Exam 2: Respiratory Drugs pt. 2 Flashcards
Use or indications of Mast Cell Inhibitors
Used for prevention of seasonal allergies and exercise-induced asthma
Name a Mast Cell Inhibitor drug preparation
Cromolyn (NasalCrom)
Action of Mast Cell Inhibitors
Decreases airway hyper-responsiveness by stabilizing the membrane of mast cells so that mediators are not released when challenged by exercise or cold air
Use of Anticholinergics
- Drug of choice for emphysema
- Bronchodilator for bronchospasm with COPD, bronchitis and emphysema
Preparations of Anticholinergics
- Aclidinium (Tudorza Pressair)
- Ipratropium (Atrovent)
- Tiotropium (Spiriva Handihaler)
Mechanism of Anticholinergics
- Blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation
- Decreases cGMP levels
Side effects of Anticholinergics
- Dry mucous membranes
- Nasal congestion
- Dyspnea
- Sputum increased
Children with asthma often experience mouthbreathing which may lead to what craniofacial development?
- Vaulted palate
- Increased anterior facial height
- Greater overjet
- Higher prevalence of crossbite
What are common medication-related oral care considerations with asthma
- Xerostomia from beta 2 agonists
a. Bacterial, fungal and viral infections - Potential for acid erosion of enamel
a. Beta agonists and theophylline exacerbate reflux disease - Candidiasis
a. Long-term use of inhaled steroids - Headache
a. Side effect of anti-leukotrienes, theophylline, some antihistamines
Avoid what drugs with theophylline?
Avoid erythromycin and ciprofloxacin = toxicity reaction
When should appointments be scheduled with those with asthma?
For late morning. Attacks are at nighttime
Why should you avoid opiates in asthma patients?
They release histamine
Pathophysiology of Chronic Bronchitis
- Chronic airflow obstruction
- Chronic inflammation of airways
- Excessive sputum = blocked airways
- *Collapse of peripheral airways
- Smooth muscle hyperplasia
Etiology of Chronic Bronchitis
- Smoking-related
- Recurrent bronchial infections in non-smokers
Medications used to manage chronic bronchitis
- Adrenergic agonists = bronchodilators (inhalers)
- Antihistamines
- Expectorants
- Antitussives
- Antibiotics
Use of Expectorants
Loosens phlegm and thins bronchial secretions to make cough productive
Mechanism of Expectorants
- Irritation of stomach while stimulating respiratory fluid volume (lubricates)
- Decrease mucous viscosity
Give the generic name for Expectorants
Guaifenesin (Mucinex, Robitussin)
Use of Anti-tussive drugs?
- Symptomatic relief of coughs
- Most effective for a chronic nonproductive cough
Mechanism of Anti-tussive drugs
- Depresses cough center in medulla
- Chemical relative of morphine lacking narcotic properties except in overdose
Give generic name for Anti-tussive drugs
- Dextromethorphan
Robitussin, Vicks 44
What is the pathophysiology of Emphysema?
- Smoke injures alveolar epithelium
- Triggers release of inflammatory mediators that attract activated neutrophils
- Neutrophils release elastase that destroys the alveolar walls
- Destruction causes enlarged air spaces distal to the terminal bronchioles and loss of elastic recoil of the lung
- Obstruction is caused by collapse of these unsupported air spaces on EXPIRATION, not inspiration
Etiology of Emphysema
- Smoking related
- Genetic alpha antitrypsin deficiency
Symptoms of Emphysema
- Barrel chest = loss of elastic recoil
- Increased respiratory effort
- Forced expiration
- Pink puffing
- Exertional dyspnea
List the medications used to manage Emphysema
- Ipratropium (Atrovent)
- Beta adrenergic agonists (long acting)
- Oral and inhaled corticosteroids
- Xanthines
All drugs used to manage emphysema produce what?
Bronchodilation to reduce the “work” of breathing
Dental treatment considerations for patients with COPD
- Promote smoking cessation
- Watch for wheezing, orthopnea while recumbent = seat pt. in a semi-reclining position
- Activate EMS for acute respiratory distress
- Avoid opiates and barbiturates
- Red Flag drug interactions if taking theophylline
- If severe, pt is risk for pulmonary hypertension, increasing risk for cardiac arrhythmias = avoid stress
