Respiratory Meds Flashcards
Antihistamines
- blocks histamines from H1 receptor sites and prevents histamine (inflammatory) response
- decreases nasopharyngeal secretions, itching
- 1st and 2nd gen antihistamines
1st Gen Antihistamines
- -mine
- S/E: drowsiness, dry mouth, blurred vision, fluid retention
diphenhydramine (benadryl) anticholinergic, chlorpheniramine is cardiac safe
2nd Gen Antihistamines
- -dine
- preferred over 1st gen
- for daily use
- less drowsiness & other anticholinergic symptoms
loratadine (claritin), fexofenadine (allegra)
loratadine given sublingual, not strong enough for violent anaphylactic response
Diphenhydramine
Benadryl
- used for acute/allergic rhinitis, pruritis, urticaria, common cold, sneezing, cough, motion sickness prevention
- S/E: drowsiness, dry mouth, dizziness, fatigue, blurred vision, disturbed coordination, urinary retention
- 98% protein bound drug (may interact w/ warfarin, gemfibrozil)
- onset 30-60 min, don’t take when driving
- contraindicated in Hx glaucoma, urinary retention, severe liver disease
- interacts w/ CNS depressants
suggest candy/gum for dry mouth
Nasal Decongestants
- stimulates alpha adrenergic receptors
- produces nasal vascular constriction, shrinks nasal mucous membranes, reduces nasal secretions
- S/E: nervousness, restlessness, rebound nasal congestion w/ prolonged use, HTN, renal failure, dysrhythmias
- may interact w/ caffeine, MAOIs, beta blockers
pseudophedrine, ephedrine, oxymetazoline (afrin)
max use 72 hrs
Intranasal glucocorticoids
- antiinflamatory steroids that decrease rhinorrhea, sneezing, congestion
- S/E: drowsiness, dizziness, nervousness, GI distress if swallowed, over drying w/ increased use
beclamethasone, fluticasone (flonase)
Antitussives
- act on cough control center in medulla to suppress cough reflex
- usually used w/ expectorants or other agents
- Rx
- same S/E as opiates
- often opioids, may be nonopioid
codeine and codeine & guaifenesin are narc, benzonatate non-narc
benzonatate aka tessalon pearls
Expectorants
- loosens bronchial secretions by reducing surface tension via dilution/thinning
- allows for elimination via coughing, does not cause coughing
- S/E: drowsiness, dizziness, irritability, nausea
guaifenesin (mucinex), dextrimethorphan (robitussin)
Restrictive vs Obstructive lung diseases
- restrictive causes decreased air capacity (issue with inhalation)
- obstructive causes air trapping (issue with exhalation)
Diseases w/in COPD
- chronic bronchitis, asthma, emphysema
Bronchial Asthma
- allergens attach to mast cells and basophils causing antigen-antibody reaction on mast cells
- mast cells stimulate release of chemical mediators and initiate the inflammatory process
MCAS
Chronic bronchitis
- “blue bloaters”
- dusky/cyanotic color, hypoxia, hypercapnia, respiratory acidosis, increasd Hgb, exertional dyspnea, clubbing, use of accessory muscles
Epinephrine
- bronchodilator
- catecholamine
- used for acute bronchospasms, asthma, anaphylaxis, angioedema, nasal congestion, status asthmaticus
- S/E: dizziness, nervousness, tremors, HTN, palpitations, tachycardia, dysrhythmias, angina
Albuterol
- selective beta adrenergic
- bronchodilator
- rapid onset (for rescue use)
- longer duration
- fewer side effects
- S/E: headache, rhinitis, excitability, tremors, bronchospasm, palpitations, tachycardia
Metaproterenol
- selective beta adrenergic
- inhalation
- long term asthma treatment
- S/E: headache, tremors, nausea, palpitations, tachycardia
Tiotropium
- anticholinergic
- maintenance treatment of bronchospasms associated w/ COPD
- S/E: dry mouth, GI distress, depression, insomnia, headache, pharyngitis, sinusitis, infection, arthralgia, peripheral edema
Iprotropium
- anticholinergic
- combined in a dose w/ albuterol to augment its effects
DuoNeb
Methylxanthine derivatives
- relaxes smooth muscle of bronchi/bronchioles & promotes bronchodilation
- used for asthma
- therapeutic range –> 5-15 mcg/mL (toxic >20)
- S/E: hyperreflexia, GI distress, seizures, insomnia, hyperglycemia, hypotension
Theophylline
rhymes with caffeine, similar s/e
What is the first choice/best mucolytic?
Water
Leukotriene receptor antagonists
- -kast and/or z
- reduce inflammatory process and decrease bronchoconstriction
- for long-term prophylaxis, not acute distress
- used for asthma, prophylaxis of exercise-induced bronchospasms
- S/E: dizziness, headache, confusion, GI distress, depression, weakness, infection, liver impairment
zafirlukast, zileuton, montelukast
Complementary therapy interactions
- ephedra may increase effect of theophylline & cause toxicity
- St. John’s wort may decrease montelukast concentration
Glucocorticoids
steroids
- -sone
- made in adrenal cortex, driven by pituitary gland
- antiinflammatory effect
- S/E: dry mouth, throat irritation, hyperglycemia, HTN, electrolyte imbalance, fluid retention, osteoporosis, psychosis, superinfections
- cannot abruptly stop taking, can be fatal
Cromolyn sodium
- inhibits histamine release from mast cells
- prevents asthmatic attacks
- good for kids
- S/E: cough, bad taste, rebound bronchospasm
Acetylcystine
- mucolytic
- liquifies and loosens thick mucus secretions
- nebulizer 5 min after bronchodilator
- should not be mixed w/ other drugs, can be mixed w/ flavor
- S/E: stomatitis, rhinorrhea, N/V
also antidote for acetaminophen
Dornase alfa
- mucolytic
- breaks down DNA in thick sputum of cystic fibrosis pts
- S/E: sore throat, laryngitis, horseness, chest pain
Trimethoprim-sulfamethoxazole
Bactrim
- antibiotic/antimicrobial
- used to treat mild to moderate exacerbations of chronic bronchitis from infectious causes
