Resipiratory Drugs Flashcards
Diseases of the lower resp. tract
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) -FORMERLY KNOWN AS EMPHYSEMA AND CHRONIC BRONCHITIS
•ASTHMA (PERSISTENT AND PRESENT MOST OF THE TIME DESPITE TREATMENT; ALSO CONSIDERED A COPD
BRONCHIAL ASTHMA
• RECURRENT AND REVERSIBLE SHORTNESS OF BREATH
• OCCURS WHEN THE AIRWAYS OF THE LUNGS
BECOME NARROW AS A RESULT OF:
• BRONCHOSPASMS
• INFLAMMATION OF THE BRONCHIAL MUCOSA
• EDEMA OF THE BRONCHIAL MUCOSA
• PRODUCTION OF VISCOUS MUCUS
ASTHMA
• STATUS ASTHMATICUS
• PROLONGED ASTHMA ATTACK THAT DOES NOT
RESPOND TO TYPICAL DRUG THERAPY
• MAY LAST SEVERAL MINUTES TO HOURS
• MEDICAL EMERGENCYCHRONIC OBSTRUCTIVE PULMONARY DISEASE
- PROGRESSIVE RESPIRATORY DISORDER
* CHARACTERIZED BY CHRONIC AIRFLOW LIMITATION, SYSTEMATIC MANIFESTATIONS, AND SIGNIFICANT COMORBIDITIES
CHRONIC BRONCHITIS
• PRESENCE OF COUGH AND SPUTUM FOR AT LEAST 3 MONTHS IN EACH OF 2 CONSECUTIVE YEARS
• SEPARATE DISEASE FROM CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
BRONCHODILATING CLASSIFICATIONS
- BETA ADRENERGIC AGONISTS
- ANTICHOLINERGICS
- XANTHINE DERIVATIVES
NON- BRONCHODILATING CLASSIFICATIONS
- LEUKOTRIENE RECEPTOR AGONISTS
- CORTICOSTEROIDS
- PHOSPHODIESTERASE-4 INHIBITORS
- MONOCLONAL ANTIBODY ANTIASTHMATIC
What do BRONCHODILATORS do?
RELAX BRONCHIAL SMOOTH MUSCLE, WHICH CAUSES DILATION OF THE BRONCHI AND BRONCHIOLES THAT ARE NARROWED AS A RESULT OF THE DISEASE PROCESS
SABA
• SHORT ACTING BETA AGONISTS; MOST COMMONLY USED DRUG IN THIS
CLASS; MUST NOT BE USED TOO FREQUENTLY
• E.G. - SALBUTAMOL (VENTOLIN)
LABA
- LONG-ACTING BETA AGONISTS (ALWAYS PRESCRIBED WITH STEROID); NOT USED AS RELIEVERS DUE TO LONGER ONSET OF ACTION
- E.G. - SALMETEROL (SEREVENT)
- LABAS ARE OFTEN COMBINED WITH STEROIDS IN COMBINATION INHALERS
BETA ADRENERGIC AGONISTS MOVEMENT
VARIABLE DEPENDENT ON PARTICULAR DRUG
BETA ADRENERGIC AGONISTS ACTION
- AGONISTS, OR STIMULATORS, OF THE ADRENERGIC RECEPTORS IN THE SYMPATHETIC NERVOUS SYSTEM
- ‘SYMPATHOMIMETIC’ – IMITATE THE EFFECTS OF NOREPINEPHRINE ON BETA RECEPTORS
- BRONCHODILATORS – DILATE THE AIRWAYS BY RELAXING BRONCHIAL SMOOTH MUSCLE
- SOME STIMULATE RECEPTORS OUTSIDE THE LUNGS
BETA ADRENERGIC AGONISTS NURSING CONSIDERATIONS - ADVERSE EFFECTS
INSOMNIA, RESTLESSNESS, ANOREXIA, VASCULAR HEADACHE, HYPERGLYCEMIA, TREMOR, STIMULATION, TACHYCARDIA, TREMOR, ANGINAL PAIN, HYPOTENSION OR HYPERTENSION
BETA ADRENERGIC AGONISTS NURSING CONSIDERATIONS - CONTRAINDICATIONS
KNOWN DRUG ALLERGY, UNCONTROLLED CARDIAC DYSRHYTHMIAS, HIGH RISK OF STROKE (BECAUSE OF THE VASOCONSTRICTIVE DRUG ACTION)
BETA ADRENERGIC AGONISTS NURSING CONSIDERATIONS - INTERACTIONS
WITH USE OF BETA BLOCKER, BRONCHODILATING EFFECTS ARE DIMINISHED
BETA ADRENERGIC AGONISTS - SABAS ADMINISTRATION
- ORAL, PARENTERAL, AND INHALATIONAL USE
* INHALATIONAL DOSAGE FORMS INCLUDE METERED-DOSE INHALERS AS WELL AS SOLUTIONS FOR INHALATION (AEROSOL NEBULIZERS).
BETA ADRENERGIC AGONISTS - LABAS ADMINISTRATION
- INHALATION
* DOSES VERY
EXAMPLES OF ANTICHOLINERGICS
• IPRATROPIUM (ATROVENT); OLDEST AND
MOST COMMONLY USED ANTICHOLINERGIC
BRONCHODILATOR
• TIOTROPIUM (SPIRIVA)
WHAT DO ANTICHOLINERGICS DO?
• INDIRECTLY CAUSE AIRWAY RELAXATION AND
DILATION
• HELP REDUCE SECRETIONS IN COPD PATIENTS
ANTICHOLINERGICS MOVEMENT
VARIABLE DEPENDENT ON PARTICULAR DRUG
ANTICHOLINERGICS ACTION
- ACETYLCHOLINE (ACH) CAUSES BRONCHIAL CONSTRICTION AND NARROWING OF THE AIRWAYS.
- ANTICHOLINERGICS BIND TO THE ACH RECEPTORS, PREVENTING ACH FROM BINDING.
- RESULT: BRONCHOCONSTRICTION IS PREVENTED, AIRWAYS DILATE
ANTICHOLINERGICS ADVERSE EFFECTS
DRY MOUTH OR THROAT, NASAL CONGESTION, HEART PALPITATIONS, GI DISTRESS, URINARY RETENTION, INCREASED INTRAOCULAR PRESSURE, HEADACHE, COUGHING, ANXIETY
ANTICHOLINERGICS INDICATIONS
PREVENTION OF THE BRONCHOSPASM ASSOCIATED WITH COPD; NOT FOR THE MANAGEMENT OF ACUTE SYMPTOMS
IPRATROPIUM (ATROVENT) ADMINISTRATION
INHALATIONAL DOSAGE FORMS INCLUDE
METERED-DOSE INHALERS, NASAL SPRAY, SOLUTIONS FOR INHALATION (AEROSOL NEBULIZERS)
TIOTROPIUM (SPIRIVA) ADMINISTRATION
INHALATION OF DRY POWDER IN HANDI
HALER; ONCE DAILY ADMINISTRATION
XANTHINE DERIVATIVES
• PLANT ALKALOIDS: CAFFEINE, THEOBROMINE, AND
THEOPHYLLINE
• ONLY THEOPHYLLINE AND CAFFEINE ARE CURRENTLY USED CLINICALLY.
• SYNTHETIC XANTHINES: AMINOPHYLLINE
THEOPHYLLINE
• MOST COMMONLY USED XANTHINE DERIVATIVE – BUT USED LEFT OFTEN DUE TO HIGH ADVERSE EFFECT PROFILE
• ORAL AND INJECTABLE (AS AMINOPHYLLINE) DOSAGE FORMS
• AMINOPHYLLINE: INTRAVENOUS (IV) TREATMENT OF PATIENTS WITH STATUS ASTHMATICUS WHO HAVE NOT RESPONDED TO FAST-ACTING BETA-AGONISTS
SUCH AS EPINEPHRINE
• NARROW THERAPEUTIC INDEX - THERAPEUTIC RANGE FOR THEOPHYLLINE BLOOD LEVEL IS 55 TO 100 MMOL/L.
• CANADIAN ASTHMA CONSENSUS GUIDELINE RECOMMENDS LEVELS BETWEEN 28 TO 55 MMOL/L.
THEOPHYLLINE MOVEMENT
VARIABLE DEPENDENT ON PARTICULAR DRUG
THEOPHYLLINE ACTION
• INCREASE LEVELS OF ENERGY-PRODUCING CYCLIC ADENOSINE MONOPHOSPHATE (CAMP)
• THIS IS DONE BY COMPETITIVELY INHIBITING
PHOSPHODIESTERASE, THE ENZYME THAT
BREAKS DOWN CAMP.
• RESULT: DECREASED CAMP LEVELS, SMOOTH MUSCLE RELAXATION,
BRONCHODILATION, AND INCREASED AIRFLOW
THEOPHYLLINE CONTRAINDICATIONS
ALLERGY, UNCONTROLLED CARDIAC DYSTHYMIAS, SEIZURE DISORDERS, HYPERTHYROIDISM, PEPTIC ULCERS
THEOPHYLLINE ADVERSE EFFECTS
NAUSEA, VOMITING, ANOREXIA, GERD, SINUS TACHYCARDIA, PALPITATIONS, VENTRICULAR DYSRHYTHMIAS, TRANSIENT INCREASED URINATION, HYPERGLYCEMIA
THEOPHYLLINE INDICATION
• DILATION OF AIRWAYS IN ASTHMAS AND COPD
• MILD TO MODERATE CASES OF ACUTE ASTHMA
• NOT FOR MANAGEMENT OF ACUTE ASTHMA ATTACK
• ADJUNCT DRUG IN THE MANAGEMENT OF COPD
• NOT USED AS FREQUENTLY BECAUSE OF POTENTIAL FOR DRUG INTERACTIONS AND VARIABLES RELATED TO DRUG LEVELS IN THE
BLOOD
THEOPHYLLINE ADMINISTRATION
ORAL – DAILY - QID
NONBRONCHODILATING RESPIRATORY
DRUGS
- LEUKOTRIENE RECEPTOR ANTAGONISTS
(MONTELUKAST, ZAFIRLUKAST) - CORTICOSTEROIDS (BECLOMETHASONE, BUDESONIDE, DEXAMETHASONE, FLUNISOLIDE, FLUTICASONE, CICLESONIDE, AND TRIAMCINOLONE)
- MAST CELL STABILIZERS: RARELY USED AND NO
LONGER INCLUDED IN CANADIAN ASTHMA MANAGEMENT CONTINUUM
LEUKOTRIENE RECEPTOR ANTAGONISTS
- NEWER CLASS OF ASTHMA MEDICATIONS
- CURRENTLY AVAILABLE DRUGS:
- MONTELUKAST (SINGULAIR®)
- ZAFIRLUKAST (ACCOLATE®)
LEUKOTRIENE RECEPTOR ANTAGONISTS MOVEMENT
VARIABLE DEPENDENT ON PARTICULAR DRUG
LEUKOTRIENE RECEPTOR ANTAGONISTS ACTION
- LEUKOTRIENES ARE SUBSTANCES RELEASED WHEN A TRIGGER, SUCH AS CAT HAIR OR DUST, STARTS A SERIES OF CHEMICAL REACTIONS IN THE BODY.
- LEUKOTRIENES CAUSE INFLAMMATION, BRONCHOCONSTRICTION, AND MUCUS PRODUCTION AND CAUSE COUGHING, WHEEZING, SHORTNESS OF BREATH
LEUKOTRIENE RECEPTOR ANTAGONISTS ACTION
• LEUKOTRIENE RECEPTOR ANTAGONISTS PREVENT LEUKOTRIENES FROM ATTACHING TO RECEPTORS ON CELLS IN THE LUNGS AND IN CIRCULATION.
• INFLAMMATION IN THE LUNGS IS BLOCKED, AND ASTHMA SYMPTOMS ARE RELIEVED.
• PREVENT SMOOTH MUSCLE CONTRACTION OF THE
BRONCHIAL AIRWAYS
• DECREASE MUCUS SECRETION
• PREVENT VASCULAR PERMEABILITY
• DECREASE NEUTROPHIL AND LEUKOCYTE INFILTRATION TO THE LUNGS, PREVENTING INFLAMMATION
LEUKOTRIENE RECEPTOR ANTAGONISTS CONTRAINDICATIONS
KNOWN DRUG ALLERGY, PREVIOUS ADVERSE DRUG REACTION, ALLERGY TO POVIDONE, LACTOSE, TITANIUM DIOXIDE, OR CELLULOSE DERIVATIVES—IMPORTANT TO NOTE BECAUSE THESE ARE INACTIVE INGREDIENTS IN THESE DRUGS
LEUKOTRIENE RECEPTOR ANTAGONISTS ADVERSE EFFECTS
- BOTH DRUGS (MONTELUKAST, ZAFIRLUKAST) MAY LEAD TO LIVER DYSFUNCTION.
- ZAFIRLUKAST - HEADACHE, NAUSEA, DIARRHEA
LEUKOTRIENE RECEPTOR ANTAGONISTS INDICATION
- PROPHYLAXIS AND LONG-TERM TREATMENT AND PREVENTION OF ASTHMA IN ADULTS AND CHILDREN
- MONTELUKAST SAFE IN CHILDREN 2 YEARS OF AGE AND OLDER
- ZAFIRLUKAST SAFE IN CHILDREN 12 YEARS OF AGE AND OLDER
- NOT MEANT FOR MANAGEMENT OF ACUTE ASTHMATIC ATTACKS
- MONTELUKAST IS ALSO APPROVED FOR TREATMENT OF ALLERGIC RHINITIS
- IMPROVEMENT WITH THEIR USE IS TYPICALLY SEEN IN ABOUT 1 WEEK
CORTICOSTEROIDS
• ANTI-INFLAMMATORY PROPERTIES
• USED IN TREATMENT OF PULMONARY DISEASES
• MAY BE ADMINISTERED INTRAVENOUSLY
• ORAL OR INHALED FORMS - INHALED FORMS REDUCE SYSTEMIC EFFECTS.
• MAY TAKE SEVERAL WEEKS BEFORE FULL
EFFECTS ARE SEEN
INHALED CORTICOSTEROIDS
- BECLOMETHASONE DIPROPIONATE (QVAR®)
- BUDESONIDE (PULMICORT TURBUHALER®)
- FLUTICASONE FUROATE (AVAMYS®)
- FLUTICASONE PROPIONATE (FLOVENT DISKUS®)
- CICLESONIDE (OMNARIS®)
CORTICOSTEROIDS ACTION
• STABILIZE MEMBRANES OF LEUKOCYTES THAT
RELEASE HARMFUL BRONCHOCONSTRICTING
SUBSTANCES
• INCREASE RESPONSIVENESS OF BRONCHIAL
SMOOTH MUSCLE TO S-adrenergic STIMULATION
• DUAL EFFECT OF BOTH REDUCING INFLAMMATION
AND ENHANCING THE ACTIVITY OF SS-AGONIST
CORTICOSTEROIDS CONTRAINDICATIONS
DRUG ALLERGY, HYPERSENSITIVITY TO GLUCOCORTICOIDS, SYSTEMIC FUNGAL INFECTION
CORTICOSTEROIDS ADVERSE EFFECTS
- PHARYNGEAL IRRITATION, COUGHING, DRY MOUTH, ORAL FUNGAL INFECTIONS
- SYSTEMIC EFFECTS ARE RARE BECAUSE LOW DOSES ARE USED FOR INHALATION THERAPY.
CORTICOSTEROIDS DRUG INTERACTIONS
• DRUG INTERACTIONS ARE MORE LIKELY TO OCCUR WITH SYSTEMIC(VERSUS INHALED) CORTICOSTEROIDS.
• MAY INCREASE SERUM GLUCOSE LEVELS, POSSIBLY REQUIRING ADJUSTMENTS IN DOSAGES OF ANTIDIABETIC DRUGS
• MAY RAISE THE BLOOD LEVELS OF THE IMMUNOSUPPRESSANTS CYCLOSPORINE AND TACROLIMUS; ITRACONAZOLE MAY REDUCE
CLEARANCE OF THE STEROIDS
• PHENYTOIN, PHENOBARBITAL, AND RIFAMPIN
• GREATER RISK OF HYPOKALEMIA WITH CONCURRENT DIURETIC USE (E.G., FUROSEMIDE, HYDROCHLOROTHIAZIDE)
INHALED CORTICOSTEROIDS INDICATION
- PRIMARY TREATMENT OF BRONCHOSPASTIC DISORDERS TO CONTROL THE INFLAMMATORY RESPONSES THAT ARE BELIEVED TO BE THE CAUSE OF THESE DISORDERS
- PERSISTENT ASTHMA
- OFTEN USED CONCURRENTLY WITH THE S-adrenergic agonists
- SYSTEMIC CORTICOSTEROIDS ARE GENERALLY USED ONLY TO TREAT ACUTE EXACERBATIONS OR SEVERE ASTHMA.
IV CORTICOSTEROIDS INDICATION
ACUTE EXACERBATION OF ASTHMA OR OTHER COPD
Broncho-dilating
ETA ADRENERGIC AGONISTS
•ANTICHOLINERGICS
•XANTHINE DERIVATIVE
Bronchial Asthma
- RECURRENT AND REVERSIBLE SHORTNESS OF BREATH
- OCCURS WHEN THE AIRWAYS OF THE LUNGS BECOME NARROW AS A RESULT OF:
- BRONCHOSPASMS
- INFLAMMATIONOF THE BRONCHIAL MUCOSA
- EDEMA OF THE BRONCHIAL MUCOSA
- PRODUCTION OF VISCOUS MUCUS
•THE ALVEOLAR DUCTS AND ALVEOLI REMAIN OPEN, BUT AIRFLOW TO THEM IS OBSTRUCTED
What are the symptoms of bronchial Asthma
Wheezing and difficult breathing
Asthma attack
A sudden and dramatic onset of asthma
Status Asthmaticus
Prolonged asthma attach that does not respond to typical drug therapy.
COPD
•PROGRESSIVE RESPIRATORY DISORDER•CHARACTERIZED BY CHRONIC AIRFLOW LIMITATION, SYSTEMATIC MANIFESTATIONS, AND SIGNIFICANT COMORBIDITIE
Chronic bronchitis
•PRESENCE OF COUGH AND SPUTUM FOR AT LEAST 3 MONTHS IN EACH OF 2 CONSECUTIVE YEARS•SEPARATE DISEASE FROM CHRONIC OBSTRUCTIVE PULMONARY DISEAS
non- bronchodilating
LEUKOTRIENE RECEPTOR AGONISTS•CORTICOSTEROIDS•PHOSPHODIESTERASE-4 INHIBITORS•MONOCLONAL ANTIBODY ANTIASTHMATI
Bronchodilators
•RELAX BRONCHIAL SMOOTH MUSCLE, WHICH CAUSES DILATION OF THE BRONCHI AND BRONCHIOLES THAT ARE NARROWED AS A RESULT OF THE DISEASE PROC
Three classes of Bronchodilators
1 .Β-ADRENERGICAGONISTS
- ANTICHOLINERGICS
- XANTHINE DERIVATIV
Beta- adrenergicagonists
Saba and Laba
