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.

Ipratropium(bronchodilator & anti-asthmatic)

N

H

OC

O

CH(CH3)2

CH

CH2OH

H3C

Br

Cholinergic Antagonists (Muscarinic receptor)Cholinergic Antagonists (Muscarinic receptor)

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)

MedicationsAlpha 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

ON

O

N

N

N

NH2

OMe

OMeDoxazosin(Cardura, Pfizer)

N

O

N

N

N

NH2

OMe

OMe

O

Prazosin(Minipress, Hypovase)

N

Cl

O

Phenoxybenzamine

N

NH

OH

Phentolamine

H2NSO2

H3CO

HN

O

CH3 OC2H5

Tamsulosin(Flomax, Astellas Pharma)

-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