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Advanced Pharm-McNeese > Respiratory Meds etc > Flashcards

Respiratory Meds etc Flashcards

1
Q

meds for treatment of Bronchospastic Disorders

A

-Bronchodilators
-Beta-2 receptor agonists (short-acting and long-acting),
anticholinergics (also known as antimuscarinics),
-methylxanthines in a variety of aerosol, oral and I.V. formulations.

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2
Q

Long Acting Beta-2 Receptor Agonists (arformoterol, formoterol, indacaterol, olodaterol, salmeterol, vilanterol)

A
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3
Q

Beta-2 Receptor Agonist Bronchodilators-SHORT-ACTING–ALBUTEROL

A

Although supposed to be a selective Beta-2 agonist, it activates Beta-1 receptors to some extent
- Useful in allergic asthma and in exercise-induced asthma
-CNS stimulation

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4
Q

Beta-2 Receptor Agonist Bronchodilators- -SHORT-ACTING-METAPROTERENOL

A

Administered orally as a syrup
Less effective for prophylaxis in exercise-induced asthma
o Less potent than albuterol
o Contraindicated in patients having an arrhythmia at the planned time of drug administration

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5
Q

Beta-2 Receptor Agonist Bronchodilators-SHORT-ACTING-TERBUTALINE

A

Beta-2 agonist, BUT has a fairly strong affinity and intrinsic activity on Beta-1 receptors.
- Fewer C.V. adverse effects when compared to epinephrine
-Not selective for the Beta-2 receptors
-Very likely to cause cardiovascular adverse effects; tachycardia, palpitations, hypertension, angina, tremors, and arrhythmias
-May cause paradoxical bronchospasm when administered by inhalation
-Expensive
-Contraindicated in patients having an arrhythmia at the planned time of the drug’s administration

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6
Q

Long Acting Beta-2 Receptor Agonists (arformoterol, formoterol, indacaterol, olodaterol, salmeterol, vilanterol)

A

-SELECTIVE
- Only administered as an inhalant.
- Longer duration of action 12-24hours
-Useful for prophylaxis of allergic and exercise-induced asthma
- Cannot be used to treat an acute attack of asthma
-black box” warning regarding a risk of asthma-related death (only in single entity long acting beta agonist products not the combination products)
- Contraindicated in patients with severe hypersensitivity to milk proteins

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7
Q

Anticholinergic (antimuscarinic) Bronchodilator Drugs; aclidinium (Tudorza)
glycopyrrolate (Seebri) (Lonhala)
ipratropium (Atrovent)
tiotropium (Spiriva)
umeclidinium (Incruse)
revefenacin (Yupelri)

A

antagonists to acetylcholine on muscarinic receptors located on the smooth muscle cells that make up the wall of the bronchi and bronchioles
- Only administered as an inhalant.
-Can be used to treat bronchospasm in asthma, chronic bronchitis and emphysema; as monotherapy, they are less effective in asthmatics than in chronic bronchitis and emphysema. In asthmatics, they are commonly prescribed together with a Beta-2 bronchodilator
-May cause dry mouth, blurred vision and drying of respiratory secretion
-Contraindicated in glaucoma
-May cause acute urinary retention in older adult men with (BPH);

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8
Q

Xanthine Bronchodilators; theophylline (Elixophylline) (Slo-phylline) (Theodur) (many others)
aminophylline (Aminophylline)

A

Stimulates the respiratory drive center in the brainstem;
Stimulates respiratory cilia; improves the mucus clearance(pts with chronic bronchitis)
Increases the contractile strength of the diaphragm; increases the force of the respiratory effort(helps pts with muscle weakness)
- Decreases pulmonary artery resistance; improves pulmonary blood flow and improves perfusion and oxygenation
-narrow margin of safety and low therapeutic index
Declined in importance in the treatment of asthma.

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9
Q

Xanthine Bronchodilators; Serum levels are increased in

A
  1. neonates and older adults
  2. liver disease
  3. congestive heart failure
  4. concomitant use of Beta-blockers
  5. concomitant use of erythromycin
  6. concomitant use of cimetidine (Tagamet)
  7. concomitant use of oral contraceptives
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10
Q

Xanthine Bronchodilators; Serum levels are decreased in

A

hildren age 1-16 years
9. cigarette smokers
10. concomitant use of phenobarbital
11. concomitant use of phenytoin (Dilantin)
12. concomitant use of rifampin
13. concomitant use of ketoconazole

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11
Q

Drugs Used For Treatment of Respiratory Inflammation

A

Leukotriene modifiers, corticosteroids and cromones

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12
Q

Leukotriene Modifiers;
zafirlukast (Accolate)
montelukast (Singulair)
zileuton (Zyflo/CR)

A

Zafirlukast and montelukast are leukotriene antagonists, meaning they block various leukotriene receptors. Zileuton is a 5-lipoxygenase inhibitor, which inhibits the formation of leukotrienes.
-prophylactically in asthma
-good for exercise-induced asthma
requires the presence of other anti-asthma medications to produce a desirable therapeutic response.
-known to cause neuropsychiatric events
-Not useful in acute bronchospasm

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13
Q

what are Leukotrienes

A

Leukotrienes are a type of inflammatory biomediator in the lung and have been shown to play a significant role in asthma and allergy. Use of these modifier drugs may prevent leukotriene-induced inflammation.

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14
Q

Zafirlukast is

A

a hepatic enzyme inhibitor; it is capable of increasing the serum concentrations of other drugs (pharmacokinetic potentiative drug-drug interaction)
- Zafirlukast must be taken on an empty stomach

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15
Q

Corticosteroid Drugs examples

A

ntravenous

o hydrocortisone (Solu-Cortef)
o methylprednisolone (Solu-Medrol)

  • Oral

o hydrocortisone (Hydrocortone)
o prednisone (Deltasone)
o dexamethasone (Decadron)
o betamethasone (Celestone)

  • Inhalational / Nasal
    beclomethasone (QVAR) / (Beconase)
    o budesonide (Pulmicort) / (Rhinocort)
    o fluticasone (Flovent, Armonair, Arnuity, Flovent))/ (Flonase)e
    (Nasacort)**available OTC
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16
Q

Corticosteroid Drugs

A

bind to intracellular receptors enter the nucleus and interact with certain genes. This genetic sequence “activation” then inhibits synthesis of specific proteins, especially prostaglandins and cytokines, which play a key role in the inflammatory process
also prevents down-regulation of the Beta-2 receptors

17
Q

Corticosteroid Drugs pros and cons

A

-Most potent anti-inflammatory med for asthma
- Synergistic action with the Beta-2 receptor agonists in the treatment of asthmatic bronchospasm
-have it in nasal sprays
-slow onset-days to week for peak effect!
-Risk of adrenal suppression with long-term use (steroid dependent)
-Oro-pharyngeal irritation and infections from excessive use rise mouth after to avoid oral yeast infections
-Chronic long-term use of high doses can lead to serious steroid-related adverse effects; weight gain, peptic ulceration, muscle wasting, hyperglycemia, increased risk of infection, osteoporosis, etc

18
Q

Cromones(mast cell stabilzers) Used in Respiratory Disorders
-cromolyn sodium (Intal)

A

bind to mast c eels to prevent release of histamine and other inflammatory biomediators so interact with other inflammatory WBC (eosinophils and macrophages) to prevent release of their inflammatory biomediators

19
Q

Cromones pros and cons

A

-Useful as prophylaxis in allergic and exercise-induced asthma
-Synergistic with the other anti-asthmatic drugs; allows reduction in the doses of the Beta-2 agonists and especially the corticosteroids
- Not useful for an acute attack of bronchospasm
-Commonly provokes paradoxical bronchospasm
- Not useful in bronchitis or emphysema; histamine release does not play a large role in the pathophysiology of these conditions

20
Q

Mucolytic Agents
-N-acetylcysteine (Mucomyst) (Mucosil)
-dornase alfa (Pulmozyme) (DNase)

A

Mucolytics are used to enhance the clearance of airway secretions in conditions such as chronic bronchitis and cystic fibrosis.

21
Q

N-acetylcysteine
(its a mucolytic)

A

inhalant with rapid onset and minimal ADRs
-Requires a good cough reflex
May cause paradoxical bronchospasm
- Has a very unpleasant (“rotten egg”) odor;
-Can increase respiratory secretions
-Has not demonstrated clear benefits in cystic fibrosis nor non-cystic fibrosis related bronchiectasis.

22
Q

dornase alfa -mucolyic

A

recombinant product of the gene for the enzyme, DNase( cuts DNA into smaller sections) -sputum of patients with Cystic Fibrosis has high extracellular DNA content
- Improves pulmonary function and FEV1 in Cystic Fibrosis patients
-its a NEB
– NOT effective in non-cystic fibrosis related bronchiectasis.
-Keep in fridge

23
Q

cough and cold drugs

A

antitussives, antihistamines, decongestants and expectorants.

24
Q

DIPHENHYDRAMINE-antitussive

A

blocks H-1 receptors in the brain stem, the center of the cough reflex.
-Has anticholinergic ADR’
-May cause rentention, thicken secretions, constipation and paradoxical excitation in children
no-pregos /lactation

25
Q

BENZONATATE-antitussive

A

local anesthetic-blocks the propagation of nerve impulses from the sensory nerve endings in the bronchial mucosa.
Can cause drowsiness, dizziness, sedation, headache, mental confusion, hallucinations, -nausea and constipation
- Risk of allergic reaction manifested by bronchospasm, laryngospasm, cardiovascular collapse

26
Q

DEXTROMETHORPHAN

A

opiate drug. As such, it blocks opiate receptors in the brain stem and blocks the cough reflex by blocking nerve transmission in the cough center
- Suppresses cough without suppressing CNS
- Abuse among teens has risen dramatically
- May produce additive CNS suppression when used in combination with other CNS depressants (such as antihistamines, alcohol)

27
Q

CODEINE AND HYDROCODONE

A

true opiate drugs. As such, they block opiate receptors in the brain stem and block the transmission of irritant nerve impulse sensations through the cough center.

28
Q

first and the second generation antihistamine for cough

A

1st gen bind to peripheral (GI tract, uterus, blood vessels, bronchial muscle) H-1 receptors as well as central H-1 receptors, and can cause both CNS stimulation and depression. In comparison, 2nd gen are more selective for peripheral receptors and are therefore less sedating. 2ndgen seldom cross the blood brain barrier.

29
Q

Disadvantages FIRST GENERATION ANTIHISTAMINES

A

All produce CNS sedation, dizziness, drowsiness
- All produce varying degrees of anticholinergic adverse effects
- Tolerance is a common problem
- Some cause paradoxical excitation in children
- Commonly cause thickening of bronchial secretions; this is an anticholinergic effect
- Precaution required in glaucoma and BPH
- Some may cause hypertension and arrhythmias; precaution required in patients with cardiovascular diseases

30
Q

Disadvantages FIRST GENERATION ANTIHISTAMINES

A

All produce CNS sedation, dizziness, drowsiness
- All produce varying degrees of anticholinergic adverse effects
- Tolerance is a common problem
- Some cause paradoxical excitation in children
- Commonly cause thickening of bronchial secretions; this is an anticholinergic effect
- Precaution required in glaucoma and BPH
- Some may cause hypertension and arrhythmias; precaution required in patients with cardiovascular diseases

31
Q

Disadvantages SECOND GENERATION ANTIHISTAMINES

A

More expensive than first generation
All have anticholinergic adverse effects (see first generation agents)
- Cause thickening of bronchial secretions
- Precaution required in glaucoma and BPH
- May cause confusion in older adults
- Astelin Nasal Spray may cause bitter taste and nasal burning; Pregnancy Category C listing

32
Q

Nasal Decongestants
ephedrine
phenylephrine (Neo-synephrine)
oxymetazoline (Afrin) (Dristan)
pseudoephedrine (Sudafed)

A

Activate alpha 1 receptors but are not selcetive a-1

33
Q

EPHEDRINE Nasal Decongestants

A

Also activates Beta-2 receptors; has mild bronchodilator action, but not enough to relieve serious bronchospasm like asthm
- Ephedrine-containing products have been used to make methamphetamine
-CNS stimulation
-Careful in heart disease; can cause HTN, Tachycardia
-no glaucoma

34
Q

PSEUDOEPHEDRINE

A

-CNS stimulation
-Careful in heart disease; can cause HTN, Tachycardia
-no glaucoma
-can cause Anorexia –Pseudoephedrine-containing products have also been used to make meth

35
Q

PHENYLEPHRINE

A

-Rapid Onset
-Tolerance and tachyphylaxis are common
- precaution in patients with cardiovascular diseases; commonly caused palpitations, hypertension, arrhythmias, tachycardia
- Commonly causes anxiety, tremors, nervousness
-precaution in pregnancy; probably contraindicated in lactation
- Nasal spray use limited to 3-5 days due to rebound congestion

36
Q

OXYMETAZOLINE

A

-OTC
Nasal drops can cause burning, stinging in nose
- Tolerance and tachyphylaxis are common
- Precaution required in C.V. disease; ma
- Use limited to 3-5 days due to rebound congestion.

37
Q

Expectorants
Guaifenesin (Robitussin)

A

stimulating secretion of thin watery secretions in the resp tract, water content of the resp mucus is increased, making it thinner.
safe in pregos-OTC
Guaifenesin is Pregnancy Category C
May increase the volume of respiratory secretions; this may add to a patient’s airway obstruction if he/she has a poor cough effort

Advanced Pharm-McNeese (5 decks)

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