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DRUGS FOR REVERSIBLE COPD

 BETA-2 AGONIST (salbutamol, salmeterol)

Therapeutic effects

Used to treat the symptoms of bronchospasm in asthma (both in an acute attack and as maintenance therapy) and chronic obstructive pulmonary disease (COPD).

1. relaxation of smooth muscle including bronchial, uterine and vascular

 2. inhibition of release of inflammatory mediators

 3. increased mucociliary clearance

Adverse effects

  • increase in heart rate, force of myocardial contraction
  • speed of impulse conduction and enhanced production of ectopic foci in the myocardium and automaticity in pacemaker tissue. This can cause dysrhythmias and symptoms of palpitations.
  • muscle tremor

adverse metabolic effect

  • hypokalemia (via redistribution of K into cells);
  • raised free fatty acid concentrations;
  • hyperglycemia due to a greater increase in glycogenolysis than in insulin secretion.
  • desensitization

MUSCARINIC RECEPTOR AGONIST (stramonium, ipratropine)

Therapeutic effects

  • ipratropium, are quaternary ammonium analogues and have reduced systemic absorption due to their positive charge
  • Ipratropium has a place in maintenance therapy and the treatment of acute severe attacks of asthma and chronic bronchitis.
  • It is compatible with β2-agonists, and such combinations are additive

Adverse effects

These include:

  • bitter taste (this may compromise compliance)
  • acute urinary retention (in patients with prostatic hypertrophy)
  • acute glaucoma has been precipitated when nebulized doses are given via a face mask;
  • paradoxical bronchoconstriction due to sensitivity to benzalkonium chloride, which is the preservative in the nebulizer solution

METHYLXANTHINES (aminophylline, theophylline)

Therapeutic effects

  • theophylline may be used for less severe symptoms or to reduce nocturnal asthma symptoms

Adverse effects

  • nausea,
  • vomiting
  • headache
  • flushing
  • hypotension
  • headache
  • insomnia

CROMOGLICATE (sodium cromoglicate, nedocromil)

Therapeutic effects

  • used to prevent exercise-induced asthma and as prophylaxis for allergic asthma in children,
  • Prevents exercise-induced asthma

Adverse effects

  • Bronchospasm
  • Headache
  • Hoarseness

GLUCOCORTICOIDS

Therapeutic effects

  • used in the treatment of asthma and in severe exacerbations of COPD

adverse effects

  • Side effects are minimal with topical therapy (oral thrush, hoarse voice

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