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Research – GlaxoSmithKline, Boerhringer Ingelheim, Sanofi, AstraZeneca, Teva
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tarix | 22.10.2018 | ölçüsü | 2,46 Mb. | | #75576 |
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Research – GlaxoSmithKline, Boerhringer Ingelheim, Sanofi, AstraZeneca, Teva Research – GlaxoSmithKline, Boerhringer Ingelheim, Sanofi, AstraZeneca, Teva Consulting – Teva, GSK Speaking – AstraZeneca, Sunovion
Address access and adherence to meds Choose most potent bronchodilators - LAMAs modestly more potent than LABAs in COPD
Combine bronchodilators with different mechanisms Add anti-inflammatories to bronchodilators for additional control - ICS+LABA or ICS+LABA+LAMA
- Phosphodiesterase inhibitors (roflumilast)
- Chronic azithromycin
Consider low dose theophylline
Hippocrates circa ~ 500 BC Hippocrates circa ~ 500 BC “Keep a watch also on the faults of the patients, which often make them lie about the taking of things prescribed” Dr Pill circa 2018 AD “Sometimes it’s not the patient’s fault, affordable access to medicines is most frequent cause for non-adherence”
Peak Inspiratory Flow Rate (matters with DPIs) Decreases With Peak Inspiratory Flow Rate (matters with DPIs) Decreases With COPD Exacerbations And Can be Suboptimal in Some Patients Even When Stable
IV or oral dexamethasone similar or slightly less effective in AECOPD - Benefit is minimal mineralcorticoid effect compared to prednisone
- More immune suppression
- Don’t use in prednisone-dependent patient
High-dose nebulized budesonide
Budesonide doses have ranged from 2 mg BID to 4 mg TID (can mix with albuterol in nebulizer) Budesonide doses have ranged from 2 mg BID to 4 mg TID (can mix with albuterol in nebulizer) Administered by high-efficiency nebulizers as Pari LC Plus® Don’t use if patient prednisone-dependent due to potential for adrenal crisis
Quinolones - ”Most broad spectrum” for ECOPD, but the least safe
- Mental status changes – especially cipro
- Prolonged QTc, esp moxifloxacin
- Hypo- and hyperglycemia
- Lots of drug and food interactions
Macrolides - Poor gram negative, but safer than quinolones
- Pneumococcal resistance, but not as common as with community-acquired pneumonia
- Low blood levels, not good if concerned about bacteremia
- Concern about CV safety of azithromycin is disproportionate to actual risk
- Drug interactions not a major issue with azithromycin
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