Term
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Definition
| Ipratropium (Atrovent HFA); Tiotropium (Spiriva HandiHaler); Aclidinium bromide (Tudorza Pressair) |
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Term
| MDI or nebulizer; decreased systemic absorption due ot quaternary structure; 3-5 times more potent than atropine |
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Definition
| Ipratropium (Atrovent HFA) |
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Term
|
Definition
| competitively inhibit cholinergic receptors in bronchial smooth muscle which leads to relaxation, dilation |
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Term
| onset 30 min, peak 1-4 hours, duration 24 hours; Dry powder inhaler |
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Definition
| Tiotropium (Spiriva HandiHaler) |
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Term
| improved adherence compared to ipratropium; improved outcomes compared to LABA in mod-severe disease; worsening CV outcomes |
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Definition
| Tiotropium (Spiriva HandiHaler) |
|
|
Term
| broncodilation through stimulating adenyl cyclcase and increasing cyclic amp, improved mucociliary clearance |
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Definition
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Term
|
Definition
| Albuterol, Levalbuterol, Fenoterol, Metaproterenol, Pirbuterol, Terbutaline; Salmeterol, formoterol, arformoterol |
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Term
| as needed for SOB, first line for acute exacerbations |
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Definition
| Short acting beta agonists |
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|
Term
| alternative to anti-cholinergic agents for chronic therapy |
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Definition
| Long acting beta agonists |
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|
Term
| low dose reduces exacerbations, does not improve lung function |
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Definition
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|
Term
| higher doses are bronchodilators but use is limited by toxicity |
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Definition
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Term
| Bronchodilator, increase diaphragm contractility, increase hypoxic drive for respiration, increase RV/LV ejection fraction, anti-inflammatory, immunomodulator |
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Definition
|
|
Term
| Toxic Range: (Methylxanthines) adverse effects |
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Definition
| nausea, jittery, insomnia, headache; N/V/D, HA, irritability, tachycardia; seizures, arrhythmias, hyperglycemia, death |
|
|
Term
| Methylxanthines Drug/Disease Interactions; Increased clearance |
|
Definition
| barbiturates; phenytoins; smoking, cigs, marijuana, ketoconazole, rifampin |
|
|
Term
| Methylxanthines Drug/Disease Interactions: Decreased clearance |
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Definition
| Allopurinol, CCBs, Corticosteroids, Macrolides, Quinolones, liver disease, BBs, Cimetidine, Influenza vaccine, Oral contraceptives, heart failure, pneumonia- viral or bacterial |
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|
Term
| Reduce capillary leak to decrease mucus production; inhibit release of proteolytic enzymes from WBC, prostaglandins |
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Definition
|
|
Term
| Inhaled steroids for maintenance therapy (Combo with LABAs) |
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Definition
| Advair (fluticasone + salmeterol), Symbicort (Budesonide + formoterol), Dulera (mometasone _ formoterol) |
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|
Term
| Inhaled steroids; demonstrated benefits |
|
Definition
| decreased respiratory symptoms, decreased frequency of exacerbations; decreased health care utilization; improved function and quality of life |
|
|
Term
| Corticosteroid therapy indications |
|
Definition
| pts with severe and very severe COPD with frequent exacerbations that are not adequately controlled on inhaled bronchodilators |
|
|
Term
| Corticosteroid Adverse effected |
|
Definition
| Withdrawals can precipitate exacerbation; loss of bone mineral density, dose-related increase in fracture risk; increased risk of pneumonia, cataracts, oropharyngeal candidiasis |
|
|
Term
| phosphodiesterase-4 inhibitor, anti-inflammatory; add on maintenance therapy for severe COPD with bronchitis |
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Definition
|
|
Term
| Roflumilast (Daliresp) adverse events |
|
Definition
| nausea/diarrhea; wt loss, depression/suicide |
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|
Term
|
Definition
| 20 mg po tid misc. medication |
|
|
Term
| Medroxyprogesterone adverse effects |
|
Definition
| weight gain, fluid retention, impotence, thromboembolism |
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|
Term
|
Definition
| controversial study results; overall very small benefit; decreased days of illness, days of antibiotic us; may be more beneficial in severe disease, steroid naive |
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|
Term
| cough suppressants/expectorants |
|
Definition
| not effective, potentially dangerous |
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|
Term
|
Definition
| often avoided due to concern for inducing bronchospasm; use actually associated with 22% reduced mortality |
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|
Term
|
Definition
| small benefit to decrease exacerbations, concerns for resistance, choose patients carefully; anti-inflammatory as well |
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|
Term
| erythromycin 250 mg BID; Azithromycin 250 mg daily x 1 year |
|
Definition
|
|
Term
|
Definition
| antioxidant: reduces inflammation, protease activity, and mucous secretion; no significant benefit overall but patients not receiving inhaled steroids did better; more research warranted |
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|
Term
| Group A First Choice Therapy |
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Definition
| Short-acting anticholinergic or short-acting beta 2 agonist |
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Term
| Group A Second Choice Therapy |
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Definition
| Long acting anti-cholinergic or Long-acting beta2 agonist OR short-acting beta2 agonist and short-acting anticholinergic |
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|
Term
| Group A Alternative Choice |
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Definition
|
|
Term
| Group B First Choice Therapy |
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Definition
| Long-acting anticholinergic or long-acting beta 2 agonist |
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Term
| Group B Second Choice Therapy |
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Definition
| Long acting anticholinergic AND long-acting beta2 agonist |
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|
Term
| Group B Alternative Choice |
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Definition
| Theophylline; Short-acting anticholinergic and/or short acting beta 2 agonist |
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|
Term
| Group C First Choice Therapy |
|
Definition
| Inhaled corticosteroid and long-acting beta2 agonist or long acting anticholinergic |
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Term
|
Definition
| Long-acting anticholinergic and long-acting beta2agonist |
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|
Term
| Group C Alternative Choice |
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Definition
| Phosphodiesterase-4 inhibitors; theophylline; short-acting anticholinergic |
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Term
|
Definition
| Inhaled corticosteroid AND long-acting beta2 agonist OR long acting anticholinergic |
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Term
|
Definition
| Inhaled corticosteroid and/or long acting beta2 agonist; inhaled corticosteroid and long-acting beta 2 agonist r long-acting anticholinergic And phosphodiesterase 4 inhibitor |
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|
Term
|
Definition
| Carbocysteine; Theophylline; short-acting anticholinergic and/or short acting beta2 agonist |
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|
Term
| Optimizing functional outcomes and quality of life |
|
Definition
| exercise rehabilitation, nutritional intervention, physical and occupational therapy, psychosocial counseling |
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Term
|
Definition
| indications: PaO2 at most 55 mmHg or SaO2 at most 89% with rest, exercise or sleep; Pa2 56-69 or Sa02 < 90% at any time with evidence of pulmonary hypertension, cor pulmonale, altered mental status, polycythemia |
|
|
Term
| Goal for Oxygen saturation |
|
Definition
| >90%, use caution with CO2 retention |
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|
Term
| cornerstone of managing acute exacerbations (But administer cautiously) |
|
Definition
|
|
Term
| Preferred in managing acute exacerbations |
|
Definition
| albuterol ever 30-60 minutes |
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|
Term
| added in managing acute exacerbations if response to SABA inadequate |
|
Definition
| Ipratropium every 4-6 hours |
|
|
Term
| managing acute exacerbations: consider adding if pts have fever and/or change in quality, volume or color of sputum; have severe underlying lung function with an FEV1 < 35% predicted; are age 60 or older |
|
Definition
| administering antibiotics |
|
|
Term
|
Definition
| streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis |
|
|
Term
| Appropriate antibiotic agents |
|
Definition
| Amoxicillin clavulanic acid; 2nd/3rd generation ceph; TMP/SMX; azithromycin, clarithromycin; doxycycline (added to steroids improved secondary endpoints) |
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|
Term
| occurred up to 25% of patients hospitalized with severe COPD exacerbation |
|
Definition
|
|
Term
|
Definition
| heparin 5000 units SQ every 8 hrs, enoxaparin 40 mg SQ daily, fondaparinux 2.5 mg SQ daily |
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|
Term
|
Definition
| Pulmonary Hypertension; Cor Pulmonale; Secondary Polycythemia; Respiratory Failure |
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|
Term
|
Definition
| Right heart failure; treatment: oxygen, careful diuresis, digoxin |
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|
Term
|
Definition
| Elevated hematocrit >50%; treatment: oxygen, periodic phlebotomy |
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|
Term
|
Definition
| optimize medication and oxygen therapy; may require mechanical ventilation in exacerbation; progressive, fatal disease |
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