Exam 2: Respiratory Drugs Flashcards
Name the types of respiratory disorders and examples of each
- Upper Respiratory tract
a. Infections
b. Sinusitis
c. Common Cold - Lower Respiratory tract
a. Asthma
b. Bronchitis
c. Emphysema
4 Criteria for diagnosis of acute bacterial sinusitis
- Persistent symptoms for at least 10 days without improvement
- Severe symptoms: fever, facial pain, purulent nasal discharge for 3-4 consecutive days at beginning of illness
- Duration of illness alone is unreliable
- CAT scans or radiographs do not differentiate viral from bacterial sinusitis = imaging not routinely recommended
Most cases of acute rhinosinusitis are of what nature?
98% are viral
What medication may be beneficial in treating acute bacterial sinus infections
- Amoxicillin-clavulanate (Augmentin)
- If penicillin allergic, then levofloxacin or clindamycin
What drugs are you to avoid with bacterial sinusitis?
Avoid decongestants and antihistamines
Name the 4 classes of drugs for Sinusitis/Allergic Rhinitis
- Pseudoephedrine
- Antihistamines
- Analgesics
- Antibiotics (if bacterial infection)
Why is use of epinephrine with decongestants a concern?
These drugs are sympathomimetics and may enhance cardiac stimulation and elevate blood pressure
Name a new nasal aerosol corticosteroid that may treat allergic rhinitis
- QNASL Nasal Aerosol
- Beclomethasone dipropionate
Name Obstructive diseases and how they are defined
- Asthma
2. COPD (chronic bronchitis, emphysema, neoplastic diseases)
What is the pathophysiology of Asthma
- Intermittent respiratory disorder
- Recurrent bronchial smooth muscle spasm, inflammation, swelling of bronchial mucosa, hypersecretion of mucous
The pathophysiology of Asthma results in what?
- Widespread narrowing of airways
- Decreased ventilation with increased airway resistance
- Decreased expiratory outflow
Goals of asthma therapy are to reduce what?
- Symptoms of asthma
- Smooth muscle spasm
- Inflammation
- Swelling of bronchial mucosa
- Hypersecretion of mucous
What is the most common form of asthma?
- Extrinsic form
- –> Inhaled seasonal allergens, pollen, dust mites, etc.
- Usually seen in children and young adults
What antibodies are present in Extrinsic asthma
- IgE
- Dose response relationship between allergen exposure and IgE mediated sensitization, positive skin test, family Hx
Intrinsic asthma is the diagnosis in approximately how many cases of asthma?
30% of cases
How do extrinsic and intrinsic asthma differ?
- Intrinsic
○ Seldom associated with family history of allergy
○ Patients are non-responsive to skin testing
○ Normal IgE levels
○ Middle-aged adults - Extrinsic
- Opposite the above
Which form of asthma is associated with endogenous causes: Emotional stress; GERD?
Intrinsic
Asthmatics are more likely to have a hypersensivity reaction to what other drug?
Aspirin
What is the Aspiring Hypersensitivity triad?
- Aspiring hypersensitivity
- Asthma
- Nasal polyps
What is the mechanism of aspirin allergy and asthma?
- Inhibits bronchodilating PGE2
- Formation of leukotrienes (bronchoconstrictors)
What preservative can serve as a trigger to asthma?
- Sulfite preservatives
○ Cause wheezing when metabolic levels of sulfite oxidase are low
○ Sulfite dioxide is produced in absence of sulfite oxidase = precipitates acute attack
What age groups are most affected by exercise-induced asthma?
Children and young adults
What is Status Asthmaticus?
- Persistent life-threatening bronchospasm despite therapy/intervention
- Attack lasts for more than 24 hours
Name and describe the classifications of asthma
- Mild
a. Symptoms only when exposed to trigger; less than twice a week
b. FEV > 80% - Moderate
a. More than twice a week that affect sleep and activity
b. FEV > 80% - Severe
a. Ongoing symptoms that limit activity
b. Frequent at night
c. FEV
Name the classes of medications used to treat asthma (as well as other chronic respiratory diseases)
- Beta adrenergic stimulants
- Steroids (adrenal glucocorticoids)
- Leukotriene-altering medications
- Mast cell inhibitors
- Expectorants
- Anti-tussive drugs
Medical consideration for mild intermittent asthma?
Rescue bronchodilator prn
Medical consideration for mild persistent asthma?
Anti-inflammatory drug with low dose inhaled corticosteroid, cromolym or anti-leukotriene
Medical consideration for moderate persistent asthma?
- One medium dose of inhaled corticosteroid, or two daily medications
- Low to medium dose inhaled corticosteroid and long-acting bronchodilator
Medical consideration for severe persistent asthma?
- Daily medications
- High-dose inhaled corticosteroid with long acting bronchodilator and oral corticosteroid
T or F, Asthma is undertreated
True
What is the preferred treatment for a mild persistant asthma according to the EPR3?
Inhaled corticosteroids
Use for beat adrenergic stimulants (Inhalers)
- Reversal of airway obstruction and bronchoconstriction
- Acute treatment of bronchospasm (asthma attack)
* *Important rescue drugs for asthma
Mechanism of beta adrenergic stimulants
- Target beta 2 receptors in airway
* *Bronchodilation
Name the various examples of short-acting beta adrenergic stimulants
- Albuterol
- Levalbuterol
- Pirbuterol
What are the usage differences for short and long acting beta adrenergic stimulants?
- Short: rescue drugs
- Long: maintenance/prevention
Name the various examples of Long-acting beta adrenergic stimulants
- Salmeterol (Serevent Diskus)
a. (duration 12 hours) - Salmeterol with fluticasone (Advair Diskus)
Indications for Advair Diskus
Maintenance of asthma and COPD associated with chronic bronchitis
Dental considerations with inhalers
- Taste alteration
- Oral candidiasis - Inhaled corticosteroids
- Overuse of inhalers can lead to a hyper-reflexive airway
- Ask patients how often they are using their rescue inhalers
a. More than once daily or two days per week suggest uncontrolled asthma - Tell patients to bring inhalers with them to appt
When might a Methylxanthine be used to treat asthma?
- Used for patients for whom newer, better asthma medications are ineffective
- Reserve drugs
- Older class of asthma drugs
- Beta adrenergic stimulant
Mechanism of Methylxanthines
Block phosphodiesterase which increases cAMP
Name the preparations of Methylxanthines
Theophylline
Sites of action for Methylxanthines
Bronchodilation, increased pulmonary vasodilation
Side effects of Methylxanthines
- Arrhythmias
- Tachycardia
- Seizures
- GI effects
What do Leukotrienes normally do?
Chemical mediators that produce similar effects to histamine
Leukotriene Drugs are primarily used for what?
Seasonal allergies
Name the Leukotriene drugs
- Zileutron (Zyflo)
- Zafirlukast (Accolate; Singulair)
Action of zileutron (Zyflo)
Inhibits the synthesis of leukotrienes
Action of zafirlukast (Singulair)
Blocks leukotriene receptors
What are the drugs of choice for reducing inflammation?
Steroids
Use of Steroids in respiratory problems
- Inflammation
- Decrease frequency and severity of asthma attacks
Mechanism of Steroids in respiratory problems
- Reduced cytokine production
- Inhibition of accumulation of basophils, eosinophils and leukocytes
Preparation types of steroids used for respiratory problems
- Intranasal, inhaled and systemic
Which steroid was switched from Prescription to OTC?
- Nasacort
- First OTC intranasal steroid
Dental considerations with Steroids
- Oral candidiasis
- Susceptibility to infection
- Delayed wound healing
- Adrenal suppresion
