COPD meds Flashcards
COPD is characterized by airflow obstruction due to:
Chronic bronchitis
Ephysema
What is chronic bronchitis?
Chronic or recurrent excess mucus secretion into the bronchial tree
Characterize the chronic bronchitis cough
Most days >3 months/year for at least 2 consecutive years
How is emphysema defined?
Defined by anatomic pathology
What is emphysema characterized by?
Permanent enlarged air spaces and destruction of alveolar walls
What is the key component of the chronic bronchitis hx?
Impressive hx of productive cough
How are chronic bronchitis pts described?
Blue bloaters
Why are chronic bronchitis pts described as blue bloaters?
CO2 retention
Two main PE findings in chronic bronchitis:
Percussion is resonant
Breath sounds are distant to auscultation
What is the key hx of emphysema
Minimal cough
How do you describe pts with emphysema and why?
Pink puffers
Tachypnea
What does pursed lip breathing compensate for in emphysema pts?
Compensate for loss of elastic recoil
Why do emphysema pts sit forward with hands on knees?
Minimizes energy of breathing
What are two key PE findings in pts w/ emphysema?
Accessory muscle use
Hyperresonant percussion
What is a major RF for chronic bronchitis and emphysema?
Cigarette smoking
Is inflammation in COPD the same or different than inflammation of asthma?
Different
How is COPD characterized?
By exacerbations
What is the definition of exacerbation of COPD?
Worsening of pts sx that is beyond normal day-to-day variations
Leads to change in medication
How many exacerbations do pts have yearly?
1-2
What % of exacerbations can be handled out patient?
80%
What are sx of severe exacerbations? Where should they be managed?
Accessory muscle use
Cyanosis
Peripheral edema
Hospital
What are sx of life-threatening exacerbations? Where should they be managed?
Mental status changes
Worsening respiratory status
Hemodynamic instability
ICU
What are the COPD medication classes?
Cholinergic antagonists Sympathomimetics Combination anticholinergics/b2 agonists Inhaled corticosteroids Long-term oxygen Antibiotics
What are cholinergic antagonists also known as?
Anti-muscarinic agents
Anticholinergics
What are sympathomimetrics also known as?
Beta 2 agonists
Is the long term O2 high or low dose?
Low dose
When do you use abx for COPD?
Exacerbations, not as prophylaxis
What line of therapy are inhaled cholinergic antagonists (ICA) and for what severity of COPD?
1st line in stable COPD
What are the available ICA agents?
Ipratropium
Tiotropium
Atropine
Do ICAs have more or less side effects that sympathomimetics?
Less
What line of tx are sympathomimetics?
2nd line
When are sympathomimetics the drug of choice?
Acute exacerbations
What do you do if response to ipratropium is unsatisfactory?
Begin trial of sympathomimetics
Do inhaled corticosteroids (ICS) modify lung function decline or improve mortality?
No
When are ICS recommended?
Pts w/ severe or very severe COPD w/ frequent exacerbations
What are some AEs of ICS?
Oropharyngeal candidiasis
Hoarse voice
Should you use ICS long term?
No, due to AEs
What has continuous O2 therapy been shown to do?
Decrease mortality
Improve quality of life
Reduce times in hospital
How do you administer O2?
Via nasal canula @ 2-3 L/min
What is the goal of long term O2?
Raise PaO2 to > 60 mm Hg
Why do you not raise PaO2 too high?
Don’t want to depress respiratory drive
What is a risk of inhibiting respiratory drive?
Death
What do you have to avoid on long term O2?
Flames (smoking)
When are abx only effective for COPD?
Infection
How long do you use the abx for COPD infections?
7-10 days
What is the MC abx used w/ COPD infection?
Azithromycin
3rd generation macrolide
for 3-5 days
Summary of COPD pharmacotherapy
See slide 61
Stepwise COPD drug therapy
1) Short acting bronchodilator for acute sx relief
2) Long acting bronchodilator
3) Combination anticholinergic + beta agonist bronchodilator
4) consider theophylline
5) Combination inhaled corticosterouds + LABA
What is the difference between inflammatory cell infiltration w/ asthma and inflammation w/ COPD?
Asthma = eosinophils and mast cells
COPD: caused by neutrophils, macrophages, T lymphocytes
