Respiratory Drugs Flashcards
What are 4 common respiratory conditions?
- Asthma
- COPD (chronic bronchitis and emphysema)
- Cystic fibrosis (CF)
- Acute respiratory distress syndrome (ARDS)
What is Bronchial Asthma?
Recurrent and reversible shortness of breath
- Happens when airways of the lungs become narrow due to Bronchospasms or inflammation of the bronchial mucosa (edema)
What is Chronic Bronchitis?
A continuous inflammation of the bronchi and bronchioles
What is Emphysema?
Occurs when air spaces enlarge as a result of the destruction of alveolar walls.
- This decreases gas exchange surface area
What are 2 examples of Bronchodilators
- Salbutamol (Ventalin)
- B2-adrenergic agonist - Ipratropium bromide (Atrovent)
- Anticholinergics - Theophylline/aminophylline
- Xanthine derivatives
What are 2 Anti inflammatory Drugs associated with the respiratory system?
- Budesonide (Pulmicort)
- Glucocorticoids - Montelukast (Singulair)
- Leukotriene modifiers
When are B-Agonists Bronchodilators used?
During the acute phase of asthmatic attacks
- It quickly reduces airway constriction and restores normal airflow
- Also used in chronic management
- A large group - sympathomimetics bronchodilators
What are the three types of B-Agonists Bronchodilators?
- Nonselective adrenergics (a and B)
- Stimulates a, B1 (cardiac) and B2 (SM)
- Eg. Epinephrine (Adrenalin) - Nonselective B-adrenergics
- Stimulates B1 and B2 receptors
- Isoproterenol - Selective B2 drugs
- Activate airways smooth muscle B2 receptors
- *Salbutamol (short acting)
- Salmeterol (long acting)
- Formoterol (long acting)
B-Agonist - Mechanism of Action
Dilation of airways
- Activation of B2 receptors increase cAMP
- Relaxes smooth muscles of airway and results in bronchial dilation and increased airflow
When is the best time to use B-Agonists?
During acute attacks and as well as preventative
B-Agonists - Common Adverse Effects
- Tachycardia due to B1 receptors being stimulated
- Tremors
- Restlessness, insomnia (CNS stimulation)
What are side effects specific to Salbutamol?
- B2 effects - muscle tremors, CNS (anxiety and nausea)
- B1 effects - incrased HR, palpitations, chest pains, angina
Occurs when inhaled too frequently
What are two important factors to be aware of when using Bronchodilators?
- Presence of smoking
2. *Adequate fluid intake
What therapeutic effects should you be monitoring for when using Bronchodilators?
- Decreased dyspnea
- Decreased wheezing, restlessness, and anxiety
- Improved respiratory patterns with return to normal rate and quality
- Improved activity tolerance
Anticholinergics - What is the mechanism of action, purpose, adverse effects and an example?
Ipratropium bromide (Atrovent)
Slower and prolonged action compared to salbutamol
Used to prevent bronchoconstriction
- COPD
- Long-term maintenance
*Not to be used alone for acute exacerbations
Can cause dry mouth or throat (cough). Minimal systemic effects
What are 2 examples of Xanthine Derivatives?
- Theophylline
- Oral - Aminophylline
- More water soluble form of theophylline. IV admin
Which group of Bronchodilators are similar to caffeine?
Xanthine derivative
When should you use Xanthine Derivatives?
In cases of chronic bronchitis, emphysema, mild-moderate cases of acute asthma, and in COPD management.
- Quick relief of bronchospasm
What are the 3 adverse effects of Xanthine Derivatives?
- CNS stimulation (anxiety, insomnia, seizures)
- CV stimulation
- Palpitations (increased force of contraction)
- Sinus tachycardia
- Ventricular dysrhythmias
- Diuresis - GI distress (nausea and vomiting)
Contradictions for Xanthine Derivatives?
- Allergy
- Cardiac dysrhythmias
- High risk of stroke
- Seizure disorders
- Peptic ulcers
What are the two main drug interactions to be aware of with Xanthine Derivatives?
Ciprofloxacin - inhibits liver CYP metabolism
Large amounts of caffeine can have deleterious effects
Xanthine Derivatives - Care implications
Patients should be aware of palpitations, nausea/vomiting, weakness/dizziness, chest pain, convulsions.
St. John’s Wort
- Increases metabolism of Xanthines
- Cigarette smoke also causes the above
Diets high in protein and low in carbohydrates lowers blood levels of xanthines
In what scenarios should you use Glucocorticoids?
When patients have chronic asthma and COPD
- Oral or IV for severe/short-term treatment
For prophylaxis treatment of asthma
Inhaled forms reduce systemic effects
- Takes several weeks for full therapeutic effect
What are 2 examples of inhaled Glucocorticoids
Budesonide (pulmicort)
Fluticasone (flovent)
- used in combination with B2-agonist salmeterol to make Advair diskus
What is a prominent adverse effect of Inhaled Glucocorticoids
Oral fungus infections like candida albicans
How can patients avoid oral fungal infections?
Gargle and rinse mouth with water after inhalation
What are 4 functions of Leukotriene Modulators?
- Prevent smooth muscle contraction of the bronchial airways
- Decrease mucus secretion
- Prevent vascular permeability
- Decrease neutrophil and other leukocyte infiltration to the lungs, preventing inflammation
What is an example of a Leukotriene receptor antagonist? (LRTAs)
Montelukast
When should you use Leukotriene Modulators
For the prophylactic and chronic treatment of asthma
- Not acute
