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Pharmacology > Week 6 ~ Respiratory System > Flashcards

Week 6 ~ Respiratory System Flashcards

1
Q

What type of treatment is used for Upper Respiratory Diseases?

A

Empirical therapy —> because it’s difficult to identify between viral and bacterial causes of the common cold

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2
Q

What are the 4 upper respiratory disease (URI) drugs used for?

A

The common cold

Mostly caused by a virus

The virus invades tissues of the URT and an inflammatory response occurs, resulting in mucus production

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3
Q

How do Antihistamines work?

A

Drugs that directly compete with histamine for specific receptor sites

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4
Q

2 Histamine Receptors?

A
  1. H1 (Histamine 1) –> Commonly referred to as Antihistamines
  2. H2 (Histamine 2) –> Reduce gastric acid in peptic ulcer disease
    - -> Include Cimetidine, Ranitidine
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5
Q

What are the 3 properties of Antihistamines?

A
  1. Antihistamine
  2. Anticholinergic
  3. Sedative
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6
Q

Antihistamines Mechanism of Action

A

Block action of histamine at the H1 Receptor sites by competing with histamine

Should be given early before histamine binds to receptors

Drying effect reduces nasal, salivary and lacrimal gland production

Sedative effect may cause drowsiness

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7
Q

What symptoms does antihistamines prevent that are caused by histamine?

A
  1. Vasodilation
  2. Increased GI and respiratory secretions
  3. Increased capillary permeability and itching
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8
Q

Antihistamines Indications

A

Nasal allergies/Allergic Reactions

Motion Sickness

Sleep Disorders

Parkinson’s Disease

Seasonal Allergies, ie hay fever

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9
Q

Antihistamines Contraindications

A

Known drug allergy

Children

Acute asthma

Heart Disease

Narrow angle glaucoma

Hypertension

Kidney Disease

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10
Q

Antihistamines Adverse Effects

A

Anticholinergic effects such as dry mouth, difficulty urinating, constipation, drowsiness, changes in vision

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11
Q

Antihistamines Drug Interactions

A

Alcohol

MOI’s

CNS Depressants…may increase CNS depressant effects

Apple/Grapefruit/Orange Juice

St Johns Wort

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12
Q

2 Types of Antihistamines

A
  1. Traditional: work peripherally and centrally
    —>have Anticholinergic effects, more effective
    Then no sedating drugs
  2. Nonsedating: work peripherally
    - –> eliminate unwanted adverse effects, longer duration
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13
Q

2 Kinds of Traditional Antihistamine Drugs?

A
  1. Diphenhydramine

2. Chlorpheniramine

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14
Q

3 Kinds of Non-Sedating Antihistamine Drugs

A
  1. Fexofenadine —> Allegra
  2. Loratadine –> Claritin
  3. Cetirizine —> Reactin
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15
Q

3 Types of Decongestants

A
  1. Adrenergics –> Sympathomimetics
  2. Anticholinergics –> Parasympatholytics
  3. Corticosteroids —> Intranasal Steroid
    (Topical)
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16
Q

What’s the largest group of Decongestant?

A

Adrenergics

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17
Q

2 methods of administering decongestants?

A
  1. Oral

2. Inhaled/topically applied to nasal membranes

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18
Q

Oral Decongestants

A

Delayed onset but prolonged effects

No rebound congestion

Effect is less potent than topical decongestants

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19
Q

Name of an Oral Decongestant?

A

Pseudo ephedrine

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20
Q

Topical Nasal Decongestants

A

Prompt onset and produces potent effect

Causes rebound congestion, making the condition worse if used for several days

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21
Q

3 Types of Topical Nasal Decongestants

A
  1. Topical Adrenergics
  2. Intranasal Adrenergic (Inhaled)
  3. Intranasal Steroids
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22
Q

3 Intranasal Adrenergic Drugs

A
  1. Oxymetazoline Hydrochloride —> Vicks, Claritin
  2. Phenylephrine Hydrochloride
  3. Xylometazoline Hydrochloride –> Otrivin
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23
Q

3 Intranasal Steroid Drugs

A
  1. Beclomethasone Dipropionate
  2. Fluticasone Proprionate
  3. Flunisolide
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24
Q

Nasal Decongestant ADRENERGICS Mechanism of Action

A

Act on blood vessels surrounding nasal sinuses

Constrict small blood vessels that supply upper respiratory tract

RESULTS: tissues shrink, nasal secretions in swollen mucous membranes are able to drain and nasal stuffiness is relieved

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25
Q

Nasal Decongestion NASAL STEROIDS Mechanism of Action

A

Shrink engorged nasal mucous membranes

Relieve nasal stuffiness by acting on blood vessels surround nasal sinuses, have an anti inflammatory effect, decrease immune cells that respond to the inflammatory response

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26
Q

Nasal Decongestant Contraindications

A

Drug Allergy

Narrow angle glaucoma

Diabetes

Hypertension

Prostatitis

Hyperthyroidism

Uncontrolled Cardiovascular disease

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27
Q

Nasal Decongestants should be used cautiously in patients with history of what?

A
  1. Stroke/TIA’s
  2. Diabetes
  3. Long Standing Asthma
  4. Benign Prostatic Hyperplasia
  5. Cerebral Arteriosclerosis
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28
Q

Decongestant Adverse Effects

A
  1. ADRENERGICS: causes nervousness, insomnia, tremors, palpitations
  2. STEROID: causes local mucosal dryness
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29
Q

4 Drugs for Upper Respiratory Disease

A
  1. Antihistamines
  2. Decongestants
  3. Antitussives
  4. Expectorants
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30
Q

2 Types of Cough

A
  1. Productive: cough up phlegm etc

2. Nonproductive: dry cough

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31
Q

What are Antitussives?

A

Drugs used to stop or reduce coughing

May be opiod or nonopiod

Used only for Non-productive coughs

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32
Q

Opiods Mechanism of Action as an Antitussives?

A

Suppress the cough reflex in the medulla

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33
Q

Types of Antitussive Opiods

A

Codeine –> Robitussin, Dimetane - C, Dimetapp - C

Hydrocondone

34
Q

Antitussive Nonopiod Mechanism of Action

A

Suppress the cough reflex by numbing the stretch receptors of the respiratory tract and preventing the cough reflex from being stimulated

35
Q

Types of Nonopiod Antitussives?

A

Dextromethorphan –> Benylin DM-E, Buckleys, Robitussin

Vick’s

36
Q

Antitussive Contraindications

A

Drug allergy

Opioid Dependancy

High risk respiratory depression

37
Q

Antitussive Opioid Adverse Effects

A

Sedation
Nausea/Vomiting
Lightheadedness
Constipation

38
Q

Antitussive Nonopioid Adverse Effects

A

Dizziness
Drowsiness
Nausea

39
Q

What are Expectorants?

A

Drugs that aid in the expectoration of mucus

40
Q

Expectorant Mechanism of Action

A
  1. Reflex Stimulation –> Loosens/thins secretions in respiratory
    Tract creating mucus that’s easier to remove
        *Gauifenesin (Robitussin)
  2. Direct Stimulation –> Secretory glands are stimulated to produce
    More respiratory tract fluids
     *Iodine containing products: Iodinated Glycerol 
                                                        Potassium Iodide (less used)
41
Q

Expectorant Indications

A

Used for relief of productive coughs associated with common cold, bronchitis, pertussis, laryngitis, sinusitis, pharyngitis

42
Q

Expectorant Contraindications

A

Drug allergy

Hyperkalemia (for potassium containing expectorants)

43
Q

Expectorant Adverse Effects

A

Nausea
Vomiting
Gastric Irritation

44
Q

Diseases of Lower Respiratory Tract?

A

COPD
Asthma
Emphysema
Chronic Bronchitis

45
Q

2 Types of Respiratory Drugs

A
  1. Bronchodilators

2. Non-Bronchodilators

46
Q

2 Bronchodilators

A

B-Adrenergic Agonists

Xanethine Derivatives

47
Q

2 Non Bronchodilators

A

Antileukotrines

Corticosteroids

48
Q

What do B-Agonists do?

A

Stimulate B2 Adrenergic Receptors which are located throughout the lungs

49
Q

3 Types of B-Agonists

A
  1. Non-Selective Adrenergics
  2. Non - Selective B-Adrenergics
  3. Selective B2 Drugs
50
Q

What do Non-Selective Adrenergics do?

A

Stimulate A1, B1 (Cardiac), B2 (Respiratory) receptors

*Include Epinephrine (Adrenaline)

51
Q

What do Non-Selective B-Adrenergics do?

A

Stimulate both B1 and B2 Receptors

*Isoproterenol

52
Q

What do Selective B2 drugs do?

A

Stimulate only B2 receptors

*Salbutamol

53
Q

B-Agonists Mechanism of Action

A

Specific receptors are stimulated and cause dilation of the airways resulting in:

Activation of B2 receptors –> Activates cAMP –> Relaxes smooth muscles of the airway –> bronchial dilation = Increased air flow

54
Q

B Agonists Indications

A

~ Bronchopasm related to asthma, bronchitis

~ Treat and prevent acute attacks

~ Treatment of hypotension and shock

~ Cause uterine relaxation to prevent premature labour

~Treat Hyperkalemia –> stimulates K+ to shift into cells

55
Q

B-Agonist Adverse Effects

A 
Anorexia
Insomnia
Restlessness
Tremors
Cardiac Stimulation
Hyperglycaemia
56
Q

B-Agonist Contraindications

A

Drug Allergy

Uncontrolled cardiac dysrhthmias

High risk of stroke

57
Q

B-Agonist Drug Interactions

A

Increase risk of hypertension

Increase risk of cardiac toxicity

Require an adjustment to Antihyperglycemic drugs

58
Q

2 Synthetic types of Xanthines?

A
  1. Aminophylline

2. Oxtriphylline

59
Q

What’s the only Xanthines Derivative used as a Bronchodilator?

A

Theophylline

60
Q

What are 3 Natural Plant Alkaloid Xanthines?

A
  1. Caffeine
  2. Theobromine
  3. Theophylline
61
Q

Xanthines Derivative Mechanism of Action

A
  1. Increase levels of energy producing cAMP by competitively inhibiting Phosphodiesterase, the enzyme that breaks down cAMP —-> decreased cAMP levels —> smooth muscle relaxation
    - -> Bronchodilation –> increased airflow
  2. Stimulate CNS and Cardiovascular System (Increase heart rate)
  3. Diuresis
62
Q

What is the category of Xanthines Derivatives?

A

Bronchodilators

63
Q

Xanthine Derivative Indications

A

Asthma
COPD
Emphysema
Chronic Bronchitis

64
Q

Xanthine Derivative Contraindications?

A 
Drug allergy
Peptic Ulcers
Seizure disorders
Hyperthyroid
Uncontrolled cardiac Dysrhthmias
65
Q

Xanthines Derivative Adverse Effects

A 
Nausea/Vomiting
Anorexia
Increased urination
Gastroesophogeal Reflux during sleep
Sinus tachycardia
Palpitations
Extra systole
Ventricular Dysrhythmias
66
Q

Xanthine Derivative Drug Interactions

A

When used with Sympathomimetics (caffeine) increased heart and CNS stimulation result

St Johns Wort (Hypericum Perforatum) and smoking enhance the rate of Xanthine drug metabolism

67
Q

Anticholinergics Mechanism of Action

A

Bind to ACh receptors, preventing ACh from binding —> prevents bronchi constriction = dilation of airways

68
Q

Types of Anticholinergic Drugs

A
  1. Ipratropium Bromide (Atrovent)
  2. Tiotropium
    * Slow and prolonged action*
69
Q

Anticholinergic Adverse Effects

A 
Dry mouth or throat
Anxiety
Headache
Cough
Nasal Congestion
Palpitations
GI distress
70
Q

What are Antileukotriene Drugs?

A

*New class of asthma medication

Prevent Leukotrienes from attaching to receptors on circulating immune cells and immune cells within the lungs = inflammation in the lungs is blocked

71
Q

2 Types of Antileukotriene Drugs?

A
  1. Montelukast - Singulair
  2. Zafirlukast - Accolate
    * Leukotriene receptor antagonists*
72
Q

What do Leukotrienes do?

A

Are substances released when a trigger such as dust starts a series of chemical reactions in the body.

They cause inflammation, mucus production, broncho constrictions, coughing, sneezing, SOB

73
Q

Antileukotriene Drug Effects

A

By blocking Leukotrienes they:
1. Prevent smooth mm contraction of bronchial airways
2. Decrease mucus secretion
3. Prevent vascular permeability
4. Decrease neutrophil and leukocytes in the lungs, preventing
Inflammation

74
Q

Antileukotriene Indications

A

Used for the prophylaxis and long term treatment of asthma in adults or children above age 12

75
Q

Antileukotriene Contraindications

A

Drug allergy

Allergy to povidone, lactose, titanium dioxide, cellulose derivatives

76
Q

Antileukotriene Adverse Effects

A

Headache
Nausea
Diarrhea
Liver Dysfunction

77
Q

Corticosteroids Mechanism of Action

A

Used for Chronic Asthma
~Available in oral and inhaled forms

Anti-Inflammatory Effects

Stabilize membranes of cells (WBC/Leukocytes) that release harmful broncho constricting substances

Increase responsiveness of bronchial smooth muscle to B-Adrenergic stimulation

78
Q

What symptoms does Corticosteroids not relieve?

A

Symptoms of Acute Asthma Attacks

79
Q

4 Inhaled Corticosteroid Drugs?

A
  1. Beclomethasone Dipropionate
  2. Budesonide
  3. Fluticasone Furoate
  4. Fluticasone Propionate - Flonase, Flovent, Diskus
80
Q

Inhaled Corticosteroid Indications

A

Bronchospastic Disorders that aren’t under control by conventional bronchodilators

NOT for acute asthma!!

81
Q

Inhaled Corticosteroid Contraindications

A

Candida/Fungal Infections

Hypersensitive to Glucocorticoids

82
Q

Inhaled Corticosteroid Adverse Effects

A

Coughing

Dry mouth

Pharyngeal Irritation

Oral Fungal Infections

Systemic effects are rare because it’s an inhalation therapy

Pharmacology (6 decks)

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