Respiratory System Drugs (Upper And Lower) Flashcards
Adrenergic bronchodilators MOA
Opens bronchi by relaxing smooth muscles, which allows more air to enter lungs, relieving respiratory distress
Adrenergic bronchodilators indications
Treatment of chronic respiratory problems due to chronic bronchoconstriction such as bronchospasm associated with acute and chronic bronchial asthma, exercise induced bronchospasm (EIB), bronchitis, emphysema, bronchiectasis
Adrenergic bronchodilators aren’t for people with
Tachycardia, palpitations, arrhythmia, brain damage, narrow angle glaucoma, cerebral arteriosclerosis
Adrenergic bronchodilators side effects
Tachycardia, palpitation, High blood pressure, anxiety, insomnia, cardiac arrhythmias, anxiety, can cause paradoxical bronchospasm when taken by inhalation
Adrenergic bronchodilators interactions
Adrenergics (additive effects), TCAs can cause hypotension, methyldopa can cause hypotension, oxytocic drugs have a risk for severe hypotension, theophylline increases risk of cardiotoxicity, beta blockers can inhibit the cardiac, bronchodilating and vasodilation effects of the adrenergic
Xanthine derivative bronchodilators MOA
Stimulate CNS to promote bronchodilation, and cause direct relaxation of the smooth muscles of the bronchi
Xanthine derivative bronchodilators indications
Symptomatic relief/prevention of bronchial asthma, reversible bronchospasm associated with chronic bronchitis and emphysema
Xanthine derivative bronchodilators side effects
Irritability , tremors, high HR, high RR, electrocardiograph changes, hyperglycemia, alopecia, restlessness, headache, nervousness, palpitations, nausea, vomiting, fever, flushing
Xanthine derivative bronchodilators aren’t for people with
peptic Ulcers, seizures (unless well controlled by anticonvulsants) , serious uncontrolled arrhythmias
Theophylline interactions
Barbiturates, nicotine, adrenergic, loop diuretics, hydantoins, ketoconazole, rifampin, charcoal, isoniazid all decrease theophylline serum levels and allopurinol, beta blockers, CCBs, cimetidine, oral contraceptives, corticosteroids, flu vaccine, macrolides, flouroquinolones, thyroid hormones, isoniazid and loop diuretics all increase theophylline serum levels
Inhaled corticosteroids MOA
Antiinflamatory, decrease airway hyperesponsiveness, decrease mast cells, block reaction to allergens
Inhaled corticosteroids indications
Prophylactic treatment and management of inflammation with chronic asthma, and can be used intranasal for nasal polyps and rhinitis
Inhaled corticosteroids side effects
Throat irritation, hoarseness, upper respiratory infections, fungal infection of mouth and throat
Inhaled corticosteroids aren’t for people with
acute Bronchospasm, acute asthma, status asthmaticus,
Inhaled corticosteroids interactions
Combination with systemic corticosteroids can increase the risk of hypothalamic-pituitary-adrenal (HPA) suppression, resulting in adrenal insufficiency
Mast cell stabilizers MOA
Stabilize mast cell membrane by preventing calcium ions from entering mast cells, which prevents the release of inflammatory mediators such as histamine and leukotrines
Mast cell stabilizers indications
Asthma, allergic disorders, EIB, allergic rhinitis, typically used in combination with other drugs, and used in step 2 of care for chronic asthma
Mast cell stabilizers side effects
Throat irritation, dryness, cough, unpleasant taste, wheeze, nausea
Mast cell stabilizers contraindications
Not for use during acute asthma attack
Zileuton MOA
Decrease formation of leukotrines
Leukotrine modifiers and immunomodulators indications
Chronic asthma in people older than 12
Leokotrine modifiers and immunomodulators aren’t for people with
Bronchospasm in acute asthma attacks, lactation
1st generation antihistamines MOA
Blocks actions of histamine at H1 receptor, bind non selectively, so they can result in CNS stimulation or depression
1st generation antihistamines side effects
Drowsiness, dry mouth, blurred vision, urinary retention, sedation, disturbed coordinations
1st generation antihistamines contraindications
Certain heart conditions, pregnancy, taking MAOI’s, have angle closure glaucoma, peptic ulcer, prostatic hypertrophy, bladder neck obstruction, lactation, newborns, premature infants
Benadryl indications
Allergy, anaphylaxis, transfusion reactions, motion sickness, sleep aid, antitussive
Benadryl side effects
Anorexia, urinary frequency
Benadryl administration
Oral, IV, IM
Benadryl interactions
Increased effects with beta blockers
Chlorpheniramine indications
Temporary relief of itchy & watery eyes, sneezing , itchy throat, runny nose caused by hay fever, allergies, or cold
Chlorpheniramine side effects
Sedation, hypotension, palpitation, urinary hesitancy
Chlorpheniramine administration
Oral
2nd generation antihistamines side effects
Dry mouth
2nd generation antihistamines restrictions
Not for use during pregnancy
Cetirizine indications
Seasonal/perennial rhinitis, urticaria
Cetirizine side effects
Sedation, pharyngitis, dizzy, somnolence
Cetirizine restrictions
Not for people sensitive to hydroxyzine
Fexofenadine side effects
Upset stomach, back pain URI
Fexofenadine restrictions
Rifampin reduces absorption, and shouldn’t be taken within 2 hours of taking antacid because it decreases concentration of drug in blood
Loratidine indications
Allergic rhinitis
Loratidine side effects
Dizzy, headache, tremor, insomnia
Loratidine administration fact
Rapidly disintegrating
Topical decongestants MOA
Localized vasoconstriction of small blood vessels in nasal membranes
Topical decongestants indications
Common cold, hay fever, sinusitis, allergic rhinitis, congestion associated with rhinitis
Topical decongestants side effects
nasal Burning, stinging, dryness, tachycardia and cardiac arrhythmias, nervousness, restlessness and insomnia, blurred vision, nausea, vomiting
Topical decongestants aren’t for people with
MAOIs
Oxymetazoline indications
Nasal congestion
Oxymetazoline side effects
Anxiety, anorexia, restlessness, arrhythmia, nervousness
Phenylephrine indications
Nasal congestion
Phenylephrine side effects
Anxiety, restlessness, anorexia, arrhythmia, blurry vision
Pseudophedrine indications
Nasal congestion
Pseudophedrine side effects
Anxiety, restlessness, anorexia, arrhythmia, blurry vision
Antitussives MOA
Depress cough center in medulla, raise cough threshold and dampen cough reflex
Antitussives indications
Relieve nonproductive cough
Antitussive aren’t for people with
Use of cosine, premature infants, during labor when premature infants are anticipated
Antitussives side effects
High fever, rash, headache
Codeine indications
Suppression of non-productive cough, relief of mild-moderate pain
Codeine side effects
Sedation, dizzy, constipation, CNS depression, orthostatic hypotension
Benzonatate indications
Symptomatic relief of cough
Benzonatate Side effects
Sedation, headache, dizzy, GI, upset, pruritus, congestion, chewing tablets can cause local anesthetic effect
Dextrometorphan indications
Symptomatic cough relief
Dextrometorphan side effects
Drowsy, dizzy, upset GI
Mucolytics MOA
Reduce viscosity of respiratory secretions by direct action on mucous (treat cystic fibrosis)
Acetylcysteine indications
Pneumonia, bronchitis, tracheobronchitis, pulmonary complications with CF, pulmonary complications with surgery and anesthesia, post traumatic chest conditions, atelecastis due to mucous obstruction, acetaminophen overdose, diagnostic bronchital studies, tracheostomy care
Mucolytics side effects
Lightheaded, dizzy, drowsy, sedation (especially with antihistamines)
Acetylcysteine side effects
Stomatitis, fever, drowsy, bronchospasm, irritation of trachea/bronchi
Expectorants MOA
Increase respiratory secretion production, and decrease mucous viscosity, which raises secretions from the respiratory passages
Expectorants indications
Bring up respiratory secretions
Expectorants side effects
Lightheaded, dizzy, drowsy, sedation
Expectorants aren’t for people with
Pregnancy, persistent cough, severe respiratory insufficiency, asthma, elderly people
Guaifenesin indications
Cough relief associated with RTI (sinusitis, asthma, bronchitis, pharyngitis, especially if cough is dry and unproductive)
Guaifenesin side effects
Nausea, dizzy, headache, rash
Potassium iodide indications
Emergency treatment for hyperthyroidism or radiation exposure
Potassium iodide side effects
Iodine sensitivity
Histamine
Substance found in various parts of the body (liver, lungs, intestines, skin), and produced from the amino acid histidine in response to injury to trigger the inflammatory response
Nonproductive cough
Dry, hacking cough that produces no secretions
Productive cough
Cough by which secretions from the respiratory tract are expelled
Rhinitis
Inflammation of the nasal passages
Intranasal steroids MOA
Inhibit response of mast cell,scans white blood cells, and also reduce mediators such as, histamine, which reduces the inflammatory response
Intranasal steroids uses
First line of treatment for symptoms of allergic rhinitis, and also can treat rhinitis caused by nonallergens, nasal polyps, and chronic sinusitis
Intranasal steroids side effects nature
Mild and minimal
Intranasal steroids side effects
Unpleasant smell or taste, nasal passage irritation, nosebleeds, fungal infections are rare, and discontinuation is recommended if nosebleeds persist
Epistaxis
Nose bleeds
Intranasal steroids pregnancy cat
C
Intranasal steroids precautions
Systemic steroids, can slow growth rate in children
Budesonide interactions
Cimetidine makes the intranasal steroids less effective
2nd generation antihistamines MOA
Selective for peripheral H1 receptors, and are less sedating
Antihistamines general uses
Relief of the symptoms of seasonal and perennial allergies, allergic and vasomotor rhinitis, allergic conjunctivitis, mild and uncomplicated angioneurotic edema and urticaria, relief of allergic reactions to drugs, blood or plasma, relief of cough caused by cold or allergies, adjunctive therapy in anaphylactic shock, treatment of Parkinson-like symptoms, nausea and vomiting relief, motion sickness relief, sedation, and adjuncts to analgesics
Antihistamine allergy signs
Skin rash or urticaria
Antihistamines precautions
Bronchial asthma, cardiovascular disease, narrow angle glaucoma, hypertension, impaired kidney function, urinary retention, pyloroduodenal obstruction, and hyperthyroidism
Antihistamines interactions
MAOIs increase anticholinergic and sedative effects, possible additive CNS depressant effect
Diphenhydramine interactions
Beta blockers increase risk of cardiovascular effects
Decongestants ex
Phenylephrine, oxymetazoline, and pseudophedrine
Pseudophedrine contraindications
Sustained release version isn’t for children under 12
Decongestants precautions
Thyroid disease, diabetes mellitus, cardiovascular disease, prostatic hypertrophy, coronary artery disease, peripheral vascular disease, hypertension, glaucoma, pregnancy (cat C)
Decongestants interactions
MAOIs cause severe headache, and possible hypertensive crisis, beta blockers cause initial hypertensive episode followed by bradycardia
Benzonatate MOA
Anesthetizing stretch receptors in the respiratory passages
Dornase alfa use
Cystic fibrosis
Acetylcysteine administrations
Nebulizer, but can also be directly instilled into a tracheostomy to liquefy secretions
OTC cough meds combined with antihistamines side effects
Lightheadedness, dizziness, drowsiness, sedation
Mucolytics contraindications
Asthma
Potassium iodide contraindications
Pregnancy (cat D)
NHs Antitussives precautions
Persistent or chronic cough, cough with excessive secretions, high fever, rash, persistent headache, nausea, vomiting
Codeine precautions
Pregnancy (cat C), and labor (cat D), COPD, acute asthmatic attack, pre existing respiratory disorders, acute abdominal conditions, head injury, increased intracranial pressure, convulsive disorders, hepatic or renal impairment, and prostatic hypertrophy
Guaifenesin pregnancy cat
C
Acetylcysteine pregnancy cat
B
Expectorants precautions
Pregnancy, lactation, persistent cough, severe respiratory insufficiency, asthma, elderly or debilitated patients
Codeine interactions
CNS depressants and alcohol can cause additive depressant effects
Dextrometorphan interactions
MAOIs cause hypotension, fever, nausea, jerking motions of the leg, coma
Potassium iodide interactions
Lithium and anti thyroid drugs effects may potentiate with iodine product and can cause hypokalemia, cardiac arrhythmias, or cardiac arrest, and thyroid function test results can be altered with iodine
Codeine contraindications
Persistent or chronic cough, or when cough is accompanied by excessive secretions
Antihistamines elderly considerations
Elderly are more likely to experience anticholinergic effects (dryness in mouth, nose and throat), dizziness, sedation, hypotension, confusion
Intranasal steroids ex
Beclmethasone, budesonide, cicleonide, flinisolide, fluticasone, mometasone, triamcinolone
1st generation antihistamines ex
Brompheniramine, chlorpheniramine, clemastine, diphenhydramine, promethazine,
2nd generation antihistamines ex
Azelastine, cetirizine, desloratidine, fexofenadine, levocetirizine, loratidine
Decongestants ex
Epinephrine, fexofenadine and pseudophedrine, naphazoline, oxymetazoline, phenylephrine, tetrahydrozoline, xylometazoline
Opioid antitussives
codeine
Nonopioid antitussives
Benzonatate, dextrometorphan, diphenhydramine
Mucolytics ex
Acetylcysteine
Expectorants ex
Guaifenesin
Asthma
Respiratory disorder characterized by bronchospasm and difficulty in breathing, especially exhaling
Dyspnea
Shortness of breath, labored or difficult breathing
Leukotrine
Inflammatory substance that is released by mast cells during an asthma attack
Tachypnea
Rapid breathing
Theophyllinization
Delivery of a high enough dose of theophylline to bring blood levels to a therapeutic range more quickly than over several days
First line intervention for long term asthma control
Inhaled corticosteroids
Quick relief asthma drugs
Short acting beta 2 Agonists (SABA) and oral steroids
SABA bronchodilators use
Relieve bronchsospasm associated with bronchial asthma, chronic bronchitis, and emphysema
SABA bronchodilators ex
Albuterol, epinephrine, salmeterol, terbutaline, ephedrine, levabuterol, metaproterenol
Along with bronchodilators, what is helpful in treating asthma
ICSs, mast cell stabilizers, leukotrine formation inhibitors, leukotrine receptor Agonists and immunomodulators
LABAs side effects
May increase risk of asthma related death
Salmeterol contraindications
Acute bronchospasm
Adrenergic bronchodilators precautions
Hypertension, cardiac dysfunction, hyperthyroidism, glaucoma, diabetes, prostatic hypertrophy, history of seizures, pregnancy (cat C), lactation
Terbutaline pregnancy cat
B
Xanthine derivative bronchodilators ex
Theophylline and aminophylline, dyphylline, oxtriphylline
LABAs ex
Salmeterol, arformoterol, formoterol, indicaterol, olodaterol
Xanthine derivative bronchodilators precautions
Cardiac disease, hypoxemia, hypertension, congestive heart failure, liver disease, Alcohol, pregnancy (cat C), lactation
Inhaled corticosteroids ex
Beclomethasone, flunisolide, budesonide, ciclesonide, fluticasone, mometasone
Beclomethasone contraindications
Relief of symptoms that can be controlled by a bronchodilator and other non steroidal meds and in the treatment of nonasthmatic bronchitis
Inhaled corticosteroids precautions
Compromised immune systems, glaucoma, kidney disease, liver disease, convulsive disorders, diabetes, pregnancy (cat C), lactation,
Budesonide pregnancy cat
B
Budesonide interactions
Ketoconazole can increase plasma levels of budesonide
Fluticasone interaction
Ketoconazole can increase plasma levels of fluticasone
Mast cell stabilizers ex
Cromolyn
Mast cell stabilizers precautions
Pregnancy (cat B), lactation, impaired renal or hepatic function
Leukotrine receptor antagonists ex
Montelukast, zafirlukast
Leukotrine formation inhibitor ex
Zileuton
Monoclonal antibody
Omalizumab
Leukotrine receptor antagonists MOA
Inhibit leukotrine receptor sites in the respiratory tract, by preventing the binding of immunoglobulin to the receptors on basophils and mast cells, limiting the allergic reaction
Omalizumab indications
Adjunctive therapy for patients 12 or older who are sensitive to allergens and who require step 5 or 6 care
Leukotrine modifiers precautions
Pregnancy (cat C)
Zileuton pregnancy cat
C
Leukotrine modifiers side effects
Headache, flu-like symptoms, anaphylactic reactions, emergency equipment should be available when administering this
Zafirlukast interactions
Increased plasma levels with aspirin, increased effect of warfarin, which also decreased zafirlukast levels, erythromycin decreases levels of zafirlukast
Zileuton interactions
Increased theophylline serum levels
Adrenergic bronchodilators elderly consideration
Elderly are at a higher risk for cardiovascular reactions (tachycardia, arrhythmia, palpitation, hypertension) and CNS reactions (restlessness, agitation and insomnia)
Oral corticosteroids elderly considerations
If elderly are at risk for osteoporosis, a calcium or vitamin D supplement can be given
Lower respiratory system anticholinergic
Aclidinium, ipratropium, tiotropium, umeclidinium