Respiratory pharmacotherapy Flashcards by matthew tarzwell

What is COPD?

a respiratory disorder which is characterized by progressive, partially reversible airway obstruction, and increasing frequency and severity of exacerbations

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What are the two conditions included under COPD?

emphysema and chronic bronchitis

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Describe the difference between emphysema and chronic bronchitis.

EMPHYSEMA: alveoli enlarge, bronchioles collapse, and the walls are damaged resulting in dec elasticity of the lungs and decreased efficiency of respiration

CHRONIC BRONCHITIS: over production of mucous resulting in obstruction. Characterized by persistent chronic cough for at least 3 months/yr for at least 2 yrs without a specific cause determined
- increased sputum production, shortness of breath, airflow limitation, and impaired gas exchange

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What is the principle cause of COPD?

Smoking

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What are some other causes (other than the primary) of COPD?

workplace exposures
air pollution
repeated infections can contribute

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Describe what asthma is.

A chronic disorder of the airways characterized by paroxysmal (sudden attack) or persistent symptoms

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What are the symptoms of asthma?

dyspnea, chest tightness, wheeze, and cough
with variable airflow limitation
airway hyper-responsiveness to a variety of stimuli
(biggest diff btwn asthma and COPD)*

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At what age is asthma most common? What is the percent prevalence in that population

Childhood

10% of the pediatric population

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What happens to the bronchioles in the lungs with asthma?

Inflammation resulting in production of phlegm

Bronchoconstriction

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Compare and contrast asthma with COPD

ASTHMA:

high proportion of non-smokers
symptom onset b4 40 yrs old
breathing difficulty intermittent (attacks)
night-time symptoms/attacks common
may be asymptomatic or few symptoms btwn attacks
symptoms may be affected by exercise

COPD:

high proportion of smokers
symptoms develop after 40 yrs old
breathing difficulty persistent and progressive
night-time attacks are uncommon
variability of symptoms is rare
symptoms worsen with exercise

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What are the 6 drugs used to treat asthma and COPD?

B2 agonists
Anticholinergics
Corticosteroids
Theophylline
Leukotriene antagonists
Cromolyn and Nedocromil

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What are the 5 drugs in B2 agonists? Sort by short/long acting.

fast acting:

salbutamol
fenoterol
formoterol
terbutaline

slow acting
- Salmeterol

don’t confuse salbutamol with salmeterol

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What is the mechanism of action for B2 agonists?

bind to B2 receptors in the body.

2 places that have these receptors

in the lungs, causes bronchodilation
in the heart causes tachycardia

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What are the therapeutic uses for B2 agonists?

COPD and asthma symptoms:

shortness of breath, wheezing, coughing

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What are the AE of B2 agonists? (2)

Tachycardia (elevated HR)

Tremors

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What is the dosing and administration information for B2 agonists?

inhalation (preferred) - inhaler, nebulization

Oral and Parenteral (not used often because of so many more AE, therefore only used in ER)

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What are the anticholinergic drugs used to treat respiratory problems? Divide into fast and short. (2)

Fast:
- ipratropium

Slow
- Tiotropium

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What is the mechanism of action for anticholinergics?

ACH causes broncoconstriction

anticholinergics block muscarinic (M3) receptors blocking ACH, causing broncodilation and dec mucous production.

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What is one of the benefits of using anticholinergics?

not only does it cause bronchodilation, it decreases mucous production.

this is why it is used early in COPD

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What are the therapeutic uses for anticholinergics?

COPD and asthma

may be more effective for COPD

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What are the AE of anticholinergics? (2)

dry mouth

urinary retention

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What is the dosing and administration information for anticholinergics?

Inhalation - inhaler/nebulizer

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What are the drugs in the corticosteroid family for respiratory treatment? Sort into oral, parenteral, and inhaled. (6)

ORAL:
- prednisone

PARENTERAL:

methylprednisone
hydrocortisone

INHALED:

fluticasone
budesonide
fluticasone/salmeterol
budesonide/formoterol

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What is the mechanism of action for corticosteroids in respiratory treatment?

rreduces inflammation within the respiratory system

What are the therapeutic uses for corticosteroids?

COPD - (last choice) | Asthma - (drug of choice)

What is another name for corticosteroids?

glucocotricosteroids or steroids | not the same as anabolic steroids

What are the AE of corticosteroids?

INHALED: - oral thrush - potential for growth abnormalities - voice hoarseness SYSTEMIC: - ulcers - fluid retention (hypertension) - osteoporosis

What is oral thrush?

an infection of the mouth that is caused by yeast Usually located at the back of the mouth where drug commonly hits when using an inhaler

What is the mechanism of action for Theophylline?

Bronchodilation by: - inhibiting phosphodiesterase and adenosine - reduces diaphragmatic fatigue (reduces tiredness from laboured breathing

What are the therapeutic uses for theophylline?

COPD and asthma

What is the dosing and administration information for theophylline?

Oral | Parenteral - aminophylline

What are the adverse effects of theophylline? (7)

(Think of what caffeine does) - tachycardia - headache - nausea - loss of appetite - tremors - restlessness - seizures

What are the nursing implications for using theophylline?

as always monitor for AE blood levels require monitoring

What are the two drugs in the leukotriene antagonist group used to treat respiratory problems?

Monteleukast Zafirleukast

What is the mechanism of action for leukotriene antagonists?

Leukotriene is a substance correlated with the pathophysiology of asthma including: - mucus secretion - airway edema - bronchoconstriction leukotriene agonists ***INHIBIT PRODUCTION**** of leukotriene

What are the AE of leukotriene antagonists? (3)

upper respiratory infections (think dec mucous production) sedation headaches

What is the mechanism of action for Cromolyn and Nedocromil?

Mast cell stabilizers: | - prevent release of histamine from sensitized mast cells

What are the therapeutic uses for Cromolyn and Nedocromil?

Asthma ONLY Primarily used in CHILDREN

How long do Cromolyn and Nedocromil take to act?

response can occur within the first 2 weeks but can take up to 6 to see max benefit

What are the AE of Cromolyn and Nedocromil? (2)

hoarseness dry throat

What are the 3 different types of inhalers?

MDI type (the typical one you think of) Diskhaler (uses powder) Turbohaler (uses powder, cylinder shape)

What are the three different ways that MDI type of inhalers can be used to administer drugs?

1) Open mouth, inhaler 1-2 inches away from mouth 2) Spacer (creates delay to help coordinate) - includes aeorochamber 3) Lips over opening

What is the purpose of using a peak flow meter daily for asthma?

allows person to monitor their condition can see if asthma is worsening from average which is an indication that an attack may happen soon.

What are the three groups of drugs used to treat seasonal allergies (hay fever)?

- Antihistamines - Intranasal Corticosteroids - Decongestants

What are seasonal allergies (hay fever)?

it is a type 1, IgE mediated allergy that has nothing to do with hay or fevers (IgE are the detectors on the mast cells) immune-system response to airborne allergens

What are the most common symptoms of seasonal allergies?

- repetitive sneezing, runny, itchy, and congested nose - dec sense of smell and taste - eyes become itchy, red, watery, or swollen with crusty eyelids - inflamed sinuses - headaches, irritability, and fatigue

List the drugs in the antihistamines family for seasonal allergies. Divide into first generation and second generation. (9)

FIRST GEN: - diphenhydramine (Benadryl) - chlorpheniramine - hydroxyzine - brompheniramine - clemastine SECOND GEN: - cetirizine (Reactine) - Loratidine (Claritin) - desloratidine - fexofenadine (Allegra)

What is the difference between first and second generation antihistamines?

First involve: 1) inc AE especially drowsiness and dry mouth 2) multiple daily doses 3) lower cost

What are the two drugs in Intranasal Corticosteroids used to treat seasonal allergies?

Fluticasone Beclomethasone

When are Intranasal Corticosteroids used?

when the NASAL symptoms in seasonal allergies are significant - prevents inflammation in the nasal passage - may be more effective than oral antihistamines (they are nasal sprays

What is the administration route for Intranasal Corticosteroids?

Nasal spray

What are the two drugs in the decongestant family? separate into nasal and oral

NASAL: Xylometazoline ORAL: Pseudoephedrine

What are the AE of pseudoephedrine?

keeps you awake (insomnia)

What are the advantages/disadvantages of using xylometazoline over over pseudoephedrine (nasal decongestant vs oral)?

- less AE than oral | - only short term use and must limit <10 / day or may develop rebound congestion

What is rebound congestion?

abnormal swelling and enlargement of nasal mucosa, results in: - complete blockage of nasal airway - discomfort can be temporarily relieved by another dose of nasal decongestant, but then comes back worse after

What are some symptoms of coughs and colds?

- Cough: dry (hacky) or wet (phlegm) - nasal congestion - watery eyes - sneezing - headaches - inability to sleep

What are the families of drugs used to treat coughs and colds?

DECONGESTANTS: insomnia, hypertension, clear nasal congestion and fluid in ears ANTIHISTAMINES: drowsy or non-drowsy, used for sneezing and watery eyes COUGH SYRUP

What are the two types of cough syrup? what type of coughs are they used for?

DM - dextromethorphan (dry cough) Guafenisen (wet cough)