Respiratory Flashcards
Nasal Glucorticoids
DRUGS:
- beclomethasone (Beconase)
- budesomide (Rhinocort)
- flunisolide (Nasarel)
- fluticasone (Flonase)
- mometasone (Nasonex)
- tramcinolone (Nasacort)
ADVERSE EFFECTS:
- nasal irritation.
- fungal infections.
Glucocorticoids
- Used for bronchospasms and prophylaxis for CHRONIC asthma. Do not use for acute asthma.
- Rinse mouth after use to avoid yeast infection, or take antifungal med prn.
- Do not stop taking it abruptly.
- Use bronchodilator before steroids.
- can raise glucose in DM or nonDM pts.
MECHANISM OF ACTION:
-Decreases swelling in the airway and mucus by stabilizing WBC membranes that would normally secrete inflammatory agents.
DRUGS: end in -sone or -ide
- beclomethasone (Vanceril, Beclovent)
- budesomide (Pulmicourt)
- dexamethasone (Decadron)
- flunisolide (Aerobid)
- fluticasone (Flovent)
- triamcinolone acetonide (Azmacort)
ADVERSE EFFECTS:
- dysphonia (haorsness/difficulty speaking)
- yeast infection (oral candidiasis, rinse mouth after use and use a spacer, antifungal meds prn).
- osteoperosis
- hyperglycemia, pt might need insulin
- adrenal suppression, dont stop taking abruptly
- cardiac stimulation (palpitations, tremors)
Mast Cell Stabilizers
MECHANISM OF ACTION:
- Inhibits release of histamine, which is the mast cells response to inflammation/irritation. Histamine can cause bronchoconstriction.
- Inhibits release of SRSA, a slow reacting substance of anaphylaxis.
USE:
- Not a bronchodilator, used for prophylaxis only, dont use with acute asthma.
- Use for chronic bronchial asthma, exercise induced bronchospasm, allergic rhinitis.
DRUGS:
- cromolyn (Intal), only sold OTC as nasalcrom
- nedocromil (Tilade)
Bronchodilators/Beta 2 adrenergic agonists (sympathomimetics, mimics sympathetic nervous system), non selective betas
BETA 2 ADRENERGIC AGONISTS
- Used for ACUTE attacks by reducing airway constriction and to restore airflow, like bronchospams, asthma, and bronchitis.
- Use before steroid.
MECHANISM OF ACTION:
- relaxes smooth muscle.
- inhibits release of mast cells (histamines).
- increase ciliary motility.
- Stimulates sympathetic nervous system, esp in lungs (remember 1 heart, 2 lungs)
ROUTE:
- oral
- inhaled through nebulizer or MDI (metered dose inhaler).
- if a spacer is used, make sure you dont hear a honking sound.
DRUGS: end in -terol
- Short acting are albuterol (Proventil, Ventolin), levalbuterol (Xopenex), pirbuterol (Maxair).
- Long acting are salmetrol (Serevent), formoteral (Foradil).
- advair is a combination of serevent, fluticasone, in an inhaled powder.
SIDE EFFECTS:
- CNS stimulation
- cardiac arrhythmia
- hypertension
- bronchospasm
- use caution w/ diabetes, cardiac disease, vascular disease, hyperthyroid.
NON SELECTIVE BETAS
DRUGS:
-metaproterenol (Alupent)
-isoproterenol (Isupprel)
- stimulates beta 1 and 2.
- contraindicated with glaucoma.
- oral and inhaled/nebulized.
- effects both cardiac and bronchodilation (remember 1 heart, 2 lungs).
Mucolytics
MECHANISM OF ACTION:
-Breaks the links that bind mucus together and liquifies it so it can be coughed up. Used for thick sputum.
DRUGS:
-acetylcysteine (Mucomyst). Smells like sulfur. Use tylenol/acetaminophen as an antidote.
Methylxanthines
end in -phylline
USE:
- bronchodilation
- relaxation of smooth muscle bronchi.
DRUGS:
- caffeine
- theophylline
- aminophylline (Truphylline). Give this IV.
ADVERSE EFFECTS:
- dysrhythmia/ cardiac stimulation
- Avoid caffeine, cigarettes
- Monitor serum theophylline blood levels.
Anticholinergics
- end in -opium.
- used in people who cannot tolerate sympathomimetics.
- dont use for ACUTE attacks.
- nasal spray or inhaler.
USE:
-maintenance of COPD, bronchospasm and emphysema.
MECHANISM OF ACTION:
- Blocks action of ACH at vagal-mediated receptor site, causing bronchial dilation.
DRUGS:
- ipratropium (Atrovent, Combivent… DONT USE WITH PEANUT ALLERGY).
- tiotropium (Spiriva)
SIDE EFFECTS:
-dry mouth
Antihistamines
USE:
- Prophylactic for allergic rhinitis.
- Decreases rhinorrhea, nasal itching, sneezing.
MECHANISM OF ACTION:
-Block action of histamine, is an antagonist to histamines.
DRUGS:
1st generation oral: end in -amine.
- Causes drowsiness/sedation, and anticholinergic effects like dry mouth, constipation, urinary hesitance.
- 1st gen drugs: chlorpheniramine (Chlor-Trimeton) and diphenhydramine (Benadryl).
2nd generation oral: end in -ine.
- Non sedating.
- 2nd gen oral drugs: cetirizine (Zyrtec), desloratidine (clarinex), loratidine (Claritin), fexofenadine (Allegra).
2nd generation nasal spray:
- bitter taste in mouth
- non sedating
- 2nd gen nasal drugs: azelastine (Astelin).
Decongestants
- end in -ine
- Can be adrenergic or sympathomimetic.
MECHANISM OF ACTION:
- vasoconstricts blood vessels of mucosa opening, like clogged nasal passages.
- promotes drainage secretions and improve airflow.
DRUGS:
- oxymetazoline (Afrin) (NASAL)
- phenylephrine (Neo-Synephrine) (ORAL)
- pseudophedrine (Sudafed) (ORAL)
ADVERSE EFFECTS:
- when using nasally, if longer than 5 days, may get rebound congestion.
- oral drug may cause cardiac stimulation.
Antitussives
- reduces coughing in NONPRODUCTIVE cough.
DRUGS:
- Codeine
- Dextromethorphan
Expectorants
MECHANISM OF ACTION:
- Irritates mucus membranes to release the mucus creating productive cough by stimulating flow in respiratory tract.
DRUGS:
-guafenesin ( Mucinex)
Leukotriene Modifiers
- some end in -lukast
USE:
- Decreases inflammation and bronchoconstriction, edema, mucus secretions, eosinophil production.
- Do not use for ACUTE attacks.
- Used for PREVENTION.
- Given orally.
MECHANISM OF ACTION:
-Blocks leukotrienes (a component of inflammatory rxn) that you see in asthma.
DRUGS:
- montelukast (singulair)
- zileuton (Zyflo)
- zafirlukast (Accolate)
ADVERSE EFFECTS:
- Monitor serm liver blood enzymes, and renal function, may cause damage.
- Monitor INR and PT when taking warfarin and zileuton and zafirlukast.
Antitubercular Meds
- Kills or inhibits growth of mycobacterium.
- Prevents or treats TB.
- Pt compliance important bc they may need to take these meds for a year.
DRUGS:
-Isoniazid: May cause peripheral neuropathy (supplement with B6 aka pyridoxine). May cause hepatotoxicity (N/V, malaise, anorexia, jaundice), so you must monitor AST (aspartate labs).
- Rifampin: May cause hepatotoxicity, monitor AST. May cause body fluids to turn red/orange color.
- Pyrazinamide: May cause hepatotoxicity, monitor AST. May cause hyperuricemia, monitor uric acid.
- Ethambutol: May cause optic neuritis (ocular toxicity= blurred vision, visual field and color disturbances). Monitor this with eye exams.
- Streptomycin: Injury to 8th cranial nerve (hearing loss,, disturbed balance). Monitor hearing with testing. May cause nephrotoxicity, monitor BUN and creatinine labs and I&O.
