Respiratory Flashcards
Differentiate the management of dry cough vs wet cough.
Dry: suppressed only if it is exhausting the patient
Wet: never suppressed
State the mechanism of action of mucolytics/expectorants and describe their efficacy.
Drugs that liquefy the mucus so it is easier to mobilize. Efficacy = they are trash
What is the best mucolytic? List two others and state which is indicated for cystic fibrosis?
Best: water
Others: guaifenesin, NAC –> N-acetylcysteine
NAC indicated for CF
List three examples of cough suppressants.
Codeine, Dextromethorphan (DM), Benzonatate
Which cough suppressant is commonly abused and which acts by numbing the cough centers in the respiratory tree?
DM: abuse –. high doses cause hallucinations
Benzonatate: numbs respiratory tree cough centers
Describe the pathophysiology of asthma.
Hyperactive bronchi lead to chronic inflammation.
What is meant by saying asthma is a polygenic process?
Many substances contribute to the inflammation –> HST, Leukotrienes, and Prostaglandins
What are the three basic approaches to managing asthma?
- Prevent allergen exposure
- Reduce inflammation and hyperactivity
- Dilate narrowed bronchi
What drug class is the mainstay of asthma treatment and how do they act?
Glucocorticoids –> reduce bronchial hyperactivity and inflammation.
By what routes are glucocorticoids administered and which formulation is hydrophilic and why?
PO, IV, and Inhalation –> Inhaled steroids are hydrophilic so the drug stays where you put it.
What is a significant AE of inhaled glucocorticoids and why does this occur?
Thrush –> all glucocorticoids are immunosuppressive
What are AEs of PO and IV glucocorticoids? (7 total)
Hyperglycemia, osteopenia, ulcers, Na retenion, HypoK, immune suppression, increased appetite
Why are IV and PO glucocorticoids administered in short bursts and tapered slowly?
They suppress the hypothalamic-pituitary-adrenal axis. Short courses avoid H-P-A suppression
What is the minimum dose of PO/IV steroids to suppress the HPA axis and what are the usual dosing instructions?
Min: 20mg prednisone for 14 days
Inst: Take in AM to mimic normal peak cortical levels
What is the mechanism of action of Cromolyn and Nedocromil and by what route are they administered?
Mast cell stabilizers - reduce HST on exposure to allergens. Administered by inhalation only.
T/F: Glucocorticoids, Cromolyn, and Nedcromil can be used to terminate acute asthma attacks.
False
What type of asthma is cromolyn and nedcromil typically used for?
Exercise induced and allergic induced
What is the primary use of long acting B-2 agonists and what is the caution with their use?
Long acting drug for maintenance. Caution for possible increased cardiac M & M
What is primatine mist?
OTC dilute epi inhaler
What is albuterol used for?
Short acting B-2 agonist used as a rescue agent
What is salmeterol used for?
Long acting B-2 agonist used in combination with steroids (Advair) for maintenance
What is the mechanism of formoterol?
Long acting B-2 agonist (faster and greater per dose potency than salmeterol)
What is the mechanism of bambuterol and salbutamol and what is unique about salbutamol?
Both long acting B-2 agonists - salbutamol is available both PO and via MDI
T/F: Albuterol is only available as an inhaled agent.
False: albuterol is available PO but it is rarely used.
Which B-2 agonist is used as a tocolytic (decrease uterine contractions)?
Terbutaline
Which anti-HTN medication should be avoided in asthmatics?
Non-selective beta blockers
What is the result of administering a parasympatholytic in respiratory disease and which disease is it most used for?
Bronchodilation - used primarily in COPD and can be an adjunct in asthma
List two anti-cholinergic agents and which is used more frequently?
Ipratropium - used more frequently
Tiotropium - long acting agent
List five side effects of anti-cholinergic agents.
Tachycardia, sedation, dry mouth, constipation, urinary retention
What class of drugs is a second-line agent in the management of asthma and what are their AEs?
Leukotriene Receptor Antagonists - relatively few and benign AEs
What is the mechanism of PDE-4 inhibitors?
PDE-4 chews up cAMP in the lungs. PDE-4 inhibitors increase cAMP which result in bronchodilation.
What is the primary indication for PDE-4 inhibitors?
COPD –> chronic bronchitis, NOT emphysema
In addition to bronchodilation, what other effect results from PDE-4 inhibitor use?
Some anti-inflammatory properties
T/F: PDE-4 inhibitors can be used for acute COPD exacerbations
False
List a PDE-4 inhibitor and what is the caution with its use?
Roflumilast –> risk of suicidal ideations
What two classes of respiratory drugs are used most in COPD?
Anticholinergics and PDE-4 inhibitors
Describe the effects of and treatment for status asthmaticus.
Life threatening condition associated with mucus plugs, refractoriness to B-2 agonists, and respiratory acidosis. Treatment is epinephrine, IV steroids, and intubation if meds are ineffective.
Describe the function of a metered dose inhaler.
Active ingredient (AI) is pressurized with a propellant. When activated, the MDI releases the AI and the propellant immediately evaporates
What are the instructions to use a MDI?
shake –> exhale –> slowly inhale and activate the MDI
Which patients typically use a spacer with their MDI?
Children
How does the patient assess the quantity remaining in their MDI?
Water drop
In addition to liquid, what other form of drug can be utilized in a MDI?
powder
What is the function of a nebulizer?
Convert solutions or suspensions of drugs into aerosols and driven by a gas or ionization process.
List some examples of inhaled corticosteroids.
Flunisolide, triamcinolone, beclomethasone, fluticasone, budesonide.
What is the most hydrophilic inhaled corticosteroid and what is the clinical implication?
Triamcinolone –> stays where you put it
What is the most lipophilic steroid?
Dexamethasone (not used as an inhaler)
What is Advair a combination of?
Fluticasone (steroid) and Salmeterol (LABA)
