O slideshow foi denunciado.

Mais Conteúdo rRelacionado

Livros relacionados

Gratuito durante 30 dias do Scribd

Ver tudo

Audiolivros relacionados

Gratuito durante 30 dias do Scribd

Ver tudo

COPD new drugs new devices

  1. 1. 3www.slideshare.net/ashraf eladawy
  2. 2. 4
  3. 3. 5 Manage Stable COPD
  4. 4. 6
  5. 5. 7 Pharmacological treatment of COPD (Lots of inhalers, lots of names…)
  6. 6. 8
  7. 7. 9 More useful to classify in terms of classes
  8. 8. 10
  9. 9. Children’s Healthcare of Atlanta
  10. 10. 12
  11. 11. 13
  12. 12. 14
  13. 13. 15
  14. 14. 16
  15. 15. 17
  16. 16. 18
  17. 17. 19
  18. 18. 20
  19. 19. 21
  20. 20. 22
  21. 21. 23
  22. 22. 24
  23. 23. 25
  24. 24. 26
  25. 25. 27
  26. 26. 28
  27. 27. 29
  28. 28. 30 Long-Acting Bronchodilators • LAMAs • Block acetylcholine- mediated bronchoconstriction (via M3 receptors) – Tiotropium – Aclidinium – Glycopyrronium (glycopyrrolate) – Umeclidinium • LABAs • Direct relaxant activity on airway smooth muscle (via β2 adrenoceptors) – Formoterol – Salmeterol – Indacaterol – Oldaterol – Vilanterol
  29. 29. 31
  30. 30. 32 LABA DPI Diskus Serevent® (salmeterol) DPI Aerolizer Foradil® (formoterol) DPI Breezhaler Onbrez® (indacaterol) SMI Respimat Striverdi® (Olodaterol)
  31. 31. 33 Serevent® (salmeterol)
  32. 32. 34
  33. 33. 35
  34. 34. 36
  35. 35. 37
  36. 36. 38
  37. 37. 39
  38. 38. 40
  39. 39. 41
  40. 40. 42 LAMA DPI HandiHaler/ SMI Respimat Spiriva® (tiotropium) DPI Breezhaler Seebri® (glycopyrronium) DPI Genuair Eklira® (aclidinium) DPI Ellipta Incruse® (umeclidinium) LAMA inhalers for COPD
  41. 41. 43
  42. 42. 44
  43. 43. 45
  44. 44. 46
  45. 45. 47
  46. 46. 48
  47. 47. 49
  48. 48. Children’s Healthcare of Atlanta Proskocil BJ et al. Proc Am Thorac Soc. 2005;2(4):305-310. SMC relaxationSMC contraction M3- muscarinic receptors Beta Agonists (LABA)Antocholinergics (LAMA) β2-adrenergic receptors Mechanisms of action of bronchodilators on airway smooth muscle
  49. 49. 51
  50. 50. 52 Fixed-dose combination LABA/LAMA DPI Ellipta Anoro® (vilanterol/umeclidinium) DPI Breezhaler Ultibro® (indacaterol/glycopyrronium) SMI Respimat Inspiolto® (olodaterol/tiotropium) DPI Genuair Duaklir® (formoterol/aclidinium) Combination LABA/LAMA inhalers for COPD
  51. 51. 53
  52. 52. 54
  53. 53. 55
  54. 54. 56
  55. 55. 57
  56. 56. 58
  57. 57. 59
  58. 58. 60
  59. 59. 61
  60. 60. 62 ICS/LABA DPI Diskus Advair® (Fluticasone/salmeterol) DPI Turbuhaler Symbicort® (Budesonide/formoterol) DPI Ellipta Relvar® (Fluticasone/vilanterol)
  61. 61. 63
  62. 62. 64 Diskus
  63. 63. 65
  64. 64. 66
  65. 65. 67
  66. 66. 68
  67. 67. 69
  68. 68. 70
  69. 69. 71
  70. 70. 72
  71. 71. 73
  72. 72. 74
  73. 73. 75
  74. 74. 76
  75. 75. 77 Phosphodiesterase-4 inhibitor: Roflumilast (Daliresp) i. Indication: As a daily treatment to reduce the risk of COPD exacerbations in patients with severe COPD (FEV1 less than 50% of predicted) associated with chronic bronchitis and a history of frequent exacerbations. ii. Mechanism: Reduces inflammation through inhibition of the breakdown of intracellular cyclic adenosine monophosphate; no direct bronchodilator activity page
  76. 76. 78
  77. 77. 79
  78. 78. 80 iii. Dose: 500 mcg orally once daily iv. Contraindications: Moderate to severe liver impairment; use in nursing mothers v. Precautions: Weight loss (monitor); psychiatric events including suicidality (monitor; weigh risk/benefit ratio in patients with preexisting psychiatric illness). Twenty percent of patients studied had weight loss of 5%–10% of body weight, compared with 7% with placebo; average weight loss was 2 kg.
  79. 79. 81
  80. 80. 82
  81. 81. 83 vi. Adverse reactions: Diarrhea, weight loss or decreased appetite, nausea, headache, back pain, influenza, insomnia, and dizziness vii. Drug interactions: Use with strong cytochrome P450 (CYP) enzyme inducers is not recommended (e.g., rifampin, phenobarbital, carbamazepine, phenytoin); use with CYP3A4 inhibitors or dual inhibitors of CYP3A4 and CYP1A2 (e.g., erythromycin, ketoconazole, fluvoxamine) increases roflumilast exposure and adverse effects (risk/benefit ratio must be weighed).
  82. 82. 84
  83. 83. 85
  84. 84. Children’s Healthcare of Atlanta 86
  85. 85. 87

×