Term
| Managing Progression of COPD... drug order as COPD worsens |
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Definition
SABA prn
then
SABA + LAAC
then
SABA+ LAAC+ LABA
then
SABA + LAAC + LABA/ICS combination
then
SABA + LAAC + LABA/ICS combination +O2 therapy |
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Term
| Which is the Long acting anticholinergic? (LAAC) |
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Definition
|
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Term
Which are the long acting beta agonists ? LABA
Which of the two has rapid onset |
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Definition
Salmeterol & Formeterol
Formeterol has rapid onset |
|
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Term
Theophylline
Place in COPD therapy ?
monitoring parameters? |
|
Definition
Theophylline
Place in COPD therapy: If SABA + LAAC + LABA/ICS is not sufficient theophylline may be used
monitoring parameters: serum level of 55 - mmol/L because of narrow therapeutic index.
P450 substrate |
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Term
Roflumilast - PDE4 inhibitor
Indication? |
|
Definition
Roflumilast - PDE4 inhibitor
Indication - Add on therapy for treatment of severe COPD associated with chronic bronchitis (chronic cough and sputum) |
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Term
| When is ICS therapy indicated ? |
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Definition
Patient is taking SABA + LAAC + LABA and still has an FEV<50% of predicted, and repeated exacerbations ( 3 or more per year)
Also consider in those who remain breathless despite optimal bronchodilator therapy |
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Term
| When is oxygen therapy recommended? |
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Definition
| Severe hypoxemia, PaO2 < 55% or SaO2 <88% |
|
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Term
| Vaccination recommendations in COPD |
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Definition
| Influenza vaccine every fall, and pneumococcal vaccine every 5-10 years. |
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Term
| Pathogens that commonly exacerbate COPD |
|
Definition
Pathogens that commonly exacerbate COPD
S. Pneumo
H. Influenzae
M. Catarrhalis
Klebsiella & P. Aerginosa in complicated pts. |
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|
Term
Antibiotics of choice vs. simple COPD exacerbation
Simple being:
- increased sputum purulence
- increased dyspnea |
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Definition
Antibiotics of choice vs. simple COPD exacerbation
Simple being:
- increased sputum purulence
- increased dyspnea
Abxs:
Amoxicillin, Doxycycline, TMP/SMX, macrolides, 2nd or 3rd gen cephalosporin |
|
|
Term
Antibiotics of choice vs. complex COPD exacerbation:
Complex being:
- increased sputum purulence
- increased dyspnea
PLUS at least 1:
- FEV less than 50%
- 4 or more exacerbations per year
- ischemic heart disease
- use of home O2
- chronic oral corticosteroid use
- antibiotic use in past 3 months |
|
Definition
Antibiotics of choice vs. complex COPD exacerbation:
Complex being:
- increased sputum purulence
- increased dyspnea
PLUS at least 1:
- FEV less than 50%
- 4 or more exacerbations per year
- ischemic heart disease
- use of home O2
- chronic oral corticosteroid use
- antibiotic use in past 3 months
Abx of choice:
Amox/clav or FQ |
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Term
| Selection of Abx in COPD exacerbation factors |
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Definition
change Abx if had the same one within past 3 months
change if no response within 24-36 hours |
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Term
When are oral corticosteroids indicated?
How long should they be used for ?
Is tapering required? |
|
Definition
When are oral corticosteroids indicated?
SEVERE COPD
How long should they be used for?
10-14 days
Is tapering required?
No, not in therapy lasting in less than 2 weeks |
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