Respiratory, Gastrointestinal, Endocrine & Bone Mineral Density Flashcards
Drugs that DECREASE VISCOSITY of secretions and help prevent thick mucus from blocking respiratory pathways. Commonly used to treat COPD & pneumonia
Mucolytics
Facilitate PRODUCTION & EJECTION of mucus and helps prevent thick mucus from blocking respiratory pathways. Commonly used to treat COPD and pneumonia.
Expectorants (Guaifensesin)
Two classifications of medications used to treat obstructive pulmonary disease
Bronchodilators & Anti-inflammatory agents
Types of Bronchodilators
Beta-adrenergic agonists, Xanthine derivatives, & anticholinergics
Anti-inflammatory agent used for obstructive pulmonary diseases
Glucocorticoids
Beta-Adrenergic Agents
Stimulation of beta-2 receptors on respiratory smooth muscle cells to cause RELAXATION via bronchodilation. Can be selective or nonselective
Ex: Albuterol, Levalbuterol, Salmeterol
Route of administration for Beta-adrenergic agents
Inhalation (preferred - inhalers or nebulizers), orally, and subcutaneously
Adverse effects of beta-adrenergic agents
Tolerance, cardiac irregularities (nonselective), stimulation of CNS receptors causing nervousness, restlessness, and tremor
Xanthine Derivatives
Treat airway obstruction by producing bronchodilation - Mechanism is debated upon.
Ex: Theophylline, caffeine, aminophylline
Adverse effects of xanthine derivatives
Toxicity (overlap of therapeutic & toxic ranges) - Nausea, confusion, irritability, and restlessness. Cardiac arrhythmias, fatal seizures
Anticholinergic Drugs
Block the acetylcholine receptors on respiratory smooth muscle cells to prevent vasoconstriction caused by increased vagal tone and acetylcholine release – Result in bronchodilation
Choice drug in COPD treatment
Choice drug in COPD treatment
Anticholinergic Drugs
Glucocorticoids
Control inflammation induced bronchospasms by causing powerful anti-inflammatory effects
Most effective drug at controlling asthma
Glucocorticoids
What should be done after taking glucocorticoid medications by mouth?
Rinse mouth out after to reduce risk of oral irritation
Adverse effects of glucocorticoids
Osteoporosis, skin breakdown, muscle wasting, retardation of growth, cataracts, glaucoma, hyperglycemia, & aggravation of DM/HTN
Leukotriene Inhibitors
Inflammatory compounds used to control airway inflammation - Combined with glucocorticoids and beta agonists for better management of COPD & asthma
First line of defense for LONG TERM asthma management - Main treatment for asthma
Glucocorticoids - Combined with beta-2 agonists for optimal results
Why are glucocorticoids preferred for asthma over bronchodilators?
They reduce the inflammation that underlies asthma, not just treat the secondary manifestations
Best choice for asthma attacks
Short acting beta-2 agonist. Leukotriene inhibitors can also be used to control inflammation
First choice drug for treating COPD by maintaining airway patency and prevent airflow restriction
Anticholinergics
Long-acting beta-2 agonists are also used to promote bronchodilation
Pharmacological management for maintaining airway patency in Cystic Fibrosis
Bronchodilators and mucolytics or expectorants limit formation of mucus plugs.
Systemic glucocorticoids are useful in limiting airway inflammation and improving pulmonary function (prednisone)
When should PT be scheduled after administration of medication?
30-60 minutes after mucolytic and expectorants are given via nebulizer
Bronchodilator Toxicity
Cardiac arrhythmias, nervousness, confusion, tremors (systemic effects)
Rehab considerations for Glucocorticoid treatment
Skin breakdown
Prevent overstressing of bones/musculotendinous structures
Drugs that control & limit gastric acid
Antacids, H2 receptor blockers, & proton pump inhibitors
Antacids
Neutralize stomach acids
Types include aluminum, magnesium, sodium bicarbonate or combinations
Adverse effects of antacids
Electrolyte imbalances, changes in other drug pharmacokinetics that rely on stomach acidity (should NOT be taken within 2 hours of other orally administered drugs)
H2 Receptor Blockers
Prevent stimulation of gastric acid secretions by blocking histamine receptors
Treat acute and long-term management of peptic ulcer & GERD
Side Effects of H2 receptor blockers
Headache, dizziness, mild GI problems, arthralgia, myalgias, tolerance
Proton Pump Inhibitors
Inhibit the enzyme responsible for secreting acid from gastric parietal cells by 80-95%
Drug of choice for long-term management of gastric/duodenal ulcers & GERD
Proton Pump Inhibitors
Adverse effects of PPI
Gastric acid rebound, gastric polyps, GI tumors, decreased bone mineralization and risk of fx
Clinical Use of Endocrine Drugs
- Replacement Therapy
- Diagnosis of Endocrine Disorders
- Exploitation of beneficial effects
- Alter normal endocrine function
Adrenocorticosteroids (2)
Glucocorticoids & Mineralcorticoids
Primarily involved in control of glucose metabolism and body’s ability to deal with stress - Decreases inflammation and suppresses immune system
Glucocortocoids
Maintains fluid and electrolyte balances in the body
Mineralcorticoids - Ex: Aldosterone
Glucocorticoids - Endocrine Indications
- Restore normal function after adrenal cortical hypofunction (Addison’s)
- After removal of adrenal glands or pituitary gland
- Rheumatoid arthritis
- Manage systemic inflammation
- Treat severe acute inflammation (no more than 4)
- Control inflammation or suppress immune system for short-periods of time
Adverse effects of endocrine glucocorticoids
Adrenocortical suppression, drug induced Cushing’s Syndrome (hypersecretion), breakdown of tissues (catabolic effect), loss of bone strength (osteoclast), peptic ulcers, slow growth, etc.
Aldosterone (Mineralcorticoids)
Maintains fluid & electrolye balance within the body - Works on kidneys to increase sodium & water reabsorption and excretion of potassium
Commonly used as replacement therapy - Addison’s disease
Negative Physiological Effect of Aldosterone
Increased production promotes renal sodium and water retention – Leads to HTN and heart failure
Can also cause inflammation, hypertrophy, and fibrosis of cardiac/vascular tissues
Adverse effects of mineralcorticoids
HTN, edema, weight gain, hypokalemia
Mineralcorticoid Antagonists
Potassium sparing diuretics used to treat HTN and heart failure
Conditions treated with Glucocorticoids
Obstructive pulmonary disease (asthma, cystic fibrosis), endocrine issues
More specific: RA, ankylosing spondylitis, lupus erythematosus, acute bursitis
What kind of supplements are taken to prevent bone loss in OP, Rickets, Osteomalacia, & Hypoparathyroidism?
Calcium Supplements
Maximum tolerated dose of Ca per day?
2,500 mg/day
Any dose above 1,000mg/day increases risk of arterial calcification and cardiovascular disease
Adverse Effects of Calcium Supplements
Hypercalcemia (constipation, drowsiness, fatigue, headache), confusion, irritability, cardiac arrhythmias, HTN, N/V
Vitamin D
Increase intestinal absorption of calcium and phosphate
Too much can cause vitamin D toxicity
Bisphosphonates
Inhibit osteoclast activity, promote bone mineralization, inhibit abnormal bone formation, prevent bone pain/fractures, and prevent bone loss
Primary treatment for Osteoporosis?
Bisphosphonates
Adverse Effects of Bisphosphonates
Death of bone tissue in jaw (osteonecrosis), atypical subtrochanteric hip fx, GI disturbances
Calcitonin
Mimics endogenous calcitonin
Prevents bone loss in OA, postmenopausal OP, and glucocorticoid induced OP
Rehab implications for Estrogen Therapy
Enhance bone mineralization by incorporating weight bearing & resistance exercises
