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1101- Basic Respiratory Care > Chapter 36, Airway Pharmacology > Flashcards

Chapter 36, Airway Pharmacology Flashcards

1
Q

What are inhaled medications for?

A
  • relax bronchial smooth muscle
  • reduce (Upper and lower) airway edema
  • prophylaxis of bronchospasm (antiasthma)
  • thin secretions
  • treat infections (bacterial, viral, fungal, etc.)
  • induce pulmonary vasodilation
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2
Q

what are the 3 phases of pharmacology

A
  • drug administration phase
  • pharmacokinetic phase
  • pharmacodynamic phase
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3
Q

Drug Administration Phase:

what is this phase

A

the method by which drug is made available to he body

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4
Q

Drug Administration Phase:

how is this delivered?

A

drugs directly to the respiratory tract uses the inhalation route
-liquid solutions, suspensions, or dry powders

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5
Q

Drug Administration Phase:

what are most common devices used to administer inhaled aerosols

A
  • metered dose inhaler (MDI)
  • soft- mist inhaler (Respimat)
  • small volume nebulizer (SVN)
  • dry-powder inhaler (DPI)
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6
Q

Drug Administration Phase:

Advantages of inhaled aerosols?

A
  • aerosol doses are usually smaller than does for systemic administration
  • onset of drug action is rapid
  • delivery is targeted to the organ requiring treatment
  • systemic side effects are often fewer and less severe
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7
Q

Drug Administration Phase:

disadvantages of inhaled aerosols

A
  • the number of variable affecting the delivered dose
  • lack of adequate knowledge of device performance
  • use among patients and caregivers
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8
Q

Pharmacokinetic Phase:

what is this phase/method?

A

describes the time course and disposition of drug in body based on its absorption, distribution, metabolism, and elimination

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9
Q

Pharmacokinetic Phase:

describe fully ionized aerosol drug

A

fully ionized aerosol drug has little or no systemic side effects (Ipratropium)

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10
Q

Pharmacokinetic Phase

describe nonionized aerosol drug

A

nonionized aerosol drug is lipid soluble and diffuses across cell membranes and into bloodstream, producing systemic side effects

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11
Q

Pharmacokinetic Phase:

what is lung availability/total systemic availability ration

A

(L/T ratio) quantifies efficiency of aerosol delivery to lung
-L/T ration= lung availability/(Lung + GI availability)

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12
Q

Pharmacodynamic Phase:

what is the mechanism of drug action

A

the mechanism’s of drug action by which a drug molecule causes its effect in the body

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13
Q

Pharmacodynamic Phase:

what causes drug effects

A

combination of drug with matching receptor

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14
Q

Pharmacodynamic Phase:

what are some (2) drug-signaling mechanism?

A

1) mediation by G protein (guanine nucleotide) -linked receptors
- -Beta-adrenergic agonists, antimuscarinic agents
2) attachment to intracellular receptors by lipid-soluble drugs
- -Corticosteroids

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15
Q

Airway Receptors and Neural Control of Lung:

what are the receptors in the lung (2)?

A

-sympathetic (adrenergic) and parasympathetic (cholinergic) receptors are in the lung

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16
Q

Airway Receptors and Neural Control of Lung:

what the neurotransmitters? (2)

A
  • in sympathetic system is norepinephrine (epinephrine -“fight or flight”)
  • in parasympathetic system is acetylcholine (“rest and digest”)
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17
Q

Airway Receptors and Neural Control of Lung:

what agent is a agonists?

A

stimulating agents

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18
Q

Airway Receptors and Neural Control of Lung:

what agent is an antagonists?

A

blocking agents

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19
Q

Airway Receptors and Neural Control of Lung:

what are the classifications? (5)

A
  1. adrenergic (LABA and SABA)
  2. antiadrenergic
  3. cholinergic (cholinomimetic)
  4. anticholinergic
  5. muscarinic
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20
Q

Adrenergic Bronchodilators:

what is the indication for use for the short-acting agents (rescue)?

A

for relief of acute reversible airflow obstruction

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21
Q

Adrenergic Bronchodilators:

what is the indication for use for long-acting agents?

A

for maintenance bronchodilation in patients with obstructive lung disease

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22
Q

Adrenergic Bronchodilators:

what are an indication for use for racemic epinephrine?

A
  • to reduce airway swelling after extubation or during croup or epiglottitis
  • to control airway bleeding during endoscopy
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23
Q

Adrenergic Bronchodilators:

what is the receptor stimulation for Alpha?

A

causes vasocontraction and vasopressor effect

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24
Q

Adrenergic Bronchodilators:

was is the receptor stimulation for Beta-1?

A

causes increased heart rate and heart contractility

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25
Q

Adrenergic Bronchodilators:

what is the receptor for Beta 2?

A

relaxes bronchial smooth muscle, stimulates mucociliary activity, and has some inhibitory action on inflammatory mediator release

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26
Q

Adrenergic Bronchodilators:

what are the 3 subgroups?

A
  1. ultra-short acting catecholamine agents
  2. short-acting noncatecholamine agents
  3. long-acting adrenergic bronchodilators
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27
Q

Adrenergic Bronchodilators:

what are 4 important factors for ultra-shorting acting agents

A
  • racemic epinephrine is the medication
  • lacks beta 2-speciaficity
  • cardiac side effects are common
  • metabolized rapidly
28
Q

Adrenergic Bronchodilators:

what are important factors for short-acting agents?

A
  • albuterol and levalbuterol are medications
  • beta-2 specific agents
  • duration of action is about 4-6 hours
  • suited for maintenance therapy
29
Q

Adrenergic Bronchodilators:

what are important factors with long-acting bronchodilators?

A
  • salmeterol, formoterol, arformoterol are the medications
  • duration of action is about 12 hours
  • mechanism allows for persistent receptor stimulation over a prolonged period of hours
30
Q

Adrenergic Bronchodilators:

of the long-acting bronchodilators, which 2 have 24 hour duration?

A

indacaterol and olodaterol (ultra-long acting)

31
Q

Adrenergic Bronchodilators:

what medication is an ultra-long acting and available in combinations

A

vilanterol

32
Q

Adrenergic Bronchodilators:

what are the adverse effects? (most common)

A
  • tremors
  • headache
  • insomnia
  • nervousness
33
Q

Adrenergic Bronchodilators:

what are adverse effects? (potential)

A
  • dizziness
  • hypokalemia
  • loss of bronchoprotection
  • nausea
  • tolerance (tachyphylaxis)
  • worsening of ventilation/perfusion ratio
34
Q

Adrenergic Bronchodilators:

what is an assessment of bronchodilator therapy?

A
  • based on indications for aerosol agent
  • vital signs, breath sounds, and breathing pattern should be evaluated before and after treatment
  • patient’s subjective response is important to evaluate
35
Q

Short-Acting Adrenergic Bronchodilator Agents:

what does albuterol (proventil, ventolin) come in?

A

syrup, pills, liquid (for nebs) and MDI

36
Q

Short-Acting Adrenergic Bronchodilator Agents:

adult dose vs. peds dose

A

peds dose is generally half the adult dose

37
Q

what is the main difference between albuterol and levalbuterol

A

cost and side effects

-levalbuterol is much more expensive and has less systemic side effects (tremors)

38
Q

Anticholinergic Bronchodilators:

when to use these type of medications

A

if triggering the “relaxer” doesn’t work, block the “constrictor”
–it works by competing with the neurotransmitter in the parasympathetic nervous system (acetylcholine)

39
Q

Anticholinergic Bronchodilators:

main uses for this medication

A

most evidence supports use in COPD

–also used to acute asthma therapy, especially if minimal response to beta agonists

40
Q

Anticholinergic Bronchodilators:

side effects?

A

DPI-cough, cry moth

-exacerbates glaucoma

41
Q

Anticholinergic Bronchodilators:

indications for use

A
  • maintenance treatment in COPD

- combined with B2 is indicated for use in patients with COPD receiving treatments who require some additional help

42
Q

Anticholinergic Bronchodilators:

mechanism of action?

A

agents act as competitive antagonists for acetylcholine on airway smooth muscle

43
Q

Anticholinergic Bronchodilators:

adverse effects

A

dry mouth, pupillary dilation, lens paralysis, increased intraocular pressure, increased heart rate, altered mental state

44
Q

Anticholinergic Bronchodilators:

side effects for SVN, MDI, and DPI (common)

A

cough, dry mouth

45
Q

Anticholinergic Bronchodilators:

side for MDI (occasional)

A

nervousness, irritation, dizziness, headache, palpitation, rash

46
Q

Anticholinergic Bronchodilators:

side effects for SVN and DPI (rarely)

A

pharyngitis, dyspnea, flulike symptoms, upper respiratory infections

47
Q

Anticholinergic Bronchodilators:

adverse effects

A

ipratropium bromide and tiotropium bromide have few systemic side effects since they are fully ionized and are not absorbed

48
Q

Anticholinergic Bronchodilators:

assessment of bronchodilator therapy

A
  • based on indications for aerosol agent
  • vital signs, breath sounds, and breathing pattern should be evaluated before and after treatment
  • patients response
49
Q

Mucus-Controlling Agents:

side effects of acetylcysteine

A
  • airway obstruction due to rapid liquefaction of secretions
  • disagreeable odor due to hydrogen sulfide
  • nausea and rhinorrhea
50
Q

side effects or dornase alfa

A
  • voice alteration
  • sore throat
  • rash
  • chest pain
51
Q

indication and purposes for Inhaled Corticosteroids

A
  • orally inhaled preparations used for anttinflammatory maintenance therapy of persistent asthma and severe COPD
  • use of intranasal steroids is for control of allergic and nonallergic rhinitis
52
Q

mechanism of action for Inhaled Corticosteroids

A
  • lipid soluble drugs that act on intracellular receptors
  • full antiinflammarory effects require hours to days
  • will not provide immediate relief of dyspnea from airways obstruction
53
Q

adverse effects of the systemic side of Inhaled Corticosteroids

A
  • incorrect use of MDI
  • adrenal insufficiency
  • acute asthma
  • HPA suppression (minimal, dose dependent)
  • extrapulmonary allergy
54
Q

adverse effects on local (topical) of Inhaled Corticosteroids

A
  • oropharyngeal fungal infections
  • dysphonia (voice alterations)
  • cough, bronchoconstriction
55
Q

assessment of drug therapy for Inhaled Corticosteroids

A

use strategies for assessment similar to those used for evaluation bronchodilators

  • -make sure patient understands importance of consistent use and not use it as rescue drug
  • -instruct patient in use of peak flowmeter
  • -assess patient for side effects
56
Q

which medication is a growing class of drugs for treatment of asthma

A

Nonsteroidal Antiasthma

57
Q

adverse effects for Nonsteroidal Antiasthma (antileukotriene agents)

A
  • headache
  • dyspepsia
  • liver enzyme elevation
58
Q

adverse effects of Nonsteroidal Antiasthma for monoclonal antibodies

A
  • injection site
  • viral infections
  • headache
  • sinusitis
  • pharyngitis
59
Q

assessment of drug therapy for Nonsteroidal Antiasthma

A

clinician should verify that patient understands that medications are controllers drugs and NOT rescue agents

60
Q

what Aerosolized Antiinfective Agents medication is no longer recommended for PCP treatment

A

nebupent

61
Q

common side effects of Nebupent

A

cough, bronchospasm and wheezing and dyspnea

62
Q

what are adverse reactions for virazole (Aerosolized Antiinfective Agents) medication

A

skin rash, eyelid erythema, conjunctivitis

**Pregnant patient and practitioners should NOT be exposed **

63
Q

side effects for cayston (Aerosolized Antiinfective Agents medication)

A

ibronchospasm, decrease in FEV (Forced expiratory volume), and allergic reactions

64
Q

side effects of colistin (Aerosolized Antiinfective Agents medication )

A

dizziness, confusion, and muscle weakness

–bronchospasm is most common side effect seen with aerosol route (pretreatment with a B2 can decrease this)

65
Q

side effects for relenza

Aerosolized Antiinfective Agents medication

A

can cause bronchospasm and allergic reactions

66
Q

what happens when you use Inhaled Pulmonary Vasodilators

A

when inhaled, produces pulmonary vasodilation, reducing pulmonary artery pressure and improving V/Q mismatching

67
Q

what are side effects for Ventavis (Inhaled Pulmonary Vasodilators medication)

A

include headache and increased cough

1101- Basic Respiratory Care (13 decks)

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