Exam 2 - Pulmonary Pharmacology Flashcards
bronchodilators class
- beta2 agonists
- anticholinergics
- xanthine derivatives
anti-inflammatories class
- leukotriene receptor antagonist (LTRAs)
- inhaled glucocorticoids
- mast cell stabilizers
what do bronchodilators do
- used to treat ALL respiratory diseases
- work by relaxing bronchial smooth muscle
short acting beta-adrenergic agonists
- albuterol
- levalbuterol
long acting beta-adrenergic agonists
- salmetrol
- formoterol
MOA: beta-adrenergic agonist
- mimic action of SNS: fight or flight
- relax and dilate the airways by stimulating the beta2-adrenergic receptors throughout the lungs
- bronchial dilation and increased airflow into and out of the lungs is the goal
when are beta-adrenergic agonist contraindicated
- uncontrolled hypertension
- cardiac dysrhythmias
- high risk for stroke
albuterol
- short acting beta2 agonist
- RESCUE DRUG
- treatment of ACUTE episodes of wheezing, chest tightness, SOA
what does use of more than one canister of albuterol a month indicate
- inadequate control of asthma and need for initiating or intensifying anti-inflammatory therapy
salmeterol
- long acting beta2 agonist
- not for acute treatments, this is a maintenance drug
- given twice a day
salmeterol warning
- has been associated with increased asthma-related deaths
- more common in black/african Americans
indications for salmeterol
- worsening of COPD
- moderate to severe asthma
what is salmeterol always given with
- an inhaled corticosteroid, not indicated for monotherapy
what does giving anticholinergics result in
- turning off cholinergic response (PNS) and turning on SNS
- SNS dominates = bronchodilaton
- perfuses increases to heart, lungs, and brain
what is a key point with anticholinergics
- blocking the effect of acetylcholine, we inhibit the normal physiological response
anticholinergic drug
ipratroprium
MOA: ipratroprium
- blocks action of acetylcholine and creates bronchodilaton
indications of ipratroprium
- used for prophylaxis and maintenance therapy
- NOT a rescue drug
- often given in combination with albuterol
side effects of anticholinergics
- dry
- hot
- blind
- red
- mad
xanthine derivatives
- theophylline
- aminophylline
MOA: xanthine derivatives
- increasing levels of the cAMP enzyme by inhibiting phosphodiesterase
- stimulates CNS and CVD system
side effects of xanthine derivatives
- toxic!!!
- n/v/d
- insomnia
- h/a
- tachycardia
- dysrhythmias
- seizures (more common in elderly)
contraindications of xanthine derivatives
- uncontrolled cardiac dysrhythmias
- seizure disorders
- hyperthyroid
- peptic ulcers
interactions of xanthine derivatives
- caffeine may increase side effects
- smoking may decrease absorption
nursing considerations for xanthine derivatives
- has a narrow therapeutic index: monitor serum levels and watch for toxicity
- lots of drug interactions
what do leukotrienes do
- they cause inflammation, bronchoconstriction, and mucus production
leukotriene receptor antagonist (LTRA) drugs
- montelukast
- zafirlukast
MOA: LTRAs
- prevent leukotrienes from attaching to receptors located on immune cells and within the lungs
- prevents inflammation
what are LTRAs used for
- oral prophylaxis and chronic treatment of asthma in adults and children
- NOT for acute asthma attacks
- can also be given for allergies
side effects of LTRAs
- headache
- nausea
- dizziness
- insomnia
- diarrhea
LTRAs drug interactions
- montelukast has a few drug-drug interactions
- zafirlukast has several drug-drug interactions
inhaled corticosteroid drugs
- beclomethasone
- budesonide
- fluticasone
MOA: inhaled corticosteroids
- reduce inflammation and enhance activity of beta agonists
- also helps with bronchodilaton
how long can it take for inhaled corticosteroids to work
- can take several weeks of continuous therapy before full effect of the steroids are realized
side effects of inhaled corticosteroids
- pharyngeal irritation
- coughing
- dry mouth
- oral infections
- RINSE MOUTH AFTER USE
what should you teach asthma patients who are using an inhaled corticosteroid
- teach to take on a regular schedule, not PRN and give the bronchodilator first to allow more thorough absorption of the steroids
combination: inhaled glucocorticoid and bronchodilator drugs
- budesonide and formoterol
- fluticasone and salmeterol
key teaching for combinations
- used for moderate to severe asthma
- THESE ARE NEVER FOR ACUTE ATTACKS
mast cell stabilizer drug
- cromolyn
MOA: mast cell stabilizer
- stabilize membranes of mast cells and prevent release of broncho-constrictive inflammatory substances
- used for prevention of acute asthma attacks
- 15-20 minutes prior to known triggers
monoclonal antibody anti-asthmatic drug
omalizumab
MOA: monoclonal antibody anti-asthmatic
- monoclonal antibody selectively binds to immunoglobulin IgE which limits the release of mediators of allergic response
why must monoclonal antibody anti-asthmatic drugs be monitored closely
- hypersensitivity reactions
- anaphylaxis is a big risk
