Therapeutics - COPD Part 2 Flashcards
(32 cards)
5 nonpharm treatments for COPD patients
physical activity
sleep
pulmonary rehab
nutrition
oxygen therapy
*guidelines on ipad
ipad
how often should a spirometry be done for COPD patients
annually
what are the 3 classes of COPD exacerbations and how are they treated
mild, moderate, severe
mild- ONLY with short acting bronchodilators (SABA with or without SAMA)
moderate - short acting bronchodilators + antibiotics (w or w/o corticosteroids)
severe - pt requires ED visits or severe hospitalization
if corticosteroids or antibiotics are used in exacerbations, what is the duration?
5-7 days
in severe but not life threatening exacerbations, we can consider a ___ or ___ corticosteroid
which are preferred
oral or IV
prednisone preferred, but nebulized budesonide has sometimes been used as monotherapy (dep on severity)
antibiotics can be considered in exacerbations when….
controversial, but if there is increased cough/sputum and infection is suspected
if a pt is on LABA + LAMA + ICS and STILL having exacerbations, name 4 things we consider
add roflumilast
add a macrolide
add dupilumab (if eosinophil 300 or more)
consider stopping ICS - lack of efficacy and risk of pneumonia. but if their eosinophils are 300 or more - watch closely for exacerbations when withdrawing ICS
azithromycin has the best evidence for use in exacerbations in what patients
former smoker
true or false
inhaler technique should be assessed only when the patient is not well controlled despite being on recommended therapy
FALSE- assess at every encounter
most common errors with MDIs and most common errors with DPIs (SHE SAID STUDY THIS)
MDI - coordination between squeezing the inhaler and breathing in slowly
DPI - not exhaling, and not take a strong deep breath and holding for 10 seconds.. not emptying breath completely
how long to wait between inhalations for MDIs
1 min
how long to hold breath after inhaling for typical MDIs
10 secs
true or false
dry powder inhalers require less coordination
TRUE - but need stronger breath
DPIs should be used with caution in patients with what allergies
lactose, milk proteins
concern with DPI
temps - especially humidity - affect it
how many times is the ellipta done
one inhalation once a day
how long till the elliptas need to be discarded after removed from foil
6 weeks
when do you “lose” a dose from a DPI
if you open and close the cover without inhaling
not possible to recover- don’t worry about taking 2 doses at once in one inhalation
pressair expires how long after opening
30 days
for what devices may you need to do 1-2 inhalations to get the full dose
handihalers
“TOP” - twist, open, press - is for what devices
respimats - spiriva, stiolto, striverdi (soft mist inhalers(
true or false
soft mist inhalers do not have a propellant
true
soft mist inhalers expire within ____ after inserting cartridge
3 months
