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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
Q

Anticholinergics: Indications

A

Prevent Bronchospasms from COPD. not for the managements of acute symptoms

26
Q

Anticholinergics Adverse effects

A

Dry mouth/throat, Nasal congestion, Heart palpitations, Gi distress, urinary retention, increased intraocular pressure, headache, coughing, anxiety

27
Q

Ipratropium Bromide

A
  • Oldest/most commonly used Anticholinergics bronchodilator
  • Liquid aerosol and multidose inhaler
  • Dosed BID
28
Q

tiotropium bromide monohydrate (Spiriva®)

A

Long acting
Treatment of obstruction in COPD
Once daily
Maintenance treatment

29
Q

Xanthine Derivatives MOA

A
  • Increase levels of CAMP which cause smooth muscle relaxation leading to bronchodilation by competitively inhibiting phosphodiesterase (enzyme that breaks down CAMP)
30
Q

Drug effects of Xanthine Derivatives

A
  • Stimulation of the CNS
  • Increased airflow
  • Cardiovascular stimulation: increasing the force and rate of the heart increasing blood flow to kidneys
31
Q

Indications Xanthine Derivatives

A

-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
Q

Contraindications Xanthine Derivatives

A
  • Allergies
  • Uncontrolled cardiac dysthymias
  • Seizure disorder
  • Hyperthyroidism
  • Peptic ulcers/GI disorders
33
Q

Caffeine

A
  • Cardiac stimulant in infants with bradycardia
  • Enhancement of respiratory drive in infants in NICUs
    (without prescription for CNS stimulant)
34
Q

Theophylline (route, therapeutic range)

A

-Most common Xanthine derivative
- Oral and injectable(as aminophylline)
- Therputic range: 55-100mmol/L or
according to asthma consensus guideline 28-55mmol/L

35
Q

Aminophylline

A

IV form of theophylline for those with status asthmaticus who have not responded to fast acting B agonists such as epinephrine

36
Q

NonBronchodilating respiratory drugs (3 types)

A

Leukotriene receptor antagonists, Corticosteroids, Mast cell stabilizers

37
Q

Leukotriene receptor antagonists

A

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
Q

Drug effects of Leukotriene receptor antagonists

A

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
Q

Leukotriene receptor antagonists Indications

A
  • 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
Q

Leukotriene receptor antagonists contraindications

A
  • 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
Q

Leukotriene receptor antagonists adverse effects

A

Liver dysfunction
Zafirlukast: headache, nausea diarrhea

42
Q

Corticosteroids (Glucocorticoids)

A

-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
Q

Corticosteroids (Glucocorticoids) MOA

A

-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
Q

List inhaled Corticosteroids (Glucocorticoids)(3)

A

beclomethasone dipropionate (Qvar®), budesonide (Pulmicort Turbuhaler®), fluticasone propionate (Flovent Dickus®)

45
Q

Inhaled Corticosteroids (Glucocorticoids) indications

A

-Bronchospastic disorder to control the inflammatory responses
- Persistent asthma
- Used with B adrenergic agonists
IV: acute exacerbation of asthma or COPD

46
Q

Inhaled Corticosteroids (Glucocorticoids) contradictions

A

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
Q

Inhaled Corticosteroids (Glucocorticoids) adverse effects

A

Pharyngeal irritation, coughing, dry mouth, oral fungal infection, systemic effects are rare because low doses are used for inhalation therapy

48
Q

Inhaled Corticosteroids (Glucocorticoids) Drug interactions

A

-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
Q

Measures that prevent/relieve/decrease symptoms of COPD

A
  • Avoiding smoking, stress, air pollutants, allergens
  • Adequate fluid intake
  • Complying with medical treatment
  • Avoiding fatigue, heat, caffeine
50
Q

What happens if salbutamol is used too frequently

A

B2 specific actions are lost at larger doses and B1 receptors begin to be stimulated causing nausea, increased anxiety, palpitation, tremors, increased heart

51
Q

Cigarette smoking _____ Xanthine metabolism

A

enhances

52
Q

interactions with charcoal/high protein/low carb food does what?

A

Mat reduce serum levels of Xanthines

53
Q

what should be used first B agonist bronchodilator or corticosteroid inhaler

A

the bronchodilator should be used several minutes before the corticosteroid to increase dilation for the corticosteroid

pharm (21 decks)

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