COPD Overview + Drugs (Class/Brand/Generic)

Question 1

Clinical presentation

Answer 1

Sputum, cough & dyspnea

Due to adults exposed to damage over time like smoking

Question 2

Assessments for COPD

Answer 2

Modified British Medical Research Council (mMRC)

COPD Assessment Test (CAT)

Question 3

Risk of Exacerbations associated with Symptoms

Answer 3

*know table (draw out)

Question 4

Starting Treatment associated with Risk of Exacerbations (ABCD)

Answer 4

A - bronchodilator *1st! (SABA or SAMA PRN - LABA or LAMA)

B - LABA or LAMA

C - LAMA

D - LAMA or LABA + LAMA (if highly symptomatic) or LABA + ICS (if eos > 300)

Question 5

Eosinophils predict the benefit from ICS

Answer 5

EOS > 300 cells/microL = expect a good response to ICS treatment

Question 6

First-line to escalation of treatment

Answer 6

Bronchodilators!

• LABA
• LAMA

Question 7

Escalation of Treatment: if Exacerbations?

Answer 7

1) LABA + ICS (eos >300) –> LABA + LAMA + ICS (eos >100)
2) LABA + LAMA —->
2a) LABA + LAMA + ICS (eos >100)
2b) roflumilast or azithromycin “former smoker” [use only if eos < 100]

Question 8

Escalation of Treatment: if Dyspnea?

Answer 8

LABA + LAMA

Question 9

ipratropium

Answer 9

Class: Short-acting muscarinic antagonists “SAMA”

Atrovent HFA (ipratropium) MDI: 2 puffs QID
+ albuterol
Combivent Respimat MDI: 1 puff QID

*SAMA = short-acting dosed more frequently

Question 10

tiotropium

Answer 10

Class: Long-acting muscarinic antagonists “LAMA”

Spiriva (tiotropium)
•HandiHaler DPI: 1 cap BID (requires 2 puffs)
•Respimat MDI: 2 puffs daily

       \+ olodacterol "LABA" Stiolto Respimat

Question 11

aclidinium

Answer 11

Class: Long-acting muscarinic antagonists “LAMA”

Tudorza Pressair (aclidinium)
+ formoterol
Duaklir Pressair

Question 12

glycopyrrolate

Answer 12

Class: Long-acting muscarinic antagonists “LAMA”

glycopyrrolate
+ formoterol “LABA” (Bevespi Aerosphere)
+ formoterol/fluticasone “LABA/ICS” (Breztri Aerosphere)

Question 13

revefenacin

Answer 13

Class: Long-acting muscarinic antagonists “LAMA”

Yupelri (revefenacin)

Question 14

umeclidinium

Answer 14

Class: Long-acting muscarinic antagonists “LAMA”

Incruse Ellipta (umeclidinium)
+ vilanterol “LABA” (Anoro Ellipta)
+ vilanterol/fluticasone “LABA/ICS” (Trelegy Ellipta)

Question 15

salmeterol

Answer 15

Class: Long-acting beta-2 antagonists “LABA”

Serevent Diskus (salmeterol) 
             \+ fluticasone "ICS"     (Advair Diskus)

Question 16

formoterol

Answer 16

Class: Long-acting beta-2 antagonists “LABA”

Perforomist (formoterol)
+ budesonide “ICS” (Symbicort)

Question 17

vilanterol

Answer 17

Class: Long-acting beta-2 antagonists “LABA”

Breo Ellipta (vilanterol/fluticasone)

LABA + ICS

Question 18

Respimat Counseling

Answer 18

1) TURN - hold inhaler upright, move base a 1/2 turn towards the arrows
2) OPEN - open cap fully (until it ‘snaps’), breathe out away from the inhaler, close lips around mouthpiece

3) PRESS - press down button while breathing in slowly
- hold breath for 10 seconds or as long as possible
- breathe out gently away from inhaler
- close cover and repeat TOP for 2 inhalations

Question 19

Dry Powder Inhalers

Answer 19

Diskus, Ellipta, Pressair, Respiclick, Flexihaler

Question 20

Dry Powder Capsules

Answer 20

HandiHaler

Question 21

Meter Dosed Inhalers

Answer 21

HFA, Respimat

Question 22

RediHaler

Answer 22

Is a breath-activated aerosol; has characteristics of MDI & DPI

Question 23

Spiriva HandiHaler Counseling

Answer 23

• Never swallow the capsules
• Open the DPI by pressing green button
• Insert capsule and close the mouthpiece
• Press the green button ‘once’ - until flat against the base
• Take 2 inhalations from each Spiriva capsule (you will hear a rattle)

Question 24

How to clean inhalers

Answer 24

Use damp cloth or tissue weekly and prime before use if > 3 days

Question 25

Tudorza Pressair Counseling

Answer 25

1) Remove protective cap
2) Before putting into mouth, check the window; the dose is ready for inhalation if it changed from °red to green°
3) Breathe out completely then put lips around mouthpiece inhale deeply until you hear the •click• sound
4) Check the window has turned to red (which indicates the full dose has been inhaled correctly)

Question 26

Rinse mouth after use of what drug class?

Answer 26

Inhaled corticosteroid (ICS)

Question 27

Name the inhaled long-acting bronchodilators (Beta-2 agonists).

Answer 27

arformoterol (Brovana)
formoterol (Perforomist)
indacaterol (Arcapta Neohaler)
olodaterol (Striverdi Respimat)
salmeterol 

**LABA

Question 28

Name the inhaled long-acting bronchodilators (anticholinergic agents)

Answer 28

aclidinium (Tudorza Pressair)
glycopyrrolate (Seebri Breezhaler)
tiotropium bromide (Spiriva)
umeclidinium (Incruse Ellipta)

**LAMA

Question 29

Roflumilast in the management of COPD

Answer 29

1) administered as a tablet PO
2) causes weight loss
3) increases cAMP levels due to inhibition of PDE-4

Question 30

indacaterol

Dosing, class, brand?

Answer 30

Dosing: once daily
Class: LABA
Brand: Arcapta Neohaler

Question 31

arformoterol

Dosing, class, brand?

Answer 31

Dosing: BID via neb
Class: LABA
Brand: Brovana

Question 32

aclidinium

Dosing, class, brand?

Answer 32

Dosing: BID (breath-actuated)
Class: LAMA
Brand: Tudorza Pressair

Question 33

umeclidium

Dosing, class, brand?

Answer 33

Dosing: once daily (breath-actuated)
Class: LAMA
Brand: Incruse Ellipta

Question 34

Severity of Post-Bronchodilator Airflow Limitation Grades (pg. 597)

Answer 34

Gold 1 - FEV1 80% or higher
Gold 2 - FEV1 50-79% or higher
Gold 3 - FEV1 30–49% or higher
Gold 4 - FEV1 <30%

Question 35

REMS medications

Answer 35

macitentan (Opsumit)
riociguat (Adempas)
bosentan (Tracleer)

boxed warning: embryo-fetal toxicity

Question 36

Target O2 sat in patient using supplement oxygen in acute COPD management

Answer 36

88-92%

pt w/ COPD usually live at a lower O2 sat