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N365: Pharmacology in Nursing > Exam 3 - Week 8: Respiratory Drugs > Flashcards

Exam 3 - Week 8: Respiratory Drugs Flashcards

1
Q

Prototype Respiratory Drugs

A
  1. Acetylcysteine (Mucomyst)
  2. Guaifenesis (Robitussin)
  3. Epinephrine (Adrenaline)
  4. Isoproterenol (Isuprel)
  5. Albuterol (Proventil)
  6. Ipratropium (Atrovent)
  7. Aminophylline (Theophylline)
  8. Cromolyn (Intal)
  9. Zafirlukast (Accolate)
  10. Beclomethasone (Vanceril)
  11. Dextromethorphan (DM)
  12. Pseudoephedrine (Sudafed)
  13. Diphenhydramine (Benadryl)
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2
Q

What is the most common condition affecting the upper respiratory tract?

A

Inflammatory conditions leading to the overproduction of secretion (mucus)

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3
Q

2 Approaches to Mucus Drugs

A

Mucolytic

Expectorant

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4
Q

Mucolytic

A

Breaks up mucus into smaller units

ex: Acetylcysteine (Mucomyst)

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5
Q

Expectorant

A

Reduces viscosity of secretions

ex: guaifenesin (Robitussin(

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6
Q

How do mucolytics and expectorants differ?

A

They both have the same outcome, but the expectorant makes the mucus more watery rather than breaking it up (it dilutes it)

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7
Q

The goal of bronchodilating drugs is…

A

to dilate bronchi in order to maximize airflow but with the fewest SE

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8
Q

Epinephrine is a _______ bronchodilator with significant cardiac effects

A

Non-selective!

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9
Q

Isoproterenol (Isuprel) is a _____ Beta Stimulating Bronchodilator

A

Non-Selective

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10
Q

Albuterol is a relatively ____ Beta 2 Agonist

A

selective

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11
Q

Ipratropium (Atrovent) is what class/type of drug and what does it do?

A

Anticholinergic bronchodilator

it relaxes smooth muscle in the bronchial tree and is used for maintenance therapy

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12
Q

Aminophylline (Theophylline) is what class/type of drug and what does it do?

A

Methylated Xanthine

It has a direct effect on smooth muscle (oral or IV) to bronchodilate

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13
Q

Prototype Mucolytic Drug

A

acetylcysteine (Mucomyst)

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14
Q

Action of acetylcysteine (Mucomyst)

A

Breaks up bonds of mucoprotein molecules from resp. secretions into smaller, more soluble, and less viscous strands

Also effects similar changes in DNA and cell debris and works best at pH 7-9

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15
Q

What is the absorption like for acetylcysteine

A

Very little absorption occurs

It undergoes Nebulization - Nebulizer form is mixed with saline so the mucomyst will act on the mucus and then stay there with little absorbed

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16
Q

ADRs of Acetylcysteine

A

FEW

Some N/V - probably from odor, Stomatitis, Rhinorrhea,

Bronchospasm could occur in asthmatics - assess airways

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17
Q

What is a unique aspect of acetylcysteine

A

It has a rotten egg odor (this can limit compliance)

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18
Q

As an inhalant, acetylcysteine acts as a mucolytic, but as a liquid it is…

A

the antidote for acetaminophen poisoning

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19
Q

It is important to allow the patient to do what after nebulization of acetylcysteine

A

Wash face after nebulization to remove the sticky coating left by the drug (it smells like rotten egg remember)

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20
Q

How long is acetylcysteine infused for if its as an acetaminophen antidote

A

72 hour for Oral; 21 Hour for IV

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21
Q

Prototype drug expectorant/bronchomucotropic

A

guaifenesin (Robutussin)

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22
Q

Action of guaifenesin

A

Directly irritates the gastric mucosa - then because it is upsetting the stomach a gastropulmonary reflex action occurs producing more watery secretions to be coughed up

It irritates gastric mucosa to increase volume and reduced viscosity of respiratory secretions (called gastropulmonary reflex action)

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23
Q

ADRs of guaifenesin

A

RARE!

Occasional GI irritation

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24
Q

What is very important to be doing while taking an expectorant like guaifenesin

A

HYDRATE! - to decrease viscosity the drug is pulling water from the body to loosen secretions so you need to be having fluids since fluids are being pulled from you

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25
Q

guaifenesin is a ___ drug

A

OTC

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26
Q

What may contribute to gastric upset when taking guaifenesin

A

if taken on an empty stomach

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27
Q

How does guaifenesin effect coughing?

A

it does not stop the cough it just helps get secretions up

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28
Q

epinephrine (as a respiratory drug)

A

Sympathomimetic (non-selective); bronchodilator

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29
Q

Action of epinephrine as a respiratory drug

A

Stimulates Alpah, Beta 1 and Beta 2 receptors

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30
Q

Stimulating Alpha receptors…

A

causes VASOCOCNSTRICTION (which is good for airways as it can reduce mucosal edema)

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31
Q

Stimulating Beta 1 Receptors …

A

stimulates heart rate and force of contraction of the heart as well as cardiac irritability

We would prefer if EP did not do this but we will fix it later

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32
Q

Stimulating Beta 2 Receptors…

A

induces bronchial smooth muscle relaxation

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33
Q

What receptors do we want the EP stimulation to occur on the most

A

Alpha and Beta 2 moreso than Beta 1

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34
Q

Absorption / Routes for EP

A

Oral cannot be used as it is destroyed by enzymes

Parenteral is a good route for absorption

Aerosol allows it to be contained to the respiratory tract

Often it is given SUBQ or Aerosol - almost never IV

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35
Q

ADRs of Epinephrine

A

Nervousness
Fear
Insomnia
Tremors
Tachycardia
Palpitation
HA
Dyspnea

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36
Q

Caution using EP when?

A

People with CAD, HTN, and Hyperthyroidism

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37
Q

What drugs should never be given concurrently with EP and why?

A

MAO Inhibitors because it will precipitate severe HTN

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38
Q

When is EP mostly used as a bronchodilator

A

Mostly in acute emergencies by EMS, in the ER, or in someone with acute bronchoconstriction

Can be a little overboard unless emergency

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39
Q

-ol may indicate a drug is what

A

A beta 2 Stimulator - Induces bronchial smooth muscle relaxation

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40
Q

Prototype drug that is a Sympathomimetic, Non-selective Beta Stimulating Bronchodilator

A

isoproterenol (Isuprel)

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41
Q

isoproterenol (Isuprel)

A

Sympathomimetic - mimics Symp.NS

Non selective Beta Stimulating Bronchodilator - only impacts beta receptors but will effect both 1 and 2

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42
Q

Action of isoproterenol

A

Stimulates beta 1 (stimulates heart) and beta 2 (bronchodilation and decreasing tone and motility of the GI tract and uterus)

DOES NOT AHVE ALPHA 1 EFFECTS - but still has Beta 1 effects which is not great

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43
Q

Preferred Route of Administration for isoproterenol (Isuprel)

A

oral and sublingual are poor routes so parenteral and inhalation are preferred or IV

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44
Q

ADRs of isoproterenol (Isuprel)

A

Tachycardia
Palpitation
HA
Nausea
Tremor
Insomnia

THE MORE IT IS USED THE LESS EFFECTIVE IT MAY BE - VERY EFFECTIVE AT FIRST BUT NOT GIVEN OVER AND OVER

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45
Q

____ is one of the most powerful bronchodilators

A

isoproterenol (Isuprel)

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46
Q

What is the issue with isoproterenol and EP

A

they both stimulate Beta 1

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47
Q

Prototype drug that is a Sympathomimetic Selective Beta 2 Stimulating Bronchodilator

A

albuterol (Proventil, Ventolin)

“vent” for ventilation

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48
Q

Action of albuterol

A

Beta 2 stimulation leading to smooth muscle of bronchial tree and peripheral vasculature relaxation

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49
Q

At high doses what can happen with albuterol

A

it can begin to effect beta 1 but at normal doses it does not

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50
Q

Preferred route of albuterol absorption

A

Inhalation (almost always)

Oral only gets 30-40% bioavailability

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51
Q

ADRs of Albuterol

A

FEW!! - More effects if huffed, but when used properly almost nothing - may feel little jitteriness d.t sympathomimetic properties

Peripheral dilation leading to decreased BP causing Tachycardia

Other: Tremors, Palpitations, Nervousness, HA, Dizziness, NV, Anxiety, Lethargy, Tinnitus

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52
Q

What does it mean that Albuterol is a SABA

A

SABA = short acting beta2 agonist

So it is a short acting RESCUE INHALER for needing help breaking things up NOW

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53
Q

How does EP and Albuterol onset and duration differ

A

EP begins quicker but lasts shorter

Albuterol is slightly longer for onset but lasts longer

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54
Q

Caution using Albuterol with what patients

A

Those with Diabetes, HTN, Cqardiac Disorders (esp. arrhythmias)

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55
Q

LABA

A

Long acting beta2 agonists

ex: salmeterol (serevent)

NOT rescuse inhalers, prevent bronchoconstriction through common use

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56
Q

Prototype SAAMA drug

A

ipratropium (Atrovent)

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57
Q

What class is ipratropium (Atrovent)

A

Anticholinergic Bronchodilator - Inhaled Short Acting Muscarinic Antagonist (SAAMA)

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58
Q

What NS is ipratropium impacting

A

PNS rather than SNS

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59
Q

What situations is ipratropium used for

A

For maintenance and prevention of bronchoconstriction NOT an acute acting agent as it takes longer to work and is never given for immediate distress since it is working on the PNS

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60
Q

SAAMA drugs like ipratropium are often given to ___ patients

A

COPD

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61
Q

Action of ipratropium (Atrovent)

A

Blocks cholinergic receptors to reduce bronchial tone

Does NOT seem to affect volume or viscosity of sputum

62
Q

Absorption of ipratropium

A

inhalation allows little absorption (less than 1%) so it has an almost exclusive effect on the mouth and airway when it works

63
Q

Distribution of Ipratropium

A

since little is absorbed it has a negligible effect - it works directly on the mouth and airways

64
Q

ADRs of Ipratropium

A

FEW!!

Dry mouth or Pharyngeal Irritation

65
Q

Recommended Dosage for Ipratropium

A

As an MDI (Measured Dose Inhaler) it is recommended to take 2 inhalations (puffs) QID with up to a maximum of 12 inhalations in a 24 hour period

66
Q

Combivent

A

vent = breathing; combi = combination drug

This is a combo fo ipratropium and albuterol which could be useful for both immediate and later effects simultaneously

67
Q

Prototype Drug Bronchodilator and Methylated Xanthine

A

Aminophylline (Theophylline)

68
Q

Action of Aminophylline

A

Inhibits phosphodiesterase - allows cAMP to increase leading to smooth muscle relaxation (esp bronchial), heart stimulation, stimulated CNS, and renal excretion

Stimulates the medullary respiratory center as well

69
Q

____ is also a methylated xanthine

A

caffeine

70
Q

Absorption/Route of aminophylline

A

Oral and Parenteral routes - IM is irritating so a capsule or IV form is given

71
Q

What is the distribution/Therapeutic level of aminophylline and when does maximum levels occur

A

max levels in 2 hours

therapeutic levle = 8-25 mcg/mL

72
Q

ADRs of Aminophyllines

A
  1. GI (anorexia, NV from vomiting center stim, abd. discomfort)
  2. CNS (nervousness, insomnia, irritability, headache, severe convulsion and coma)
  3. CV (tachycardia, severe hypotension and arrhythmia)
  4. Renal - urinary frequency

TONS of SE - helps airways open but has a lot of major ADRs (similar to caffeine)

73
Q

Why do smokers need higher dosages of aminophylline

A

because the half life of aminophylline is shorter in smoker than non smokers - so they need a higher dosage since they excrete and such more

74
Q

What should always be done when taking aminophylline

A

take it with food to decrease GI irritability

75
Q

How commonly is aminophylline used

A

Nowadays it is not a common drug to see used

76
Q

Prototype Drug Antiallergic/Histamine Inhibitor/Mast Cell Stabilizer

A

cromolyn sodium (Intal)

77
Q

Action of cromolyn sodium

A

Inhibits histamine and other inflammation mediators by stabilizing the cytoplasmic membrane of mast cells

So it stabilizes and stops major inflammation rather than acting on a receptor or anything

78
Q

Since cromolyn sodium stops mast cells before releasing histamines…

A

it is a GOOD PREVENTOR - but is not good for stopping an acute attack already occurring and inflammation already ocurring

79
Q

Route for Cromyln Sodium

A

Inhalation - Rapid but only 10% will penetrate deep into the lungs

Comes as an MDI, turbo inhaler, nasal spray, and opthalmic solution for allergic eye disorders

80
Q

ADR of cromyln sodium

A

only common one is throat irritation

81
Q

cromolyn sodium is used for …

A

asthma PROPHYLAXIS (prevention) - it has no use in an acute attack

82
Q

What education should be done for people on cromolyn sodium

A

always rinse mouth after inhalation treatment because it can disrupt mouth flora

83
Q

cromolyn sodium is good for use in ___ and has minimal ___

A

children; ADRs

84
Q

If cromolyn sodium is used 15 minutes prior, it can even prevent

A

excercise induced asthma attacks

85
Q

Prototype Leukotriene Receptor Antagonist (LRA) drug

A

zafirlukast (Accolate)

“Dr Seuss Drug” - weird name

86
Q

Action of zafirlukast

A

it competes for leukotriene receptor sites (blocks them) and blocks inflammatory response (bronchoconstriction and inflammatory cell infiltration) as a result of leukotrienes

Blocks leukotriene receptors - a cytokine that causes inhlammation - so it prevents inflammation from occurring

87
Q

Is ziafirlukast good for acute treatment?

A

No, it is a maintenance therapy and prophylaxis use only - it will not reverse bronchospasms in acute attack

88
Q

Why is the idea that zafirlukast is a maintenance therapy stressed

A

because most other drugs are fast or for prevention, and on a resp. treatment on a floor would be something like albuterol so this is very STRICLY for prevention

89
Q

What is important to know about the absorption of zafirlukast

A

if taken with food bioavailability is decreased 40% - DO NOT TAKE WITH FOOD

It does come in a tablet form

90
Q

ADRs of zafirlukast

A

GI issues

HA

ELEVATED LIVER FXN TESTS (may need a baseline liver test and get it done periodically)

91
Q

Why must caution be done hen giving zafirlukast alongside warfarin and aspirin

A

Warfarin - the two can increase warfarin concentration and elevated PT

Aspirin - with ASA the plasma levels of zafirlukast will increase

92
Q

When should zafirlukast be taken

A

“Empty Stomach Teaching”

So one hour before meals or two hours after

93
Q

Corticosteroids

A

the most effective anti-inflammatory drugs (anti-inflammatory in respiratory as well)

can be oral, inhaled, parenteral (depending on situation acuteness)

Inhaled version only for lungs

94
Q

Prototype Inhaled Corticosteroid (ICS)

A

beclomethasone (Vanceril)

95
Q

-asone on a drug name means what

A

corticosteroid

96
Q

Action of beclomethasone

A

exact mechanism in astham is poorly understood - however it involves antibody formation suppression

it blocks enzymes that produce the inflammatory process in tissues

Important to know: IT DECREASES INFLAMMATION!!!

97
Q

ADRs of beclomaethasone

A

Hoarseness

Dry Mouth

LOCALIZED THRUSH INFECTION

98
Q

What should be done after taking beclomethasone

A

rinse your mouth out so the steroid does not deposite in the mouth and allow yeast overgrowth

99
Q

What is a potential SE from taking beclomethasone to be aware of

A

It could be absorbed systemically a little causing a systemic steroid response in the body - most effective long term control treatment

100
Q

Corticosteroids are mainly used in what situations (respiratory-wise)

A

mostly for prevention but cna be used acute depending on the form

101
Q

-ol means what

A

beta 2 stimulant

102
Q

Anti-tussive

A

suppress the cough reflex

it makes you cough less unlike the mucus drugs

103
Q

Avoid using anti-tussives in what patients

A

ones that need the cough to keep airways clear

104
Q

What else can be used as an antitussive

A

codeine and other mild narcotic agents

105
Q

Prototype drug that is antitussive, non opioid

A

dextromethorphan (DM)

an OTC Antitussive that is not an opioid

106
Q

Action of dextromethorphan

A

acts CENTRALLY to suppress medullary cough center (elevating cough threshold) but has NO analgesic or addictive properties

It suppresses the cough center of the brain

107
Q

dextromethorphan has No ___ or ___ properties, but at high doses…

A

analgesic or addictive properties: but at high doses it can give a high/buzz so its harder to get now

108
Q

ADRs of Dextromethorphan

A

INFREQUENT (unless taken too much)

GI distress and drowsiness

109
Q

Dextromethorphan is a synthetic opiate derivative so what does this mean for those taking it

A

it is devoid of analgesic and respiratory depressant effects (except in overdose)

While it may be similar to opioids that may explain why high doses cause a high and why it decreases coughing normally

110
Q

There is some questioning as to the effectiveness of what drug?

A

dextromethorphan - some research shows it may do next to nothing in reality

111
Q

What would a drug with DM (ex: Robitussin DM) in the name mean

A

it means its a drug mixed with dextromethorphan

112
Q

___ is a very effective anti tussive that is natural

A

honey

113
Q

Why does mixing DM and something like robitussin present a problem

A

because youre giving DM to decrease coughing but robitussin increases breakup of secretions you need to cough up - its counterproductive

114
Q

Decongestant Drugs

A

decrease nasal congestion secondary to inflammation in the upper respiratory tract

115
Q

Prototype Decongestant Drug

A

pseudoephedrine (Sudafed)

116
Q

Action of pseudoephedrine

A

Stimulates Alpha and Beta adrenergic receptors directly and also causes NEP release (mild EP basically) which causes effects on the cardiac, respiratory, uterine, CNS, and vascular systems

117
Q

How does pseudoephedrine act on the cardiac system as a decongestant

A

vasoconstriction and cardiac stimulation (may increase BP)

do not give to someone with HTN

118
Q

How does pseudoephedrine act on the respiratory system as a decongestant

A

bronchial muscle relaxation - but less prominent than with EP

119
Q

How does pseudoephedrine act on uterine activity

A

it decreases activity

120
Q

How does pseudoephedrine act on the CNS

A

acts as a stimulant on the cerebral cortex and medulla somewhat

121
Q

How does pseudoephedrine act on the vascular system

A

it causes vasoconstriction (shrinking the mucous membranes) but less so than with EP

122
Q

How does pseudoephedrine shrink mucus membranes

A

through vasoconstriction

123
Q

The main way that pseudoephedrine causes its decongestant effect is how

A

through vasoconstriction that shrinks inflamed membranes and improves drainage/airflow

124
Q

pseudoephedrine is almost like a mild what

A

epinephrine - both are in the sympathetic nervous system family

125
Q

How does alpha 1 effects impact decongestion

A

it decreases things and decreases swelling and congestion in the nasal passageway through vasoconstriction

126
Q

Route of pseudoephedrine

A

oral

127
Q

What is important to know about the distribution of pseudoephedrine

A

it crosses the blood brain barrier

128
Q

ADRs of pseudoephedrine

A

MINIMAL - though CV effects like tachycardia and flushing can occur

129
Q

When should pseudoephedrine not be taken

A

avoid taking near bedtime as stimulation can occur leading to you being awake

130
Q

What is the issue with pseudoephedrine as a former-OTC and now current BTC (Behidn the counter) drug

A

it is used to make methamphetamines

it is now behind the counter and amount bought by a person is tracked by the CDC

131
Q

Sometimes Sudafex is still seen as an OTC, but what is true about this current version

A

it is just the trade name drug - it does not have pseudoephedrine as its active ingredient but rather other mild decongestion drugs that do not work the same and are not used to make methamphetamines

132
Q

Antihistamines

A

drugs used to treat symptoms associated with allergies for the most part

133
Q

Prototype Antihistamine (H1 blocking) Drug

A

diphenydramine (Benadryl)

134
Q

Other than as an antihistamine, what is diphenhydramine sometimes used for

A

its sleep SE so use as a hypnotic (Bendaryl)

135
Q

Action of diphenhydramine

A
  1. Competes with histamine for H1 receptor sites preventing physiologic action of histamine
  2. Inhibits release of AcH
  3. Sedative effect
136
Q

By competing for H1 receptor sites and blocking histamine, what effects does that have on the body when taking diphenhydramine

A
  1. Smooth muscle restriction will be stopped (bronchi and GI) or constrict others (fine blood vessels)
  2. Vascular - inhibits vasoconstrictor effects of histamine and more important vasodilator effects
  3. Cap Permeability - storongly antagonizes histamine action to increase cap permeability and formation of edema
137
Q

What action of histamine does diphenhydramine NOT effect and why?

A

The stimulation of gastric secretion as this effect is on H2 receptors not H1

138
Q

Why does diphenhdyramine inhibit AcH release

A

It does this to block PNS muscarinic glands making mucus in order to decrease production

this makes it useful for colds as well as allergies

139
Q

Only take diphenhydramine…

A

close to bedtime

140
Q

Route of Diphenhdyramine

A

Oral, well absorbed, or IV - or even topical

141
Q

ADRs of Diphenhydramine

A

Rarely Serious!!! - Often disappear with continued therapy

CNS: SEDATION, dizziness, tinnitus, lassitude, blurred vision, diplopia

GI: Loss of appetite, NV, epigastric dsitress, constipation, diarrhea, dry mouth

Other: urinary frequency, palpitations, hypotension, HA, tingling, weakness of hand (atropine like action of H1 blockers)

Potential Allergic Manifestations in the form of DERMATITIS when applied topically

MOST OF THESE ADRs DO NOT OCCUR

142
Q

After taking diphenhydramine do not…

A

operate heavy machinery like a car

143
Q

Diphenhydramine should never be taken with…

A

alcohol!!! - it will enhance sedative effects and is a potentially deadly mixture because ROH is a CNS depressant and this is a sedative that can lead to death

144
Q

If diphenhdyramine is taken enough…

A

tolerance can occur

145
Q

Diphenhydramine is often used as a ____ and ___

A

antihistamine AND hypnotic

146
Q

An expectorant drug like guaifenesin is often used to relieve:

A. A persistent dry hacking cough
B. Bronchial irritation
C. Vascular congestions
D. Chest or upper airway congestions

A

Answer: D. chest or upper airway congestion

(could be A in a way if they want mucus getting out)

147
Q

The optimal therapeutic range for theophylline (Theodur) is:

A. 8-15 mcg/mL
B. 30-35 mcg/mL
C. 2-5 mcg/mL
D. 20-25 mcg/mL

A

Answer: A. 8-15 mcg/mL

148
Q

Which of the following is indicated for treatment of an acute asthma attack?

A. Beclomethasone
B. Zafirlukast
C. Ipratropium
D. Albuterol

A

Answer: D. Albuterol

149
Q

Stumper inhaled steroids should be given cautiously to patients with…

A. DM
B. Hypotension
C. Active Respiratory Infection
D. Hypothyroidism

A

Answer: C. Active Respiratory Infection

Can allow overwhelming infeciton when given steroids - suppresses the immune system by suppressing inflammation

150
Q

Psuedoephedrine works by …

A. mimicking the PNS
B. mimicking the SNS
C. Blocking the PNS
D. Blocking the SNS

A

Answer: B: Mimicking the SNS

(it mimicks the SNS like a mild EP)

N365: Pharmacology in Nursing (15 decks)

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