resp drugs (includes ppt, drug table, notes, pharm HW) Flashcards
what is faster acting?
anticholinergic or beta 2 adrenergic agonist
what are they trying to achieve when taken for asthma
- Beta2-adrenergic agonists are shorter acting than anticholinergics.
bronchodilation
what is example of beta 2 adrenergic agonists studied
albuterol aka ventolin
which kinds of meds are bronchodilators?
Beta 2-adrenergic agonists: Ventolin/albuterol
Anticholinergics: Ipratopium aka atrovent
Methylxanthines: aminophylline (related to caffeiene)
zafirkulast
anticholinergic and beta 2 adrenergic agonists which acts on SNS and which on PNS?
Do they block or activate?
- Beta2-adrenergic agonists activate the sympathetic nervous system.
- Anticholinergics block the parasympathetic nervous system.
which drug that we studied puts pt at risk of candidiasis
beclomethasone a corticosteroid
which kind of drug is used for prophylaxis of persistent, chronic asthma
- Leukotriene modifiers (Zafirukast)
how are these drugs Corticosteroids, leukotriene modifiers, mast cell stabilizers, and monoclonal antibodies useful in terms of their tx of asthma?
they all dec inflammation
which serious adverse effects might occur from ventolin/albuterol?
Tachycardia
Nervousness
Headache according to pharm worksheet
from Davis PARADOXICAL BRONCHOSPASM (excess use of inhalers), chest pain, palpitations also seem serious
how long would you need to wait until Zafirlukast would begin to work?
-onset/duration unknown, but peak is 1 wk,
what kind of meds would pt w COPD be on regularly?
Bronchodilators Why? Limitations?
Beta 2-adrenergic agonists: Venolin/albuerol
Anticholinergics: atrovent
Methylxanthines: aminophylline (related to caffeiene)
Corticosteroids Why? Limitations?
Beclomethasone (Beclovent): prevention (thrush is side effect)
Budesonide (Pulmicort)
Fluticasone (Flovent)
what kind of other pharm intervention might COPD pt get and when?
Influencza vaccine and pneumococcal pneumonia vaccine (every 5 yrs)
Sometimes Antibiotics are used as these patients are at risk for chronic and frequent infections d/t mucus, impaired ability to cough etc
may be on mucolytic agents, alpha 1 antitrypsin augmentation therapy
when are bronchodilators given?
• Given PRN or regularily throughout the day or prophylactically (eating, walking)
who is more likely to take corticosteroids, COPD or asthma pt? what effect would this have for the pt long term (in terms of benefits)?
asthma
it improves sympoms but doesnt slow the delcine of lung fx
what kinds of meds would pt w mild COPD have?
short acting bronchodilator
what kinds of meds would pt w moderate/severe COPD have?
short acting bronchodilator along with regular tx of 1 or more long acting bronchodilator
what kinds of meds would pt w very severe/severe COPD have?
regular tx
1 or more bronchodilators
inhaled corticosteroids
who is a mucolytic or expectorant not good to be used for?
expectorants/mucolytics- don’t use for older adult. Mucolytics can be used for someone who can handle a little mucus in their lungs as it draws fluid into the lung
how is cough reflex stim?
• The cough reflex is stimulated when receptors in the bronchi, alveoli, and pleura (lining of the lungs) are stretched. Sends a signal to the cough centre in medulla
what are the two categories of antitussives?
Two categories: opioids and nonopioids (less effective)
how are opioid antitussives formulated?
• Codeine and dilaudid are usually combined with other resp drugs and are rarely used alone for purpose of cough suppression
how do antitussives work?
• Opioid antitussive codeine and hydrocodone suppress the cough reflex through direct action on the cough centre in the CNS (medulla)
what other effects do antitussives have?
• Also have analgesia and drying effect on the mucosa of the resp tract- inc viscosity of secretions (reduces symp of runny nose and postnasal drip)
what is an expectorant?
MoA?
• Aid in the expectoration (coughing up and spitting out) of excessive mucus that has accumulated in resp track, by breaking down and thinning sec.
- Through reflex stimulation
- Loosening and thinning of the resp tract sec occurs in reponse to an irritation of the GI tract produced by the drug
- Used for relief of productive cough common with cold, bronchitis, laryngitis, pharyngitis, pertussis, influenza, pertussis, and measles
what kind of drug is beclomethasone?
MoA?
T: antiasthmatics, anti-inflm (steroidal)
P: corticosteroids (inhalation)
MoA: Potent,locally acting anti-inflammatory and immune modifier.
Dec freq and severity of asthma attacks. Improves asthma symptoms.
side effects of beclomethasone (cort)
headache,agitation, dysphonia,hoarseness,
CHURG-STRAUSS SYNDROME
assessments for beclomethasone
Resp status and lung sounds.
May cause dec bone mineral density w prolonged therapy.
Labs: periodic adrenal fx tests to look at hypothalamic-pituitary-adrenal axis suppression w chronic therapy.
should beclomethasone be used for acute asthma attack?
will it act in this time
no its contraindicated for acute attack
onset within 24hrs not immed
how to use inhaled corticosteroids like beclomethasone
Use bronchodilator for 5min before cort. To use MDI prime;shake inhaler well; exhale completely, close lips around it; breathe in slowly and deeply while pressing canister. Hold breath as long as possible. Wait 1-2min between inhalations. Rinse after.
which drug did we study that is adrenergic and used to tx COPD and asthma?
How does it work?
Albuterol is a bronchodilator and beta 2 adrenergic.
Binds to beta2-adrenergic receptor in airway sm muscle, leading to activation of cAMP. Inhibits phosphorylation of myosin and dec intracellular calcium.
indication of albuterol
Used to control and prvent a/w obstr d/t COPD and asthma. When inhaled gives relief for acute bronchospasm and prevention of exercise induced bronchospasm
assessments before admin of albuterol and periodically through therapy?
ASSESSMENTS
Lung sounds, pulse, BP before admin and during peak of med.
Note sputum char. Monitor pulm fx tests before &periodically
Labs: may cause dec K w improperly high doses/nebulization
side effects of albuterol
Chest pain, palpitations, nervousness, restlessness, tremor, PARADOXICAL BRONCHOSPASM (excess use of inhalers),
less common: hyperglycemia, HTN, arrhythmia, hypokalemia
what teaching/implementation is nec to know to give albuterol?
Shake inhaler. Allow 1min between inhalations of aerosol med. Prime w 4 test sprays.
Teach: albuterol before other inhaled meds and wait 5mins before giving them. Rinse after each inhalation to dec dry mouth.
what kind of med is Ipratopium?
what are its indications?
T: allergy, cold, and cough; bronchodilators
P: anticholinergics
Inhaln: maintenance therapy of reversible airway obstruction due to COPD, adjunctive tx for bronchospasm d/t asthma
ssessments for Ipratopium, and anticholinergic bronchodilator?
side effects
Resp status before admin and at peak of med.
Dizziness, headache, nervousness, blurred vision, sore throat, HoTN, palpitations, GI irritation (No common or severe side effects)
if you had corticosteroids and anticholinergic and adrenergic bronchodilators what order would you give them in?
adrenergic then anti Ach, then cort waiting 5mins between
what to teach pts about using ipratopium
- Use of inhaler
- Rinse mouth after, proper oral hygiene + sugarless gum for dry mouth
- Not to exceed 12 doses in 24 hrs
who is it bad to give antitussives to? why?
who are they used for?
this is dangerous when used inappropriately. Do not give to kids in general. You want them to be able to expectorate—you want to prevent PNEUMONIA!! This could be used for ICP or for pt who is beyond exhaustion and they need to rest. Use them judiciously. Derived from opiates
Corticosteroids what to focus of in terms for pt in terms of teaching?
Corticosteroids-Focus on mouth care for pts!!! Give them rinse, spit, something to cleanse mouth. They are at risk of fungal infection. Look in their mouths. People with AIDS are very vulnerable to mouth sores.
aminophylline indication and class?
INDICATIONS
Long term control of reversible airway obstruction d/t asthma or COPD
to prevent asthma attacks
Bronchodilator
P: xanthines
aminophylline MoA
Inhibits phosphodiesterase, producing inc tisuee concentrations of cAMP, causing bronchodilation + CNS stimulation
- Positive inotropic + chronotropic effect
cause bronchodilation by inc levels of cAMP
• They do this by competitively inhibiting phosphodiesterase (enzyme that breaks cAMP down)
• Higher intracellular levels of cAMP contribute to smooth muscle relaxation and inhibit IgE released from allergens
• Also stimulate the CNS because theophylline is metabolized to caffine in the body. Enhances resp drive
• Inc force of contraction and inc HR.
• raises CO and blood flow to kidneys. Inc GFR producing a diuretic effect
aminophylline assessments
ASSESSMENTS BP, pulse Resp status I/O (possible diuresis or fluid overload) Cardio changes (esp if hx of issues) - Pulmfx tests before + after
aminophylline most serious and common side effects
SIDE EFFECTS
Anxiety, tachycardia, N+V
SEIZURES
ARRHYTHMIAS
aminophylline other info to know
- Given IV with loading dose and continuous infusion (?) want to keep constant serum levels
TEACHING - Fluids to decresp secretion viscosity
- Not to take with cough + cold remedies – may inc risk of arrhythmias
what does Zafirlukast treat? class?
Long term control of asthma
- Not for acute attacks
T:Antiasthmatic
Bronchodilators
P: leukotriene antagonists
MoA of Zafirlukast/what effect does it have?
Antiagonizes effects of leukotrienes, which are components of slow-reacting substance of anphylaxis (SRSA). These substances mediate airway edema, smooth muscle constriction.
Decreases inflm process in asthma.
Lilley says
• Substances are produced during the allergen reaction called leukotrienes which cause inflm, bronchoconstriction, and mucus production (leads to coughing wheezing, and SOB)
assessments and side effects of Zafirlukast
ASSESSMENTS
- Resp assess
- Mood + suicidal ideation
- Liver fx
SIDE EFFECTS Headache SUICIDAL THOUGHTS HEPATOTOXICITY nausea diarrhea
teaching about Zafirkulast
when should it not be used?
- Not during lactation.
-not for acute asthma attack
TEACHING - Regularly scheduled doses; taken regardless of whether or not has asthma symptoms
-onset/duration unknown, peak 1 wk,
now notes from lilley on Xanthines, corticosteroids, antileukotriene, monoclonal ab
…
how are glucocorticoids used to tx asthma and COPD
at what point/severity would they be used?
- Reducing inflm and enhancing the activity of the B-agonists.
- Act by stabilizing the membranes of cels that normally release harmful bronchoconstricting substances (histamine, etx) these cells include leukocytes or WBC
- Generally for acute exacerbations
when are monoclonal abs used and how do they work
- binding and forming complexes with unbound IgE
- omalizumab blocks the high affinity receptors on the surfaces of the mast cells and basophils and reduces IgE cascade
- histamine release from basophils is also reduced.
- Prescribed to people with moderate or severe allergic asthma
