Respiratory Drugs

Question 1

Bronchodilators

Answer 1

Beta Adrenergic Agonists
Xanthine Derivitives
Anticholinergics

Question 2

Beta Andrenergics

Answer 2

albuterol
levelbuterol
salmeterol
Short acting: Use PRN, rescue inhalers (albuterol, levalbuterol)
Long acting: Used for control or maintenance (salmeterol, formoterol)

Question 3

Kinetics of Beta Andrenergics

Answer 3

Absorbed well thru GI and resp tract
Onset 5-15 min via inhalation, bronchodilation within 30 min
Renally excreted

Question 4

MOA of Beta Andrenergics

Answer 4

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

Question 5

Cautions with Beta Andrenergics

Answer 5

Hypersensitivity to drug
CV disease (Increase HR/BP)
DM (Increase Blood sugar)
Hyperthyroidism (Increase HR)
Seizure disorder (Increase SNS)

Question 6

Adverse effects of Beta Andrenergics

Answer 6

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

Question 7

Education with Beta Andrenergics

Answer 7

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

Question 8

Xanthine Derivitives

Answer 8

theophyline (P) (Theo-Dur, Slo-Bid)

Others end in “phyline” and caffeine

Question 9

Kinetics of Xanthine Derivitives

Answer 9

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

Question 10

MOA of Xanthine Derivitives

Answer 10

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)

Question 11

Cautions for Xanthine Derivitives

Answer 11

CV disease, arrythmias, seizure disease, Peptic ulcer disease, Liver/Renal disease

Question 12

Adverse effects of Xanthine Derivitives

Answer 12

Hypotension
Hyperglycemia
Seizures
Fever, rash, tachypnea/tachycardia, arrythmias, irritability, N/V, Headache, Diuresis, Insomnia

Question 13

Toxicity with Xanthine Derivitives

Answer 13

Therapeutic range: 5-20 mcg/ml
Mild = 30 mcg/mL
Potentially serious = 40 mcg/mL
Severe = 45 mcg/mL

Question 14

Drug interactions with Xanthine Derivitives

Answer 14

Interacts with almost anything

Question 15

Education with Xanthine Derivitives

Answer 15

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

Question 16

Anticholinergics

Answer 16

ipratropium (Atrovent), tiotropium (Spiriva, long acting), Tudorza (COPD tx)

Question 17

Kinetics of Anticholinergics

Answer 17

Inhaler only
No oral absorption, good resp absorption
Partial hepatic metabolism, renal excretion
Longer duration than adrenergic agonists
Slower onset, used with beta agonists

Question 18

MOA of Anticholinergics

Answer 18

Antagonize muscarinic recpetors = Decreased cGMP = bronchodilation

Question 19

Cautions with Anticholinergics

Answer 19

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

Question 20

Adverse effects with Anticholinergics

Answer 20

Headache
Dry mouth
Anxiety
Dizziness, palpitations, dry mouth, constipation, urinary retention, worsening of narrow angle glaucoma
Can't see, spit, pee, or shit