Chronic obsrtuctive pulmonary disease (COPD) Medical Presentation

Chronic Obsrtuctive Pulmonary Disease PowerPoint Presentation

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Published on : Oct 11, 2019 | Views : 1683 | Downloads : 8

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What is COPD ? Overview : Chronic obsrtuctive pulmonary disease (COPD) is a type of obstructive pulmonary disease characterized by long term poor air flow. COPD typically worsens over time , an airflow obstruction that is not fully reversible. COPD is historically described as emphysema and chronic bronchitis. The primary cause of COPD is cigarette smoking implicated in 85% of diagnosed cases.
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Copd: is a Long term poor airflow with chronic bronchitis emphysema and in some cases asthma. Chronic bronchitis emphysema Long lasting productive cough Gradual damage of lung tissue (specifically thinning and destruction of the alveoli ) asthma Reccurent episodes of wheezing ,brethlessness, cough and chest tightness
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Is a syndrome of chronic limitation in expiratory air flow encompassing emphysema and chronic bronchitis Airflow obstruction can be accompanied by airflow hyperresponsivness and may not be fully reversible. 1) chronic bronchitis : consists of persistent cough plus sputum production for most days of 3 months in at least 2 consecutive years. 2) emphysema : is abnormal permanent enlargement of the airspaces distal to the terminal bronchioles , accompanied by destruction of their walls and without obvious fibrosis. Copd Definition
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Oxidative stress Airflow limitation Mucus hypersecretion Exacerbations Systemic features pathophysiology:
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Symtoms
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Causes of COPD
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Classification of severity of airflow limitation ; spirometric Gold classification
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treatment goals : Relieve symptoms Reduce the frequency and severity of exacerbations Improve exercise tolerance Improve health status Minimize adverse effects from treatment
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NON PHARMACOLOGIC THERAPY Oxygen therapy Pulmonary rehabilitaion surgery
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smooking cessation therapies: Nicotine inhaler
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Adverse effects of bupropion : increased risk o seizures insomnia anxiety irritability headache dercreased appetite. Bupropion
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Verenicline Adverse effects of verenicline : nausea,vomiting, Headache, constipation , sleep disturbance and unusual dreams.( verenicline is category C in pregancy ).
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vaccinations All patients with COPD should receive the influenza vaccine yearly and polysaccharide pneumococal vaccine once before age 65 ; then a one time revaccination 5 years or more after the first vaccination.
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COPD medications Bronchodilators 1)beta2-agonists 2)Anticholinergics 3)Methylxanthines 4)Combinations Anti-inflammatories 1)Inhaled corticosteroids 3)Oral corticosteoids 4) phosphodiesterase 4 inhibitors
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Fixed combinations Albuterol +iptratropium Fenoterol + iptratropium Budesonide+ formoterol Salmeterol + fluticasone Formoterol+beclomethasone
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bronchodilators Inhaled bronchodilators, including the β2-adrenergic agonists and anticholinergic agents (ipratropium and tiotropium]), are the foundation of therapy for COPD (These drugs increase airflow, alleviate symptoms, and decrease exacerbation rates. The long-acting agents, LABAs and tiotropium,are preferred as first-line treatment of COPD for all patients except those who are at low risk with less symptoms. Combination of both an anticholinergic and a β2 agonist may be helpful in patients who have inadequate response to a single inhaled bronchodilator
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Adrenergic agonists contraindication: Used with caution in patients with: hyperthyroidism, glaucoma, diabetes hypokalemia,seizures cadiovascular disease; Heart failure hypertension arrhythmias coronary disease MOA: Stimulation of beta-2-receptors Activation of adenyl cyclase ATP cyclic AMP Activation of protein Kinase Inhibition of release of calcium into cytoplasm bonchodilation
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Adverse effects: Palpitations Tachycardia Insomnia Irritability Tremors Hypokalemia Drug-drug interactions: Beta-adrenocepror antagonists. Other a drenergic agonists. Some diuretics Antidepressants ( MAOI) Cardiac glycosides Ect…
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Beta-2-agonists Short acting beta-2-adrenoceptor agonists (SABA) .*Short-acting β2 agonists (SABAs) have a rapid onset of action (5 to 30 minutes) and provide relief for 4 to 6 hours. They are used for symptomatic treatment of bronchospasm, providing quick relief of acute bronchoconstriction. Direct acting β2-selective agonists include albuterol and levalbuterol [These agents provide significant bronchodilation
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Albuterol ( salbutamol )
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Long acting beta-2-adrenoceptor agonists (LABA) Beta-2-agonists Salmeterol and formoterol are long-acting β2 agonists (LABAs) and chemical analogs of albuterol. Salmeterol and formoterol have a long duration of action, providing bronchodilation for at least 12 hours . Use of LABA monotherapy is contraindicated. LABAs are available as a combination product with an ICS.
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formeterol
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salmeterol
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Salmeterol/Fluticasone
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Formoterol/budesonide Trade name : symbicort
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Formoterol/beclomethasone Trade name Foster
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anticholinergics Short acting muscarinic antagonists (sama) iptratropium Long acting muscarinic antagonists (lama= tiotropium The anticholinergic agents block vagally mediated contraction of airway smooth muscle and mucus secretion. Inhaled ipratropium, a quaternary derivative of atropine, is not recommended for the routine treatment of acute bronchospasm in asthma, as its onset is much slower than inhaled SABAs. However, it may be useful in patients who are unable to tolerate a SABA or patients with concomitant COPD.
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Side effects: xerestomia , bitter taste and local anticholinergic effect
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Iptratripium/salbutamol Combivent
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Iptratropium/fenoterol
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ipratropium
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tiotropium
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Theophylline can help your lungs work better, but it may not control all of your symptoms. theophylline has been largely replaced with β2 agonists and corticosteroids due to its narrow therapeutic window, adverse effect profile, and potential for drug interactions. Overdose may cause seizures or potentially fatal arrhythmias Theophylline is metabolized in the liver and is a CYP1A2 and 3A4 substrate. It is subject to numerous drug interactions. Serum concentration monitoring should be performed when theophylline is used chronically. Methylxanthine theophylline
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Theophylline MOA : Is a methylxanthine derivative that inhibits phosphodiesterase , the enzyme reponsible for the metabolismof cAMP to AMP . Increased levels of cAMP result in bronchodilation. Theophylline has no significant anti-inflammatory effects. Caffeine or xanthine containing foods and beverages Diet high in protein and charcoal broiled beef and low in carbohydrates High-carbohydrate, low protein diet: Drug-food interaction Drug-drug interactions: Allopurinol, calcium channel blokers cimetidine, corticosteroids, disulfiram, ephedrine, hormonalcontraceptives, influenza virus vaccine quinolones Tetracyclines Carbamazepine nonselective beta-adrenergic blockers,.
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Contraindications of theophylline *hypersensitivity to drug or other xanthines (such as coffe, thobromine) *Active peptic ulcer *Seizure disorders Side effects: Nausea vomiting stomach abdominal pain headache trouble sleeping diarrhea , irritability, restlessness, nervousness, shaking, or increased urination may occur
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theophylline
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Corticosteroids The addition of an ICS to a long-acting bronchodilator may improve symptoms, lung function and quality of life in COPD patients with FEV1 of less than 60% predicted. However, the use of an ICS is associated with an increased risk of pneumonia, and therefore, use should be restricted to these patients. Although often used for acute exacerbations, oral corticosteroids are not recommended for long-term treatment.
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MOA: corticosteroids ara presumed to act by their broad anti_inflammatory efficacy mediated in part by the inhibtion of production of inflammatory cytokines. Corticosteroids inhibit the lympholytic and and eosinophilic inflamation of the airways . Drug-drug interactions: Ephedrine ,Rifampin , Phenytoin, Estrogens, warfarin, diuretics , amphotericin B , physostigmine, cholestyramine, keteconazole ect… Use corticosteroids with caution in patients with the following conditions: osteoporosis or any other bone disease current or past tuberculosis, glaucoma ,sores in the nose or recent nose surgery (if using nasal spray forms of corticosteroids) underactive or overactive thyroid liver disease stomach or intestine problems diabetes heart disease high blood pressure high cholesterol kidney disease or kidney stones myasthenia gravis skin conditions that cause the skin to be thinner and bruise more easily.
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Side effects: Cough , increased chance of infections , infections of mouth , hoarse voice , sore mouth of throat, weakened bone , gaining weight , getting easily bruised .
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budesonide
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fluticasone
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Medications
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is an oral phosphodiesterase-4 inhibitor used to reduce exacerbations in patients with severe chronic bronchitis. Although its activity is not well defined in COPD,it is theorized to reduce inflammation by increasing levels of intracellular cAMP in lung cells. Roflumilast is not a bronchodilator and is not indicated for the relief of acute bronchospasm. Its use is limited by common side effects including nausea, vomiting, diarrhea, and headache Phosphodiesterase-4-inhibitor Roflumilast
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Other pharmacological thereatment
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1)List three drugs in INHALER form. 2)Which of the following is the manufacturer of ventolin ? Novartis-Pfizer- Merck-Bayer – Abott-Glaxo smith kline Questions
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References : Lipincott pharmacology sixth edition Drugs.com Drugsinjordan.com Healthline.com Medicaldictionary.thefreedictionary.com Signhealth.com Medecinenet.com WebMD.com
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Done by : Kawtar Jalal