Respiratory Drug Class Actions/Uses/Adverse Reactions/Interactions

Question 1

Intranasal steroids (INSs)

Answer 1

Action:
- inhibit inflammatory cell response (mast cells, neutrophils, eosinophils, macrophages)
- decrease inflammatory mediators (histamine)

Uses:
- allergic rhinitis
- nonallergic rhinitis
- nasal polyps
- chronic sinusitis

Adverse Reactions:
- unpleasant taste/smell
- nasal irritation/dryness
- epistaxis

Interactions:
- cimetidine&raquo_space; decrease effectiveness budesonide
- systemic steroids&raquo_space; increase blood leveled budesonide

Question 2

first-generation antihistamines

Answer 2

Action:
- non-specific binding to central and peripheral H1 receptors
- blocks histamine from binding

Uses:
- allergy symptoms
- allergic reactions to blood, plasma, drugs
- anaphylaxis
- sedation
- allergic rhinitis or conjunctivitis

Adverse Reactions:
- drowsiness, sedation, disturbed coordination
- dry mouth, nose, throat
- thickening of bronchial secretions

Interactions:
- rifampin&raquo_space; decrease fexofenadine absorption
- aluminum/magnesium antacids&raquo_space; decrease fexofenadine blood levels
- MAOIs&raquo_space; increased sedative effect
- CNS depressants&raquo_space; additive CNS depressant effect
- beta blockers&raquo_space; increase risk cardiovascular effects with diphenhydramine

Question 3

second-generation antihistamines

Answer 3

Actions:
- selectively binds to peripheral H1 receptors
- less sedating effects

Uses:
- allergy symptoms
- allergic rhinitis and conjunctivitis
- allergic reactions to drugs, plasma, blood
- anaphylaxis

Adverse Reactions:
- less drowsiness than first-gen
- dry mouth, nose, throat
- thickening of bronchial secretions
- can still cause drowsiness, dizziness

Interactions:
- rifampin&raquo_space; decrease fexofenadine absorption
- aluminum/magnesium antacids&raquo_space; decrease fexofenadine blood levels
- MAOIs&raquo_space; increased sedative effect
- CNS depressants&raquo_space; additive CNS depressant effect
- beta blockers&raquo_space; increase risk cardiovascular effects with diphenhydramine

Question 4

Decongestants

Answer 4

Actions: sympathomimetic
- localized vasoconstriction of small blood vessels in nasal membrane reduces swelling

Uses:
- congestion associated with colds, allergies, sinusitis, rhinitis

Adverse Reactions:
- topical: burning, stinging, dryness
- oral: tachycardia/arrhythmias, nervousness, restlessness, insomnia, blurred vision, nausea, vomiting

Interactions:
- MAOIs&raquo_space; severe headache, HTN, hypertensive crisis
- beta adrenergic blockers&raquo_space; initial HTN episode followed by bradycardia

Question 5

Antitussives

Answer 5

Actions:
*centrally acting&raquo_space; codeine, dextromethorphan
- depresses cough center in the medulla
*peripherally acting&raquo_space; benzonatate
- anesthetizes stretch receptors in respiratory passages

Uses:
- relieve nonproductive cough

Adverse Reactions:
- lightheadedness, dizziness, drowsiness when combined with antihistamines

Interactions:
- CNS depressants&raquo_space; additive depressant effect with codeine
- MAOIs&raquo_space; hypotension, fever, nausea, leg jerking, coma with dextromethrophan

Question 6

Expectorants (guaifenesin)

Answer 6

Actions:
- increase respiratory secretion production
- decrease mucus viscosity

Uses:
- help bring up respiratory secretions

Adverse Reactions:
- nausea, vomiting, dizziness, headache, rash

Question 7

Mucolytics (acetylcysteine)

Answer 7

Actions:
- decrease respiratory secretion viscosity by direct action on the mucus

Uses:
- acute bronchiopulmonary disease (pneumonia, bronchitis)
- tracheostomy care (given via nebulizer directly into tracheostomy)
- pulmonary complications of CF or associated with surgery/anesthesia
- post traumatic chest conditions
- atelectasis due to mucous obstruction
- acetaminophen overdose
- diagnostic bronchial studies

Adverse Reactions:
- stomatitis, nausea, vomiting, fever, drowsiness, bronchospasm, irritation of trachea and bronchi

Question 8

beta adrenergic bronchodilators

Answer 8

Actions:
- bind to beta adrenergic receptors to induce bronchodilation

Uses:
- bronchospasm associated with acute or chronic asthma
- exercise induced bronchospasm (EIB)
- bronchitis
- emphysema
- bronchiectasis

Adverse Reactions:
- tachycardia, arrhythmias, palpitations, HTN
- nervousness, anxiety, insomnia
- excessive use may cause paradoxical bronchospasm

Interactions:
- adrenergic drugs&raquo_space; additive adrenergic effect
- tricyclic ADs&raquo_space; hypotension
- beta-adrenergic blockers&raquo_space; inhibits cardiac, bronchodilating, and vasodilation effects
- methyldopa&raquo_space; hypotension
- oxytocic drugs&raquo_space; severe hypotension
- theophylline&raquo_space; increased risk cardiotoxicity

Question 9

xanthine derivative bronchodilators

Answer 9

Actions:
- stimulate CNS to directly relax smooth muscles of the bronchi

Uses:
- symptomatic relief of asthma
- prevention of asthma
- bronchospasm associated with chronic bronchitis or emphysema

Adverse Reactions:
- restlessness, irritability, headache, nervousness, tremors
- tachycardia, palpitations, increased respirations
- nausea, vomiting, fever, flushing, hyperglycemia, alopecia

Interactions:
- decreased theophylline levels&raquo_space; barbiturates, charcoal, hydantoins, ketoconazole, nicotine, adrenergics, isoniazid, loop diuretics, rifampin
- increased theophylline levels&raquo_space; allopurinol, beta blockers, calcium channel blockers, cimetidine, oral contraceptives, corticosteroids, flu vaccine, macrolides, quinolones, thyroid hormones, isoniazid, loop diuretics

Question 10

inhaled corticosteroids (ICSs)

Answer 10

Actions:
- decrease airway hyperresponsiveness
- decrease number of mast cells in airway
- blocks reaction to allergens
- increases sensitive to beta2 receptors&raquo_space; increases effectiveness of beta2 agonists

Uses:
- management and prophylaxis of chronic asthma

Adverse Reactions:
- throat irritation, hoarseness
- URTIs
- fungal infection of mouth and throat

Interactions:
- ketoconazole&raquo_space; increase plasma budesonide and fluticasone

Question 11

mast cell stabilizers (cromolyn)

Answer 11

Actions:
- stabilizes mast cell membrane by blocking calcium ions from entering
- prevents release of inflammatory mediators (histamine, leukotriene)

Uses:
- used in combination with other drugs for asthma and allergic rhinitis

Adverse Reactions:
- throat irritation, dryness
- unpleasant taste
- cough or wheeze

Interactions:
- none

Question 12

leukotriene modifiers

Answer 12

Actions:
- zileuton&raquo_space; leukotriene inhibitor; blocks formation of leukotrienes, decreasing bronchoconstriction
- montelukast, zafirlukast&raquo_space; leukotriene receptor antagonist; inhibit is leukotriene receptor sites in respirator tract

Uses:
- prophylaxis and treatment of chronic asthma (12+ years old only)

Adverse Reactions:
- headache
- flu-like symptoms

Interactions:
- aspirin&raquo_space; increase plasma level zafirlukast
- warfarin&raquo_space; increase anticoagulant effect
- theophylline&raquo_space; decease zafirlukast levels; increase serum theophylline (zileuton)
- erythromycin&raquo_space; decrease zafirlukast levels

Question 13

immunomodulators

Answer 13

Actions:
- prevents binding of immunoglobulin to receptors on basophils and mast cells&raquo_space; limits allergic reaction

Uses:
- adjunctive therapy for clients who are sensitive to allergens and who require step 3 or higher care for asthma

Adverse Reactions:
- may cause anaphylactic reactions