Flashcards in COPDFC Deck (46):
atrovent HFA & MOA
ipratropioum, shortt acting anticholinergic
short acting anticholinergic
combivent, and MOA
ipratropium + albuterol, short acting anticholinergic , SABA
what is the MOA of anticholinergics for COPD?
block the action of acetylcholine at parasympathic sites in brochial smooth muscle leading to bronchodilation
spiriva & MOA
tiotropium, long acting anticholinergic
daliresp & MOA
symbicort & MOA
formoterol/budesonide, long acting Beta agonist, corticosteroid
advair discus & MOA
salmeterol / fluticasone, long acting Beta agonist, corticosteroid
LABA vs SABA effectiveness comparision
If used on regular basis, LABA are more effective and convenient than tx w/ SABA
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.
COPD vaccinations each fall
influenza and pneumococcal (repeat if >65, and received vaccine more than 5 year ago)
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
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)
blocks the action of acetylcholine and decrease cGMP at parasympathetic sites in bronchial smooth muscle causing bronchodilation.
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
Short Acting Anticholinergics, names and dosing
Ipratropium bromide (Atrovent HFA) 1-2 inhalations TID-QID (MDI), 0.5 mg TID-QID (NEB)
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
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.
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.
Salmeterol, Formoterol, Arfomoterol, Indacaterol
Side effects of long acting beta agonists
SE: tremor, shakiness, lightheadedness, cough, palpitations, hypokalemia, tachycardia, hyperglycemia
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.
advair diskus dose? Generic?
1 inhalation BID, salme/fluticasone
1 cap daily (requires two puffs per cap)
serevent diskus, generic and dosign
(Salmeterol) 1 inhalation BID
symbicort generic , dosing?
formoterol/ budesonide, 2 inhalations BID
foradil aerolizer, perforomist, GENERIC
arcapta and MOA, dosing
indacaterol, LABA, 74mg capsula USE WITH NEOHALER DAILY, do not swallow
Brovana, generic, MOA, dosing
15 meg BID (NEB), arformoterol, LABA, it is the r isomer of formoterol
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.
Phosphodiesterase 4 inhibitor (Daliresp), increase cAMP levels, lead to reduced lung inflammation
500 mcg PO daily
Roflumilast side effects
SE: wt loss, decrease appetite, diarrhea, insomnia, depression, psychiatric events (suicidal)
when taking combivent, how long do you wait between each dose of the two inhlations
about 2 minutes before taking the 1st puff
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
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
bronchitis and emphysema
sxs of copd
chronic cough and sputum prudction, dyspnea
in the alveoli an inflammatory response due to noxious particles causes destruction of tissues of the lungs.
smoking, alpha 1 antitrypsin deficiency, dust chemical, pollustions
bronchodilators how use
short acting rescue or scheduled.
atroven hfa- 1-2 puffs tid- qid
albuterol + ipratropium
combivent 2 puff qid
spiriva 1 capsule daily
advair- 1 puff bid.