Pharm110 Chp 16 Bronchodilators and Other Respiratory Agents

Question 1

Bronchodilators

Answer 1

8 types
Sympathomimetic (acute) can be used alone, react with B2 receptors

Xanthine (acute) can be used alone, react with B2 receptors

Anticholinergics (acute) must be used with a S or X and block ACh receptors

Leukotriene receptor (chronic) antagonists attach to leukotriene receptors

5-lipoxygenase inhibitors (chronic) prevent release of leukotriene from mast cells

Mast cell stabilizers (chronic) prevent degeneration of mast cells

Corticosteroids (chronic) reduce inflammation

Mucolytics (chronic) breaks up chemical bonds of glycoproteins in the bronchial secreations

Question 2

Sympathomimetics

Answer 2

Treat acute asthma attacks
Attach to Beta2 adrenergic receptors
Quickly reduce airway constriction and restore normal airflow
Relief of bronchospasm, bronchial asthma, bronchitis, and other pulmonary diseases

Question 3

Sympathomimetic types and agents

Answer 3

2 types
Selective
Non selective

Selective beta2 drugs

• stimulate only beta2 receptors
  e. g. albuterol

Non selective beta-adrenergics
Stimulate both beta1, and beta2 receptors
e.g. isoproterenol

Question 4

Sympathomimetic side effects

Answer 4

Frequent use leads to beta1 receptors being stimulated- Albuterol loses its selective action.

Nausea, increased anxiety, palpitations, tremors, and increased heart rate

Question 5

Xanthines

Answer 5

Caffeine family
Oldest bronchodilators used.
Acute asthma symptoms

e.g. theophylline, aminophylline

Increase levels of energy producing cAMP by inhibiting enzyme that breaks it down
Result
Smooth muscle relaxation
Bronchodilation
Increase airflow in the lungs

Causes cardiac life threatening side effects (Sinus tachycardia, palpitations, ventricular dysrhythmias)
Produce diuresis, loss of potassium ions, threatens neuromuscular transmission in cardiac muscle.

Question 6

Anticholinergics

Answer 6

ACh causes bronchial constriction.
Anticolinergics bind to ACh receptors, preventing constriction, airways dilate.
Acute asthma symptoms

e.g. Ipratropium bromide,
tiotropium bromide

Not used for acute asthma exacerbations!
Side effects
Dry mouth
GI distress
Anxiety

Question 7

Leukotriene receptor antagonists

Answer 7

Directly prevent bronchoconstriction
Developed to treat asthma
Most popular and effective agents
For prophylactic treatment of chronic asthma
Improvement should be in about 1 week

e.g. Montelukast
Zafirlukast

Block leukotrienes from binding to receptors
prevent smooth muscle contraction
Decrease mucus secretion
Decrease neutrophil and leukocyte infiltration in to the lungs

Side effects
Headache
Diarrhea
Liver dysfunction

Question 8

5-Lipoxygenase Inhibitors

Answer 8

New class of leukotriene receptor antagonists
Inhibit the formation of leukotrienes
Used to inhibit some cancer growth

Prevent lung inflammation
For chronic asthma

e.g. Zileuton

Monitor for drug interactions because it will increase toxicity to propranolol, warfarin, and theophylline.

Question 9

Mast cell stabilizers

Answer 9

Used prophylactically for chronic asthma
No direct bronchodilator activity
Indirect acting
Stabilize the cell membranes of mast cells from degeneration, monocytes and macrophages.
Prevent release of inflammatory mediators

For chronic asthma prophylaxis

e.g. Cromolyn
Nedocromil

Side effects
Sore throat, Dizziness, Rhinitis, Bronchospasm

Question 10

Inhaled Corticosteroids

Answer 10

Anti-Inflammatory
Reduced side effects
Used for chronic asthma prophylaxis

e.g. Fluticasone propionate and salmeterol (Advair)
Beclomethasone dipropionate
Triamcinolone acetonide
Flunisolide

Stablize membranes of cells that release harmful bronchoconstricting substances
Increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation

Question 11

Respiratory agents client education

Answer 11

Receive flu and pneumonia vaccinations
Receive prompt treatment for any illness
Check with health care provider before taking any other medications.
Encourage 3 to 4 L/day of fluids as possible.
Do not wear perfume or colognes when working with clients.
Do not use talc or bath powder around clients.

Question 12

Mucolytics

Answer 12

Reduce thickness and stickiness of pulmonary secretions, so that removal by ciliary action and cough is facilitated.
Used in treatment of obstructive pulmonary diseases.
For chronic prophylaxis

e.g. acetylcysteine

Usually administered by nebulizer, because it is so irritating and can cause life threatening bronchospasms.
Mixed with bronchodilator

Capable of reacting with certain materials, so nebulizers with rubber and copper should be avoided, and only ones with plastic, glass, aluminum or stainless steel should be administered with mucolytics.