Respiratory Pharm II Flashcards
what kind of drugs are mast cell stabilizers?
what is their use?
What is the most important drug for this use?
mechanism of action?
how do we administer?
what animal?
anti-inflammatories used for inflammatory respiratory disease
> Effective in syndromes marked by mast cell activity and hypersensitive airways
> Sodium Cromoglycate
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q Mechanism of action unclear
q Inhibit release of mast cell inflammatory mediators; preventative !
> No direct bronchodilator properties
q Also modulate leukocyte function and distribution to airways q Administered via inhalers or nebulized (1-2% solution)
> Use largely limited to horses at this time
use of antitussives for inflammatory respiratory disease?
- when are the useful?
- what animals?
- what drug classes are used? mechanism of action?
Can be beneficial provided cough is not productive !!
q Chronic cough can cause airway injury, syncope, fatigue & delay sleep
q Ideally reduce cough frequency and severity without impairing mucociliary
apparatus
> Useful in dogs; can be useful in cats; rarely indicated in horses
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Centrally-acting antitussives classified as opioid and non-opioid agents
q Depress cough center via centrally-acting mechanisms in medulla
> Mechanisms are poorly understood for non-opioids
> Opioids may suppress cough via kappa or mu opiate receptors
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Other drug classes may produce antitussive effects
q Bronchodilators, by inhibition of bronchoconstriction
q Mucolytics/expectorants, by removing irritant
popular non-opioid antitussive for vet use
Dextromethorphan (Benylin DM, Robitussin DM)
Dextromethorphan
- what is this drug? what is its use?
- mechanism of action?
- what drug is it related to?
- not reccommended for what animal?
non-opioid antitussive
Dextromethorphan (Benylin DM, Robitussin DM)
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q Non-narcotic opiate derivative of codeine; no opioid receptor effects q It is the D-isomer of levorphan; L-isomer is an opiate
q No analgesic, sedative or addictive properties; cough threshold
q Antitussive potency similar to codeine with fewer side effects
> Available in combination with expectorants and decongestants
> Liquid and tablets available
> Caution; some preparations contain acetaminophen
> Not recommended in cats as an antitussive
> May not attain effective drug levels at current dosage recommendations in dogs; currently not recommended in dogs until more data is available on safety and efficacy
popular opioid antitussive drugs in vet med
- Butorphanol (Torbutrol®)
- Hydrocodone (Hycodan®, others)
Butorphanol
- what kind of drug is this? use for resp disease?
- what animals?
- comparison to similar drugs
- PK, bioavailability
opioid antitussive for inflammatory resp disease
q Antitussive and analgesic (most common use)
q Approved for use as antitussive in the dog; useful in cats also
q As antitussive-100X more potent than codeine; 4X more potent than
morphine
q Available as tablets and injectable
q High first-pass effect following oral administration; ~20% bioavailability
hydrocodone
- what kind of drug is this? use for resp disease?
- when to use?
- what animals
- comparison to similar drugs
- side effects
- formulations
opioid antitussive for inflammatory resp disease
q Useful in coughs not responding to other agents
q Used most frequently in the dog
q More potent than codeine
q Side effects can include constipation
q Usually formulated in combination with homatropine (Hycodan®) but
can be found combined with decongestants and expectorants
what do mucokinetic drugs do? when are they indicated? effects?
facilitate removal of secretions from respiratory tree
q Are indicated for mgmt of viscous pulmonary secretions
q Mucolytic and expectorant effects include…
> Improved ciliary activity; bronchodilators
> Increasing hydration and/or ionic strength of secretions; water, saline
> Rupturing sulfur (S-S) linkages in mucus
Mucolytic and expectorant effects include…
> Improved ciliary activity; bronchodilators
Increasing hydration and/or ionic strength of secretions; water, saline
Rupturing sulfur (S-S) linkages in mucus
what drug is good for rupturing sulfur linkages in mucus
N-Acetyl-L-Cysteine
> Oral, injectable and aerosolization (10% solution) are effective routes
(Mucomyst)
what is Dembrexine? use and properties? how to administer?
q Mucokinetic approved for use in horses
q Also possesses expectorant and secondary antitussive properties
q Administer 2X daily as a powder in the grain feed
what do expectorants do? effectiveness?
uses? mechanism?
- popular drugs
Expectorants increase fluidity (watery secretions) of respiratory secretions; evidence of effectiveness in animals is lacking
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Often used as adjuvants for cough management; secretions increased by:
- Vagal reflex > increase bronchiole secretions following GI mucosa irritation
> Potassium Iodide; or guaifenesin (Mucinex); components of many cough remedies
indications for decongestants
Indications include sinusitis (viral, allergic), reversing sneezing and other complications of postnasal drip—largely based on extrapolation from human use indications
types of decongestants used in vet med
- H1 antihistamines (antagonists)
q Dimenhydrinate (Gravol®), Diphenhydramine (Benadryl®) - Sympathomimetics
q Ephedrine, Pseudoephedrine, Phenylephrine
what type of drug is Dimenhydrinate? what are its effects?
side effects?
Decongestant, H1 antihistamines (antagonists)
> often combined with sympathomimetics
q Sedation can be a side-effect with older generation agents
q Systemic administration can cause cardiovascular and CNS adverse effects
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similar to Diphenhydramine (Benadryl)
