Therapeutics - COPD

Question 1

true or false

in COPD, the airway inflammation is typically IRREVERSIBLE, and in asthma it is typically reversible

Answer 1

true

Question 2

what are the 2 types of environmental COPD

Answer 2

COPD-C (cigs)
COPD-P (air pollution, etc)

Question 3

what is the term for genetic COPD

Answer 3

COPD-G

Question 4

3 types of genetic COPD

Answer 4

-alpha 1 antitrypsin deficiency

-decline of gene function in MMP12/GSH-S-transferase

-siblings of patients with severe COPD

Question 5

gold standard lab test for diagnosing COPD

Answer 5

spirometry

Question 6

when may a chest radiography/imaging studies be done on a COPD patient

Answer 6

to rule out other lung diseases

Question 7

true or false

in COPD exacerbations, it is always necessary for the patient to be hospitalized for treatment

Answer 7

false

Question 8

name 6 vaccines that are particularly recommended for those with COPD

Answer 8

pneumococcal
Tdap
covid
influenza
RSV
shingles

Question 9

what are the 2 main questions we ask when choosing appropriate therapy for stable COPD patients

Answer 9

which drug class is appropriate?

what is the best delivery mechanism?

Question 10

name the 3 main drug classes in stable COPD patients

Answer 10

bronchodilators
corticosteroids
PDE4 inhibitors

Question 11

inhaled __________ are ESSENTIAL in COPD

as regular or as PRN?

Answer 11

inhaled bronchodilators

regularly scheduled AND as needed SABA or SAMA

Question 12

____ acting formulations show the most overall improvement

Answer 12

long acting

Question 13

which has a greater effect on decreasing exacerbations - LABA or LAMA

Answer 13

LAMA, but a combo of both together is superior

ie - anoro (umeclidinium + vilanterol)

Question 14

true or false

in COPD, multiple inhalers is preferred over one

Answer 14

false - one preferred

Question 15

how do beta agonists help in COPD (counseling)

Answer 15

they open the airways to prevent and treat symptoms of COPD

Question 16

side effects of beta agonists

Answer 16

tachycardia (reflex)
tremor
hypokalemia
headache

Question 17

name 2 SABAs

Answer 17

albuterol
levalbuterol

Question 18

name 4 LABAS

Answer 18

salmeterol
formoterol
olodaterol
arformoterol

Question 19

AE of SAMA/LAMA

Answer 19

dry mouth
blurred vision
constipation
headache
bitter taste

Question 20

differentiate between SAMA vs LAMA in terms of pharmacology

Answer 20

SAMA - block M2 and M3 receptors

LAMA - selective for M1 and M3

Question 21

true or false

studies have shown that SABA (albuterol) are more effective than SAMA (ipratropium)

Answer 21

false - ipratropium over albuterol

Question 22

for which med should the patient be counseled that they may have a bitter, metallic taste

Answer 22

ipratropium

Question 23

what meds does incruse ellipta contain

Answer 23

ONLY umediclinium (long acting anticholinergic/LAMA)

Question 24

what does spiriva contain

Answer 24

tiotropium only (LAMA)

Question 25

what does atrovent contain

Answer 25

ipratropium only (SAMA)

Question 26

name 2 types of ORAL bronchodilators

Answer 26

methylxanthines and PDE4 inhibitors

Question 27

name a methylxanthine

Answer 27

theophylline

Question 28

consideration of old age + theophylline

Answer 28

decreased clearance! may need to decrease dose

Question 29

DDI concerns of theophylline

Answer 29

CYP3A4/2E1/1A2

Question 30

name some SE of theophylline (dose related)

Answer 30

tachycardia arrhythmias tremor seizure sleep disturbances

Question 31

true or false PDE4 inhibitors work by increasing the amount of cAMP

Answer 31

true - prevent the breakdown of cAMP by inhibiting PDE4

Question 32

DDI concern of PDE4 inhibitors like roflumilast

Answer 32

CYP3A4 and CYP1A2

Question 33

AE of roflumilast

Answer 33

abdominal pain sleep issue headache weight loss

Question 34

for roflumilast, what patients have been shown to benefit most from it

Answer 34

patients who have a history of hospitalizations for severe exacerbations - better for patients who have severe COPD

Question 35

roflumilast can be considered an option in pts with severe-very severe COPD along with..........

Answer 35

long acting bronchodilators

Question 36

true or false roflumilast and theophylline can be used together

Answer 36

FALSE - cannot

Question 37

roflumilast should be used with caution in patients who have....

Answer 37

depression

Question 38

true or false roflumilast can be used for relief of acute bronchospasm

Answer 38

false - not indicated

Question 39

name a PDE 3/4 inhibitor

Answer 39

ensifentrine

Question 40

**DDI and AE of ensifentrine (highlighted on slide)

Answer 40

DDI - CYP3A4 and 1A2 AE - nausea, diarrhea, abdominal pain, sleep issues, headache, weight loss

Question 41

true or false ensifentrine is used for maintenance

Answer 41

true

Question 42

true or false ensifentrine should be used with caution in patients with depression

Answer 42

true

Question 43

name a biologic that can potentially be used for COPD

Answer 43

dupilumab

Question 44

specific use for dupilumab in COPD

Answer 44

add on maintenance for pts with controlled COPD and an eosinophilic phenotype

Question 45

*AE and DDI of dupilumab (highlighted on slide)

Answer 45

DDI CYP1A2 and 3A4 AE - rash, urticaria, angioedema, immune thrombocytopenia

Question 46

true or false dupilumab is oral

Answer 46

false - injectable

Question 47

MOA dupilumab

Answer 47

blocks IL-4 and IL-13

Question 48

what is used to treat COPD exacerbations

Answer 48

oral steroids like prednisone/methylprednisolone

Question 49

role of long term ICS in COPD patients state any concerns and when how they are best used in therapy

Answer 49

may consider as combo therapy in patients with moderate-severe COPD concern with using in COPD is the risk for pneumonia bc it lowers eosinophil markers therefore, best benefit in patients with over 300 cells/mL best used as TRIPLE therapy rather than dual: LABA + LAMA + ICS

Question 50

true or false monotherapy with inhaled corticosteroids is recommended in COPD

Answer 50

FALSE - not rec

Question 51

true or false monotherapy with oral corticosteroids is not recommended in COPD

Answer 51

true

Question 52

if the patient has 100-300 eospinophils/mL and has 1 exacerbation per year, is adding an ICS to the regimen favored?

Answer 52

YES

Question 53

patient has history of mycobacterial infection should we add an ICS to their regimen

Answer 53

NO

Question 54

true or false antitussives are recommended in COPD

Answer 54

false

Question 55

true or false nebulized hypertonic saline solutions show a clear benefit in COPD

Answer 55

false - inconsistent resutls

Question 56

___ may help cough in moderate/severe COPD

Answer 56

LAMAs - like tiotropium and amilclidnium

Question 57

role of N-acetylcysteine and carbocysteine in pts with COPD

Answer 57

further evaluation needed MAY decrease exacerbations in pts not getting an ICS

Question 58

azithromycin/erythromycin in COPD is used for how long? what are the risks?

Answer 58

1 year prolonged QT, resistance, impaired hearing (azithro)

Question 59

if a pt is not responding too well to the recommended therapies and has severe resting hypoxemia, what do we give

Answer 59

oxygen therapy

Question 60

how long does berztri have to be discarded once removed from the foil what about trellegy

Answer 60

3 weeks trellegy - 6 weeks