Lecture 53 - Drugs for Lung Disease; Anti-tussives; Anti-histamines Flashcards Preview

PT1 B2 > Lecture 53 - Drugs for Lung Disease; Anti-tussives; Anti-histamines > Flashcards

Flashcards in Lecture 53 - Drugs for Lung Disease; Anti-tussives; Anti-histamines Deck (23)
Loading flashcards...
1
Q

what drug classes are used in the setting of Asthma and COPD acute exacerbations ?

A

○ SABA
○ Short-acting anticholinergics
○ Systemic corticosteroids

2
Q

What drugs are used as maintenance therapy for asthma?

A
§ ICS
			§ LABA (in conjunction with ICS)
			§ Cromolyn and Nedocromil
			§ Leukotriene modifiers
			§ Omalizumab
3
Q

What drugs are used as maintenance therapy for COPD?

A

§ Long-acting anticholinergics

§ LABA

4
Q

Bronchodilators for COPD and Asthma?

A

Beta2 Agonists

Anticholinergics

Methylxanthines

5
Q

Mechanism of Beta 2 agonists?

A

Stimulates beta2 receptors causing an increase in cAMP which causes smooth muscle relaxation (bronchodilation), mast cell stabilization and skeletal muscle stimulation

6
Q

Side effects of SABA and LABA

A

Tachycardia/palpitations
Transient decrease in serum potassium levels
Tremors
Lactic acidosis

LABA – same as above, but also carry increased risk of asthma realted death when not used with corticosteroids

7
Q

Anticholinergics

    • what are some drugs?
    • mechanism
A
Ipratropium bromide (short-acting)
Tiotropium (long-acting)

Inhibit muscarinic receptors (M1 and M3) in bronchial smooth muscle which blocks Ach binding and increases cGMP which leads to bronchodilation

8
Q

Anticholinergics – side effects?

A
Blurred vision
Dry mouth
Nausea
Urinary retention
CNS effects
Tachycardia
Increased CV events
9
Q

Methylxanthines –

    • what drug is in this class?
    • mechanism ?
A

Theophylline

Non-selective inhibition of phosphodiesterase which increases cAMP and cGMP  bronchodilation

Inflammatory cell regulation

Competitive antagonist of adenosine and stimulates endogenous catecholamine release (beta2  bronchodilation)

10
Q

Why is Theophylline rarely used clinically ?

what are some side effects?

A

narrow therapeutic window

Nausea and vomiting
Gastric upset
Tachyarrhythmia
Jitteriness
Insomnia
Headache
seizures
11
Q

Corticosteroids —
indications for use

– what are they drugs? which has the lowest potency, which has the highest?

A

Acute exacerbation of asthma and COPD
maintenance therapy to prevent bronchospasm
allergic rhinitis

Hydrocortisone (low potency)
Prednisone (medium potency)
Methylprednisone (medium potency)
Dexamathasone (high potency)

12
Q

Side effects of corticosteroids

– what specific infection can occur with inhaled corticosteroids?

A

Acute setting: Hypergylcemia, HTN,

Long term: HPA suppression, growth retardation, muscle myopathy, osteoporosis, impaired wound healing

Oral steroids – candidiasis

13
Q
Mast Cell Stabilizing Drugs
- 
what are they? 
mechansim? 
indications?
A

Cromolyn
Nedocromil

Inhibits mast cell degranulation

Long term treatment for prevention of symptoms of asthma

14
Q

Side effects of mast cell stabilizing drugs?

A

cromolyn: Cough and wheezing

Nedocromil – Cough and wheezing + dyguesia

15
Q

Leukotriene Modifiers

two types? (different mechanisms)
what are the drugs?

A

Leukotriene receptor antagonists — • Zafirlukast (Accolate); Montelukast (Singular; taken once a day)

5-lipoxygenase inhibitor that prevents conversion from arachindonic acid to leukotrienes
Zileuton

16
Q

Indications for the use of leukotrinee modifiers?

side effects for each class?

why is Zileuton not really used ?

A

◊ Long term control and prevention in patients with asthma
Allergic rhinitis

Luekotriene Antagonists: Headache
Nausea
Abdominal pain

Zileuton –
Liver toxicity
Hyperbilirubinemia

17
Q

Antihistamines
mechanism?
whats the difference between first and second generation?

A

Competitive antagonist to H1-receptors that prevent histamine binding and action which will allow for bronchodilation (and effects on vascular smooth muscle and endothelial cells as well as nerves)

First generation: lipophilic and non-selective, anticholinergic effects

Same mechanism as above
Second generation: specific to peripheral histamine receptor

18
Q

what are some first generation anti-histamines drugs?

Indications?

side effects?

A

Diphenhydramine HCl
Hydroxyzine
Promethazine

Allergic reactions
Allergic rhinitis
Anti-emetic

Anti-cholinergic effects: dry mouth, drowsiness, urinary retention, blurry vision
GI effects: nausea, abdominal pain
CNS effects: sedation, drowsiness

19
Q

what are some second generation anti-histamines ?

Indications?

side effects?

A

Cetirizine/Levocetirizine
Loratidine
Fexofenadine

same indications

Low to none sedative, GI or anti-cholinergic effects

20
Q

Antitussives:
- mechanism of the following drugs:

Opioids: (Codeine, Hydrocodone, Hydromorphone)

Dextromethorphan

A

Acts centrally on respiratory center in medulla and nucleus tractus solitaris to increase cough threshold

21
Q

Side effects of opioids

side effect of Dextromethrophan

A

Nausea and vomiting
Sedation
Constipation

CNS effects at high doses: confusion, excitation, nervousness, irritability
Respiratory depression may occur with very high doses

22
Q

Antitussive: Benzoate

mechanism:

side effects?

A

Anesthetic effect on stretch receptors of the vagal afferent fibers in the bronchi, alveoli and pleura —> blocking of cough reflex

May also suppress transmission of signal of cough reflex at medulla

Nausea
Mucosal numbness (if you chew it)
23
Q

Expectorant: Guaifenesin

mechanism –

indications –

Symptoms –

A

Loosens and thins lower respiratory secretions

Symptomatic relief of ineffective productive coughs

Nausea and vomiting
Dizziness
Diarrhea