Pharm Side Door test Flashcards
-Methylxanthines (Side Door)
-Referred to simply as xanthines, xanthine derivatives, or as methylxanthines
-These are phosphodiesterase inhibitors which indirectly increase the amount of cyclic AMP within smooth muscle causing bronchodilation
-Xanthines used therapeutically include:
-Caffeine found in the seeds of a coffee plant
-Theophylline found in tea leaves (mostly oral medications Theo-Dur
-Clinical uses of theophylline include the management of:
-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 ICS -Side effects and narrow therapeutic index may make it a poor choice vs. others agents
-Clinical uses of theophylline include the management of:
-Chronic obstructive pulmonary disease(COPD)
-The global initiative for chronic obstructive lung disease (gold) states that inhaled bronchodilators are preferred when available
-Theophylline: recommended by GOLD as alternative to B2 agonist and anticholinergics -Not used in acute exacerbation
-Clinical uses of theophylline include the management of:
-Apnea of prematurity in neonates
-Methylxanthines are considered the first line agents of choice as treatment
-Theophylline was most extensively used in the past, but caffeine citrate may be a better choice (as it is safer, higher therapeutic index)
All xanthine’s have the following effects
-CNS stimulation
-Skeletal muscle stimulation -Bronchodilaton -Pulmonary vasodilation -Smooth muscle relaxation -Theophylline is generally classified as a bronchodilator
-The basic effects on the lung are:
-Decreased airway resistance (result of Bronchodilation
-Decreased pulmonary vascular resistance (result of pulmonary vasodilation)
-Stimulated ventilation (CNS)
metabolic rates of Theophylline
-There is variability in individual metabolic rates among patients, which makes it difficult to control therapeutic dosages
-To optimum serum theophylline level for maximal bronchodilation in adults is between 10n and 20 mcg/ml. And 5-10 mcg/mL in neonates and children
-Side effects or lack of therapeutic effects are associated with the following serum levels:
-10-20 micrograms/ ml therapeutic range
- > 20 micrograms/ ml Nausea - 40-45 micrograms/ ml seizures -Asthma management - 5 to 15 ug/ ML ug means micrograms -COPD management -5 to 10 ug/ ml
toxic effects of Theophylline
-It is possible for an individual to bypass the nausea phase of toxicity and begin having seizures immediately
aminophylline
-It should be noted that aminophylline is a double salt of theophylline compound to give aqueous solubility
-This enables one to give the drug IV
-Adverse Reaction with Theophylline
-Central nervous system
-Headaches
-Anxiety -Restlessness -Insomnia -Tremor Convulsions
-Adverse Reaction with Theophylline
-Respiratory
-Tachypnea
-Adverse Reaction with Theophylline
-Renal
-Diuresis
xanthines contraindications
-Because of side effects in the gastrointestinal system, xanthines are contraindicated in subjects with active peptic ulcers or acute gastritis
-Mucolytic
-Mucolytic refers to an agent that breaks down or liquifies thick mucus to a watery state
-Mucoactive
-Mucoactive refers to any agent that has an effect on mucus secretion (mucolytic, expectorant, mucokinetic, etc.)
indication for mucoactive therap
-The general indication for mucoactive therapy is to reduce the accumulation of airway secretions, with improvement in pulmonary function ans gas exchange and the prevention of repeated infection and airway damage
-Disease in which mucoactive therapy is indicated are those with hypertension or poor clearance of airway secretions such as
-Cystic Fibrosis
-Acute and chronic bronchitis
-Three drugs are available that have been used for administration as an aerosol, to treat abnormal pulmonary secretions
-N-acetylcysteine (NAC) aka mucomyst
-Dornase alfa aka Pulmozyme -Hypertonic saline
-The therapeutic options for controlling mucus hypersecretion are outlined as follows
-Remove causative factors where possible
-Treat infections -Stop smoking -Avoid pollution and allergens
-Acetylcysteine
-Generic name: N-Acetylcysteine, Acetylcysteine, or NAC
-TRade name: Mucomyst, 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
-Acetylcysteine
-Indication for use
-Treatment of conditions associated with viscous secretions
-Also used for Acetaminophen overdose
-Acetylcysteine
-Side effects
-Bronchospasm
-Nausea
-Rhinorrhea
