Drugs used in COPD

Question 1

what are the characteristics of COPD?

Answer 1

-85% of pts are smokers
- irreversible airflow obstruction due to
–> emphysema
–> chronic bronchitis
- symptoms: barrel chest, dyspnea, sputum, chronic cough

Question 2

what is emphysema?

Answer 2

1. cigarette smoking is the major cause
2. dyspnea due to large insufficient gas exchange
3. permanent enlargement of bronchioles and alveoli due to destruction of their walls

Question 3

what is the patho of emphysema?

Answer 3

1. tissue damage by proteases
2. neutrophils and macrophages accumulate
3. oxidative injury by reactive oxygen species
   –> suppress protease activities

Question 4

what is a1- antitrypsin deficiency?

Answer 4

1. protease inhibitor produced in the liver
2. inhibits neutrophil elastase
3. rare genetic disorder leading to insufficient a1- antitrypsin activity
4. increased neutrophil migration and lung damage

Question 5

what is chronic bronchitis?

Answer 5

1. chronic inflammation in bronchial tubes
   –> fibrosis/ narrow of airways
   –> mucus hyper secretion
2. coexists with emphysema
3. cigs are major cause

Question 6

what is the patho of chronic bronchoitis?

Answer 6

1. initiated by irritants exposure
2. inflammation with infiltration of CD8+ T cells, macrophages, and neutrophils
3. microbial infection may play a secondary role in maintaining inflammation and exacerbating symptoms

Question 7

ATHMA VS. COPD (site, onset, symptoms, cells, mediators, ROS)

Answer 7

Question 8

what drugs are SABAs?

Answer 8

1. albuterol
2. levoalbuterol

Question 9

what drugs are LABAs?

Answer 9

1. salmeterol
2. formoterol

Question 10

what drugs are unltra long LABAs?

Answer 10

1. indacterol
2. olodacterol
3. vilanterol
4. bambuterol

Question 11

what drugs are antimuscarinics (LAMA)?

Answer 11

1. ipratropium
2. tiotropium
3. umeclidinium
4. aclidinium

Question 12

what drug is a PDE4 inhibitor?

Answer 12

1. roflumilast

Question 13

what are some combo drugs?

Answer 13

1. fluticasone furoate/ vilanterol
2. fluticasone furoate/ umeclidinium bromide/ vilanterol

Question 14

what do SABAs do?

Answer 14

1. short acting for quick relief
2. rapid onset, but response is less than seen in asthma

Question 15

what do LABAs do?

Answer 15

1. q12h
2. not for acute relief of symptoms

Question 16

what do ultra-LABAs do?

Answer 16

1. QD
2. can be used as monotherapy for COPD- not for asthma

Question 17

what do SAMAs do?

Answer 17

1. as effective as albuterol in patients with COPD
2. rapid onset

Question 18

what do LAMAs do?

Answer 18

1. QD
2. maintenance therapy
3. Quaternary amine salt like ipratropium

Question 19

what do methylxanthines do?

Answer 19

1. once considered first line
2. mostly replaced by LABA and LAMA
3. used for pts who are intolerant to or cannot use inhaled bronchodilators

Question 20

what does roflumilast do?

Answer 20

1. COPD but not asthma approved
2. increase cAMP conc
3. suppress release of cytokines and chemokines

Question 21

when do we use ICS in COPD and what is the mechanism?

Answer 21

1. short term use if they have exacerbations
2. inhalation therapy for chronic stable COPD
   MECHANISM
3. decrease mucus release
4. suppress protease release and prostaglandin production

Question 22

what can we use as a1-antitrypsin replacement therapy?

Answer 22

1. derived from donated blood
2. reduced lung tissue loss and destruction in patients with a1-antitrypsin deficiency
   –> prolastin, aralast, zemaira
   –> expensive