Respiratory infections and drugs

Question 1

What makes up the upper respiratory tract?

Answer 1

nasal/oropharynx plus trachea

Question 2

What makes up the lower respiratory tract?

Answer 2

lower trachea, lungs

Question 3

What are upper respiratory tract disorders?

Answer 3

nasal congestion, allergic rhinitis, cough productive and non-productive

Question 4

What are lower respiratory tract issues?

Answer 4

pulmonary congestion, acute or chronic asthma, COPD which is emphysema plus chronic bronchitis

Question 5

Where do codeine, hydrocodone, and dextromethorphan work for respiratory issues?

Answer 5

medullary cough center

Question 6

What are the beta agonists that work in the llungs?

Answer 6

Short aacting beta 2 agonists and long acting beta 2 agonists often combined with corticosteroids

Question 7

What is albuterol for?

Answer 7

Short acting beta 2 agonist prototype with minor beta 1 activity;

Question 8

How do you get levalbuterol?

Answer 8

Remove the s-isomer from the racemic albuterol

Question 9

What are the differences between albuterol and levalbuterol?

Answer 9

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

Question 10

What are the benefits of levalbuterol?

Answer 10

More active so maybe fewer nebulizer treatments, more costly,

Question 11

What is salmeterol?

Answer 11

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

Question 12

What are precautions and contraindiciations of respiratory beta 2 agonists?

Answer 12

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

Question 13

What are the adverse drug reactions of beta agonist?

Answer 13

tachycardia and palpitations when beta 2 selectivity is lost; headache, CNs issues like tremors

Question 14

What are beta agonist drug interactions?

Answer 14

beta blocking agents that are in competition with beta agonists; therapeutic effect of both meds are lost; includes beta blocker eye drops

Question 15

What are the clnical uses for beta agonists?

Answer 15

bronchospasm related to asthma, bronchitis, and copd

Question 16

What is albuterol dosing?

Answer 16

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

Question 17

What is salmeterol dosing?

Answer 17

Diskus 1 puff twice a day; not good for exacerbations; don’t use for persistent asthma; combine with corticosteroid

Question 18

How are exercise induced bronchospasms treated?

Answer 18

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

Question 19

What is patient education for beta agonists?

Answer 19

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

Question 20

What are xanthin derivatives?

Answer 20

oral agents like theophylline and IV agents like aminophylline and caffeien

Question 21

How does theophylline/caffeine work?

Answer 21

inhibits phosphodiesterase enzyme in bronchial smooth muscle, leading to bronchial dilation
2nd or third line drug for asthma or COPD

Question 22

What are precautions and contraindications for theophylline/caffeine

Answer 22

monitor patients with heart issues, monitor for theophylline toxicity, takes longer to clear with renal dysfunction

Question 23

What are teh adverse drug reactions of theophylline/caffeine?

Answer 23

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

Question 24

What are theophylline food and drug interactions?

Answer 24

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

Question 25

What are drug interactions with caffeine?

Answer 25

metabolic inteference with enzymes; decreased metabolism with ketoconazole and fluconazole, increased with phenobarbital and phenytoin

Question 26

What are caffeien adverse drug reactions?

Answer 26

cardiac arrythmias, tachycarida, agitation, insominia, HA, N/V

Question 27

What is apnea of prematurity?

Answer 27

apnea in premature babies that lasts mroe than 20 seconds

Question 28

How is apnea of prematurity treated?

Answer 28

caffiene citrate 10 to 20 mg/kg given, maintenance dose of 5 mg/kg daily

Question 29

What should be monitored with theophylline?

Answer 29

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

Question 30

What is patient education for theophylline?

Answer 30

take exactly as presribed, avoid drinking large amounts of caffiene

Question 31

What are examples of inhaled anticholinergics?

Answer 31

ipatropium bromide and tiotropium bromide

Question 32

How does Atrovert work?

Answer 32

Blocks muscarinic receptors in smooth muscle; causes smooth muscle relaxation

Question 33

How does spiriva work?

Answer 33

inhibits muscarinic receptors in lungs; causes smooth muscle relaxation