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Advanced Pharmacology > Pulmonary management > Flashcards

Pulmonary management Flashcards

1
Q

What is the target of pharmacologic management of pulmonary disorders?

A

1) reducing inflammation
2) stimulating bronchodilation
3) blocking bronchoconstriction

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2
Q

How does the sympathetic nervous system impact the pulmonary system?

A

epinephrine binds to beta adrenergic 2 receptors to produce vasodilation

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3
Q

How does the parasympathetic nervous system impact the pulmonary system?

A

muscarinic receptors release acetylcholine when foreign body is in airway, causing bronchoconstriction

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4
Q

What class of pulmonary drugs produces immediate vasodilation and serves as the rescue drug?

A

Short-acting Beta Adrenergic Agonists

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5
Q

Albuterol

A
  • Short- acting beta adrenergic agonist
  • acts like epinephrine => binds to beta 2 receptors in lungs => bronchodilation
  • RESCUE
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6
Q

Salmeterol and Formoterol

A
  • Long acting beta adrenergic agonists

- NOT rescue therapy

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7
Q

Side effects of beta adrenergic agonists

A

minimal in inhaled versions

  • increased HR, RR, and BP
  • hyperglycemia
  • hypokalemia, hypo mg
  • skeletal muscle tremors
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8
Q

How do anticholinergics work in the respiratory system?

A

block acetylcholine receptors- block parasympathetic response of bronchoconstriction and mucus secretion

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9
Q

Ipratropium bromide (Atrovent)

A

short-acting anticholinergic

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10
Q

Tiotrorium bromide (Spiriva)

A

long-acting anticholinergic

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11
Q

What is the safety concern with inhaled anticholinergics?

A

suppresses protective mechanism (bronchoconstriction and mucus secretion)

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12
Q

What other drugs have anticholinergic effects that can impact the resp. system?

A
  • TCAs
  • first generation antihistamines
  • opiates
  • antidiarrheals
  • bladder antispasmodics
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13
Q

How is the inflammatory response involved in pulmonary conditions?

A

antigen => IgE activation of mast cells => histamines and leukotrienes released => bronchospasm

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14
Q

How do antihistamines work in the respiratory system?

A
  • block binding of histamine to receptors on brochi => block bronchoconstriction
  • help with symptoms, not control of disease
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15
Q

First generation antihistamines

A
  • cross the BBB=> sedating, suppress cough, anticholinergic
  • Diphenhydramine
  • Meclizine
  • Chlorpheniramine
  • Hydroxyzine
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16
Q

Second generation antihistamines

A
  • non-sedating
  • Cetirizine (Zyrtec)
  • Fexofenadine (Allegra)
  • Desloratidine (Clarinex)
  • Loratidine (Claritin)
17
Q

How do Leukotreine Receptor Antagonists work?

A
  • 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
18
Q

Leukotreine Receptor Antagonists (Leukotriene modifiers)

A
  • Zileuton
  • Zafirlukast
  • Montelukast (Singulair)
19
Q

How to corticosteroids impact the respiratory system?

A
  • Suppress inflammation by blocking precursors that trigger mast cell production
  • decrease inflammation, reverse mucosal edema, decrease capillary permeability, inhibit release of leukotrienes
20
Q

What are potential systemic effects of corticosteroids?

A
  • stimulate vasoconstriction
  • mobilizing fuels (glucose)
  • promote free water excretion
  • suppress inflammation
  • promote osteoclastic activity
21
Q

What drugs are used to treat cough?

A
  • First gen antihistamines
  • inhaled anticholinergics
  • expectorants
  • opiate suppressants
22
Q

How do first gen antihistamines treat cough?

A

anticholinergic effect => mild cough suppressant

23
Q

When are anticholinergics used to treat cough?

A

if cough persists long after acute infection

24
Q

How do expectorants aid in treatment of cough?

A

Guanfenisen reduces surface tension of bronchial secretions => thinner and liquified secretions => cough is more productive

25
Q

What safety concern is there with expectorants

A

can reduce surface tension of platelets => avoid in patients with bleeding issues or on plt meds

26
Q

How do opiate suppressants work in the treatment of cough?

A
  • directly suppress cough centers in brain

- among most effective but most dangerous => last choice

27
Q

Theophylline

A
  • bronchodilator (esp. for asthma)
  • has a narrow therapeutic window- need to monitor serum levels
  • toxicity = seizures and arrhythmias
  • CYP450 substrate- many drug interactions
28
Q

What are some important education points for pulmonary medications

A
  • controller vs rescue medications

- possible systemic adverse effects (corticosteroids and anticholinergics)

29
Q

Rescue inhalers

A

albuterol (Proventil, Ventolin, Proair)

levalbuterol (Xopenex)

30
Q

Control inhalers- corticosteroids

A
  • chronic asthma*
  • Budesonide (Pulmicort)
  • Fluticasone (Flovent, Flonase)
  • Beclomethasone (Qvar)
  • Mometasone (Asmanex, Nasonex)
31
Q

What is the drug of choice for maintenance of chronic asthma?

A

inhaled corticosteroids

32
Q

Control inhalers- anticholinergics

A
  • COPD more than asthma*
  • Ipratroprium bromide (Atrovent)- short-acting
  • Tiotroprium bromide (Spiriva)- long-acting
  • Revefenacin (Yuperil)
33
Q

Control inhalers- anticholinergics

A
  • Salmeterol (Serevent)

- Formoterol (Foradil, Perforomist)

34
Q

Combo inhalers- ICS + LABA

A

Advair- fluticasone + salmeterol
Symbicort- budesonide + formoterol
Dulera- mometasone + formoterol
Breo- fluticasone + vilanterol

35
Q

Combo inhalers- anticholinergic + LABA

A

Anora Ellipta
Stiolto Respimat
COPD only

36
Q

Roflumilast (Dalisrep)

A
  • oral agent for COPD
  • same family as theophylline- relaxes bronchiole smooth muscle
  • associated with suicidal ideation and wt loss
  • avoid in severe liver disease

Advanced Pharmacology (9 decks)

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