Respiratory: Asthma/COPD Flashcards
Bronchial Asthma
bronchospasms: narrowing
Inflammation of bronchial mucosa
Status asthmaticus: medical emergency. prolonged asthma attack that does not respond to therapy
COPD
Chronic bronchitis and emphysema
Inflammation of airway epithelium. Infiltration of Inflammatory cells and release of cytokines.
Chronic Bronchitis
Chronic inflammation of bronchioles or bronchi
Due to prolonged exposure to irritants
Emphysema
Alveoli enlarge due to destruction of alveolar walls
Surface area of gas exchange reduced
Bronchodilator Drugs
B2-Adrenergic Agonists
•Salbutamol
Anticholinergics
Ipratropium bromide (atrovent)
Xanthine Derivatives
Theophylline/Aminophylline
Anti-Inflammatory Respiratory Drugs
Glucocorticoids
•Budesonide
Leukotriene Modifiers
•Montelukast
Bronchodilators: B agonists
Sympathomimetic bronchodilators
Stimulate bronchial smooth muscle B2 adrenergic receptors
•Short Acting B Agonists
•Long Acting B Agonists
Selective B2 drugs activate smooth muscle B2 adrenergic receptors.
•Salbutamol
B agonist indications
Relief of bronchospasm related to Asthma , COPD, etc.
Treatment of:
Acute attacks
Prevent attacks: Chronic management, exercise-induced
B Agonist (Salbutamol) Adverse effects
Tachycardia (B1)
Tremors (B2)
Restlessness (B1, B2)
Insomnia (B1, B2)
Stimulates B1 receptors as well; increased HR, palpitations, chest pain
B1: heart
B2: Lungs/muscles
B Agonist Care Considerations
Increase fluid intake
Avoid exposure to irritants: smoking
Monitor for therapeutic effects:
•Decreased dyspnea
•Decreased wheezing
•Improved resp patterns
•Improved activity tolerance
Anticholinergics
Bronchodilator
Prevents bronchoconstriction (fixed schedule use)
•COPD
•NOT used alone for acute exacerbations
Drug: Ipratropium bromide
Anticholinergic main adverse effect
Dry mouth
Methylxanthines (Xanthine derivatives)
Bronchodilator
Quick relief of bronchospasm. greater airflow into and out of lungs.
Theophylline
•Oral med
Aminophylline
•More water-soluble form of theophylline
•IV administration
Methylxanthines (Xanthine derivatives) Adverse Effects
CNS stimulation
•Anxiety, insomnia, seizures
Cardiovascular Stimulation
•Palpitations
•Tachycardia
•Ventricular dysrhythmias
GI distress
•Nausea, vomiting
Methylxanthines (Xanthine derivatives) Drug Interactions
Ciprofloxacin increases effects of theophylline by inhibiting CYP metabolism
Large amounts of caffeine can intensify adverse effects
Liver enzyme inducers such as antiseizure drugs increase metabolism of theophylline, thus decreasing effects of theophylline
Anti-Inflammatory Respiratory Drugs
Glucocorticoids
•Budesonide - Inhaled
•Fluticasone - Inhaled
Leukotriene Modulators
•Montelukast
Glucocorticoids
Anti-Inflammatory
Steroid drugs: structure based on cholesterol
Inhaled: Used for chronic asthma and COPD
Oral/IV for severe/short-term Tx
Not for symptomatic relief of asthma attacks.
Inhaled forms reduce systemic effects
May take several weeks for full effect
DRUGS:
Budesonide
Fluticasone
Glucocorticoids Mechanism Of Action
Many mechanisms
•Reduce inflammatory mediators
•Decrease cytokine production
•Reduce edema
Inhaled Glucocorticoids Combination Preparation
Glucocorticoid + long-acting b2-agonist (LABA)
•Budesonide + formoterol = symbicort
•Fluticasone + Salmeterol = Advair Diskus
Inhaled Glucocorticoid Indications
Prophylaxis for asthma and COPD (with LABA)
Inhaled Glucocorticoid Adverse Effects
Oral fungal infections
Coughing
Dry mouth
Inhaled Glucocorticoid Care Considerations
Avoid if candida in sputum
May slow growth in children
Possible bone loss
If also using b2 agonist bronchodilator: use bronchodilator FIRST
Teach patients to gargle and rinse mouth after use to prevent against fungal infection
Leukotriene Modulators
Anti-Inflammatory
Leukotrines are released in immune response in asthma. Causes inflammation, bronchoconstriction, mucus, wheezing, cough, SOB.
Leukotriene modulators reduce inflammation in lung
DRUG:
Montelukast
Leukotriene Indications
Prophylaxis and chronic treatment of asthma in adults and children.
Montelukast in children ages 2+
NOT for acute asthma attacks
