Module 8: Respiratory Drugs Flashcards
Respiratory Drug Classes to know
- Beta2-adrenergic agonists
- Anti-cholinergics
- Corticosteroids
- Leukotriene modifiers
- Mast cell stabilizers
- Methylxanthines
- Expectorants
- Anti-tussives
- Mucolytics
- Decongestants
Asthma Pathway
Allergen, nonallergen stimulus
IgE inflammatory response
Bronchoconstriction;bronchospasm
Release of histamine, other mast cell products
Bronchial edema; increased mucus production; bronchoconstriction; bronchospasm
Airway obstruction
Expiratory wheezing, cough, increased mucus, dyspnea
Inhaled Drugs deposited in?
Spacer:
80-90% inhaled medication deposited in mouth or swallowed; 10-20% reaches airway.
-large volume chamber attached to metered-dose inhaler; decreases deposition of drug in mouth by reducing velocity of injected aerosol before entering mouth; in device, small particles continue into airway.
R.D.
Beta2-adrenergic Agonists treat:
Short-acting:
Long-acting:
-When you stimulate beta2-adrenergic receptors in smooth muscle?
- treat asthma, chronic obstructive pulmonary disease (COPD)
- fast relief [albuterol, pirbuterol, levalbuterol, metaproterenol, terbutaline]
- longer duration, not acute symptom control [salmeterol]
- increases cylic adenosine monophophate (cAMP)➡bronchodilation
Adverse effects of Beta2-adrenergic Agonists
Short-acting:
Long-acting:
- beta2-adrenergic agonist adverse effects: paradoxical bronchospasm, tachycardia, palpitations, tremors, dry mouth.
- beta2-adrenergic agonist adverse effects: bronchospasm, tachycardia, palpitations, hypertension, tremors.
R.D.
Anti-cholinergics treat:
They Inhibit muscarinic receptors➡
Block parasympathetic nervous system, rather than?
Adverse effects:
- Treat chronic obstructive pulmonary disease (COPD)
- bronchodilation [ipratropium]
- rather than stimulate sympathetic nervous system
- nervousness, tachycardia, nausea, vomiting, paradoxical bronchospasm
R.D.
Corticosteroids for:
Short and long term:
Inhibit production of:
Adverse effects:
- Anti-inflammatory drugs for treatment of asthma
- [beclomethasone, budesonide, prednisone, prednisolone, hydrocortisone]
- cytokines, leukotrienes, prostaglandins, other inflammatory mediators
- mouth irritation, oral candidiasis, upper respiratory tract infection.
R.D.
Leukotriene Modifiers treat:
Leukotrienes:
Inhibit:
Adverse effects:
- Treatment of mild asthma [montelukast, zafirlukast, zileuton]
- released from mast cells, eosinophils, basophils; cause smooth-muscle contraction in airways, increased secretions
- inhibit leukotriene interaction and production of 5-lipoxygenase
- headache, dizziness, nausea, vomiting, myalgia
R.D.
Mast cell stabilizers use for:
Stabilize mast cell membrane➡
Adverse Effects:
-prevention of asthma attacks [cromolyn]
prevent release of inflammatory mediators
IgE antibodies➡ Exposure to antigen (A) ➡ Mast cell degranulation (allergic response)
-Inhaled mast cell stabilizer adverse effects: Pharyngeal, tracheal irritation cough wheezing bronchospasm headache
R.D.
Methylxanthines also called ______ treat:
Decrease airway reactivity, bronchodilator (relax bronchial smooth muscle), decrease?
Caution: High fat meals increase:
Smoking, marijuana increase its:
Note: caffeine is a?
- xanthines; treatment of respiratory disorders (ACE= asthma, chronic bronchitis, emphysems [theophylline]
- decreases inflammatory mediators
- high fat meals increase theophylline concentrations➡ increased risk of toxicity; has narrow therapeutic window
- increase its elimination
- caffine is a xanthine derivative
R.D.
Expectorants:
Adverse Effects:
- reduces thickness, adhesiveness, surface tension of mucus so more easily cleared; results in more productive cough [guaifenesin]
- [guaifenesin] nausea, vomiting, diarrhea, abdominal pain, drowsiness, headache, hives, rash.
R.D.
Anti-tussives:
Different mechanisms:
Adverse Effects
-Benzonatate:
-Opioid anti-tussives:
- suppress or inhibit coughing; typically for dry, non-productive coughs
- Anesthetize stretch receptors in bronchi, alveoli, pleurae [benzonatate]
- Direct action on cough center in medulla of brain, lowering cough threshold [codeine, dextromethorphan, hydrocodone]
- needs to be swallowed whole; chewing or crushing can produce local anesthetic effect in mouth/throat, compromising airway
- commonly nausea, vomiting, sedation, dizziness, constipation
R.D.
Mucolytics:
Acetylcysteine:
Adverse effects:
- acts directly on mucus; decreases thickness by altering molecular composition so more easily eliminated [acetylcysteine]
- antidote for acetaminophen overdose
- “rotten egg” odor may cause nausea; bronchospasm in asthmatics
R.D.
Decongestants
- Systemic:
- Topical:
Adverse Effects:
-Decongestant
-Topical
- stimulates sympathetic nervous system to reduce swelling (reduce blood supply) of vascular network in respiratory tract [ephedrine, phenylephrine, pseudoephedrine]
- vasoconstrictors of smooth muscle in vasculature when applied directly to swollen nasal mucous membranes [ephedrine, phenylephrine, naphazoline, oxymetazoline]
Decongestant adverse effects result from CNS stimulation
- Nervousness, restlessness
- Insomnia
- Nausea
- Palpitation, tachycardia
- Difficulty urinating
- Elevated blood pressure
-Topical decongestants can have rebound nasal congestion with prolonged use
