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Pathophysiology and Pharmacology > Resipiratory Drugs > Flashcards

Resipiratory Drugs Flashcards

1
Q

Diseases of the lower resp. tract

A

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

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2
Q

BRONCHIAL ASTHMA

A

• 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

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3
Q

ASTHMA

A 
• STATUS ASTHMATICUS
   • PROLONGED ASTHMA ATTACK THAT DOES NOT 
      RESPOND TO TYPICAL DRUG THERAPY
   • MAY LAST SEVERAL MINUTES TO HOURS
   • MEDICAL EMERGENCY
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4
Q

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

A
  • PROGRESSIVE RESPIRATORY DISORDER

* CHARACTERIZED BY CHRONIC AIRFLOW LIMITATION, SYSTEMATIC MANIFESTATIONS, AND SIGNIFICANT COMORBIDITIES

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5
Q

CHRONIC BRONCHITIS

A

• PRESENCE OF COUGH AND SPUTUM FOR AT LEAST 3 MONTHS IN EACH OF 2 CONSECUTIVE YEARS
• SEPARATE DISEASE FROM CHRONIC OBSTRUCTIVE
PULMONARY DISEASE

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6
Q

BRONCHODILATING CLASSIFICATIONS

A
  • BETA ADRENERGIC AGONISTS
  • ANTICHOLINERGICS
  • XANTHINE DERIVATIVES
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7
Q

NON- BRONCHODILATING CLASSIFICATIONS

A
  • LEUKOTRIENE RECEPTOR AGONISTS
  • CORTICOSTEROIDS
  • PHOSPHODIESTERASE-4 INHIBITORS
  • MONOCLONAL ANTIBODY ANTIASTHMATIC
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8
Q

What do BRONCHODILATORS do?

A

RELAX BRONCHIAL SMOOTH MUSCLE, WHICH CAUSES DILATION OF THE BRONCHI AND BRONCHIOLES THAT ARE NARROWED AS A RESULT OF THE DISEASE PROCESS

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9
Q

SABA

A

• SHORT ACTING BETA AGONISTS; MOST COMMONLY USED DRUG IN THIS
CLASS; MUST NOT BE USED TOO FREQUENTLY
• E.G. - SALBUTAMOL (VENTOLIN)

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10
Q

LABA

A
  • 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
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11
Q

BETA ADRENERGIC AGONISTS MOVEMENT

A

VARIABLE DEPENDENT ON PARTICULAR DRUG

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12
Q

BETA ADRENERGIC AGONISTS ACTION

A
  • 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
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13
Q

BETA ADRENERGIC AGONISTS NURSING CONSIDERATIONS - ADVERSE EFFECTS

A

INSOMNIA, RESTLESSNESS, ANOREXIA, VASCULAR HEADACHE, HYPERGLYCEMIA, TREMOR, STIMULATION, TACHYCARDIA, TREMOR, ANGINAL PAIN, HYPOTENSION OR HYPERTENSION

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14
Q

BETA ADRENERGIC AGONISTS NURSING CONSIDERATIONS - CONTRAINDICATIONS

A

KNOWN DRUG ALLERGY, UNCONTROLLED CARDIAC DYSRHYTHMIAS, HIGH RISK OF STROKE (BECAUSE OF THE VASOCONSTRICTIVE DRUG ACTION)

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15
Q

BETA ADRENERGIC AGONISTS NURSING CONSIDERATIONS - INTERACTIONS

A

WITH USE OF BETA BLOCKER, BRONCHODILATING EFFECTS ARE DIMINISHED

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16
Q

BETA ADRENERGIC AGONISTS - SABAS ADMINISTRATION

A
  • ORAL, PARENTERAL, AND INHALATIONAL USE

* INHALATIONAL DOSAGE FORMS INCLUDE METERED-DOSE INHALERS AS WELL AS SOLUTIONS FOR INHALATION (AEROSOL NEBULIZERS).

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17
Q

BETA ADRENERGIC AGONISTS - LABAS ADMINISTRATION

A
  • INHALATION

* DOSES VERY

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18
Q

EXAMPLES OF ANTICHOLINERGICS

A

• IPRATROPIUM (ATROVENT); OLDEST AND
MOST COMMONLY USED ANTICHOLINERGIC
BRONCHODILATOR
• TIOTROPIUM (SPIRIVA)

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19
Q

WHAT DO ANTICHOLINERGICS DO?

A

• INDIRECTLY CAUSE AIRWAY RELAXATION AND
DILATION
• HELP REDUCE SECRETIONS IN COPD PATIENTS

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20
Q

ANTICHOLINERGICS MOVEMENT

A

VARIABLE DEPENDENT ON PARTICULAR DRUG

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21
Q

ANTICHOLINERGICS ACTION

A
  • 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
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22
Q

ANTICHOLINERGICS ADVERSE EFFECTS

A

DRY MOUTH OR THROAT, NASAL CONGESTION, HEART PALPITATIONS, GI DISTRESS, URINARY RETENTION, INCREASED INTRAOCULAR PRESSURE, HEADACHE, COUGHING, ANXIETY

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23
Q

ANTICHOLINERGICS INDICATIONS

A

PREVENTION OF THE BRONCHOSPASM ASSOCIATED WITH COPD; NOT FOR THE MANAGEMENT OF ACUTE SYMPTOMS

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24
Q

IPRATROPIUM (ATROVENT) ADMINISTRATION

A

INHALATIONAL DOSAGE FORMS INCLUDE

METERED-DOSE INHALERS, NASAL SPRAY, SOLUTIONS FOR INHALATION (AEROSOL NEBULIZERS)

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25
Q

TIOTROPIUM (SPIRIVA) ADMINISTRATION

A

INHALATION OF DRY POWDER IN HANDI

HALER; ONCE DAILY ADMINISTRATION

26
Q

XANTHINE DERIVATIVES

A

• PLANT ALKALOIDS: CAFFEINE, THEOBROMINE, AND
THEOPHYLLINE
• ONLY THEOPHYLLINE AND CAFFEINE ARE CURRENTLY USED CLINICALLY.
• SYNTHETIC XANTHINES: AMINOPHYLLINE

27
Q

THEOPHYLLINE

A

• 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.

28
Q

THEOPHYLLINE MOVEMENT

A

VARIABLE DEPENDENT ON PARTICULAR DRUG

29
Q

THEOPHYLLINE ACTION

A

• 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

30
Q

THEOPHYLLINE CONTRAINDICATIONS

A

ALLERGY, UNCONTROLLED CARDIAC DYSTHYMIAS, SEIZURE DISORDERS, HYPERTHYROIDISM, PEPTIC ULCERS

31
Q

THEOPHYLLINE ADVERSE EFFECTS

A

NAUSEA, VOMITING, ANOREXIA, GERD, SINUS TACHYCARDIA, PALPITATIONS, VENTRICULAR DYSRHYTHMIAS, TRANSIENT INCREASED URINATION, HYPERGLYCEMIA

32
Q

THEOPHYLLINE INDICATION

A

• 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

33
Q

THEOPHYLLINE ADMINISTRATION

A

ORAL – DAILY - QID

34
Q

NONBRONCHODILATING RESPIRATORY

DRUGS

A
  1. LEUKOTRIENE RECEPTOR ANTAGONISTS
    (MONTELUKAST, ZAFIRLUKAST)
  2. CORTICOSTEROIDS (BECLOMETHASONE, BUDESONIDE, DEXAMETHASONE, FLUNISOLIDE, FLUTICASONE, CICLESONIDE, AND TRIAMCINOLONE)
  3. MAST CELL STABILIZERS: RARELY USED AND NO
    LONGER INCLUDED IN CANADIAN ASTHMA MANAGEMENT CONTINUUM
35
Q

LEUKOTRIENE RECEPTOR ANTAGONISTS

A
  • NEWER CLASS OF ASTHMA MEDICATIONS
  • CURRENTLY AVAILABLE DRUGS:
    • MONTELUKAST (SINGULAIR®)
    • ZAFIRLUKAST (ACCOLATE®)
36
Q

LEUKOTRIENE RECEPTOR ANTAGONISTS MOVEMENT

A

VARIABLE DEPENDENT ON PARTICULAR DRUG

37
Q

LEUKOTRIENE RECEPTOR ANTAGONISTS ACTION

A
  • 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
38
Q

LEUKOTRIENE RECEPTOR ANTAGONISTS ACTION

A

• 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

39
Q

LEUKOTRIENE RECEPTOR ANTAGONISTS CONTRAINDICATIONS

A

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

40
Q

LEUKOTRIENE RECEPTOR ANTAGONISTS ADVERSE EFFECTS

A
  • BOTH DRUGS (MONTELUKAST, ZAFIRLUKAST) MAY LEAD TO LIVER DYSFUNCTION.
  • ZAFIRLUKAST - HEADACHE, NAUSEA, DIARRHEA
41
Q

LEUKOTRIENE RECEPTOR ANTAGONISTS INDICATION

A
  • 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
42
Q

CORTICOSTEROIDS

A

• 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

43
Q

INHALED CORTICOSTEROIDS

A
  • BECLOMETHASONE DIPROPIONATE (QVAR®)
  • BUDESONIDE (PULMICORT TURBUHALER®)
  • FLUTICASONE FUROATE (AVAMYS®)
  • FLUTICASONE PROPIONATE (FLOVENT DISKUS®)
  • CICLESONIDE (OMNARIS®)
44
Q

CORTICOSTEROIDS ACTION

A

• 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

45
Q

CORTICOSTEROIDS CONTRAINDICATIONS

A

DRUG ALLERGY, HYPERSENSITIVITY TO GLUCOCORTICOIDS, SYSTEMIC FUNGAL INFECTION

46
Q

CORTICOSTEROIDS ADVERSE EFFECTS

A
  • PHARYNGEAL IRRITATION, COUGHING, DRY MOUTH, ORAL FUNGAL INFECTIONS
  • SYSTEMIC EFFECTS ARE RARE BECAUSE LOW DOSES ARE USED FOR INHALATION THERAPY.
47
Q

CORTICOSTEROIDS DRUG INTERACTIONS

A

• 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)

48
Q

INHALED CORTICOSTEROIDS INDICATION

A
  • 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.
49
Q

IV CORTICOSTEROIDS INDICATION

A

ACUTE EXACERBATION OF ASTHMA OR OTHER COPD

50
Q

Broncho-dilating

A

ETA ADRENERGIC AGONISTS
•ANTICHOLINERGICS
•XANTHINE DERIVATIVE

51
Q

Bronchial Asthma

A
  • 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
52
Q

•THE ALVEOLAR DUCTS AND ALVEOLI REMAIN OPEN, BUT AIRFLOW TO THEM IS OBSTRUCTED

What are the symptoms of bronchial Asthma

A

Wheezing and difficult breathing

53
Q

Asthma attack

A

A sudden and dramatic onset of asthma

54
Q

Status Asthmaticus

A

Prolonged asthma attach that does not respond to typical drug therapy.

55
Q

COPD

A

•PROGRESSIVE RESPIRATORY DISORDER•CHARACTERIZED BY CHRONIC AIRFLOW LIMITATION, SYSTEMATIC MANIFESTATIONS, AND SIGNIFICANT COMORBIDITIE

56
Q

Chronic bronchitis

A

•PRESENCE OF COUGH AND SPUTUM FOR AT LEAST 3 MONTHS IN EACH OF 2 CONSECUTIVE YEARS•SEPARATE DISEASE FROM CHRONIC OBSTRUCTIVE PULMONARY DISEAS

57
Q

non- bronchodilating

A

LEUKOTRIENE RECEPTOR AGONISTS•CORTICOSTEROIDS•PHOSPHODIESTERASE-4 INHIBITORS•MONOCLONAL ANTIBODY ANTIASTHMATI

58
Q

Bronchodilators

A

•RELAX BRONCHIAL SMOOTH MUSCLE, WHICH CAUSES DILATION OF THE BRONCHI AND BRONCHIOLES THAT ARE NARROWED AS A RESULT OF THE DISEASE PROC

59
Q

Three classes of Bronchodilators

A

1 .Β-ADRENERGICAGONISTS

  1. ANTICHOLINERGICS
  2. XANTHINE DERIVATIV
60
Q

Beta- adrenergicagonists

A

Saba and Laba

Pathophysiology and Pharmacology (17 decks)

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