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NUR1125 > Drugs for COPD > Flashcards

Drugs for COPD Flashcards

1
Q

what are the route for theophylline

A
  • oral-ER
  • IV
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2
Q

which of the following is a likely a/e of inhaled ipratropium bromide
A) diarrhea
B) nasal congestion & mucus production
C) dry mouth
D) palpitation

A

C

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3
Q

which of the following drugs can be added to slow fibrosis progress in severe COPD pt not responding to triple therapy
A) salmeterol
B) azithromycin
C) fluticasone
D) roflumilast

A

B & D

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4
Q

list 6 risk factors of COPD

A
  1. asthma
  2. smoking
  3. chemical agent
  4. AAT (alpha1 antitrypsin) deficiency
  5. pollution eg. dust, silica
  6. > 40 y/o
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5
Q

which of the following is the best 1st line bronchodilator for sustained bronchodilation throughout the day
A) indacaterol
B) fluticasone
C) tiotropium bromide
D) roflumilast

A

C

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6
Q

which pt should ICS not be given to (3)

A
  • repeated pneumonia event (long term ICS use can lead to immunosuppression)
  • EOS <100
  • hx of mycobacterial infection eg. TB
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7
Q

why are some patient not compliant to mucolytic

A

drug give off a strong sulphur taste & smell

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8
Q

what are some a/e of roflumilast

A
  1. insomnia
  2. diarrhea
  3. nauseae
  4. weight loss
  5. decrease appetite
  6. depression
  7. suicidal thought

caution in pt with hepatic impairment

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9
Q

list 2 contraindication of azithromycin

A
  1. cholestatic jaundice
  2. hepatic impairment
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10
Q

list 2 drug from b2 agonist, with onset & duration of action for each drug

A
  1. salbutamol (5-15min onset, 4-6hrs duration)
  2. indacaterol (5min onset, 24hrs duration)
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11
Q

which pt is ICS favor use in (2)

A
  • EOS 100-300
  • 1 moderate exercabation/year
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12
Q

what are some other ways to treat COPD

A
  1. vaccination eg. influenza
  2. smoking cessation
  3. nicotine replacement
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13
Q

list 3 mucolytic drug & their derivative

A
  1. acetylcysteine, carbocisteine (cysteine derivative)
  2. erdosteine (thiol derivative)
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14
Q

is LABA allowed to be given independently for trtx of COPD

A

yes, unless patient have asthma

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15
Q

which class of bronchodilator drug is 2nd line for COPD

A

b2 agonist

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16
Q

what is 2 use & efficacy of PDE4 inhibitor

A
  • reduce freq of COPD exacerbation
  • slow progress of fibrosis
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17
Q

what is 1 caution when giving roflumilast

A

caution in pt with hepatic impairment

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18
Q

which of the following would be the 1st line drug for mild COPD
A) salbutamol
B) ipratropium bromide
C) indacaterol
D) tiotropium bromide

A

B

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19
Q

which of the following drug can be added on as needed when exercising to help pt with mild COPD to breath early
A) salbutamol
B) tiotropium bromide
C) salmeterol
D) theophylline

A

A

20
Q

briefly explain the MOA of azithromycin

A
  • macrolide antibiotic that prevent bacteria growth by interfering with their protein synthesis
  • also have antifibrotic & airway smooth muscle relaxation effect, making it useful for former smokers
21
Q

which of the following drugs is the most appropriate to add once per day to produce greater sustained bronchodilation throughout the day and night
A) azithromycin
B) salbutamol
C) salmeterol
D) indacaterol

A

D

22
Q

what is the use & efficacy of azithromycin

A
  • antifibrotic & airway smooth muscle relaxation effect reduce risk of exacerbation
  • prevent and treatment of exacerbation due to bacterial infection
23
Q

what are the caution when giving acetylcysteine

A
  • elderly or weak (debilitated) patient with severe respiratory insufficiency
  • pt with asthma
24
Q

which class of drug does theophylline belongs to

A

methylxanthine

25
Q

which class of bronchodilator drug is 1st line for COPD

A

muscarinic receptor antagonist

26
Q

which of the following drug can be added to increase bronchodilation & stimulation of respiration in a severe COPD pt not responding to triple therapy
A) roflumilast
B) theophylline
C) formoterol
D) salbutamol

A

B

27
Q

list 1 drug from PDE4 inhibitor & explain the MOA

A

roflumilast

inhibit PDE4 to prevent the breakdown of cAMP, this results in
- reduce inflammatory cell activity
- inhibit fibrosis
- airway smooth muscle relax

28
Q

list 2 drug example of muscarinic receptor antagonist, with onset and duration of action

A
  1. ipratropium bromide (5-30min onset, 6-8hrs duration)
  2. tiotropium bromide (30min onset, 24hrs duration)
29
Q

what is the MOA of erdosteine

A

free sulfhydryl group open disulphide bond in mucoprotein, reducing mucus viscosity

30
Q

which of the following is the most common a/e of inhaled salbutamol
A) tachycardia
B) tremor
C) heart attack
D) urinary retention

A

B

31
Q

what is the common and severe a/e of azithromycin

A

common: GI disturbance eg. nausea/vomiting, diarrhea

severe: arrhythmia

32
Q

what is the MOA of indaceterol

A

it mimic the action of endogenous adrenaline are adrenoceptor site, resulting in
- airway smooth muscle relaxation
- mast cell stabilisation
- decrease microvascular leakiness
- increase mucociliary clearance

33
Q

when an inhaled LABA is added, which other drug will help to prolong the effectiveness
A) antibiotic
B) ICS
C) muscarinic receptor antagonist
D) PDE4 inhibitor

A

B

34
Q

what is the use & efficacy of b2 agonist drugs

A
  1. second line for COPD bronchodilation in group A, but LABA must be use in group B & E
  2. LABA + ICS prolong effectiveness
  3. SAMA + SABA or triple therapy (LAMA + LABA + ICS)
35
Q

what is the 3 GOLD classification for COPD

A

group A (any bronchodilator): 0-1 moderate exacerbation w no hospitalization

group B (LAMA+LABA): 0-1 moderate exacerbation w no hospitalization

group E (LAMA+LABA or LAMA+LABA+ICS if EOS ≥300): ≥2 moderate exacerbation or ≥1 leading to hospitalization

36
Q

what is the MOA of muscarinic receptor antagonist

A
  • inhibit m3 receptor to reduce bronchoconstriction
  • reverse vagal nerve to reduce bronchospasm & mucus secretion
37
Q

which pt is required to be given ICS (4)

A
  • EOS ≥300
  • hx of asthma
  • COPD exacerbation leading to hospitalization
  • ≥2 moderate exacerbation/year
38
Q

list 3 a/e of muscarinic receptor antagonist

A

limited systemic a/e as drug is taken via inhalation
1. unpleasant taste
2. dry mouth
3. urinary retention (esp in elderly)

39
Q

what is the MOA of theophylline

A
  1. inhibit PDE
  2. block adenosine receptor
  3. increase release of adrenaline from adrenal medulla
  4. CNS stimulant action on respiration
40
Q

which of the following is available in a combined double inhaler
A) budesonide + salbutamol
B) fluticasone + indacaterol
C) fluticasone + salmeterol
D) budesonide + formoterol

A

C & D

41
Q

list 2 a/e of erdosteine

A
  • bronchospasm
  • GI disturbance
42
Q

which class of anti-inflammatory drug is first line for COPD

A

ICS

43
Q

what are some a/e of theophylline

A
  • GI disturbance eg. anorexia, nausea/vomiting, abdominal discomfort
  • CNS eg. tremor, insomnia, seizure
  • arrhythmia
44
Q

list 4 type of vaccination for stable COPD

A
  1. influenza
  2. 23 valent pneumococcal polysaccharide vaccine (PPSV23)
  3. 13 valent pneumococcal conjugated vaccine (PCV13)
  4. Tdap

PPSV23 & PCV13 are pneumococcal vaccine against streptococcus pneumoniae

PPSV23 & PCV13 are recommended for pt ≥65, while PPSV23 is recommended for younger pt w comobid condition eg. chronic heart/lung disease

45
Q

list 4 drugs that aid in smoking cessation

A
  1. nicotine patch
  2. varecicline (partial agonist that may cause neuropsychiatric a/e in pt)
  3. bupoprion (antidepressant)
  4. nortryptiline (antidepressant)
46
Q

what is the use & efficacy of muscarinic antagonist

A

first line bronchodilation for COPD, especially for GOLD group A, and LAMA (tiotropium) must be use in group B & E

NUR1125 (10 decks)

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