Pharmacological Management of Airway and Lung Diseases

Question 1

Antihistamine Agents

Answer 1

Action: Block the effects of histamine resulting in a decrease in nasal congestion, mucosal irritation, and symptoms of the common cold, sinusitis, conjuctivitis, and allergies.
Indications: Respiratory seasonal allergies, rhinitis, and sneezing.
Side effects: Arrhythmias, postural hypotension, GI distress, dizziness, drowsiness, headache, blurred vision, fatigue, nausea, thickening of bronchial secretions.
Examples: Benadryl (diphenhydramine), Allegra (fexofenadine), Zyrtec (cetirizine HCL), Claritin (loratadine)

Question 2

Anti-Inflammatory Agents

Answer 2

Action: Inhaled corticosteroids, leukotriene modifiers, and mast-cell stabilizers to prevent inflammatory-mediated bronchoconstriction by inhibiting production of inflammatory cells and suppressing release of inflammatory mediators; reverses capillary permeability, reducing airway edema.
Indications: Bronchospasm, asthma
Side effects: Corticosteroids - Damage of supporting tissues, skin breakdown, osteoporosis, glaucoma, and delayed growth. Nasal irritation and dryness, sneezing, and bloody mucus. Leukotriene modifier - liver dysfunction. Mast-cell stabilizer - bronchospasm, throat and nasal irritation, cough, GI distress.
Examples: Corticosteroids - Qvar (beclomethason dipropionate), PUlmicort (budesonide), AeroBid (flunisolide). Leukotriene modifier - Zyflo (zileuton). Mast-cell stabilizer - Nasalcrom (cromolyn sodium)

Question 3

Bronchodilator Agents

Answer 3

Action: Relieve bronchospasm by stimulating the receptors that cause bronchial smooth muscle relaxation or by blocking the receptors that trigger bronchoconstriction.
Indications: bronchospasm, wheezing, and SOB in asthma or COPD
Side effects: paradoxical bronchospasm, dry mouth, GI distress, chest pain, palpitations, tremor, nervousness.
Examples: Anticholinergic: Atrovent (ipratropium), Spiriva (tiotropium). Sympathomimetics: Ventolin (albuterol), Primatene mist (epinephrine), Serevent (salmeterol). Xanthine derivative: Theo-Dur (theophylline), Aminophylline.

Question 4

Expectorant Agents

Answer 4

Action: Increase respiratory secretions to loosen mucus. Reduces viscosity of secretions and increases sputum volume to improve efficiency of cough reflex and ciliary action in removing accumulated secretions.
Indications: Cough associated with respiratory tract infections and conditions like sinusitis, pharyngitis, bronchitis, and asthma when mucus and congestion are present.
Side effects: GI distress, drowsiness
PT implications: Perform airway clearance interventions within 1 hour after drug administration.
Examples: Mucinex (guaifenesin), terpin hydrate

Question 5

Mucolytic Agents

Answer 5

Action: Decreases viscosity of musuc secretions by altering their composition. Administered by a nebulizer.
Indications: Viscous mucus secretions due to pneumonia, emphysema, chronic bronchitis, and cystic fibrosis.
Side effects: pharyngitis, oral mucosa inflammation, rhinitis, chest pain
PT implications: Perform airway clearance interventions within 1 hour after drug administration.
Examples: Pumozyme (dornase alpha), Mucosil or Mucomyst (acetylcysteine)