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Respiratory drugs Flashcards

1
Q

Bronchial Asthma

A

Recurrent and reversible shortness of breath. - Occurs when airways of the lungs become narrow but the alveolar ducts and alveoli remain open.

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2
Q

What causes Bronchial asthma

A

Airway Narrowed from (X).
- Bronchospasms,
- Inflammation of the bronchial mucosa,
- Edema of the Bronchial Mucosa,
- Production of Viscous mucus

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3
Q

Symptoms of Bronchial asthma

A

Wheezing and difficulty breathing

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4
Q

Asthma attack

A

When airways close suddenly and dramatically

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5
Q

Status asthmaticus

A

A prolonged asthma attack that does not respond to typical drug therapy. May last several min to hrs and is a medical emergency

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6
Q

COPD

A

(Chronic Obstructive Pulmonary Disease)
Progressive, chronic airflow limitation, systematic manifestations and significant comorbidities

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7
Q

Chronic Bronchitis

A

Cough and sputum for at least 3 months -2yrs (not COPD)

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8
Q

What is a Bronchodilator. 3 classes?

A

Relax Bronchial smooth muscles which then cause dilation of the bronchi and bronchioles
- B adrenergic agonists
- Anticholinergics
- Xanthine derivatives

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9
Q

Three types of B adrenergic Agonists with ex.

A

Short acting B agonists Inhalers (SABA)
- Salbutamol
Long acting B agonists (LABA)
- Salmeterol
Long acting B agonist and glucocorticoid steroid combination inhaler (for severe/moderate asthma attack)
- Budesonide/Formoterol fumarate dihydrate

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10
Q

B Adrenergic agonists

A
  • Used during acute asthma attacks and quickly reduces airway constriction and restores normal airflow.
  • Stimulate the adrenergic receptors in the Sympathetic nervous system (Sympathomimetics)
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11
Q

Three subtypes of B adrenergic agonists

A

Nonselective adrenergics, Nonselective B adrenergics, Selective B2 drugs

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12
Q

Nonselective Adrenergics

A

Stimulate B, B1 (cardiac) and B2 (respiratory) receptors ( all beta cells throughout the body)
ex Epinephrine (epipen)

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13
Q

Nonselective B adrenergics

A

Stimulate B1 and B2 cells
Ex. Isoproterenol Hydrochloride

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14
Q

Selective B2 drugs

A

Only stimulate B2 receptors
Ex. Salbutamol

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15
Q

B adrenergic agonists MOA

A

Activation of B2 receptors activated cyclic adenosine monophosphate (CAMP) which relax the smooth muscles in the airway causing dilation and increase airflow

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16
Q

B adrenergic agonists indications

A

-Relief of bronchospasms related to asthma, COPD, and other pulmonary diseases
-Used to treat/prevent acute asthma attacks
-used in hypertension and shock

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17
Q

B adrenergic agonists: contraindications

A

Allergies, Uncontrolled cardiac dysrhythmias, Risk of stroke due to vasoconstrictive drug action

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18
Q

Nonselective adrenergic agonists Adverse effects

A

Mixed a and B agonists produce the mist adverse effects
- Insomnia, restlessness, anorexia, vascular headache, hyperglycemia, tremor, cardiac stimulation

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19
Q

Non selective B adrenergic agonists adverse effects…

A

Tachycardia, tremor, anginal pain, vascular headache

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20
Q

B2 adrenergic agonists adverse effects

A

B2 (salbutamol)
- Hypotension, vascular headache, tremor

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21
Q

B adrenergic agonists: Interactions

A
  • Lowered effect when nonselective B blockers are used together
  • MOAIs, Sympathomimetics increase risk for hypertension
  • Monitor patients with diabetes as it may increase BG (epinephrine)
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22
Q

Salbutamol Sulphate

A

-Short acting B2 specific,
-most common drug in class,
-Oral, Parenteral, Inhalation (included with metered dose inhalers as well as solutions for inhalation (aerosol nebulizers)

23
Q

Salmeterol

A
  • Long acting B2 specific
  • Only used with an inhaled glucocorticoid steroid
  • Maintenance treatment of asthma and COPD
  • Max dose of one puff BID
24
Q

Anticholinergics MOA

A

Anticholinergics bind to ACh receptors preventing ACh from binding to prevent ACh from constricting the airways. Helps reduce secretions of COPD

25
Anticholinergics: Indications
Prevent Bronchospasms from COPD. not for the managements of acute symptoms
26
Anticholinergics Adverse effects
Dry mouth/throat, Nasal congestion, Heart palpitations, Gi distress, urinary retention, increased intraocular pressure, headache, coughing, anxiety
27
Ipratropium Bromide
- Oldest/most commonly used Anticholinergics bronchodilator - Liquid aerosol and multidose inhaler - Dosed BID
28
tiotropium bromide monohydrate (Spiriva®)
Long acting Treatment of obstruction in COPD Once daily Maintenance treatment
29
Xanthine Derivatives MOA
- Increase levels of CAMP which cause smooth muscle relaxation leading to bronchodilation by competitively inhibiting phosphodiesterase (enzyme that breaks down CAMP)
30
Drug effects of Xanthine Derivatives
- Stimulation of the CNS - Increased airflow - Cardiovascular stimulation: increasing the force and rate of the heart increasing blood flow to kidneys
31
Indications Xanthine Derivatives
-Dilation of airways in Asthma and COPD - Mild to moderate acute asthma - Not for management for Asthma - Management for COPD - Not often used because of drug interaction and drug levels in the blood
32
Contraindications Xanthine Derivatives
- Allergies - Uncontrolled cardiac dysthymias - Seizure disorder - Hyperthyroidism - Peptic ulcers/GI disorders
33
Caffeine
- Cardiac stimulant in infants with bradycardia - Enhancement of respiratory drive in infants in NICUs (without prescription for CNS stimulant)
34
Theophylline (route, therapeutic range)
-Most common Xanthine derivative - Oral and injectable(as aminophylline) - Therputic range: 55-100mmol/L or according to asthma consensus guideline 28-55mmol/L
35
Aminophylline
IV form of theophylline for those with status asthmaticus who have not responded to fast acting B agonists such as epinephrine
36
NonBronchodilating respiratory drugs (3 types)
Leukotriene receptor antagonists, Corticosteroids, Mast cell stabilizers
37
Leukotriene receptor antagonists
Prevents leukotriene from attaching to receptors on the cells in the lungs and in circulation stopping inflammation, bronchoconstriction and mucus production. (stops coughing wheezing, shortness of breath)
38
Drug effects of Leukotriene receptor antagonists
Blocks leukotrienes: prevents smooth muscle contraction of the bronchial airway, decrease mucus secretion, prevent vascular permeability, decrease neutrophil and leukocyte infiltration to the lungs, preventing inflammation
39
Leukotriene receptor antagonists Indications
- prophylaxis and long term treatment and prevention of asthma in adults and children - Not meant for management of acute asthma attacks - Improvement with their use is typically seen in about a week
40
Leukotriene receptor antagonists contraindications
- drug allergies - Previous adverse drug reaction - Allergy to povidone, lactose, titanium dioxide, or cellulose derivatives. important as they are inactive ingredients in the drug
41
Leukotriene receptor antagonists adverse effects
Liver dysfunction Zafirlukast: headache, nausea diarrhea
42
Corticosteroids (Glucocorticoids)
-Anti Inflammatory properties -Used in treatment of pulmonary diseases -May be given IV, oral or inhaled but inhaled reduce systemic effects -May take several weeks before full effects
43
Corticosteroids (Glucocorticoids) MOA
-Stabilize membranes of cells that release harmful bronchoconstriction substance (WBC) -Increase responsiveness of bronchial smooth muscle to B adrenergic stimulation - Dual effect of both reducing inflammation and enhancing the activity of B Agonists - Restore responsiveness of bronchial smooth muscle increasing the potency of B agonist drugs (salbutamol)
44
List inhaled Corticosteroids (Glucocorticoids)(3)
beclomethasone dipropionate (Qvar®), budesonide (Pulmicort Turbuhaler®), fluticasone propionate (Flovent Dickus®)
45
Inhaled Corticosteroids (Glucocorticoids) indications
-Bronchospastic disorder to control the inflammatory responses - Persistent asthma - Used with B adrenergic agonists IV: acute exacerbation of asthma or COPD
46
Inhaled Corticosteroids (Glucocorticoids) contradictions
Drug allergy, not intended for sole therapy for acute asthma attack, hypersensitivity to glucocorticoids, sputum positive for candida organisms, patients with systemic fungal infection
47
Inhaled Corticosteroids (Glucocorticoids) adverse effects
Pharyngeal irritation, coughing, dry mouth, oral fungal infection, systemic effects are rare because low doses are used for inhalation therapy
48
Inhaled Corticosteroids (Glucocorticoids) Drug interactions
-More likely to occur with systemic/inhaled -May increase glucose levels (needing antidiabetic drugs) -Raises blood levels of immunosuppressants cyclosporine and tacrolimus -Diuretic use may increase hypokalemia(low potassium)
49
Measures that prevent/relieve/decrease symptoms of COPD
- Avoiding smoking, stress, air pollutants, allergens - Adequate fluid intake - Complying with medical treatment - Avoiding fatigue, heat, caffeine
50
What happens if salbutamol is used too frequently
B2 specific actions are lost at larger doses and B1 receptors begin to be stimulated causing nausea, increased anxiety, palpitation, tremors, increased heart
51
Cigarette smoking _____ Xanthine metabolism
enhances
52
interactions with charcoal/high protein/low carb food does what?
Mat reduce serum levels of Xanthines
53
what should be used first B agonist bronchodilator or corticosteroid inhaler
the bronchodilator should be used several minutes before the corticosteroid to increase dilation for the corticosteroid

pharm (21 decks)

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