Drugs used in COPD Flashcards
what are the characteristics of COPD?
-85% of pts are smokers
- irreversible airflow obstruction due to
–> emphysema
–> chronic bronchitis
- symptoms: barrel chest, dyspnea, sputum, chronic cough
what is emphysema?
- cigarette smoking is the major cause
- dyspnea due to large insufficient gas exchange
- permanent enlargement of bronchioles and alveoli due to destruction of their walls
what is the patho of emphysema?
- tissue damage by proteases
- neutrophils and macrophages accumulate
- oxidative injury by reactive oxygen species
–> suppress protease activities
what is a1- antitrypsin deficiency?
- protease inhibitor produced in the liver
- inhibits neutrophil elastase
- rare genetic disorder leading to insufficient a1- antitrypsin activity
- increased neutrophil migration and lung damage
what is chronic bronchitis?
- chronic inflammation in bronchial tubes
–> fibrosis/ narrow of airways
–> mucus hyper secretion - coexists with emphysema
- cigs are major cause
what is the patho of chronic bronchoitis?
- initiated by irritants exposure
- inflammation with infiltration of CD8+ T cells, macrophages, and neutrophils
- microbial infection may play a secondary role in maintaining inflammation and exacerbating symptoms
ATHMA VS. COPD (site, onset, symptoms, cells, mediators, ROS)
what drugs are SABAs?
- albuterol
- levoalbuterol
what drugs are LABAs?
- salmeterol
- formoterol
what drugs are unltra long LABAs?
- indacterol
- olodacterol
- vilanterol
- bambuterol
what drugs are antimuscarinics (LAMA)?
- ipratropium
- tiotropium
- umeclidinium
- aclidinium
what drug is a PDE4 inhibitor?
- roflumilast
what are some combo drugs?
- fluticasone furoate/ vilanterol
- fluticasone furoate/ umeclidinium bromide/ vilanterol
what do SABAs do?
- short acting for quick relief
- rapid onset, but response is less than seen in asthma
what do LABAs do?
- q12h
- not for acute relief of symptoms
what do ultra-LABAs do?
- QD
- can be used as monotherapy for COPD- not for asthma
what do SAMAs do?
- as effective as albuterol in patients with COPD
- rapid onset
what do LAMAs do?
- QD
- maintenance therapy
- Quaternary amine salt like ipratropium
what do methylxanthines do?
- once considered first line
- mostly replaced by LABA and LAMA
- used for pts who are intolerant to or cannot use inhaled bronchodilators
what does roflumilast do?
- COPD but not asthma approved
- increase cAMP conc
- suppress release of cytokines and chemokines
when do we use ICS in COPD and what is the mechanism?
- short term use if they have exacerbations
- inhalation therapy for chronic stable COPD
MECHANISM - decrease mucus release
- suppress protease release and prostaglandin production
what can we use as a1-antitrypsin replacement therapy?
- derived from donated blood
- reduced lung tissue loss and destruction in patients with a1-antitrypsin deficiency
–> prolastin, aralast, zemaira
–> expensive
