BRTP07 Pharmacology Flashcards
4 forms of aerosol administration
- SVN- small volume nebulizer
- Breath actuated nebulizer
- DPI- dry powdered inhaler
- MDI- metered dose inhaler
Advantages of delivering inhaled drugs
Directly administered to target organs
smaller doses/ fewer side effects
rapid onset
disadvantages of delivering inhaled drugs
Delivered dosage may vary
Lack of knowledge by caregiver and or patient on proper administration
efficacy
a measurement term applied to a drugs EFFECTIVENESS at a receptor site. The higher the rating, the better it works.
refers to the maximum effect that a drug can deliver
potency
the amount of drug needed to produce the desired effect.
the lower the dose required, the higher the potency
tolerance
Receptor sites can change and adapt over time, increasing amounts of drug may be required to get the same therapeutic effect. The cells/ tissue becomes less sensitive to stimulation of the drug.
Half life
refers to the length of time it takes for the concentration of a drug to decrease by 1/2 through metabolism and elimination
half-life determines the frequency of drug administration
Steady state
refers to the amount of drug going in versus what is being eliminated. It takes 5-6 half lives to reach steady state, or its maximal concentration in the body
Agonist
STIMULATES
Stimulates or has affinity (attraction) for a receptor and causes a specific response
Antagonist
BLOCKS ACTION
Alpha receptors (1)
Vasoconstriction and vasopressor
Increase blood pressure
Beta 1
Increased heart rate and myocardial contractility
How hard the heart squeezes
Beta 2
Relaxes smooth bronchial muscle, stimulates mucociliary activity
Adrenergics
STIMULATE
Stimualte the SYMPATHETIC nervous system to DILATE bronchial smooth muscle, relieve bronchospasm in asthma, pnuemonia, cystic fibrosis, bronchiectasis, emphysema
Adrenergics are associated with what?
Agonist
Stimulate sympathetic nervous system
Anticholinergics
Aka antimuscarinic
BLOCK parasympathetic nervous system to block bronchospasm: helpful in asthma emphysema, chronic bronchitis
Anticholinergics are associated with what
Antagonist
Also known as antimuscarinic
Block parasympathetic
6 drug categories
- Adrenergic
- Anticholinergics (antimuscarinic)
- Mucoactive or mucolytic
- Anti-asthmatics
- Corticosteroids
- Anti-infectives
5 drug indications
Sympathomimetics Parasympatholytica Racemic epi Steroids or antiasthmatics Antibiotics
If you have a patient with stridor what type of drug would you want to give and what type of receptor sure is utilized?
Racemic Epi
Alpha 1
COPD Patients respond well to what category of drug? And is it considered an agonist or antagonist?
Anticholinergics/ antagonist
If i want to cause bronchodilation what receptor site would I want to target? What category of drug?
Beta 2
Agonist
Mucoactive or mucolytic
Work to thin and LOOSEN SECRETIONS
Bronchial pneumonia, cystic fibrosis, bronchitis, bronchiectasis
Anti-asthmatics
Work to block the immune response that causes inflammation or bronchospasm
Corticosteroids
Block the immune response that causes bronchospasm, enhance the action of adrenergics: asthmatics
(Also emphysema and chronic bronchitis) only in moderate to severe cases
Anti-infectives
Antibiotics or antiviral drugs given to treat or prevent certain pneumonias, particulary chronic
Pneumocytis in HIV patients and recurrent pneumonias in cystic fibrosis patients
What indicates need for sympathomimetics
Asthma, COPD, wheezing
What indicates need for parasympatholytics
COPD
Severe or chronic asthma
What indicates racemic epi
Stridor, upper airway swelling or obstruction
What indicates steroids or antiasthmatics
Chronic or severe asthma
What indicates antibiotics
Infection, pneumonia, purulent (full of pus) secretions
What is the purpose of giving a mucolytic? And to whom are these administered to?
Break down mucous/ move mucous
Given to people with bronchitis, pneumonia, cystic fibrosis
You are treating a patient with cystic fibrosis. One of the medications you need to nebulize is TOBI.
- What category is TOBI?
Antibiotic
6 rights of a patient
- Right patient
- Right drug
- Right dose
- Right time
- Right route
- Right documentation
Bronchodilators
Broncho constriction is caused by stimulation of the parasympathetic nervous system. This results in bronchospasm and increased mucous secretion.
The parasympathetic nervous system can be stimulated by irritants, allergens or stress
Bronchospasm can be treated by?
Stimulating the sympathetic nervous system to cause dilation (adrenergic bronchodilators)
Blocking the parasympathetic nervous system to prevent bronchospasm (anticholinergic)
Blocking an allergic reaction that is triggering the parasympathetic nervous system. These drugs are steroids or other drugs called anti asthmatics, not bronchodilators
Indications for bronchodilators
Wheezing due to REVERSIBLE causes.
Usually reversible but can be due to unilateral issue or obstruction.
More on wheezing
Anyone with inflammation if the airways can have wheezing, the inflammation triggers constriction if the smooth airway muscle which makes the airway smaller and causes wheezing.
Ultra short acting drug
Drug name:
Racemic epinephrine
Brand name:
Micronefrin
Nephron
Long acting adrenergic
Salmeterol
Arformoterol
Formoterol
Remember SAF aka long acting drugs are used to keep someone “safe”
Brand names for long acting adrenergic
Salmeterol— serevent
Arformoterol— brovana
Formoterol— foradil (dpi) and perforomist (svn)
Short acting adrenergic drugs
Albuterol (proventil/ ventolin)
Levalbuterol HCL (xopenex)
Mucoactive drugs
Dornase alfa (pulmozyme)
Acetylcysteine (mucomyst)
Anticholinergic
Ipratropium bromide (atrovent)
Tiotropium bromide (spiriva)
Anticholinergic and adrenergic
Ipratropium bromide
And
Albuterol
(Brand name)
Combivent and duoneb
Anti-infective
Pentamidine isethionate (NebuPent)
Corticosteroids
Beclomethasone Dipropionate (QVAR)
Fluticasone Propionate (flovent) (flovent discus)
Budesonide (pulmicort)
Adregenics work best in what patients?
Asthmatics
Anticholinergics work better in who?
COPD patients
SABA
Short acting beta adrenergic
SAAC or SAMA
Short acting anticholinergics
Short acting antimuscarinic
SABAs; SAACs; SAMAs
Rescue bronchodilators are fast acting (within 5-15 mins)
Quick peak (30-60 mins)
Usually shorter acting 4-6 hours (proventil or xopenex, atrovent)
LABA
Long acting beta adrenergic
LAAC OR LAMA
Long acting anticholinergic
Long acting antimuscarinic
LABAs; LAACs; LAMAs
Long acting (12 hours) adrenergics and cholinergic blockers (anticholinergics) are controller drugs used for frequent symptomatic poorly controlled lung disease.
3 Short acting bronchodilator adrenergics
Ultra short acting:
Racemic epinepherine
Short acting:
Albuterol
Levalbuterol
Difference between albuterol and levalbuterol
Albuterol is a beta 1 and beta 2
Levalbuterol is Beta2
levalbuterol will not cause tachycardia and tremors
Side effects of short acting and long acting adrenergics
Tachycardia Tremor Headache Insomnia Dizziness Nervousness Hypokalemia Nausea Tachyphylaxis
3 long acting bronchodilator adrenergics
Salmeterol (serevent)
Arformoterol (brovana)
Formoterol (foradil, performist)
Formoterol and aformoterol are also considered?
Fast acting (12 hrs)
Anticholinergic bronchodilators
Ipratropium (SAAC) (atrovent) (duoneb) (combivent) (called combivent when combined with albuterol)
Tiotropium (LAAC)
Umeclindinium (LAAC)
Side effects of anticholinergic bronchodilators
Dry mouth
Increased HR
Urinary retention
Use with caution if glaucoma is present
Clinical application
Your patient has been diagnosed with mild to moderate COPD
What would be the initial bronchodilator of choice?
Spirivia (tiotropium)
Atrovent (ipratropium)
(Proventil ventolin) (albuterol)
When should you terminate a treatment?
Tachycardia
When HR increases of 20% or 20 bpm
One of your adrenergic bronchodilators has a very special use for upper airway obstruction. What is it and what tyoes of situations would it be used in?
Racemic epinephrine
Rescue situations
Mucoactive/ mucolytic drugs
Pulmozyme (dornase alfa)- breaks DNA strands to thin purulent(infected/ pus filled) secretions. Wonder drug for CYSTIC FIBROSIS patients. Main side effect is voice alteration
Mucomyst (acetylcysteine)- breaks disulfide bonds, used for thick mucous; ROTTEN EGG SMELL; common side effect bronchocontrictions. PRETREAT W BRONCHODILATOR
Hypertonic NaCl- salt attracts water into the airways thinning mucus
Patients with thick or copious airway secretions are given what kinda of drugs?
Mucolytics
Patients with secretions in their airway will have what breath sounds?
Rhonchi aka coarse crackles or low pitched wheezes
Fine crackles are also called?
Rales or just “crackles”
What causes rhonchi/ coarse crackles?
What causes fine crackles?
- Secretions in large airways
2. Fluid in small airways or atelectasis
Your patient has a long standing diagnosis of cystic fibrosis.
What mucolytic of choice and what is the standard recommended dose?
Pulmozyme (dornase alfa)
2.5 mg a day
