Pharm of COPD - Fitzpatrick Flashcards
COPD is characterized by disruption of _____
Alveoli
Major immune cell players for COPD vs. asthma
COPD = CD8+, neutrophils, macrophages Asthma = CD4+, eosinophils
Compared to asthma, COPD is less responsive to ______
Corticosteroids
Compared to asthma, airway flow limitation in COPD is ______
Irreversible
Compared to asthma, nearly all of COPD patients are ______
Smokers
Symptoms of COPD not included in asthma
- Chronic, productive cough
- Persistent, progressive breathlessness
Symptoms of asthma not included in COPD
- Nocturnal breathlessness
- Day-to-day variation in symptoms
In COPD, the primary way to dilate the bronchioles is via ______
Muscarinic antagonism
Muscarinic (M1-3) antagonist drugs in COPD (2)
- Ipratropium
- Tiotropium
In COPD, the primary way to pharmacologically diagnose the disease is via _____
Muscarinic agonism (Methacholine)
What nerve innervates the SM of the airways, and is thus the target for COPD therapy?
Vagus nerve
What 2 things are targeted in the airways by anti-COPD treatments?
- Pulmonary smooth muscle
- Mucus glands
Differences between Ipratropium and Tiotropium
Ipra - short acting, 3-4x per day, includes M2
Tio - long acting, 1x per day, M1 and M3 only
COPD treatments DO _____, but do NOT ____
- DO decrease symptoms, exacerbation, etc.
- Do NOT halt long-term progression
4 “Gold Stages” of COPD
- Intermittent symptoms
- Persistent symptoms
- Frequent exacerbations
- Respiratory failure
Treatment of Stage 1 COPD
Short acting drugs…
- Ipratropium, albuterol, or both
Treatment of Stage 2 COPD
Long acting + short acting…
- Tiotropium + albuterol (+ Salmeterol or Formoterol)
Treatment of Stage 3 COPD
2 Long acting drugs…
- Tiatropium + Salmeterol/Formoterol
Treatment of Stage 4 COPD
Long acting + ICS…
- Tiatropium
- Budesonide + Formoterol (typical combo)
- Fluticasone + Salmeterol (typical combo)
Can Ipra and Tio be used in asthma?
Yes, but not as effective as beta-2 agonists
- Used if patient does not tolerate or respond to SABA/LABA
Chronic treatment with ____ should be avoided at all costs
Systemic glucocorticosteroids
What miscellaneous asthma drug can also be used for COPD if warrented?
Theophylline
3 points of advice for COPD patients
- Get a flu shot every year
- Get the pneumococal vaccine
- Avoid crowds and sick people
Can SABAs and LABAs be used in COPD?
YES
