Respiratory infections and drugs Flashcards
What makes up the upper respiratory tract?
nasal/oropharynx plus trachea
What makes up the lower respiratory tract?
lower trachea, lungs
What are upper respiratory tract disorders?
nasal congestion, allergic rhinitis, cough productive and non-productive
What are lower respiratory tract issues?
pulmonary congestion, acute or chronic asthma, COPD which is emphysema plus chronic bronchitis
Where do codeine, hydrocodone, and dextromethorphan work for respiratory issues?
medullary cough center
What are the beta agonists that work in the llungs?
Short aacting beta 2 agonists and long acting beta 2 agonists often combined with corticosteroids
What is albuterol for?
Short acting beta 2 agonist prototype with minor beta 1 activity;
How do you get levalbuterol?
Remove the s-isomer from the racemic albuterol
What are the differences between albuterol and levalbuterol?
Albuterol is the racemic mixture of R and S isomers;
R is the active isomer responsible for bronchodilation;
S-isomer doesn’t have any therapeutic effect but has been implicated in some bronchospasm
Levalbuterol is the R isomer
What are the benefits of levalbuterol?
More active so maybe fewer nebulizer treatments, more costly,
What is salmeterol?
it is more selective for beta 2 than albuterol and has minor beta 1 activity; onset is 45 minutes with 12 hour activity; not meant to be used as a rescue inhaler
What are precautions and contraindiciations of respiratory beta 2 agonists?
cardiac arrythmias that occur as dosage increases and beta 2 selectivity decreases and beta 1 increases;
there can be potential drug induced hyperglycemai in diabetics;
Long acting beta agonists like salmeterol and formoterol risks outweight benefits and shouldn’t be used by itself in asthma for any age; There is a 2 fold risk of incidents and death; shouldn’t be used as rescue inhaler; use with corticosteroids;
albuterol is safe for use in children
What are the adverse drug reactions of beta agonist?
tachycardia and palpitations when beta 2 selectivity is lost; headache, CNs issues like tremors
What are beta agonist drug interactions?
beta blocking agents that are in competition with beta agonists; therapeutic effect of both meds are lost; includes beta blocker eye drops
What are the clnical uses for beta agonists?
bronchospasm related to asthma, bronchitis, and copd
What is albuterol dosing?
2 puffs every 4 to 6 hours; immediate acting is useful for acute exacerbations; nebulizer dose is 2.5 mg, can be repeated after 5 to 10 minutes; can be combined with ipratropium
What is salmeterol dosing?
Diskus 1 puff twice a day; not good for exacerbations; don’t use for persistent asthma; combine with corticosteroid
How are exercise induced bronchospasms treated?
2 puffs of albuterol 15 minutes before exericse; considered a rescue inhaler;
salmeterol 2 puffs 30 -60 minutes before exercise; don’t take if already taking daily dose of salmeterol; don’t take as needed
What is patient education for beta agonists?
demonstrate metered dose inhaler and have patient teach back; check inhaler if patient says it isn’t working;
use spacer for patients having trouble administering
What are xanthin derivatives?
oral agents like theophylline and IV agents like aminophylline and caffeien
How does theophylline/caffeine work?
inhibits phosphodiesterase enzyme in bronchial smooth muscle, leading to bronchial dilation
2nd or third line drug for asthma or COPD
What are precautions and contraindications for theophylline/caffeine
monitor patients with heart issues, monitor for theophylline toxicity, takes longer to clear with renal dysfunction
What are teh adverse drug reactions of theophylline/caffeine?
cardiac arrythmias, tachycarida, insomina, agitation, HA, N/V, toxicty greater than twenty causes all previously mentioned, toxicity greater than 35 can causes arrythmias, tachycardia, hypotension, hyperglycemai, death, seizures, brain damage
What are theophylline food and drug interactions?
interactions due to metabolism enzymes: decreased interaction with ketoconazole and fluconazle; increased action with phenobarbital and phenytoin; smoking tobacco adds to clearance, beta agonists may increase toxicity
What are drug interactions with caffeine?
metabolic inteference with enzymes; decreased metabolism with ketoconazole and fluconazole, increased with phenobarbital and phenytoin
What are caffeien adverse drug reactions?
cardiac arrythmias, tachycarida, agitation, insominia, HA, N/V
What is apnea of prematurity?
apnea in premature babies that lasts mroe than 20 seconds
How is apnea of prematurity treated?
caffiene citrate 10 to 20 mg/kg given, maintenance dose of 5 mg/kg daily
What should be monitored with theophylline?
signs of toxicity, draw frequently when trying to titrate to good level (8-12 mcg/mL); after titrated, draw every 6-12 months or when new drugs are added or deleted
What is patient education for theophylline?
take exactly as presribed, avoid drinking large amounts of caffiene
What are examples of inhaled anticholinergics?
ipatropium bromide and tiotropium bromide
How does Atrovert work?
Blocks muscarinic receptors in smooth muscle; causes smooth muscle relaxation
How does spiriva work?
inhibits muscarinic receptors in lungs; causes smooth muscle relaxation
