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COPD Pharmacol

Pharmacology of drugs used in COPD

QuestionAnswer
List the drugs used in COPD treatment Smoking cessation drugs SABA SAMA LABA LAMA Xanthines Corticosteroids Antibacterials
Ipratropium is a SAMA
Name the LAMA's Aclidium Glycopyroonium (glycopyrrolate) Tiotropium Umclidinium
Which class of drugs are the first line treatment for COPD? Smoking cessation drugs Treatment for nicotine dependence may be necessary (NRT, bupropion, varenicline)
Explain the pharmacology of SAMA and LAMA's Competitive antagonists of endogenous ACh at the muscarinic receptors, binds to the muscarininc receptor causing bronchodilaation and decreases mucous secretion. (Blocks the muscarinic actions of acetylcholine)
What is ipratropium indicated for? Symptomatic relief of COPD (and asthma, although rarely used)
What is the dose of ipratropium (Adult, in COPD)? MDI 42mcg 2 inhalation 3-4 times a day prn
What is the dose of ipratropium in severe acute asthma? 8 inhalation (168mcg) via a spacer OR 500mcg nebule given every 20 minutes fr 3 doses with salbutamol
What are the LAMA's indicated for? Long term maintenance treatment of bronchospasm and dyspnoae of COPD Preferred to regular ipratropium for stable COPD Add on therapy in patients with asthma taking high dose ICS + LABA
Which one of the LAMA's has twice daily dosing? Aclidinium - 322mcg bd
What is the dose of glycopyrronium? 50mcg 1 d
What are the doses of tiotropium? Respimat = 2.5 mcg 1 d (with oldaterol) Handihaler = 18mcg 1 d
What is the dose of umeclidineum? 62.5 mcg 1 d
How effective are SAMA and LAMA's in COPD? Same asa, if not more effective than B2 agonists Reduce air trapped in the lungs and improve exercise tolerance
How effective are SAMA's and LAMA's in asthma? Less effective than b2 agonists, less efficient protection against bronchial challenges Used as an add on therapy when LABA isn't effective or tremor from B2 agonist use if problematic
What precautions do you need to be wary of with SAMA/LAMA use? Severe renal impairment (CrCL < 50ml/min) Recent MI < 6months, unstable arrythmias, hospitalisation with class 2 or 4 HF, prostatic hyperplasia, bladder neck obstruction, narrow angle glaucoma (blurred vision or halos)
True or false: you cannot use a SAMA and a LAMA together True
What are the ADR's of SAMA/LAMA's? Bitter taste (ipra), dry mouth, dental caries, throat irritation, inhalation induced bronchospasm, blurred vision, dizziness (common for ipra), urinary retention Rare: constitpation, palpitations, allergy
How are oral corticosteroids used in COPD? Mainly used to treat exacerbations
What is the recommended dose of oral prednisolone in a COPD exacerbation? 30-50mg d for 5-10 days
How are inhaled corticosteroids used in COPD? Regular ICS reduce exacerbations Used at later stages of stepped management, used in high doses
When is ICS use initiated in COPD management? Initate ICS/LABA + LAMA at FeV1 < 50% predicted, or 2 exacerbations in last 12 months Trial ICS for 3-6 months and continue only if beneficial
What is ICS use in COPD associated with? Pneumonia - vaccination is important
What is the dose of budesonide + formoterol in COPD? 400/12mcg bd
What is the dose of fluticasone furoate + vilanterol in COPD? 100/25mcg 1 d
What is the dose of fluticasone propionate + salmeterol in COPD? 250 or 500/50mcg bd
Why are antibacterials used in COPD? Bacterial infections can cause exacerbations
List the bacteria commonly found to cause an exacrbation in COPD Streptococcus pneumoniae, haemophilus influenzae, moraxella catarrhalis
Created by: LDM
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