COPD

Question 1

COPD

Answer 1

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

Question 2

Two subtypes of COPD

Answer 2

Chronic bronchitis and emphysema

Question 3

Chronic bronchitis

Answer 3

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

Question 4

Emphysema

Answer 4

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

Question 5

Risk factors of COPD

Answer 5

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

Question 6

Anticholinergic long acting

Answer 6

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

Question 7

Anticholinergic short acting

Answer 7

Ipratropium (Atrovent)

Question 8

Long acting B agonists

Answer 8

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

Question 9

Short acting B agonists

Answer 9

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

Question 10

Inhaled corticosteroids

Answer 10

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

Question 11

Combined Products

Answer 11

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

Question 12

ADRs of COPD drugs

Answer 12

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

Question 13

Bronchodilator highlights

Answer 13

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

Question 14

Primary use of bronchodilators

Answer 14

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

Question 15

B2 agonist bronchdilators MOA

Answer 15

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

Question 16

Albuterol Pearls

Answer 16

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

Question 17

ADR of LABA

Answer 17

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

Question 18

LABA Pearls

Answer 18

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

Question 19

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

Answer 19

Aformoterol (Brovana)

Question 20

Risks with LABA monotherapy

Answer 20

increased overall death, but not when used with corticosteroids

Question 21

Anticholinergic Bronchodilators MOA

Answer 21

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

Question 22

Short acting anticholinergic bronchodilators

Answer 22

Ipratropium (atrovent)

Question 23

Long Acting anticholinergic bronchodilators

Answer 23

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

Question 24

Pearls of anticholinergic bronchodilators

Answer 24

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

Question 25

Ipratropium (atrovent) pearls

Answer 25

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

Question 26

Tiotropium (Spiriva)

Answer 26

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

Question 27

Theophylline (Theo dur) MOA

Answer 27

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

Question 28

Theophylline (Theo dur) ADR

Answer 28

tachy, HA, insomnia, restlessness, GI intolerance

Question 29

Theophylline (Theo dur) clinical use

Answer 29

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

Question 30

Inhaled corticosteroids MOA

Answer 30

anti-inflammatory, immunosuppressive, antiproliferative

Question 31

Long term ICS use

Answer 31

only appropriate for symptomatic COPD pts w/ an FEV

Question 32

ADRs of ICS

Answer 32

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

Question 33

ICS drug type

Answer 33

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

Question 34

ICS Pearls

Answer 34

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

Question 35

Combination products

Answer 35

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

Question 36

Combo products

Answer 36

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

Question 37

Roflumilast (Daliresp)

Answer 37

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

Question 38

Expectorants and mucollytics

Answer 38

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

Question 39

Antibiotics for COPD

Answer 39

severe exacerbations

Question 40

Non pharm options for COPD

Answer 40

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

Question 41

Guaifenesin (Mucinex)

Answer 41

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

Question 42

Primary treatment goals of COPD

Answer 42

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

Question 43

Treatment of Mild COPD

Answer 43

active reduction of risk factors, vaccinations, Shortacting bronchodilators

Question 44

Treatment of moderate COPD

Answer 44

regular treatment with long-acting bronchodilators, pulm rehab

Question 45

Treatment of severe COPD

Answer 45

inhaled corticosteroids

Question 46

Treatment of very severe COPD

Answer 46

long term O2, systemic steroids, surgery

Question 47

Prevention and risk factor reduction

Answer 47

smoking cessation, influenza and pneumonococcal vaccine, pulmonary rehab

Question 48

5 A's of smoking cessation

Answer 48

Ask, advise, assess, assist, arrange

Question 49

Smoking cessation options

Answer 49

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

Question 50

Smoking cessation drugs

Answer 50

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

Question 51

Treatment of COPD exacerbations

Answer 51

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

Question 52

Must have following symptoms for antibiotic therapy

Answer 52

increased dyspnea, sputum volume, and sputum purulence