Respiratory Pt. 2 - Exam 4 Flashcards
Pseudoephedrine (Sudafed) MOA?
stimulates smooth muscle alpha adrenergic receptors, producing vasoconstriction and reducing nasal congestion (sympathomimetic) - mimics the sympathetic nervous system
Pseudoephedrine is the sympathomimetic drug of the ______________ & ___________ chemical classes
phenethylamine
amphetamine
Indications to used Pseudoephedrine ?
nasal congestion
avoid using Pseudoephedrine during the ___ trimester
1st
caution advised in the 2nd and 3rd trimesters due to possible risk of teratogenicity
Serious reactions with Pseudoephedrine ?
Arrhythmias
HTN
Common reactions with Pseudoephedrine ?
Insomnia
Urinary Retention
Tachycardia
Tremor
Others: HA, CNS stimulation, Palpitations, Increased BP, Anxiety, Dizziness, Nausea
Peds dosing of Pseudoephedrine is based on?
age
Never give a child under __ years old any kind of cough or cold product containing decongestants or AH, w/o seeking advice of a HCP - it is bad for the kidneys
2
use nasal saline, honey in water
Antihistamines MOA?
decrease histamine-mediated contraction of smooth muscle of the bronchi, intestine, and uterus
Antihistamines clinical use?
prevent allergic responses mediated by histamine, such as rhinitis and urticaria
First Generation Antihistamines H-1 examples?
Diphenhydramine ( Benadryl)
Chlorpheniramine
Second Generation Antihistamines H-2 examples?
Certirizine (Zyrtec)
Desloratadine ( Clarinex)
Antihistamines with _______ & _________ see decrease in absorption.
calcium and magnesium
Antihistamines pharmacokinetics ?
rapidly absorbed in 15-30 min, 60-70% protein bound, metabolism is minimal, excretion in feces and urine; HF: wide range
Antitussives (codiene, dextromethorphan) act on the cough center in the _______ by elevating its threshold for the cough reflex
medulla
Clinical uses of Antitussives ?
cough suppression, throat irritation
often combined with benzocaine in thrust lozenges to block the pain from throat irritation when coughing
Examples of Antitussives ?
Dextromethorphan (Delays)
Guaifenesin/hydrocodone (Hycotuss, and antitussive/expectorant)
Diphenhydramine/dextromethorphan (Duratuss DM, an antihistamine/antitussive)
Antitussives potentiate _____ , as psych medication for bipolar or depression - mood stabilizer) by increasing the risk of toxicity; do not use concurrently
MAOI’s - monoamine oxidase inhibitors
_______ & Antitussives potentiate each other; possibility of respiratory distress
alcohol
Codeine _________ - pill and liquid form
phosphate
Benzonatate - ________ ______ - great for cough and not a narcotic
Tessalon Perles
Codeine Phosphate MOA?
binds to various opioid receptors, producing analgesia, sedation and antitussive effects )opioid agonist)
Schedule Drug controlled
Codeine Phosphate Black Box warning
death related to ultra-rapid metabolism of codeine to morphine - respiratory depression and death have occurred in children who receive codeine post-tonsillectomy and/or adenoidectomy
Antitussives have risks from concomitant use with _______________, ___ ___________
Benzodiazepines, CNS Depressants
When codeine is ingested , it is converted to ________ in the liver by CYP2D6
morphine
Some people have DNA variations that make this enzyme more active, causing codeine to be converted to morphine faster and more completely than in other people.
_____-_____ ____________ are more likely to have higher than normal amounts of morphine in their blood after taking codeine
ultra-rapid metabolizers
indications for antitussives ?
cough
Codeine/Guaifenesin liquid is a cough suppressant and ___________ combination
expectorant - which work by loosening mucus
_____ using antitussives in pregnant and lactation.
avoid
Serious reactions when using antitussives ?
respiratory depression
CNS depression
Others:
Hypotension, orthostatic, Bradycardia, Syncope, seizures, bowel obstruction
Hydrocodone/ Homatropine trade name is ?
Hycodan
Hydrocodone is a ________ cough medicine
narcotic
____________ is a drug that works against the narcotic to prevent an overdose of this medication
Homatropine
Hycodan (hydrocodone/homatropine) is a ______________ & ________ cough suppressant combination
anticholinergic and narcotic
The anticholinergic properties of Hycodan ( hydrocodone/homatropine) work by ?
drying up secretions
Homatropine is the anticholinergic
The narcotic properties of Hycodan ( hydrocodone/homatropine) work by ?
depressing the cough reflex in the brain
Homatropine is an _____________
anticholinergic
Homatropine is an anticholinergic medication that is an antagonist at __________ _____________ receptors and thus the PNS.
muscarinic acetylcholine
Homatropine is also used in the eyes as a ___________ and as a _________.
cycloplegia and mydriatic
Benzonatate (Tessalon Perles) MOA?
anesthetizes respiratory passage, lung, and pleural stretch receptors, reducing cough reflex (ester local anesthetic)
A __________, chemically related to other ester local anesthetics such as procaine and tetracaine used in the eye
butyl amine
Benzonatate safe because it acts more locally
Indications for Benzonatate?
cough
Xanthine Derivatives stimulate the ___________ center?
respiratory
Xanthine Derivatives such as aminophylline and theophylline interact with ________, ____________, _______ by increasing levels
caffeine, St. Johns wort, ephedra
Anticholinergics inhibit muscarinic cholinergic receptors , like ________ or ________ which acts longer and my have ________ effects with other anticholinergics
Tiotropium (Spiriva)
Examples of inhaled anti-inflammatory agents?
Leukotriene receptor agonists (LTA)
Oxygenase inhibitors
Monoclonal ABS
Mast Cell Stabilizers (sodium chromoglycates , Leukotriene modifiers)
Leukotriene receptor agonists inhibit enzyme responsible for producing inflammatory response to leukotrienes by ________ the leukotriene’s receptor that makes __________________ possible
blocking,bronchoconstriction
Used in long-term control and prevention of symptoms in mild persistent asthma
Leukotriene receptor agonists
____________ are used as a combination therapy with inhaled corticosteroids for moderate persistent asthma
Leukotriene receptor agonists
NOT FOR COPD
Examples of Leukotriene receptor agonists?
Zafirlukast (Accolate)
Montelukast (Singulair)
what must be taken regularly, even during symptom-free periods
Leukotriene receptor agonists
must take it every day whether they have active dyspnea or not
Zafirlukast (Accolate) and Montelukast (Singulair) need to be taken every single day to build up levels in the body to get ___________ effect
therapeutic
Persistent asthma or asthma caused by allergies, cats, grass, pollen and environment type things take singular if __ months or older and ________ if __ years or older
singular if 12 months age and older and
Accolate if 5 years or older
Class of Oxygenase inhibitors
mast cell stabilizers
Example of oxygenate inhibitors?
Zileturon (Xyflo) 600 mg PO BID
MOA of Zileturon (Xyflo)?
inhibits 5-lipoxygenase, interfering w/ leukotriene formation (leukotriene inhibitor)
Clinical uses of Zileturon (Xyflo)?
long term control of mild persistent asthma in those older than 12 y.o.
Zileturon (Xyflo) is used with ___ in moderate persistent asthma as combination therapy
ICS
What do you want to monitor when taking long term oxygenate inhibitors ?
LFT periodically during the first year cause these medications make LFT increase
The idea of a “_____ ______” was first proposed by ____ _______ in the 20th century
magic bullet
paul ehrlich
“a compound could be made that selectively targeted a disease-causing organism, then a toxin for that organism could be delivered along with the agent of selectivity”
who said this?
paul Ehrlich 20th century
Monoclonal antibodies bind to ___ receptors on mast cell and eosinophils preventing release of mediators to the allergic response
IgE
Clinical uses for Monoclonal antibodies ?
Moderate to persistent asthma
especially in those patients reactive to perennial allergens and in whom asthma symptoms are not controlled by ICS
Example of Monoclonal antibodies ?
Omalizumab (Xolair) modulator
BBW of Monoclonal antibodies ?
Anaphylaxis - 6% risk of reaction when infused with the medicine
can occur right away or after many dosages
Combination products use ___
ICS
Examples of Combination products?
Advair - salmeterol/fluticasone
Combivent - Albuterol/ipratropium
There are differences in _______ when using combination products
potency
________ is a highly reactive nonmetal and oxidizing agent that readily forms oxides with most elements as well as other compounds
oxygen
Oxygen is used to treat emphysema , PNA, CHF and some disorders that cause increased pulmonary artery pressure and any disease that _______ the bodies ability to take up and use _______ oxygen
impairs
gaseous
Medical devices for delivery of oxygen:
tanks regulators PPD ventilators tents masks nasal canulas oxygen generators (90-95%)
02 delivery percentages ________ from nasal cannula to nonrebreathers
increases
nasal cannula, simple mask, venturi’s mask, partial rebreather, nonrebreather
28% ro 60-90%
On the venturi mask you can adjust the _______ ______ and you can change the oxygen delivery amount
venturi barrel
venturi is a way to start to lean people off oxygen therapy
blue 24% white 28% orange 31% yellow 35% red 40& green 60%
Nebulizer machines are for delivery of ________
they are not delivery machines they are just compressors
aerosols
Examples of Durble medical good (DMG)?
nebulizers
canes
hospital bed
CPAP - continuous positive airway pressure is a therapy common treatment for obstructive _____ _____
sleep apnea
make sure you used distilled clean water for humidification
Helix is what combo?
oxygen and helium
what is the benefit of using helix?
this mixture of helium and oxygen generates less resistance than atmospheric air when passing through the airways of the lungs, and thus requires less effort by a patient to breathe in and out of the lungs
what is the mixture amount of helix?
O2 - 21%
Helium - 79%
what type of oxygenation administration rose is used in critical care and ICU units and used in ARDS?
HeliO2 blender
