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Vanessa respiration ppnp > copd pharmacology > Flashcards

copd pharmacology Flashcards

1
Q

what are the combination of drugs used for acute COPD?

A
  1. SABA + SAMA
  2. increase dose
  3. SABA + anticholinergic
  4. add anti biotics if there is infection

after stable

  1. LABA or LAMA
  2. ICS + LABA
  3. LABA +LAMA
  4. if eos count more than 100 , ICS+LAMA+LABA
  5. if fev1 less than 50% and there is chronic bronchitis add ROFLUMILAST
  6. if former smoker add AZITHROMYCIN
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2
Q

what antibiotics should be added for acute COPD ?

A

add to reduce risk of exacerbation

  1. patient prone to exacerbation
    - AZITHROMYCIN or ERYTHROMYCIN
  2. if patient have chronic bronchitis and frequent exacerbation
    - pulse therapy with moxifloxacin
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3
Q

what is group A?

A

0 or 1 exacerbation
no hospitalization
no symptom (cat score less than 10)

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4
Q

what is group B?

A

0 or 1 excerbation
no hospsitalization
bad symptom (cat score 10 or more)

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5
Q

what is group C ?

A

more than or equal to 2 moderate exacerbation
more than or equal to 1 leading to hospitalization

no symptom (cat score less than 10)

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6
Q

what is group D ?

A

more than or equal to 2 moderate exacerbation
more than or equal to 1 leading to hospitalization

bad symptom (cat score 10 or more)

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7
Q

what is the medication used for group A ?

A
  1. SABA (salbutamol) **

2. SAMA(ipratropium) + SABA (salbutamol)

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8
Q

what are the medication used for group B ?

A
  1. LAMA (glycopyrronium shorter and tiotropium longer)

2. LABA ( formoterol, salmeterol shorter, indacaterol , olodaterol longer)

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9
Q

what are the medication used for group c ?

A

LAMA (glycopyrronium shorter and tiotropium longer)

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10
Q

what are the medication used for group D ?

A
  1. LAMA
  2. LAMA + LABA
  3. if eos higher than 300, ICS+ LABA

if still not enough

  1. ICS +LABA +LAMA
  2. add another bronchodilator (theophyline)
  3. add PDE inhibitor (roflumilast)
  4. antifibrotic (azithromycin)
if wanna add mucolyticcs 
without ICS (cysteine derivatives: actylcystine and carbocisteine)
with or without ICS (erdosteine)
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11
Q

what to take note when taking SABA ?

A

altho little effect on heart rate ,
check for heart rate and tremors and tachycardia at high doses)
when taken with beta1 selective blocker, it will reduce the effect of beta 2 agonist

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12
Q

what to take note for SAMA?

A

dry mouth

if taken with levosulpiride, SAMA may diminish the therapeutic effect of this med

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13
Q

what is the use of theophylline?

A

add on drug when ICS + LABA is not enough for group D copd

it is a bronchodilator (aminophylline too)

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14
Q

what is the mechanism of theophylline?

A

relaxation of smooth muscle in lung
dilation and opening of airways
imitate the action of adrenaline at beta 2 receptors and trigger sympathetic response
non selective, target all the receptors

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15
Q

what is the adverse effect of theophylline and aminophylline ?

A
  1. narrow therapeutic window
  2. many drug drug interactions
  3. GI discomfort
  4. CNS nervousness and tremors
  5. arrhythmia
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16
Q

what is the PDE - inhibitor drug used for ?

A

only for group D

is add on if not enough bronchodilation

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17
Q

what is the medication name of PDE - inhibitor ?

A

roflumilast

18
Q

what is the mechanism of PDE -inhibitor?

A

prevent CAMP break down

  1. reduce inflammatory cell activity
  2. inhibition of fibrosis
  3. relaxation of smooth muscle

promotes bronchodilation

19
Q

what are the adverse effects of PDE-inhibitor?

A

same as theophylline (CNS, headache , insomia)

20
Q

what is the contra of PDE-inhibitor ?

A

hepatic impairment (liver failurea)

21
Q

what is the route for PDE - inhibitor ?

A

oral

22
Q

when to consider use of ICS treatment?

when it is a strong support ?

A
  1. history of hospitalization
  2. 2 or more moderate excerbation of COPD per year
  3. blood eos more than 300
  4. history of asthma
23
Q

when to consider use of ICS ?

consider use

A

1 moderate exacerbation of copd per year

blood eos 100-300

24
Q

when not to use ICS ?

A
  1. repeated pneumonia events
  2. blood eos less than 100
  3. history of mycobacterial infection
25
Q

what are the example of medication of ICS? inhaled

A

Fluticasone

budesonide

26
Q

what are some examples of IV corticosteroids ?

A

hydrocortisone (IV) `

27
Q

what is the mechanism of corticosteroid ?

A
  1. potent inflammatory action

2. upregulates beta 2 adrenoreceptor expression

28
Q

what are the side effects of corticosteroid ?

A

rare due to limited systemic absorption

  1. orapharyngeal candidiasis (yeast infection in mouth)
  2. dysphonia (enfeebled voice due to localised muscle wasting)
  3. cough and throat irritation
  4. adrenal suppression, body stop producing corticosteroid
  5. easy bruising
  6. cataracts
  7. osteoporosis
29
Q

what are some extra notes for corticosteroid ?

A
  1. do not use in the long run
  2. if patient have asthma and copd use this
  3. decrease hyper responsiveness in 4-6 weeks
  4. reduce need for beta 2 agonist
  5. improved lung function
30
Q

what is the route for corticosteroids?

A

inhalation

  • higher receptor binding affinity and therefore a lower dose is required
  • extensive first pass metabolism , less systemic side effects

iv (acute) but need to give early as onset is slow

31
Q

what is antibiotic (antifibrotic ) medication used for?

A

for ongoing fibrosis and increased exacerbation

  1. add on drug for group D
  2. acute patients that are prone to exacerbation and infection and previous smoker
32
Q

what is the name of medication of antibiotic and antifibrotic ?

A

azithromycin

33
Q

what is the mechanism of antifibrotic ?

A
  1. anti biotic prevent bacteria proliferation

2. anti fibrotic and airway smooth muscle relaxant

34
Q

what are the adverse effect for antifibrolytic ?

A

diarrhea, nausea, vomitting as the medication kill of good bacteria too
severe ; cardia arrythmia

35
Q

what are the contra for anti fibrolytic ?

A

cholestatic jaundice

hepatic dysfunction

36
Q

mucolytic medication (thiol derivative name)

A

erdosteine

37
Q

what is the mechanism of mucolytic ? and when to use

A

lowers mucous viscosity

when there is mucus in the lungs

38
Q

what are the adverse effect of mucolytic ?

A

bronchospasm
rash, wheezing, hypotention , dyspnoea
GI disturbance

39
Q

what are the contra of mucolytic

A

elderly or weakened patients with respiratory insufficiency

patients with asthma

40
Q

what are the vaccination recommended for patient with COPD ?

A

PPSV 23 and PCV 13 for patients older than 65

PPSV23 for younger patients with significant conditions including chronic heart or lung disease

Vanessa respiration ppnp (6 decks)

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