COPD Medication Therapy PDF

Initiating COPD Medication Therapy Using GOLD Guidelines: GOLD Group A: Short-acting bronchodilator (SABA or SAMA) as needed. GOLD Group B: Long-acting bronchodilator (LABA or LAMA). GOLD Group E: Combination of LAMA or LABA, or dual LAMA/LABA, depending on severity(COPD_Augsburg...

Initiating COPD Medication Therapy Using GOLD Guidelines: GOLD Group A: Short-acting bronchodilator (SABA or SAMA) as needed. GOLD Group B: Long-acting bronchodilator (LABA or LAMA). GOLD Group E: Combination of LAMA or LABA, or dual LAMA/LABA, depending on severity(COPD_Augsburg). Goals of COPD Therapy: The primary goals are to relieve symptoms, improve exercise tolerance, reduce the frequency and severity of exacerbations, and decrease mortality. Chronic medications focus on reducing exacerbation frequency, which is linked to better long-term outcomes (COPD_Augsburg). Management of Acute COPD Exacerbation: Outpatient: SABA (e.g., albuterol) with or without a SAMA (e.g., ipratropium) and possibly a short course of oral corticosteroids (e.g., prednisone 40 mg for five days). Inpatient: Supplemental oxygen to maintain saturation >90%, nebulized SABA/SAMA, systemic corticosteroids, and, if indicated, antibiotics for increased sputum purulence or dyspnea(COPD_Augsburg). Proper Inhaler Technique: Metered Dose Inhaler (MDI): Shake, exhale, press, and inhale slowly over 3-5 seconds; hold breath for 10 seconds. Dry Powder Inhaler (DPI): Load dose, exhale away from the inhaler, inhale quickly and deeply over 1-2 seconds, no shaking required. Respimat/Soft Mist Inhaler: Twist base, open cap, press to release mist while inhaling slowly.  Nebulizer: Typically used for patients who cannot use MDIs during exacerbations (COPD_Augsburg). Symptoms of Nicotine Withdrawal: Common symptoms include craving, nervousness, restlessness, irritability, mood swings, anxiety, sleep disturbances, and increased appetite(COPD_Augsburg). Prescribing Smoking Cessation Therapy: Options include Nicotine Replacement Therapy (NRT) (patch, gum, lozenge), Varenicline (Chantix), and Bupropion (Zyban). Choice of therapy may depend on patient preference, previous attempts, and comorbidities(COPD_Augsburg). Follow-Up After Smoking Cessation Prescription: Follow-up should include monitoring for withdrawal symptoms, evaluating any adverse effects of cessation medications, reinforcing cessation strategies, and providing support through behavioral counseling or referrals to support services. Adjust therapy as needed based on patient response and challenges(COPD_Augsburg). COPD Medications 1. Albuterol o Class: Short-Acting Beta Agonist (SABA) o Mechanism: Stimulates beta-2 receptors in bronchial smooth muscle, causing bronchodilation. o Indications: Acute relief of bronchospasm in COPD or asthma; prevention of exercise-induced bronchospasm. o Adverse Effects: Tremor, tachycardia, palpitations, nervousness. o Contraindications: Hypersensitivity to albuterol or other beta-agonists.  o Interactions: Beta-blockers (may reduce efficacy); caution with other stimulants. o Monitoring: Not generally required. o Patient Education: Use as directed for acute symptoms; instruct on proper inhaler technique; may use 15 minutes prior to exercise for prevention. 2. Ipratropium (Atrovent) o Class: Short-Acting Muscarinic Antagonist (SAMA) o Mechanism: Blocks muscarinic receptors, reducing bronchoconstriction and mucus secretion. o Indications: Maintenance therapy for COPD; often combined with SABA for exacerbations. o Adverse Effects: Dry mouth, blurred vision, cough, headache. o Contraindications: Hypersensitivity to atropine derivatives; caution in patients with glaucoma. o Interactions: Caution with other anticholinergic medications. o Monitoring: Not generally required. o Patient Education: Instruct on correct inhaler use; avoid getting spray in eyes; may experience a bitter or metallic taste. 3. Salmeterol o Class: Long-Acting Beta Agonist (LABA) o Mechanism: Prolonged beta-2 stimulation causes extended bronchodilation. o Indications: Maintenance treatment for COPD; not used alone in asthma. o Adverse Effects: Headache, muscle cramps, potential for tachycardia. o Contraindications: Not for monotherapy in asthma; hypersensitivity.  o Interactions: Beta-blockers, caution with concurrent QT-prolonging medications. o Monitoring: Periodic evaluation of respiratory symptoms. o Patient Education: Not for acute symptom relief; use daily as prescribed. 4. Tiotropium (Spiriva) o Class: Long-Acting Muscarinic Antagonist (LAMA) o Mechanism: Inhibits muscarinic receptors, leading to prolonged bronchodilation. o Indications: Maintenance treatment for COPD. o Adverse Effects: Dry mouth, constipation, urinary retention. o Contraindications: Hypersensitivity; caution with narrow-angle glaucoma and BPH. o Interactions: Other anticholinergics may increase side effects. o Monitoring: Monitor for anticholinergic effects in elderly patients. o Patient Education: Use daily as directed; avoid contact with eyes; rinse mouth after inhalation. 5. Salmeterol/Fluticasone (Advair) o Class: Combination LABA/Inhaled Corticosteroid (ICS) o Mechanism: Salmeterol provides long-acting bronchodilation; fluticasone reduces airway inflammation. o Indications: Maintenance treatment of COPD and asthma (when ICS is needed). o Adverse Effects: Oral thrush, hoarseness, tremor. o Contraindications: Not for acute exacerbations. o Interactions: Beta-blockers, QT-prolonging drugs; consider systemic corticosteroid interactions.  o Monitoring: Monitor for respiratory symptoms, thrush, and potential adrenal suppression. o Patient Education: Rinse mouth after use to avoid thrush; do not use for acute symptoms. 6. Budesonide (Pulmicort) o Class: Inhaled Corticosteroid (ICS) o Mechanism: Anti-inflammatory, decreases airway swelling and mucus production. o Indications: Maintenance therapy for asthma and COPD (especially with frequent exacerbations). o Adverse Effects: Oral thrush, hoarseness, cough. o Contraindications: Acute bronchospasm; hypersensitivity. o Interactions: Increased risk of infection with immunosuppressive drugs. o Monitoring: Monitor for oral thrush and adrenal function in long-term use. o Patient Education: Rinse mouth after each use; regular use is needed for effectiveness. Smoking Cessation Medications 1. Nicotine Patch o Class: Nicotine Replacement Therapy (NRT) o Mechanism: Delivers nicotine transdermally, reducing withdrawal symptoms. o Indications: Aid for smoking cessation. o Adverse Effects: Skin irritation, insomnia, vivid dreams. o Contraindications: Recent MI, arrhythmia, severe angina.  o Interactions: Other stimulants (e.g., caffeine) may worsen side effects. o Monitoring: Assess for adverse reactions, especially skin irritation. o Patient Education: Apply to clean, dry skin daily; rotate application sites; remove at bedtime if sleep issues arise. 2. Nicotine Gum o Class: Nicotine Replacement Therapy (NRT) o Mechanism: Provides nicotine through buccal absorption, reducing withdrawal. o Indications: Aid for smoking cessation, particularly for cravings. o Adverse Effects: Mouth soreness, hiccups, jaw pain. o Contraindications: Recent MI, arrhythmia, severe angina. o Interactions: Avoid acidic beverages (e.g., coffee) before use as it can reduce absorption. o Monitoring: Watch for oral health issues and signs of overuse. o Patient Education: Chew until peppery taste, then "park" between cheek and gums; avoid acidic drinks before use. 3. Bupropion (Zyban) o Class: Norepinephrine-Dopamine Reuptake Inhibitor (NDRI); antidepressant o Mechanism: Reduces craving by increasing dopamine and norepinephrine levels; may act as a nicotine receptor antagonist. o Indications: Smoking cessation; also used for depression. o Adverse Effects: Insomnia, dry mouth, anxiety, risk of seizures. o Contraindications: Seizure disorders, eating disorders, MAOI use.  o Interactions: Caution with drugs that lower seizure threshold (e.g., antipsychotics). o Monitoring: Watch for neuropsychiatric symptoms; assess for blood pressure changes. o Patient Education: Start 1-2 weeks before quit date; take doses early in the day to avoid insomnia. 4. Varenicline (Chantix) o Class: Partial Nicotinic Receptor Agonist o Mechanism: Partially stimulates nicotinic receptors to reduce cravings and withdrawal while blocking effects of nicotine if smoking occurs. o Indications: Smoking cessation. o Adverse Effects: Nausea, vivid dreams, headache, potential mood changes. o Contraindications: Caution with history of psychiatric disorders or seizures. o Interactions: Minimal, though caution with alcohol. o Monitoring: Monitor for neuropsychiatric symptoms and mood changes. o Patient Education: Take after meals with a full glass of water to reduce nausea; set a quit date within the first 1-2 weeks of starting.