Respiratory Pharmacology ( WK2- Ch 26)

Question 1

To minimize muscle wasting, bone loss, and other side effects associated with anti-inflammatory steroids (glucocorticoids), it is preferred that these drugs be administered _____ to control airway inflammation in asthma and chronic obstructive pulmonary disease (COPD).

Answer 1

by inhalation

Question 2

Which drug has the primary adverse effect of cardiovascular irregularities (increased blood pressure, palpitations)?

Answer 2

decongestants

Question 3

Therapists may notice arrhythmias while monitoring the electrocardiogram (ECG) or while taking the patient’s pulse. These cardiac abnormalities may indicate a problem with the ___________ medications.

Answer 3

bronchodilator

Question 4

High doses and prolonged or excessive use of nasal decongestants are potentially harmful because these drugs:

Answer 4

can increase blood pressure

Question 5

Compared to systemic pulmonary medications, inhaled pulmonary medications are ______________ ( better or worse ) at delivering drugs directly to the lungs. Additionally, inhaled pulmonary medications have ___________ ( local or systemic ) effects, and therefore __________ (fewer or more) systemic side effects at therapeutic doses.

Answer 5

better, local, fewer

Question 6

What are the four categories of respiratory medications ?

Answer 6

control of respiratory tract irritation and secretion
bronchodilators
control of airway inflammation
other

Question 7

Sedative effects is the primary concern with which of the following medications

Answer 7

antihistamines

Question 8

Mucolytics and expectorants are usually ______ ( well or poorly) tolerated. Therefore there are _________ ( serious or no major) rehab concerns with their use.

Answer 8

well, no major

Question 9

Due to its effectiveness in controlling airway inflammation, patients with COPD and asthma are often given combination products such as an anti-inflammatory steroid with a bronchodilator. These combination drugs are used for:

Answer 9

long-term prevention

Question 10

What is MOA and primary problems of antitussives ?

Answer 10

• Suppress cough reflex at the brainstem such as opiods do. ( hydrocodone, codeine)
• sedation, dizziness, GI upset
• overuse may lead to dependence
• no symptomatic relief in children

Question 11

What is the MOA of antihistamines and primary problems ?

Answer 11

• Block histamine type I receptor; decreases the effect of histamine on upper respiratory tract. ( allergy medications like allegra, zyrtec)

-sedation and fatigue if drug cross BBB
- sedative effects, can dry out repiratory tract and limit productive cough which may not be good thing is mucous is accumulating without release

Question 12

What is the MOA of decongestants and primary problems ?

Answer 12

• Alpha 1 receptor agonists ( epinephrine, pseudoepinephrine)
• vasoconstrict nasal mucosa to produce less mucous discharge
• may cause headache, nausea, nervousness; cardiovascular stimulation, could increase HR and BP, potentially dangerous

Question 13

What is the MOA of mucolytics and expectorants, and primary problems ?

Answer 13

• mucolytics break up mucous, decrease viscosity of mucous, making it easier to expel mucous
• expectorants increase production of a thinner more liquid phlegm, enhance mucolytics
• usually well tolerated, excessive use however may cause nausea, vomiting, irritation of mouth
• no major rehab concerns

Question 14

Describe the MOA of beta-adrenergic agonists and their primary problems.

Answer 14

• stimulation of beta 2 receptors on the lungs which increases intracellular cAMP which initiates smooth muscle relaxation of the bronchioles.
• bronchial irritation and constriction; cardiac stimulation, CNS stimulation with excessive use

there are selective and non- selective agonists

Question 15

What is the MOA of xanthine derivatives and primary problems ?

Answer 15

• drugs that are chemically similar to caffeine, powerful bronchodilator but exact mechanism is unclear
• theophylline toxicity is the major problem; nausea, confusion, irritability, restlessness, cardiac arrythmias, seizures
• risk from toxicity may increase if drug cant clear like in impaired liver disease, congestive heart failure, infections etc.

Question 16

What is the MOA of anticholinergic drugs and primary problems?

Answer 16

• acetylcholine stimulates bronchial smooth muscle contraction; block Ach receptors
• tolerated well at lower doses; side effects increase at higher doses, may lead to dry mouth, constipation, tachycardia, confusion

Question 17

Describe the general MOA of anti-inflammatory steroids and primary problems.

Answer 17

• inhibit virtually all components of the inflammatory process
• may have catabolic and metabolic side effects
• development of inhaled agents was big as it is more direct at lower dosages.
• primary issues include muscle wasting and osteoporosis, many other metaboic effects, inhaled reduces side effects.

Question 18

Explain the general MOA of Cromones and Leukotriene modifiers

Answer 18

Cromones prevent the release of histamine from pulmonary mast cells

Leukotriene modifiers are lipid compounds that are similar to prostaglandins but are derived from arachidonic acid in a different way

effective at preventing things like asthma attacks

those with bronchoconstrive disease should avoid COX inhibitors

Question 19

What is the greatest risk of oxygen supplementation ?

Answer 19

O2 is flammable, nasal cannula, face masks, and tracheal administration can cause nose bleeds, and airway irritation

Oxygen toxicity due to free radicals