COPD drugs

Question 1

List the severity, FEV1 and treatment for COPD

Answer 1

Mild: FEV1 greater than 80% and treatment: SABA when needed
Moderate: FEV1 50-79 and treatment: One or more dilators + IGC (inhaled glucocorticoids)
Severe: FEV1 30-49 and treatment: One or more dilators + IGC and AB (Antibiotic)
Very Severe: FEV1 less than 30 or chronic respiratory failure symptoms and treatment: one or more dilators + IGC + AB + Assisted ventilation

Question 2

What is the mnemonic for COPD treatment?

Answer 2

Corticosteroids
Oxygen
Prevention (cigarette smoking cessation, infection control)
Dilators (anti cholinergeric and beta 2 agonist)

Question 3

Moving on to cough medications the first are opioids: antitussives, Codeine and Dextrometorphan. What is the use and how do these drugs suppress cough?

Answer 3

Use:
–have a limited role. coughing is a symptom and whenever possible, therapy is directed to its etiology. However, in acute respiratory tract infections where cough disrupts sleep, antitussives may be used.
Opiates suppress cough:
–decrease the CNS cough center’s sensitivity to peripheral stimuli, these actions occur at doses lower than those required for analgesia

Question 4

What is the MOA for codeine and dextromethorphan?

Answer 4

Dextromethorphan: a synthetic derivative of codeine
MOA for dextromethorphan:
–suppresses the response of the cough center, but it does not have any analgesic or addictive potential and is less constipating than codine

Question 5

For a cough another drug that can be used is a Mucolytic Agent called N-acetylcysteine, what is the use of this drug?

Answer 5

Mucolytic agent and used for management of acetaminophen overdose
–useful for CF patients
Breaks disulfide bonds in mucus and liquefies it making it easier to cough out

Question 6

Moving on to agents for Rhinitis are the H1 antagonists, Diphenhydramine, Chlorpheniramine, Loratadine, Fexofenadine and Cetirizine. What is their use in regards to rhinitis?

Answer 6

Rhinitis: inflammation of mucous membranes of the nose
Etiology of Rhinitis:
–most commonly causes by viruses or by hypersensitivity responses to airborne allergens
Tx:
–try avoidance therapy for allergic rhinitis

Question 7

In regards to rhinitis, if irritant avoidance is not realistic or if the rhinitis appears to be caused by a virus, what are the medical options?

Answer 7

1. Nasal corticosteroids
2. Cromolyn Sodium
3. Antihistamines
4. Alpha adrenergic agonists
5. Corticosteroids commonly used to treat chronic rhinitis: beclomethasone and flunisolide
   - –not improvement after 2 weeks than start therapy

Question 8

What is the MOA for anti-histamines?

Answer 8

Blockers of H1 histamine receptors

Question 9

Which H1 blockers or antihistamines produce drowsiness?

Answer 9

Diphenhydramine, Chlorpheniramine and Cyproheptadine: all cross the BBB and produce drowsiness
Loratadine, Fexofenadine and Cetirizine: non drowsy antihistamines

Question 10

Alpha adrenergic agonists can be used in rhinitis, what is the MOA of alpha adrenergic agonist?

Answer 10

Constrict dilated arterioles

–in nasal mucosa and reduce airway resistance

Question 11

What are some alpha adrenergic agonists used in treatment of rhinitis?

Answer 11

Phenylephrine and Pseudoephedrine
Phenylephrine is also used to dilate pupil and increase BP
Effects of prolonged use of nasal decongestants:
–rebound nasal congestion often occurs after discontinuation from prolonged use