Treatment of COPD

BronchodilatorsThere are three types of
bronchodilators used clinically: β2-agonists,
anticholinergics and methylxanthines.[8]These
drugs relax the smooth muscles of the airway
allowing for improved airflow. Many patients feel
less breathless after taking bronchodilators.
Cholinergic Antagonists (Muscarinic receptor)
Br
CH(CH3) 2
H 3C
N
H
CH2 OH
O
CH
C
O
Ipratropium
(bronchodilator & anti-asthmatic)
Adrenergic Receptors in the CNS
-Blockers
Alpha blockers (also called alpha-adrenergic blocking agents)
constitute a variety of drugs which block α1-adrenergic receptors in
arteries and smooth muscles.

These drugs may be used to treat:･benign prostatic hyperplasia
(BPH)･high blood pressure (hypertension). This is not typically the
drug of choice unless the patient also has BPH.･symptoms of non
inflammatory chronic pelvic pain syndrome, a type of prostatitis. As a
side effect they may reduce blood pressure and result in
lightheadedness.

Benign Prostatic Hyperplasia
Treatment of benign prostatic hyperplasia (BPH)
Medications
Alpha blockers (α1-adrenergic receptor antagonists) (such as doxazosin, prazosin, alfuzosin
and tamsulosin) and certain antiandrogens such as the 5α-reductase inhibitors (finasteride
and dutasteride) are used, often together, in suppressing the symptoms. Alpha-blockers
relax smooth muscle in the prostate and bladder neck decreasing the degree of blockage of
urine flow. Alpha-blockers may cause ejaculation back into the bladder (retrograde
ejaculation). This is not harmful.
There is also extensive evidence of the efficacy of Serenoa repens (saw palmetto) fruit
extracts in alleviating mild-to-moderate BPH symptoms. A systematic review of evidence
found comparable efficacy to finasteride. (Wilt et al., 2002) Other herbal medicines that
have solid research support in systematic reviews include beta-sitosterol from Hypoxis
rooperi (African star grass) and Prunus africanum (pygeum) bark, while there is less
substantial support for the efficacy of Cucurbita pepo (pumpkin) seed and Urtica dioica
(stinging nettle) root. (Wilt et al., 2000) At least one double-blind trial has also supported the
efficacy of rye flower pollen. (Buck, et al., 1990)
Sildenafil shows some symptomatic relief, suggesting a possible common etiology with
erectile disfunction. (Brown 2005)o
Examples of commercial -blockers
O
O
O
N
N
N
O
N
N
N
OMe
OMe
O
N
Prazosin
(Minipress, Hypovase)
N
Doxazosin
(Cardura, Pfizer)
OMe
NH2
OMe
NH2
N
O
N
H2NSO2
O
N
H
OH
Cl
Phenoxybenzamine
H
N
Phentolamine
H3CO
CH3
Tamsulosin
(Flomax, Astellas Pharma)
OC2H5
-Blockers

Beta blockers (sometimes written as β-blockers)
are a class of drugs used for various indications,
but particularly for the management of cardiac
arrhythmias and cardioprotection after myocardial
infarction. Whilst once first-line treatment for
hypertension, their role was downgraded in June
2006 in the United Kingdom to fourth-line as they
perform less well than other drugs, particularly in
the elderly, and there is increasing evidence that
the most frequently used beta-blockers at usual
doses carry an unacceptable risk of provoking type
2 diabetes.[1]
Hypertension
What are -blockers used for?




Numerous studies suggest that beta-blockers can reduce
mortality by 25% to 40% in patients with certain kinds of heart
failure, and cut sudden cardiac death up to 50% in patients with a
recent heart attack.
Current Uses
Treatment･Angina pectoris (chest pain associated with lack
of oxygen to the heart)･Arrhythmias (irregular heart
rhythms)･Heart attack･Heart failure･Hypertension (high
blood pressure)
Prevention･Protects the heart in people who have coronary
artery disease･Reduces risk of stroke･Protective prior to
non-cardiac surgery in persons at high risk of
complications