Part 9-2 (Respiratory Pharmacology)

Question 1

Control of airway inflammation

Answer 1

Glucocorticoids
Cromones
Leukotriene modifiers

Question 2

Glucocorticoids

Answer 2

Powerful anti-inflammatory steroids
Systemic administration has many harmful effects
Inhaled agents have given earlier, more extensive use in airway disease

Question 3

Glucocorticoids primary problems

Answer 3

General catabolic effects (Muscle wasting, osteoporosis)

Question 4

Glucocorticoids concerns

Answer 4

Severe side effects minimized if inhaled at limited daily dosage

Question 5

Beclomethasone daily dosing limits

Answer 5

Adult 1500 micrograms

Child 400 micrograms

Question 6

Budesonide Daily dosing limits

Answer 6

Adult 1600 micrograms

Child 400 micrograms

Question 7

Flunisolide Daily dosing limits

Answer 7

Adult 2000 micrograms

Child 400 micrograms

Question 8

Triamcinolone Daily dosing limits

Answer 8

Adult 1600 micrograms

Child 1200 micrograms

Question 9

Combination products

Answer 9

An anti-inflammatory steroid is combined with a bronchodilator, usually a long acting beta-2 agonist
Convenient
Very useful in COPD and asthma

Question 10

Cromones

Answer 10

Cromolyn
Prevent release of histamine, other inflammatory mediators from pulmonary mast cells
Can prevent attack if taken before exposure to initiating agent

Question 11

Leukotrienes

Answer 11

Leukotrienes: lipid compounds…mediate inflammatory response
Play important role in airway inflammation
Produced from arachidonic acid by lipoxygenase enzyme

Question 12

Leukotriene modifiers

Answer 12

Lipoxygenase inhibitor
Leukotriene receptor blockers
Can supplement inhaled glucocorticoids; some concers about hepatic toxicity

Question 13

Supplemental oxygen

Answer 13

Can reduce hypoxemia whenever alveolar PO2 is unable to provide adequate O2 delivery to the pulmonary circulation
Nasal cannula, mask, tent/hood, direct delivery to endotracheal tube

Question 14

Supplemental O2 dosing

Answer 14

Liters per minute
SOPD patients: 88-92% SaO2
Other patients: 94-98% SaO2

Question 15

Benefits of supplemental O2

Answer 15

Increased exercise tolerance
Decreased morbidity
Improved quality of life

Question 16

Risks of supplemental O2

Answer 16

Fire
Can cause dry nose/dry airway/mucous occlusion
Oxygen toxicity

Question 17

Oxygen toxicity

Answer 17

Increased likelihood of generating oxygen free radicals

Free radicals damage membranes, proteins, and DNA

Question 18

Surfactant replacement

Answer 18

Typically administered to neonates via endotracheal tube

3 sources: human, animal, artificial

Question 19

Surfactant replacement risks

Answer 19

Pulmonary or intracranial hemorrhage, obstruct airway, decreased oxygen saturation during administration
Benefits outweigh risks

Question 20

Nitric Oxide

Answer 20

Relaxes vascular smooth muscle
Administered by inhalation to neonates to facilitate perfusion, improve V/Q ratio
May increase chance of survival, decrease risk of developing chronic lung disease

Question 21

Drugs to help quit smoking

Answer 21

Nicotine replacement
Bupropion: prolongs effects of dopamine, decrease cravings
Varenicline: Partial agonist at nicotine receptors

Question 22

Respiratory Drugs Rehab concern summary

Answer 22

Beneficial effects during exercise/postural drainage
Schedule rehab to capitalize on drug effects
-Inhaled bronchodilators: 10 minutes
-Mucolytics/expectorants: 30-60 minutes
Look for signs of excessive use