degradation of alveolar walls that causes air to get trapped
What is emphysema?
secrete chemokines to stimulate neutrophils
What is the role of macrophages in COPD?
secrete proteases; this causes emphysema and mucus hypersecretion
What is the role of neutrophils in COPD?
less eosinophils
Why are IL-5 & IL-4 drugs NOT used in COPD?
loss of cilia, airway remodeling/dyspnea, decreased oxygen exchange
What are the 3 main pathophysiological consequences of COPD?
pneumonia
What can increased mucus production lead to in COPD?
neutrophils, macrophages, CD8+ T lymphocytes
Which cells are involved in COPD? (3)
LTB4, IL-8, TNF-a
Which inflammatory mediators are involved in COPD? (3)
SABA, SAMA
What medications would be used for relief of acute symptoms? (2)
IL-5, LT-antagonist, IL-4, IgE, ICS
Which drugs used in Asthma would NOT be useful in COPD? (4)
reduction of airway remodeling/dyspnea
What are bronchodilators/anti-inflammatory drugs used for in COPD?
indacaterol, olodaterol, vilanterol
What are the Ultra-long acting LABAs? (3)
true
SABAs & SAMAs are equally effective in COPD. T/F?
false
LABAs are more effective than LAMAs in COPD. T/F?
anticholinergics; vagal tone may be the only reversible element in airway obstruction; decreased ACh production
Which is more effective, Anticholinergics or B2 agonists?
Why?
TNF-a
_______ induces ACh secretion.
tiotropium, aclidinium, umeclidinium, glycopyrronium, revefenacin
What are the LAMAs? (5)
glaucoma; nebulizer
__________ can occur when anticholinergics are taken via ________.
inhibition of PDE- bronchodilation; antagonism of adenosine- prevent bronchoconstriction; histone deacetylation- prevent transcription of inflammatory genes; IL-10 release- apoptosis of neutrophils/eosinophils
MOA of Methylxanthines? (4)
can increase risk of pneumonia
Why are ICS generally avoided in COPD?
anticholinergics
-M3 receptor antagonist that prevent bronchoconstriction & mucus
production.
activate GPCR adenyl-cyclase to induce smooth muscle relaxation/bronchodilation
B2 agonist MOA?
inhibits PDE4; prevents cAMP degradation which decreases activity of inflammatory cells, IL-8, TNF-a
Roflumilast MOA?
CYP3A4; CYP1A2
Roflumilast is metabolized via ______ & ______.
weight loss (N/V), neuropsychiatric
AE's of Roflumilast? (2)
f; orally
Roflumilast is administered via inhalation. T/F?
A1-antitrypsin
-coats lungs & protects them from neutrophil elastase.
c
Where is A1-antitrypsin produced?
a) lungs
b) kidneys
c) liver
d) adrenal glands
azithromycin, erythromycin
Which ABs can we give for COPD exacerbations? (2)
n-acetylcysteine + water
Which mucolytic treatment can we use in COPD?