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TCA 10 - COPD > Treatment > Flashcards

Treatment Flashcards

1
Q

What is the first line of treatment for COPD?

A

Smoking cessation

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2
Q

What is involved in smoking cessation?

A
  • Professional advice
  • Nicotine replacement
  • Antidepressants (bupropion)
  • Nicotine receptor blockers (varenicline)
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3
Q

What is the treatment ladder in COPD?

A
  1. Start a SABA or SAMA
  2. Start a LABA + LAMA (if no asthmatic or steroid responsive features) or LABA + ICS (if asthmatic or steroid responsive features)
  3. Start LABA + LAMA + ICS
  4. Escalate to specialist care:
    Nebulisers
    Oral theophylline
    Carbocisteine (mucolytic)
    Long-term prophylactic antibiotics
    LTOT
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4
Q

When would you step up from a SABA or SAMA?

A

If patient remains breathless or has exacerbations

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5
Q

What are asthmatic or steroid responsive features?

A
  • Any previous diagnosis of asthma or atopy
  • Higher blood eosinophil count
  • Substantial variation in FEV1 over time (at least 400ml)
  • Substantial diurnal variation in PEF (at least 20%)
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6
Q

When would you give triple therapy (LABA + LAMA + ICS)?

A

If patient has a severe exacerbations (requiring hospitalisation) or they have 2 moderate exacerbations within a year

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7
Q

What would you do if after 3 months from changing from a LABA + LAMA to triple therapy, the patient’s symptoms have not improved?

A

Go back to LABA + LAMA

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8
Q

When would a patient be referred for LTOT?

A
  • SpO2 <92% breathing air
  • PaO2 <7.3kPa on air when stable
  • PaO2 7.3-8kPa when stable + 1 of the following:
    Secondary polycythaemia
    Peripheral oedema
    Pulmonary HTN
  • FEV1 < 50%
  • Cyanosis
  • Raised JVP
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9
Q

What inhalers are salbutamol (SABA) inhalers?

A

Ventolin
Airomir
Salamol easi-breathe

BLUE

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10
Q

What inhalers are terbutaline (SABA) inhalers?

A

Bricanyl

WHITE

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11
Q

What inhalers are salmeterol (LABA) inhalers?

A

Serevent

GREEN

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12
Q

What inhalers are formoterol (LABA) inhalers?

A

Oxis

BLUE/GREEN

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13
Q

What are the side effects of B2 agonists?

A
  • Tachycardia
  • Arrhythmias
  • Myocardial ischaemia
  • Tremor
  • Paradoxical bronchospasm
  • Hypokalaemia
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14
Q

What inhalers are ipratropium (SAMA) inhalers?

A

Atrovent

GREEN

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15
Q

What inhalers are tiotropium (LAMA) inhalers?

A

Spiriva

GREEN

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16
Q

What are the side effects of Anti-muscarinic/anti-cholinergic drugs?

A
  • Dry mouth
  • Nausea
  • Headache
17
Q

What cautions must you consider when giving Anti-muscarinic/anti-cholinergic drugs?

A
  • Prostatic hyperplasia and bladder outflow obstruction

* Patients susceptible to glaucoma

18
Q

What inhalers are beclomethasone inhalers?

A

Becotide

BROWN

19
Q

What inhalers are budesonide inhalers?

A

Pulmicort

BROWN

20
Q

What inhalers are combined budesonide and formoterol?

A

Symbicort

RED

21
Q

What inhalers are fluticasone inhalers?

A

Flixotide

BROWN

22
Q

What inhalers are combined fluticasone and salmeterol?

A

Seretide

PURPLE

23
Q

What are the side effects of ICS?

A
  • Candidiasis
  • Hoarseness
  • Adrenal suppression
  • Osteoporosis
  • Growth restriction in children
24
Q

What are the signs of theophylline toxicity?

A
  • Tachycardia
  • Arrhythmias
  • Agitation
  • Convulsions
  • Hypokalameia
  • Levels can increase in sepsis and viral infections
25
Q

What are the common drug interactions with theophylline?

A
  • Ciprofloxacin and OCP reduce clearance

* Anticonvulsants increase clearance

26
Q

How can patients prevent COPD exacerbations?

A
  • Vaccination – influenza, pneumococcal
  • Oxygen – short burst for symptoms or >15 hrs/day
  • Physiotherapy
  • Pulmonary rehabilitation
  • End of life care
27
Q

What oxygen masks are used for COPD and why?

A

Venturi masks
• Can give a defined concentration of inspired oxygen
• Used in COPD where it is important not to over-ventilate the patient

28
Q

What oxygen saturations do we aim for in COPD patients?

A

88-92%

TCA 10 - COPD (5 decks)

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