Drugs Affecting the Respiratory System Flashcards

Question

Antitussives: Mechanisms of Action

Answer 1

Opioids Suppress the cough reflex by direct action on the cough center in the medulla Examples: codeine (Robitussin A-C, Dimetane-DC), hydrocodone is used in the hospital (Hycodan) Non-opioids Suppress the cough reflex by directly affecting the cough center in the medulla. Chemically related to opioid agonists. Examples: dextromethorphan (Vicks Formula 44,Robitussin-DM), benzonatate (Tessalon Perles)

Answer 2

Used to stop the cough reflex when the cough is nonproductive and/or harmful

Answer 3

Benzonatate Dizziness, headache, sedation, nausea, and others Dextromethorphan Dizziness, drowsiness, nausea Opioids Sedation, dry mouth, nausea, vomiting, constipation

Answer 4

Loosening and thinning of respiratory tract secretions occurs by drawing in water Example: Guaifenesin The secretory glands are stimulated directly to increase their production of respiratory tract fluids

Answer 5

Used for the relief of dry, non-productive coughs associated with: Common cold Acute Bronchitis Influenza

Answer 6

Guaifenesin Nausea, vomiting, anorexia Iodinated preparations GI irritation, enlarged thyroid gland, bitter taste. Pregnancy category X

Answer 7

Expectorants should be used with caution in the elderly or those with asthma or respiratory insufficiency. Check allergies Patients taking expectorants should receive more fluids, if permitted, to help loosen and liquefy secretions Report a fever, cough, or other symptoms lasting longer than a week Monitor for intended therapeutic effects

Answer 8

``` Indications Cystic fibrosis Pneumonia (PNA) TB Atelectasis Acetaminophen O.D. Prevention of contrast-induced nephropathy (CT scan, injected iodine is toxic to kidneys. Drug helps as an antioxidant) ```

Answer 9

Splits disulfide bonds responsible for holding mucous together Liquefies thick, tenacious secretions Binds with reactive hepatotoxic metabolites of acetaminophen Acts as an antioxidant by binding to free radicals in the prevention of contrast-induced nephrotoxicity

Answer 10

Most serious: brochospasms & bronchoconstriction, anaphylaxis Most common: N/V, rhinorrhea

Answer 11

Monitor for anaphylactic reactions Caution in patients with asthma Warn patient of med’s foul odor May induce vomiting. Caution in pts w/ esophageal varices or peptic ulcer disease Monitor lung sounds Administer inhaled beta agonist prior (if ordered) Encourage fluids, pulmonary hygiene

Answer 12

Long-term control Long-term control medicines are taken daily over a long period of time. Antileukotrienes - improve symptoms and pulmonary function and reduce the need for quick-relief medications Cromolyn – prevents the release of histamine Inhaled steroids - most effective to reduce inflammation of the airways Long-acting β2-agonists - relaxes the smooth muscles of the airways for long-term prevention of symptoms, especially at night Quick relief Quick-relief medications are used to help counter the effects of an acute asthma episode. Intravenous systemic corticosteroids Short-acting inhaled β2-agonists (Xopenex)

Answer 13

Bronchodilators β2-adrenergic agonists Anticholinergics Xanthine derivatives Anti-inflammatories Antileukotrienes Corticosteroids Mast cell stabilizers

Answer 14

Large group, sympathomimetics (stimulate SNS, dilates the lungs) Stimulate β2-adrenergic receptors throughout the lungs Used during acute phase of asthmatic attacks Quickly reduce airway constriction and restores normal airflow through bronchodilation

Answer 15

1.) Nonselective adrenergic agonist Stimulate α (vasoconstriction), β1 (cardiac), and β2 (respiratory) receptors Example: epinephrine. Tachycardia, vasoconstriction 2.) Nonselective β-agonist Stimulate both β1 and β2 receptors Example: metaproterenol (Alupent) 3.) Selective β2 agonist Stimulate only β2 receptors Short-acting example: albuterol (Proventil, can cause some mild B1 palpitations), levalbuterol (Xopenex), terbutaline (Brethine) Long-acting example: salmeterol (Serevent Diskus), formoterol (Brovana)

Answer 16

P Albuterol: drug of choice for an acute exacerbation. Can be used for prevention Binds to β-2 receptors in lungs, causing relaxation of bronchial smooth muscles Result: relieves bronchoconstriction, reduces airway resistance, facilitates mucus drainage, increased VC Relief of bronchospasm related to asthma, bronchitis, and other pulmonary diseases Useful in treatment of acute attacks as well as prevention Used to produce uterine relaxation to prevent premature labor (terbutaline)

Answer 17

``` Hypertension, tachycardia, palpitations Anxiety, tremors Headache Insomnia GI: Dyspepsia, N/V Rarely: Bronchospasms , urticaria, angioedema ```

Answer 18

``` Tachycardia Hypertension Palpitation Anxiety Tremors ```

Answer 19

Avoid exposure to conditions that precipitate bronchospasms (allergens, smoking, stress, air pollutants) Adequate fluid intake Compliance with medical treatment Avoid excessive fatigue, heat, extremes in temperature, caffeine Always have a rescue inhaler available (albuterol, short acting B2 agonist) Encourage patients to get prompt treatment for flu or other illnesses, and to get vaccinated against pneumonia or flu

Answer 20

Acetylcholine (ACh) Neurotransmitter of parasympathetic nervous system Causes bronchoconstriction and narrowing of the airways Anticholinergics bind to cholinergic (muscarinic) receptors, preventing ACh from binding Result: decreased contractility of smooth muscle which reduces bronchospasm

Answer 21

Meds: Ipratropium bromide (Atrovent) P Tiotropium (Spiriva) Slow and prolonged action Used to prevent bronchoconstriction NOT used for acute asthma exacerbations!

Answer 22

Common: Cough, hoarseness, throat irritation Classic anticholinergic adverse effects: dry mouth, constipation, urinary retention, blurred vision. Less likely than with systemic anticholinergics If inadvertently sprayed into eyes: ocular irritation & pain, mydriasis, blurred vision

Answer 23

Plant alkaloids: theophylline, caffeine theobromine Only theophylline is used as a bronchodilator Synthetic xanthines: *****theophylline P aminophylline

Answer 24

Causes bronchodilation by relaxing smooth muscles of the airways Result: relief of bronchospasm and greater airflow into and out of the lungs Inhibits phosphodiesterase: Increases force of contraction of diaphragmatic muscles Bronchodilation CNS stimulation + inotropic effects (contractility of the heart/can cause tachycardia. Bradycardia could also occur)

Answer 25

Dilation of airways in asthma, chronic bronchitis, and emphysema Mild to moderate cases of acute asthma Adjunct drug in the management of COPD Used for LONG-TERM control Due to its numerous side-effects, these drugs are now rarely administered for clinical use.

Answer 26

GI: Nausea, vomiting, anorexia, gastroesophageal reflux CV: Tachycardia, palpitations, arrhythmias GU: Transient diuresis CNS: Irrritability, restelessness, muscle twitching Respiratory: Tachypnea **signs of toxicity include tremor, seizures, tachycardia, ventricular arrhythmias.

Answer 27

Contraindications: status asthmaticus, history of PUD or GI disorders Cautious use: cardiac disease Report to physician: Palpitations, weakness, convulsions, nausea, dizziness, vomiting, chest pain MANY interactions! Excessive intake of xanthine-containing food or drinks increase the risk of CV & CNS side effects Smoking decreases drug levels

Answer 28

Leukotriene receptor antagonists Inhaled corticosteroids (ICS) Mast cell stabilizers

Answer 29

``` Also called leukotriene receptor antagonists (LRTAs) Newer class of asthma medications Currently available drugs montelukast (Singulair) zafirlukast (Accolate) P zileuton (Zyflo) ```

Answer 30

Leukotrienes are powerful inflammatory mediators released when a trigger, such as cat hair or dust, starts a series of chemical reactions in the body Leukotrienes cause inflammation, bronchoconstriction, and mucus production Result: coughing, wheezing, dyspnea zileutron (Zyflo) actually inhibits lipoxygenase therefore preventing formation of leukotrienes

Answer 31

By blocking leukotrienes: Prevent smooth muscle contraction of the bronchial airways Decrease mucus secretion Prevent vascular permeability Decrease neutrophil and leukocyte infiltration to the lungs, preventing inflammation

Answer 32

Prophylaxis and chronic treatment of asthma in adults and children older than age 12 NOT meant for management of acute asthmatic attacks Montelukast (Singulair) is approved for use in children ages 2 and older, and for treatment of allergic rhinitis

Answer 33

``` zafirlukast (Accolate) Headache Gastritis Pharyngitis Rhinitis Liver dysfunction ``` montelukast (Singulair) has fewer adverse effects

Answer 34

Ensure that the drug is being used for chronic management of asthma, not acute asthma Teach the patient the purpose of the therapy Improvement should be seen in about 1 week Medications should be taken every night on a continuous schedule, even if symptoms improve

Answer 35

Most effective anti-inflammatory drugs for respiratory conditions Used for chronic asthma Do not relieve symptoms of acute asthmatic attacks Oral, inhaled, or parenteral forms

Answer 36

Treatment of bronchospastic disorders that are not controlled by conventional bronchodilators NOT considered first-line drugs for management of acute asthmatic attacks or status asthmaticus Tx of allergic rhinitis- intranasal flunisolide ``` Examples: Flunisolide (Aerobid) Beclomethasone (Beclovent, Qvar) fluticasone (Flovent) triamcinolone acetonide (Azmacort) ```

Answer 37

``` Pharyngeal irritation Coughing Sore throat, hoarsness Dry mouth Oral fungal infections: RINSE MOUTH Systemic effects are rare because of the low doses used for inhalation therapy ```

Answer 38

Contraindicated in patients with active fungal infections, AIDS, TB, or other bacterial or viral infections Teach patients to gargle and rinse the mouth with lukewarm water afterward to prevent the development of oral fungal infections If a β-agonist bronchodilator and corticosteroid inhaler are both ordered, the bronchodilator should be used several minutes before the corticosteroid to provide bronchodilation before administration of the corticosteroid

Answer 39

contain histamine, serotonin, bradykinin, and leukotrienes When ruptured, substances are released and cause an inflammatory response Mast cell stabilizers inhibit mast cell rupture and degranulation ``` Examples: Cromolyn sodium (Intal) or intranasl: (NasalCrom) ```

Answer 40

``` Oral inhalation form Bronchospasms Throat irritation Cough If lactose intolerant, GI discomfort ``` Intranasal form Nasal irritation, sneezing Ophthalmic drops Ocular irritation

Answer 41

Emphasize that this drug is for prophylaxis only. NOT to be used in an acute asthma attack. Must be taken daily as maintenance drug For exercise-induced bronchospasm, pt should take 15-20 min prior to starting exercise.