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89 Cards in this Set
- Front
- Back
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List some common ailments of the upper respiratory system
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-Common Cold
-Seasonal Rhinitis |
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What are two common diseases of the lower respiratory system?
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-Asthma
-COPD |
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What is Asthma?
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Chronic disease in which the airway ocasionally constricts, becomes inflamed, and is lined with excessive amounts of mucus.
-often in response to one or more triggers |
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Describe COPD
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-Chronic Obstructive Pulmonary Disease
-Characterized by the presence of progressive airflow obstruction. -Non reversible |
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What are 2 general categories of drugs for the lower respiratory diseases?
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-Bronchodilators
-Anti-inflammatory Agents |
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What is the purpose of bronchodilators?
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-For a acute use.
-They dilate the bronchioles and the pulmonary vasculature |
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What are anti-inflammatory used for?
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Used as preventative and maintenance.
-Decreases the production and release of inflammatory mediators |
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List the 3 categories of bronchodilators
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-B2-adrenergic receptor agonists
-Methylxanthines -Anticholingeric Agents |
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What are the 3 categories of Anti-Inflammatory Agents?
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-Corticosteroids
-Mast cell Stabilizers -Leukotriene modifiers |
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What receptor in the Lungs is used for relaxation of smooth muscle?
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B2
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Which adrenergic receptors are used in the heart to increase heart rate?
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B1 and B2
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List the 4 B2-Adrengeric receptor agonists.
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-Epinepherine (Adrenaline, Primatene)
-Albuterol (Proventil, Ventolin) -Levalbuterol (Xopenex) -Selmeterol (Severent) |
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What is the mechanism of action for B2-Adrenergic receptor agonists?
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-Act on B2 in lungs
-Increase cAMP concentration within bronchial smooth muscle -Relaxation of airway smooth muscle (bronchodilation) |
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What are the main class of drugs to treat asthma?
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B2-adrenergic receptor agonists
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Are B2 receptors normally activated?
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No, B2 AAs activate them by increasing cAMP concentrations
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What is the therapeutic effect of B2 AAs?
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Relaxation of airway smooth muscle--> bronchodilation
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What is the onset of action for short acting B2 AAs?
What is the Duration of action? Give one example. |
-5 mins
-3 to 8 hours -Albuterol -short: work quickly but don't last long |
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What is the onset of action for long acting B2 AAs?
Duration of action? Example? |
-OOA: 20 mins
-DOA: 12 hours -Ex: Salmeterol |
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Are long acting B2 AAs used for maintenance or acute symptoms?
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Maintenance
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What receptors do non-selective B2 AAs act on and what effect do they have?
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-They act on both B1 and B2
-Ex Epinephrine -Have increase amount of side effects that can work on heart to Increase HR |
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What receptors do Selective Agents act on and why are they more advantageous?
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-Act on B2 receptors only
Ex. Albuterol and Salmuterol The selective nature is preferable because it minimizes side effects |
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What are the routes of administration for B2 AAs?
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-Inhalation
-Oral -Subcutaneously |
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What are the 3 types of Inhaled routes for B2 AAs?
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-Nebulizer
-Metered Dose Inhalers -Dry Powders (Diskus) |
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What type of effect does the inhaled route have on the lungs?
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Topical effect
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What percentage of inhaled drugs stay in the lungs?
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90%
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What percentage does inhaled drug enter the system (circulatory) system?
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10%
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How long should a pt hold their breath after inhaling a MDI?
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10 seconds
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Give an example of a B2 AA MDI
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albuterol
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What should you use for pts who need to use a MDI but lack coordination?
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Spacer (young children)
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How long should you wait in between puffs while using a MDI?
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1 minute
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What is another way of describing a dry powder inhaler?
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Open Diskus
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How long should the pt hold their breath for a Dry Powder inhaler?
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10 seconds
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What is an example of a B2 AA dry powder inhaler?
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salmuterol
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How long does one disk of a dry powder inhaler last?
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about 60 uses or 1 month
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What is the oral route of B2 AA?
Is it risky? |
-capsule form of albuterol
-Yes, there is increase risk of adverse effects because it works systemically. |
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What route is epinephrine administered as a B2 AA?
Does it have adverse effects? |
Subcutaneous
-Yes, increased risk of adverse effects |
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What are the adverse effects associated with B2 AAs?
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-Tachycardia: more in oral than inhalation form
-Decreased serum potassium levels (pushes K into the cell) -Tremor -Tolerance (counteract with withdrawal or add other agents) |
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List some significant drug interactions with B2 AAs
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-Adrenergic medications
-B2 blockers (mostly in the heart, but may be non selective. combination would reverse desired effects in the lungs) |
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What are the two drugs categorized as Methylxantines?
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-Aminophylline (Truphylline)
-Theophylline (Slo-Bid, Theo-Dur) |
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What is the mechanism of action for Methylxanthines?
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-They are phosphodiesterase inhibitors (enzyme responsible for breakdown of cAMP)
-inhibiting phosphodiesterase causes overall relaxation of SM airway. -Has nothing to do with B2 receptors |
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What are the therapeutic effects of methylxanthines?
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-Relaxation of airway SM--> bronchodilation
|
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What class of drug is theophylline and how is it administered?
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-Methylxanthines
-All oral preparations |
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What should you consider when switching between theophylline brands?
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Watch the dosing because one is not the same the other.
-You can go from therapeutic to toxic levels very quickly |
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What Methylxanthine is administered via IV?
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Aminophylline
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What percentage of methylxanthines are metabolized by the liver and through which enzyme?
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-90%
-CYP 1A2 |
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What should you do dosing wise with methylxanthines in the presence of a CYP INDUCER?
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Increase the dose.
-ex smoking or anti epileptics |
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What type of drug is present if you must decrease your dose of Methylxanthine in order to prevent toxic levels?
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CYP inhibitor
Ex. antimicrobials and anti-fungals |
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List the adverse effects of Methylxanthines.
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-N/V
-Tremor -Headache -Arrhythmias -Seizures Most of these are seen when serum concentration is >20mcg/mL |
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What should you instruct your pts to do who are on methylxanthines?
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-Take with food or dairy because of GI upsets
-Monitor for cigarette use (enzyme inducer) |
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What is the mechanism of action for anticholinergic agents?
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Competes with Ach at the muscarinic receptor site and causing decreased vagal tone to the airway --> bronchodilation
|
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What therapeutic effect do anticholinergic agents have on the respiratory system?
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Inhibition of bronchospasm mediated by the parasympathetic nervous system.
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Give an example of a short acting ANTICHOLINERGIC AGENT and what is its duration of action?
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-Ipratropium (Atrovent)
-3-4 hour DOA |
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What is the route of administration for Anticholinergic Agents?
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Inhalation ONLY!
|
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State the long acting ANTICHOLINGERIC AGENT.
-What is its duration of action? |
Tiotropium (Spiriva)
-24 hours DOA |
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What are the adverse effects of anticholinergic drugs?
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-Blurred vision (mydriasis)
-High doses you see: -headache -flushed skin -tachycardia -urinary retention -may add to cataracts in older adults |
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Do Inhaled or Systemic Corticosteroids have LESS side effects?
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Inhaled
|
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LIst the corticosteroids that are administered by inhalation.
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-Budesonide (Pumicort)
-Fluticasome (Flovent) |
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What are the corticosteroids that are administered orally and parenterally?
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-Hydrocortisone (Solu-Cortef)
-Methylprednisolone (Solu-Medrol) -Prednisone (Deltasome) -Dexamethasome (Decadron) |
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What is the PRIMARY mechanism of action for corticosteroids?
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-Inhibits the production or release of inflammatory mediators
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What are the additive mechanism of actions for corticosteroids?
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-Improves B2 receptor agonists sensitivity to the B2 receptor in acute setting.
-Preventing or reversing airway remodeling. |
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Are corticosteroids good for long term use?
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No
|
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Which corticosteroids are good for acute exacerbations?
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Systemic (oral or parenteral administered)
|
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What is the therapeutic effect of corticosteroids?
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Reduce inflammation
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What is the most common adverse affect of inhaled corticosteroids?
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Fungal infections of the mouth
|
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What are the common adverse effects of systemic corticosteroids?
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-Decreased calcium in the bones (osteoperosis)
-High blood pressure -Glucose intolerance (hyperglycemia) |
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What are less common side effects of systemic corticosteroids?
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-Thinning of the skin
-Muscle weakness (myopathy) -CNS effects (euphoria, depression) -Impaired wound healing |
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What should you do when removing a pt from corticosteroids?
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Taper them carefully
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What should you tell your pt to do after using a corticosteroid inhaler?
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Tell them to rinse their mouth after each use.
|
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State the drug categorized as under Mast Cell Stabilizers?
How is it administered? |
-Cromolyn (Intal, Nasalcrom)
-Nebulizer or dry powder inhaler |
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What is the mechanism of action for Cromolyn?
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-Inhibits the breakdown of mast cells
-Prevents the release of histamines, prostagladins and leukotrienes that cause broncho spasms |
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What is the therapeutic effect of mast cell stabilizers?
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-Prevention of bronchospasm
-Most effective when administered 30 minutes before exposure to an allergen or exercise |
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What are the adverse effects of Mast Cell Stabilizers?
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-Tracheal irritation
-Cough -Taste disturbances (aluminum taste) |
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What education should you give to a pt on Mast Cell Stabilizers?
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-Caution the pt not to discontinue abruptly.
-Caution the patients to continue taking this drug even during symptom-free periods |
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List the Receptor Antagonists under Leukotriene Modifiers?
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-Montelukast (singulair)
-Zafirlukast (Accolate) |
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What drug is an inhibitor of 5-lipoxygenase?
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-Zileuton (Zyflo)
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Where do leukotrienes come from?
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Arachidonic acid cascade
|
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What is the mechanism of action for leukotriene modifiers?
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Either inhibit 5-lipoxygenase or block the leukotriene receptor site.
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What are the therapuetic effects of leukotriene modifiers?
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-Reduce inflammation (often used as an alternative to corticosteroids
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Are Leukotriene Modifiers used for the acute relief of bronchoconstriction?
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NO
|
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What are the drug interactions for Zariflukast?
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Inhibit CYP 2C9 and CYP 3A4
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Which Leukotriene Modifier inhibits CYP 1A2 and CYP 3A4?
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Zileuton
|
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What liver enzymes does Montelukast metabolize?
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CYP 3A4 and CYP 2C9
|
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What is preferential about Montelukast?
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It is metabolized by liver enzymes, but doesn't inhibit them.
-Least amount of drug interactions -Most prescribed |
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Which class of drugs require a liver panel every 6 months? Why?
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Leukotriene Modifiers
-Cause Hepatotoxicity |
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What are the adverse effects of Leukotriene Modifiers?
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-Hepatotoxicity
-Headache -GI upsets |
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How should a patient take his or her leukotriene modifier?
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-Take on an empty stomach
-Take continuously |
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What orally administered drug blocks leukotriene receptors?
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Montelukast (singulair)
|
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Which drug inhibits the degradation of cAMP?
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Theophylline (Theo-Dur)
|
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Which drug prevents the release of histamine from mast cells?
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Cromolyn (Intal)
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