Respiratory 2 Flashcards
Names of Muscarinic antagonists
Ipratropium bromide (atrovent)
Atropine
Tiotrpium (spiriva)
Decreased airway conduction is caused by
- constriction of smooth muscle
- production of mucus
- inflammation
Muscarinic antagonists mechanism
competitive antagonists of Ach at the muscarinic
-inhibit Ach mediated constriction of bronchial airways
What does AcH do at muscarinic receptors
constricts bronchial airways
What patients are muscarinic antagonists good for?
for patients who are intolerant to sympathomimetics or methylxanthines
-variable in bronchodilation effectiveness
sympathomimetic
mimicking the sympathetic responses
Ipratropium characteristics
Quaternary amine
poorly absorbed
does not cross blood brain barrier
-aerosol
-low systemic absorption (limits adverse effects)
-SHORT ACTING
-used for COPD and asthma patients
Tiotropium
Spiriva
Long Acting muscarinic antagonist
Atropine sulfate
-readily absorbed in systemic circulation
-adverse effects
-limits the treatment of asthma
Atropine sulfate adverse effects
drowsiness
sedation
dry mouth
blurred vision
Glucocorticoids target was
inflammatory response
are FIRST LINE AGENTS for PERSISTENT ASTHMA
Types of glucocorticoids
Beclomethasone (Beclovent, Vanceril)
Triamcinolone acetate (Azmacort)
Budesonide (Rhinocort)
Flunisolide (AeroBid)
Fluticasone propionate (Flovent)
Important types of Glucocorticoids
Budesonide (rhinocort)
Fluticasone propionate (flovent)
What indicates the need for steroid treatment
inflammation is present
(COPD, asthma or other parts of the body)
Glucocorticoid Mechanism
Attenuating prostoglandin and leukotriene synthesis via Annexin A1
-this inhibits the immune response
-increases sympathomimetics and decreases inflammation
what do glucocorticoids do for other respiratory medications
give them access to work properly by “solving” inflammation
What part of the immune response do glucocorticoids inhibit
the production of cytokines and chemoattractants
Mast Cells
produce histamine in response to
How can glucocorticoids be administered
Oral, topical, inhalation
Inhalation of glucocorticoids are used for
initial treatment for asthma, you add agents as needed
-inflammation
-use prophylactically rather than to reverse acute attacks
Glucocorticoids side effects
hoarseness
oral candidiasis (thrush)
adrenal surpression (serious)
osteoporosis (serious)
considerations before prescribing glucocticoids
pt compliance
steroid use previously
names of Leukotriene inhibitors
zafirlukast (Accolate)
montelukast (Singulair)
Mechanism of Leukotriene inhibitors
agonists of leukotriene receptor (LT1).
Blocks cyst-leukotriene C4, D4, E4 (LTC4, LTD4, LTE4)
“try to stop the inflammatory response before it starts”
leukotrienes
chemicals your body releases when introduced to something youre allergic to
Characteristics of Leukotriene inhibitors
reduces bronchoconstriction and inflammatory cell response
-alternative to medium dose inhaled glucocorticoids
Adverse affects of Zafirlukast
headaches
elevation of liver enzymes
Administration of Leukotriene inhibitors
orally 1-2 QD
Zafirlukast interactions
inhibits the metabolism of warfarin
Zileuton (Zyflo)
Inhibits 5-lipoxygenase
-immediate and sustained 15% improvement FEV1
-relieves bronchial constriction from exercise
5-lipoxygenase
rate eliminating enzyme in leukotriene biosynthesis
-inhibited by Zilueton (zyflo)
Administration of Zileuton
PO 4 times daily
Side effects of Zileuton
Liver toxicity (monitor hepatic enzymes, elderly women at risk)
Flu like symptoms
Zileuton interactions
inhibits P-450’s (in liver)
decreases the metabolism of warfarin and theophylline
Types of Alfa-1 Protease Inhibitors
Aralast and Prolastin
Mechanism of Alfa-1 protease Inhibitors
inhibits alpha-1 proteinase
-treats emphysema
What does alpha-1 proteinase do?
a peptide that inhibits elastase release (elastase destroys the lungs parenchyma)
Administration of Alfa-1 Protease Inhibitors
Via IV injection weekly
-treats for homozygous deficiency
Anti-IgE antibody names
Omalizumab
Anti-IgE antibody mechanisms
Binds to IgE high affinity receptor
-blocks the binding of IgE mast cells, basophils, allergic response cells
-lowers free serum IgE by up to 90%
What does Anti-IgE antibodies do in the early and late phase
Reduces early phase degranulation (histamine) of mast cells
Reduces late phase release of mediators
what to Anti-IgE antibodies not do
block allergen-antibody rxn
-leads to a reduction in allergen concentrations
Target audience of Anti-IgE antibody
12+ years old
Refractory to inhaled glucocorticoid
Asthmatic patients with allergies
Administration of Anti-IgE antibodies
Via SQ injection Q2-4 weeks
Chromones names
Cromolyn sodium
Nedocromil
What is Chromones used for
long term controller therapy that prevents asthma symptoms and improve airway functions
Target audience of Chromones
Patients with mild, persistent, or exercise induced asthma
Chromones Mechanism
Modulates the mast cell mediator release and eosinophil recruitment
-inhibits early and late asthmatic responses to allergen challenge and bronchospasm
Side effects of Chromones
clinical response is less predictable than inhaled corticosteroids
Rhinitis characteristics
congestion, increased mucus production, vasodilation, fluid accumulation in mucosal spaces
Parasympathetic stimulation and Airway dilation are produced by
inflammatory mediators
inflammatory mediators
histamine, leukotienes, prostaglandins, kinins
what are Antihistamines
H-1 receptor antagonists
-preventative therapy (before reaction)
1st generation Formulary of Antihistamines
Diphenhydramine
brompheniramine
chlorpheniramine2
2nd generation formulary antihistamines
loratadine
Antihistamines Actions
-reduce parasympathetic tone of arterioles
-decrease secretion through anticholinergic activity
anticholinergics
are more effective but dose required produces systemic adverse affects
Ipratropium bromide (atrovent) is also used for
nasal spray for rhinorrhea, rhinitis
Alpha Adrenoceptor agonists
nasal decongestants
Alpha adrenoceptor agonists names
Epinephrine and oxymetazoline (via nasal aerosols)
Pseudophendrine (PO)
Phenylephrine (PO or nasal)
Administration of Alpha-Adrenoceptor agonists
aerosol- rapid onset, few systemic affects, rebound nasal congestion
oral- longer duration, increased systemic effects, less. potential for rebound congestion
