COPD Medications Flashcards
Spirometry
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
Spirometry Criteria
Current and former smokers >40 years and answer yes to any one of the following questions
- Do you cough regularly
- Do you bring up phlegm regularly?
- Do even simple chores make you short of breath
- Do you wheeze when you exert yourself or at night
- Do you frequently get colds that persist longer than those of other people you know?
What can you use if the patient is SOB
Ventolin or Atrovent per as needed
What LABA is also a LAMA
Oxy
Pulmonary Rehabilitation
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
Management of COPD
- Self Managment Education/Smoking Cessation
- Short Acting Bronchodilators
- Long Acting Bronchodilator
- Pulmonary Rehabilitation (this should actually be throughout the whole treatment
- Inhalaed Corticosteroids
- Oxygen
- Surgery
From early diagnosis to end of life care
Early Diagnosis (spirometry) and Prevention= Decreased FEV1
End of Life Care=Increased Dyspnea
Mild COPD Pharmacology
Begin with SABD prn
If there is still persistenet dyspnea then continue onto
LAAC + SABD prn
OR
LABA + SABD prn
Severe COPD Pharmacology
Severe COPD= Frequent AECOPD (> 1/year)
Begin with LAAC + ICS/LABA + SABA prn
If persistent dyspnea move onto
LAAC + ICS/LABA + SABA prn +/- Theophylline
Moderate COPD Pharmacology
Moderate COPD=Infrequent AECOPD (<1/year)
Begin with LAAC or LABA + SABA prn
If persistent dyspnea move onto
LAAC + ICS/LABA + SABA prn
Long Acting Muscarinic Antagonist (LAMA)
Spiriva® (Tiotropium)
Tudorza® (Aclidinium Bromide)
Seebri® (Glycopyronnium Bromide)
Incruse® (Umeclidinium) *Not on the market yet
Long Acting B2 Agonists (LABA)
Oxeze® (Formoterol)
Serevent® (Salmeterol)
Onbrez® (Indacaterol)
Streverdi® (Oladaterol)*Not on the market yet
LAMA/LABA
Ultibro® (Glycopyronnium/Indacaterol)
Anoro® (Umeclidinium/Vilanterol)
ICS (Inhaled Corticosteroids)/LABA
Symbicort® (Budesonide/Formoterol)
Advair® (Fluticasone Proprionate/Salmeterol)
Breo® (Fluticasone Furoate/Vilanterol)
Short Acting Bronchodialators (SABD)
Ventolin® or Airomir® (Salbutamol)
Bricanyl® (Terbutaline)
Atrovent® (Ipratropium)
Combivent® (Salbutamol/Ipratropium)
Spiriva Category
LAMA
Spiriva Devices and Cost
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
Spiriva Generic Name
Generic Name: Tiotropium
Spirivia Side Effects
Dry Mouth, Urinary Retention, Constipation, Headache, Nasopharyngitis
Aclidinium Bromide Category and Generic Name
LAMA
Brand Name Tudorza
Aclidinium Bromide Device and Cost
Genuair - 400 mcg – 1 inhalation twice a day, no capsule
$70/60 doses – covered by Alberta Blue Cross
Tudorza Side Effects
Dry Mouth
Urinary Retention
Constipation
Headache
Nasopharyngitis
Glycopyronnium Bromide
Category and Brand Name
LAMA
Seebri
Glycopyronnium Bromide
Device
Breezhaler – 50 ug/capsule – 1 inhalation via capsule once a day
$70/30 doses – covered by Alberta Blue Cross
Seebri Side Effects
Dry Mouth
Urinary Retention
Constipation
Headache
Nasopharyngitis
Indacaterol Category and Generic Name
LABA
Onbrez
Note:Only indicated for COPD not Asthma, unlike other LABA agents.
Indacaterol
Device and Cost
Breezhaler – 75ug/capsule – 1 inhalation via capsule once a day
$62.83/30 doses – covered by Alberta Blue Cross
Onbrez Side Effects
Headache
Tremor
Increased Heart Rate
Muscle Spasm
Glycopyronnium Bromide/ Indacaterol Category and Brand Name
LAMA/LABA
Glycopyronnium Bromide/ Indacaterol
Glycopyronnium Bromide/ Indacaterol Device
Breezhaler – 50/110ug percapsule – 1 inhalation via capsule once a day
$44/30 doses – Special Auth
Ultibro Side Effects
Headache
Tremor
Increased Heart Rate
Muscle Spasm
Dry Mouth
Urinary Retention
Constipation
Nasopharyngitis
Umeclidinium/Vilanterol Category and Generic Name
Umeclidinium/Vilanterol
LAMA/LABA
Umeclidinium/Vilanterol Device and Cost
Ellipta – 62.5/25ug – 1 inhalation once a day, no capsule
$160.19/30 doses – Special Auth
Anoro Side Effects
Dry Mouth
Urinary Retention
Constipation
Headache
Nasopharyngitis
Tremor
Increased Heart Rate
Muscle Spasm
Fluticasone Furoate/VilanterolCategory and Generic Name
ICS/LABA
Fluticasone Furoate/Vilanterol
Note:Only indicated for COPD not Asthma, unlike other ICS/LABA combos
Fluticasone Furoate/Vilanterol Device and Cost
Ellipta – 100/25ug – 1 inhalation once a day
$103.48/30 doses – Special Auth
Breo Side Effects
Oral Thrush
Hoarse Voice
Sore Throat
Headache
Tremor
Increased Heart Rate
Muscle Spasm
Ipratropium/Salbutamol Category and Generic Name
(Ipratropium/Salbutamol)
SAAC/SABA
Ipratropium/Salbutamol Device and Cost
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
Combivent Side Effect
Dry mouth
Tremor
Headache
Blurred Vision
Urinary Retention
Increased Heart Rate
Nervousness
Sweating
COPD Severity Classification Based on Spirometry
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
COPD Severity Classification Based on Spirometry
Very Severe
Spirometry Post Bronchodilator
FEV1 Less than 30% predicted
FEV1/FVC <0.7
COPD Severity Classification Based on Spirometry
Severe
Spirometry Post Bronchodilator
FEV1 between 30-50% predicted
FEV1/FVC <0.7
COPD Severity Classification Based on Spirometry
Modertate
Spirometry Post Bronchodilator
FEV1 between 50-80% predicted
FEV1/FVC <0.7
COPD Severity Classification Based on Spirometry
Mild
Spirometry Post Bronchodilator
FEV1 Greater than or equal to 80% predicted
FEV1/FVC <0.7
Severe COPD
Disability/Symptons Using MRC Dyspnea Scale
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
Moderate COPD
Disability/Symptons Using MRC Dyspnea Scale
SOB from COPD causing patient to stop after walking approximately 100m (or a few minutes) on the level
MRC 3-4
Mild COPD
Disability/Symptons Using MRC Dyspnea Scale
SOB from COPD when hurrying on level or walking up a slight hill
MRC 2
HandiHaler Use
- Open the HandiHaler. Separate only one of the blisters from the blister card; then open the blister to expose the capsule
- Insert the capsule into the capsule chamber and close the mouthpiece against the grey base until you hear a click.
- Press the green piercing button once and release
- Exhale away from the device
- Put your mouth around the mouthpiece and breathe in quickly and deeply. You will hear or feel the Spiriva capsule vibrate or rattle.
- Remove device from mouth, hold breath for 10 seconds and breath normally
- Open device and check to see contents of capsule are empty, if not then repeat steps 4 to 6
HandiHaler Helpful Hints
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
Respimat Use
- With the green cap closed, press the safety catch while pulling off the clear base.
- 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.
- Replace the clear base
- 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).
- 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.
- 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.
- Hold your breath for 10 seconds
Respimat Helpful Hints
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
Genuair Inhaler Use
- Press down on Green Button & release
- Watch the control window color change from red to green – now ready for use
- Exhale away from the device
- Put your mouth around the mouthpiece and breath in quickly & deeply
- Breathe in until you hear a “click” noise. Continue to breathe in even after the click noise to ensure you get the full dose.
- Remove device from your mouth, hold breath for 10 seconds and breath normally
Genuair Inhaler Helpful Hints
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
Breezhaler Inhaler Techniques
- Pull off cap & Tilt the mouthpiece to open the inhaler
- Prepare the capsule by peeling the blister pack to expose one capsule
- Insert the capsule in the capsule chamber
- Close the inhaler until you hear a click
- Hold the inhaler upright and press the buttons on the side firmly until you hear a click – this ensures the capsule is pierced
- Exhale away from the device
- Put your mouth around the mouthpiece and breath in quickly & deeply
- A whirling sound will occur as you breathe in and you will experience a sweet taste
- Remove device from mouth, hold breath for 10 seconds and breath normally
- Open device and check to see contents of capsule are empty, if not then repeat steps 6 to 9
- Remove capsule by tipping it out and close mouthpiece and replace cap
Breezhaler Inhaler Helpful Hints
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
Ellipta Inhaler Use
- Slide the cover down to expose the mouthpiece. You should hear a click.
- Exhale away from the device
- Put your mouth around the mouthpiece and take a slow deep breath in
- Remove device from your mouth and hold your breath for 5-10 seconds then breathe normally.
- Close the inhaler by sliding the cover up and over the mouthpiece as far as it will go.
Ellipta Inhaler Helpful Hints
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
Fluticasone Furoate/Vilanterol
Category
ICS/LABA
Note:Only indicated for COPD not Asthma, unlike other ICS/LABA combos
