Respiratory Pharmacology Flashcards
What does the Respiratory System do?
Mediates Gas exchange between the external environment and the blood stream.
The Upper respiratory tract conducts air to the lower tract and humidifies/conditions the air
Protects the lungs from harmful substances
What is the Common Cold? What are the signs and symptoms? What is the treatment?
Virus that invades mucosa of upper respirator tract, nose, pharynx/larynx
Signs/Symptoms: excessive mucus production-> sore throat, coughing, upset stomach.
Treatment: Reduce symptoms
Antihistamines, where does it work?
Act directly on histamine receptor sites; H1 blockers
What is histamine?
Endogenous chemical involved in various allergic reactions.
What are the sedating antihistamines?
H1 Antihistamine
- Chlorphenramine
- Diphenhydramine (Benadryl)
- Hydroxyzine
Benadryl Action/Adverse Effcts
Antagonizes the effect of histamine at H1 receptor sites
ADE: CNS depressant, drowsiness, dizziness, hypotension, dry mouth
What are the Non-Sedating Antihistamines?
Claritin, Allegra, Zyrtec
What are three types of decongestants and what are the routes of administration?
Adrenergic, Anticholinergic, Corticosteroids
Routes: Oral for systemic, Inhaled (right to the lungs, some systemic), Nasal: Local some systemic
Adrenergic Nasal Drugs; Where is it applied, what is the main side effect, and drug name
- Topical application directly into Nares.
- Has a rebound effect (only use for 72 hours, congestion will get worse if taken more than this) -
- Oxymetazoline/Afrin
- Phenylephrine/Neo-synephrine
Intranasal Steroids, what are they used for, what is the action, what are some examples?
Used prophylactically to prevent nasal congestion in patients with chronic Upper Resp. Infections
Action: Aimed at anti-inflammatory Response
Examples: Nasacort (Triamcinolone), Flonase (Fluticasone), Nasalide (Flunisolide)
Oral Forms of Decongestants and Side Effects
Pseudoephedrine (Sudafed)
S/E: Headache, dizziness, nervousness, nausea, cardiovascular irregularities (increased BP/palpitations)
What drugs are used to treat cough? (general categories)
Antitussive: suppresses cough (opiod, non-opiod) Sedation, dizziness, GI upset
Mucolytics
Expectorants
Antitussive Drugs Action and Adverse Effects (Opioids)
All opiods have antitussive effects. (Codeine is only opioid used as cough medicine)
Action: Suppress cough reflex by acting on cough center in Medulla
Advsere Effects: CNS and respiratory depression/additive potential
Antitussive Drugs (non-opioid)
Generic: Dextromethorpan
Trade Name: Vicks, Robitussin DM
Safe, Non-addicting, no CNS/respiratory depression
Mucolytics/Expectorants Action and Side Effects
Mucolytics: decrease viscosity of respiratory secretions
Expectorants: facilitate production/ejection of mucus
Action: loosening/thinning secretions
Side effects: GI, take with food
Expectorants Trade Name, Therepeutic Effect
Guaifenesin
Trade name: Robitussin, Humibid, Guiatuss
Therapeutic Effect: Relief of resiratory congestions and cough suppression.
Mucolytics: How it works, administration and Side Effects
Acetylcysteine (Mucomyst): Primary mucolytic drug
Work by splitting the disulfide bonds of mucoproteins
Administered by inhalation/intratracheal instillation
S/E: N/V, inflammation, rhinorrhea
Obstructive Pulmonary Disease: Types, Characterization, Treatment Goals, Medication Classes
Bronchial Asthma, COPD
Characterized by Bronchospasm, airway inflamm, mucous plugging
Treatment goals: prevent/reverse bronchial constriction/obstruction of airways
Medication Classes:
- Bronchodilators:Beta agonists, Xanthine derivatives, anticholinergics
- Anti-inflamm: corticosteroids, Chromolyn sodium
Beta-Adrenergic Agonists: What do they do
Stimulation of beta-2 receptors result in relaxation of bronchiole smooth muscle-> used to prevent/inhibit airway obstructions
Specific Beta-Adrenergic Agonists
Albuterol: Short Acting
Long Acting: salmeterol, formoterol, bambuterol, metaproterenol
Albuterol General Action, Use, Administration
Relax bronchial smooth muscle,
First line therapy for SOB,
Adminsitered via Inhaler/nebulizer,
Very safe
Albuteral Action, Indication, Contraindications
Sympathomimetic
Actions: Beta 2 adrenergic agonist, relaxes bronchial smooth muscle, minimal cardiac SE
Indications: Treatment of bronchospasm associated with asthma, chronic bronchitis, emphysema; prevention of exercise induced bronchospasm.
Contraindications: Hypersensitivity to sympathomimetics, cardiac arrhythmia, tachycardia/tachyarrhythmias
Albuterol Adverse Reactions, Precautions
- Adverse:
- Paradoxical bronchospasm,
- tachycardia, palpitations,
- angina,
- PVCs,
- hypo/hypertension,
- tremor,
- hyperglycemia,
- peripheral vasodilation,
- nervousness,
- nausea/vomiting
- Precautions: Diabetes, hyperthyroidism, seizures
Metaproterenol Sulfate Actions, Indications, Contraindications
Action: Agonist for Beta 2, acts on smooth muscle
Indications: relieve bronchospasm of COPD/Asthma
Contraindications:
- Hypersensitivity to sympathomimetics
- Hyperthyroidism
- Cerebrovascular/cardiovascular disorders
- Tachycardia/tachydysrhythmias
Metaproterenol Sulfate Adverse Reactions
Dose-related tachycardia, palpitations, nervousness, HTN, tremors, headaches, N/V
Xanthine Derivatives: Theophylline Actions, Adverse Reactions, Indications
Action: Beta 2 Agonist: directly relaxes bronchial smooth muscle, dilates pulomary/coronary arterioles, Mild diureticrespiratory center stimulant
Adverse Rxn: Toxicity b/w levels of 15-20mcg/ml, Toxicity: nausea, confusion, irritability, restlessness, cardiac arrhythmias, seizures
Indications: relieve bronchospasm, management of CHF, pulmonary edema, adminstered orally as tablet
Nonselective sympathomimetics
Stimulates both beta 1/2 and akpha
not used to treat asthma since they increase peripheral resistance and increased risk for tachycardia
Includes: epinephrine, ephedrine
Methylxanthines
CNS stimulants that also bronchodilate
Used only when beta 2 specifcs don’t work
Chief S/E: N/V, insomnia, restlessness, dysrhythmias.
Anticholinergics
Ipratropium: atropine derivative
Causes Bronchodilation
Inhaled, no systemic effects
S/E: dry mouth
Glucocorticoids
Anti-inflamm.
Lowers production of inflamm. substance
Inhaled type: Beclomethasone
Oral: Prednisone
Preventative
Few S/E when inhaled; long periods of admin can lead to adrenal suppression/hyperglycemia
Cromolyn
Safest of all anti-asthma
S/E: coughing/wheezing
Used for preventing asthma in adults/children
Leukotriene Antagonists
Leukotrienes contribute to both inflamm and bronchoconstriction
Zyflo blocks synthesis of leukotrienes, Accolate blocks the receptors
S/E: headache, stomachache, flu-like symptoms for children
Considerations in Rehabilitation
RTs play a critial role in preventing pulmonary mucus accumulation
Program of Chest PT most effecive when administered 30 minutes to 1 hour after agents administered.
Cardiac S/E of Beta-adrenergic/xanthine should be considered.
