Flashcards in COPD guidance & drugs Deck (25)
What is step one in treating COPD (hint: PRN drugs)?
SABA or SAMA (Ipratropium) when required
SABA can be continued at all stages but SAMA must be discontinued if a LAMA is used (i.e. wouldn't be using ipratropium and tiotropium together)
If FEV is over 50% what is the treatment plan??
LABA OR LAMA (tiotropium)
If this fails then use LABA + ICS combination inhaler
If this fails triple therapy with all three: LABA + ICS + LAMA
If FEV is under 50 % what is the treatment plan?
LAMA alone or LABA/ ICS combination inhaler
(consider LABA/ LAMA combo if ICS declined)
If this fails triple therapy: LABA + ICS + LAMA
Name some of the LABA + ICS combination inhalers used in COPD?
LABA + ICS combos are commonly seen in COPD as they are indicated if FEV is over under 50 %
Steroids are only licensed in COPD if given in combination inhalers
Symbicort Turbohaler: Budesonide + Formoterol
Seretide 500 Accuhaler: Fluticasone + Salmeterol
NB: seretide MDI not licensed in COPD
If symptoms persist after triple therapy in COPD what should be used?
What duration of prednisolone is indicated for COPD exacerbations?
30mg daily 7 - 14 days
Can be stopped abruptly as not over 3 weeks use
How is oxygen administered in COPD patients?
24-28 % through a venturi facemark to avoid hypercapnia
88-92 % target
Why doe patients on nebulisers need to wear goggles with ipratropium nebs?!
Because acute closed angle GLAUCOMA can occur
especially if used with nebulised salbutamol
What are the main side effects with anti muscarinic inhalers?
These are ipratropium (SAMA) and tiotropium (LAMA)
ARRHYTHMIAS therefore cautioned in CARDIAC DISORDERS. Also need to used with caution with drugs that cause Hypokaleamia/ hyperkaleamia as this can cause arrhythmias
GLAUCOMA- Ipratropium nebs- wear goggles
Antimuscarinic SEs such as dry mouth, constipation, sweating, urinary retention etc but these are more common with oral therapy.
What is the risk of INTRAVENOUS SHORT ACTING BETA 2 AGONISTS SUCH AS SALBUTAMOL in DIABETICS?
Risk of HYPERGLYCAEMIA
Also a risk of diabetic Ketoacidosis!!
What are the CHM warnings associated with the LABAs formoterol and salmeterol?
Do not prescribe alone- only add on to ICS therapy
Do not initiate in rapidly deteriorating asthma
Don't used for relief of exercise induced asthma unless regular ICS used too
report symptoms of paradoxical bronchospasm
Clear improvement within 3 -4 weeks of ICS therapy indicates which COPD or Asthma?
This can be used to differentiate between the two
When is Ipratropium not allowed to be continued in COPD?
If patients are on a LAMA (tiotropium)
What is spiriva? How often is it given?
Comes as either Spiriva inhalation powder (18mcg capsules)
or Spiriva Respimat pressurised MDI
It is given OD (One capsule/ 2 puffs of respimat inhaler)
What is the role of ICS in COPD?
To reduce exacerbations
Slight lack of evidence of ICS benefits in COPD
Reasonably high doses required (e.g 800mcg budesonide)
Steroids only licensed in COPD if in combination inhalers
When should osteoporosis prophylaxis be considered with oral predinisolone use?
received over 3 courses of steroids
lasting over 7 days
in the previous 12 months
All patients over 65 should receive prophylaxis
Chronic productive cough in COPD treatment?
We know beta blockers are cautioned in asthma... but can they be given in COPD?
Yes... but just monitor closely monitor for broncho spasms
What is Aclidinium?
A LAMA also used in maintenance of COPD
Comes as the "Genuair" inhaler- a DPI that has a little window that turns from green to red if dose is inhaled correctly
What is Glycopyrronium?
A LAMA used in COPD maintenance
What is Umeclidinium?
Another LAMA used in COPD maintenance.
Comes as the Ellipta DPI - has a dose counter- also comes in a combo Ellipta inhaler: Umeclidinium with vilanterol.
Tiotropium is a LAMA used for maintenance of COPD but not suitable for treatment of _______
What is paradoxical bronchospasm?
paradoxical means 'contradictory/ going against oneself'
Paradoxical bronchospasm is where ICS can actually do the opposite to what they're meant to and cause airways to constrict and breathing to get worse. This means that ICS should not be used again
We know salbutamol can cause potassium disturbance... a SABA... Can LABAs?
Yes Laba can also cause Hypokaleamia