COPD and anticholinergic drugs

Question 1

What favours use for ICS in COPD?

Answer 1

History of hospitlizations for exacerbations, 2+ moderate exacerbations in past 12 months, blood eosinophils >300, asthma.

Question 2

What is against use for ICS in COPD?

Answer 2

Repeated pneumonia events, blood eosinophils <100, Hx of mycobacterial infection.

Question 3

What drugs significantly cause anticholinergic burden?

Answer 3

TCAs, paroxetine, prochlorperazine, sedating antihistamines, atropine, benzatropine, oxybutynin, tolterodine, hyoscine.

Question 4

What are anticholinergic symptoms?

Answer 4

Red as a beet - flushing (vasodilation)
Dry as a bone - dry skin and membranes
Blind as a bind - mydriasis
Mad as a hatter - delirium, confusion
Hot as a hare - fever
Full as a flask - urinary retention

Question 5

What did the article on triple therapy find for triple vs dual therapy for COPD?

Answer 5

Decreased moderate or severe exacerbation, better trough FEV1, no difference in mortality or AE but increased episodes of pneumonia

Question 6

True or false: SAMA and LAMA therapy can be used together?

Answer 6

False

Question 7

What is the typical recommended duration of dual therapy post MI?

Answer 7

12 months

Question 8

Who needs ICS as part fo COPD management?

Answer 8

1+ severe exacerbation requiring hospitlisation in past 12 months, 2+ moderate exacerbations (both with significant symptoms despite dual therapy), pts stabilised on triple therapy.

Question 9

Prednisolone dosing for exacerbations?

Answer 9

40-50mg for 5-14 days

Question 10

What is the cumulative dose for increased risk of prednisolone AE?

Answer 10

1g.

Question 11

What agent decreases risk of GI bleeding?

Answer 11

PPI

Question 12

What are the options for gout flare up and dosing?

Answer 12

Colchicine - 1mg then 500mcg 1 hr later, do not repeat for 3 days
NSAIDs - high dose for 3-5 days (all equal)
Prednisone - 20-50mg daily (typically 3-5 days)

Question 13

What is target urate?

Answer 13

<0.36mmol/L