Lower Respiratory Drugs Flashcards
Prototypes:
Bronchodilator’s:
— albuterol (inhaler)
— salmeterol (inhaler)
— ipratropium (inhaler)
— theophylline/aminophylline
Anti-inflammatories:
— fluticasone (inhaler)
— montelukast
What is Alpha 1-Adrenergic AGONIST?
— sympathomimetic: mimics function of SNS
— mimics the action of epinephrine and norepinephrine
— causes smooth muscle and vessel constriction
— used as a decongestant
What is a Beta2-Adrenergic AGONIST?
— sympathomimetic
— mimics effects of SNS
— dilation of bronchi with increased rate and depth of respiration
Ex: albuterol
ANTI-cholinergics:
— substance that BLOCKS neurotransmitter acetylcholine in CNS & PNS
— effects the vagus nerve to relax bronchial smooth muscle
— promotes bronchodilation
Ex: asthma therapy (inhaler)
What are medication cautions exacerbated by sympathetic activity?
— glaucoma
— hypertension
— coronary artery disease
— peripheral artery disease
— diabetes (increased glucose)
— hyperthyroidism (increased HR)
— prostate hypertrophy
What are medication cautions exacerbated by anticholinergic effects (parasympathetic)?
— constipation
— prostate hypertrophy
— hypertension
— tachycardia
— dementia
What are characteristics of asthma (triggers)?
Bronchoconstriction, inflammation, mucous production
Respiratory characteristics of COPD?
— chronic cough
— mucous production
— expiratory airway collapse with air trapping
Characteristics of pneumonia:
— bronchitis
— emphysema
— inflammation
— infection
What are some clinical manifestations of asthma, COPD, and pneumonia?
— shortness of breath/dyspnea
— increased work of breathing, use of accessory muscles
— sputum production
— hypoxia
What is the role of histamine?
Stimulates larger bronchi to cause smooth muscle spasms, inflammation, and edema
Medication used as a “rescue inhaler”:
Sympathomimetic: beta2-Adrenergic agonist
— albuterol
— short acting beta agonist
— used on acute onset; used 4-6 hours PRN
What medication is used as a “maintenance inhaler”:
Sympathomimetic: beta2-adrenergic agonist
— salmeterol
— long acting beta agonist
— prevention of bronchospasms; used twice a day
What is albuterol and what does it do?
Adrenergic AGONIST:
— rescue inhaler
— short acting beta agonist (SABA)
— promotes bronchodilation
— inhaler; onset: 5-15 minutes
What are adverse effects of albtuerol?
Sympathomimetic stimulation:
— cardiac arrhythmias
— HTN
— sweating
— tremors
— worsened bronchospasms
Receptors are not targeted perfectly
— some patients can have the opposite effects and make things worse
What is salmeterol and what does it do?
Adrenergic AGONIST:
— inhaler
— used for maintenance
— long acting; used on schedule
— promotes bronchodilation
What are contradictions to salmeterol?
Increased risk for asthma-related deaths
— inhaled corticosteroids to decrease risk
What is ipratropium (atrovent) and what does it do?
Respiratory ANTI-cholinergic
— used for maintenance; asthma prevention
— BLOCKS acetylcholine; promotes airway dilation
— inhaler; scheduled drug
What are some adverse effects of ipratropium (atrovent)?
— dry mouth
— nasal congestion
— heart palpitations
What is fluticasone (Flovent) and what does it do?
Inhaled corticosteroid:
— decrease inflammatory response to airways
— maintenance; prevention and treatment of asthma
— inhaler; scheduled medication
What are adverse effects to fluticasone (Flovent)?
— sore throat
— hoarseness
— coughing
— dry mouth
— fungal infections
Nursing: rinse mouth after inhalation to reduce fungal infections
Positive effects of combination respiratory drugs?
Greater control over symptoms by approaching disorder from two different pathways
— must consider BOTH adverse effect profiles
Inhaler education:
— promote use of spacer
— clean weekly
— rinse mouth after inhaler use (especially with corticosteroid)
— timing of administration (rescue, or maintenance)
What is the sequence for using multiple inhalers?
- Bronchodilator’s
— beta agonist agents
— wait 1 minute between puffs
— wait 5 minutes before administering next medication - Corticosteroids
— always administer AFTER bronchodilator’s
— wait 1 minute between puffs
— rise mouth afterwards to prevent fungal infection
What is montelukast (singulair) and what does it do?
Leukotriene receptor ANTAGONIST:
— blocks production of inflammation
— blocks receptors for production of leukotrienes (inflammatory)
— oral medication; prophylaxis for asthma in adults & children
— maintenance medication
What are some adverse affects of montelukast (singulair)?
Headache, nausea, diarrhea
What is theophylline/aminophylline and what does it do?
Xanthine derivatives; HIGH RISK: not commonly used
— theophylline: oral; prevention of bronchospasm
— aminophylline: IV; reversal of bronchospasm
— rescue medication
— direct effect on smooth muscles of respiratory tract
— metabolizes to caffeine; leads to toxic effects very fast
— NARROW therapeutic window; low margin of safety
What are some adverse effects of theophylline/aminophylline?
— GI upset
— nausea
— irritability
— tachycardia
— seizure
— brain damage
— possible death
Contradiction: cardiovascular disease
