Lecture 28 - Respiratory Drugs Flashcards Preview

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Flashcards in Lecture 28 - Respiratory Drugs Deck (59):
1

What are the changes seen in an asthmatics airway?

Epithelial damage
Mucus secretion
Mucosal inflammation + edema
Smooth muscle contraction

2

What is happening at the cellular level with allergies and the airway wall?

Allergen stimulates = Mast cell + DC
Mast cell = Stim. Neu + EOS
EOS = DC's
DCs --> Th2 --> EOS

3

What molecule causes bronchodilation?

increase in cAMP

4

What two things affect the levels of cAMP?

AC + PDE

5

What occurs at the level of AC in regards to bronchial activity?

Beta agonists stimulate = Increase in AC = Increase cAMP

6

What occurs at the level of the PDE in regards to bronchial activity?

Theophylline inhibits = Increase cAMP
Also inhibits adenosine from causing constriction

7

What are B2 agonists really good at?

Bronchodialators

8

What is the mechanism in which B2 agonists are able to cause bronchodilation?

Increase cAMP = relax smooth muscle
Inhibit histamine release from mast cells

9

What are the respiratory drug families?

Beta-2 agonists
Muscarinic antagonists
Phosphodieseterase Inhibitors
Corticosteroids
Leukotriene inhibitors
Janus Kinase Inibitors
Respiratory Stimulant
Antihistamine

10

Drugs within family: Beta-2 agonists

Albuterol
Levalbuterol
Clenbuterol
Terbutaline
Salmeterol

11

Drugs within family: Muscarinic Antagonists

Ipratopium
Tiotropium

12

Drugs within family: Phosphodiesterase inhibitors

Theophylline
Aminophylline

13

Drugs within family: Corticosteroids

Fluticasone
Budenoside
Prednisilone

14

Drugs within family: Leukotrine inhibitors

Zafirlukast
Montelukast

15

Drugs within family: JAK inhibitors

Oclacitinib

16

Drugs within family: Respiratory stimulants

Doxapram

17

Drugs within family: 1st gen. antihistamines

Diphenhydramine
Chlorpheniramine
Clemastine
Promethazine

18

Drugs within family: 2nd gen, antihistamines

Loratadine
Desloratadine
Fesofenadine
Cetirizine

19

What are the general characteristics of B2-agonists?

~4 to 6 hours of effect
Immediate action
Stops attacks

20

Which B2 agonist is NOT inhaled but rather oral?

Terbutoline

21

What is Salmeterol used for generally ?

Longer duration
Good for chronic use

22

What is Salmeterol NOT used for?

To stop attacks, doesn't work for this

23

What is an adverse affect of Salmeterol?

Down-regulation of beta receptors

24

What can be given with Salmeterol to stop the down regulation of beta-receptors?

Corticosteroids

25

What B2 agonists is thought to have the least amount of side effects?

Levoalbuterol

26

What type (adminstration wise) of B2 agonist gives the most side effects?

Oral

27

What are side effects of Beta-2 agonist use?

Tachycardia
Skeletal muscle tremors

28

Why are the side effects so few and far between with the muscarinic antagonists used in the respiratory system?

Inhaled - very large compounds so they don't get into the body

29

What are the muscarinic antagonists used for most commonly?

RAO in horses

30

How would Beta-2 agonists and corticosteroids be used together clinically?

Betas would be for rescue therapy
Given before inhaled corticosteroids to help increase the distribution when taken

31

What syrup is used in horses with RAO?

Clenbuterol - DO NOT USE IN CATTLE

32

What is the specific use of Salmeterol?

Improves signs of airway obstruction in horses with RAO
Use in mild to moderate cases

33

What beta-2 agonist is NOT TO BE USED IN COWS?

CLENBUTEROL

34

Which Beta 2 agonist can be injected into horses?

Terbutaline

35

What do the phosphodiesterase inhibitors cause biochemically?

Increase cAMP -- inhibit PDE
Block adenosine receptors

36

What effects do phosphoesterase inhibitors have physiologically?

Relax smooth muscle
Stimulates CNS + Heart
May be anti-inflammatory

37

Why is phosphodiesterase inhibitors the best to work against bronchocontriction?

beta and muscarinics are not responsible for the process

38

Which phosphodiesterase inhibitor is injected?

Aminophylline

39

What are phosphodiesterase inhibitors mostly used for?

Dogs + Cats for bronchitis

40

What are side effects of PDE inhibtors?

SNS effects basically
CNS + Cardiac + Muscle

41

What is important to note when using PDE inhibitors with other drugs?

Under go liver metabolism - can react with many other drugs
Low TI

42

What is seen cellularly in inflammation of the airways?

Inflammatory cell infiltrates
Bronchocontriction
Hypersecretion of mucous
Epithelium permeability + destruction
Edema

43

What are corticosteroids used for?

Decrease inflammation
Reduce bronchial reactivity
Improve B agonist response

44

What two steroids are inhaled?

Fluticasone
-- and --
Budesonide

45

What are inhaled steroids commonly used for?

RAO
-- and --
Feline asthma

46

What are the upsides of using Leukotriene inhibitors?

Decrease the need for steroids
Few side effects

47

What is the down side to using Leukotriene inhibitors?

Not bronchodilators
No effect on in-progress attack
Cant be used alone - not strong enough

48

When is a respiratory stimulant used? What is the drug called?

Doxapram
Emergency in anesthesia
Decrease respiratory depression with opioids
Hypoxic-iscehmia encephalopathy

49

How does Doxapram work?

Works on chemoreceptors on carotid artery + aorta
Stimulate respiratory center

50

What are the two major effects of Histamine? What receptors are involved?

Vasodilation = H1 + H2
-- and --
Bronchospasm = H1

51

What does H1 do for vasodilation?

Stimulates release of NO

52

What are the effects of Anti-histamines?

Inhibit smooth muscle response
Inhibit vasodilation
Inhibit flare + itch

53

Which type of anti-histamines have a CNS effect?

First generations

54

What are the first generations used for due to their CNS effects?

Motion sickness
Nausea + Vomiting

55

Which first generation antihistamine is used for nausea and vomiting?

Promethazine

56

What type of action do first generation antihistamines have at the receptor site?

Competitive antagonists

57

What are the different characteristics of second generation antihistamines?

No entrance into the brain
-- and --
No anticholinergic effects

58

What is a good second generation antihistamine to use in patients with liver disease or those on several drugs? Why?

Cetirizine
Excreted completely by the kidney

59

What is the mechanism of Oclacitinib?

Decrease inflammatory mediators + Cytokines
Great for puritis + dermatitis