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Flashcards in COPD Deck (52):
1

COPD

chronic, obstructive pulmonary disease that is characterized by airflow limitation that is not fully reversible and progressive, associated with abnormal inflammatory response

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Two subtypes of COPD

Chronic bronchitis and emphysema

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Chronic bronchitis

cough and sputum production for at least 3 months of two consecutive years in absence of other bronchial disease; chronic cough, increased mucous, SOB, throat clearing

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Emphysema

over inflation of distal airspaces with destruction of aveolar sacs and loss of stretch and recoil, trapped air worsens oxygenation; cough, SOB, limited exercise

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Risk factors of COPD

smoking, occupation, environment, air pollution, nutrition, infection, socio-economic status, age

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Anticholinergic long acting

umeclindiniu, (incruse), Aclidinium (tudorza), Tiotropium (Spiriva)

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Anticholinergic short acting

Ipratropium (Atrovent)

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Long acting B agonists

Salmeterol (Serevent), Formoterol (Foradil), Aformoterol (Brovana), INdacaterol (Arcapta), Vilanterol (only in combo)

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Short acting B agonists

Albuterol (Proventil), Levalbuterol (Xopenex), Terbutalin (Brethine), Pirbuterol (Maxair)

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Inhaled corticosteroids

Beclomethasone (Qvar), Budesonide (Pulmicort), Flunisolide (Aerospan), Fluticasone (Flovent)

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Combined Products

Ipratropium/Albuterol, Fluticasone/salmeterol (Advair), Budesonide/Formoterol (Symbicort)

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ADRs of COPD drugs

Very little concern because drug is inhaled and goes straight to the source

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Bronchodilator highlights

short and long acting B2 agonist, anticholinergic agents, Methyxanthine-theophylline

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Primary use of bronchodilators

symptomatic relief of SOB, may not increase exercise tolerance or improve FEV

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B2 agonist bronchdilators MOA

Agonist at B2 receptor catalyzing ATP conversion to cAMP resulting in bronchial smooth muscle relaxation

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Albuterol Pearls

DOC for rescue, always use albuterol first if using other inhalers, tachy most notable with high doses, tablets and syrups available, some therapy for hyperkalemia

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ADR of LABA

headache, arthralgia, tremor, anxiety, palpitations, diarrhea, nausea, insomnia

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LABA Pearls

Not for emergency, long duration and onset, used in combo with ICS or anticholinergics, may use in addition to albuterol,

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What is the only LABA approved for COPD instead of asthma?

Aformoterol (Brovana)

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Risks with LABA monotherapy

increased overall death, but not when used with corticosteroids

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Anticholinergic Bronchodilators MOA

Inhibition of acetylcholine at muscarinic receptors resultin in bronchodilation, decreases respiratory secretions

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Short acting anticholinergic bronchodilators

Ipratropium (atrovent)

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Long Acting anticholinergic bronchodilators

Tiotropium (Spiriva), Umeclidinium (incruse), Aclidinium (Tudorza)

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Pearls of anticholinergic bronchodilators

Ipratropium DOC for inpt use, combo with albuterol, niche with asthma indication; longer duration, longer onset, restrictive price tag

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Ipratropium (atrovent) pearls

give multiple doses per day, combo for ease of administration, decrease cost

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Tiotropium (Spiriva)

Increased cost, long duration, once daily, decreased exacerbation, given in conjunction w/ LABA +/- ICS, can be used as mono therapy

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Theophylline (Theo dur) MOA

methylxanthine, PDE I, increases cAMP causes bronchodilator effect, less effective and tolerated than LABA

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Theophylline (Theo dur) ADR

tachy, HA, insomnia, restlessness, GI intolerance

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Theophylline (Theo dur) clinical use

primarily considered when pt cannot tolerate inhaled bronchodilators or have maxed out inhaled therapies, coupled with LABA to improve FEV

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Inhaled corticosteroids MOA

anti-inflammatory, immunosuppressive, antiproliferative

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Long term ICS use

only appropriate for symptomatic COPD pts w/ an FEV

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ADRs of ICS

Oral thrush, patients should always wash/rinse mouth after dose, HA, upper respiratory tract infection

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ICS drug type

Fluticasone (Flovent), Budesonide (pulmicort), Mometasone (Asmanex)

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ICS Pearls

usually combo, unfavorable benefit-to-risk ratio, short term improvement

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Combination products

ipratropium/ albuterol, salmeterol/ fluticasone (advair), Formoterol/ Budesonide (symbicort)

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Combo products

in absence of cost restriction these are most commonly used agents and way of future!

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Roflumilast (Daliresp)

PDE-I, treat sever to very severe, reduces exacerbations treated with ICS, LABA, only PO, ADR: poor appetite, N/V. diarrhea, do not give with theophylline

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Expectorants and mucollytics

Best option? acetylcysteine (Mucomyst), gaifenesin (mucinex)

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Antibiotics for COPD

severe exacerbations

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Non pharm options for COPD

pulm rehab, o2 therapy (stage 4), surgical intervention

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Guaifenesin (Mucinex)

mucolytic, cough expectorant, tablet and liquid, no ADRs or DI, take w/ lot of H2O

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Primary treatment goals of COPD

Relieve symptoms, prevent progression, improve exercise tolerance, improve health status, prevent complications, reduce mortality/SE

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Treatment of Mild COPD

active reduction of risk factors, vaccinations, Shortacting bronchodilators

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Treatment of moderate COPD

regular treatment with long-acting bronchodilators, pulm rehab

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Treatment of severe COPD

inhaled corticosteroids

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Treatment of very severe COPD

long term O2, systemic steroids, surgery

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Prevention and risk factor reduction

smoking cessation, influenza and pneumonococcal vaccine, pulmonary rehab

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5 A's of smoking cessation

Ask, advise, assess, assist, arrange

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Smoking cessation options

gum, inhaler, nasal spray, transdermal patch, sublingual tablet, lozenge, prescription, E cigs

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Smoking cessation drugs

Varenicline (Chantix), Buproprion (Welbutrin, Zyban), Nortriptylline

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Treatment of COPD exacerbations

Bronchodilators (SABA DOC, anticholinergic), Corticosteroids, O2, mechanical ventilation, antibiotics controversial

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Must have following symptoms for antibiotic therapy

increased dyspnea, sputum volume, and sputum purulence