Respiratory Pharmacology Flashcards
What are the two main respiratory pathologies?
Asthma and COPD
Characteristics of asthma
- Episodic and reversible
- Inflammatory condition
- Marked by a reduction in expiratory air flow (bronchioles obstructed by muscle spasm, edema of mucoa and thick secretions)
What medication would be used for immediate relief of asthma?
Albuterol
What medication would be used for long-term treatment of asthma?
Anti-inflammatory steroid
What is asthma precipitated by?
Precipitated by allergens, pollution, exercise, stress, upper respiratory infection, sulfites
What are the symptoms of asthma?
- Symptoms include wheezing and shortness of breath
Characteristics of COPD
- Chronic and irreversible airway obstruction
- Air Trapping
What are the two types of COPD?
- Emphysema
- Chronic bronchitis
What is emphysema?
- Alveolar destruction
- Airspace enlargement
- Airway collapse
- Slow onset usually due to smoking, may resmble old age
What do we not give pts w/ COPD?
Nitrous
What is a possible surgical treatment for COPD
Lobectomy
What is the main treatment for respiratory pathologies?
Metered dose inhalers that deliver medication directly to the bronchioles
What are the advantages of metered dose inhalers?
- Lower dose means less adverse effects
- Greater bronchiodilating effect
- Can be accurately measured
- Rapid, predictable onset of action
Disadvantages of metered dose inhalers
Difficult to use properly
Easily overused which can lead to diminished response
Need for “spacer”
What type of autonomic agents are used in the treatment of respiratory pathologies?
- Short-acting beta-2 agonists
- Cholinergic Antagonists
- Inhaled corticosteroids
- Leukotriene receptor antagonists
- Antihistamines
What are short-acting beta-2 agonists used for?
“Rescue Inhalers”
Albuterol
Used for acute episodes or management of mild symptoms
Why are long-acting beta-2 agonists use controversial?
Long acting beta agonists can cause death
-Not a tx for asthma
-Not anti-inflammatory
What are cholinergic antagonists used for?
- Management of moderate to severe COPD
- Management of chronic bronchoconstriction
- NOT for acute episodes
What are some adverse effects of beta-2 agonists?
- Increased HR and BP
- Anxiety
- Tremor
- Xerostomia
What are some adverse effects of cholinergic antagonists?
- Blurred vision and sensitivity to light
- Headache
- Nausea
- Cough
- Tachychardia
- Xerostomia and altered taste
What is the mechinism of action of inhaled corticosteroids?
- Reduce hypersensitivity of airway to allergens
- Reduce inflammation
-Decrease narrowing of airways
-Decrease swelling at bronchioles
What are some types of inhaled corticosteroids?
Qvar (beclomethasone)
Flovent (fluticasone)
Pulmicort (budesonide)
What are some adverse effects of inhaled corticosteroids?
Xerostomia
Hoarse voice
Cough
Increased fungal infections (oral candidiasis)
What are the 4 I’s?
When you take a drug that reduces inflammation:
* Reduced immunity
* Increased risk of infection
* Impaired wound healing
What condition may people have when they use inhaled corticosteroids that they may not realize they have until a clinician looks in their mouth? How can this be prevented?
- Fungal pharyngitis
- Pt. should be instructed to gargle and rinse w/ water after use
When using a corticosteroid and beta-2 agonist together, which should be used first?
Beta-2 agonist
What is the mechanism of action of leukotriene receptor antagonists?
- Block the action fo leukotrienes (inflammatory mediators)
- Inhibit the immune response to allergens
- Decrease airway contriction, mucous secretion
- Promote bronchodilation
What form are leukotriene receptor antagonists made in?
Singulair (montelukast)- Pill (not inhaled)
Who are leukotriene receptor antagonists given to?
Those who don’t want or cannot have steroids
What are leukotriene receptor antagonists used to treat?
- People with asthma
- Used to treat allergies
- NOT used to treat COPD
What is an adverse effect of leukotriene receptor antagonists?
Causes increased risk of suicidal ideation
What is the mechanism of action of antihistamines?
Selectively block histamine-1 receptors
Decrease allegic rxn
How are antihistamines organized?
- By generations
- Based on potential for sedation
Describe 1st generation antihistamines
- High potential for sedation
- diphenhydramine- Benadryl
Describe 2nd generation antihistamines
- Considered “non-sedating”
- loratadine- Claritin
- centirizine- Zyrtec
What are antihistamines used to treat?
- Seasonal allergies
- Mild allergic rxns
- Anaphylaxis
- Nausea
- Motion sickness
Adverse effects of antihistamines
Sedation
Xerostomia
Constipation
Headache
Tachycardia
What can occur if a LA is used when the patient is taking Benadryl?
Can cause arrhythmias
What is the mechanism of action of antitussives?
- Act directly on the medulary cough center of the brain to reduce cough reflex
- Do not work on your lungs, they work in your brain
Types of antitussives
dextromethorphan (DXM)
codeine
hydrocodone
Adverse effects of antitussives
Dying effect on the mucous membranes
Drowsiness and sedation
GI upset
When should antitussives be used?
At the end of a cold to control nonproductive cough
Mechanism of action of nasal decongestants
Stimulate alpha receptors in nasal mucosa
- promote vasoconstriction
- shrink nasal mucous membranes
- improve airflow
Types of nasal decongestants
Topical: Afrin (oxymetazoline)
Systemic: Sudafed (pseudophedrine)
What are nasal decongestants used for?
Relieve discomfort of nasal congestion from common cold, sinusitis and allergic rhinitis
Adverse ffects of nasal decongestants
Local stinging and burning
Rebound congestion
Tachycardia
What is the mechanism of action of topical nasal steroid decongestants?
Reduce inflammation and allergic response in nasal passages
Types of topical nasal steroid decongestant
Nasonex
Flonase
Rhinocort
Uses for topical nasal steroid decongestant
Seasonal alelrgic rhinitis
Adverse effects of topical nasal steroid decongestants
Local burning, irritation, stinging
Dryness of mucosa
Headache
Mechanism of action of expectorants
Reduce adhesiveness and surfce tension
Allows easier movement of less viscous secretions
Types of expetorants
Robitussin (guaifenesin)
Mucinex
Uses for expectorants
Symptomatic relief of respiratory cnditions characterized by a dry, nonproductive cough
Adverse effects of expectorants
GI symptoms
Headache, dizziness
