Exam 3 - Week 8: Respiratory Drugs Flashcards
Prototype Respiratory Drugs
- Acetylcysteine (Mucomyst)
- Guaifenesis (Robitussin)
- Epinephrine (Adrenaline)
- Isoproterenol (Isuprel)
- Albuterol (Proventil)
- Ipratropium (Atrovent)
- Aminophylline (Theophylline)
- Cromolyn (Intal)
- Zafirlukast (Accolate)
- Beclomethasone (Vanceril)
- Dextromethorphan (DM)
- Pseudoephedrine (Sudafed)
- Diphenhydramine (Benadryl)
What is the most common condition affecting the upper respiratory tract?
Inflammatory conditions leading to the overproduction of secretion (mucus)
2 Approaches to Mucus Drugs
Mucolytic
Expectorant
Mucolytic
Breaks up mucus into smaller units
ex: Acetylcysteine (Mucomyst)
Expectorant
Reduces viscosity of secretions
ex: guaifenesin (Robitussin(
How do mucolytics and expectorants differ?
They both have the same outcome, but the expectorant makes the mucus more watery rather than breaking it up (it dilutes it)
The goal of bronchodilating drugs is…
to dilate bronchi in order to maximize airflow but with the fewest SE
Epinephrine is a _______ bronchodilator with significant cardiac effects
Non-selective!
Isoproterenol (Isuprel) is a _____ Beta Stimulating Bronchodilator
Non-Selective
Albuterol is a relatively ____ Beta 2 Agonist
selective
Ipratropium (Atrovent) is what class/type of drug and what does it do?
Anticholinergic bronchodilator
it relaxes smooth muscle in the bronchial tree and is used for maintenance therapy
Aminophylline (Theophylline) is what class/type of drug and what does it do?
Methylated Xanthine
It has a direct effect on smooth muscle (oral or IV) to bronchodilate
Prototype Mucolytic Drug
acetylcysteine (Mucomyst)
Action of acetylcysteine (Mucomyst)
Breaks up bonds of mucoprotein molecules from resp. secretions into smaller, more soluble, and less viscous strands
Also effects similar changes in DNA and cell debris and works best at pH 7-9
What is the absorption like for acetylcysteine
Very little absorption occurs
It undergoes Nebulization - Nebulizer form is mixed with saline so the mucomyst will act on the mucus and then stay there with little absorbed
ADRs of Acetylcysteine
FEW
Some N/V - probably from odor, Stomatitis, Rhinorrhea,
Bronchospasm could occur in asthmatics - assess airways
What is a unique aspect of acetylcysteine
It has a rotten egg odor (this can limit compliance)
As an inhalant, acetylcysteine acts as a mucolytic, but as a liquid it is…
the antidote for acetaminophen poisoning
It is important to allow the patient to do what after nebulization of acetylcysteine
Wash face after nebulization to remove the sticky coating left by the drug (it smells like rotten egg remember)
How long is acetylcysteine infused for if its as an acetaminophen antidote
72 hour for Oral; 21 Hour for IV
Prototype drug expectorant/bronchomucotropic
guaifenesin (Robutussin)
Action of guaifenesin
Directly irritates the gastric mucosa - then because it is upsetting the stomach a gastropulmonary reflex action occurs producing more watery secretions to be coughed up
It irritates gastric mucosa to increase volume and reduced viscosity of respiratory secretions (called gastropulmonary reflex action)
ADRs of guaifenesin
RARE!
Occasional GI irritation
What is very important to be doing while taking an expectorant like guaifenesin
HYDRATE! - to decrease viscosity the drug is pulling water from the body to loosen secretions so you need to be having fluids since fluids are being pulled from you
guaifenesin is a ___ drug
OTC
What may contribute to gastric upset when taking guaifenesin
if taken on an empty stomach
How does guaifenesin effect coughing?
it does not stop the cough it just helps get secretions up
epinephrine (as a respiratory drug)
Sympathomimetic (non-selective); bronchodilator
Action of epinephrine as a respiratory drug
Stimulates Alpah, Beta 1 and Beta 2 receptors
Stimulating Alpha receptors…
causes VASOCOCNSTRICTION (which is good for airways as it can reduce mucosal edema)
Stimulating Beta 1 Receptors …
stimulates heart rate and force of contraction of the heart as well as cardiac irritability
We would prefer if EP did not do this but we will fix it later
Stimulating Beta 2 Receptors…
induces bronchial smooth muscle relaxation
What receptors do we want the EP stimulation to occur on the most
Alpha and Beta 2 moreso than Beta 1
Absorption / Routes for EP
Oral cannot be used as it is destroyed by enzymes
Parenteral is a good route for absorption
Aerosol allows it to be contained to the respiratory tract
Often it is given SUBQ or Aerosol - almost never IV
ADRs of Epinephrine
Nervousness Fear Insomnia Tremors Tachycardia Palpitation HA Dyspnea
Caution using EP when?
People with CAD, HTN, and Hyperthyroidism
What drugs should never be given concurrently with EP and why?
MAO Inhibitors because it will precipitate severe HTN
When is EP mostly used as a bronchodilator
Mostly in acute emergencies by EMS, in the ER, or in someone with acute bronchoconstriction
Can be a little overboard unless emergency
-ol may indicate a drug is what
A beta 2 Stimulator - Induces bronchial smooth muscle relaxation
Prototype drug that is a Sympathomimetic, Non-selective Beta Stimulating Bronchodilator
isoproterenol (Isuprel)
isoproterenol (Isuprel)
Sympathomimetic - mimics Symp.NS
Non selective Beta Stimulating Bronchodilator - only impacts beta receptors but will effect both 1 and 2
Action of isoproterenol
Stimulates beta 1 (stimulates heart) and beta 2 (bronchodilation and decreasing tone and motility of the GI tract and uterus)
DOES NOT AHVE ALPHA 1 EFFECTS - but still has Beta 1 effects which is not great
Preferred Route of Administration for isoproterenol (Isuprel)
oral and sublingual are poor routes so parenteral and inhalation are preferred or IV
ADRs of isoproterenol (Isuprel)
Tachycardia Palpitation HA Nausea Tremor Insomnia
THE MORE IT IS USED THE LESS EFFECTIVE IT MAY BE - VERY EFFECTIVE AT FIRST BUT NOT GIVEN OVER AND OVER
____ is one of the most powerful bronchodilators
isoproterenol (Isuprel)
What is the issue with isoproterenol and EP
they both stimulate Beta 1
Prototype drug that is a Sympathomimetic Selective Beta 2 Stimulating Bronchodilator
albuterol (Proventil, Ventolin)
“vent” for ventilation
Action of albuterol
Beta 2 stimulation leading to smooth muscle of bronchial tree and peripheral vasculature relaxation
At high doses what can happen with albuterol
it can begin to effect beta 1 but at normal doses it does not
Preferred route of albuterol absorption
Inhalation (almost always)
Oral only gets 30-40% bioavailability
ADRs of Albuterol
FEW!! - More effects if huffed, but when used properly almost nothing - may feel little jitteriness d.t sympathomimetic properties
Peripheral dilation leading to decreased BP causing Tachycardia
Other: Tremors, Palpitations, Nervousness, HA, Dizziness, NV, Anxiety, Lethargy, Tinnitus
What does it mean that Albuterol is a SABA
SABA = short acting beta2 agonist
So it is a short acting RESCUE INHALER for needing help breaking things up NOW
How does EP and Albuterol onset and duration differ
EP begins quicker but lasts shorter
Albuterol is slightly longer for onset but lasts longer
Caution using Albuterol with what patients
Those with Diabetes, HTN, Cqardiac Disorders (esp. arrhythmias)
LABA
Long acting beta2 agonists
ex: salmeterol (serevent)
NOT rescuse inhalers, prevent bronchoconstriction through common use
Prototype SAAMA drug
ipratropium (Atrovent)
What class is ipratropium (Atrovent)
Anticholinergic Bronchodilator - Inhaled Short Acting Muscarinic Antagonist (SAAMA)
What NS is ipratropium impacting
PNS rather than SNS
What situations is ipratropium used for
For maintenance and prevention of bronchoconstriction NOT an acute acting agent as it takes longer to work and is never given for immediate distress since it is working on the PNS
SAAMA drugs like ipratropium are often given to ___ patients
COPD