respi - drugs for copd

Question 1

1st line bronchodilator for copd

Answer 1

muscarinic receptor antagonist

Question 2

name a SAMA and state its onset and doa

Answer 2

ipratropium bromide; onset 5-30min, DOA 6-8h

Question 3

name a LAMA and state its onset and doa

Answer 3

Tiotropium bromide; onset 30 min, DOA 24h

Question 4

moa of muscarinic receptor antagonist

Answer 4

• inhibit M3 receptor-mediated bronchoconstriction
• reverses vagal nerve-mediated bronchospasm and mucus secretion

Question 5

adverse effects of muscarinic receptor antagonist

Answer 5

1. dry mouth
2. urinary retention
3. unpleasant taste

Question 6

adverse effect of β2 agonist

Answer 6

1. downreg of β2 receptors (caution in asthmatics)
2. tremors and muscle cramps
3. palpitations and tachycardia
4. hypokalaemia/hyperglycaemia

Question 7

adverse effects of theophylline

Answer 7

• narrow therapeutic window
• many DDIs
• GI: nausea, vomiting, abdominal discomfort, anorexia
• CNS: nervousness, tremors, anxiety, insomnia, seizures
• CVS: arrhythmias

Question 8

factors that strongly favour use of ICS

Answer 8

1. hist of hosp for exacerbation of copd
2. ≥ 2 moderate exacerbation of copd per yr
3. blood eosinophils ≥ 300
4. concomitant asthma

Question 9

factors that favour use of ICS

Answer 9

1. 1 moderate exacerbation of copd per yr
2. blood eosinophils 100 - <300

Question 10

factors against use of ICS

Answer 10

1. repeated pneumonia
2. blood eosinophils < 100
3. hist of micobacterial infections

Question 11

name a PDE-4 inhibitor and its mode of administration

Answer 11

roflumilast (oral)

Question 12

moa of PDE-4 inhibitor

Answer 12

• inhibition of PDE-4 prevents breakdown of cAMP → ↓ inflammatory cell activity, inhibit fibrosis, bronchodilation

Question 13

adverse effects of PDE-4 inhibitor

Answer 13

• headaches, dizziness, insomnia
• weight loss, diarrhoea, nausea, decreased appetite
• anxiety, depression, suicide ideation
• caution in hepatic impairment

Question 14

moa of azithromycin

Answer 14

• anti-fibrotic and airway smooth muscle relaxant → reduces risk of exacerbations
• prevent and treat exacerbations due to bacterial infection

Question 15

moa of mucolytics

Answer 15

free sulfhydryl group open disulphide bonds in mucoproteins → break down mucous by lowering viscosity

Question 16

adverse effects of mucolytics

Answer 16

1. bronchospasm
2. anaphylactoid rxns (rash, hypotension, dyspnea, wheeze)
3. GI disturbance

Question 17

in which groups should mucolytics be used with caution?

Answer 17

1. elderly/debilitated pts w severe respi insufficiency
2. asthma pts (due to bronchospasm as adverse effect)

Question 18

abs to reduce risk of acute exacerbations

Answer 18

1. azithromycin
2. erythromycin
3. pulse therapy w moxifloxacin

Question 19

vaccinations for copd

Answer 19

1. influenza
2. SARS-CoV-2
3. PCV21/20
4. RSV for ≥ 60yo or chronic heart/lung disease
5. tdap
6. zoster for > 50 yo

Question 20

therapy for smoking cessation

Answer 20

1. nicotine replacement (gum/patch)
2. varenicline
3. bupropion
4. notryptiline