Chapter 36, Airway Pharmacology Flashcards
What are inhaled medications for?
- 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
what are the 3 phases of pharmacology
- drug administration phase
- pharmacokinetic phase
- pharmacodynamic phase
Drug Administration Phase:
what is this phase
the method by which drug is made available to he body
Drug Administration Phase:
how is this delivered?
drugs directly to the respiratory tract uses the inhalation route
-liquid solutions, suspensions, or dry powders
Drug Administration Phase:
what are most common devices used to administer inhaled aerosols
- metered dose inhaler (MDI)
- soft- mist inhaler (Respimat)
- small volume nebulizer (SVN)
- dry-powder inhaler (DPI)
Drug Administration Phase:
Advantages of inhaled aerosols?
- 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
Drug Administration Phase:
disadvantages of inhaled aerosols
- the number of variable affecting the delivered dose
- lack of adequate knowledge of device performance
- use among patients and caregivers
Pharmacokinetic Phase:
what is this phase/method?
describes the time course and disposition of drug in body based on its absorption, distribution, metabolism, and elimination
Pharmacokinetic Phase:
describe fully ionized aerosol drug
fully ionized aerosol drug has little or no systemic side effects (Ipratropium)
Pharmacokinetic Phase
describe nonionized aerosol drug
nonionized aerosol drug is lipid soluble and diffuses across cell membranes and into bloodstream, producing systemic side effects
Pharmacokinetic Phase:
what is lung availability/total systemic availability ration
(L/T ratio) quantifies efficiency of aerosol delivery to lung
-L/T ration= lung availability/(Lung + GI availability)
Pharmacodynamic Phase:
what is the mechanism of drug action
the mechanism’s of drug action by which a drug molecule causes its effect in the body
Pharmacodynamic Phase:
what causes drug effects
combination of drug with matching receptor
Pharmacodynamic Phase:
what are some (2) drug-signaling mechanism?
1) mediation by G protein (guanine nucleotide) -linked receptors
- -Beta-adrenergic agonists, antimuscarinic agents
2) attachment to intracellular receptors by lipid-soluble drugs
- -Corticosteroids
Airway Receptors and Neural Control of Lung:
what are the receptors in the lung (2)?
-sympathetic (adrenergic) and parasympathetic (cholinergic) receptors are in the lung
Airway Receptors and Neural Control of Lung:
what the neurotransmitters? (2)
- in sympathetic system is norepinephrine (epinephrine -“fight or flight”)
- in parasympathetic system is acetylcholine (“rest and digest”)
Airway Receptors and Neural Control of Lung:
what agent is a agonists?
stimulating agents
Airway Receptors and Neural Control of Lung:
what agent is an antagonists?
blocking agents
Airway Receptors and Neural Control of Lung:
what are the classifications? (5)
- adrenergic (LABA and SABA)
- antiadrenergic
- cholinergic (cholinomimetic)
- anticholinergic
- muscarinic
Adrenergic Bronchodilators:
what is the indication for use for the short-acting agents (rescue)?
for relief of acute reversible airflow obstruction
Adrenergic Bronchodilators:
what is the indication for use for long-acting agents?
for maintenance bronchodilation in patients with obstructive lung disease
Adrenergic Bronchodilators:
what are an indication for use for racemic epinephrine?
- to reduce airway swelling after extubation or during croup or epiglottitis
- to control airway bleeding during endoscopy
Adrenergic Bronchodilators:
what is the receptor stimulation for Alpha?
causes vasocontraction and vasopressor effect
Adrenergic Bronchodilators:
was is the receptor stimulation for Beta-1?
causes increased heart rate and heart contractility
Adrenergic Bronchodilators:
what is the receptor for Beta 2?
relaxes bronchial smooth muscle, stimulates mucociliary activity, and has some inhibitory action on inflammatory mediator release
Adrenergic Bronchodilators:
what are the 3 subgroups?
- ultra-short acting catecholamine agents
- short-acting noncatecholamine agents
- long-acting adrenergic bronchodilators
Adrenergic Bronchodilators:
what are 4 important factors for ultra-shorting acting agents
- racemic epinephrine is the medication
- lacks beta 2-speciaficity
- cardiac side effects are common
- metabolized rapidly
Adrenergic Bronchodilators:
what are important factors for short-acting agents?
- albuterol and levalbuterol are medications
- beta-2 specific agents
- duration of action is about 4-6 hours
- suited for maintenance therapy
Adrenergic Bronchodilators:
what are important factors with long-acting bronchodilators?
- 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
Adrenergic Bronchodilators:
of the long-acting bronchodilators, which 2 have 24 hour duration?
indacaterol and olodaterol (ultra-long acting)
Adrenergic Bronchodilators:
what medication is an ultra-long acting and available in combinations
vilanterol
Adrenergic Bronchodilators:
what are the adverse effects? (most common)
- tremors
- headache
- insomnia
- nervousness
Adrenergic Bronchodilators:
what are adverse effects? (potential)
- dizziness
- hypokalemia
- loss of bronchoprotection
- nausea
- tolerance (tachyphylaxis)
- worsening of ventilation/perfusion ratio
Adrenergic Bronchodilators:
what is an assessment of bronchodilator therapy?
- 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
Short-Acting Adrenergic Bronchodilator Agents:
what does albuterol (proventil, ventolin) come in?
syrup, pills, liquid (for nebs) and MDI
Short-Acting Adrenergic Bronchodilator Agents:
adult dose vs. peds dose
peds dose is generally half the adult dose
what is the main difference between albuterol and levalbuterol
cost and side effects
-levalbuterol is much more expensive and has less systemic side effects (tremors)
Anticholinergic Bronchodilators:
when to use these type of medications
if triggering the “relaxer” doesn’t work, block the “constrictor”
–it works by competing with the neurotransmitter in the parasympathetic nervous system (acetylcholine)
Anticholinergic Bronchodilators:
main uses for this medication
most evidence supports use in COPD
–also used to acute asthma therapy, especially if minimal response to beta agonists
Anticholinergic Bronchodilators:
side effects?
DPI-cough, cry moth
-exacerbates glaucoma
Anticholinergic Bronchodilators:
indications for use
- maintenance treatment in COPD
- combined with B2 is indicated for use in patients with COPD receiving treatments who require some additional help
Anticholinergic Bronchodilators:
mechanism of action?
agents act as competitive antagonists for acetylcholine on airway smooth muscle
Anticholinergic Bronchodilators:
adverse effects
dry mouth, pupillary dilation, lens paralysis, increased intraocular pressure, increased heart rate, altered mental state
Anticholinergic Bronchodilators:
side effects for SVN, MDI, and DPI (common)
cough, dry mouth
Anticholinergic Bronchodilators:
side for MDI (occasional)
nervousness, irritation, dizziness, headache, palpitation, rash
Anticholinergic Bronchodilators:
side effects for SVN and DPI (rarely)
pharyngitis, dyspnea, flulike symptoms, upper respiratory infections
Anticholinergic Bronchodilators:
adverse effects
ipratropium bromide and tiotropium bromide have few systemic side effects since they are fully ionized and are not absorbed
Anticholinergic Bronchodilators:
assessment of bronchodilator therapy
- based on indications for aerosol agent
- vital signs, breath sounds, and breathing pattern should be evaluated before and after treatment
- patients response
Mucus-Controlling Agents:
side effects of acetylcysteine
- airway obstruction due to rapid liquefaction of secretions
- disagreeable odor due to hydrogen sulfide
- nausea and rhinorrhea
side effects or dornase alfa
- voice alteration
- sore throat
- rash
- chest pain
indication and purposes for Inhaled Corticosteroids
- 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
mechanism of action for Inhaled Corticosteroids
- 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
adverse effects of the systemic side of Inhaled Corticosteroids
- incorrect use of MDI
- adrenal insufficiency
- acute asthma
- HPA suppression (minimal, dose dependent)
- extrapulmonary allergy
adverse effects on local (topical) of Inhaled Corticosteroids
- oropharyngeal fungal infections
- dysphonia (voice alterations)
- cough, bronchoconstriction
assessment of drug therapy for Inhaled Corticosteroids
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
which medication is a growing class of drugs for treatment of asthma
Nonsteroidal Antiasthma
adverse effects for Nonsteroidal Antiasthma (antileukotriene agents)
- headache
- dyspepsia
- liver enzyme elevation
adverse effects of Nonsteroidal Antiasthma for monoclonal antibodies
- injection site
- viral infections
- headache
- sinusitis
- pharyngitis
assessment of drug therapy for Nonsteroidal Antiasthma
clinician should verify that patient understands that medications are controllers drugs and NOT rescue agents
what Aerosolized Antiinfective Agents medication is no longer recommended for PCP treatment
nebupent
common side effects of Nebupent
cough, bronchospasm and wheezing and dyspnea
what are adverse reactions for virazole (Aerosolized Antiinfective Agents) medication
skin rash, eyelid erythema, conjunctivitis
**Pregnant patient and practitioners should NOT be exposed **
side effects for cayston (Aerosolized Antiinfective Agents medication)
ibronchospasm, decrease in FEV (Forced expiratory volume), and allergic reactions
side effects of colistin (Aerosolized Antiinfective Agents medication )
dizziness, confusion, and muscle weakness
–bronchospasm is most common side effect seen with aerosol route (pretreatment with a B2 can decrease this)
side effects for relenza
Aerosolized Antiinfective Agents medication
can cause bronchospasm and allergic reactions
what happens when you use Inhaled Pulmonary Vasodilators
when inhaled, produces pulmonary vasodilation, reducing pulmonary artery pressure and improving V/Q mismatching
what are side effects for Ventavis (Inhaled Pulmonary Vasodilators medication)
include headache and increased cough
