respiratory drugs Flashcards
what is asthma ?
chronic inflammatory disorder of the airway- caused by immune mediated immune inflammation
symptoms are a result of inflammation and bronchoconstriction
signs and symptoms of asthma ?
Sense of breathlessness
Tightening of the chest
Wheezing
Dyspnea
Cough
what is copd ?
chronic obstructive pulmonary disease - non reversible long term that can be characterize by air flow restrictions and inflammation
most often caused by cigarettes
signs and symptoms of copd
Chronic cough
Excessive sputum production
Wheezing
Dyspnea
Poor exercise tolerance
Patho of COPD
symptoms are mostly a result from chronic bronchitis and emphysema - which take place from an exagerated inflammatory response to smoke
what is emphysema
enlargement of the air space within the bronchioles and alveoli brought on by the deterioration of these walls
meds that are used for asthma and copd
glucococorticoids ( anti inflammatory agents
bronchodilators (beta 2 agonists )
anti inflammatory drugs are
foundation of asthma treatment, taken for long term control
mechanism of action of glucocorticoids?
Mechanism of action = suppress inflammation
Reduce bronchial hyperreactivity and decrease airway mucous production
Reduce infiltration and activity of inflammatory cells
Usually administered by inhalation, but IV and oral routes are also options
use of glucocortcoids
Prophylaxis of chronic asthma
Dosing must be on a fixed schedule, not as needed (PRN)
Not used to abort an ongoing attack because beneficial effects develop slowly
glucocortcoids are considered :
the first line of therapy for for management of inflammatory component of asthma
- persistant asthma patients should use this daily
oral use of glucocorticoids
For patients with moderate to severe persistent asthma or for management of acute exacerbations of asthma or COPD
- should be used only when symptoms cannot be controlled with safer medications (inhaled glucocorticoids, inhaled beta2 agonists
Treatment should be as brief as possible
adverse effects of inhaled glucocorticoids
Adrenal suppression
Oropharyngeal candidiasis
Dysphonia
averse effects of oral forms
why is adrenal suppression an issue with glucocortcoid use
prolonged use of glucocorticoids can decrease the ability of the body to make its own endogenous glucocorticoids
- periods of high stress, bpdy cannot produce glucocortcoids which is needed, patients will have to be given a higher dose of either oral or IV if this is the case
Leukotriene Receptor Antagonists
Suppress effects of leukotrienes( promote smooth muscle constrictions , blood vessel permeability , and direct recruitment of inflammatory cells
considered second line agents
how do leukotrine modifiers help patients with asthma ?
can reduce bronchoconstriction and inflammatory responses such as edema and mucous secretion
problems with Leukotriene Receptor Antagonists
Generally well tolerated but can cause adverse neuropsychiatric effects, including depression, suicidal thinking, and suicidal behavior
Zileuton [Zyflo]
Zafirlukast [Accolate]
Montelukast [Singulair]
Leukotriene Receptor Antagonists
what is a mast cell stabilizer
Used for prophylaxis, not for quick relief
Suppresses inflammation; not a bronchodilator
mast cell stabilizer mechanism of action
Stabilizes cytoplasmic membrane of mast cells, thereby preventing release of histamine and other mediators; in addition, inhibits eosinophils, macrophages, and other inflammatory cells
therapeutic use of mast cell stabilizer
Chronic asthma
Exercise-induced bronchospasm (EIB)
Allergic rhinitis
what is a bronchodilator ?
symptomatic relief but do not alter the underlying disease process (inflammation)
principal bronchodilators are: beta2-adrenergic agonists
patients that are also taking bronchodilators should also be taking what ?
glucocorticoid for long-term suppression of inflammation
what do beta 2 adrenergic agonists do ?
activate the beta 2 receptors in the smooth muscle of the lungs , which will relieve the bronchospasm
Beta2 agonists have a limited role in suppressing histamine release in the lung and increasing ciliary motility
What is a SABA
short acting beta 2 agonist use PRN to stop an ongoing attack taking place,
can be taken before exercise to prevent an attack
treatment of choice for an attack in the hospital
used with asthma and COPD
what is a laba ?
Inhaled long-acting beta2 agonists
Long-term control in patients who experience frequent attacks
dosing is on fixed schedule —> NOT PRN
effective for stable COPD treatment
using a LABA as treatment
When used to treat asthma, must always be combined with a glucocorticoid
contraindicted to treat asthma alone
adverse effects of beta 2 agonists
inhaled : Tachycardia, angina, tremor
oral : Excessive dosage: Angina pectoris, tachydysrhythmias
Tremor
what do anti cholinergic drugs do ?
Improves lung function by blocking muscarinic receptors in the bronchi, thereby reducing bronchoconstriction
action and use of anticholinegic drugs
Improves lung function by blocking muscarinic receptors in the bronchi, thereby reducing bronchoconstriction
Therapeutic effects begin within 30 seconds, reach 50% of maximum in 3 minutes, and persist about 6 hours
adverse effects of anticholinergic drugs
Dry mouth and irritation of the pharynx
Glaucoma
Cardiovascular events
tiotropium and ipratropium
Long-acting, inhaled anticholinergic agent approved for maintenance therapy of bronchospasm associated with COPD
Not approved for asthma
tiotropium works by
Relieves bronchospasm by blocking muscarinic receptors in the lung
adverse effects of anticholinergic drugs
LABA/ glucocorticoids
Indicated for long-term maintenance in adults and children
Not recommended for initial therapy
management of chronic asthma
step wise therapy : Step chosen for initial therapy is based on pretreatment classification of asthma severity, moving up or own is based off of asthma control
therapy for acute severe exacerbation
Oxygen—To relieve hypoxemia
A systemic glucocorticoid—To reduce airway inflammation
A nebulized, high-dose SABA—To relieve airflow obstruction
Nebulized ipratropium—To further reduce airflow obstruction
management of copd 2 goals :
Reduce symptoms, thereby improving the patient’s health status and exercise tolerance
Reduce risks and mortality by preventing progression of COPD and by preventing and managing exacerbations
pharmacological management of stable COPD
Bronchodilators
Glucocorticoids
Phosphodiesterase-4 inhibitors
management of a copd exacerbation
SABAs (specifically inhaled, either alone or in combination with inhaled anticholinergics) are preferred for bronchodilation during COPD exacerbations
Systemic glucocorticoids
Supplemental oxygen to maintain an oxygen saturation of 88% to 92%
what is allergic rhinitis ? symptoms ?
Inflammatory disorder of the upper airway, lower airway, and eyes
Sneezing
Rhinorrhea
Pruritus
Nasal congestion
For some people: Conjunctivitis, sinusitis, and asthma
what is the pathophysiology of allergic rhinitis
Triggered by airborne allergens
Allergens bind to immunoglobulin E (IgE) on mast cells
Triggers release of inflammatory mediators
Histamine, leukotrienes, prostaglandins
what kinds of drugs are used to treat rhinitis ?
Glucocorticoids (intranasal)
Antihistamines (oral and intranasal)
Sympathomimetics (oral and intranasal)
first choice for treatment ? what are some of the side effects ?
FLONASE/Fluticasone , highly effective for prevention and treatment
has mild adverse effects- Drying of nasal mucosa or sore throat
Epistaxis (nosebleed)
Headache
Rarely, systemic effects (adrenal suppression and slowing of linear pediatric growth)
oral antihistamines for rhinitis ? what are some of the adverse reactions ?
Does not reduce nasal congestion, effective when taken prophylactically and should be taken regularly when it is allergy season even with no symptoms
mild sedation will be seen with first gen medications and less is seen with second gen meds
Intranasal Antihistamines: Azelastine and Olopatadine
treats rhinitis in kids over 12 and adults
intra nasal antihistamine Systemic absorption can be sufficient to cause
somnolence
Nosebleeds
Anticholinergic effects
Unpleasant taste
what does Intranasal Cromolyn Sodium do ?
Reduces symptoms by suppressing release of histamine and other inflammatory mediators from mast cells
Prophylaxis
administering intranasal cromolyn
Administer before symptoms start
Response develops in 1 to 2 weeks
Minimal adverse reactions: Less than with any other drug for allergic rhinitis
Sympathomimetics
Reduce nasal congestion (do not reduce rhinorrhea, sneezing, or itching, Activate alpha1-adrenergic receptors on nasal blood vessels
adverse effects of Sympathomimetics
Rebound congestion
CNS stimulation
Cardiovascular effects and stroke
Abuse
topical vs oral administration of Sympathomimetics
Topical agents act more quickly than oral agents and are usually more effective
Oral agents act longer than topical preparations
Systemic effects occur primarily with oral agents; topical agents usually elicit these responses only when dosage is higher than recommended
rebound congestion will be commonly seen with
prolonged use of topical agents but not with oral agents
Antihistamine-sympathomimetic combinations
Claritin D
Allegra D
Zyrtec D
what is an antitussive ?
Drugs that suppress cough
Nonopioid antitussives
Dextromethorphan
Diphenhydramine
Benzonatate
opoid antitussive
Codeine and hydrocodone
what are expectorants ?
Renders cough more productive by stimulating flow of respiratory tract secretions
ex) Guaifenesin [Mucinex, Humibid]
