Respiratory Drugs Flashcards
Bronchodilators
Beta Adrenergic Agonists
Xanthine Derivitives
Anticholinergics
Beta Andrenergics
albuterol
levelbuterol
salmeterol
Short acting: Use PRN, rescue inhalers (albuterol, levalbuterol)
Long acting: Used for control or maintenance (salmeterol, formoterol)
Kinetics of Beta Andrenergics
Absorbed well thru GI and resp tract
Onset 5-15 min via inhalation, bronchodilation within 30 min
Renally excreted
MOA of Beta Andrenergics
Mimic SNS (Increase flight or flight) - stimulate receptors in smooth muscles of lungs to relax = bronchodilation
Relieve bronchospasms, facilitates mucous drainage and reduces airway resistance
Increase CAMP = Increase bronchodilation
NO ANTI-INFLAM ACTION
Cautions with Beta Andrenergics
Hypersensitivity to drug CV disease (Increase HR/BP) DM (Increase Blood sugar) Hyperthyroidism (Increase HR) Seizure disorder (Increase SNS)
Adverse effects of Beta Andrenergics
Tachy, palpations, anxiety Overuse can cause rebound bronchoconstriction Decrease K with dialysis HTN Cough N/V (when PO) Arrythmias Tremor, nervousness, dizziness Brochospasms, throat irritation
Education with Beta Andrenergics
Tolerance can develop with frequent use = tx failure
Teach fast acting is a rescue drug
Teach proper inhaler use
Limit caffeine intake (interferes with effectiveness)
Encourage hydration to thin secretions
Xanthine Derivitives
theophyline (P) (Theo-Dur, Slo-Bid)
Others end in “phyline” and caffeine
Kinetics of Xanthine Derivitives
No inhalers, PO/IV only Good oral absorption but food can alter Liver/Kidney Clearance influenced by smoking Used for chronic asthma NOT acute attacks
MOA of Xanthine Derivitives
Direct effect on smooth muscle in lungs and blood vessels = relaxation/dilation
Inhibit phosphodiasterase = Increased CAMP = Increased bronchodliation
Also dilate coronary arteries (decreased BP) and dilate renal arteries (Increase diuresis)
Cautions for Xanthine Derivitives
CV disease, arrythmias, seizure disease, Peptic ulcer disease, Liver/Renal disease
Adverse effects of Xanthine Derivitives
Hypotension
Hyperglycemia
Seizures
Fever, rash, tachypnea/tachycardia, arrythmias, irritability, N/V, Headache, Diuresis, Insomnia
Toxicity with Xanthine Derivitives
Therapeutic range: 5-20 mcg/ml
Mild = 30 mcg/mL
Potentially serious = 40 mcg/mL
Severe = 45 mcg/mL
Drug interactions with Xanthine Derivitives
Interacts with almost anything
Education with Xanthine Derivitives
Make a list of all OTC’s and share with provider
Avoid food/beverages w/ large amts of caffeine (chocolate)
Read OTC labels for caffeine content and other ingredients
Eat low-carb and high protein diets
Charcoaled-broiled beef can increase theo elimination
Smoking decreases theo levels
Do not use for an acute attack
Do not use with grapefruit = Increase toxicity levels
Anticholinergics
ipratropium (Atrovent), tiotropium (Spiriva, long acting), Tudorza (COPD tx)
Kinetics of Anticholinergics
Inhaler only No oral absorption, good resp absorption Partial hepatic metabolism, renal excretion Longer duration than adrenergic agonists Slower onset, used with beta agonists
MOA of Anticholinergics
Antagonize muscarinic recpetors = Decreased cGMP = bronchodilation
Cautions with Anticholinergics
Bladder obstruction, prostatic hypertrophy (BPH)
Closed angle glaucoma
Soy bean/peanut allergies
Lactose intolerant patients
So not use as single agent for bronchospasm, used with beta agonist
Adverse effects with Anticholinergics
Headache Dry mouth Anxiety Dizziness, palpitations, dry mouth, constipation, urinary retention, worsening of narrow angle glaucoma Can't see, spit, pee, or shit
