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Flashcards in COPD Deck (19)
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1

COPD

Chronic bronchitis + emphysema

2

Rescue therapy options

-SABA
-SAMA
-SABA + SAMA (more effective than either drug alone)

3

SAMAs (-iums)

-Slower onset but longer duration compared to SABA
-Ipratropium
-Ipratropium + albuterol (SAMA + SABA)

4

SAMA MOA and ADR

-ACh released in airways from vagus nerve
-Muscarinic antagonist block ACh to prevent smooth mm contraction and mucus secretion
-ADR: dry mouth most common, caution with glaucoma and BPH

5

Maintenance Therapy

-LABA or LAMA for pts w mod-severe dyspnea OR increase risk of exacerbations
-LAMA > LABA for mod-severe COPD

6

LAMAs (-iums)

-QD agents: *Tiotropium DPI or SMI, Umeclidinium DPI, Revedenacin neb
-BID agents: Aclidinium DPI, glycopyrrolate neb
-1st line for bronchospasm ass with COPD
-Same interactions and ADRs as SAMA

7

LABAs (-terols)

-QD agents: olodaterol SMI
-BID agents: Salmeterol DPI, Formoterol neb, Afromoterol neb
-Used for bronchospasm ass w COPD

8

LABA/LAMA combos

-Can improve lung fcn and dec sx
-For pts w mod-severe dyspnea, at risk of exacerbation, persistent sx on single long-acting drug

-Glycoprrolate/formoterol HFA BID
-Aclidinium/formoterol DPI BID
-Umeclidinium/vilanterol DPI QD
-Tiotropium/olodaterol SMI QD

-Used these first before ICS/LABA combo

9

ICS/LABA combo

-For pts with mixed asthma/COPD
-ICS monotherapy NOT approved
-Decrease AE-COPD by 25%
-Increase risk of thrush

-Fluticasone/Salmeterol HFA BID
-Fluticasone/Vilanterol DPI QD
-Budesonide/Formoterol HFA BID

10

LAMA/LABA/ICS

-Umeclidinium/vilanterol/fluticasone furoate DPI QD
-Glycopyrrolate/formoterol/budesonide BID

11

Roflumilast

-Tablet for maintenance
-MOA: PDE4 inhibitors --> decreases inflammation
-Indications: severe COPD w chronic bronchitis*
-ADRs: N/V/D most common, CI in liver dz

12

Group A

-CAT score <10, <1 exacerbation, no COPD hospitalizations/yr
-Provide a short or long-acting bronchodilator (albuterol, ipratropium, salmeterol, tiotropium)

13

Group B

-CAT >10, <1 exacerbation, no COPD hospitalizations/yr
-At least 1 long-acting bronchodilator (LAMA > LABA)

14

Group C

-CAT <10, >2 exacerbations or >1 COPD hospitalization/yr
-At least 1 long-acting bronchodilator (LAMA > LABA)
-LABA + LAMA if sx improve c/t using single long-acting bronchodilator
-ICS for more severe cases already on LABA+LAMA or pts with asthma (d/c if improvements seen)

15

Group D

-CAT >10, >2 exacerbations, >1 COPD hospitalizations/yr
-LAMA + LABA
-ICS for same reason as group C

16

Pax Daddy Maintenance
Therapy

-Step 1: SABA +/- SAMA
-Step 2: Add long-acting bronchodilator (LAMA > LABA), if adding LAMA, d/c SAMA
-Step 3: SABA + LAMA + LABA
-Step 4: ICS added for severe dz or those with asthma
-Step 5: add roflumilast

17

Non-pharm maintenance

-Smoking cessation
-O2 therapy--> only therapy shown to alter mortality**
-Immunizations (flu and pneumococcal)
-Pulm rehab

18

AE-COPD tx

-O2 (NIPPV): PaO2 goal 60-70 mmHg, POx 90-94%
-Bronchodilators (all pts): Albuterol +/- ipratropium (MDI or neb)
-Systemic roids (all pts): Methylprednisolone or prednisone
-Abx: when cough and sputum purulence present**

19

Minimizing AE-COPD readmission

-Step 1: written action plan for exacerbations**
-Step 2: rescue q4-6 hr until sx improve
-Step 3: Prednisone x5d
-Step 4: add abx for signs of infection
-Step 5: Prepare for crisis, call 911
-Step 6: Provide close f/u