Pulmonary management Flashcards
What is the target of pharmacologic management of pulmonary disorders?
1) reducing inflammation
2) stimulating bronchodilation
3) blocking bronchoconstriction
How does the sympathetic nervous system impact the pulmonary system?
epinephrine binds to beta adrenergic 2 receptors to produce vasodilation
How does the parasympathetic nervous system impact the pulmonary system?
muscarinic receptors release acetylcholine when foreign body is in airway, causing bronchoconstriction
What class of pulmonary drugs produces immediate vasodilation and serves as the rescue drug?
Short-acting Beta Adrenergic Agonists
Albuterol
- Short- acting beta adrenergic agonist
- acts like epinephrine => binds to beta 2 receptors in lungs => bronchodilation
- RESCUE
Salmeterol and Formoterol
- Long acting beta adrenergic agonists
- NOT rescue therapy
Side effects of beta adrenergic agonists
minimal in inhaled versions
- increased HR, RR, and BP
- hyperglycemia
- hypokalemia, hypo mg
- skeletal muscle tremors
How do anticholinergics work in the respiratory system?
block acetylcholine receptors- block parasympathetic response of bronchoconstriction and mucus secretion
Ipratropium bromide (Atrovent)
short-acting anticholinergic
Tiotrorium bromide (Spiriva)
long-acting anticholinergic
What is the safety concern with inhaled anticholinergics?
suppresses protective mechanism (bronchoconstriction and mucus secretion)
What other drugs have anticholinergic effects that can impact the resp. system?
- TCAs
- first generation antihistamines
- opiates
- antidiarrheals
- bladder antispasmodics
How is the inflammatory response involved in pulmonary conditions?
antigen => IgE activation of mast cells => histamines and leukotrienes released => bronchospasm
How do antihistamines work in the respiratory system?
- block binding of histamine to receptors on brochi => block bronchoconstriction
- help with symptoms, not control of disease
First generation antihistamines
- cross the BBB=> sedating, suppress cough, anticholinergic
- Diphenhydramine
- Meclizine
- Chlorpheniramine
- Hydroxyzine
Second generation antihistamines
- non-sedating
- Cetirizine (Zyrtec)
- Fexofenadine (Allegra)
- Desloratidine (Clarinex)
- Loratidine (Claritin)
How do Leukotreine Receptor Antagonists work?
- block the synthesis of leukotrienes or block the binding of leukotrienes to receptors
- similar action as antihistamines, but act further down the inflammation pathway- more specific to bronchoconstriction
Leukotreine Receptor Antagonists (Leukotriene modifiers)
- Zileuton
- Zafirlukast
- Montelukast (Singulair)
How to corticosteroids impact the respiratory system?
- Suppress inflammation by blocking precursors that trigger mast cell production
- decrease inflammation, reverse mucosal edema, decrease capillary permeability, inhibit release of leukotrienes
What are potential systemic effects of corticosteroids?
- stimulate vasoconstriction
- mobilizing fuels (glucose)
- promote free water excretion
- suppress inflammation
- promote osteoclastic activity
What drugs are used to treat cough?
- First gen antihistamines
- inhaled anticholinergics
- expectorants
- opiate suppressants
How do first gen antihistamines treat cough?
anticholinergic effect => mild cough suppressant
When are anticholinergics used to treat cough?
if cough persists long after acute infection
How do expectorants aid in treatment of cough?
Guanfenisen reduces surface tension of bronchial secretions => thinner and liquified secretions => cough is more productive
What safety concern is there with expectorants
can reduce surface tension of platelets => avoid in patients with bleeding issues or on plt meds
How do opiate suppressants work in the treatment of cough?
- directly suppress cough centers in brain
- among most effective but most dangerous => last choice
Theophylline
- bronchodilator (esp. for asthma)
- has a narrow therapeutic window- need to monitor serum levels
- toxicity = seizures and arrhythmias
- CYP450 substrate- many drug interactions
What are some important education points for pulmonary medications
- controller vs rescue medications
- possible systemic adverse effects (corticosteroids and anticholinergics)
Rescue inhalers
albuterol (Proventil, Ventolin, Proair)
levalbuterol (Xopenex)
Control inhalers- corticosteroids
- chronic asthma*
- Budesonide (Pulmicort)
- Fluticasone (Flovent, Flonase)
- Beclomethasone (Qvar)
- Mometasone (Asmanex, Nasonex)
What is the drug of choice for maintenance of chronic asthma?
inhaled corticosteroids
Control inhalers- anticholinergics
- COPD more than asthma*
- Ipratroprium bromide (Atrovent)- short-acting
- Tiotroprium bromide (Spiriva)- long-acting
- Revefenacin (Yuperil)
Control inhalers- anticholinergics
- Salmeterol (Serevent)
- Formoterol (Foradil, Perforomist)
Combo inhalers- ICS + LABA
Advair- fluticasone + salmeterol
Symbicort- budesonide + formoterol
Dulera- mometasone + formoterol
Breo- fluticasone + vilanterol
Combo inhalers- anticholinergic + LABA
Anora Ellipta
Stiolto Respimat
COPD only
Roflumilast (Dalisrep)
- oral agent for COPD
- same family as theophylline- relaxes bronchiole smooth muscle
- associated with suicidal ideation and wt loss
- avoid in severe liver disease
