copd pharmacology Flashcards
what are the combination of drugs used for acute COPD?
- SABA + SAMA
- increase dose
- SABA + anticholinergic
- add anti biotics if there is infection
after stable
- LABA or LAMA
- ICS + LABA
- LABA +LAMA
- if eos count more than 100 , ICS+LAMA+LABA
- if fev1 less than 50% and there is chronic bronchitis add ROFLUMILAST
- if former smoker add AZITHROMYCIN
what antibiotics should be added for acute COPD ?
add to reduce risk of exacerbation
- patient prone to exacerbation
- AZITHROMYCIN or ERYTHROMYCIN - if patient have chronic bronchitis and frequent exacerbation
- pulse therapy with moxifloxacin
what is group A?
0 or 1 exacerbation
no hospitalization
no symptom (cat score less than 10)
what is group B?
0 or 1 excerbation
no hospsitalization
bad symptom (cat score 10 or more)
what is group C ?
more than or equal to 2 moderate exacerbation
more than or equal to 1 leading to hospitalization
no symptom (cat score less than 10)
what is group D ?
more than or equal to 2 moderate exacerbation
more than or equal to 1 leading to hospitalization
bad symptom (cat score 10 or more)
what is the medication used for group A ?
- SABA (salbutamol) **
2. SAMA(ipratropium) + SABA (salbutamol)
what are the medication used for group B ?
- LAMA (glycopyrronium shorter and tiotropium longer)
2. LABA ( formoterol, salmeterol shorter, indacaterol , olodaterol longer)
what are the medication used for group c ?
LAMA (glycopyrronium shorter and tiotropium longer)
what are the medication used for group D ?
- LAMA
- LAMA + LABA
- if eos higher than 300, ICS+ LABA
if still not enough
- ICS +LABA +LAMA
- add another bronchodilator (theophyline)
- add PDE inhibitor (roflumilast)
- antifibrotic (azithromycin)
if wanna add mucolyticcs without ICS (cysteine derivatives: actylcystine and carbocisteine) with or without ICS (erdosteine)
what to take note when taking SABA ?
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
what to take note for SAMA?
dry mouth
if taken with levosulpiride, SAMA may diminish the therapeutic effect of this med
what is the use of theophylline?
add on drug when ICS + LABA is not enough for group D copd
it is a bronchodilator (aminophylline too)
what is the mechanism of theophylline?
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
what is the adverse effect of theophylline and aminophylline ?
- narrow therapeutic window
- many drug drug interactions
- GI discomfort
- CNS nervousness and tremors
- arrhythmia
what is the PDE - inhibitor drug used for ?
only for group D
is add on if not enough bronchodilation
what is the medication name of PDE - inhibitor ?
roflumilast
what is the mechanism of PDE -inhibitor?
prevent CAMP break down
- reduce inflammatory cell activity
- inhibition of fibrosis
- relaxation of smooth muscle
promotes bronchodilation
what are the adverse effects of PDE-inhibitor?
same as theophylline (CNS, headache , insomia)
what is the contra of PDE-inhibitor ?
hepatic impairment (liver failurea)
what is the route for PDE - inhibitor ?
oral
when to consider use of ICS treatment?
when it is a strong support ?
- history of hospitalization
- 2 or more moderate excerbation of COPD per year
- blood eos more than 300
- history of asthma
when to consider use of ICS ?
consider use
1 moderate exacerbation of copd per year
blood eos 100-300
when not to use ICS ?
- repeated pneumonia events
- blood eos less than 100
- history of mycobacterial infection
what are the example of medication of ICS? inhaled
Fluticasone
budesonide
what are some examples of IV corticosteroids ?
hydrocortisone (IV) `
what is the mechanism of corticosteroid ?
- potent inflammatory action
2. upregulates beta 2 adrenoreceptor expression
what are the side effects of corticosteroid ?
rare due to limited systemic absorption
- orapharyngeal candidiasis (yeast infection in mouth)
- dysphonia (enfeebled voice due to localised muscle wasting)
- cough and throat irritation
- adrenal suppression, body stop producing corticosteroid
- easy bruising
- cataracts
- osteoporosis
what are some extra notes for corticosteroid ?
- do not use in the long run
- if patient have asthma and copd use this
- decrease hyper responsiveness in 4-6 weeks
- reduce need for beta 2 agonist
- improved lung function
what is the route for corticosteroids?
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
what is antibiotic (antifibrotic ) medication used for?
for ongoing fibrosis and increased exacerbation
- add on drug for group D
- acute patients that are prone to exacerbation and infection and previous smoker
what is the name of medication of antibiotic and antifibrotic ?
azithromycin
what is the mechanism of antifibrotic ?
- anti biotic prevent bacteria proliferation
2. anti fibrotic and airway smooth muscle relaxant
what are the adverse effect for antifibrolytic ?
diarrhea, nausea, vomitting as the medication kill of good bacteria too
severe ; cardia arrythmia
what are the contra for anti fibrolytic ?
cholestatic jaundice
hepatic dysfunction
mucolytic medication (thiol derivative name)
erdosteine
what is the mechanism of mucolytic ? and when to use
lowers mucous viscosity
when there is mucus in the lungs
what are the adverse effect of mucolytic ?
bronchospasm
rash, wheezing, hypotention , dyspnoea
GI disturbance
what are the contra of mucolytic
elderly or weakened patients with respiratory insufficiency
patients with asthma
what are the vaccination recommended for patient with COPD ?
PPSV 23 and PCV 13 for patients older than 65
PPSV23 for younger patients with significant conditions including chronic heart or lung disease
