COPD 2 Flashcards
Do B2 agonists have limited or substantial effect in COPD?
Limited
Which muscarinic antagonists are used in COPD?
Ipratropium
Tiotropium
Aclindinium
What is ipratropium?
Non-specific muscarinic antagonist
What is tiotropium?
M3 selective antagonist
When are IV corticosteroids used in COPD?
Acute exacerbations
Inhibition of PDEIII and IV in airway smooth muscle leads to what?
Bronchodilation
What do PDE inhibitors do?
Increase intracellular cAMP.
Inhibit chemotaxis, granule release, respiratory burst,
Inhibits TNFa release
What is theophylline?
A weak, non-selective phosphodiesterase inhibitor
What is Roflulimast?
PDE IV selective inhibitor
What are the organisms tht infect up to 50% of stable COPD patients?
Haemophilus influenzae
Streptococcus pneumoniae
What are the viral infections associated with acute exacerbation of COPD?
Rhinovirus
Influenza
Parainfluenza
Coronavirus
What is alondronate?
Bisphosphonate used in osteoporosis
What is alondronates mechanisms of action?
Apoptosis of bone-resorbing osteoclasts.
Inhibiton of osteoclast activation
What are the supposed mechanisms of action of statins in COPD?
Improved vascular function. Reduced pulmonary hypertension. Immunomodulation? Decreased Systemic inflammation Decreased Th1 activation
What are the other treatments for COPD?
O2
Physiotherapy
Mucolytics
Why don’t bronchodilators work very well in COPD?
Occlusion is not due to bronchoconstriction
Why dont glucocorticoids work very well in COPD?
Oxidative stress results in decreased steroid sensitivity.
Neutrophil apoptosis inhibited by glucocorticoids
Histone acetylase = ?
Increased binding of transcription factors.
NFkB AP-1 CREB
DNA not constrained by the histone
Histone deacetylase = ?
Transcriptional suprression.
DNA wrapped tightly on nucelosome surface
HDAC or HAC represses inflammatory gene expression?
HDAC
Histone deacetylase
What does increased HAT and decreased HDAC cause?
Increased inflammation
