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Pharmacology > Respiratory > Flashcards

Respiratory Flashcards

1
Q

what are some examples of disorders of the respiratory tract

A
  • asthma
  • chronic obstructive pulmonary disease (bronchitis and emphysema)
  • allergic rhinitis, cough and cold
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2
Q

what are smooth muscles and bronchioles controlled by

A
  • ANS
  • sympathetic nervous system is activated during stressful situations -> bronchiolar smooth muscle relaxes and bronchodilation results
  • more air enters the alveoli -> increasing the oxygen supply to the body during stress or exercise
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3
Q

what is pathogenesis and diagnosis of asthma like

A
  • chronic lung disease
  • inflammation of the airways
  • bronchoconstriction
  • improves either spontaneously or with tx
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4
Q

how many Canadians deal with asthma and how many children

A
  • 8.4% of Canadian population, 12% of children
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5
Q

when does asthma begin

A
  • usually in childhood but can occur at any age
  • less than 12% of all children younger than 18 reported having asthma attacks
  • approximately 156,000 emergency department visits and 10 deaths per week
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6
Q

what is the pathogenesis of asthma

A
  • airway inflammation (mucosal edema and mucous secretions)
  • release of inflammatory mediators (histamine, prostaglandins, leukotrienes and other cytokines)
  • triggered by exposure to allergens: dust, plant pollen, smoke, and animal dander; exercise,; stress; changes in weather; and upper respiratory viral infections
  • these inflammatory mediators cause swelling of the airways and provoke contraction of the airway smooth muscle -> airway obstruction
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7
Q

what occurs during an asthma attack

A
  • cough, shortness of breath, wheezing. hyper responsiveness and subsequent airway obstruction
  • bronchospasm – mediated through the beta 2 receptors located on the bronchioles. may be rapidly relieved by inhaled bronchodilators. occurs within minutes, while inflammation (mucous secretions) is slower in onset, taking hours
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8
Q

when does asthma get worse and what are some symptoms

A
  • may worsen at night
  • upon wakening in the morning
  • during exercise
  • with colds or exposure to allergens
  • symptoms: wheezing, prolonged or troublesome cough, difficulty breathing, breathlessness (dyspnea), chest tightens
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9
Q

what are the classifications of asthma

A
  • mild intermittent
  • mild persistent
  • moderate persistent
  • severe persistent
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10
Q

what is mild intermittent asthma like (signs)

A
  • 2 days a week or less/and awakenings less than 2 times a month
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11
Q

what is mild persistent asthma like (signs)

A
  • more than 2 days a week but less than one time a day; awakenings 2x a month or more
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12
Q

what is moderate persistent asthma like (signs)

A
  • every day
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13
Q

what is severe persistent asthma like (signs)

A
  • most of the time
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14
Q

what are asthma therapy goals

A
  • decrease the frequency of asthma attacks
  • terminate attacks progress
  • drug regimens are tailored to the pattern, severity and triggers
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15
Q

what are the classifications of asthma medications

A
  • long term control medications
  • quick relief medications
  • inhaled corticosteroids
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16
Q

what are long term control medications for asthma

A
  • also referred to as long term preventive, controller or maintenance medications
  • taken daily on a long term basis in order to achieve and maintain control of persistent asthma
  • antiinflammatory effects
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17
Q

what are quick relief medications for asthma

A
  • also referred to as reliever or acute rescue medications

- quick reversal of acute airflow obstruction and relief of bronchospasm

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18
Q

what are inhaled corticosteroids

A
  • the drugs of choice to for persistent asthma
  • safe and high efficacy
  • reduce hospitalizations and complications with regular use
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19
Q

what is used for moderate to severe asthma

A
  • inhaled corticosteroid and a long acting beta 2 agonist (LABA) for adults and children over 5 years of age
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20
Q

what are other long-term preventive medications for asthma

A
  • cromolyn sodium (intal) stabilizes the mast cell and prevent rupture and the release of mediators = mast cell stabilizers
  • leukotriene receptor blockers (montelukast) are alternative tx -> block action of leukotrienes
  • methylxantines (theophylline) cause bronchospasm
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21
Q

what is step up/step down

A
  • as the severity of asthma increases -> increase amount and frequency of medications (step up)
  • as the severity of asthma decreases -> decrease amount and frequency of medications (step down)
  • goal is to keep asthma under control with no symptoms
  • cough is usually first sign of lack of control
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22
Q

what are some adverse effects of inhaled corticosteroids

A
  • cough, oral candidiasis (thrush) and with high doses, growth suppression
  • lesions appear white on the mucosa and rub off when wiped with gauze
  • patient should brush teeth and rinse mouth with water after every inhalation dose to prevent fungal infections
  • when a Pte uses inhaler with spacer, the incidence of oral candidiasis drops markedly
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23
Q

what are the guidelines for patients taking inhaled corticosteroids

A
  • monitor for fungal infection in the oral cavity
  • the patient should brush their teeth and rinse with water after inhalation dose
  • may require fluoride tx at home for dry mouth
  • hoarseness may develop.
24
Q

what are long acting beta 2 selective agonists

A
  • laba
  • bronchodilators causing the airway smooth muscles to relax
  • long duration of action up to 12 hours or more
  • used with a low or medium dosage of an inhaled corticosteroid to improve asthma control and should not be used alone
  • ex: salmeterol
25
Q

what are adverse effects of laba

A
  • xerostomia, tachycardia (increased heart rate) headache, tremor, nausea
  • used alone = overstimulation of the beta-agonist receptors -> makes the short acting beta agonists less effective
  • use of LABAs as a rescue medication has resulted in complications of altered heart rhythm and death
26
Q

what are some guideline for patients taking salmeterol

A
  • assess salivary flow; assess need for fluoride rinse
  • stress importance of good oral hygiene
  • monitor vital signs, especially patients with heart disease
  • keep patient in a semisupine position
27
Q

what are methylxanthines

A
  • theophylline and aminophylline
  • bronchodilators that relax the airway smooth muscle to control asthmatic symptoms
  • no longer recommended for acute exacerbations or as a drug of choice for asthma
28
Q

what are mast cell stabilizers

A
  • cromolyn sodium and nedocromil sodium
  • anti-inflammatory actions that inhibit the release of histamine and other medicators of allergic reactions that lead to airway inflammation
  • both medications are administered by inhalation
  • may be alternative tx in mild persistent asthma
29
Q

what are leukotriene modifiers

A
  • may be alternative first line tx for mild persist asthma
  • may serve as adjuncts to inhaled corticosteroids for more severe disease
  • montelukast is one of the most prescribed because of its once a day dosing and approval for young children
30
Q

what are some other agents for asthma

A
  • combination therapy of ipratropium bromide and salbutamol can be helpful for COPD
  • fluticasone and salmeterol is beneficial for patients with moderate or severe asthma who benefit from the addition of a bronchodilator, rather than increasing the anti inflammatory therapy
31
Q

what are some quick relief medications for bronchospasm

A
  • used for prompt relief of bronchospasm and associated symptoms including cough, chest tightness, and wheezing
  • drugs: short acting beta 2 receptor selective agonists, anticholinergics, systemic corticosteroids
32
Q

what are bronchodilators

A
  • when inhaled, the beta 2 agonists provide the quickest onset (5-15 mins) and relief of symptoms by bronchodilation (relaxation of bronchiole smooth muscle)
  • short acting beta 2 receptor selective agonist = salbutamol
  • regular daily use is not generally recommended because tachyphylaxis (drug tolerance) due to overstimulation of the receptors may reduce their effectiveness
33
Q

what are some guidelines for patients on salbutamol

A
  • may leave patient in a semisupine chair position’
  • after each inhalation, the patient should rinse mouth with water to prevent dryness
  • may need daily fluoride tx at home if dry mouth is persistent
  • use salivary substitutes if dry mouth is persistent
  • have inhalant on bracket table during dental tx
  • inhaled beta-adrenergic agonists produce little systemic toxicity because only small amounts of the drug are absorbed
  • epi is primarily used in an emergency situation for severe bronchoconstriction or in some cases of croup
34
Q

what are bronchodilators

A
  • used for quick relief
  • anticholinergic agents
  • cholinergic innervation is an important factor in the regulation of airway smooth muscle tone
  • for patients who cannot tolerate beta 2 agonists or as an adjunct to beta 2 agonists for additional relief of bronchoconstriction
  • ex: ipratropium bromide HFA
35
Q

what are corticosteroids

A
  • suppress inflammation
  • systemic corticosteroids are used when asthma cannot be controlled by bronchodilators alone
  • corticosteroids taken orally take more than 4 hours to have a therapeutic effect by reducing inflammation
  • usual = 30 mg (6 tablets of 5 mg) x 5 days
36
Q

what are some guidelines for patients taking systemic corticosteroids

A
  • monitor patients for oral candidiasis (thrush; white areas that do not rub off)
  • monitor salivary flow
  • patients taking steroids more than 20 mg more than 2 weeks may require additional doses for stressful dental procedures; consult with a physician
  • avoid aspirin because of GI problems
  • frequent oral prophylaxis
37
Q

what are the 3 routes of drug administration for inhaled devices

A
  • nebulizer
  • dry powder inhaler (DPI)
  • metered dose inhalers (MDI)
38
Q

what is COPD

A
  • chronic obstructive pulmonary disease (COPD)
  • includes chronic bronchitis, emphysema
  • no cure
  • medication management involves a variety of steps by step treatment regimens similar to that for asthma
  • addition of oxygen for emphysema
  • addition of antibiotics and atrovent for bronchitis
39
Q

what is rhinitis

A
  • inflammation of the nasal mucosa (mucous membranes in the nasal cavities) is most frequently caused by allergic reactions to allergens
  • 2 types: allergic rhinitis, seasonal rhinitis
40
Q

what are clinical features of rhinitis

A
  • nasal congestion
  • rhinorrhea (runny nose)
  • itching
  • sneezing
  • mucus production
  • vasodilation and airway narrowing
41
Q

what are histamine receptors

A
  • symptoms are due to the release of histamine from mast cells and basophils
42
Q

what are histamine 1 receptors

A
  • located on the smooth muscle of the bronchi, veins, capillaries, heart and GI tract
  • involved in allergic reactions that cause rhinitis
  • activation causes bronchoconstriction, vasodilation, and constriction of the intestinal smooth muscle, itching, pain
  • antihistamine are react with these receptors
43
Q

what are histamine 2 receptors

A
  • located on the brain, stomach, heart and blood vessels
  • activation of these receptors causes an increase in gastric acid production in the stomach
  • not primarily involved in allergic reactions and drugs that bind to these receptors are used for the tx of ulcers
  • ER uses ranitidine, a histamine 2 blocker (Zantac) as part of anaphylaxis protocol
44
Q

what are the 5 classifications of drugs used to treat rhinitis

A
  • antihistamines (oral)
  • alpha adrenergic agonists (decongestants)
  • topical corticosteroids (nasal sprays)
  • mast cell stabilizers (nasal sprays)
  • antibiotics are not useful for treating colds because they kill bacteria
45
Q

what are antihistamines

A
  • block the histamine 1 receptors
  • eliminate the symptoms (sneezing, itching, rhinorrhea) associated with rhinitis
  • ineffective in treating the common cold
  • contraindicated in: narrow angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer disease and bladder obstruction)
46
Q

what are histamine 1 blockers

A
  • treat allergic reactions (allergic rhinitis) and motion sickness
  • first generation: Benadryl: anticholinergic side effects: xerostomia, sedation, urine retention
  • second generation: non sedating antihistamines, ferofenadine (allegra), cetirizine (reaxctine) and loratadine (claritin)
47
Q

what are guidelines for patients taking antihistamines

A
  • anticholinergic side effects (dry mouth) are common
  • consider home fluoride applications
  • monitor for caries
  • stress meticulous oral hygiene
48
Q

what are nasal decongestants

A
  • alpha adrenoceptor agonists
  • constricting blood vessels in the nasal mucosa
  • reduce blood supply to the nose and decrease edema
  • ex: otrivin, neo-synephrine, dristan
  • prolonged use (3-5 days) causes rebound congestions
  • oral (systemic) forms should not be used or used with caution in Ptes with: hypertension, hyperthyroidism, diabetes, cardiovascular disease, glaucoma, urinary obstruction or taking beta-blocker drug or MAOIs
49
Q

what are topical (intranasal) corticosteroids

A
  • reduce inflammation of the nasal mucosa
  • effective drugs for relieving symptoms of sneezing, itching, congestion, rhinorrhea (runny nose)
  • administering as nasal sprays: beclomerthaspone, mometasone, fluticasone, budesonide
50
Q

what is viral rhinitis

A
  • called the common cold
  • a self limiting condition best treated conservatively
  • nasal decongestants (eg pseudoephedrine) may be needed
51
Q

what is a cough

A
  • initial stimulus for cough most likely starts in the mucosa from the nose through the branching points in the tracheobronchial tree
  • reflex
  • defense mechanism
52
Q

what are antitussives

A
  • used to suppress a cough

- opioids, including codeine, hydrocodone and hydromorphone

53
Q

what are expectorants

A
  • acts as local irritants in the airways or the GI tract
  • stimulate cough
  • thin sputum through increased secretion of water
  • ex: guaifenesin
54
Q

how can ptes avoid dry moiuth

A
  • drink plenty of water
  • avoid alcohol
  • avoid alcohol containing mouth rinses
  • antihistamines frequently used during the year increased dry mouth incidence
55
Q

asthma = ?

A
  • bronchospasm + inflammatory component

Pharmacology (21 decks)

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