Introduction:Lower Respiratory Tract Flashcards

Question

What are Pharmacokinetics of ipratropium (Atrovent)?

Answer 1

Anticholinergics Inhalants Ipratropium --> rapid onset (15 min); 1-2hr hour peak Can be combined with albuterol ---> combivent ----> dosed less frequently

Answer 2

Anticholinergics Anticholinergic effects --> dizziness, headache, fatigue, dry mouth, palpitations, urinary retention have been reported events of hypersensitivity and paradoxical bronchospasm.

Answer 3

r/t Anticholinergic effects Allergy to soy products or peanuts

Answer 4

Anticholinergics Increase in anticholinergic effects when combined with other anticholinergics

Answer 5

Inhaled steroids

Answer 6

Inhaled steroids Reduces inflammation Increases beta-agonist activity  muscle relaxation Decreases the inflammatory response in the airway; this action will increase airflow and facilitate respiration in an airway narrowed by inflammation.

Answer 7

Inhaled steroids Treatment of bronchospastic disorders that are not controlled by conventional bronchodilation -Could be used for asthma patient Used early in disease process with bronchodilator In acute episodes corticosteroid is given IV (then orally for several days)

Answer 8

Advair  fluticasone and salmeterol Symbicort  budesonide and formoterol

Answer 9

Inhaled steroids Limited due to inhalation Dry mouth, sore throat, hoarseness Oral fungal infections (**oral care!!)

Answer 10

Not for acute attack Pregnancy/lactation inhaled steroids are not for emergency use and not for use during an acute asthma attack or status asthmaticus

Answer 11

Active respiratory infection These preparations should be used with caution in any patient who has an active infection of the respiratory system because depression of the inflammatory response could result in serious illness. ***Bronchodilate first…. then steroid

Answer 12

Leukotrienes  substances released when a trigger starts a series of chemical reactions in the body Leukotrienes cause inflammation, bronchoconstriction, and mucus production Result: coughing, wheezing, shortness of breath

Answer 13

Leukotriene Receptor Antagonists

Answer 14

Leukotriene Receptor Antagonists Prevent leukotrienes from attaching to receptors on cells in the lungs and in circulation Decreases vascular permeability Decreases mucus production Inflammation in the lungs is blocked, and asthma symptoms are relieved

Answer 15

Leukotriene Receptor Antagonists Prophylaxis and chronic treatment of asthma in adults and children (NOT meant for management of acute asthmatic attacks) Tx of allergic rhinitis

Answer 16

Leukotriene Receptor Antagonists HA, N/V/D Elevated LFTs Generalized myalgia Long term effects not fully studied upper respiratory infection, pharyngitis, cough, headache, dizziness, nausea, diarrhea, abdominal pain, elevated liver enzyme concentrations, vomiting, generalized pain, fever, and myalgia. Serious neuropsychiatric events (including depression, suicide, hallucinations, and aggressive behavior) have been reported in patients taking leukotriene receptor antagonists. Montelukast has a boxed warning regarding the risk of neuropsychiatric events.

Answer 17

Leukotriene Receptor Antagonists Allergy Metabolized extensively in the liver/renal Pregnancy/lactation – fetal toxicity in animal studies

Answer 18

Leukotriene Receptor Antagonists coumadin, ASA, CCBs, cyclosporine warfarin, theophylline, phenytoin, aspirin, and others. Check for interactions before administering these medications.

Answer 19

Leukotriene-receptor antagonists very useful in children Acute episodes best managed by short B2 then steroid Parent teaching important If inhalants used for exercise asthma use 30 to 60 minutes prior to exercise Adults – periodic review of administration technique/new drugs Pregnancy safety not established Older adults – assess co-morbidities, renal/hepatic function…start low! General: Yearly flu vaccine a must!

Introduction:Lower Respiratory Tract Flashcards

Chapter 55