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DPT 530 > Pulmonary/Respiratory Medications > Flashcards

Pulmonary/Respiratory Medications Flashcards

1
Q

what are respiratory meds used for?

A

common cold, seasonal allergies, asthma, COPD, chronic bronchitis, CF, maintaining proper airflow, and facilitation of mucus and secretion clearance

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2
Q

what are the 5 types of respiratory meds?

A

1) antitussives
2) decongestants
3) antihistamines
4) mucolytics/expectorants
5) drugs to maintain airway patency

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3
Q

what are antitussives used to do?

A

suppress cough

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4
Q

antitussives are often combined with ____ and _____

A

aspirin, acetaminophen

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5
Q

how do non-opioid derivative of antitussives work?

A

they inhibit irritation effects of histamine on mucosa or have anesthetic effects on the resp epithelium

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6
Q

how does Benzonatate (Tessalon) work as an antitussive?

A

with local anesthetic effects on resp mucosa

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7
Q

how does Codeine work as an antitussive?

A

it inhibits the cough reflex by direct effects on the cough center in the BS

Hydrocodone
Hydromorphone

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8
Q

how does Dextromethorphan work as an antitussive?

A

it is a non-narcotic that inhibits the cough reflex

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9
Q

how does Diphenhydramine (Benadryl) work as an antitussive?

A

as an antihistamine

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10
Q

what are common adverse rxns to antitussives?

A

sedation

GI upset

dizziness

tolerance and dependence if used too long

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11
Q

what do decongestants treat?

A

symptoms of mucous discharge like a runny nose, stuffy head, common cold, or respiratory infections

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12
Q

how do alpha 1 adrenergic agonists work as decongestants?

A

by binding to receptors on blood vessels of nasal mucosa to cause vasoconstriction

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13
Q

how are decongestants administered?

A

orally or via nasal spray

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14
Q

decongestants can excite___ and ____ and cause a ____ in sympathetic activity

A

CVS, CNS, increase

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15
Q

what are the decongestant meds?

A

Ephedrine (Bronkaid)-oral

Oxymetazolin (Afrin, Dristan)-nasal spray

Phenylephrine (Sudafed, PE)-oral

Pseudoephedrine (Chlor Timeton)-oral

Xylometazoline-nasal spray

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16
Q

what are common adverse rxns to decongestants?

A

dizziness, nervousness, inc BP, inc heart palpitations

headache, nausea

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17
Q

what are antihistamines used to treat?

A

viral infection symptoms of common colds

allergic response to seasonal allergies

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18
Q

how do antihistamines work?

A

they block the H1 subtype receptor that histamine acts on in vascular and resp tissues

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19
Q

what do antihistamines do?

A

decrease nasal congestion, conjunctivitis, mucosal irritation and discharge, and coughing and sneezing

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20
Q

t/f: antihistamines may be used in asthma for rhinitis and sinusitis

A

true

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21
Q

what are some of the sedating antihistamines?

A

Bromepheniramine (Dimetapp)

Cetirizine (Zyrtec)

Chlorpheniramine (Chlor-Trimeton)

Desloratadine (Clarinex)

Diphenhydramine (Benadryl)

Levocetirizine (Xyzal)

Dimenhydrinate (Dramamine)

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22
Q

what are some non-sedating antihistamines?

A

Cetirizine (Zyrtec)

Loratadine (Claritin)

Desloratadine (Clarinex)

Fexofenadine (Allegra)

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23
Q

can some antihistamines be either sedating or non-sedating?

A

yes

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24
Q

how do non-sedating antihistamines work?

A

by increasing the selectiveness for H1 receptors leading to decreased side effects

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25
Q

what are common adverse rxns to antihistamines?

A

sedation, blurry vision, incoordination

fatigue, dizziness, GI upset

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26
Q

what are 1st generation antihistamines?

A

sedating antihistamines that cross the BBB causing CNS side effects

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27
Q

why do 1st generation antihistamines have sedating effects?

A

bc they cross the BBB

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28
Q

which antihistamine lead to an increased risk of falling in older populations?

A

Diphenhydramine (Benadryl)

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29
Q

what are 2nd generation antihistamines?

A

non-sedating antihistamines that don’t cross the BBB as easily

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30
Q

what do mucolytics/expectorants do?

A

decrease the viscocity of resp secretions to facilitate production and ejection of mucus

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31
Q

mucolytics/expectorants relieve acute symptoms from ____ to ____ and ____ and ____

A

cold, pneumonia, emphysema, chronic bronchitis

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32
Q

t/f: mucolytics/expectorants are often combined with other meds like antitussives, decongestants, and bronchodilators

A

true

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33
Q

what is the primary mucolytic drug?

A

Acetylcysteine (Mucomyst, Mucosil)

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34
Q

how does Acetylcysteine (Mucomyst, Mucosil) work?

A

it splits the disulfide bond of mucoproteins to decrease the viscocity of secretions

antioxidant effects decrease free radical damage in resp tissues

thins secretions

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35
Q

how is Acetylcysteine (Mucomyst, Mucosil) administered?

A

inhalation

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36
Q

what is the primary expectorant drug?

A

Gualfenesin

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37
Q

how does Gualfenesin work?

A

by increasing production of resp secretions, thus encouraging expectoration of phlegm and sputum

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38
Q

how is Gualfenesin administered?

A

oral syrup/elixir

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39
Q

what are the two drugs for maintaining airway patency?

A

1) bronchodilators
2) anti-inflammatory agents

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40
Q

what are the 3 bronchodilators?

A

1) beta adrenergic agonists
2) xanthine derivatives
3) anti-cholinergic drugs

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41
Q

what are the 3 anti-inflammatory agents?

A

1) glucocorticoids (corticosteroids)
2) cromones
3) leukotriene inhibitors

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42
Q

what are the 3 different types of administration of bronchodilators?

A

1) MDIs (metered dosed inhalers)
2) nebulizer
3) DPI (dry powder inhaler

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43
Q

what is MDI administration?

A

administration of bronchodilators

drugs contained in a small aerosol canister with a specific amount dispensed each time

the inhaled dose is timed with resp effort

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44
Q

what is a Nebulizer?

A

administration of bronchodilators

drug and air mixed to form a mist that’s inhaled through a mask

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45
Q

how long are Nebulizers administered?

A

over a period of about 10 minutes

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46
Q

t/f: DPI administration is superior to MDI and nebulizers

A

false

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47
Q

how do beta adrenergic agonists work?

A

they stimulate beta 2 adrenergic receptors on resp smooth musc cells to produce bronchodilation

48
Q

are beta adrenergic agonists selective or nonselective?

A

either

49
Q

do selective or nonselective alpha adrenergic agonists have less side effects?

A

selective

50
Q

what do alpha adrenergic agonists bronchodilators usually end in?

A

“-terol”

51
Q

how often are alpha adrenergic agonist bronchodilators administered?

A

inhaled 2x/day

inhaled 1x/day for ultra long acting

52
Q

what are some alpha adrenergic agonist bronchodilators?

A

Albuterol (Proventil, Ventolin)-inhalation, oral (IMPORTANT)

Arformaterol (Brovana)-inhalation

Isoproterenol (Isuprel)-inhalation or IV

Metaproterenol (Alupent)-aerosol inhalation or oral (IMPORTANT)

Terbutaline (Brethaire, Bricanyl)-inhalation, oral, SQ

Epinephrine (Primatene) and Isopruterenol (Isuprel, Medihaler-Iso) - nonselective

53
Q

what receptors do Isopruterenol (Isuprel, Medihaler-Iso) stimulate?

A

alpha 1, beta 1, and beta 2

54
Q

what are common adverse rxns to alpha adrenergic agonist bronchodilators?

A

airway irritation w/inc use

inc tolerance with inc use

if not selective, cardiac irregularities

nervousness

tremor

restlessness

55
Q

how do xanthine derivatives work as bronchodilators?

A

by inhibiting phosphodiesterase enzyme (PDE) on bronchial smooth muscle

dec inflammatory cell fxn

act on adenosine antagonist to block the effects of adenosine to cause relaxation of smooth muscle

56
Q

what are theophylline, caffeine, and theobromine?

A

xanthine derivatives

57
Q

what is the normal fxn of adenosine?

A

restrictive effects in fight or flight mode

58
Q

t/f: xanthine derivatives cause bronchodilation to treat asthma and obstructive lung disease

A

true

59
Q

how are xanthine derivative administered?

A

orally

60
Q

what is one of the most commone xanthine derivatives used?

A

Theophylline

61
Q

what are Aminophylline and Dyphylline?

A

xanthine derivatives

62
Q

what is theophylline toxicity?

A

blood plasma levels of >15-20

63
Q

what are the early signs of theophylline toxicity?

A

nausea, confusion, irritability, restlessness

64
Q

what are the severe signs of theophylline toxicity?

A

cardiac arrhythmias, seizures at >20

65
Q

what pts are more at risk for theophylline toxicity bc they don’t metabolize the drug the same?

A

pts over 55 yo

pts w/liver disease

pts with CHF

pts prone to infection (pneumonia)

66
Q

how to anticholinergic drugs work as bronchodilators?

A

they block muscarinic cholinergic receptors to prevent Ach from causing bronchoconstriction

67
Q

what are the drug of choice for COPD?

A

anticholinergics

68
Q

what are some anticholinergic drugs?

A

Ipratoprum (Atrovent)-aerosol inhaler 3-4x/day

Tiotroprum (spiriva) -aerosol inhaler, long acting, 1x/day

Atropine-inc risk of side effects

69
Q

what are the side effects of anticholinergics?

A

confusion, dry mouth, constipation, urinary retention, tachycardia, blurred vision

70
Q

why do Atrovent and Spiriva have fewer side effects than Atropine?

A

bc they are poorly absorbed into systemic circulation

71
Q

are the muscarinic receptors blocked or stimulated to produce bronchoconstriction? why?

A

blocked bc activation causes constriction

72
Q

are the adrenergic receptors blocked or stimulated to produce bronchoconstriction? why?

A

stimulated bc activation relaxes smooth musc

73
Q

what are the 3 anti-inflammatory agents?

A

1) glucocorticoids
2) cromones
3) leukotriene inhibitors

74
Q

what are glucocorticoids?

A

corticosteroids used to treat inflammation and bronchospasms

75
Q

how do glucocorticoids work?

A

they inhibit production of pro-inflammatory products (cytokines, PGs, leukotrienes)

increase production of anti-inflammatory proteins

76
Q

how are glucocorticoids administered?

A

orally or inhalation for long term use

IV for acute attack

77
Q

t/f: corticosteroids are most effective for asthma

A

true

78
Q

what do glucocorticoids usually end in?

A

“-asone”

79
Q

what are some glucocorticoids?

A

Beclomethasone (Qvar)-inhalation

Budesonide (Pulmicon)-inhalation
(IMPORTANT)

Dexamethasone (Dexpak)-oral, IM, IV (IMPORTANT)

Methylprednisolone (Medrol, Solumedrol)-oral, IV, IM (IMPORTANT)

Prednisolone-oral, IV, IM (IMPORTANT)

Prednisone-oral

80
Q

what are common adverse rxns to glucocorticoids?

A

osteoporosis, skin breakdown, musc wasting

dec growth in children, glaucoma, cataracts, HYPERGLYCEMIA, HTN, adrenal glands suppression if stopped suddenly (min when administered via inhalation)

risk of resistance or tolerance

Cushing’s syndrome with long term use

irritable

81
Q

what are the characteristics of Cushing’s syndrome?

A

round face and midsection, thin extremities

82
Q

how do cromones work as anti-inflammatory agents?

A

they inhibit the release of histamine and leukotrienes from pulm mast cells and desensitize mas cells over time

they prevent bronchospasms in asthma (won’t reverse it tho)

dec airway hyperresponsiveness w/prolonged use

83
Q

what are cromonesused to treat?

A

they are used prophylactically for asthma attacks that are triggered by specific activities (exercise and pet/pollen exposure)

84
Q

how are cromones administered?

A

via inhalation (MDI) or nebulizer

85
Q

what is the only cromone available in the US?

A

cromolyn sodium (Intal)

OR

non prescription Nasalcrom (a nasal spray for seasonal allergies, hay fever, and rhinitis)

86
Q

what are the adverse effects of cromones?

A

very few are known, mostly just nasal passage irritation

87
Q

what do leukotreine inhibitors do?

A

they inhibit resp inflammatory compound that contribute to bronchoconstriction

88
Q

what are some leukotreine inhibitors?

A

Zileuton (Zyflo)

Montelukast (Singulair)

Zafiriukast (Accolate)

89
Q

how does Zileuton (Zyflo), a leukotreine inhibitor, work?

A

it decreases the production of leukotreine

90
Q

how does Zafiriukast (Accolate), a leukotreine inhibitor, work?

A

it blocks the receptor for leukotreines on resp tissue and is fairly selective

91
Q

t/f: leukotriene inhibitors can be combined with glucocorticoids and beta agonists for asthma and COPD

A

true

92
Q

t/f: adverse effects with leukotriene inhibitors is rare

A

true

93
Q

what are the 1st line agents used for most asthma pts?

A

glucocorticoids

94
Q

are glucocorticoids used to treat even new or mild cases of asthma?

A

yes

95
Q

t/f: meds for asthma now have direct effects on the underlying disease processes (inflammation of the airways)

A

true

96
Q

glucocorticoids are also combined with ____ meds to optimal results in asthma

A

long acting beta 2 agonist

97
Q

glucocorticoids with long acting beta 2 agonists are esp helpful when?

A

when pts don’t respond to inhaled glucocorticoids alone

98
Q

t/f: glucocorticoids with long acting beta 2 agonists can provide anti-asthmatic effects at lower and safer doses of the inhaled glococorticoid

A

true

99
Q

combining long acting beta 2 agonists with glucocorticoids prevents ____ side effects of an oral glucocorticoid

A

systemic

100
Q

what can be used as the primary method for symptomatically treating asthma attacks?

A

short acting beta 2 agonists

101
Q

how are short acting beta 2 agonists administered to symptomatically treat asthma attacks?

A

through MDIs as rescue inhaler

102
Q

what is the main rx for managing acute episodes of asthma?

A

short acting beta 2 agonists

103
Q

if pts use rescue inhaler excessively, what should we do?

A

refer them back to their physician for further evaluation of alternative drug strategies

104
Q

t/f: leukotriene inhibitors can be effective for long term rx of asthma esp if it is exercise induced

A

true

105
Q

what may be combined with glucocorticoids to decrease the amount of steroid needed and prevent systemic side effects?

A

leukotriene inhibitors

106
Q

what are some examples of glucocorticoids combined with beta 2 bronchodilators?

A

Advair HFA: FluticaSONE and SalmeTEROL

Advair Diskus: FluticaSONE and SalmeTEROL

Dulera: Budesonide and FormoTEROL

Symbicort: MometaSONE and FormoTEROL

107
Q

what is the 1st line to promote bronchodilation in COPD?

A

anticholinergics (Ipratropium, Tiotropium)

108
Q

other than anticholinergics, what meds can be used initially for COPD?

A

long acting beta 2 agonists

109
Q

t/f: the beta 2 agonists and anticholinergics can be combined for optimal rx of COPD

A

true

110
Q

why may theophylline also be used to manage bronchospasms in COPD?

A

bc even in low doses, it has anti-inflammatory effects

111
Q

the focus of rx for CF is on what?

A

maintaining airway patency as much as possible

112
Q

what drugs help limit mucus production and mucus plugs in CF?

A

bronchodilators and mucolytic/expectorants

113
Q

how do glucocorticoids help CF?

A

by limiting airway inflammation and improving pulmonary fxn

114
Q

t/f: glucocorticoids are ideal rx for children with COPD

A

false, use a higher dose of NSAIDs instead

115
Q

what antibacterial drug is used to rx the frequent resp infections associated with CF?

A

Azithromycin

116
Q

aerosol preps that contain deoxyribonuclease and nebulizer rx that include recombinant human deoxyribonuclease (rhDNase) assist with what in CF?

A

decreasing the viscocity of resp secretions

117
Q

what are PT implications for respiratory pts?

A

be aware of pts prone to bronchospasms (inhaler should be on them) as exercise can be a trigger

encourage responsible, correct use of inhaler

encourage expectoration

coordinate PT with resp rx (30-60 min post nebulizer)

learn to assist with resp hygiene

watch for side effects of bronchodilators (arrhythmias, tremors, nervousness)

watch for signs of theophylline toxicity

be aware of potential effects of prolonged use of systemic glucocorticoids (breakdown of skin, bone, musculotendinous structures)

DPT 530 (14 decks)

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