Respiratory Drugs Flashcards
three drug classes given to prevent bronchoconstriction
B2 agonists
methylxanthines
anticholinergics
which drug class is most effective for acute bronchospasm
b2 agonists
Why should we given inhaled drugs for lung diseases?
decreased systemic effects
faster and more direct drug delivery to site of action
How much drug reaches the lungs when utilizing a metered dose inhaler?
10%
20% with spacer
Which drug delivery system results in the highest % of drug reaching the lungs?
nebulizers
List some short acting inhaled B2 agonists
albuterol
levoalbuterol
Which B2 agonists can be given PO
albuterol
terbutaline
List two methylxanthines
theophylline
aminophylline
List one short acting and one long acting inhaled anticholinergic
short = ipratropium
long = tiotropium
Can bronchodilators prevent future asthma attacks?
No - symptomatic relief only
no decrease in inflammation
What is a SABA
short acting beta2 agonist
What is the onset, peak, and duration of action of SABAs
onset = immediate
peak = 30mins
DOA = 3-5hrs
Are LABAs or SABAs administered PRN?
SABAs - immediate onset for acute attack
LABAs are administered on a schedule
Adverse effects of B2 agonists
inhaled - none/minimal
PO -
- tremors
- tachycardia
- nervousness
- hyperglycemia
- hypokalemia
Mechanism of action of methylxanthines
adenosine receptor blockade = relaxation of bronchial smooth m
How are methylxanthines metabolized?
CYP450
Why do methylxanthines require laboratory monitoring?
variable PK (variable metabolism)
low therapeutic index w/ serious adverse effects
route of administration of methylxanthines
PO or IV (not inhaled)
Adverse effects of methylxanthines
CNS excitation (even seizure)
cardiac stim (dysrhythmias)
vasodilation/hypotension
diuresis
N/V, diarrhea
How do anticholinergics work in asthma/COPD?
block M receptors in bronchi = decreased bronchoconstriction
What is a SAMA
short acting inhaled muscarinic antagonist
What is a LAMA
long acting inhaled muscarinic antagonist
Which inhaled anticholinergics are quaternary ammoniums?
ipratropium
tiotropium
What is the implication of an inhaled drug being a quaternary ammonium?
Drug cannot cross membranes - it stays in the lungs and has no systemic adverse effects
In asthma and COPD, treatment consists of two goals. What are these goals?
Anti-inflammation
Bronchodilation
Which anti-inflammatory is the most effective for long term control of airway inflammation?
glucocorticoids
Route of administration of glucocorticoids for asthma/COPD?
usually inhaled
acute exacerbations = PO/IV
Adverse effects of inhaled glucocorticoids
thrush
hoarseness
(long term high dose can have systemic adverse effects)
adverse effects of systemic glucocorticoids
adrenal suppression
osteoporosis
hyperglycemia
immunosuppression
fluid retention
hypokalemia
peptic ulcer disease
growth suppression (peds)
List some inhaled glucocorticoids
beclomethasone
budesonide
fluticasone
How do leukotriene receptor antagonists work?
Suppress effects of leukotrienes
decreased:
- smooth m constriction
- blood vessel permeability
-inflammation
Route of administration of leukotriene receptor antagonists
PO
adverse effects of leukotriene receptor antagonists
depression/SI
various depending on the specific drug (esp liver injury, CYP450 inhibition)
List some leukotriene receptor antagonists
zileuton
zafirlukast
montelukast
Which is the safest leukotriene receptor antagonist?
montelukast
Name the mast cell stabilizer
cromolyn
How do mast cell stabilizers work?
stabilize mast cell membrane = decreased histamine & inflammatory mediator release
–> decreased inflammation
Which is the safest of ALL the anti-inflammatories used for asthma?
cromolyn
How do monoclonal antibodies work?
Ab bind target substance, rendering it inert
Adverse effect of all monoclonal antibodies used for any purpose
injection site reactions
hypersensitivity reactions (can be as serious as anaphylaxis)
How do phosphodiesterase 4 inhibitors work for COPD?
inhibit PDE4 (enzyme that breaks down cAMP) –> increased cAMP
results in:
- suppression of cytokines
- decreased WBC infiltration
List one PDE4 inhibitor
roflumilast
Adverse effects of PDE4 inhibtors
diarrhea
anorexia
HA
back pain
insomnia
List two glucocorticoid+LABA combinations
Symbicort
Advair
List one SABA+anticholinergic combination
Combivent
Most effective treatment of allergic rhinitis
intranasal glucocorticoids
Do we use B2 agonists in allergic rhinitis
no - not a airway constriction issue
use anti-inflammatories primarily since it’s an inflammation issue
Which type of sympathomimetics (which receptor) are used in allergic rhinitis & why?
a1 receptor agonists = vasoconstriction decreases swelling & vessel permeability in the nose.
Which type of antihistamines are associated with sedation? List a coulple
1st generation
chlorpheniramine
diphenhydramine
List a couple sympathomimetics used for allergic rhinitis
phenylephrine
pseudoephedrine
Why is the use of sympathomimetics for allergic rhinitis limited to a couple days?
Rebound congestion can occur
What type of cough is useful to be treated with a cough suppressant?
nonproductive
sleep-depriving
What is another name for cough suppressants?
antitussives
What is an expectorant? (definition)
promotes secretion of sputum
What is a mucolytic (definition)?
breaks down thick mucus (so secretions can be expelled more easily)
List an expectorant
guaifenesin
List a couple mucolytics
hypertonic saline
acetylcysteine
How do opioid antitussives suppress cough?
elevate the cough threshold in CNS
Which is the most effective cough suppressant?
codeine
What schedule drug is codeine when used for a cough suppressant
V
List a couple nonopioid antitussives
dextromethorphan
diphenhydramine
benzonatate
