Pulmonary Medications Flashcards
Medications that affect the pulmonary system can be classified by mechanism of action:
- Bronchodilation and/or mitigation of bronchoconstriction
- Facilitation of mucociliary/secretion clearance
- Increased alveolar ventilation and/or improved oxygenation
- Improved control of the breathing pattern
Structures of the respiratory system that respond to pharmacologic intervention:
- Bronchi and bronchioles: function to maintain airflow
- Alveoli: responsible for gas exchange
_______________ are the most frequently used drugs in the treatment of pulmonary disease
- Bronchodilators
Normal tone is a balance between constrictive and dilatational stimuli that results from equal ____________ and _____________ (muscarinic) influences.
Disruption of normal bronchomotor tone by an outside stimulant leads to _____________
- Adrenergic and cholinergic
- Bronchospasm
In what two ways do bronchodilators influence the ANS
- cAMP—facilitates smooth muscle relaxation and inhibits mast cell degranulation, causing bronchodilation
- cGMP—facilitates smooth muscle constriction and enhances mast cell release of histamine, causing bronchoconstriction
In the lungs, the effects of cAMP and/or cGMP can be attributed to any of the following:
- Muscarinic receptor stimulation→ increased cGMP→enhanced bronchoconstriction
- Adrenergic β2 receptor stimulation→ increased cAMP→ bronchodilation
- α1 receptor stimulation results in a decrease in cAMP and facilitates bronchoconstriction
Describe the 3 different adrenergic receptors
- α receptors— distributed within peripheral/bronchial smooth muscle, myocardium, mucosal blood vessels
- β1 receptors— found in cardiac tissue, mucosal blood vessels
- β2 receptors— found in bronchial smooth muscles, peripheral smooth muscle, and skeletal muscle
Adrenergic agonists bronchodilators
- Epinephrine (adrenaline): Short duration of action, Acts directly on all receptor types, Drug of choice (intramuscular or subcutaneous) for treating acute bronchospasm and acute anaphylactic reaction
- Ephedrine increases norepinephrine synaptic concentrations on all receptor types.
- β2-specific agents produce bronchiolar dilation by relaxing the bronchial smooth muscle through facilitation of increased cAMP levels.
Shot versus long acting beta 2 adrenergic agonists
- Short-acting beta2-adrenergic agonists (SABAs): Work quickly (generally within 3–5 minutes), but last for relatively short periods (4–6 hours), Often prescribed as quick-reliever medications because of their fast relief of shortness of breath, Used to prevent or decrease symptoms of bronchospasm triggered by specific situations (e.g., exercise, cold weather)
- Long-acting β2-adrenergic agonists (LABAs): Considered maintenance drugs because of long-lasting features; Help provide stable airways on a day-to-day basis
What are the 2 methods of providing bronchodilator meds by inhalation
- Metered dose inhaler (MDI)—device that delivers a specific amount of medication to the lungs in the form of a short burst of aerosolized drug
- Nebulizer—device used to administer medication in the form of a mist inhaled into the lung
Describe adrenergic antagonists bronchodilators
- These medications inhibit adrenergic receptors.
- α-receptor stimulation produces both vasoconstriction and bronchoconstriction.
- α-adrenoceptor antagonists reduce α-adrenergic activity in the bronchi of patients with pulmonary disease.
- α-Antagonists prevent the decrease of cAMP, causing bronchodilation.
What do beta adrenergic bronchodilators end in
- End in -terol
Sympathetic/adrenergic is to parasympathetic/muscarine (True/False)
- True
Describe muscarinic antagonists bronchodilators
- These drugs inhibit cholinergic receptors.
- Vagus nerve (tenth cranial nerve) provides parasympathetic innervation to the lungs.
- Muscarinic antagonists that reduce vagal tone are used to manage bronchoconstriction in COPD.: Include ipratropium (Atrovent) and tiotropium (Spiriva); Given by inhalation; not absorbed as well into the systemic circulation
Describe Methylxanthines
- enhance intracellular level of cAMP through the inhibition of the enzyme phosphodiesterase (PDE)
Describe corticosteroids
- reduce the inflammatory response, decrease mucosal swelling, and increase bronchial lumen and airflow
Describe mast cell stabilizers
- work to stabilize mast cells and prevent the release of histamine and other inflammatory mediators
Describe leukotriene inhibitors
- strong inflammatory mediators that promote neutrophil–endothelial interactions, induce bronchoconstriction, and increase airway hyperresponsiveness
Describe anti-IgE monoclonal antibodies
- laboratory-created antibodies that bind specifically to IgE antibodies and prevent their action (usually for patients with severe asthma)
Possible new anti-inflammatory treatments in development:
- Protease inhibitors
- Inhibitors of neutrophil elastase
- Cathepsins
- Matrix metalloproteases
New drug development for pulmonary disease focuses on
- Identifying specific genetic mutations
- Targeting the action of specific cell receptors to achieve desired effects
- Issues related to cost, accessibility, and FDA approval
Pirfenidone (Esbriet) and Nintedenab (Ofev) are the two antifibrotic medications for IPF.
- Shown to reduce the decline in pulmonary functions and clinical status in patients with IPF.
- Patients should continue taking the drug for the rest of their life or until undergoing lung transplant.
What are the 2 main causes/pathophysiology of pulmonary artery HTN (PAH)
- Vasculopathy of small pulmonary arteries
- Imbalance of signals
_____________ are the primary medications for pulmonary arterial hypertension (PAH).
- Vasodilators
How is cystic fibrosis transmembrane conductance regulator (CFTR) protein made
- DNA contains instructions for formation
- RNA transcribes the instructions
- Ribosomes translate the instructions for creation
- Once made the CFTR protein moves through the cell to the cell surface (trafficking)
- Once at the surface the CFTR protein acts as a chloride channel
Describe Ivacaftor (Kalydeco)
- first therapeutic agent to target the defective protein made by CFTR gene mutation
Describe Trikafta (Elexacaftor/tezacaftor/ifacaftor)
- combination of three drugs approved for patients with CF at least 12 years old with at least one F508del mutation
Describe decongestants
- Treat symptoms of “runny nose and stuffy head” associated with the common cold, allergies, and respiratory infections
- Symptoms are caused by vasodilation and “leaky” blood vessels, leading to mucosal swelling and fluid leaks.
- Alpha-adrenergic sympathomimetics are most common decongestants.
- Stimulate α receptors and cause vasoconstriction, reducing or preventing the underlying pathology
- End in -rine/-line
Describe antihistamines
- Mostly used to treat respiratory allergic responses associated with seasonal allergies
- Interact with two receptor types: H1 and H2 receptors
Describe antitussives
- Indicated for short-term treatment of cough
- Should only be used to suppress an ineffective, dry hacking cough; not indicated for coughs caused by retained secretions
- Act to block the overly active receptors or to increase the threshold of the cough center in the medulla portion of the brain
- End in -adine/-amine
Describe mucoactive agents
- Promote mobilization and removal of secretions from the respiratory tract
- Four basic types: mucolytics, expectorants, wetting agents, and surface-active agents
Describe expectorants
- Facilitate expectoration of respiratory secretions by increasing hydration of the airway or the volume of secretions
- Most prevalent expectorants are simple hydration (via aerosol, i.e., 3% saline or orally, iodinated glycerol, and glyceryl guaiacolate)
Describe respiratory stimulants
- Analeptics cause central respiratory excitation with subsequently increased respiratory activity.
- Doxapram (Dopram) is most widely used analeptic.: When administered intravenously, prevents a rise in partial pressure of arterial carbon dioxide with oxygen therapy in acute ventilatory failure; Also used to prevent respiratory depression in high-risk postoperative patients
Describe respiratory depressants
- Include sedatives, tranquilizers, and narcotic analgesics
- Should generally be avoided in patients with pulmonary disease because they suppress ventilatory drive
- Respiratory depressants may be indicated for some mechanically ventilated patients.
- May be prescribed if anxiety or agitation contributes to increased work of breathing
- Can include intravenous morphine, midazolam (Versed), Propofol (Diprivan), Fentanyl, or diazepam (Valium)
Describe neuromuscular blocking drugs
- Used with lighter general anesthesia to produce a desired degree of immobilization for surgery
- Used to facilitate endotracheal intubation, control laryngeal spasm, treat diseases that cause neuromuscular hyperactivity
Describe antimicrobial agents
- Used to combat unicellular organisms (bacteria, viruses, fungi)
- Antibacterial drugs may be classified as bactericidal (killing or destroying bacteria) or bacteriostatic (limiting growth and proliferation of bacteria)
Reserve antimicrobials includes drugs reserved for treatment of confirmed or suspected infections caused by _________________________
- Multidrug resistant organisms
- Considered last resort drugs to be used when all alternatives have failed
Antibiotics in the reserve group include
- Colistin
- Polymyxin B
- Fosfomycin
- Linezolid
- Meropenam
What is the most common indication for oxygen therapy
- Arterial hypoexmia
- PaO2 <60
The therapeutic administration of oxygen can elevate the arterial oxygen tension and increase the arterial oxygen content shifting the oxyhemoglobin dissociation curve to the _______ and improving _______________ oxygenation
- Right
- Peripheral tissue oxygenation
What are the roles of Nitrous Oxide (NO)
- Regulating blood circulation
- Diffuses to the vascular smooth muscle cells
- Endotoxic shock
- Pulmonary HTN
- Adult respiratory distress syndrome (ARDS)
- HTN in various disease states
