Lower Respiratory Tract Agents Flashcards
Pharmacology Exam 1
Where does gas change occur?
In the lower respiratory tract.
What does the lower respiratory tract consist of?
The bronchial tree and alveoli
What are lower respiratory agents used for?
Asthma, COPD, Pneumonia and Respiratory Distress Syndrome
What form does respiratory agents come in?
Oral, Nebulizer and injection, sometimes combination therapy is needed.
What are the 6 drug classes within the Lower Respiratory Tract Agents?
Xanthines
Sympathomimetics
Anticholenergics
Inhaled Steroids
Leukotriene Receptor Antagonists
Lung Surfactants.
What is the suffix(es) and/or generic drug names of Xanthines?
Methylaxines
Caffeine
Theophylline
What is the suffix(es) and/or generic drug names of Sympathomimetics?
“-terol” Levalbuterol and Albuterol
“-proterenol” Isoproterenol and Metaproterenol
Outlier is Epinephrine.
What is the suffix(es) and/or generic drug names of Anticholenergics?
“-tropium” Ipratropium
“clinium” Aclidinium
What is the suffix(es) and/or generic drug names of Inhaled Steroids?
“-one” Beclomethasone, Triamcinolone
“-esonide” Budesonide
What is the suffix(es) and/or generic drug names of Leukotriene Receptor Antagonists?
“-lukast” Zafirlukast and Montelukast
What is the suffix(es) and/or generic drug names of Lung Surfactant?
“actant” Beractant and Calfactant
How does Xanthines work?
Xanthines have a direct effect on the smooth muscles of the respiratory tract, bronchi, reparatory tract and the blood vessels. Exact method of action is not known.
How does Sympathomimetics work?
They are Beta 2 selective agonists which dilates the bronchi, increases respiratory rate, increases depth of respiration, SABA (short acting beta 2 agonist) & LABA (long acting beta 2 agonist). Mimics the effect of the sympathetic nervous system
How does Anticholinergics work?
By blocking vagal effect which leads to relaxation of smooth muscle in the bronchi (bronchodilation)
How does Inhaled Steroids work?
By decreasing inflammaton response in the airways. Takes 2-3 weeks to work due to being oral
How does Leukotriene Receptor Antagonists work?
They act at the side of the problem associated with asthma. Inhibits SRSA (Slow reacting substances of anaphylaxis) Block receptors for the production of leukotrienes.
What are Leukotrienes?
Leukotrienes are a group of inflammatory chemicals that play a role in allergic diseases and inflammation.
What are SRSA’s (Slow reacting substances of anaphylaxis)?
Slow-reacting substance of anaphylaxis (SRS-A) is a substance that’s released during an allergic reaction and causes smooth muscles to contract slowly and steadily. It’s a key mediator of immediate-type hypersensitivity reactions and is thought to play a major role in asthma.
How does Lung Surfactants work?
They replace the surfactant that is missing in the lungs of the neonates with respiratory distress syndrome (RDS) They work immediately.
What is Theophylline used for?
Theophylline is a Xanthine and is used for symptomatic relief of asthma and COPD and for the reversal of bronchospasms.
What is Albuterol used for?
Albuterol is a Sympathomimetic drug and is used for acute asthma attacks, COPD, Anaphylaxis prevention of exercise induced asthma. LAVA used for MAINTENCENCE of chronic respiratory diseases due to being long acting.
What is Ipratropium used for?
Ipratropium is a Anticholinergic and is used for the treatment of bronchospasms associated with COPD.
What is Budesonide used for?
Budesonide is an Inhaled Steroid and is used for prevention of asthma and COPD. It is however NOT used for EMERGENCY asthma attacks
What is Montelukast used for?
Montelukast is a Leukotriene Receptor Antagonist and is used for the long term treatment of Asthma.
What is Calfactant used for?
Calfactant is a a recue treatment for children who have developed RDS/missing surfactant. Often neonates that was prematurely born.
What are some lifespan considerations to take into account when prescribing a child Lower respiratory tract agents?
Lower Respiratory Tract agents are usually prescribed for Asthma and usually as long acting inhaled steroids, short acting beta-agonists (SABA’s)
Leukotriene receptor antagonists are best for prevention.
Children that need these drugs should avoid allergens, smoke, crowds and dust.
Theophylline should only be administered if nothing else works
What are some lifespan considerations to take into account when prescribing Lower respiratory tract agents to an adult?
Avoid allergens and triggers. Periodic spirometry to monitor lung capacity.
Benefit vs risk in pregnancy
What are some lifespan considerations to take into account when prescribing Lower respiratory tract agents to an older adult?
More likely to to experience adverse affect of the drugs due to older adults more likely to have preexisting renal and hepatic impairment, hence they will metabolize and secrete the drug differently. Start low go slow.
May need pulmonary toileting which means they should be positions properly for breathing, elevated in the bed, have rest periods and encourage productive coughing.
What are some contraindications that would not make Aclidinium a good choice for a patient?
If the patient have acute bronchospasm or require immediate intervention.
Aclidinium is a Anticholinergic drug.
What are some contraindications that would not make Budesonide a good choice for a patient?
It is not an emergency drug for acute asthma attacks.
What are some contraindications that would not make Zafirlukast a good choice for a patient?
Not a drug for acute asthma attacks.
What cautions should be made when a patient is taking methylxanthines?
GI problems, Heart disease, Renal and hepatic disease, Alcoholism, Hyperthyroidism these may all be worsened by the effect of Xanthines
What cautions should be made when a patient is taking Isoproterenol?
Isoproterenol is a Sympathomimetic and conditions aggravated by SNS stimulation, cardiac arrythmias, hypertension, sweating, pallor and flushing could be exacerbated.
What cautions should be made when a patient is taking Ipratropium?
Ipratropium is an Anticholinergics and any condition aggravated by the anticholinergic effect could be exacerbated. Glaucoma, Urinary retention and dry mouth.
What cautions should be made when a patient is taking Triamcinolone?
Acute respiratory infection. Triamcinolone is an Inhaled Steroid and so if there is and active respiratory infection the patient may inhale the infection into the lungs.
What cautions should be made when a patient is taking Montelukast?
Monetlukast is a Leukotriene Receptor Antagonist and it could make hepatic impairment worse.
What are some possible adverse effects when a patient is taking Theophylline?
Theophylline is a Xanthine and the adverse effects are related to the Theophylline levels in the blood which may cause GI issues, Cardiac (tachy), CNS effects, Severe toxicity (seizure arrythmias, hypertension and coma) Used in ER situations - Low margins for safety.
What are some possible adverse effects when a patient is taking Metaproterenol?
Metaproterenol is a Sympathomimetic drug and it could lead to unexplained Paradoxical bronchospasms. The sympathomimetic stimulation could increase BP, HR and increase blood flow to organs. It can stimulate the CNS and cause GI upset.
It could also cause cardiac arrythmias and hypertension.
What are Paradoxical bronchospasms
a rare and potentially life-threatening adverse effect that occurs when the airways constrict after using a bronchodilator. Bronchodilators are typically used to treat asthma and other conditions by relaxing the muscles in the bronchial tubes. However, in some cases, the muscles constrict instead, which can lead to respiratory distress or failure
What are some possible adverse effects when a patient is taking Ipratropium?
Ipratropium is a Anticholinergic and it could cause adverse effects such as dry moth, hoarseness, sore throat, dizziness, headaches, nervousness, palpitations and urinary retention (is systematic absorption occur) and Paradoxical Bronchoconstriction.
What are some possible adverse effects when a patient is taking Beclomethasone?
Beclomethasone is a Inhaled Steroid and could cause adverse effects such as sore throat/hoarseness, coughing, dry mouth.
Pharyngeal & Laryngeal fungal infection from steroid being in the mouth.
What are some possible adverse effects when a patient is taking Montelukast?
Montelukast is a Leukotriene Receptor Antagonist and may cause flu like symptoms, pharyngitis, cough, generalized pain, fever, myalgia (muscle pain).
It could effect the CNS and cause headaches and dizziness.
It could effect the GI tract and cause nausea, diarrhea, vomiting and elevated liver enzymes/
It has a black box warning of a Neuropsychiatric effect and aggressive behavior, depression and suicide especially in children.
What is the Black Box Warning for Leukotriene Receptor Antagonists?
May cause a neuropsychic effect of aggressive behavior, depression and suicidal ideology and hallucinations, especially in children.
What are some drug-drug interaction that’s important to know for Theophylline?
Theophylline is a Xanthine and any drug metabolized in the liver may interact with Xanthines. Substances in cigarettes increase metabolism of Xanthine which means that when a patient stops smoking it could lead to toxicity due to dosage being too high all of a sudden.
Xanthines have narrow safety margins. There are numerous adverse effects. The are only to be used in critical ICU situations or when other drugs don’t work.
What are some drug-drug interaction that’s important to know for Montelukast?
Montelukast is a Leukotriene Receptor Antagonist and there are several drug-drug interactions due to this drug being metabolized by the P450 system, so it interacts with many other drugs metabolized in the same system. Check for interactions before administration.
What physical nursing assessment should be done prior to administering Xanthines to patients?
Respiration, cardiac, abdomen, vital signs and ECG.
What physical nursing assessment should be done prior to administering Sympathomimetics to patients?
Respiration, Cardiac, vital signs. neuro and effects of drug.
What physical nursing assessment should be done prior to administering Anticholinergics to patients?
Skin, mucous membrane.
CNS: orientation, affect and reflexes and urinary output.
What physical nursing assessment should be done prior to administering Inhaled Steroids to patients?
Respiratory
Vital signs
Temperature
CV: BP, pulse, cardiac auscultation
What physical nursing assessment should be done prior to administering Leukotriene Receptor Antagonists to patients?
Abdominal evaluation and Labs for liver functions due to adverse effects on liver.
What nursing assessment should be done when administering surfactants to a patient?
The time of birth and exact weight for dosage. Physical exam for effect of drug, vital signs, blood gasses and oxygen saturation.
What nursing implementation should be done when administering Xanthines to patients?
Should be administered with food to prevent GI upset. If given via IV it should be switched to oral form as soon as possible because systemic effect is more manageable with oral form.
What nursing implementation should be done when administering Sympathomimetics to patients?
Patient teaching for proper administration. Drug should be taken 30-60 min prior to exercise for patients experiencing exercised induced asthma.
If GI upset happens the patient should eat small frequent meals
What nursing implementation should be done when administering Inhaled Steroids to patients?
Patient teaching to rinse mouth and wash inhaler after use to prevent fungal infection both in mouth and inside the inhaler. The drug takes 2-3 weeks to work so patient should continue to use the drug even if they don’t see immediate effect.
What nursing implementation should be done when administering Leukotriene Receptor Antagonists to patients?
Patients should know that this drug is not for acute asthma attacks and they should monitor for infection related to the adverse effect of flu like symptoms and respiratory infection.
What nursing implementation should be done when administering surfactant to patients?
The baby should be monitored continuously. Ensure tube placement before administrating suction before drug administration but wait to to use suction again until 2 hrs after drug administration. There is a risk of damage to the trachea. Monitor for patient response and breathing.
Which lower respiratory tract agents are most commonly used in children?
Long-acting inhaled steroid
* Short-acting beta2 agonist (SABA)
* Leukotriene receptor antagonist
Theophylline only if nothing else works
Which drug class have a direct effect on the smooth muscles of the respiratory tract in the bronchi and blood vessels?
Xanthine’s
*Theophylline
What drug is used for reversal of bronchospasm, COPD and asthma?
Theophylline which is a Xanthine
What labs should be ordered prior to administering Xanthine to a patient?
Liver and renal functions since Xanthine are metabolized in the liver and have small safety margins.
Theophylline levels since adverse effects of xanthine ae related to theophylline levels in the blood.
What are the adverse effects of theophylline levels in the blood?
GI upset, nausea, irritability, and tachycardia to seizure, brain damage, and even death.
what drug class have the suffixes “terol” and “protereol”?
Sympathomimetics
Which drug category works as Beta2- Adrenergic agonists?
Sympathomimetics
They dilate the bronchi
Increases respiratory depth
This is because the mimic the effect of the sympathetic nervous system.
Why would a patient use anticholinergic medications instead of sympathomimetics?
Because the have conditions that makes them unable to tolerate the sympathomimetic effects.
They block the vagal nerve, so the patient is still experiencing bronchodilation but its not as effective as sympathomimetics.
Which drug class decreases the inflammatory response in the airways?
Inhaled steroids
Which of the following drugs are used as the maintenance treatment of bronchospasms related to COPD?
Cholestyramine
Levalbuterol
Theophylline
Ipratropium
Ipratropium which is an anticholinergic
Which lower respiratory tract category drug have suffixes “one” and “esonide”
Inhaled Steroids.
Which lower respiratory tract category drug have suffixes “lukast”
Leukotriene receptor antagonists.
Zafirlukast and Montelukast
What is a way to memorize the adverse reactions of anticholinergic effect?
Can’t see
Can’t pee
Can’t spit
Can’t shit
What is a way to memorize the drugs that are bronchodilators using the word BAM?
Beta 2 Agonists (Sympathomimetics)
Anticholinergics
Methylxanthines (Xantines)
What is a way to memorize the drugs that soothes inflammation using the word SLM?
Steroids
Leukatrine Receptors
Mast Cell Stabilizers (we dont need to know this one)
Beta2 Agonist (sympathomimetic)
Bad asthma attack
Steroid 3’s
Swelling and Inflammation
Slow onset
Sores in the mouth
Leukotriene Receptor Antagonists
Long-term management
Long onset (1-2 weeks)
Prevention
NOT FOR ACUTE ATTACKS
Methylxanthines
What do they do?
Think caffeine- these amp you up
Take in the AM
3 Ts
Toxic: over 20 mg/L
Tonic-clonic seizures
Tachycardia and dysrhythmia
Patient teaching related to inhalers
Wait 1 minute between puffs
Sympathomimetic and steroid inhaler
Sympathomimetic inhaler first
Wait 5 minutes
Then Steroid Inhaler
Canister inhalers
Shake it before you take it
