COPDFC Flashcards
atrovent HFA & MOA
ipratropioum, shortt acting anticholinergic
ipratropium MOA
short acting anticholinergic
combivent, and MOA
ipratropium + albuterol, short acting anticholinergic , SABA
what is the MOA of anticholinergics for COPD?
block the action of acetylcholine at parasympathic sites in brochial smooth muscle leading to bronchodilation
spiriva & MOA
tiotropium, long acting anticholinergic
daliresp & MOA
roflumilast
symbicort & MOA
formoterol/budesonide, long acting Beta agonist, corticosteroid
advair discus & MOA
salmeterol / fluticasone, long acting Beta agonist, corticosteroid
LABA vs SABA effectiveness comparision
If used on regular basis, LABA are more effective and convenient than tx w/ SABA
SABA + anticholinergics effectiveness of combination. When to add an ICS?
Produce greater improvements in lung function than either drug given alone. Addition of an ICS to bronchodilators is appropriate for symptomatic COPD pts w/ more severe dz (stage 3-4). Avoid chronic tx w/ system corticosteroid due to unfavorable benefit-risk ratio in most pts.
COPD vaccinations each fall
influenza and pneumococcal (repeat if >65, and received vaccine more than 5 year ago)
Pts w/ severe hereditary alpha-1 antitrypsin deficiency, therapy?
May place on alpha-1 proteinase inhibitor (Prolastin, Aralast, or Zemaira) given as wkly IV infusion, many SE including anaphylaxis
Acute COPD exacerbation treatment
antibiotics, inhaled anticholinergic bronchodilator + oral steroid (taper steroid over 2 wks). Azithromycin 250 mg/d reduce risk of acute exacerbation b/c anti-inflammatory and immunomodulatory (may decrease hearing)
Anticholinergics MOA
blocks the action of acetylcholine and decrease cGMP at parasympathetic sites in bronchial smooth muscle causing bronchodilation.
Side effects of anticholinergics
SE: Dry mouth (more w/ tiotropium), URTI, pharyngeal irritation, bitter taste ,Caution: pts w/ myasthenia gravis, narrow angle glaucoma, BPH, bladder neck obstruction
Short Acting Anticholinergics, names and dosing
Ipratropium bromide (Atrovent HFA) 1-2 inhalations TID-QID (MDI), 0.5 mg TID-QID (NEB)
ipratropium + SABA, what is the SABA? What dosing?
+ albuterol (Combivent, Duoneb) 2 inhalations QID, 0.5 mg TID-QID (NEB), wait 2 min btw inhalations
if you are allergic to what should you not take combivent? What occurrence should lead pt to immediately dc combivent?
Combivent contain soy, caution pt w/ soy/peanut allergy or atropine. Can cause paradoxical bronchospasm (narrowing of airways, is life threatening), stop use and get emergency help.