KARCH: CH. 55 - Drugs Acting on the Lower Respiratory Tract Flashcards
_____: drugs that help w/ breathing by dilating the airways; helpful in symptomatic relief or prevention of bronchial asthma & bronchospasm R/T COPD.
Bronchodilator
_____: an abnormal pattern of breathing characterized by apneic periods followed by periods of tachypnea; May reflect delayed blood flow through the brain.
Cheyne-Stokes respiration
_____: drugs that selectively & competitively block or antagonize receptors to produce leukotrienes D4 and E4 (components of slow-reacting substance of anaphylaxis [SRSA]).
Leukotriene receptor antagonists
_____: drugs that work at the cellular level to inhibit the release of histamine (released from mast cells in response to inflammation or irritation) and the release is a slow-reacting substance of anaphylaxis [SRSA].
Mast cell stabilizer
_____: drugs that mimic the effects of the SNS.
Sympathomimetics
_____: naturally occurring substances; including caffeine and theophylline - that have a direct effect on the resp. tract smooth muscle, both in the bronchi & blood vessels.
Xanthenes
COPD Manifestations of COPD: (3) Prevention and Treatment for COPD:
MANIFESTATION OF COPD: Air is trapped in the lower respiratory tract The alveoli degenerate and fuse together The exchange of gases is greatly impaired PREVENTION & TREATMENT: ↓ Environmental exposure to irritants Stop smoking Filter allergens from the air Avoid exposure to known irritants & allergens Open conducting airways thru muscular bronchodilation ↓ Effects of inflammation on the airway lining
Adult Respiratory Distress Syndrome (ARDS) Characteristics: Caused by: Treatment:
CHARACTERISTICS: The progressive loss of lung compliance & ↑ hypoxia CAUSED BY: CV collapse; major burns; severe trauma; rapid depressurization TREATMENT: Treat/reverse underlying cause combined w/ ventilation support.
Bronchodilators/Antiasthmatics
General use:
Sub-classifications: (3)
Drugs for each sub-class:
MOA:
GENERAL USE:
- To facilitate respiration by dilating the airways
SUB-CLASSIFICATIONS:
- Xanthines
- Sympathomimetics
-
Anticholinergics
-
MOA:
- Blocks vagus nerve activity & dilates bronchi.
-
DRUGS:
- Aclidinium (Tudorza Pressair)
- Ipratropium (Atrovent)
- Tiotropium (Spiriva)
- Umeclidinium (Incruse Ellipta)
-
MOA:
Bronchodilators/Antiasthmatics
Sub-class: Xanthines
Bronchodilators/Antiasthmatics
Sub-class: Xanthines
DRUGS:
- Aminophylline
- Caffeine (Caffedrine)
- Dyphylline
- Theophylline
MOA:
- Relaxes smooth muscle
- Directly relaxes bronchial smooth muscle & blood vessels, causing bronchodilation, ↑ vital capacity & ↑ force of the diaphragmic muscle.
INDICATIONS:
- To prevent or treat bronchial asthma
- To reversal bronchospasm R/T COPD, chronic bronchitis, or emphysema.
PHARMACOKINETICS:
- Narrow therapeutic margin
- Rapidly absorbed for the GI tract
- Metabolized in the liver and excreted in the urine
CONTRAINDICATIONS:
- GI problems
- CAD
- Respiratory dysfunction
- Renal & Hepatic disease; Alcoholism
- Hyperthyroidism
DRUG-DRUG INTERACTIONS:
- Many drugs!
- Substances in cigarettes
ADVERSE EFFECTS:
- NOTE: SE are R/T Theophylline serum level
- Anorexia, N/V, Proteinuria
- Irritable, Restless, Dizzy, Fever, Flushing
- Tachycardia, Palpations, Deadly arrhythmias, Respiratory arrest, Seizure, Brain damage, Death
ASSESS:
- Peptic ulcer, Gastritis, CAD
- Monitor BP, HR/pulse, Heart sounds, Peripheral perfusion, Baseline ECG
- Skin
- LABS:
- Renal & Hepatic function
- Theophylline serum level
- Urinalysis (RF Proteinuria)
- BS
Bronchodilators/Antiasthmatics
Sub-class: Sympathomimetics
Bronchodilators/Antiasthmatics
Sub-class: Sympathomimetics
DRUGS:
- Albuterol (Proventil HFA)
- Arformoterol (Brovana)
- Ephedrine
- Epinephrine (EpiPen)
- Formoterol (Foradil)
- Indacaterol (Arcapta)
- Isoproterenol (Isuprel)
- Levalbuterol (Xopenex HFA)
- Metaproterenol
- Olodaterol (Striverdi Respimat)
- Salmeterol (Serevent)
- Terbutaline
MOA:
- Mimics the SNS - dilates bronchi & & ↑ rate & depth of respirations.
- Beta2 selective adrenergic agonists
INDICATIONS:
- Acute asthma attack
- Bronchospasm in acute or chronic asthma
- Prevention of exercise-induced asthma
PHARMACOKINETICS:
- Rapidly distributed after injection, transformed in the liver to metabolites that are excreted in the urine.
CONTRAINDICATIONS:
- Depends on the underlying condition severity
DRUG-DRUG INTERACTIONS:
- General anesthetics
ADVERSE EFFECTS:
- Sympathomimetic stimulation
- CNS stimulation
- N/V, cardiac arrhythmias, HTN, bronchospasm, sweating, pallor, and flushing
ASSESS:
- Cigarette use
- Pregnancy & Lactation
- Cardiac disease, CVD, Arrhythmias
- DM, Hyperthyroidism
- Reflexes and orientation
Bronchodilators/Antiasthmatics
Sub-class: Anticholinergics
Bronchodilators/Antiasthmatics
Sub-class: Anticholinergics
DRUGS:
- Aclidinium (Tudorza Pressair)
- Ipratropium (Atrovent)
- Tiotropium (Spiriva)
- Umeclidinium (Incruse Ellipta)
MOA:
- Blocks vagus nerve activity & dilates bronchi.
- Blocks vagal mediated reflexes by antagonizing the action of acetylcholine.
INDICATIONS:
- Maintenance & treatment of bronchospasm R/T COPD.
- Tx seasonal allergic rhinitis (as nasal spray)
- Preferred for PTs that CAN’T tolerate Sympathomimetics SNS effects.
PHARMACOKINETICS:
- Onset: 15-min. (if inhaled)
- Peak: 1-2 hr.
- Duration: 3-4 hr.
CAUTION:
- Any condition that would be aggravated by the anticholinergic effects of the drug
DRUG-DRUG INTERACTIONS:
- Other anticholinergics
ADVERSE EFFECTS:
- Anticholinergic effects: Dizzy, HA, fatigue, nervous, dry mouth, sore throat, urinary retention
- Cough
- Palpations
ASSESS:
- Acute bronchospasm, Bladder neck obstruction, BPH
- LOC, orientation, affect, reflexes
- B/P, HR/pulse, RR & LS, Urinary O/P
True or False:
The adverse effects of the Xanthines are related to theophylline levels in the blood and include brain damage.
True
Rationale: Adverse Effects: Related to theophylline levels in the blood; GI upset, nausea, irritability, and tachycardia to seizure, brain damage, and even death
Inhaled Steroids
Inhaled Steroids
DRUGS:
- Beclomethasone (Beconase AQ)
- Budesonide (Pulmicort Respules, Pulmicort Flexhaler)
- Ciclesonide (Alvesco)
- Fluticasone (Flovent Diskus, Flovent HFA)
- Triamcinolone (generic)
INDICATIONS:
- Very effective tx for bronchospasm
- Prevent & tx asthma
- Chronic steroid-dependent bronchial asthma
PHARMACOKINETICS:
- Well absorbed from the respiratory tract
- Metabolized by natural systems, mostly w/in the liver, excreted in urine.
CONTRAINDICATIONS:
-
NOT for emergencies!
- NO acute attack
- NO status asthmaticus
- NO Pregnancy or Lactation
ADVERSE EFFECTS:
- Sore throat
- Hoarseness
- Coughing
- Dry mouth
- Pharyngeal & laryngeal fungal infections
ASSESS:
- Systemic infections
- Pregnancy & Lactation
- VS, RR & LS, nares
Leukotriene Receptor Antagonists
Leukotriene Receptor Antagonists
DRUGS:
- Zafirlukast (Accolate)
- Montelukast (Singulair)
- Zileuton (Zyflo)
MOA:
- Acts more specifically at the site of the problem associated with asthma.
- Selectively and competitively blocks/antagonize receptors to produce leukotrienes
INDICATIONS:
- Prophylaxis & chronic tx of bronchial asthma in adults and kids <12 yr.
PHARMACOKINETICS:
- Rapidly absorbed from GI tract, extensively metabolized in the liver and primarily excreted in feces
ADVERSE EFFECTS:
- HA, Dizzy, Myalgia, N/VD, Abdominal pain
- ↑Liver enzymes
- Generalized pain
DRUG-DRUG INTERACTIONS:
- Propranolol, Theophylline, Terfenadine, or Warfarin
- Calcium channel blockers, Cyclosporine, or Aspirin
CAUTION:
- Hepatic or renal impairment
- Pregnancy and lactation
ASSESS:
- Acute bronchospasm or asthmatic attack
- LABS: Renal & hepatic function
- Temperature, orientation, affect
