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RCP pharm > Other Bronchodilators > Flashcards

Other Bronchodilators Flashcards

1
Q

What are all the Methylxanthines and where are they found?

A
  • Caffeine…found in the seeds of coffee plants
  • Theophylline (Theo- Dur, Theolair)…found in tea leaves
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2
Q

What are the diseases that Theophylline help manage?

A
  • Asthma
  • COPD (Chronic obstructive Pulmonary Disease)
  • Apnea of prematurity in neonates
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3
Q

How does Theophylline help mange asthma?

A
  • 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
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4
Q

How does theophylline help mange COPD?

A
  • 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)
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5
Q

How does Theophylline help manage Apnea of prematurity in neonates?

A
  • 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,
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6
Q

What are the effects of xanthine’s?

A
  • CNS stimulation
  • Skeletal muscle stimulation
  • Pulmonary vasodilation
  • Smooth muscle relaxation (why it’s considered a bronchodilator)
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7
Q

What are the effects of Methylxanthines on the lungs?

A
  • Decrease airway resistance
    (result of bronchodilation)
  • Decrease pulmonary vascular resistance
    (result of pulmonary vasodilation)
  • Stimulated ventilation (CNS)
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8
Q

What are the therapeutic serum levels of Theophylline?

A
  • 10-20 mcg/mL (adults) (also therapeutic range)
  • 5 to 15 mcg/mL (asthma management)
  • 5 to 10 mcg/mL (COPD management)
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9
Q

What are the side-effect levels of Theophylline?

A

< 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

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10
Q

Is the therapeutic range of Theophylline effect everyone the same?

A
  • 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
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11
Q

What is aminophylline?

A
  • A double salt of theophylline compounded to give aqueous solubility
  • This enables one to give the drug IV
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12
Q

What are the adverse reactions with Theophylline on the CNS?

A

Headache
Anxiety
Restlessness
Insomnia
Tremor Convulsion

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13
Q

What are the adverse reactions of Theophylline on the gastrointestinal?

A

Because of the side effects in the gastrointestinal system, xanthines are contraindicated in subjects with active peptic ulcers or acute gastritis

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14
Q

What are the adverse reactions with Theophylline on the Respiratory, Cardiovascular, and Renal?

A

Respiratory:
- Tachypnea

Renal:
- Diuresis

Cardiovascular:
- Palpitations
- Ventricular arrhythmias
- Hypotension

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15
Q

What are Mucolytics vs Mucoactive?

A
  • 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.)
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16
Q

What is the general reason for Mucoactive therapy?

A
  • To reduce the accumulation of airway secretions
  • Improve pulmonary function and gas exchange
  • Aids in the prevention of repeated infection and airway damage
17
Q

What are some diseases that in which Mucoactive therapy would be involved?

A
  • Cystic Fibrosis - genetic condition, airway becomes clogged with mucous b/c of overproduction
  • Acute and Chronic Bronchitis
18
Q

What are 3 drugs Mucoactive used as an aerosol? (Generic - Trade)

A

N-acetylcysteine (NAC) - Mucomyst

Dornase alfa - Pulmozyme

Hypertonic saline - use with ultrasonic Neb

19
Q

What are some causative factors that you can remove to help manage mucous secretions?

A

Treat infections
Stop smoking
Avoid pollution and allergens

20
Q

Acetylcysteine

A
  • 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
21
Q

What are the side effects of Acetylcysteine?

A

Bronchospasm
Excessive liquefaction of dried, retained secretions
Hypersensitivity
Nausea
Rhinorrhea - excessive runny nose

22
Q

What are the indication for the use of Acetylcysteine?

A
  • Treatment of conditions associated with viscous secretions
  • Also used for Acetaminophen (Tylenol) overdose
  • Contraindications: Hypersensitivity
23
Q

What are the side effects of Acetylcysteine?

A
  • Bronchospasm
  • Nausea
  • Rhinorrhea - excessive runny nose
24
Q

What is HIGHLY recommended when giving Acetylcysteine?

A

-Highly recommended that the drug be administered in conjunction with a bronchodilator!
- Foul smelling !!!

25
Q

What is Dornase Alpha?

A
  • 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
26
Q

How do you give the optimal delivery of Dornase Alpha?

A

Requires a nebulizer system capable of producing appropriate sized particles and quantity of aerosol

27
Q

What are the approved Nebs for Dornase Alpha?

A
  • Hudson RCI UP-DRAFT II OPTI-NEB*
  • Acron II nebulizer*
  • PARI LC PLUS nebulizer*
  • Mesh Neb
28
Q

What are the side effects of Dornase Alpha?

A
  • Voice alteration
  • Pharyngitis (inflammation of the airways)
29
Q

What are Expectorants?

A
  • 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

30
Q

What is Sodium bicarbonate?

A

Inflammation caused by bicarbonate is thought to draw water into secretions

31
Q

What are Antihistamines?

A
  • 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)
32
Q

What is Guaifenesin (Mucinex)?

A
  • Usually considered as an expectorant
  • Thought that expectorant action is mediated by stimulation of the GI tract
33
Q

What are Antitussive?

A

Drugs that suppress the cough reflex

Note: Productive coughs should not be suppressed!

34
Q

What are the 4 classification of Cough & Cold agents?

A

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)

35
Q

What are other names for Methylxanthines?

A

xanthines, xanthine derivatives, or as methylxanthines

36
Q

What does Methylxanthines do?

A

They are phosphodiesterase inhibitors which indirectly increase the amount of cyclic AMP within smooth muscle causing bronchodilation

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