Pharmacotherapy of COPD

Helpfulness: 0
Set Details Share
created 2 weeks ago by brandibyler
8 views
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

List the treatment goals for reducing symptoms of COPD:

  • Relieve symptoms
  • Improve health status
  • Improve exercise tolerance
2

List the treatment goals for reducing risk of COPD:

  • Prevent disease progression
  • Prevent and treat exacerbations
  • Reduce mortality
3

How may dyspnea present in a person w/ COPD?

  • Progressive
  • Worse w/ exercise
  • Persistent
4

How may chronic cough present in a person w/ COPD?

  • Intermittent (initially)
  • May or may not be productive
5

On physical exam, what may be observed in a pt with COPD?

  • Barrel chest
  • Use of accessory respiratory muscles
  • Increased RR
  • Shallow breathing
  • Pursed lips during expiration
6

T/F: Smoking cessation is the interventions with the least capacity to influence the natural history of COPD

False

7

How do you determine pack year history?

# packs/day x # of years

8

First line agents for smoking cessation

  • Nicotine replacement therapy
  • Bupropion (Zyban)
  • Varenicline (Chantix)
9

T/F: All smokers should be offered smoking cessation counseling at every visit.

True

10

List the 5 As for smoking cessation strategy:

  • Ask
  • Advise
  • Assess
  • Assist
  • Arrange
11

T/F: No medications alter LT decline of COPD or reduce mortality

True

12

Therapeutic agents for stable COPD

  • β2 agonists (short and long acting)
  • Anticholinergics (short and long acting)
  • Methylxanthines
  • Inhaled corticosteroids
  • PDEi
  • Combo therapy
13

First line for category C:

LAMA

14

First line for category A

prn SAMA or SABA

15

First line for category D:

  • LAMA
  • LAMA+LABA
  • ICS + LABA
16

First line for category B:

LABA or LAMA

17

List the 3 components of the COPD management cycle

  • Review
  • Assess
  • Adjust
18

In the COPD management cycle, what are we reviewing?

  • Symptoms
  • Exacerbations
19

In the COPD management cycle, what are we assessing?

  • Inhaler technique and adherence
  • Non-pharm approaches (including pulmonary rehab and self-management education)
20

In the COPD management cycle, what are we adjusting?

  • Escalate
  • Switch inhaler device/molecules
  • De-escalate
21

Meds that increase FEV1 by altering airway smooth muscle:

Bronchodilators

22

T/F: Bronchodilators do all of the following:

  • Improves lung elastic recoil
  • Helps empty lungs of air
  • Decreases hyperinflation and rest and during exercise
  • Improves exercise tolerance

False

23

SABAs last how long?

4-6 hrs

24

LABAs last how long?

12-24 hrs

25

T/F: The use of routine SABAs with LABAs should be avoided

True

26

AEs of β2 agonists:

  • Sinus tachycardia
  • Nervousness
  • Tremor
  • Hypokalemia
  • Increased O2 demand at rest
  • Tachyphylaxis
27

T/F: LABAs have been shown to:

  • Improve FEV1, lung vol, and QoL
  • ↓ SOB and exacerbations
  • No impact on LT lung decline or mortality

True

28

Examples of SABAs:

  • Albuterol
  • Levalbuterol
  • Pirbuterol
29

Examples of LABAs:

  • Salmeterol
  • Formoterol
  • Arformoterol
  • Olodaterol
  • Indacterol
30

Which LABAs are dosed BID?

  • Salmeterol
  • Formoterol
  • Arformoterol
31

Which LABAs are dosed daily?

  • Olodaterol
  • Indacterol
32

Which LABA(s):

  • Significantly improve FEV1 and lung volumes, dyspnea, health related QoL, and exacerbation rate
  • No effect on rate of decline of lung function or mortality
  • Salmeterol
  • Formoterol
33

Which LABA(s):

  • Bronchodilator effect is significantly > Salmeterol and Formoterol
  • Significant effects on breathlessness, health status, and exacerbation
  • Cough noted following inhalation

Indacterol

34

______________ inhalers block muscarinic receptors in bronchial smooth muscle causing bronchodilation

Anticholinergic

35

SAMAs last how long

8 hrs

36

LAMAs act how long:

12-24 hrs

37

Most studied anticholinergic:

Tiotropium

38

AEs of anticholinergics

  • Dry mouth
  • Bitter metallic taste
  • blurry vision
39

Ipratropium is a _______ (SAMA/LAMA)

SAMA

40

Ipratropium dosing

2 puffs q6-8 hrs

41

LAMAs w/ q day dosing:

  • Tiotropium (spiriva)
  • Umeclindinium (Incruse Ellipta)
42

LAMAs w/ BID dosing:

  • Aclidiunium (Tudorza Pressair) (q12hrs)
  • Glycopyrrolate (Seebri Neohaler)
43

Which medication is less effective and less well tolerated than LABAs that must be routinely measured and within therapeutic range?

Methylxanthines (Theophylline)

44

AEs of Theophylline:

  • Tremor
  • Arrhythmias
  • Seizures
  • HA
  • Insomnia
  • Nausea
  • GERD
45

Pt education for theophylline:

Take w/ food, blood tests, AE potential, smoking

46

Examples of combo bronchodilators:

  • Ipratropium/albuterol (SAMA + SABA)
  • Umeclidinium + vilanterol (LAMA+LABA)
  • Tiotropium + ololdaterol (LAMA+LABA)
  • Glycopyrrolate + indacaterol (LAMA+LABA)
47

T/F: Role of corticosteroids is controversial bc efficacy varies pt to pt, and withdrawal from the treatment could lead to exacerbation

True

48

AEs of corticosteroids:

  • Oral candidiasis (Thrush)
  • Hoarseness
  • Increased risk of pneumonia
  • May be associated w/ osteoporosis
49

Pt education for corticosteroids:

  • Inhaler technique
  • Rinse mouth after using
50

Examples of inhaled corticosteroids:

  • Beclomethasone
  • Budesonide
  • Ciclesonide
  • Flunisolide
  • Fluticasone
  • Trimacinolone
  • Mometasone
51

T/F: ICS+LABA combo therapy is more effective than either individual component

True

52

Elderly pts may have difficulty with:

  • Spacers
  • Dry powder inhalers
  • Nebulized formulations
53

Example of PDEi

Roflumilast (Daliresp)

54

T/F: Roflumilast may or may not be used in conjunction w/ a bronchodilator

False

55

Roflumilast is dosed ______ (BID/Daily)

Daily

56

AEs of Roflumilast

  • N/D
  • Weight loss
  • Depression
  • Insomnia
  • Mood disturbances
57

Roflumilast should be avoided in pts w/ significant ________ dysfxn

Liver

58

T/F: Roflumilast does not treat bronchospasm

True

59

Roflumilast is indicated for pts in which grade(s) (ABCD) as an alternative choice?

C, D

60

Roflumilast reduces exacerbations in pts treated w/ corticosteroids by _______%

15-20%

61

T/F: Regular use of antibiotics may reduce exacerbation risk

True

62

T/F: Moxifloxacin was shown to reduce exacerbations in pts prone to exacerbations in a study that dosed it at 250 mg/day or 500 mg 3x/wk for 1 year

False

63

Which vaccine can decrease infections, hospitalizations and mortality in COPD pts?

Influenza

64

Which vaccine is indicated for all pts 65 and older or w/ significant CV dz that reduces CAP for pts w/ an FEV1 <40%?

Pneumococcal

65

T/F: Mucolytics (Carbocysteine and N-acetylcysteine) may reduce exacerbations in pts not receiving ICS

True

66

T/F: The regular use of cough suppressants is recommended in COPD pts because coughs do not serve a protective fxn and should be kept to a minimum

False

67

Non-pharm trtmt:

  • Smoking cessation
  • Pulmonary rehab
  • Exercise training must continue at home for sustained effect
68

T/F: LT admin of O2 (>15 hr/d) in pts w/ chronic respiratory failure increases survival

True

69

Most common risk factor for acute exacerbations:

Viral (or maybe bacterial) respiratory tract infections

70

Prevention of exacerbation:

  • Smoking cessation
  • Influenza and pneumonococcal vaccine
  • Med education (compliance and technique)
  • Maximize maintenance therapy
  • Consider pulmonary rehab
  • Home FU post hospital discharge
71

T/F: Acute exacerbations are based entirely on the clinical presentations of the pt (i.e. cough, dyspnea, sputum production) and there are no labs or biomarkers to confirm diagnosis

True

72

Most common bacteria in severe COPD

P. aeruginosa

73

Signs of severity of exacerbations:

  • Accessory muscle use
  • Paradoxical chest wall mvmt
  • ↓ alertness
  • Peripheral edema
  • Hemodynamic stability
  • Signs of R sided HF
  • Worsened cyanosis
74

Factors favoring hospitalization for Trtmt of COPD exacerbation:

  • Presence of high risk comorbidity
  • Suboptimal response to outpt mngmt
  • Worsening of dyspnea
  • Inability to eat/sleep during symptoms
  • Mental status changes
  • Lack of home support for care
  • Uncertain diagnosis
75

Mild exacerbation should be treated w:

SABD

76

Moderate exacerbation should be treated w:

SABD+ABX and/or oral corticosteroid

77

Severe exacerbation should be treated w:

SABD+ABX and/or oral corticosteroid + O2 (Requires hospitalization or visits ED)