respiratory system Flashcards
3 regulatory factors
- mucous secretion
- vascular permeability
- bronchial muscle tone
2 types of copd
- chronic obstructive bronchitis
- emphysema
signs and symptoms of asthma
- wheezing
- cough
- shortness of breath
- difficulty breathing
- episodic
- triggers by allergens
what causes copd
- long term /chronic exposure to irritants (esp. pollution and smoking)
- could also be short term/ acute (eg. e-cig, vaping)
asthma versus copd
- asthma is episodic, copd is progressive and irreversible
- asthma is younger, copd is older/elderly
chronic bronchitis signs
- persistant cough
- sputum
- enlargement of mucous glands
emphysema signs
-enlargement of air spaces (due to destruction of alveolar walls)
example of mucokinetic drug
-guaifenesine
what does mucokinetic drug do
- increase mucous production
- increase fluidity of mucous
- ciliary clearance
what is mucokinetic drug used to treat
cough
AE of mucokinetic drug
- headache
- nausea, vomiting
example of mucolytic drug
N-acetylcysteine
what is N-acetylcysteine used to tx
- antidote for acetaminophen toxicity
- copd
how does N-acetylcysteine work
- breaks S-S bonds that hold glycoproteins together in mucous
- decrease mucous viscosity
AE of N-acetylcysteine
- stomatitis
- nausea, vomiting
- rhinorrhea
- bronchospasm
what does atropine (antimuscarinic) do in the lungs
-decrease fluid production
tx indications for atropine (pre-op)
-reduce salivation and excessive respiratory secretions
tx indications for atropine (peri-op)
-prevent cholinergic effects which result from vagal stimulation (bradycardia, hypotension, cardiac arrythmia)
tx indications for atropine (post-op)
-with anticholinesterase agents to terminate curarization
how does Beta 2 agonist cause bronchiole m relaxation
-activate PKA which will inactive MLCK
MLCK causes contraction
what does theophylline do
inhibit bronchoconstriction
asthma can be treated with a combination of __ and __
beta 2 agonist + corticosteroids
tx indications for epi
- asthma
- anaphylactiv shock, hypersensitivity rxns
- cardiac arrest
- vasoconstrictor and LA
terbutaline classification
selective beta 2 agonist
terbutaline AE
- tremor, palpitations, nervousness, headache
- nausea, tachycardia, cardiac arrythmias
why does terbutaline affect the heart
because it still has affinity for beta 1 receptors
compare inhaler, oral, and iv for onset of action
- inhaler: fast
- oral: slow
- IV: very fast
compare inhaler, oral, and iv for duration
- inhaler: medium
- oral: long
- IV: short
AEs of salbutamol/albuterol
- nervousness, tremor
- hypotension (peripheral vasodilation)
- tachycardia
salmeterol classification
long-acting beta 2 agonist (LABA)
can salmeterol be used to treat asthma attack
NO! its a long-term, maintanence drug
AEs of salmeterol
nervousness, tremor, tachycardia
does salmeterol bind directly to beta 2
no, it has an exosite and couples/un-couples to the beta 2 receptor
formoterol classification
long-acting beta 2 agonist
does formoterol bind directly to beta 2
yes. it doesn’t have exosite binding
can formoterol be used to treat asthma attack
NO! its a long-term, maintanence drug
AEs for formoterol
headache, palpitations, nervousness, tremor, tachycardia
**AE on oral health for salmeterol and formoterol
- xerostomia
- candidiasis
- tooth pain
are LABAs the first choice of drugs for asthma tx
no! lots of AE and deaths
how can muscarinic antagonists help treat asthma
- increase bronchodilation
- decrease mucous secretion
name 3 muscarinic antagonists that can treat respiratory disease
- atropine
- ipratropium bromid
- tiotropium
which muscarinic receptors does ipratropium bromide have a higher affinity for
M1, then M3=M2
why is atropine not given for asthma
lot of AEs. also crosses BBB, so CNS AEs as well
ipratropium bromide is prefered over atropine because__
it doesnt pass BBB so no CNS AEs
ipratropium bromide is a ____derivative
4ry atropine
tiotropium
- long acting
- tx: COPD
- M3 affinity > M1»_space; M2
example of methylated xanthine
theophylline
mechanism of action: theophylline
- inhibits phosphodiesterase 3 and 4 -> increased cAMP -> increase PKA -> bronchoDILATION
- adenosine receptor antagonism
- anti-inflammatory
why is theophylline not commonly used
- narrow therapeutic index
- inter-individual variation in liver metabolism
half life of theophylline can be increased with which drug interactions
- oral contraceptives
- erythromycin
half life of theophylline can be decreased with which drug interactions
- phenytoin
- barbiturates
name the anti-inflammatory drug classifications
- glucocorticoids
- biologics (MABs): IL-5 and Leukotrine
what effect does glucocorticoids have on inflammatory response
they inhibit inflammatory response
name the 3 mechanisms of actions of glucocorticoids
- block GRE: decrease TF for synthesis of CK
- more polypeptide lipocortin-1: decrease pro-infl. mediators
- less T cell synthesis (inhibit IL): decrease IgE, mast cells, eosinophils
are glucocorticoids for tx of asthma
not for acute asthma attacks
-maintenance/chronic asthma (prevention of inflammation in asthma)
name the 2 glucocorticoid drugs for asthma
- fluticasone
- ciclesonide
why does glucocorticoids lead to systemic AEs
-lots gets swallowed -> GI -> first pass (liver) _> systemic circulation
what can be taken to reduce systemic AEs with glucocorticoids
spacer or mouth wash
name all systemic AEs for glucocorticoids
- osteoporosis, stunt growth
- increase susceptibility to infection
- ulcer
- cushing’s
- sodium retention and hypertension
name all oral AEs for glucocorticoids
- xerostomia
- candidiasis
- glossitis
- ulcerations
IL-5 modifying drugs involve MABs. what are MABs
monoclonal antibodies
IL-5 receptor is blocked by which drug
fasenra (benralizumab)
name an anti-IgE MABs
omalizumab
is omalizumab used for asthma attacks
no!
what are the AEs of omalizumab
- anaphylactic/ allergy
- cerebrovascular events
- malignancies
what are the oral AEs of omalizumab
- toothache
- candidiasis
- orofaryngeal pain
- sinusitis
leukotriene synthesis inhibitor (inhibits 5-lipoxigenase)
zileuton
leukotriene receptor antag (Cys-Lt1 antag)
- montelukast
2. zafirlukast
can leukotriene receptor antag (Cys-Lt1 antag) be used to tx asthma
no. they are for prophylaxis or chronic tx of asthma
why is zafirlukast better than montelukast
- longer half life
- higher bioavailability
- only 1 cyp enzyme
- low oral AEs
what are the AEs on oral health for montelukast
- toothache
- increased bleeding
- thrombocytopenia
fenoterol (beta 2 ag) can be combined with which muscarinic antag
ipratropium bromide
salmeterol can be combined with which corticosteroid. can it be for acute asthma?
fluticasone. no
formoterol can be combined with which corticosteroid. can it be for acute asthma?
budesonide. no
systemic AEs for long acting beta 2 ag + corticosteroid
- upper resp. tract infection
- tachycardia, HT, arrythmmias, nervousness
- headache, sinusitis, migraine
oral AEs for long acting beta 2 ag + corticosteroid
- xerostomia
- candidiasis
- glossitis
- ulcerations
why should you be careful giving NSAID (like aspirin, ibuprophen) to someone with respiratory illness? What can you give instead?
NSAID leads to bronchoconstriction (AE). better to give acetominophen
why should you be careful giving propanolol to someone with respiratory illness? What can you give instead?
- non-selective
- atenolol is selective to beta 1
why should you be careful giving ACE inhibitors and angiotension receptor blockers to someone with respiratory illness?
AE of them causes dry, hacking, nonproductive cough
ACE inhibitors
- captopril
- benazepril
angiotensin receptor blockers
- losartan
- candesartan
what are the 6 drugs you must have in your office for respiratory illnesses
- oxygen
- E
- nitroglycerin
- diphenhydramine / chlorpheniramine
- salbutamol
- ASA
