COPD MEDS

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Author:
ssilvis
ID:
202639
Filename:
COPD MEDS
Updated:
2013-02-22 19:03:46
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Copd meds
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MEds
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  1. TWO CATEGORIES THAT MAKE UP COPD:
    • 1.  Chronic bronchitis- recurrent productive cough associated with inflammation of the bronchioles: Major symptom is a productive cough.
    • 2.  Emphysema- permanent destruction and enlargement (loss of elasticity) of airspaces distal to bronchioles: Major symptom is dyspnea.
  2. DEFINITION OF COPD:
    • 1.  Small airway obstruction
    • 2.  Reduced expiratory flow (CO2 retention)
  3. INCIDENCE OF COPD:
    • 1.  12.1 million (2001)
    • 2.  4th leading cause of death
    • 3.  By 2020: expected to be 3rd leading cause of death
  4. RISK FACTORS OF COPD:
    • 1.  Smokers (30 xs greater r/f death)
    • 2.  Air pollution
    • 3.  Occupational exposure (ex. aspestis)
    • 4.  Genetic (protein alpha 1 antitrypsin deficiency)
  5. PRINCIPLE RISK FACTORS:
    • 1.  Smoking
    • 2.  Advanced age
  6. BOTH EMPHYSEMA AND CHRONIC BRONCHITIS RESULT IN?
    • 1.  Airway obstruction which is IRREVERSIBLE
    • 2.  Dyspnea
    • 3.  Decreased blood oxygen concentrations
    • 4.  Elevated blood CO2 concentrations
  7. STAGES OF COPD:
    • 1.  Stage 0: At risk (lung function normal/chronic cough)
    • 2.  Stage I: Mild (mild airflow limitation)
    • 3.  Stage II: Moderate (airflow limitation)
    • 4.  Stage III: Severe (worsening airflow limitation/repeated exacerbations)
    • 5.  Stage IV: Very severe (severe airflow limitation)
  8. COPD PHARMACOLOGIC MANAGEMENT:
    • 1.  Beta 2 Agonists
    •      -Albuterol
    •      -Terbutaline
    • 2.  Combination B2 and Anti-cholinergic
    •      -Combivent
    • 3.  Combination B2 and Inhaled steroids
    •      -Advair Diskus
    • 4.  Anti-cholinergics
    •      -Spiriva and Ipratropium bromide
    • 5.  Methylxanthines
    •      -Theophylline
  9. RECOMMENDED ORDER FOR COPD TREATMENT IN PRIMARY CARE:
    • 1.  1st line: short acting bronchodilator
    • 2.  2nd line: inhaled beta 2 agonist and anticholinergics
    • 3.  3rd line: Beta 2 agonist and theophylline, rescue inhaled steroid
    • 4.  4th line: referral to pulmonary specialist.
  10. COPD STEP-PROGRESSION OF THERAPY:
    • Stage 0: at risk- avoid risk factors (smoking)/ vaccines (flu/pneumo)
    • Stage I: above and short-acting bronchodilator
    • Stage II: abopve andlong acting bronchodilator
    • Stage III: above and rehab and inhaled gluocoricoids
    • Stage IV: above and supportive O2 (O2 can be whatever stage that it is clinically indicated).
  11. BETA 2 AGONISTS:
    • Prototype-
    • 1.  Albuterol
    • 2.  Terbutaline
    • Action-
    • Relaxes smooth muscle, dilate airways, relieve symptoms of SOB in COPD
    • Considerations:
    • Cannot exceed 12 inhalations daily or can get rebound effect.
    • Combo therapy: Combivent-
    • action: combines bronchodilator effect of albuterol and anticholinergic effect of ipratropium.
    • COMBO THERAPY IS BEST- IT IS THE CORNERSTONE FOR MANAGING COPD
  12. ANTI-CHOLINERGICS:
    • Prototype:
    • 1.  Atrovent-short acting
    • 2.  Spiriva- long acting
    • Action:
    • Relax bronchial muscles
    • Act as Bronchodilator
    • Considerations:
    • 1.  Short acting: onset after 15 min-duration 3-4 hrs.
    • 2.  Longacting: 1 capsule qd (duration 24 hrs)
    • 3.  Not used in  ACUTE episodes
    • 4.  contra-indicated: glaucoma, BPH, pregnancy/lactiation, peanut allergies
    • Adverse Events: Restlessness, dizziness, h/a, blurred vision, palpitations, urinary retention.
  13. COPD ADJUNCTIVE THERAPIES:
    • 1. Smoking cessation
    • 2.  Oxygen support: must be able to demonstrate need for payment:
    •      Group 1- PaO2 less than 55 mmHg
    •                    ABG less than 88%
    •      Group 2- PaO2 56-59
    •                    ABG less than 88%
    • 3.  Concurrent diagnosis- have to have at least one of GROUP 2 and 1 of these comorbidities: CHF or Erythrocythemia (Hct greater than 56%)
    • 4.  Pulmonary rehab programs

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