Other Bronchodilators Flashcards
What are all the Methylxanthines and where are they found?
- Caffeine…found in the seeds of coffee plants
- Theophylline (Theo- Dur, Theolair)…found in tea leaves
What are the diseases that Theophylline help manage?
- Asthma
- COPD (Chronic obstructive Pulmonary Disease)
- Apnea of prematurity in neonates
How does Theophylline help mange asthma?
- Sustained-release theophylline is indicated as an alternative for maintenance therapy of mild, persistent asthma and higher in patients older than 5 years of age
- Listed as an alternative for patients older than 5 years of age in combination with an ICS (Incolical Steroid)
- Side effects and narrow therapeutic index may make it a poor choice vs other agents
How does theophylline help mange COPD?
- Theophylline: recommended by GOLD as alternative to β2-agonist and anticholinergics
- Not used in acute exacerbations
- Global Initiative for Chronic Obstructive Lung Disease (or GOLD)
How does Theophylline help manage Apnea of prematurity in neonates?
- Methylxanthines are considered the first-line agents of choice as treatment
- Caffeine citrate a better choice (as it is safer, higher therapeutic index)
- Theophylline was most extensively used in the past,
What are the effects of xanthine’s?
- CNS stimulation
- Skeletal muscle stimulation
- Pulmonary vasodilation
- Smooth muscle relaxation (why it’s considered a bronchodilator)
What are the effects of Methylxanthines on the lungs?
- Decrease airway resistance
(result of bronchodilation) - Decrease pulmonary vascular resistance
(result of pulmonary vasodilation) - Stimulated ventilation (CNS)
What are the therapeutic serum levels of Theophylline?
- 10-20 mcg/mL (adults) (also therapeutic range)
- 5 to 15 mcg/mL (asthma management)
- 5 to 10 mcg/mL (COPD management)
What are the side-effect levels of Theophylline?
< 5 mcg/mL - no effects seen
> 20 mcg/mL - nausea
> 30 mcg/mL - cardiac arrhythmias
40 - 45 mcg/mL - seizures
It is possible for an individual to bypass the nausea phase of toxicity and begin having seizures immediately
Is the therapeutic range of Theophylline effect everyone the same?
- No, there is variability in individual metabolic rates among patients, which makes it difficult to control therapeutic dosages
- Blood levels are important to monitor in patients receiving methylxanthine drugs as toxicity is serious
- In practice, an initial loading dose is given followed by a maintenance dosage adjusted to obtain therapeutic plasma levels
What is aminophylline?
- A double salt of theophylline compounded to give aqueous solubility
- This enables one to give the drug IV
What are the adverse reactions with Theophylline on the CNS?
Headache
Anxiety
Restlessness
Insomnia
Tremor Convulsion
What are the adverse reactions of Theophylline on the gastrointestinal?
Because of the side effects in the gastrointestinal system, xanthines are contraindicated in subjects with active peptic ulcers or acute gastritis
What are the adverse reactions with Theophylline on the Respiratory, Cardiovascular, and Renal?
Respiratory:
- Tachypnea
Renal:
- Diuresis
Cardiovascular:
- Palpitations
- Ventricular arrhythmias
- Hypotension
What are Mucolytics vs Mucoactive?
- Mucolytics, refers to an agent that breaks down or liquifies thick mucus to a watery state
- Mucoactive refers to any agent that has an effect on mucus secretion
(mucolytic, expectorant, mucokinetic, etc.)
What is the general reason for Mucoactive therapy?
- To reduce the accumulation of airway secretions
- Improve pulmonary function and gas exchange
- Aids in the prevention of repeated infection and airway damage
What are some diseases that in which Mucoactive therapy would be involved?
- Cystic Fibrosis - genetic condition, airway becomes clogged with mucous b/c of overproduction
- Acute and Chronic Bronchitis
What are 3 drugs Mucoactive used as an aerosol? (Generic - Trade)
N-acetylcysteine (NAC) - Mucomyst
Dornase alfa - Pulmozyme
Hypertonic saline - use with ultrasonic Neb
What are some causative factors that you can remove to help manage mucous secretions?
Treat infections
Stop smoking
Avoid pollution and allergens
Acetylcysteine
- Generic name: N-Acetylcysteine, Acetylcysteine, or NAC
- Trade name: Mucomyst (most common), Mucosil
- Mechanism of action: Lyses disulfide bonds holding mucoproteins together, thus increasing fluidity of mucoid sputum
- Concentration : 20% W/V solution or 10% W/V solution
What are the side effects of Acetylcysteine?
Bronchospasm
Excessive liquefaction of dried, retained secretions
Hypersensitivity
Nausea
Rhinorrhea - excessive runny nose
What are the indication for the use of Acetylcysteine?
- Treatment of conditions associated with viscous secretions
- Also used for Acetaminophen (Tylenol) overdose
- Contraindications: Hypersensitivity
What are the side effects of Acetylcysteine?
- Bronchospasm
- Nausea
- Rhinorrhea - excessive runny nose
What is HIGHLY recommended when giving Acetylcysteine?
-Highly recommended that the drug be administered in conjunction with a bronchodilator!
- Foul smelling !!!
What is Dornase Alpha?
- Trade name: Pulmozyme
- Indication: For the management of cystic fibrosis
- Mode of Action: Indication: For the management of cystic fibrosis; to decrease in the size of the DNA in the sputum
How do you give the optimal delivery of Dornase Alpha?
Requires a nebulizer system capable of producing appropriate sized particles and quantity of aerosol
What are the approved Nebs for Dornase Alpha?
- Hudson RCI UP-DRAFT II OPTI-NEB*
- Acron II nebulizer*
- PARI LC PLUS nebulizer*
- Mesh Neb
What are the side effects of Dornase Alpha?
- Voice alteration
- Pharyngitis (inflammation of the airways)
What are Expectorants?
- Medications meant to increase the volume or hydration of airway secretions for clearance
Cough suppressants should never be given to patients with thick, retained secretions
What is Sodium bicarbonate?
Inflammation caused by bicarbonate is thought to draw water into secretions
What are Antihistamines?
- Drugs that reduce the effects mediated by histamine, a chemical released by the body during allergic reactions
- Antihistamines are often administered to reduce secretions (e.g., runny nose and sneezing)
What is Guaifenesin (Mucinex)?
- Usually considered as an expectorant
- Thought that expectorant action is mediated by stimulation of the GI tract
What are Antitussive?
Drugs that suppress the cough reflex
Note: Productive coughs should not be suppressed!
What are the 4 classification of Cough & Cold agents?
1) Sympathomimetics: For decongestion
- Pseudoephedrine (Sudafed)
2) Antihistamines: To reduce (dry) secretions
- Diphenhydramine HCI (Benadryl), Cetirizine (Zyrtec), Loratadine (Claritin)
3) Expectorants: To increase mucus clearance
- Guaifenesin (Mucinex)
- Robitussin DM
4) Antitussives: To suppress the cough reflex
- Codeine, Dextromethorphan (Delsym, Trocal,
- Robitussin Maximum Strength Cough)
What are other names for Methylxanthines?
xanthines, xanthine derivatives, or as methylxanthines
What does Methylxanthines do?
They are phosphodiesterase inhibitors which indirectly increase the amount of cyclic AMP within smooth muscle causing bronchodilation
