Lower Respiratory Drugs

Question 1

• terols

Answer 1

• B2 adrenergic agonists; bronchodialators
• Short-acting, rescue inhalers
  
  • albuterol (MDI/Neb)
  • Levalbuterol (MDI/Neb)
• Long acting, maintenance therapy
  
  • salmeterol (diskus DPI)
• MOA: bronchodilation, decrease histamine, increase ciliary motion
• Side effects: can cause B1 activation (tachycardia, dysrhythmia, angia, HTN, palpitation), nervousness, tremors, HA, increased BG
• Contraindications: pregnancy, tachycardia, hyperthyroidism
• Avoid stimulants (caffeine, nicotine)
• Tolerance: do not increase the frequency, call the provider or 911
• Do not use more than prescribed –> OD –> paradoxical airway resistance
• Use before inhaled corticosteroids

Question 2

• opiums

Answer 2

• Anticholinergic bronchodialators
• MOA: anticholinergic (PNS) → bronchodilation
• Maintenance treatment
• Ex: ipratropium, tiotropium
• Synergistic effect when combined with β-agonists
  
  • albuterol + ipratropium
• Contraindication: peanut allergy, glaucoma, BPH

-No cardiac adverse effects because of local effect as an inhaler
- Large doses may cause systemic anticholinergic effects
- Rinse mouth (taste), allow at least 5 min between
various inhalers

“Op, I ate a peanut”

Question 3

Corticosteroids (glucocorticoids)

Answer 3

• MOA: anti-inflammatory
• Must always wean off (stopping abruptly can cause adrenal crisis)
• IV:
  
  • methylprednisolone
  • Acute exacerbation of inflammatory disorders
    (requires loading dose)
  • exacerbations of COPD, asthma, cystic fibrosis…
• PO:
  
  • methylprednisolone, prednisone
  • to wean from IV and to continue to wean
  • end-stage disease for maintenance
• DPI/MDI/Nebulized:
  
  • budesonide, fluticasone
  • Maintenance therapy (scheduled), avoid OD (not a
    rescue drug, not PRN)
  • It takes 1-4 weeks to reach max result
  • if concurrent with a β2 adrenergic agonist, always take
    β2 adrenergic agonist first
  • rinse mouth with water and spit after each use to
    avoid throat/oral candidiasis
  • after rinsing the mouth, drink water to avoid
    pharyngitis
• Nasal Spray:
  
  • budesonide, fluticasone
  • UR inflammation & congestion associated with allergic
    rhinitis
  • side effects: dryness of nasal mucosa (epistaxis)
• Side effects: hyperglycemia (in DM), leukocytosis, immunosuppressant, water/Na retention (worsening HF, HTN, hypokalemia (dysrhythmia), & increased IOP, worsening glaucoma), SubQ tissue loss (paper skin), adrenal suppression/crisis, osteoporosis
• Can do combination therapy (glucocorticoid + B2 agonist)

Question 4

Theophylline

Answer 4

• Bronchodialator
• PO is maintenance, IV is for emergencies
• MOA: bronchodilator, anti-inflammatory effects,
  CNS & respiratory stimulant, dilates coronary & pulmonary circulation, diuretic
• Indications:
  - IV: neonatal apnea (stimulates respiration in newborns)
  
  • IV: emergency respiratory depression caused by CNS depressant OD
  • IV: anesthetic recovery
  • IV/PO: bronchodilator (for asthma, COPD, status asthmatics)
• CNS effects: restlessness, tremors, twitching, insomnia, seizure, dieresis, tinnitus, tachycardia, palpitations, dysrhythmia, dependence & withdraws symptoms
• Side effects: N/V, HA, dysrhythmia => hypotension; seizure, cardiopulmonary collapse; GIB; hyperglycemia
• Narrow therapeutic range (5-15 mcg/ml, high risk of toxicity),

“Hay, Nadia & Vlad Did Have Some Cool Children. God Bless, Hallelujah!”

Question 5

Montelukast

Answer 5

• Leukotriene modifier
• PO
• MOA: suppress the effect of LT => ↓ inflammation, edema, mucus => bronchodilation
• Indication: maintenance therapy (not for acute SOB)
• For 1-year & up
• Side effects:depression, suicidal ideation, liver failure, drug interactions
  
  • Causes liver failure → causes drug toxicity
  • first pass is not as effective
  • do liver function tests
  • don’t do hepatotoxic agents (acetaminophen, alcohol)

Question 6

Acetylcysteine

Answer 6

• Inhalation: mucolytic
• PO, IV: acetaminophen OD & liver failure
• PO: prevents nephrotoxicity before & after IV contrast therapy
• MOA: breakdown protein structure of bronchial secretions
• Indication: cystic fibrosis, COPD & bronchitis
• Side effects: dizziness, drowsiness, orthostatic hypotension, tachycardia, hepatotoxicity
• Contraindications: kids <7yo
• Encourage hydration
• PO form has rotten egg smell; can mix with drinks to his the smell

“Did David Offer Her Helpful Tissues”

Question 7

Supplemental Oxygen

Answer 7

• Uses: continuous, PRN for DOE & QHS, acute SOB
• Side effects: vasoconstriction, hypoxia (lose respiratory drive)
• Available in tanks, condensers & piped (medical facilities)