Resp Meds Flashcards
What is the mechanism of action of a short acting beta 2 receptor agonist?
Bronchial smooth muscle relaxation causing bronchodilation through activating beta2-adrenergic receptors
What is the indication of short acting beta 2 receptor agonists?
Prevention or relief of bronchospasm in asthma or COPD. Used PRN, inhaled.
What are the side effects of short acting beta 2 receptor agonists?
In larger doses, may cause anxiety, nausea, tremors, palpitations, increased heart rate -> tachydysrthythmias, angina, seizures.
What are the contraindications/interactions of short acting beta 2 receptor agonists?
Effects may be diminished if pt is taking beta blockers. Avoid use in pts taking MAOIs/other sympathomimetics r/t risk of hypertension.
What is an example of a short acting beta 2 receptor agonist?
Salbutamol (Albuterol)
What is the mechanism of action of a long acting beta 2 receptor agonist?
Bronchial smooth muscle relaxation causing bronchodilation.
What is the indication of long acting beta 2 receptor agonist?
Prevention/long term control of bronchospasm in asthma or COPD. Fixed schedule, not PRN, inhaled.
What are the side effects of long acting beta 2 receptor agonist?
May increase risk of death if used monotherapy in asthma.
What are the contraindications/interactions of long acting beta 2 receptor agonist?
Effects may be diminished if pt is taking beta blockers. Avoid use in pts taking MAOIs/other sympathomimetics r/t risk of hypertension.
What is an example of a long acting beta 2 receptor agonist?
Salmeterol
In asthma, what must be given alongside a long acting beta 2 agonist?
A glucocorticoid.
What is the mechanism of action of an anticholinergic?
Blocks muscarinic receptors in the bronchi -> reduced bronchospasm
What is the indication of an anticholinergic?
Slower onset compared to beta agonist. Used for prevention of bronchospasm. COPD “off label” for asthma. Inhaled.
What are the side effects of an anticholinergic?
Dry mouth, throat, nasal congestion. Not readily absorbed systemically, but if it does this can increase intraocular pressure.
What are the contraindications/interactions of an anticholinergic?
Caution in pts with acute angle glaucoma or prostate enlargement. Possible addictive toxicity in use with other anticholinergic drugs.
What is an example of an anticholinergic?
Ipratropium, tiotropium
What is the mechanism of action of methylxanthines?
Bronchodilation by relaxing the smooth muscle of the bronchi. Not firmly established - likely from blocking adenosine receptors.
What is the indication of methylxanthines?
Chronic - asthma, decrease frequency and severity of attacks. No longer recommended for COPD.
PO or IV
What are the side effects of methylxanthines?
Toxicity, nausea, vomiting, diarrhea, insomnia, restlessness.
What are the contraindications/interactions of methylxanthines?
Caffeine, tobacco, marijuana, many drug interactions.
What is an example of methylxanthines?
Aminophylline, theophylline
What is the mechanism of action of inhaled corticosteroids?
Reduces inflammation, decreases edema and results in bronchodilation. Increases responsiveness to beta agonists (eg salbutamol)
What is the indication of inhaled corticosteroids?
Persistent asthma, often used in conjunction with beta agonists. May also be used in moderate to severe COPD or in exacerbations as they can improve symptoms.
What are the side effects of inhaled corticosteroids?
Oral-pharyngeal candidiasis, dysphonia, delay growth in children?, long term bone loss.
Why is there no serious risk of toxicity when using inhaled corticosteroids?
Because there is no adrenal suppression.
What are the contraindications/interactions of inhaled corticosteroids?
Less contraindications/interactions when inhaled.
What is an example of an inhaled corticosteroid?
Beclomethasone, budesonide
What is the mechanism of action of leukotriene receptor antagonists?
Suppress effects of leukotrienes (which promote smooth muscle constriction, vessel permeability, and inflammatory responses directly). Decreases bronchoconstriction.
What is the indication of leukotriene receptor antagonists?
Maintenance therapy in chronic asthma. Second line therapy (if inhaled glucocorticoids cannot be used). Used for adults and children 5 and above. PO
What are the side effects of leukotriene receptor antagonists?
Headache, GI, arthralgia, myalgia, neuropsychiatric effects
What are the contraindications/interactions of leukotriene receptor antagonists?
Interacts with various drugs eg aspirin, erythromycin, warfarin
What is an example of leukotriene receptor antagonists?
Zafirlukast
What are Metered drug inhalers (MDI)?
- Pressurized devices
- 1 minute in between uses
- Teaching important!
- Spacer
What is Respimat?
- Fine mist
- Less drug in the mouth and oropharynx
What are Dry-powder inhalers (DPI)
- Micronized powder
- Breath activated
- Spacers not used
What are Nebulizers?
- Mist
- For some this may be more effective
Life span considerations for children?
- Special delivery devices
- SABA - approved over 2 but may be used younger
- Methylxanthines - all ages
- Anticholinergics - safety not established under 11
- Inhaled glucocorticoids preferred
Life span considerations for breastfeeding?
- Caution recommended
- Inhaled considered safe - system contraindicated
Life span considerations for pregnant?
Uncontrolled asthma associated with fetal risks
Life span considerations for older adults?
Consider benefits vs. risks
Low doses of opioids are very effective in decreasing ___________________ (morphine sulphate is used most commonly)
The perception of dyspnea
- Exact mechanism unknown
What are Antitussives?
- Cough suppressants
- Should be only given for an ongoing dry, non-productive cough
- Opioid based (codeine)
What are Expectorants used for?
To reduce viscosity of secretions for easier removal
What are Mucolytics used for?
- Break down chemical structure of mucus for easier removal by coughing
- Use with caution
