L24 drugs used in COPD

Question 1

COPD

Answer 1

chronic obstructive pulmonary disease

Question 2

COPD affects more than ____ of the US adult population

Answer 2

10%

Question 3

COPD is the _____ leading cause of death in US in 2018

Answer 3

4th

Question 4

_____- of COPD pateints are smokers

Answer 4

85%

Question 5

COPD irreversible airflow obstruction due to

Answer 5

emphysema
chronic bronchitis

Question 6

COPD symptoms

Answer 6

-chronic cough
-sputum
-dyspnea
-barrel chest

Question 7

emphysema

Answer 7

-permanent enlargement of bronchioles and alveoli due to destruction of their walls
-dyspnea due to insufficient gas exchange
-cigarette smoking is the major cause
-frequently asymptomatic until the later stage of life

Question 8

patholphysiology of emphysema

Answer 8

tissue damage by proteases
oxidative injury by reactive oxygen species (ROS)

Question 9

tissue damage by proteases

Answer 9

-irritants in cigarette smoke cause inflammation in alveoli.
-Neutrophils and macrophages accumulate.
-Activated neutrophils and macrophages release proteases (ex. neutrophil
elastase), resulting tissue damage.

Question 10

oxidative injury by reactive oxygen species (ROS)

Answer 10

-ROS in cigarette smoke deplete antioxidants in the lungs (ex. superoxide
dismutase, glutathione).
-ROS inactivate ⍺1-antitrypsin, which normally suppresses the protease activities.
-Activated neutrophils also release ROS

Question 11

alpha 1-antitrypsin

Answer 11

-Protease inhibitor produced in the liver (53 kDa)
-Inhibits neutrophil elastase.
-Limits lung tissue damage

Question 12

alpha 1-antitrypsin deficiency

Answer 12

-Rare genetic disorder leading to insufficient ⍺1-Antitrypsin activity
-increased neutrophil migration
-Increased lung damage via inflammation and protease activity

Question 13

chronic bronchitis

Answer 13

-chronic inflammation in bronchial tubes
(mucus hypersecretion and fibrosis and narrowing of airways)
-frequently coexists with emphysema
-cigarette smoking is the major cause

Question 13

symptoms of chronic bronchitits

Answer 13

-producing cough
-wheezing
-shortness of breathe/ chest pain

Question 14

pathophysiology of chronic bronchitis

Answer 14

-Initiated by the exposure to irritants (cigarette smoke or other air pollutants)
 Hypersecretion of the bronchial mucous glands.
 Hypertrophy of mucous glands
 Metaplastic formation of mucin-secreting goblet cells
 Inflammation with infiltration of CD8+ T cells, macrophages, and neutrophils (no involvement of eosinophils)
-Microbial infection may paly a secondary role in maintaining inflammation and
exacerbating symptoms.

Question 15

tissue remodeling in COPD

Answer 15

-Fibrosis of small airways
-Hyperinflation of lungs:
 Alveolar enlargement
 Alveolar wall destruction
-Mucus hypersecretion

Question 16

asthma vs COPD in site

Answer 16

asthma; proximal airways
COPD; peripheral airways

Question 17

asthma vs COPD in onset

Answer 17

asthma; childhood
COPD; late adulthood

Question 18

asthma vs COPD in symptoms

Answer 18

asthma; episodic attack
COPD; progressive deterioration of pulmonary function

Question 19

cells affects in asthma vs COPD

Answer 19

asthma: mast cells, eosinophils, CD4+ T cells
COPD; neutrophils, macrophages, CD8+ T cells

Question 20

key mediators in asthma vs COPD

Answer 20

asthma: IL-4, IL-5, IL-13
COPD; IL-8, TNF-alpha, IL-1b, IL-6

Question 21

nonpharmacological therapy treatment of COPD

Answer 21

-Smoking cessation
-Exercise
-Immunization
-Long-term oxygen therapy

Question 22

pharmacological therapy in treatment of COPD

Answer 22

-Bronchodilators
 β2 selective agonists (short-acting, long-acting, and ultra-long-acting)
-Antimuscarinic agents (short-acting and long-acting)
-Methylxanthines
-Corticosteroids for patients with exacerbations
-alpha 1-antitrypsin replacement therapy (rare)

Question 23

beta 2 selective agonist: short-acting (SABA)

Answer 23

-Albuterol, levalbuterol
-Repid onset, but the response is less than seen in asthma.

Question 24

beta 2 selective agonist long acting (LABA)

Answer 24

-Salmetrol, formoterol
-Every 12 hours
-Not for acute relief of symptoms

Question 25

beta 2 selective agonist: ultra long acting (Ultra LABA)

Answer 25

-Indacaterol, olodaterol, vilanterol, bambuterol
-Once a day
-Can be used as monotherapy for COPD (not for asthma).
-Combination
 Fluticasone furoate/vilanterol

Question 26

antimuscarinic agents: short acting (SAMA)

Answer 26

-ipratropium
-As effective as albuterol in patients with COPD

Question 27

antimuscarinic agents: long acting (LAMA)

Answer 27

-Tiotropium, aclidinium, umeclidinium
-Once a day
-Approved for maintenance therapy of COPD.
-Quaternary amine salt like ipratropium
-Combination
 Fluticasone furoate/umeclidinium
bromide/vilanterol

Question 28

mathylxantines

Answer 28

-Once considered first-line therapy for COPD.
-Mostly replaced by LABA and antimuscarinics.
-Theophylline

Question 29

methylxantines: theoohylline

Answer 29

 Used in patients who are intolerant to or cannot use inhaled bronchodilators.
 Bronchodilation and anti-inflammatory action
 Systemic administration may be beneficial on peripheral airways

Question 30

roflumilast

Answer 30

 Phosphodiesterase-4 (PDE4) inhibitor
 Increases the intracellular cAMP concentration as methylxanthines.
 Suppresses the release of cytokines and chemokines
 Approved for COPD, but not for asthma

Question 31

corticosteroids uses in COPD

Answer 31

-Short-term systemic use for acute exacerbations
-inhalation therapy for chronic stable COPD

Question 32

mechanisms of cortiosteroids

Answer 32

 Decrease mucus release by reducing capillary permeability
 Suppress protease release from immune cells
 Suppress prostaglandin production

Question 33

alpha 1-antitrypsin replacement therapy: products

Answer 33

-Derived from donated blood
-Prolastin® , Aralast®, Zemaira®

Question 34

alpha 1- antitrypsin replacement therapy

Answer 34

-Reduces lung tissue loss and destruction in patients with severe ⍺1-Antitrypsin deficiency.
-Expensive (>$50k a year)

Question 35

short acting beta 2 selective agonist (SABA)

Answer 35

-Albuterol
-Levalbuterol (Xopenex®)

Question 36

long acting beta 2 selective agonist (LABA)

Answer 36

-Salmetrol (Serevent ®)
-Formoterol

Question 36

ultra long acting beta 2 selective agonists

Answer 36

-Indacaterol (Arcapta® )
-Olodaterol (Strieverdi®)
-Vilanterol (
-Bambuterol (Bambec ®, Oxeol ®)

Question 36

methylxanthine

Answer 36

theophylline

Question 36

antimuscarinic

Answer 36

-Ipratropium (Atrovent ®)
-Tiotropium (Spiriva ®)
-Aclidinium (Tudorza ®, Pressair®)
-Umeclidinium (Incruse Ellipta ®)

Question 36

PDE4 inhibitor

Answer 36

Roflumilast (Daliresp ®)

Question 36

combinations

Answer 36

-Fluticasone furoate/vilanterol (Breo
Ellipta ®)
-Fluticasone furoate/umeclidinium
bromide/vilanterol (Trelegy Ellipta ®)