Podcast
Questions and Answers
A patient with COPD requires a medication that provides rapid relief from airway constriction. Which of the following would be MOST appropriate?
A patient with COPD requires a medication that provides rapid relief from airway constriction. Which of the following would be MOST appropriate?
- Salmeterol
- Tiotropium
- Albuterol (correct)
- Ipratropium
Which medication is a long-acting muscarinic antagonist (LAMA) that can provide sustained airway relaxation in COPD management?
Which medication is a long-acting muscarinic antagonist (LAMA) that can provide sustained airway relaxation in COPD management?
- Ipratropium
- Formoterol
- Tiotropium (correct)
- Albuterol
Why is Salmeterol used with caution for Asthma patients?
Why is Salmeterol used with caution for Asthma patients?
- It has a direct impact on increased eosinophil activity
- It can cause a rapid decrease in lung function
- It increases the risk of hyperglycemia
- It may increase the risk for asthma-related deaths (correct)
A COPD patient is prescribed Stiolto Respimat. What two drug classifications does this medication belong to and what is the typical dosage?
A COPD patient is prescribed Stiolto Respimat. What two drug classifications does this medication belong to and what is the typical dosage?
Which of the following is an important monitoring consideration for patients using inhaled corticosteroid (ICS) and LABA combination inhalers?
Which of the following is an important monitoring consideration for patients using inhaled corticosteroid (ICS) and LABA combination inhalers?
In which of the following situations would oral corticosteroids be MOST appropriate for a patient with COPD?
In which of the following situations would oral corticosteroids be MOST appropriate for a patient with COPD?
Why are methylxanthines (theophylline) considered a third-line treatment option in COPD management?
Why are methylxanthines (theophylline) considered a third-line treatment option in COPD management?
How do phosphodiesterase-4 (PDE-4) inhibitors, such as roflumilast, work in the treatment of COPD?
How do phosphodiesterase-4 (PDE-4) inhibitors, such as roflumilast, work in the treatment of COPD?
According to the 2021 COPD guidelines, what is the recommended initial treatment for a patient with two moderate exacerbations or one leading to hospitalization?
According to the 2021 COPD guidelines, what is the recommended initial treatment for a patient with two moderate exacerbations or one leading to hospitalization?
In COPD management, what does the Refined ABCD Assessment Tool primarily evaluate to properly plan treatment?
In COPD management, what does the Refined ABCD Assessment Tool primarily evaluate to properly plan treatment?
According to the 2023 COPD guidelines, what are the two key categories for COPD assessment now in place for COPD?
According to the 2023 COPD guidelines, what are the two key categories for COPD assessment now in place for COPD?
What initial pharmacological treatment is recommended for a patient in GROUP E, according to the 2023 COPD guidelines?
What initial pharmacological treatment is recommended for a patient in GROUP E, according to the 2023 COPD guidelines?
What role do eosinophils (EOS) in peripheral blood play in acute COPD exacerbations?
What role do eosinophils (EOS) in peripheral blood play in acute COPD exacerbations?
A patient with COPD has a confirmed diagnosis using spirometry. What should be assessed using the ABCD Assessment Tool to properly plan the treatment?
A patient with COPD has a confirmed diagnosis using spirometry. What should be assessed using the ABCD Assessment Tool to properly plan the treatment?
What potential adverse effects must be monitored for in a patient using a combination inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) inhaler?
What potential adverse effects must be monitored for in a patient using a combination inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) inhaler?
A COPD patient is prescribed roflumilast. What parameter would be most important to monitor?
A COPD patient is prescribed roflumilast. What parameter would be most important to monitor?
A patient is prescribed Ipratropium + albuterol. What drug classifications do each of these belong to?
A patient is prescribed Ipratropium + albuterol. What drug classifications do each of these belong to?
A patient who occasionally uses Ventolin is struggling to catch his breath. How many puffs of Ventolin is he suppose to administer, and how often can he administer it?
A patient who occasionally uses Ventolin is struggling to catch his breath. How many puffs of Ventolin is he suppose to administer, and how often can he administer it?
What is the dose of Atrovent spray?
What is the dose of Atrovent spray?
A patient is using Budesonide/Formoterol(Symbicort). What other possible side effect could the patient experience if they have this condition?
A patient is using Budesonide/Formoterol(Symbicort). What other possible side effect could the patient experience if they have this condition?
Flashcards
SABA
SABA
Medications that quickly dilate airways for rapid relief.
SAMA
SAMA
Anticholinergic medications that widen airways by blocking muscle tightening.
LABA
LABA
Medications for long-term airway dilation.
LAMA
LAMA
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ICS
ICS
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PDE-4 inhibitors
PDE-4 inhibitors
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Albuterol
Albuterol
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Ipratropium bromide
Ipratropium bromide
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Salmeterol
Salmeterol
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Tiotropium
Tiotropium
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ABCD Assessment Tool
ABCD Assessment Tool
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Eosinophil (EOS)
Eosinophil (EOS)
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Study Notes
- COPD medications aim to dilate airways, reduce inflammation, and manage symptoms.
Short-Acting Beta Agonists (SABA)
- Provide rapid relief by quickly dilating airways.
- Examples include albuterol and levalbuterol.
- Albuterol (Ventolin or ProAir) is administered as 2 puffs every 4-6 hours as needed, with a dose of 90 mcg/spray.
Short-Acting Muscarinic Antagonists (SAMA)
- These anticholinergics widen airways by blocking muscle tightening.
- Ipratropium bromide (Atrovent) is a SAMA available in inhaled or nebulized form, with a dose of 17 mcg/spray.
Long-Acting Beta Agonists (LABA)
- Offer long-term airway dilation.
- Salmeterol (Serevent Diskus) carries an increased risk of asthma-related deaths and should be used with caution in asthma patients, in conjunction with an asthma medication for long-term management.
- Other examples include arformoterol, formoterol, indacaterol, and olodaterol.
Long-Acting Muscarinic Antagonists (LAMA)
- These anticholinergics provide sustained airway relaxation.
- Tiotropium (Spiriva) is inhaled, with a dose of 18 mcg/cap, dispensed as 1 handihaler for 30 or 90 caps.
- Other examples include aclidinium, glycopyrrolate, and umeclidinium.
Combination Medications
- SAMA + SABA: Ipratropium + albuterol
- LAMA + LABA:
- Glycopyrrolate + formoterol
- Indacaterol + glycopyrrolate
- Tiotropium + olodaterol (Stiolto Respimat, 18 mcg/cap, inhaled once every 24 hours)
- Umeclidinium + vilanterol
- ICS + LABA:
- Budesonide + formoterol (Symbicort)
- Fluticasone + salmeterol (Advair Diskus or HFA)
- Fluticasone + vilanterol (Breo Ellipta)
- For ICS + LABA combinations, it is important to monitor for ACOS, rinse after use, monitor for glaucoma/cataracts, and watch for hyperglycemia/hypokalemia.
Inhaled Corticosteroids (ICS)
- Reduce inflammation in the airways.
- Examples include budesonide and fluticasone.
Oral Corticosteroids
- Used as add-on therapy in specific situations in manageable COPD for a short course of 5 days.
- Long-term use is not recommended.
- Examples include methylprednisolone and prednisone.
Phosphodiesterase-4 (PDE-4) Inhibitors
- Roflumilast (Daliresp) is an oral medication.
- Selectively inhibits phosphodiesterase type 4 (PDE4) to increase intracellular cAMP levels.
Methylxanthines (Theophylline)
- Considered a third-line treatment due to adverse events and limited clinical efficacy.
- Used after inhaled β2-agonists and anticholinergic agents.
COPD Guidelines (2021)
- For two moderate exacerbations or one leading to hospitalization, treatment includes LAMA.
- LAMA + LABA or ICS + LABA is used depending on the case of highly symptomatic CAT > 20 if eos ≥ 300.
- For none or one moderate exacerbation (not leading to hospital admission), treatment starts with a bronchodilator.
- The Refined ABCD Assessment Tool refines spirometrically confirmed diagnosis of COPD and uses evaluation of exacerbations to properly plan treatment.
COPD Guidelines (2023)
- Two key categories for COPD are E and AB.
- Assessment of exacerbations requiring an E.
- Assessment of airflow obstruction for AB.
- ABE is now in place for COPD.
- Initial Pharmacological Treatment for GROUP E (Two moderate exacerbations or ≥ 1 leading to hospitalization) includes LABA + LAMA.
COPD and Eosinophils
- Eosinophils (EOS) in peripheral blood play a key role in acute COPD exacerbations.
- Eosinophil-increased COPD is an important variant and individualized treatment.
- Increased eosinophil count/percentage in peripheral blood correlates with acute exacerbation and COPD prognosis.
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