Respiratroy Tract Drugs: Asthma And COPD (79) Flashcards by Ella Thorsteinson

Bronchial asthma

Recurrent and reversible shortness of breath
-lung airways narrow (bronchospasms, inflammation of bronchial mucosa)

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Bronchospasms are a response

To mechanicals released form immune system and secretions

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Airflow limitation is caused by

Bronchospasms and inflammation

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Bronchial asthma

Alveolar ducts/alveoli remain open but airflow is obstructed
-causing difficulty breathing or wheezing

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Status asthmaticus

Medical emergency
-prolonged asthma attack
-does not respond to usual medical therapy

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COPD

Chronic obstructive pulmonary disease
-obstruction is constantly present, but can vary in severit y

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Tobacco smoke and air pollution causes

Inflammation of the airway epithelium
-release of cytokines

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Chronic bronchitis is

Continous inflammation of the bronchi and bronchioles
-result of prolonged exposure to bronchial irritants

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Emphysema

Air spaces enlarge as a result of the destruction of alveolar walls
-surface area is reduced
-impaired res[iration

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Bronchodilator’s

-B2 adrenergic agonists
-anticholinergics
-can think derivatives

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B2 adrenergic agonists

Albutamol salbutamol

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Anticholinergics

Ipratropium bromide

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Xanthine derivatives

Theophylline/aminophylline

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Anti inflammatory drugs

-glucocorticoids
-leukotriene modifiers

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Issues with inhalers

Technique
-local effect and much quicker

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PO drug will interact with more

Receptors = more AE

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Bronchodilator’s: B agonists are

Sympathomimetic bronchodilators
-stimulate bronchial smooth muscle b2 andrenergic receptors

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Two types of smooth muscle b2 adrenergic receptor s

-short acting B agonists (SABA)

-long acting B agonists (LABA)q

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Selective b2 drugs

Activate airway smooth muscle b2 adrenergic receptors

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Example of selective b2 drugs

Salbutamol (SABA)

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Mechanisms of action of B agonists

Dilation of airways

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How do B agonists dilate airways

Activation of smooth muscle b2 receptors

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Activation of smoooht muscle b2 receptors

Relax smooth muscles of the airway resulting in bronchial dilation
-increasing airflow

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Indications for B agonists

-relief of bronchospasm related to asthma, COPD, other pulmonary disease
-acute asthma attacks
-repent attacks

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Adverse effects of B agonists

-cardiac stimulation -tremors -restlessness and insomnia

Why do B agonists cause cardiac stimulation

Tachycardia

Salbutamol adverse effects

-b2 receptor effects -decrease receptor selectivity

Salbutamol adverse effects: b2 receptor effects

Muscle tremor, CNS, anxiety, nausea

Salbutamol adverse effects: decreases receptor selectivity

Stimulates b1 adrenergic receptors in heart

Stimulation of b1 adrenergic receptors in heart causes

Increased heart rate, palpitations, chest pains, angina

Why do these adverse effects happen in salbutamol

When inhaled form is used too frequently

Adverse effects are more likely with (salbutamol)

More likely with oral preparations

Good to encourage what sort of measures for clients taking bronchodilators/B agonists

Good state of health in order to prevent, relieve or decrease symptoms of asthma/COPD

Avoid exposure to conditions that

Precipitate bronchospsms, like smoking, allergens, stress, air pollutants

What else is important for bronchodilators and B agonists

Adequate fluid intake

What therapeutic effects should we be monitoring for, when on b agonists

Decreased: dyspnea, wheezing, restlessness and anxiety Improved: respiratory patterns, activity tolerance

Mechanism of action of anticholinergics

Anticholinergic drug binds to cell membrane blocking ilgand from binding at binding site

Example of anticholinergics

Ipratropium

Anticholinergics prevent… (how)

Bronchoconstriction on a fixed schedule use

Anticholinergics are NOT used for

Acute exacerbations

Tiotrpium, aclidinium, umeclidinium all have a

Longer duration of action

Adverse effects of anticholinergics

-dry mouth or throat (reduces secretions) -systemic effects (minimal)

Two types of methylxanthines

Theophylline and aminophylline

Methylxanthines are an example of

Bronchodilators -smooth muscle relaxation -greater airflow

Theophylline is given

Orally

Aminophylline is a more ____ ____ form of theophylline

Water-soluble

Aminophylline is given

IV administration

Mechanisms of action for methylxanthines

Indications of methylxanthines

-mild to moderate cases of acute asthma -adjunct agent in the management of COPD

Theophylline is very similar in molecular structure to

Caffeine

Adverse effects of methylxanthines

-CNS stimulation -CV stimulation -GI distress

Adverse effects of methylxanthines: CNS stimulation

Anxiety, insomnia, seizures

Adverse effects of methylxanthines: CV stimulation

-palpations (inc force of contraction and a fast HR) -sinus tachycardia (increased HR) -ventricular dysrhythmias -diuresis (increased blood flow to kidneys)

Interactions with methylxanthines: theophylline

Increased effects of theophylline when interacting with ciprofloxacin -inhibits liver CYP metabolism

Large amounts of caffeine can

Intensify adverse effects of methylxanthines

Decreased effects of theophylline occur when

Liver enzyme inducers -as it increases the metabolism of theophylline

Liver enzyme inducers example

Phenytoin, phenobarbital -anti seizure drugs

Cortisol looks similar to

Cholesterol

Glucocorticoids group

There are many drugs in this group

Glucocorticoids have a similar action

To cortisol, which is an adrenal steroid hormone

Steroid drugs structure

Based on cholesterol

Glucocorticoids are….

Anti inflammatory

Inhaled glucocorticoids

Used for chronic asthma and COPD

Oral and IV glucocorticoids would only be used for

Severe and short term treatment

Inhaled forms of glucocorticoids do what

Reduce systemic effects

How long does it take for glucocorticoids to reach a therapeutic effect?

Several weeks

Mechanisms of action for glucocorticoids (4)

-reduce inflammatory mediators -decrease production of cytokines -reduce infiltration and activity of inflammatory cells -reduces edema

Cholesterol and cortisol look very similar to

Budesonide

Examples of inhaled glucocorticoids

Budesonide

Combined preparation of glucocorticoids (2)

-glucocorticoid + Long Acting B2 Agonist (LABA) -budesonide + formoterol

Fluticasone

Inhaled glucocorticoids

Fluticasone is used…

Alone or in combination with advair discus

Fluticasone and advair diskus

Combo with long acting b2 agonist salmeterol

Indications of inhaled glucocorticoids

Prophylaxis treatment of asthma and COPD

COPD is prophylactically treated with

LABA

Adverse effects of inhaled glucocorticoids

-oral fungal infections -pharyngeal irritation -coughing -dry mouth -rare systemic effects

Care implications of inhaled glucocorticoids

-avoid if have candidia in sputum -may slow growth in children (does not reduce adult height) -possible bone loss (weight bearing exercise)

Bronchodilators and glucocorticoids

Bronchodilators should be used several minutes before the glucocorticoid to provide bronchodilators before administration of the glucocorticoid

What should you teach to clients to avoid oral fungal infections

Gargle and rinse the mouth with water afterward to prevent the development of oral fungal infections

Leukotrienes cause

-inflammation -bronchoconstriction -mucus protection -leukocyte recruitment

Leukotrienes cause

Bronchoconstricion and vascular permeability

What are leuotrienes

Released in immune responses in asthma -mast cells, eosinophils

Leukotrienes cause what symptoms

Coughing, wheezing, SOB

Leukotriene modulators

Suppress leukotriene effects

What do leukotriene modulators do when it comes to suppressing leukotriene effects

-prevent smooth muscle contraction of the bronchial airways -decrease mucus secretion -prevent vascular permeability -decrease neutrophil and other leukocyte infiltration to the lungs preventing inflammation

Leukotriene modulators cause what to be reduced

Inflammation in lunch is reduced -asthma symptoms then are relieved

Example of leukotriene receptor antagonists

Montelukast

Example of leukotriene synthesis inhibitor

Zileuton

Montelukast

Generally well tolerated

Indications of leukotriene modulators

-prophylaxis and chronic treatment of asthma in adults and children

leukotriene modulators are NOT

Used for acute asthmatic attacks

Prophylactic and chronic treatment of asthma in adults and children

Montelukast in children ages 2 and older

Care implications of leukotriene modulators

-ensure that the drug is being used for chronic management of asthma not acute

Improvement from leukotriene modulators should be seen within

1 day to 1 week