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Flashcards in COPDFC Deck (46):
1

atrovent HFA & MOA

ipratropioum, shortt acting anticholinergic

2

ipratropium MOA

short acting anticholinergic

3

combivent, and MOA

ipratropium + albuterol, short acting anticholinergic , SABA

4

what is the MOA of anticholinergics for COPD?

block the action of acetylcholine at parasympathic sites in brochial smooth muscle leading to bronchodilation

5

spiriva & MOA

tiotropium, long acting anticholinergic

6

daliresp & MOA

roflumilast

7

symbicort & MOA

formoterol/budesonide, long acting Beta agonist, corticosteroid

8

advair discus & MOA

salmeterol / fluticasone, long acting Beta agonist, corticosteroid

9

LABA vs SABA effectiveness comparision

If used on regular basis, LABA are more effective and convenient than tx w/ SABA

10

SABA + anticholinergics effectiveness of combination. When to add an ICS?

Produce greater improvements in lung function than either drug given alone. Addition of an ICS to bronchodilators is appropriate for symptomatic COPD pts w/ more severe dz (stage 3-4). Avoid chronic tx w/ system corticosteroid due to unfavorable benefit-risk ratio in most pts.

11

COPD vaccinations each fall

influenza and pneumococcal (repeat if >65, and received vaccine more than 5 year ago)

12

Pts w/ severe hereditary alpha-1 antitrypsin deficiency, therapy?

May place on alpha-1 proteinase inhibitor (Prolastin, Aralast, or Zemaira) given as wkly IV infusion, many SE including anaphylaxis

13

Acute COPD exacerbation treatment

antibiotics, inhaled anticholinergic bronchodilator + oral steroid (taper steroid over 2 wks). Azithromycin 250 mg/d reduce risk of acute exacerbation b/c anti-inflammatory and immunomodulatory (may decrease hearing)

14

Anticholinergics MOA

blocks the action of acetylcholine and decrease cGMP at parasympathetic sites in bronchial smooth muscle causing bronchodilation.

15

Side effects of anticholinergics

SE: Dry mouth (more w/ tiotropium), URTI, pharyngeal irritation, bitter taste ,Caution: pts w/ myasthenia gravis, narrow angle glaucoma, BPH, bladder neck obstruction

16

Short Acting Anticholinergics, names and dosing

Ipratropium bromide (Atrovent HFA) 1-2 inhalations TID-QID (MDI), 0.5 mg TID-QID (NEB)

17

ipratropium + SABA, what is the SABA? What dosing?

+ albuterol (Combivent, Duoneb) 2 inhalations QID, 0.5 mg TID-QID (NEB), wait 2 min btw inhalations

18

if you are allergic to what should you not take combivent? What occurrence should lead pt to immediately dc combivent?

Combivent contain soy, caution pt w/ soy/peanut allergy or atropine. Can cause paradoxical bronchospasm (narrowing of airways, is life threatening), stop use and get emergency help.

19

Long Acting Anticholinergics, name and dosing? How to take? How often to clean device?

Tiotropium (Spiriva handihaler) 1 cap inhaled daily (requires 2 puffs), breathe in slowly and deeply, clean device 1x/month.

20

LABA

Salmeterol, Formoterol, Arfomoterol, Indacaterol

21

Side effects of long acting beta agonists

SE: tremor, shakiness, lightheadedness, cough, palpitations, hypokalemia, tachycardia, hyperglycemia

22

If you add a ICS to LABA what are the risks/ benefits?

Combo w/ ICS increase pneumonia risk, however decrease exacerbations and improve lung function compare to individual components.

23

advair diskus dose? Generic?

1 inhalation BID, salme/fluticasone

24

SPIRIVA dose

1 cap daily (requires two puffs per cap)

25

serevent diskus, generic and dosign

(Salmeterol) 1 inhalation BID

26

symbicort generic , dosing?

formoterol/ budesonide, 2 inhalations BID

27

foradil aerolizer, perforomist, GENERIC

formoterol

28

arcapta and MOA, dosing

indacaterol, LABA, 74mg capsula USE WITH NEOHALER DAILY, do not swallow

29

Brovana, generic, MOA, dosing

15 meg BID (NEB), arformoterol, LABA, it is the r isomer of formoterol

30

MDI use

MDI: Shake well before use. Prime prior to first use (3-4 sprays into the air away from face) and again if inhaler has not been used for > 2 weeks.

31

Roflumilast

Phosphodiesterase 4 inhibitor (Daliresp), increase cAMP levels, lead to reduced lung inflammation

32

Roflumilast dosing

500 mcg PO daily

33

Roflumilast side effects

SE: wt loss, decrease appetite, diarrhea, insomnia, depression, psychiatric events (suicidal)

34

when taking combivent, how long do you wait between each dose of the two inhlations

about 2 minutes before taking the 1st puff

35

why should pts close their eyes when taking atrovent or combivent?

it has an anticholinergic, so if it lands in their ey ie tcan cuse blurry vision, glaucoma, worsingn of eye conditions or eye pain

36

counseling for how to use the spiriva handihaler

make sure you do not swallow the capsules, insert the capsule into the device, press the green piercing button once not more than once, breathe in slowly and deeply so that you can hear the capsule vibrate, hold breath as long as comofrotable, Repeat second puff, clean once a month

37

copd causes

bronchitis and emphysema

38

sxs of copd

chronic cough and sputum prudction, dyspnea

39

emphysema

in the alveoli an inflammatory response due to noxious particles causes destruction of tissues of the lungs.

40

risk factors

smoking, alpha 1 antitrypsin deficiency, dust chemical, pollustions

41

bronchodilators how use

short acting rescue or scheduled.

42

ipratropium bromide

atroven hfa- 1-2 puffs tid- qid

43

albuterol + ipratropium

combivent 2 puff qid

44

tiotropium

spiriva 1 capsule daily

45

salmeterol flutciasone

advair- 1 puff bid.

46

tudorza

long acting anticholinergic