Chronic obstructive pulmonary disease drug therapy

The most serious side effects early in ACS are hypotension, bradycardia, and heart block. Initial acute administration of //-blockers is not appropriate for patients presenting with decompensated heart failure. However, therapy may be attempted in most patients before hospital discharge after treatment of acute heart failure. Diabetes mellitus is not a contraindication to //-blocker use. If possible intolerance to //-blockers is a concern (e.g., due to chronic obstructive pulmonary disease), a short-acting drug such as metoprolol or esmolol should be administered IV initially. 

The pharmacists of Care-Rite Pharmacy also developed patient educational tools to be used during the patient assessment and patient education components of the Pharmacy Check-up Service. Because many of the targeted patients have similar medical conditions, education materials were developed for specific disease states, including hypertension, ischemic heart disease, diabetes, asthma, chronic obstructive pulmonary disease (COPD), etc. Also, educational materials were developed for certain therapeutic classes of medications. The Care-Rite pharmacists also determined that many patients needed individualized education materials, so they implemented a drug information/educational service as part of the MTM service. With this service, patients can ask questions regarding their medical conditions and/or drug therapies. The pharmacists will research and provide an individualized written response for each patient. 

A beta-blocker may be used in the treatment of primary open-angle glaucoma, but these drugs are contraindicated for use in persons with chronic obstructive pulmonary disease and heart block (see Chapter 10). A careful history should be taken before initiating therapy to avoid potentially fatal ramifications. It is advisable to monitor patients who are taking beta-blockers (e.g., pulse, blood pressure) and to inquire about side effects at periodic follow-up examinations. 

Poole P J, Black P N 2001 Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary disease. British Medical Journal 322 1271-1274 Rees P J, Dudley F1998 Oxygen therapy in chronic lung disease. British Medical Journal 317 871-874 Rees P ], Dudley F1998 Provision of oxygen at home. 

The first MDI products were developed by Riker Laboratories and marketed in 1956, using a newly patented design of metering valve. In most countries the MDI is now established as the principal dosage form of inhalation drug therapy for bronchial asthma and chronic obstructive pulmonary disease (COPD). Since its introduction, MDI technology has evolved steadily. However, with the phase-out in the commercial use of chlorofluorocarbon (CFC) propellants, which have been the mainstay of pharmaceutical MDIs, the pace of MDI technology development has accelerated with the transition to hydrofluorocarbon (HFC) propellants. ... 

These drugs are used to alleviate depression, and are also used in the therapy of diabetic neuropathy. They may also be effective in the treatment of obsessive compulsive disorder (OCD) and attention-deficit hyperactivity disorder. Certain drugs of this class have also been therapeutically useful in the treatment of childhood enuresis (e.g., imipramine), fibromyalgia (e.g., amitriptyline), and chronic obstructive pulmonary disease (COPD) (e.g., protriptyline). 

A double-blind, randomized clinical trial over 7 days compared oral pure 1,8-cineole (3 x 200 mg/day) to Ambroxol (3 x 30 mg/day) in 29 patients with chronic obstructive pulmonary disease (COPD). Vital capacity, airway resistance, and speci c airway conductance improved signi cantly for both drugs, while the intrathoracic gas volume was reduced by 1,8-cineole but not Ambroxol. All parameters of lung function, peak ow, and symptoms of dyspnea were improved by 1,8-cineole therapy but were not statistically signi cant in comparison to Ambroxol due to the small number of patients. In addition to other properties, it was noted that the oxide seemed to have bronchodilatory effects (Wittman et ah, 1998). 

S. Onoue, et al. New treatments for chronic obstructive pulmonary disease and viable for-mulation/device options for inhalation therapy. Expert Opin DrugDeliv 6,793-811,2009. B.M. Ibrahim, et al. Challenges and advances in the development of inhalable drug formulations for cystic fibrosis lung disease. Expert Opin DrugDeliv 8, 451-466, 2011. 

More broadly, timolol therapy should be considered with caution in patients with any significant sign, symptom, or history for which systemic beta-blockade would be medically imwise.This includes disorders of cardiovascular or respiratory origin (e g., asthma, chronic bronchitis, and emphysema) as well as many other conditions. Spirometric evaluation after institution of timolol therapy may help to identify patients in whom bronchospasm develops after commencement of therapy. In general, however, patients with asthma and other obstructive pulmonary diseases should avoid this drug. Sympathetic stimulation may be essential to support the circulation in individuals with diminished myocardial contractility, and its inhibition by P-adrenoceptor antagonists may precipitate more severe cardiac feilure. 

Accretion of a viscid mucus is the hallmark of the more chronic forms of obstructive pulmonary disease. The presence of the mucus exacerbates the pathology both by providing a mechanical block to the inspiration and expiration of air and by preventing topical drugs from reaching the distal bronchi. Although not universally accepted, therapy which will liquify the mucus so that It can be expectorated should have a place in the treatment of COPD. Sulfhydryl drugs such as N-acetylcysteine are available for this use. 

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