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drugs affecting the respiratory system Flashcards

1
Q

bronchodilators are also known as:

A

beta 2-receptor agonists (B2RAs)

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2
Q

what are bronchodilators used for?

A

widely used for patients of all ages to treat reversible bronchoconstriction caused by: asthma, reactive airway disease (RAD), or COPD

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3
Q

most commonly prescribed bronchodilator

A

albuterol (ProAir, Ventolin, Proventil)

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4
Q

SABA examples

A

albuterol
levoabuterol (Xopenex)

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5
Q

LABA

A

formoterol
salmeterol

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6
Q

education for formoterol

A

comes in a drug powder capsule
- capsule is placed into an aerolizer, which is then squeezed to break the capsule, and then the patient inhaled the medication
- patients need to be educated not to swallow the capsule

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7
Q

ultra long acting B2RA

A
  • Indacaterol (Arcapta Neohaler)
  • Olodaterol (Striverdi Respimat)
  • Vilanterol
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8
Q

pharmacodynamics of bronchodilators

A

Act on the smooth muscle of the bronchial tree to reverse bronchospasm
- Thereby, decreasing airway resistance and residual volume and increasing vital capacity and airflow

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9
Q

albuterol

A
  • A selective beta2 agonist w/ some minor beta1 activity
  • Can increase HR by directly stimulating beta2 receptors in the heart and vascular smooth muscle
  • Can cause tremors d/t stimulation of skeletal muscle beta2 receptors
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10
Q

spacer education

A

It is recommended that a spacer device be used with MDIs (AeroChamber, InspirEase) to increase deposition of medication into the lungs, rather than just in the mouth

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11
Q

overuse of B2RAs

A
  • Seizures
  • Hypokalemia
  • Anginal pain
  • Hypertension
  • May have stimulant-like effects
  • Headache
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12
Q

what are inhaled anticholinergics used for?

A

used primarily in the treatment of COPD

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13
Q

uses of inhaled anticholinergics in asthma

A
  • Ipratropium may be used in combination with albuterol as the emergent treatment of an asthma exacerbation or when a patient is intolerant to beta 2 agonists,
  • tiotropium bromide added to an ICS/LABA combination may be used for those whose asthma is not well controlled
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14
Q

ipratropium bromide (Atrovent)

A
  • a quaternary amine anticholinergic
  • structurally similar to atropine

available as:
- single medication (Atrovent) - combined with albuterol (combivent)

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15
Q

pharmacodynamics of anticholinergics

A
  • acts to block the muscarinic cholinergic receptors by antagonizing the action of acetylcholine
  • this decreases the formation of cyclic guanosine monophosphate (cGMP)
  • leads to decreased contractility of the smooth muscle of the lungs
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16
Q

rational drug selection of anticholinergics in COPD and asthma

A

Ipratropium and tiotropium are second-line bronchodilators in the treatment of asthma and COPD

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17
Q

what do leukotriene modifiers do?

A

act to decrease the inflammation of the lungs in patients with asthma

Leukotrienes are substances that induce numerous effects the contribute to the inflammatory process, including:
- Smooth muscle contractility
- Neutrophil aggregation, degranulation, and chemotaxis
- Vascular permeability
- Activation of lymphocyte

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18
Q

leukotriene modifier drugs

A
  • Zafirlukast (Accolate)
  • Montelukast (Singulair)
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19
Q

clinical use for zafirlukast

A

Indicated in the treatment of chronic asthma in children at least 5 years of age and in adults

20
Q

montelukast clinical use

A
  • Indicated for use in the treatment of persistent asthma for patients aged 12 months or older
  • May be prescribed for the prevention of exercise-induced bronchoconstriction in adolescents aged 15 years or older and in adults
  • Used to treat seasonal allergic rhinitis
21
Q

anti-inflammatory effects of corticosteroids in respiratory system

A
  • Reduction in severity of asthma symptoms
  • Increased peak flow readings
  • Decreased airway hyperresponsiveness
22
Q

Most commonly prescribed inhaled corticosteroids for asthma are:

A
  • beclomethasone dipropionate (QVAR)
  • budesonide (Pulmicort)
  • flunisolide (AeroBid, Aerospan)
  • mometasone furoate (Asmanex Twisthaler)
  • fluticasone (Arnuity Ellipta, ArmonAir RespiClick, Flovent)
23
Q

intranasal corticosteroids drugs

A
  • beclomethasone (Beconase)
  • triamcinolone (Nasacort)
  • budesonide (Rhinocort)
  • flunisolide (Nasalide, Nasarel)
  • mometasone (Nasonex)
  • fluticasone (Flonase)
  • ciclesonide (Omnaris, Zetonna)
24
Q

inhaled corticosteroid pharmacodynamics

A
  • in the treatment of asthma and allergic rhinitis, the primary actions of orally inhaled corticosteroids are anti-inflammatory
  • inhaled adrenocorticosteroids inhibit the immunoglobulin E (IgE) and mast cell-mediated migration of inflammatory cells into the bronchial tissue (late-phase allergic reaction)
25
clinical use of inhaled corticosteroids in asthma
- The inhaled corticosteroids are the preferred long-term control medications for managing the inflammatory process associated with asthma - The patient with persistent asthma is started on inhaled corticosteroids or an ICS/LABA combination according to guidelines for the management of asthma (GINA)
26
clinical use of inhaled corticosteroids in allergic rhinitis
Allergic rhinitis results when allergens come in contact with the nasal mucosa, causing a hypersensitivity reaction - Nasal corticosteroids are used to manage the inflammatory response associated with seasonal or perennial allergies
27
# use of inhaled antihistamines
used for tx of seasonal allergic rhinitis and vasomotor rhinitis
28
inhaled antihistamine drugs
o Azelastine o Olopatadine
29
pharmacodynamics azelastine (inhaled antihistamine)
- An H1 agonist - A potent inhibitor of histamine release from the mast cells - Inhibit the effects of histamine by competing with histamine for H1 binding sites - May also interfere with histamine- and leukotriene-induced bronchospasm
30
pharmcodynamics of olopatadine (inhaled anti-histamine)
a selective H1 receptor antagonist
31
clinical use of inhaled antihistamines
allergic rhinitis, specifically the s/s of: * Rhinorrhea * Sneezing * Nasal pruritus
32
effects of antihistamines
- Inhibition of respiratory, vascular, and GI smooth muscle constriction by antagonism of the constrictor action on smooth muscle - Strongly block the action of histamine that results in increased capillary permeability and formation of edema and wheal - Decrease the flare and itch responses of histamine on peripheral nerve endings
33
first generation antihistamines binding
bind nonselectively to the central H1 receptors and cause both CNS stimulation and depression
34
commonly prescribed first generation antihistamines
- diphenhydramine (Benadryl) - clemastine (Tavist) - the alkylamines - brompheniramine (Dimetane) - chlorpheniramine (Chlor-Trimeton) - the piperazine hydroxyzine (Atarax, Vistaril) - the piperidine cyproheptadine (Periactin) - carbinoxamine maleate (Arbinoxa)
35
second generation antihistamines binding
selective for peripheral H1 receptors - therefore, they are less sedating
36
second generation antihistamine drugs
- cetirizine (Zyrtec) - levocetirizine (Xyzal) - the piperidines ** desloratadine (Clarinex) ** exofenadine (Allegra) ** loratadine (Alavert, Claritin)
37
first generation antihistamine contraindications
- narrow-angle glaucoma - lower respiratory tract symptoms (they thicken secretions and impair expectoration) - stenosing peptic ulcer - symptomatic prostatic hypertrophy - bladder neck obstruction - pyloroduodenal obstruction - MAOI use
38
clinical use of antihistamines
- Respiratory allergies - Hypersensitivity reactions (Diphenhydramine is usually the drug of choice for patients w/ the acute hypersensitivity reactions) - Urticaria and angioedema - Nighttime sleep aid - Motion sickness/antiemetic (Dimenhydrinate (Dramamine) is used in the treatment and prevention of nausea, vertigo, and vomiting associated w/ motion sickness)
39
pharmacodynamics of decongestants
Alpha-adrenergic receptor agonists (sympathomimetics) that produce vasoconstriction by stimulating alpha receptors within the mucosa of the respiratory tract - Temporarily reduces the swelling associated with inflammation of the mucous membranes
40
oral decongestant contraindications
- MAOI therapy (possible HTN crisis) - severe HTN or CAD
41
clinical use of decongestant
 Used for the temporary relief of nasal congestion due to: * The common cold * Sinus infection * Allergic rhinitis  Promote nasal or sinus drainage  Relief of eustachian tube congestion
42
pharmacodynamics of antitussives
Cough results when sensory stimuli or irritation in the bronchial tree stimulates cough receptors - A message is sent via the afferent nervous system to the cough centers in the medulla Antitussives work either centrally or peripherally to affect the cough
43
dextromethorphan pharmacodynamics
Acts centrally in the cough center in the medulla to elevate the threshold for coughing
44
antitussive use and meds
Dextromethorphan, codeine, and benzonatate are used to control nonproductive cough
45
pharmacodynamics of expectorants
Main MOA is to increase the output of the respiratory tract by decreasing adhesiveness and surface tension - The increased flow of the thinned secretions promotes ciliary action  facilitates the removal of respiratory mucous - Changes a dry, nonproductive cough into a more productive cough

Pharmacology Exam 2 (11 decks)

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