tremor

Increased Heart Rate

Muscle Spasm

38
Q

Ipratropium/Salbutamol Category and Generic Name

A

(Ipratropium/Salbutamol)

SAAC/SABA

39
Q

Ipratropium/Salbutamol Device and Cost

A

Respimat – 20/100ug – 1 inhalation four times a day (max dose 6 inhalations/24 hrs)

$44.85/120 doses – not covered by Alberta Blue Cross

40
Q

Combivent Side Effect

A

Dry mouth

Tremor

Headache

Blurred Vision

Urinary Retention

Increased Heart Rate

Nervousness

Sweating

41
Q

COPD Severity Classification Based on Spirometry

A

This is the old school way of doing it now there is a new gold classification that has not been published yet but is coming

42
Q

COPD Severity Classification Based on Spirometry

Very Severe

A

Spirometry Post Bronchodilator

FEV1 Less than 30% predicted

FEV1/FVC <0.7

43
Q

COPD Severity Classification Based on Spirometry

Severe

A

Spirometry Post Bronchodilator

FEV1 between 30-50% predicted

FEV1/FVC <0.7

44
Q

COPD Severity Classification Based on Spirometry

Modertate

A

Spirometry Post Bronchodilator

FEV1 between 50-80% predicted

FEV1/FVC <0.7

45
Q

COPD Severity Classification Based on Spirometry

Mild

A

Spirometry Post Bronchodilator

FEV1 Greater than or equal to 80% predicted

FEV1/FVC <0.7

46
Q

Severe COPD

Disability/Symptons Using MRC Dyspnea Scale

A

SOB from COPD resulting in the patient being too breathless to leave the house, breathlessness when dressing or undressing

MRC 5

Or presence of chronic respirtory failure or clinical signs of right heart failure

47
Q

Moderate COPD

Disability/Symptons Using MRC Dyspnea Scale

A

SOB from COPD causing patient to stop after walking approximately 100m (or a few minutes) on the level

MRC 3-4

48
Q

Mild COPD

Disability/Symptons Using MRC Dyspnea Scale

A

SOB from COPD when hurrying on level or walking up a slight hill

MRC 2

49
Q

HandiHaler Use

A
  1. Open the HandiHaler. Separate only one of the blisters from the blister card; then open the blister to expose the capsule
  2. Insert the capsule into the capsule chamber and close the mouthpiece against the grey base until you hear a click.
  3. Press the green piercing button once and release
  4. Exhale away from the device
  5. Put your mouth around the mouthpiece and breathe in quickly and deeply. You will hear or feel the Spiriva capsule vibrate or rattle.
  6. Remove device from mouth, hold breath for 10 seconds and breath normally
  7. Open device and check to see contents of capsule are empty, if not then repeat steps 4 to 6
50
Q

HandiHaler Helpful Hints

A

After opening a strip from the blister card, the shelf life of the remaining capsules of that strip is 5 days

If more than one capsule is exposed to air then it should be discarded

Handihaler should be replaced after 1 year of use

Priming- Point it at the ground and twist it until you get a good mist going and then give three extra puffs

51
Q

Respimat Use

A
  1. With the green cap closed, press the safety catch while pulling off the clear base.
  2. Take the cartridge out of the box. Push the narrowend of the cartridge into the inhaler until it clicksinto place. The cartridge should be pushed firmlyagainst a firm surface to ensure that it has gone all the way in.
  3. Replace the clear base
  4. Hold the device upright, with the green cap closed, turn the clear base in the direction of the white arrows on the label until it clicks (half a turn).
  5. Open the cap until it snaps fully open. Exhale away from the device, then close your lips around the end of the mouthpiece without covering the air vents. Point the device to the back of the throat.
  6. While taking in a slow, deep breath through your mouth, press the dose release button and continue to breathe in slowly for as long as you can.
  7. Hold your breath for 10 seconds
52
Q

Respimat Helpful Hints

A

When using the inhaler for the first time prime it by actuating it towards the ground until a full aerosol cloud appears then repeat the process 3 more times.

If it has not been use > 7 days – prime once.

If it has not been used >21 days then prime it as if it has never been used as listed above.

Respimat should be discarded 3 months after the cartridge has been inserted into the inhlaer

Has a Dose indicator. Includes extra doses for priming. When it reaches the red zone patient has 7 days of medication left (14 doses)

Device locks once 60 doses has been reached

53
Q

Genuair Inhaler Use

A
  1. Press down on Green Button & release
  2. Watch the control window color change from red to green – now ready for use
  3. Exhale away from the device
  4. Put your mouth around the mouthpiece and breath in quickly & deeply
  5. Breathe in until you hear a “click” noise. Continue to breathe in even after the click noise to ensure you get the full dose.
  6. Remove device from your mouth, hold breath for 10 seconds and breath normally
54
Q

Genuair Inhaler Helpful Hints

A

No capsule

Dose indicator moves down displaying intervals of 10

When a red striped band appears you are nearing your last dose

When the inhaler is empty the green button will not return to its full upright position (it is locked) and the dose indicator should read “0.”

Must be used within 90 days of opening

55
Q

Breezhaler Inhaler Techniques

A
  1. Pull off cap & Tilt the mouthpiece to open the inhaler
  2. Prepare the capsule by peeling the blister pack to expose one capsule
  3. Insert the capsule in the capsule chamber
  4. Close the inhaler until you hear a click
  5. Hold the inhaler upright and press the buttons on the side firmly until you hear a click – this ensures the capsule is pierced
  6. Exhale away from the device
  7. Put your mouth around the mouthpiece and breath in quickly & deeply
  8. A whirling sound will occur as you breathe in and you will experience a sweet taste
  9. Remove device from mouth, hold breath for 10 seconds and breath normally
  10. Open device and check to see contents of capsule are empty, if not then repeat steps 6 to 9
  11. Remove capsule by tipping it out and close mouthpiece and replace cap
56
Q

Breezhaler Inhaler Helpful Hints

A

Rapidly absorbed and reaches peak plasma levels in 5 mins

Clear capsule which makes contents easily visible

Creates a whirling sound – cues patients that the dose is being inhaled

Sweet taste as the medicine goes into the lungs

Dispose of each breezhaler after 30 days and use the new one supplied in each pack

57
Q

Ellipta Inhaler Use

A
  1. Slide the cover down to expose the mouthpiece. You should hear a click.
  2. Exhale away from the device
  3. Put your mouth around the mouthpiece and take a slow deep breath in
  4. Remove device from your mouth and hold your breath for 5-10 seconds then breathe normally.
  5. Close the inhaler by sliding the cover up and over the mouthpiece as far as it will go.
58
Q

Ellipta Inhaler Helpful Hints

A

Make sure you are not covering the vent so instruct the patient to hold on the side or near the bottom

No capsule

Visible dose indicator starting at 30 doses

Discard device 6 weeks after it has been removed from the foil tray or when the dose counter reads “0,” whichever comes first

59
Q

Fluticasone Furoate/Vilanterol

Category

A

ICS/LABA

Note:Only indicated for COPD not Asthma, unlike other ICS/LABA combos

Intreventions 2 (19 decks)

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