Respiratory Drugs Flashcards by Claire watkins

What are the 2 types of cough?

Productive/ Useful

Non-productive / Useless

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Which cough do you suppress?

Useless

ONLY suppress useful when its exhausting tho the patient

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What are the two types of cough medicine?

Expectorants

Suppressants

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How do cough expectorants work?

Mucolytic– reduce viscosity of the mucus secreations

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What are the 2 types of mucolytics?

Guaifenesin

NAC (Mucomyst)

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Who uses NAC?

Cystic Fibrosis

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What is as effective as guifenesin?

WATER

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What are the 3 types of cough suppressants?

Codeine (narcotic)
Dextromethorphan (OTC centrally acting)
Benzonatate (local numbing agent)

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What do you call DM abusers?

Syrup heads

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How do you treat ACE-I cough?

NOTHING, switch to ARM

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What is another name for cough suppressant?

anti-tussive

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What is asthma?

chronic inflammatory process of hyperactive bronchi

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What type of disorder is asthma?

Polygenic disorder- histamine, leukotrienes, prostaglandins

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Basic approach to asthma treatment?

Prevent allergen exposure
Reduce inflammation & hyperactivity
Dilate the narrowed bronchi

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How do glucocorticoids treat asthma?

reduce bronchial hyperactivity and inflammation

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How are glucocorticoids administered?

PO, IV, Inhalation

Use inhalation first (no systemic toxicity)

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are glucocorticoids lipophilic or hydrophilic?

Hydrophilic (so they stay in lungs)

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what is a/e of steroids?

thrush (inhalation)

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What are the 6 risks of steroids?

Sodium retention
Hyperglycemia
Osteopenia
PUD
Hypokalemia
Immune suppression

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Which steroids produce HPA suppression?

PO and IV (not inhaled)

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How do you manage PO/IV steroids?

TAPER doses, always administer in the morning (steroids are activating)

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What is a stress dose?

burst of steroids (50-100mg) to deal with stress since the body produces steroids to stress

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Who should get stress dose?

Addisons disease

What is risk of steroids?

growth stunting

What is Cromolyn?

Powder inhaler | Mast cell stabilizer, so reduces histamine release on exposure to allergens

When should you use Cromolyn?

Preventative therapy, does NOT terminate acute attacks. Role in exercise-induced asthma

B2 agonists do what?

Bronchodilators (stimulate B2 receptors on lungs and vasculature) Sympathomimetics

What is Primatene Mist?

OTC Epi, no longer available

Name the main short acting B2 agonist

Albuterol, rescue agent

How does albuterol come?

PO (syrup, tabelets) but they lose B2 selectivity so patient may complain of tachycardia

What are the long acting B2 agonists?

Salmeterol Formoterol SLOW ON SLOW OFF so not for acute attacks

What should you avoid in asthmatics?

Non-selective B blockers

What is Terbutaline?

B2 agonist with potent effects on smooth muscle, tocolytic

What is tocolytic?

Delays / reverses labor, opposite of misoprostol

What does ACh do to the lungs?

Opposite of epi/Ne, bronchoconstricts

What does anti-cholinergic do?

Bronchodilate, parasympatholytic agents

What is anti-cholinergic inhalers used for?

COPD, sometimes adjunct in asthma

What do anticholinergics end it?

"-tropium"

Leukotriene receptor antagonists are used for what?

second line agents for asthma but not many head-to-head comparisons with other forms.

What does PDE-4 do?

Phosphodiesterase Inhibitors 4- class of pacman like enzymes that chew up cAMP

What does cAMP do?

Bronchodilation

How does PDE-4 inhibitor work?

increases levels of cAMP = bronchodilation

Who should use PDE-4 inhibitors?

COPD assocated with chronic bronchitis, NOT emphysema

What else do PDE-4 inhibitors have?

anti-inflammatory properties

What does PDE-5 do?

causes erections

What is the association with the main PDE-4 inhibitor? name it and dosage

Roflumilast, 500mcg PO Qd, associated with suicidal ideations

What is status asthmaticus? What would you see? How do you treat?

life threatening emergency. See: mucus plugs, refractoriness to B2 agonists, respiratory acidosis. Treat with IV steroid therapy, may require intubation

Why does status asthmaticus occur?

not breathing = anaerobic metabolism takes over = lactic acid build up and CO2 build up

What does MDI stand for? What is in them?

Meter Dose Inhaler = active ingredient + propellant

What propellant is used?

HFAs have replaced CFCs (global warming risk)

How do you take a MDI?

shake, exhale, slowly inhale while you actuate MDI

MDI for elderly and children have what?

spacer

What is risk with MDI?

localized thrush-- treat with gargling warm water following administration

how do you know how much is in your MDI?

drop in water, if it floats its empty, sinks its completely full

What is a nebulizer?

converted solutions or suspensions of drugs into aerosols, usually driven by a gas or ionization process

What is the combination steroid inhaler?

Advair Diskus- steroid + long acting B2 agonist

Can drugs be absorbed through the lungs?

YES, put down ET tube, double the dose