Respiratory Flashcards
Congestion
Common cold, allergies, bronchitis, various respiratory infections
obstruction
asthma, copd, emphysema
Antitussives
For congestion
•Used to suppress coughing, often in conjunction with Acetaminophen
•Short term use
•Efficacy is questionable, especially for non-prescription products
Decongestants
For congestion
•Alpha-1 Adrenergic agonists
•Stimulate nasal vasoconstriction
•Can cause CNS excitation (HA, dizziness, nervousness, HTN, palpitations)
•May cause rebound congestion when used long term
Antihistamines
For congestion
•Histamine: regulates normal function: gastric secretion, CNS neural modulation, allergies
•Block H1 receptors (4 types of H receptors)
•Decreases nasal congestion, mucosal irritation, and discharge (rhinitis, sinusitis), and conjunctivitis
•Able to cross blood-brain barrier (sedation)
•Newer generation much improved with regards to CNS sedation
Mucolytics and Expextorants
For congestion
•Acetylcysteine: breaks disulfide bonds of mucoproteins, forming less viscous secretion
•Used in combination with other decongestants or antihistamines
•Guaifenesin: Increases production of pulmonary secretions, encouraging the ejection of mucus and phlegm
•GI upset is a side-effect
Bronchodilators: beta-adrenergic agonists
For obstruction
•Act on B-2 receptors on respiratory smooth muscle cells to cause relaxation and bronchodilation
•Usually administered by inhalation (rapid acting)
•Metered-dose inhalers (MDI), dry powder inhalers (DPI), nebulizers
•Adverse effects include: airway irritation, nervousness, restlessness, tremor, increased HR
Bronchodilators: anti-cholinergics
For obstruction
•Action: Block muscarinic cholinergic receptors to prevent acetylcholine-induced bronchoconstriction
•Drugs of choice for treating COPD, chronic bronchitis,
•Inhaled for the treatment of respiratory disorders
•Adverse effects: dry mouth, constipation, urinary retention, confusion, blurred vision (less likely with inhaled versions)
Bronchodilators: Xanthine Derivatives
For obstruction
•CNS stimulant for reversible airway obstruction (bronchitis, emphysema)
•Works on smooth muscle cells to bronchodilate, but also has anti-inflammatory effect by inhibiting phosphodiesteraseenzyme
•Administered orally
•Theophylline toxicity (nausea, confusion, irritability, seizures, arrhythmias
•Serious, life-threatening effects may be the first sign of toxicity
•Avoid long-term use
•Not used frequently anymore
Anti-inflammatory: glucocorticoids
For obstruction
•Most effective agents for controlling asthma
•Induce anti-inflammatory effects via inhibition of the proinflammatory proteins and promotion of anti-inflammatory proteins, inhibit migration of neutrophils and monocytes
•Decreased side effects if inhaled (except for thrush)
•Adverse effect: thrush, catabolic effect on support tissues (osteoporosis, skin, muscle wasting), aggravation of diabetes mellitus, and HTN
•Avoid prolonged use orally
Anti-Inflammatory: cromones
for obstruction
•Leukotrienesmediate airway inflammation
•Inhibit lipoxygenase enzyme
•Can be combined with glucocorticoids for optimal COPD and asthma management
•Few adverse effects, mild liver impairment
Asthma pathophysiology
- Dual components of inflammation and bronchospasm
- Various triggers
- Inflammation of airway sensitize it to bronchospasms
Long term management of asthma
- Shift recently to more anti-inflammatory drugs (inhaled glucocorticoids)
- Long acting beta-blockers should not be used alone
- Combined preparations (glucocorticoid + bronchodilator)
- Example: Advair(Fluticasone + Sameterol)
- Rescue inhalers as backup
- Decreasing role of theophylline
- Non-pharm measures
COPD managment
- Prevent airflow restriction, maintain airway patency = Anticholinergics/beta-adrenergic blockers
- Short-term: oral glucocorticoids
- Combined preparations
KEY POINTS
- Exercise can exacerbate asthma
- Bring rescue inhaler to treatment sessions
- Be aware of side effects of bronchodilators •HR •Arrhythmias •Nervousness, confusion signs of toxicity
- Make adjustments to tissue loading in the case of long-term glucocorticoid use
•Drugs can be used to control irritation and maintain airflow through the respiratory passages.
•Common cold, flu & allergy symptoms controlled with antitussives, decongestants, antihistamines, mucolyticsand expectorants.
•Airway obstructions such as asthma, bronchitis & emphysema treated with bronchodilator agents and anti-inflammatory drugs
.•Rehab can assist with respiratory hygiene and breathing exercises, while also improving overall cardiorespiratory endurance.
