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PHM 702: Pulm and ToXXX > COP D: (chronic) > Flashcards

COP D: (chronic) Flashcards

1
Q

COPD Dx

A

Spirometer: post bronchodilator FEV1/FVC <0.70

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2
Q

COPD presentation

A
  • DYSPNEA - progressive, persistent, and worse with exercise
    • Chest tightness post-exerise
  • Cough - intermittent or persisent, productive or not
  • Chronic sputum production
  • Wheezing - varies
  • Commorbidites
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3
Q

Risk factors for COPD

A
  • Cigarette smoke
    • second hand smoke
  • Occupational dust and chimmcals
  • Pollution
  • Genes: alpha-1 antitrypsin deficiency
  • Hx of severe childhood respiratory infections
  • Lower socioecoomic status
  • Increased age
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4
Q

COPD

A

preventable and treatale disease that is characterized by persistenatn respiratory symptoms and airflow limitation that is d/t airway and/or alveolar abnormalities usually caused by significant exxposure to noxious particle or gases

  • pts have a mix of emphysema and bronchitis
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5
Q

Chronic COPD treatment optiosn

A
  • Bronchodilators
    • SABA
    • LABA
    • SAMA
    • LAMA
    • Theophylline
  • Corticosteroids
    • ICS
    • systemic
  • Phsophodiesterase inhibitors
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6
Q

chronic COPD pharmacotherapy classes

A
  • bronchodilators: short and long acting beta agonsits adn muscarinic antags, theophylline
  • inhaled corticosteroids
  • phosphodiesterase-4 inhibitor (roflumilast)
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7
Q

Beta agonist MOA in COPD

A

stimulate beta2 adrenergic receptors → relax airway smooth msucle → bronchodilation

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8
Q

SABA mono prodcuts for COPD

A
  • albuterol MDI, DPI, and neb
  • levalbuterol MDI and neb
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9
Q

LABA mono produts for COPD

A
  • salmeterol DPI (also available for asthma)
  • formoterol neb
  • olodaterol respimat
  • aformoterol neb
  • indacterol DPI
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10
Q

muscarinic antag MOA in COPD

A

block bronchoconstrictor effects of ACh on the M3 muscaric receptors in airway smooth msucle

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11
Q

SAMA mono products for COPD

A
  • ipratropium MDI and neb (has a slighly longer duration of action thatn SABAs)
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12
Q

LAMA mono products for COPD

A
  • tiotropium respimat (SMI, also available for asthma) and DPI
  • aclidinium DPI
  • umeclidinium DPI
  • glycopyrrolate DPI and neb
  • revefenacin neb
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13
Q

Muscarinic antag ADR

A
  • dry mouth - techincally anticholinergic but little systemic absorption
    • Tiotropium may cause metallic taste
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14
Q

theophylline in chornic COPD

A

not preferred, less effective and less well tolerated than other long acting bronchodilators

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15
Q

Short acting combo products for COPD

A

SABA + SAMA: albuterol/ipatropium respimat and duoneb

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16
Q

LAMA+LABA combo products for COPD

A
  • Indacaterol/glycopyrrolate DPI (technically LABA/LAMA)
  • Tiotropium/oldaterol respimat (SMI)
  • Umeclidinium/vilaterol DPI
  • Glycopyrrolate/formoterol MDI
  • Aclidinium/formoterol DPI
17
Q

Corticosteroids in chronic COPD

A
  • ICS not as a monotherapy
  • NO PO glucocorticods unless exacerbation
18
Q

ICS/LABA combo products for COPD

A
  • Fluticasone/vilnterol DPI
  • Fluticasone/salmeterol DPI and MDI
  • Budesonide/formoterol MDI
  • Mometasone/formoterol MDI
19
Q

ICS/LAMA/LABA prodcuts for COPD

A

not first line
* Fluticasone/umeclidinium/vilanterol DPI
* Budesonide/glycopyrrolate/formoterol MDI

20
Q

roflumilast MOA in COPD

A

reduce breakdown of intracellular cAMP → reduce inflamation
- (phosphodiesterase-4 inhibtiors)

21
Q

Roflumilast ADR

A
  • nausea
  • diarrhea
  • weight loss
  • sleep disturbance
  • HA
  • worsening of depression
22
Q

Roflumilast DDI

A
  • CYP 3A4 inhibitors and inducers, 1A2 inducers
    • DO NOT USE WITH THEOPHYLLINE
23
Q

What COPD populations do you NOT use ICS in ever

A
  • Repeated PNA events
  • Hx of mycobacterial infection
  • Blood eos < 100
24
Q

Non-pharm COPD

A
  • Smoking cessation
  • Vaccine
    • Flu
    • Pneumoccocal
    • TDap
    • Zoster (shingles)
    • COVID
  • Pulm rehab
  • Long-term supplemental O2 (goal is >90%)
    • Long term is use >15hrs/day
  • There are surgical options
25
Q

COPD assessment

A
  1. Confirm dx (FEV1/FVC <0.7)
  2. Assess airflow obstruction (FEV1 value)
  3. Assess symptoms and risk of exacerbation
26
Q

COPD FEV1 assessment

A
  • GOLD 1 - mild: FEV1 >80% predicted
  • GOLD 2 - moderate: 50% < FEV1 < 80%
  • GOLD 3 - severe: 30% < FEV1 < 50%
  • GOLD 4 - very severe: FEV1 < 30%
27
Q

COPD Group A requirements

A
  • 0 or 1 moderate exacerbations (NOT leading to hospitalzations)
  • AND mMRC 0-1 or CAT <10
28
Q

COPD Group B requirements

A
  • 0 or 1 moderate exacerbations (NOT leading to hospitalzations)
  • AND mMRC >2, CAT >10
29
Q

COPD Group E requirements

A
  • 2+ moderate exacerbations in past year OR
  • 1+ in the last year that led to hospitalzation
30
Q

COPD Group A initial treatment

A

bronchodilator (LABA or LAMA preferred over SABA or SAMA UNLESS there is only occasional dyspnea)
- still give a SABA, SABA, or SAMA/SABA for symptom relief

31
Q

COPD Group B intial treatment

A

LABA+LAMA
- still give a SABA, SABA, or SAMA/SABA for symptom relief

32
Q

COPD Group E initial treatment

A

LABA+LAMA (LABA+LAMA+ICS if blood eosinophil >300)
- still give a SABA, SABA, or SAMA/SABA for symptom relief

33
Q

COPD follow-up: patient has dyspnea as predominant feature

A
  • Escalate to next step (LABA or LAMA → LABA+LAMA)
  • Consider switching inhaler type
34
Q

COPD follow up: patient has exacerbation as predominatn feature

A
  • If on LABA or LAMA,
    • Escalate to LABA+LAMA
      • If blood eos>300, go all the way to LABA+LAMA+ICS i
  • If on LABA+LAMA
    • If FORMER smoker, add zithro
    • If FEV1 <50% AND chronic bronchitis, add roflumilast
    • If blood eos >100, escalate to LABA+LAMA+ICS
35
Q

COPD ICS descalation

A
  • can consider de-escalating to LABA+LAMA if NO exacerbations in past year
    • If pt has a hx of asthma or features of asthma present, ICS is INDICATED
36
Q

COPD mild exacerbation treatment

A

SABA

37
Q

COPD moderate exacerbation treatment

A

SABA + ABX and/or PO corticosteroids

38
Q

Asthma-COPD overlap treatment

A

ICS with LABA+/- LAMA

PHM 702: Pulm and ToXXX (14 decks)

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