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Pharmacology > Respiratory > Flashcards

Respiratory Flashcards

1
Q
  • Antihistamines
    ◦ Overview
A

‣ Histamine 1 causes: flushing / edema (vasodilation), itching, pain, increased mucus secretion, inflammation, bronchoconstriction
* Blocking H1 receptors: reverses all of these, increases drowsiness, does NOT reduce congestion
‣ Uses: mild allergy / seasonal allergic rhinitis, motion sickness, insomnia, common cold (not that effective) (severe allergy => use epinephrine and maybe Bendryl too)
‣ A/E: sedation, anti-cholinergic effects (can’t see, can’t pee, can’t spit, can’t poop), dizziness / incoordination / confusion / fatigue, GI upset
* Acute toxicity: dilated pupils, flushed face, hyperpyrexia, tachycardia, dry mouth, urinary retention; can progress to coma, cardiovascular collapse, death
◦** In kids: CNS excitation** / palpitations (paradoxical effect)
‣ Drug interactions (effects similar to sedation / anticholinergic): alcohol, barbituates, benzodiazepines, opioids, sedatives, CNS depressants, tricylic antidepressants, MAOIs, ototoxic drugs
‣ Caution: avoid in 3rd trimester pregnancy (fetal malformations), lactation (excreted in breast milk)

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2
Q
  • Antihistamines
    ◦ 1st generation antihistamines
    ‣ Overview
A
  • A/E: highly anticholinergic,** more sedation**, generally less expensive
    * Contraindications: **older adults **- clearance reduced with age, tolerance develops when used as hypnotics, risk of confusion, may aggravate S/S of BPH d/t anticholinergic
    ◦ Use of diphenhydramine in acute situations of severe allergic rxn may be appropriate
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3
Q
  • Antihistamines
    ◦ 1st generation antihistamines
    ‣ diphenhydramine (Benadryl)
A
  • MOA: binds to H1 receptors to block histamine effects
    * For: DOC seasonal allergic rhinitis / acute urticaria, allergic conjunctivitis, motion sickness, insomnia, rhinorrhea
    * Admin: use lowest dose possible
    * A/E: sedation, anticholinergic effects, paradoxical in kids (CNS excitation / palpitations), dizziness
    ◦ Acute toxicity
    * Caution: avoid as a sedative in children
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4
Q
  • Antihistamines
    ◦ 2nd generation antihistamines
    ‣ Overview
A
  • A/E: less sedating, fewer anticholinergic effects, usually more expensive
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5
Q
  • Antihistamines
    ◦ 2nd generation antihistamines
    ‣ fexofenadine (Allegra)
A
  • Admin: available OTC in PO form
    ◦ FexoFenadine avoid Fruit juices Four hours beFore (and 1-2 hrs after admin)
    * A/E: good in efficacy and safety; reduce dose in renal failure
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6
Q
  • Antihistamines
    ◦ 2nd generation antihistamines
    ‣ Intranasal antihistaminse - azelastine (Astelin, Astepro)
A
  • Admin: intranasal
    ◦ AsteLIN:** only 12+ yrs**
    ◦ AstePRO: for < 12 yrs ; you are a PRO if you give to kids under 12
    * A/E: drowsiness, nose bleeds, HA, unpleasant taste (d/t intranasal route)
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7
Q
  • Asthma and COPD
    ◦ Asthma overview
A

‣ Def: chronic inflammatory disease of the airway caused by immune-mediated inflammation of the airway
* Treat both inflammation and bronchoconstriction
‣ S/S: wheezing, chest tightness, cough, dyspnea on exertion
‣ Triggers: weather, cockroaches, mold, dust
‣ Admin:
* Metered dose inhalers (MDIs): need hand-eye coordination (difficult for kids, older adults with athritis)
* Spacers: used with MDI, forgiving of bad hand-eye coordination
* Respimats (soft mist inhalers): no prolents (must breathe in and hold breathe for 10 sec), needs coordination
* Dry powder inhalers: easy to use (do not need spacer), must be able to inhale the power (difficult with elderly COPD pts)
* Nebulizers: breathe in as a mist (mixed with NS) over a few minutes

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8
Q
  • Asthma and COPD
    ◦ COPD overview
A

‣ Chronic bronchitis, emphysema, or both => chronic, progressive, mostly irreversible
* Chronic bronchitis: from hypertrophy of mucus-secreting glands in airway
* Emphysema: an enlarged airspace between the bronchioles and alveoli d/t the deterioration of the surrounding walls

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9
Q
  • Asthma and COPD
    ◦ Glucocorticoids
    ‣ Overview
A
  • MOA: anti-inflammatory agents, **used prophylactically **
    * For: **most effective drug for long term control **of airway inflammation (NOT PRN !), suppress inflammation, reduce bronchial hyperreactivity, decrease airway mucus production
    * Admin: usually inhaled, fixed schedule, discontinue long term tx slowly
    ◦ Inhaled: 1st line therapy for asthma control, use daily with persistent asthma, effective and safe
    ◦ Oral: moderate to severe persistent asthma, management of acute exacerbations is asthma and COPD, tx should be as brief as possible d/t A/E
    ◦ *will NOT abort an acute asthma attack; inhaled is preferred to oral d/t A/E
    * A/E:
    ◦ Inhaled: adrenal suppression, oropharyngeal candidiases (pt should rinse mouth after each use), dysphonia (drug may sit in oral pharynx and cause hoarseness), bone loss with long term use, glaucoma / cataractics with continuous use of high doses, may slow growth in children
    ◦ Oral: none if dose < 10 days; adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, growth suppression in children
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10
Q
  • Asthma and COPD
    ◦ Glucocorticoids
    ‣ Inhaled glucocorticoids - fluticasone (Flovent)
A
  • For: DOC prophylactic longterm use
    * Admin: given as meter dose inhaler or dry powder inhaler; fixed schedule, pt should rinse mouth afterwards
    * I played the flute for a long time in band and we stuck to a strict schedule. After practice, I washed my mouth.
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11
Q
  • Asthma and COPD
    ◦ Bronchodilators
    ‣ Overview
A
  • MOA: Beta 2 agonists
    * For: provide symptomatic relief of asthma / COPD (no anti-inflammatory properties => glucocorticoids should be given afterwards)
    * Admin: usually inhaled, fixed schedule for long term control, PRN for acute attacks; usually adjunct therapy or monotherapy in mild asthma with infrequent attacks
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12
Q

◦ Bronchodilators
‣ Beta 2 agonists
Comparison SABA vs. LABA

A

See notability

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13
Q

◦ Bronchodilators
‣ Beta 2 agonists
* albuterol (Proventil)

A

◦ MOA: SABA, promotes bronchodilation
◦ For: long or short term control; DOC acute asthma attack
◦ Admin:** 3-4 times daily**
◦ A/E: tremors, tachycardia, insomnia, anxiety

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14
Q

◦ Bronchodilators
‣ Beta 2 agonists
* levalbuterol (Xoponex)

A

◦ MOA: SABA
◦ Admin: inhaled, usually a meter dose inhaler; PRH for acute attacks
‣ Take before exerise to prevent exercise induced bronchospasm
◦ A/E: less impact on HR (good choice for pt with heart disease of some sort)

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15
Q

◦ Bronchodilators
‣ Beta 2 agonists
* salmeterol (Serevent Diskus)

A

◦ MOA: LABA, NOT 1st line therapy
◦ Admin: inhaled, fixed schedule (NOT PRN); use with glucocorticoid in same inhaler otherwise you die (frequently combined with fluticasone => rinse mouth after use)
‣ May need to inc frequency of dosing with long term use
‣ fluticasone / salmeterol (Advair)
* Combo of LABA and glucocorticoid

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16
Q

◦ Methylxanthines
** ‣ theophylline**

A
  • MOA: causes CNS excitation, bronchodilation (relaxes smooth muscle in lung)
    * For: prevents attacks at night and for** stable asthma**; for COPD use Beta 2 agonists and glucocorticoids 1st
    * Admin: PO, take at nighttime
    * A/E: N/V/D, dysrhythmias, convulsions (CNS stimulant), cardiac death
    * Monitoring: drug lvls, liver function (d/t narrow therapeutic range)
    * Drug interactions: caffeine, tobacco, marijuana
17
Q

◦ Anticholinergics
‣ ipratropium (Atrovent)

A
  • MOA: relieves bronchospasm (works on muscarinic receptors), less effective than B2 agonists
    * For: FDA approved for COPD, used off label for asthma (prophylactic)
    * Admin: inhaled, works very fast
    * A/E: anticholinergic, pharynx irritation
18
Q

◦ Leukotriene modifiers
‣ montelukast (Singular)

A
  • MOA: blocks receptor activation by leukotrienes
    * For: prophylaxis and maintenance of asthma, prevention of exercise induced bronchospasm, to tx allergic rhinitis
    ◦ NOT for acute attacks, **not 1st line (add on with glucocorticoids or bronchodilators) **
    * Admin: PO
    * A/E: generally well-tolerated; depression, mood changes, suicidal ideation
    * Drug interactions: phenytoin (decreases montelukast lvl)
    * Luke Skywalker needs his montelukast before battle. When he finds out his dad is Vader, he gets depressed, moody, and even suicidal.
19
Q

◦ Asthma in pregnancy

A

‣ Asthma: most chronic condition seen in pregnancy; control worsens (difficult to manage- be proactive instead of reactive)
‣ A/E: risk of preterm birth, intrauterine growth restriction, pregnancy-induced HTN, pre-eclampsia, congenital malformations of nervous / respiratory / digestive systems, later development of respiratory disease
‣ Goal: continue asthma meds and control S/S during pregnancy

20
Q

◦ Physical activity and exercise
‣ For asthma patients

A
  • Take meds as prescribed, have rescue medication handy, perform a 15 min warm up and cool down, check air quality index, breathe through nose as much as possible, avoid outdoor areas with a lot of allergens, keep windows and doors closed indoors
    ◦ Postpone exercise if symptoms not well controlled or if you have a cold or respiratory infxn
21
Q

◦ Physical activity and exercise
‣ For COPD patients

A
  • Take meds as prescribed, avoid prolonged sitting, make physical exercise a part of routine, exercise every other day, do not over do it, warm up for 5 min and cool down
    ◦ Use short acting inhaler 15 min before activity and keep it with you, wait 2 hrs after eating to exercise
22
Q
  • Drugs for allergic rhinitis, cough, and cold
    ◦ Overview
A

‣ Types of allergic rhinitis: seasonal (fall or spring, rxn to outdoor allergens), perennial (non-seasonal, rxn to indoor allergens)
‣ Tx:
* Intranasal glucocorticoids (1st line)
* PO and intranasal antihistamines (1st line, most effective as prophylactic tx, will NOT reduce nasal congestion)
* PO and intranasal sympathomimetics (adjunct therapy)

23
Q
  • Drugs for allergic rhinitis, cough, and cold
    ◦ Intranasal glucocorticoids
    ‣ fluticasone (Flonase)
A
  • For: most effective for prevention and tx of allergic rhinitis
    * Admin: takes about two weeks to be effective so dose daily, NOT PRN
    * A/E: nasal mucosal drying / burning / itching sensation, sore throat, epistaxis (nose bleed), HA
24
Q
  • Drugs for allergic rhinitis, cough, and cold
    ◦ Sympathomimetics
A

‣ Intranasal / topical:
* MOA: causes rapid and intense vasoconstriction which leads to reduced swelling of membranes and decreases nasal congestion
* Admin:** limit use to 3-5 days to prevent rebound congestion**
◦ Drops are preferred for kids, sprays less effective
‣ Oral:
* MOA: causes** prolonged and moderate vasoconstriction** which leads to reduced swelling of membranes and decreases nasal congestion
* A/E: systemic effects of restlnessness, irritability, anxiety, insomnia, generalized vasoconstriction
* Contraindications: avoid in pts with cardiovascular disorders including HTN
‣ phenylephrine (Sudafed PE)
* Admin: nasal, PO, topical (fast and effective) IV to tx HoTN d/t vasoconstriction
‣** pseudoephedrine (Sudafed)**
* MOA: lower CNS stimulation, can be** converted to methamphetamine** (restrictions on amt purchased)
◦ More effective than phenylephrine
* Admin: PO only

25
Q
  • Anti-tussives
    ◦ Overview
A

‣ For: dry cough (wet cough needs to get sputum out, so suppressing cough would be harmful)

26
Q
  • Anti-tussives
    Meds
A

◦ Opioids
‣ Most effective: codeine; high abuse potential
◦ Dextromethorphan
‣ Most effective OTC
◦ Other non-opioids
‣ Diphenhydramine
‣ Benzonatate: do not chew d/t risk for laryngospasm, contraindicated in children

27
Q
  • Expectorants
    ◦** guaifenesin / pseudoephedrine (Mucinex-D)**
A

‣ MOA: thins sputum and stimulates respiratory secretions to make coughs more productive
‣ Admin: may need higher than recommended dose to be effective
* Often combined with dextromethorphan

28
Q
  • Cold remedies
A

◦ Combination preparations
‣ Usually a combo of: nasal decongestant, anti-tussive, analgesic, antihistamine, caffeine
◦ In children
‣ No proof exists that cold remedies are effective or safe in children (known for potential harm and death)
* No OTC cold remedies for children < 2 yo, uncertain for children 2-11 but recommended to avoid at least until 6 yo
* Instead use: NS sprays, bulb suction to get out secretions

Pharmacology (5 decks)

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