Drugs for COPD

Question 1

What is an example of a SAMA used in COPD?

Answer 1

Ipratropium bromide (6-8hrs)

Question 2

What is an example of a SABA used in COPD?

Answer 2

Salbutamol (4-6hrs)

Question 3

What is an example of a LAMA used in COPD?

Answer 3

1) Glycopyrronium bromide (12-24hrs)

2) Tiotropium bromide (24hrs)

Question 4

What are 2 examples of LABAs used in COPD?

Answer 4

1) Salmeterol (12hrs)
2) Formoterol (12hrs)
3) Olodaterol (24hrs)
4) Indacaterol (24hrs)

Question 5

How do muscarinic antagonists differ from ß-agonists in their regulation of bronchodilatory action in COPD treatment?

Answer 5

Muscarinic: inhibit M3 receptor-mediated bronchoconstriction

ß-agonist: Activate ß2 adrenoceptors to mediate bronchodilation

Question 6

What is GOLD?

Answer 6

Global initiative for chronic obstructive lung diseases

Question 7

What is given to a COPD px with a recent hospitalisation due to exacerbation?

Answer 7

Group E: LABA + LAMA (can include ICS if blood eos >300)

LABA:
- Glycopyronnium bromide (12-24 hours)
- Tiotropium bromide (24 hours)

LAMA:
- Salmeterol (12 hours)
- Formoterol (12 hours)
- Olodaterol (24 hours)
- Indacaterol (24 hours)

Question 8

What is given to a COPD px with 1 moderate exacerbation (not leading to hospital admission) but mMRC dyspnoea scale 0-1, CAT<10?

Answer 8

Group A: SABA/SAMA
- Ipratropium bromide/salbutamol

Question 9

What is given to a COPD px with 1 moderate exacerbation (not leading to hospital admission) but mMRC dyspnoea scale ≥2, CAT ≥10?

Answer 9

Group B: LABA + LAMA

LABA:
- Glycopyronnium bromide (12-24 hours)
- Tiotropium bromide (24 hours)

LAMA:
- Salmeterol (12 hours)
- Formoterol (12 hours)
- Olodaterol (24 hours)
- Indacaterol (24 hours)

Question 10

What is the moa of Muscarinic Receptor Antagonists used in COPD?

Answer 10

1) Inhibit M3 receptor-mediated bronchoconstrictions
2) Reverses vagal nerve-mediated bronchospasm & mucus secretion

Question 11

What are 2 AEs of Muscarinic Receptor Antagonists used in COPD?

Answer 11

1) Unpleasant taste
2) Parasympatholytic (xerostomia, urinary retention in elderly)

Limited systemic side effects as not well absorbed into systemic circulation when taken by inhalation

Question 12

What is the moa of ß-agonists used in COPD?

Answer 12

1) ß2-adrenoceptor activation mediated bronchodilation
2) Increase in mucociliary clearance

Question 13

LABAs used in COPD are often combined with ______________ to prolong effectiveness.

Answer 13

Glucocorticoid

Question 14

What are the components of a triple inhaler?

Answer 14

LAMA + LABA + glucocorticoid

Question 15

What are 3 AEs of using ß-agonists in COPD treatment?

Answer 15

1) Tremor (commonest side effect) and muscle cramps

2) Peripheral vasodilatation (e.g., flushing)

3) Palpitations & tachycardia (nonselective ß-agonism → ß1 agonist effects)

4) HypoK+/Hypergly
(usually transient and/or insignificant but beware of DDIs with other drugs causing hypoK+/hypergly)

5) ß2-adrenoceptor tolerance (caution in COPD patients who also have asthma)

Question 16

What is the moa of ICS used in COPD treatment?

Answer 16

1) Anti-inflammation
2) upregulate ß adrenoceptor expression

Question 17

What is the use of ICS in COPD treatment?

Answer 17

Combined with LABAs to counter downregulation of ß2adrenoceptors by LABAs

e.g. budesonide + formoterol, fluticasone + salmeterol

Question 18

What are 4 AEs of ICS used in COPD?

Answer 18

1) Oropharyngeal candidiasis (due to localised immunosuppression)
2) Dysphonia (enfeebled voice due to localised muscle wasting)
3) Cough / throat irritation
4) Adrenal suppression (e.g., fluticasone)
5) Easy bruising (especially in elderly)
6) Posterior subcapsular cataracts
7) Osteoporosis

Question 19

When should ICS NOT be added to bronchodilator COPD treament?

Answer 19

1) Repeated pneumonia events
2) Blood eosinophils <100 cells/uL
3) Hx of mycobacterial infection

Question 20

How is theophylline administered for COPD treatment?

Answer 20

Oral-ER and IV

Question 21

What is the moa of theophylline in COPD treatment?

Answer 21

Bronchodilator:
Methylxanthine →
1) inhibit phosphodiesterases
2) Block adenosine receptors
3) ↑adrenaline release from adrenal medulla
4) CNS stimulant on respiration

Question 22

What are 3 AEs of theophylline in COPD treatment?

Answer 22

1) Narrow therapeutic window (therapeutic range: 5-20 mg/L)
2) Many DDIs
3) GI: Nausea, vomiting, abdominal discomfort, anorexia
4) CNS: Nervousness, tremor, anxiety, insomnia, seizures
5) CVS: Arrhythmias

Question 23

What is an example of a PDE-4 inhibitor used in COPD treatment?

Answer 23

Roflumilast (oral)

Question 24

What is the moa of Roflumilast?

Answer 24

Inhibition of PDE-4 prevents breakdown of cAMP:
1) Reduced inflammatory cell activity
2) Inhibition of fibrosis
3) Relaxation of smooth muscle

Question 25

What is the use of PDE-4 inhibitors (eg. Roflumilast) in COPD treatment?

Answer 25

1) reduces episodes of exacerbation
2) Slows progress of fibrosis

Question 26

What are 3 AEs of PDE-4 inhibitors (eg. Roflumilast) in COPD treatment?

Answer 26

1) CNS: Headaches, dizziness, insomnia
2) Systemic: diarrhoea, nausea, ↓appetite
3) Rare: anxiety, depression, suicidal ideation
4) Caution in px with hepatic impairment

Question 27

What is the moa of Azithromycin used in COPD?

Answer 27

1) Macrolide antibiotic prevents bacteria from growing by interfering with protein synthesis

2) anti-fibrotic and airway smooth muscle relaxant

Question 28

What are 2 AEs of Azithromycin in COPD?

Answer 28

Common: Diarrhoea, nausea, vomiting
Severe: Cardiac arrhythmia

Contraindicated history of cholestatic jaundice or hepatic dysfunction

Question 29

What are 3 Mucolytics used in COPD treatment?

Answer 29

1) Acetylcysteine
2) Carbocisteine
3) Erdosteine

Question 30

What are 3 antibiotics to reduce the risk of acute exacerbations in COPD px?

Answer 30

Prone to exacerbations: either
1) Azithromycin
2) Erythromycin

Chronic bronchitis/frequent exacerbation:
- Moxifloxacin pulse therapy

Question 31

What are 4 vaccinations recommended for stable COPD?

Answer 31

1) Influenza
2) SARS-CoV2
3) PPSV23 + (PCV20/PCV15)
4) Tdap (if not alr vaxxed)
5) VZV (if >50 y/o)

Question 32

What are 3 pharmacological interventions for smoking cessation?

Answer 32

Nicotinic agonists:
1) Nicotine replacement
2) Varenicline

Antidepressants:
3) Bupropion
4) Nortryptilline