Module 7 - REspiratory Flashcards
Decongestant - Action:
Decongestants are ___________ agents that stimulate _________ and _______-adrenergic receptors, causing ______________________ in the respiratory tract mucosa and thereby improving ___________.
sympathomimetic; alpha and beta; vasoconstriction; ventilation
Topical decongestants in the form of _________ _________ slow _____________ motility and mucocilicary __________.
nasal sprays; ciliary; clearance
Topical decongestants should not be used more than _____ days, because it can cause ___________ ___________.
3; rebound congestion
Oral decongestants have the same mode of action as topical but can cause more ____________responses.
systemic
Asthma and allergic rhinitis are Type ___ hypersensitivity. In this type Imunoglobulin ______ attached to ___________ cells binds with an antigen causing a release of _____________, ___________, and _________.
Type I. IgE; mast cells; histamine, leukotrienes, and prostaglandins (causing inflammation)
Histamine is synthesized and stored in _____________ and _____________.
mast cells and basophils
True or False
Histamine release may be triggered by allergic and non-allergic mechanisms.
True
Vasodilation, increased capillary permeability, pain, itching, bronchoconstriction, and CNS effects are the result of ___________ stimulation.
H1 stimulation
Release of gastric acid from the parietal cells of the stomach is the result of ___________ stimulation.
H2 stimulation
Two major classes of histamine receptor antagonists:
H1 receptor antagonists are used to treat ______________. H2 receptor antagonists are used to treat ______________.
H1: mild allergic reactions; H2: gastric and duodenal ulcers
H1 Antagonists Method of Action:
Relieve __________ symptoms by blocking ___________ receptors on __________ ___________ ____________, ____________ and ___________ ____________. They do NOT block release of _______________ from _________ cells and _______________.
allergy, histamine, small blood vessels, capillaries, and sensory nerves.
histamine; mast cells and basophils
First generation H1 antagonists (dipenhydramine, hydroxyzine, chlorpheniramine, etc.) frequently cause _______________ and ________________ effects.
sedation and anticholinergic effects
True or False
Second generation H1 receptor antagonists (loratidine & fexofinidine) often cause sedation and dry mouth.
False
1st generation antihistamines are contraindicated in:
lactating mothers, narrow angle glaucoma, men with BPH, elderly.
Decongestant contraindications
Narrow angle glaucoma, hypertension, severe CAD; caution in pt with hyperthyroidism, diabetes and prostatic hypertrophy
Decongestant side effects
Hypertension, increased HR, palpitations, headache, dizziness, GI distress and tremor
Expectorant Mechanism of Action
Increase the output of respiratory tract fluid by decreasing the adhesiveness and surface tension of the respiratory tract and by facilitating removal of viscous mucous.
Expectorants and other cough products should not be used for more than _______ because they can ___________ ________ of other a more _______ __________ ____________.
one week; mask symptoms; serious underlying disorder.
Cough suppressant MOA
Diminish the cough reflex by direct inhibition of the cough center in the medulla
Expectorant contraindications
Breast feeding mothers, pregnancy cat c
Cough suppressant contraindications
pt with productive cough, hx of substance abuse, COPD; children - especially under 2
Cough suppressant side effects
dizziness, nausea, drowsiness, sedation
How is bacterial sinusitis differentiated from viral sinusitis in children?
symptoms persist without improvement for more than 10 days or when they are unusually sever facial tenderness, transient perorbital swelling, daytime cough, or fever of 102.2 (39) or higher in combination with purulent rhinorrhea
First line tx for bacterial sinusitis in children?
Amoxicillin 45mg/kg normal dose or 90mg/kg high dose if mild-moderate. Augmentin 90mg/kg if severe or at risk for s. pneumoniae (day care or recent abx)
Asthma is a chronic _______________ disease characterized by ______________of the airways, bronchial ________________, and __________________.
inflammatory; inflammation; hyperreactivity; bronchospasm.
______________is often the underlying cause of asthma.
allergy
What two types of drugs are used to treat asthma?
anti-inflammatory and bronchodilators
Advantages of inhaled asthma drugs (3)
- increase therapeutic effects (delivered to site of action)
- reduce systemic effects
- facilitate rapid relief
Inhaled steroids: MOA
Supress inflammation and promote synthesis of bronchial beta2 receptors; increase their responsiveness to beta2 agonists.
What are the most effective anti-asthma drugs for reducing risk of asthma flare up (prevents attacks)?
Glucocorticoids
True / False
Glucocorticoids are for long term prophylaxis, not aborting an ongoing attack.
True
When should glucocorticoids be administered orally for asthma?
Only when it is severe.
How long does it take for glucocorticoid therapy to achieve maximum effectiveness?
Approximately 2 weeks
Glucocorticoid contraindications
acute attacks; use cautiously with children due to growth restriction
Glucocorticoid side effects
candidiasis, dysphonia, hoarseness, cough, headache; can promote bone loss - low dose as possible and weight bearing exercise with adequate vit d and calcium
Prolonged glucocorticoid therapy can cause (5):,
adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer, and growth suppression
What may be used as a first line therapy in children because it doesn’t affect linear growth?
Cromolyn/Mast cell stabilizers (reduce inflammation primarily by preventing release of mediators from mast cells)
What is commonly used for EIB? And how?
Cromolyn; 15 min before anticipated exertion
Disadvantages of cromolyn?
Taken 3-4 times/day
SABA MOA
provide smooth muscle relaxation by activating beta2 receptors in bronchial smooth muscle
SABA/LABA contraindications
Use caution with ischemic heart disease, hypertension, cardiac arrhythmia, seizure disorder, and hyperthyroidism
SABA/LABA side effects
tachycardia, muscle tremor, hypokalemia, hyperglycemia, increased lactic acid, headache.
What does nebulized ipratropium do for an acute severe exacerbation of asthma? What else is also done?
Relieves airflow obstruction; O2, systemic glucocorticoid, nebulized saba
Allergens:
house dust mite, warm blooded pets, cockroaches, mold
Triggers:
tobacco smoke, wood smoke, household sprays
Key points for COPD:
Reduce triggers
Pharmocologic therapy for COPD is focused on
reducing symptoms, frequency and severity. It does not change to decline of lung function
COPD tx for those at high risk for exacerbations:
inhaled ICS and LABA
