Exam 3: Respiratory Agents Flashcards
Class: antitussives
MOA: Acts on the cough control center of the medulla (CNS) to suppress the cough reflex -> decreases frequency and intensity of cough
Indications: Dry/annoying cough
Contraindications: Productive coughs
ADRs: different for nonopioid v. opioid
Interactions:
Implications:
Dextromethorphan
nonopioid antitussive
included in many different OTC meds, low dose, minimal ADRs
similar effect as opioids w/o ADRs
can have synergistic effect w/ morphine (enhance effectiveness for pain)
well absorbed, 15-30 min
Codeine
opioid antitussive
most effective antitussive
low dose (1/10 of the pain dose)
CNS depression -> sedation warning
Schedule V for cough and II for pain
Class: expectorants
MOA: Stimulates flow of secretions (turns non-prod into productive cough); Reduces viscosity and surface tension
Indications: Nonproductive coughs, colds, sinusitis, bronchitis
ADRs: Dizziness, HA, rash, urticaria
Implications: hydration still the best option -> push fluids
Guaifenesin
expectorant (Robitussin, Mucinex)
Used in many OTC meds
Action: ↓ mucus viscosity & ↓decrease surface tension
nonproductive cough»_space;> productive
Class: mucolytic
MOA: Changes the molecular composition of mucus, decreases viscosity
Indications: THICK mucus: Chronic bronchitis, Cystic fibrosis
Contraindications: Severe respiratory insufficiency, asthma, or hx of bronchospasms
ADRs: Bronchospasm, N/V, rash, hypersensitivity (IV use more common)
Acetylcysteine
mucolytic (Mucomyst)
THICK mucus
ADR: Foul Odor, bronchospasm; n/v, runny nose, throat or lung irritation, sore mouth, stomatitis, hemoptysis
*can be used IV to reverse acetaminophen hepatotoxicity
Class: antihistamines
MOA: Histamine 1 receptor antagonists
Indications: prophylactic
Diphenhydramine
1st gen oral antihistamine (Benadryl)
“-ramine”
Contraindications: caution in patients with glaucoma, hyperthyroidism (^HR), HTN or BPH/urinary ret., BEERs
ADRs: sedation and **anticholinergic side effects
Interactions: CNS effects with ETOH, hypnotics, anti-psychotics, anxiolytics, narcotics- anticholinergic effects: antipsychotics, TCAs-
Loratidine
2nd gen oral antihistamine (Claritin)
“-dine” or “-zine”
non-sedating and fewer side effects
Azelastine, Olopatadine
2nd gen intranasal antihistamines
metered-spray device
ADR: epistaxis, HA , bad taste, possible somnolence reported by some patients
Class: Decongestants
sympathomimetics
MOA: Activates alpha1 adrenergic receptors on nasal blood vessels VASOCONSTRICTION
Indications: Nasal congestion
Oxymetazoline
Decongestant Intranasal
rapid nasal decongestion
ADRs: Rebound congestion from overuse
Implications: Limiting use to 3-5 consecutive days or break cycle: discontinuing use or dc one nares @time
Pseudoephedrine
Decongestant (Sudafed)
PO response is delayed, moderate, and prolonged
ADRs: systemic vasoconstriction, CNS -> restlessness, irritability, insomnia (similar to amphetamines)
Contraindications: Caution with CV disorders: HTN, CAD, arrhythmias, cerebrovascular disease
Implications: HIGH ABUSE POTENTIAL r/t to CNS stimulation
Class: Glucocorticoids
-SONE
MOA: Anti-inflammatory (decreases synthesis & release of mediators, infiltration and activity of inflammatory cells, and edema of airway mucosa)
* also increases the number of bronchial beta2 receptors and responsiveness to beta2 agonists
Indications: Prophylactic use for asthma or allergic rhinitis NOT FOR ATTACKS
Beclomethasone
INH glucocorticoid (IGC)
effective, daily, safer than PO
improved efficacy when used with a B2 agonist
low risk of toxicity - spacers, % absorbed
ADRs: Oral candidiasis, dysphonia
Implications: mouth rinses
Prednisone
PO glucocorticoid
2nd line, when IGC isn’t controlling symptoms
ADRs: systemic -> Prolonged use (>10 days) -> Adrenal suppression; Osteoporosis, hyperglycemia, hypernatremia, hypokalemia, immunosuppression, fluid retention, growth suppression in children
**Acute adrenal insufficiency if abruptly withdraw
Implications: Recommend alternate day dosing if ADRs severe and would need to increase dosing if pt experiences extreme stress to compensate for their lack of endogenous response
Fluticasone
Intranasal glucocorticoid
Best if used daily prophylactically, OTC and prescription
ADRs: primarily localized -> dry nasal mucosa, burning and/or itching, epistaxis (nosebleed), sore throat, & headache
Class: leukotriene modifiers
anti- inflammatory
3 PO meds:
Zi LEU ton
Zafir LU kast
Monte LU kast
MOA: blocks leukotriene receptors, suppress effects of leukotrienes ↓ Bronchoconstriction ↓ Inflammatory response
Indications: Prophylactic asthma or COPD management (inadequate alone for asthma, 2nd line therapy)
ADRs: Neuropsychiatric effects
Montelukast
PO (Singulair)
Indication: relieves nasal congestion
MOA: Blocks leukotriene receptors
Class: monoclonal antibodies
anti- inflammatory
-MAB
SQ injection only
Indication: pts > 12years, allergy related, uncontrolled by IGC
MOA: Binds to IgE – these will limit the release of allergic mediators (histamine, leukotrienes)
ADRs: hypersensitivity/anaphylaxis
Omalizumab
Monocolonal antibodies (Xolair)
Approved only for Allergy symptoms – esp. in Asthma
MOA: combines with free immunoglobulin E (IgE)…decreasing the available IgE to bind to receptors on the surface of mast cells. By decreasing mast cell activation, airway bronchospasm and airway inflammation are also decreased
ADRS: anaphylaxis
Class: Mast cell stabilizer
anti- inflammatory
prophylactic, inhaled, safest - rare ADRs
MOA: Stabilizes the membrane of the Mast Cell; decreases release of inflammatory mediators = Suppresses inflammation
Cromolyn
mast cell stabilizer
Class: Beta 2 Adrenergic agonist
bronchodilator
- TEROL
MOA: sympathomimetic -> relaxes smooth muscle of bronchiole; promotes bronchodilation
Indications: Asthma/COPD and EIB
Implications: too high of a dose loses selectivity and pt can experience B1 ADRs
Albuterol
SABA bronchodilator
selective B2 agonist -> don’t experience systemic effects unless dose too high
Indication: quick onset (5-30 min) -> used to ABORT ATTACK
ADRs: OD -> tachycardia, tremors, angina, seizures
Salmeterol
LABA bronchodilator
prophylactic -> persistent or frequent attacks (not rescue), inhaled
selective B2 agonist -> don’t experience systemic effects unless dose too high
Not monotherapy: taken with glucocorticoids to increase effectiveness
Class: Methylxanthines
bronchodilator
PO Theo PHYLLINE
IV Amino PHYLLINE
MOA: Relaxes smooth muscle of bronchi, bronchioles and pulmonary blood vessels
***Narrow therapeutic range: 5-15 mcg/mL
ADRs: can indicate toxicity vomiting, restless, dizzy, diarrhea, insomnia, Severe dysrhythmias , Ventricular dysrhythmias, convulsions
Interactions: caffeine & smoking
Class: Anticholinergics
-PIUM
MOA: block muscarinic receptors -> block vasoconstriction in pulmonary blood vessels
Indications: approved for COPD and used off label for asthma
ADRs: ** anticholinergic side effects Dry mouth, irritation of pharynx, glaucoma, CV events
Tiotropium = LAMA (maintenance med for COPD)
Drugs for Acute, Severe Asthma Exacerbation
Oxygen to relieve hypoxemia
Inhaled high-dose SAβA to relieve airflow obstruction
Systemic glucocorticoid to reduce airway inflammation
Nebulized ipratropium to further reduce airflow obstruction
(consider IV fluids)
Phosphodiesterase-4 inhibitors
anti-inflammatory for COPD only to reduce exacerbation frequency
Roflumilast (Daliresp)
MOA: Selective inhibition of PDE-4 enzyme -> allows for accumulation of intracellular CyclicAMP
cAMP : Role as anti-inflammatory
^ cAMP -> decrease cytokines & inflammatory cells
ADR: mood changes, depression, suicidal behavior, weight loss, Loss of appetite, GI upset, diarrhea, insomnia, HA, dizziness
“PIERr”
primary TB meds
Pyrazinamide
Isoniazid
Ethambutol
Rifampinr
rifapentine
MOA: bactericidal
ADRs: all hepatotoxic
Prophylactic treatment contraindicated for pt w/liver disease
Implications: Teachings around antibiotic use, monitor liver enzymes, teachings around signs of liver impairment (Stomach pain, Nausea, Anorexia, fatigue, Dark colored urine, clay colored stools, Jaundice)
Isoniazid (INH)
Bactericidal -> highly selective for M. tuberculosis, primary for active & latent infections
ADRs: hepatotoxicity, peripheral neuropathies, drug induced B6 deficiency (CNS impact)
Interactions: CYP450 inhibitor (so monitor drug levels of other meds taken w/ it)
Implications: no alcohol, supplemental B, report new meds to provider, tingling in extremities
Rifampin
Bactericidal: “broad spectrum”
ADRs: hepatotoxicity, discoloration of body fluids, GI disturbances
Interactions: anticoagulants and seizure meds *?
Teaching: glasses instead of contacts (staining), urine/tear discoloration
Pyrazinamide
Bactericidal
ADRs: hepatotoxicity, non-gout polyarthralgia, n/v, rash, photosensitivity
Ethambutol
Bacteriostatic: used when bacteria are sensitive rifampin & isoniazid -> effective against actively dividing mycobacteria
ADR: hepatotoxicity, Optic neuritis (Constricted visual fields, decreased ability to see red and green), GI distress, Anorexia, Nausea Other: confusion, disorientation, HA, peripheral neuritis
Admin with food
Considerations for hepatotoxic drugs
monitor liver enzymes, avoid acetaminophen, alcohol
Rifapentine
Long acting analog of Rifampin
only Respiratory TB (must be used w/another med due to resistance)
Same ADRS as Rifampin
Considerations for CYP450 inhibitors
Decreasing levels of other medications because don’t have the same level of enzymes to metabolize the meds
especially important for meds with low therapeutic range
