Pulmonary/Respiratory Medications Flashcards
what are respiratory meds used for?
common cold, seasonal allergies, asthma, COPD, chronic bronchitis, CF, maintaining proper airflow, and facilitation of mucus and secretion clearance
what are the 5 types of respiratory meds?
1) antitussives
2) decongestants
3) antihistamines
4) mucolytics/expectorants
5) drugs to maintain airway patency
what are antitussives used to do?
suppress cough
antitussives are often combined with ____ and _____
aspirin, acetaminophen
how do non-opioid derivative of antitussives work?
they inhibit irritation effects of histamine on mucosa or have anesthetic effects on the resp epithelium
how does Benzonatate (Tessalon) work as an antitussive?
with local anesthetic effects on resp mucosa
how does Codeine work as an antitussive?
it inhibits the cough reflex by direct effects on the cough center in the BS
Hydrocodone
Hydromorphone
how does Dextromethorphan work as an antitussive?
it is a non-narcotic that inhibits the cough reflex
how does Diphenhydramine (Benadryl) work as an antitussive?
as an antihistamine
what are common adverse rxns to antitussives?
sedation
GI upset
dizziness
tolerance and dependence if used too long
what do decongestants treat?
symptoms of mucous discharge like a runny nose, stuffy head, common cold, or respiratory infections
how do alpha 1 adrenergic agonists work as decongestants?
by binding to receptors on blood vessels of nasal mucosa to cause vasoconstriction
how are decongestants administered?
orally or via nasal spray
decongestants can excite___ and ____ and cause a ____ in sympathetic activity
CVS, CNS, increase
what are the decongestant meds?
Ephedrine (Bronkaid)-oral
Oxymetazolin (Afrin, Dristan)-nasal spray
Phenylephrine (Sudafed, PE)-oral
Pseudoephedrine (Chlor Timeton)-oral
Xylometazoline-nasal spray
what are common adverse rxns to decongestants?
dizziness, nervousness, inc BP, inc heart palpitations
headache, nausea
what are antihistamines used to treat?
viral infection symptoms of common colds
allergic response to seasonal allergies
how do antihistamines work?
they block the H1 subtype receptor that histamine acts on in vascular and resp tissues
what do antihistamines do?
decrease nasal congestion, conjunctivitis, mucosal irritation and discharge, and coughing and sneezing
t/f: antihistamines may be used in asthma for rhinitis and sinusitis
true
what are some of the sedating antihistamines?
Bromepheniramine (Dimetapp)
Cetirizine (Zyrtec)
Chlorpheniramine (Chlor-Trimeton)
Desloratadine (Clarinex)
Diphenhydramine (Benadryl)
Levocetirizine (Xyzal)
Dimenhydrinate (Dramamine)
what are some non-sedating antihistamines?
Cetirizine (Zyrtec)
Loratadine (Claritin)
Desloratadine (Clarinex)
Fexofenadine (Allegra)
can some antihistamines be either sedating or non-sedating?
yes
how do non-sedating antihistamines work?
by increasing the selectiveness for H1 receptors leading to decreased side effects
what are common adverse rxns to antihistamines?
sedation, blurry vision, incoordination
fatigue, dizziness, GI upset
what are 1st generation antihistamines?
sedating antihistamines that cross the BBB causing CNS side effects
why do 1st generation antihistamines have sedating effects?
bc they cross the BBB
which antihistamine lead to an increased risk of falling in older populations?
Diphenhydramine (Benadryl)
what are 2nd generation antihistamines?
non-sedating antihistamines that don’t cross the BBB as easily
what do mucolytics/expectorants do?
decrease the viscocity of resp secretions to facilitate production and ejection of mucus
mucolytics/expectorants relieve acute symptoms from ____ to ____ and ____ and ____
cold, pneumonia, emphysema, chronic bronchitis
t/f: mucolytics/expectorants are often combined with other meds like antitussives, decongestants, and bronchodilators
true
what is the primary mucolytic drug?
Acetylcysteine (Mucomyst, Mucosil)
how does Acetylcysteine (Mucomyst, Mucosil) work?
it splits the disulfide bond of mucoproteins to decrease the viscocity of secretions
antioxidant effects decrease free radical damage in resp tissues
thins secretions
how is Acetylcysteine (Mucomyst, Mucosil) administered?
inhalation
what is the primary expectorant drug?
Gualfenesin
how does Gualfenesin work?
by increasing production of resp secretions, thus encouraging expectoration of phlegm and sputum
how is Gualfenesin administered?
oral syrup/elixir
what are the two drugs for maintaining airway patency?
1) bronchodilators
2) anti-inflammatory agents
what are the 3 bronchodilators?
1) beta adrenergic agonists
2) xanthine derivatives
3) anti-cholinergic drugs
what are the 3 anti-inflammatory agents?
1) glucocorticoids (corticosteroids)
2) cromones
3) leukotriene inhibitors
what are the 3 different types of administration of bronchodilators?
1) MDIs (metered dosed inhalers)
2) nebulizer
3) DPI (dry powder inhaler
what is MDI administration?
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
what is a Nebulizer?
administration of bronchodilators
drug and air mixed to form a mist that’s inhaled through a mask
how long are Nebulizers administered?
over a period of about 10 minutes
t/f: DPI administration is superior to MDI and nebulizers
false
how do beta adrenergic agonists work?
they stimulate beta 2 adrenergic receptors on resp smooth musc cells to produce bronchodilation
are beta adrenergic agonists selective or nonselective?
either
do selective or nonselective alpha adrenergic agonists have less side effects?
selective
what do alpha adrenergic agonists bronchodilators usually end in?
“-terol”
how often are alpha adrenergic agonist bronchodilators administered?
inhaled 2x/day
inhaled 1x/day for ultra long acting
what are some alpha adrenergic agonist bronchodilators?
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
what receptors do Isopruterenol (Isuprel, Medihaler-Iso) stimulate?
alpha 1, beta 1, and beta 2
what are common adverse rxns to alpha adrenergic agonist bronchodilators?
airway irritation w/inc use
inc tolerance with inc use
if not selective, cardiac irregularities
nervousness
tremor
restlessness
how do xanthine derivatives work as bronchodilators?
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
what are theophylline, caffeine, and theobromine?
xanthine derivatives
what is the normal fxn of adenosine?
restrictive effects in fight or flight mode
t/f: xanthine derivatives cause bronchodilation to treat asthma and obstructive lung disease
true
how are xanthine derivative administered?
orally
what is one of the most commone xanthine derivatives used?
Theophylline
what are Aminophylline and Dyphylline?
xanthine derivatives
what is theophylline toxicity?
blood plasma levels of >15-20
what are the early signs of theophylline toxicity?
nausea, confusion, irritability, restlessness
what are the severe signs of theophylline toxicity?
cardiac arrhythmias, seizures at >20
what pts are more at risk for theophylline toxicity bc they don’t metabolize the drug the same?
pts over 55 yo
pts w/liver disease
pts with CHF
pts prone to infection (pneumonia)
how to anticholinergic drugs work as bronchodilators?
they block muscarinic cholinergic receptors to prevent Ach from causing bronchoconstriction
what are the drug of choice for COPD?
anticholinergics
what are some anticholinergic drugs?
Ipratoprum (Atrovent)-aerosol inhaler 3-4x/day
Tiotroprum (spiriva) -aerosol inhaler, long acting, 1x/day
Atropine-inc risk of side effects
what are the side effects of anticholinergics?
confusion, dry mouth, constipation, urinary retention, tachycardia, blurred vision
why do Atrovent and Spiriva have fewer side effects than Atropine?
bc they are poorly absorbed into systemic circulation
are the muscarinic receptors blocked or stimulated to produce bronchoconstriction? why?
blocked bc activation causes constriction
are the adrenergic receptors blocked or stimulated to produce bronchoconstriction? why?
stimulated bc activation relaxes smooth musc
what are the 3 anti-inflammatory agents?
1) glucocorticoids
2) cromones
3) leukotriene inhibitors
what are glucocorticoids?
corticosteroids used to treat inflammation and bronchospasms
how do glucocorticoids work?
they inhibit production of pro-inflammatory products (cytokines, PGs, leukotrienes)
increase production of anti-inflammatory proteins
how are glucocorticoids administered?
orally or inhalation for long term use
IV for acute attack
t/f: corticosteroids are most effective for asthma
true
what do glucocorticoids usually end in?
“-asone”
what are some glucocorticoids?
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
what are common adverse rxns to glucocorticoids?
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
what are the characteristics of Cushing’s syndrome?
round face and midsection, thin extremities
how do cromones work as anti-inflammatory agents?
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
what are cromonesused to treat?
they are used prophylactically for asthma attacks that are triggered by specific activities (exercise and pet/pollen exposure)
how are cromones administered?
via inhalation (MDI) or nebulizer
what is the only cromone available in the US?
cromolyn sodium (Intal)
OR
non prescription Nasalcrom (a nasal spray for seasonal allergies, hay fever, and rhinitis)
what are the adverse effects of cromones?
very few are known, mostly just nasal passage irritation
what do leukotreine inhibitors do?
they inhibit resp inflammatory compound that contribute to bronchoconstriction
what are some leukotreine inhibitors?
Zileuton (Zyflo)
Montelukast (Singulair)
Zafiriukast (Accolate)
how does Zileuton (Zyflo), a leukotreine inhibitor, work?
it decreases the production of leukotreine
how does Zafiriukast (Accolate), a leukotreine inhibitor, work?
it blocks the receptor for leukotreines on resp tissue and is fairly selective
t/f: leukotriene inhibitors can be combined with glucocorticoids and beta agonists for asthma and COPD
true
t/f: adverse effects with leukotriene inhibitors is rare
true
what are the 1st line agents used for most asthma pts?
glucocorticoids
are glucocorticoids used to treat even new or mild cases of asthma?
yes
t/f: meds for asthma now have direct effects on the underlying disease processes (inflammation of the airways)
true
glucocorticoids are also combined with ____ meds to optimal results in asthma
long acting beta 2 agonist
glucocorticoids with long acting beta 2 agonists are esp helpful when?
when pts don’t respond to inhaled glucocorticoids alone
t/f: glucocorticoids with long acting beta 2 agonists can provide anti-asthmatic effects at lower and safer doses of the inhaled glococorticoid
true
combining long acting beta 2 agonists with glucocorticoids prevents ____ side effects of an oral glucocorticoid
systemic
what can be used as the primary method for symptomatically treating asthma attacks?
short acting beta 2 agonists
how are short acting beta 2 agonists administered to symptomatically treat asthma attacks?
through MDIs as rescue inhaler
what is the main rx for managing acute episodes of asthma?
short acting beta 2 agonists
if pts use rescue inhaler excessively, what should we do?
refer them back to their physician for further evaluation of alternative drug strategies
t/f: leukotriene inhibitors can be effective for long term rx of asthma esp if it is exercise induced
true
what may be combined with glucocorticoids to decrease the amount of steroid needed and prevent systemic side effects?
leukotriene inhibitors
what are some examples of glucocorticoids combined with beta 2 bronchodilators?
Advair HFA: FluticaSONE and SalmeTEROL
Advair Diskus: FluticaSONE and SalmeTEROL
Dulera: Budesonide and FormoTEROL
Symbicort: MometaSONE and FormoTEROL
what is the 1st line to promote bronchodilation in COPD?
anticholinergics (Ipratropium, Tiotropium)
other than anticholinergics, what meds can be used initially for COPD?
long acting beta 2 agonists
t/f: the beta 2 agonists and anticholinergics can be combined for optimal rx of COPD
true
why may theophylline also be used to manage bronchospasms in COPD?
bc even in low doses, it has anti-inflammatory effects
the focus of rx for CF is on what?
maintaining airway patency as much as possible
what drugs help limit mucus production and mucus plugs in CF?
bronchodilators and mucolytic/expectorants
how do glucocorticoids help CF?
by limiting airway inflammation and improving pulmonary fxn
t/f: glucocorticoids are ideal rx for children with COPD
false, use a higher dose of NSAIDs instead
what antibacterial drug is used to rx the frequent resp infections associated with CF?
Azithromycin
aerosol preps that contain deoxyribonuclease and nebulizer rx that include recombinant human deoxyribonuclease (rhDNase) assist with what in CF?
decreasing the viscocity of resp secretions
what are PT implications for respiratory pts?
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)
