Respiratory drugs Flashcards
H1 blockers MOA
bind to H1 receptors and block histamine release; mild anticholinergic effect
SE for all H1 blockers
Anticholinergic–constipation, urinary retention, dry mouth
Contraindications for H1 blockers
can inc BP–Closed angle glaucoma, cardiac disease, kidney disease, HTN, bronchial asthma, COPD, PUD, seizures, BPH, preg
- if disease is controlled, its prob fine
Diphenhydramine Class and indications
- 1st gen sedating antihistamines
- Mild allergic rxns, motion sickness, insomnia, can be given with severe anaphylactic rxns
Diphenhydramine SE
Drowsy, dizzy, severe CNS depression, dry mouth, urinary retention, constipation, often knocks people out, can make ppl hyperactive (often kids)
Diphenhydramine NC
- PO and IV
- monitor for urinary retention and constipation, dizziness when ambulating
- avoid driving and tasks for mental alertness (take drug at night if necessary)
Loratadine (claritin), fexofenadine (Allegra), cetirizine (Zyrtec) class and indications
2nd gen non-sedating antihistamines
- allergic rhinits
- chronic idiopathic urticaria
Loratadine (claritin), fexofenadine (Allegra), cetirizine (Zyrtec) SE
Fewer SE, less drowsy and fatigue
Loratadine (claritin), fexofenadine (Allegra), cetirizine (Zyrtec) NC
- can take in the morning
- all PO
Dextromethorphan, codeine, benzonatate (Tessalon Perles) class and indications
Antitussive; cough suppressant (chronic or acute)
Dextromethorphan, codeine, benzonatate (Tessalon Perles) MOA
Directly suppresses the cough reflex in the brain
Dextromethorphan, codeine, benzonatate (Tessalon Perles) SE
CNS depressant
Dextromethorphan, codeine, benzonatate (Tessalon Perles) NC
- PO, syrups, sprays, lozenges
- DON’T take with other CNS depressants (esp codeine)
- dextro and codeine can by abused
- Codeine and benzonatate RX
Guaifenesin (mucinex) class and indications
Expectorant, dec mucus in colds, bronchitis
Guaifenesin (mucinex) MOA
Dec surface tension of sec helping make mucus easier to cough up
Guaifenesin (Mucinex) SE and NC
- few mild GI
- encourage fluids
- be careful with asthma pt and chronic cough
- questionable efficiency
Acetylcysteine (Mucomyst) class and indications
Mucolytics; bronchopulmonary disease, CF
Acetylcysteine (Mucomyst) MOA
dec viscosity of mucus–easier to cough up
Acetylcysteine (Mucomyst) SE and NC
- Few SE, BRONCHOSPASM may occur, SMELLS AWFUL
- best thru neb or trach
- monitor lungs closely
ipratropium class and indications
Anticholinergics, PROPHYLAXIS and maintenance, not rescue
ipratropium MOA
Work on acetylcholine receptors–turn off PNS and on SNS–bronchodilation
ipratropium SE and NC
- Dry as a bone, hot as a hatter, blind as a bat, red as a beet, mad as a hatter
- often given with albuterol
Theophylline (TheoDur/Theo-24) and aminophylline MOA
Inc levels of the cAMP enzyme by inhibiting phosphodiesterase–stim CNS and CVD sys–inc smooth muscle relax and bronchodilate
Theophylline (TheoDur/Theo-24) and aminophylline class and indications
- xanthine derivatives
- prevent tx asthma attack and COPD exacerbations
Theophylline (TheoDur/Theo-24) and aminophylline SE
Caffeine high (theophylline); N/V/D and lack appetite more normal SE; tox–tachy, HA, insomnia, dysrthmias, sz
Theophylline (TheoDur/Theo-24) and aminophylline NC
- 2nd line bc high risk tox–reverse with activated charcoal
- CI: peptic ulcer, sz dx, hyperthyroid, uncontrolled cardiac dysrhythmias
- intx with caffeine (inc fx) and smoking (dec absorption)–may dec dose if stop smoking
- narrow therapeutic index–monitor serum levels
- lots drug intx
Montelukast, zafirlukast class and indications
Leukotriene receptor antagonist (LTRA); Prophylaxis and chronic tx of asthma
Montelukast, zafirlukast MOA
Prevent leukotrienes from attaching to receptors located on immune cells and within the lungs, prevent inflam
Montelukast, zafirlukast SE
HA, N/D, dizzy, insomnia
Montelukast, zafirlukast NC
- give PO
- can give to kids over 12M
- zafirlukast can only be given to kids over 5Y
- chewable tabs and granules
- improve in a week
- mont has few drug intx (Zafir has more)
- NOT acute asthma
Beclomethasone, budesonide, fluticasone, dipropionate class and indications
Inhaled corticosteroids; prevent persistent asthma attacks and COPD
Beclomethasone, budesonide, fluticasone, dipropionate MOA
Dec inflam and enhance activity of beta agonists (also help with bronchodilate)
Beclomethasone dipropionate, budesonide, fluticasone SE
Pharyngeal irritation, cough, dry mouth, oral fungal infx
Beclomethasone diproprionate , budesonide, fluticasone NC
- Give with neb or MDI
- can takes weeks of cont therapy before full effect
- give bronchodilator FIRST then corticosteroid
- RINSE MOUTH AFTER
Budesonide & formoterol, fluticasone & salmeterol class and indications
Combo: inhaled glucocorticoid and bronchodilator; mod to severe asthma, never for ACUTE attack
Which drug combo works faster?
Budesonide & formoterol
Cromolyn (Intal) class and indications
mast cell stabilizer; prevent acute asthma attack
Cromolyn MOA
Stabilize membranes of mast cells and prevent release of broncho-constrictive inflam subs
How to use cromolyn
Take 15-20 minutes prior to known trigger
Omalizumab (Xolair) class
monoclonal antibody anti-asthmatic
Omalizumab MOA
Monoclonal antibody selectively binds to immunoglobulin IgE which limits release of mediators of allergic response
Omalizumab NC
- injection
- monitor for hypersensitivities–BIG RISK ANAPHYLAXIS (CLOSE MONITOR)
Roflumilast class and indications
Selective PDE-4 inhibitor; prevention of COPD exacerbation
Roflumilast MOA
PDE-4 inhibitor–dec inflam in lungs
Roflumilast SE and NC
N/V/D, HA, muscle spasm, dec appetite, uncontrolled tremors
- oral
- not work acute or immediate
Target of traditional allergy meds
H1 receptors
Phenylephrine, pseudoephedrine (Sudafed) class and indications
Sympathomimetics
- nasal congestion, allergic rhinits, sinusitis, common cold
Phenylephrine, pseudoephedrine (Sudafed) MOA
Mimics the action of SNS, activates alpha1-adrenergic receptors–causes vasoconstriction of BVs, causing nasal turbinates to shrink and opens nasal passages
Phenylephrine, pseudoephedrine (Sudafed) SE
Dry you out, all r/t to CNS stimulation–agitation, insomnia, anxiety, tachy, heart palpitations “wired”
Phenylephrine, pseudoephedrine (Sudafed) NC
- don’t use for over 4 days bc rebound congestion occurs when stop after prolonged use–TAPER
- pseudoephedrine has potential for abuse but works better bc CNS stim “upper”–register and limit on it
- OTC about requirements and limits on how much
Beta adrenergic agonists
short or long acting drugs
How long do long acting drugs work? indications?
12-24h; prevention drugs (extended release-like)
Beta adrenergic agonist MOA
mimic action of SNS with fight or flight; relax and dilate airways by stim beta2-adrenergic receptors thru lungs–bronchial dilation and inc airflow in and out is the goal
Non-selective adrenergic drugs: name and MOA
Epinephrine; Stim both beta 1 and 2 receptors AND alpha receptors which causes vasoconstrict and dec edema and swelling in mucus mems, dec secretions; also stim beta1 which causes CV fx like inc HR and BP and CNS stim–nerves and tremors
Non-selective beta-adrenergic MOA
stim beta 1 and 2 receptors, no alpha
Selective beta 2 receptors: MOA
Only acts on beta 2 receptors; preferred for pulmonary conditions
Which beta agonist drugs have the most adverse effects?
non-selective
beta adrenergic agnonist indications
prevention or relief of bronchospasm r/t asthma/bronchitis, other pulm condx (will be used for condx otuside pulm sys too)
Beta adrenergic agonist CIs
Uncontrolled HTN, cardiac dysrhythmias, high risk for stroke
Short acting beta agonist: name, indication, length of time to work
Albuterol and levalbuterol, work immediate, last 4-6h, rescue, PO or inhaler
long acting beta agonist name, indication, runtime
Salmeterol and formoterol, preventers, last 12-24h, only inhaled
Beta agonist SE
HTN or hypotxn, insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, vascular HA
Beta agonist NC
- fx may dec with beta blockers
- avoid use with MAOIs and sympathomimetics–HTN
- if give with beta blocker (can reverse), watch for bronchospasm
- v short half life
- may inc need for insulin
Albuterol/Proventil indications
***first line tx of acute asthma attack, also bronchitis, emphysema; acute wheeze, chest tight, SOA–Not for everyday use; prevent exercise-induced asthma
Albuterol/Proventil NC
- onset in minutes
- inhale q4-6h
- used for exercise induced asthma inhaler
- NOT for daily use
- use more than 1 canister/M indicates inadequate control os asthma–need to inc anti-inflam therapy
salmeterol NC
- inhale 2x/d
- use with inhaled corticosteroid
- inc asthma-related deaths (esp in Black pop)
Preventer meds
Anticholinergics, xanthine derivatives, inhaled corticosteroids, leukotriene modifiers, mast cell stabilizers, LABA
Quick relief/rescue meds
SABA, albuterol/Proventil