Exam One (PNS, OXYGENATION & TB) Flashcards
what percent of drug reaches the lungs with MDI?
10%
what percent of drug reaches the lungs with dry powder inhaler?
20%
How much time between puffs of albuterol?
1 minute between puffs
How much time between albuterol and glucocorticoid?
5 minutes between puffs
Two classes of respiratory medications?
Bronchodilators and anti-inflammatory
Three classes of bronchodilators
- Beta-2 Agonists
- Anticholinergics
- Methylxanthines
Five classes of anti-inflammatory medications
- Glucocorticoids
- Leukotriene modifiers
- Mast cell stabilizers
- Monoclonal Antibodies
- Phosphodiesterase Inhibitors
MOA Beta-2 agonists
act by relaxing bronchial smooth muscle –> bronchodilation
What is the drug of choice for bronchoconstriction
Beta-2 agonists
Drug of choice for acute bronchoconstriction
SABA
- Albuterol (Proventil HFA)
Albuterol =
Proventil HFA
What is given during an asthma attack?
Albuterol
what is LABA used for
prevention and maintenance
Prototype for LABA
Salmeterol (servent diskus)
Salmeterol =
Servent diskus
Is LABA used alone?
NO; increased risk of death so use with glucocorticoid
SE for beta-2 agonists (high doses)
tachycardia, tremors, palpitations, angina
How to administer beta-2 agonists
start to inhale, activate inhaler, hold the breath for 10 seconds, then wait 1 minute before second inhalation
MOA for anticholinergics
blocks the parasympathetic nervous system –> bronchodilation
Prototype for anticholinergics
Ipratropium (atrovent)
Ipratropium =
atrovent
Onset for SABA
Peak
Q ?
Onset = immediate
Peak = 30-60 min
Q 6H in hospital
Onset for anticholinergics
Peak
Lasts?
Onset = 30 seconds Peak = 3 minutes Lasts = 6 hours
SE of anticholinergics
dry mouth, irritation of pharynx
Contraindications for anticholinergics
peanut allergy and glaucoma (increase IOP)
Methylxanthines oral prototype
Theophylline (theodur)
Theophylline =
theodur
Why are methylxanthines no longer standard therapy
narrow margin of safety
- NO SMOKING!
Half life varies 2-15 hours
Drug-drug interactions
Methylxanthines IV prototype
Aminophylline (somophyllin)
Aminophylline =
somophyllin
Aminophylline admin?
SLOW iv admin
MOA of glucocorticoids
suppress inflammation
Prototype of glucocorticoids
Beclomethasone
Combination glucocorticoid therapy
Adavir discus (fluticasone + salmetrol) Symbicort (budesonide + formoterol)
Inhaled glucocorticoid therapy used for ___
prevention
how long for full effects of inhaled glucocorticoids
1-4 weeks for full effects
SE of glucocorticoids
adrenal suppression, candidiasis, dyphonia
how to prevent candidiasis with glucocorticoids
last med taken, rinse and spit
oral glucocorticoids given for ____
acute bronchoconstriction
oral glucocorticoid prototype
prednisone
iv glucocorticoid prototype
methylprednisone (solumedrol)
how do you transition from oral to inhaled glucocorticoids?
use both for a while, then off oral (if you just stop you’ll face adrenal suppression)
what glucocorticoid is given for acute asthma that has been hospitalized
high dose solumedrol for several days
MOA of leukotriene modifiers
modifying the action of leukotrienes
why are leukotrienes important
important in the inflammatory response resulting in edema, inflammation and bronchoconstriction
prototype for leukotriene modifiers
montelukast (singular)
montelukast =
singular
how long for effects of montelukast
24 hours to see maximum effects
SE of montelukast
neuropsych effects (depression and suicidal ideation)
MOA of mast cell stabilizers
inhibits mast cells from releasing histamine and other chemical mediators of inflammation
prototype of mast cell stabilizers
Cromolyn (intal)
how do you admin mast cell stabilizers
nebulizer
SE of mast cell stabilizers
cough and bronchospasm
- rebound bronchospasm if stopped abruptly
Prototype of monoclonal antibodies
Omalizumab (Xolair)
Omalizumab =
xolair
MOA of monoclonal antibodies
binds to IgE in the body
when do you use monoclonal antibodies
severe, persistent allergic asthma not controlled by high dose steroids
administration of monoclonal antibodies
injected SQ Q2-4 weeks
why are monoclonal antibodies difficult
$10,000/year
SE of monoclonal antibodies
viral infections, URI, sinusitis, headache, injection site response
serious SE of monoclonal antibodies
anaphylaxis
aggravators of allergic asthma
pet dander and dust mite feces
prototype for phosphodiesterase type 4 (PDE4) inhibitor
roflumilast
MOA PDE4 inhibitor
blocks action of enzyme PDE4 that breaks down cAMP resulting in a decrease in release of inflammatory response
indication for PDE4 inhibitor
severe COPD with chronic bronchitis
common SE for PDE4 inhibitors
loss of appetite and weight loss
serious SE for PDE4 inhibitors
psychiatric effect (anxiety, depression, suicidal ideation)
two categories for allergic rhinitis
preventers and relievers
3 preventers for allergic rhinitis
- Antihistamines
- Intranasal glucocorticoids
- mast cell stablizers
relievers for allergic rhinitis
oral and nasal decongestants (sympathomimetics)
antihistamine MOA
work to block the actions of histamine at the H1 receptor classified as 1st generation and 2nd generation
methods for admin antihistamines
oral and intranasal
Antihistamines more effective when taken ____
prophylactically
prototype 1st generation antihistamine
diphenhydramine (Benadryl)
SE of diphenhydramine
sedation, anticholinergic effects (dry mouth, trouble urinating, etc)
prototype 2nd generation antihistamine
loratadine (Claritin)
benefit of 2nd generation antihistamine
less sedation
what is most effective for seasonal allergies
intranasal glucocorticoids
SE for intranasal glucocorticoids
drying/burning sensation, epistaxis
prototype for intranasal glucocorticoids
fluticasone (Flonase)
fluticasone =
flonase
Sympathomimetics/ Decongestants MOA
stimulate SNS to relieve congestion
alpha-1 agonist (vasoconstriction of nasal blood vessels)
administration of decongestants
oral or intranasal routes
SE of decongestants
HTN, CNS stimulation (insomnia)
what type of patients should not receive decongestants
cardiac patients
prototype of oral decongestants
pseudoephedrine (Sudafed)
pseudoephedrine =
sudafed
prototype of intranasal decongestants
oxymetazoline (afrin)
oxymetazoline =
afrin
what do you watch out for with intranasal decongestants
rebound congestion
rebound congestion
prolonged use causes escalating congestion requiring more drug to get the same result
how long should patients use intranasal decongestants
3-5 days
how to stop intransal decongestants
nasal glucocorticoid for 2-6 weeks; starting 1 week before stopping intranasal decongestant
Antitussives (two options?)
opioid and non-opioid
opioid antitussive prototype
codeine
non opioid antitussive prototype
dextomethorpan (robotussin)
dextomethorpan =
robotussin
what does an expectorant do
stimulate the flow of secretions
prototype experctorant
guaifenesin
what does a mucolytic do
makes mucus more water; and cough more productive
prototype mucolytic
acetylcysteine (mucomyst)