COPD

Question 1

Non-pharmacological treatments

Answer 1

• Smoking cessation
• Current immunisation
• Pulmonary rehabilitation

Question 2

Pharmacological management for COPD

Answer 2

A) BRONCHODILATORS (reliever) - B2 adrenoceptor agonists, xanthines, muscarinic receptor antagonists
B) SYMPTOM CONTROLLERS (long acting B2 adrenoceptor agonists)
C) ANTI-INFLAMMATORY DRUGS (preventer) - glucocorticoids, oral steroids, leukotriene receptor antagonists

also, antibiotics, vaccinations and O2 therapy

Question 3

Eg. and MOA of leukotriene receptor antagonist

Answer 3

MOTELUKAST (Singulair tablets): competitive antagonists of LTC4, D4, E4 (potent bronchoconstrictors which amplify inflammatory process)

Question 4

E.g. and MOA of leukotriene synthesis inhibitors

Answer 4

ZILEUTON (zyflo): Blocks formation of LTB4, C4, D4, E4. Inhibits 5-lipoxygenase

Question 5

Types of inhaled glucocorticoids and trade names

Answer 5

Beclomethasone (QVA puffer)
Budesonide (pulmicort turbuhaler)
Fluticasone (Flixotide puffer/accuhaler)

Question 6

SE of glucocorticoids

Answer 6

• Inhibits inflammatory cells in the lung
• Inhibits activation of macrophages and mediator release from eosinophils
• Reduces formation of inflammatory cytokines
• Reduction in IL-3 synthesis
• Inhibits induction of COX-2
• Inhibits formation of arachadonic acid by inducing synthesis of lipocontin (<inhibits phopholipase A2 and subsequent formation of PGs and LTs)

Question 7

Ipatropium bromide trade name

Answer 7

Atrovent

Question 8

MOA and DOA Ipatropium bromide

Answer 8

MOA: Antagonises bronchial constriction caused by parasympathetic stimulation. More effective for COPD than asthma.
DOA: slow onset of action (max effect 30-60 minutes), 3-5 hours. Often used in combo with short acting B2 agonist.

Question 9

SE of B agonists

Answer 9

Tremor + tachycardia
Overuse –> tolerance and desensitisation (should be taken on an “as needed” basis in the early stages of disease)
Co-morbidity with CVD - drug interactions

Question 10

Name short acting B2 agonists + trade names and DOA

Answer 10

Salbutamol (ventolin/asmol)
Terbutaline (bricanyl)
DOA: Max effect 30 mins, DOA 4-6 hours

Question 11

Long acting B agonist and DOA

Answer 11

Salmeterol (Serevent), DOA: 12 hours

Question 12

Seretide

Answer 12

Salmeterol + fluticasone combo

Question 13

Mechanism of B2 adrenergic agonists

Answer 13

Dilates bronchial smooth muscle by a direct action on B2 adrenergic receptors
Antagonises bronchoconstriction of the smooth muscle irrespective of the spasmogen involved (physiological antagonism)
Inhibits the release of inflammatory mediators by mast cells