Module 5 - Respiratory System Flashcards
(37 cards)
What class of durg is Beclomethasone [QVAR HFA] and what is it used for?
Class: GLUCOCORTICOIDS (Corticosteroids)
Inhaled corticosteroids are considered 1st line therapy for persistent asthma and are the most potent and effective therapy for long-term treatment of asthma (however they are less effective in COPD than in asthma)
What is the MOA of Beclomethasone?
Gluccocorticoids reduce asthma symptoms by suppresing inflammation. Antiinflammatory effects:
- Decrease synthesis and release of inflammatory mediators ( eg, leukotriens, histamine, prostaglandins)
- Decreased infiltration and activity of inflammatory cells (eosinophils, leukocytes)
- Decreased edema of the airway mucosa (secondary to a decrease in vascular permeability)
What would you advise patients taking beclomethasone, an inhaled steroid, that are used as adjucts to bronchodilators?
Advise patients using bronchodilators to use the bronchodilator several minutes before the corticosteroid inhalant to enhance penetration of the steroid into the bronchial tree.
What are the side and adverse effects of glucocorticoids like Beclomethasone?
- Hoarseness is a common side effect of inhaled steroids.
- Overgrowth of oropharyngeal Candida albicans (monilia) is common but can be reduced if the patient used a spacer and swishes his or her mouth with water then expectorates after using the drug.
- Glucocorticoids may slow skeletal growth in children but do not appear to decrease size.
- Decreased bone density.
- Ophthalmic complications
What drug class does Albuterol belong to?
- Bronchodilator
- Selectiv B2 agonist
- Albuterol (# 14) serves as the prototype of the fast-acting beta-2 agonists.
What is Albuterol’s MOA?
- Stimulation of beta-2 receptors activates adenylyl cyclase, which promotes the formation of cAMP. cAMP inhibits the action of calcium and promotes smooth muscle relaxation and, in bronchial smooth muscle, causes bronchodilation, decreased mucus secretion, and increased mucocillary clearance.
What are indications for albuterol?
- The sympathomimetics are indicated for the relief and prophylaxis of reversible bronchospasm associated with acute and chronic bronchial asthma, exercise-induced bronchospasm, bronchitis, emphysema, bronchiectasis or other obstructive pulmonary diseases.
- Albuterol is fast acting (onset 5 min) and lasts 3-6 hours.
What are side and adverse effects of Albuterol?
- Usual adverse events include palpitations, chest pain, rapid heart rate, hyperglycemia, angina, and skeletal muscle tremor or nervousness but are more common with systemic use than with inhalation.
- Other common side effects include headache, skeletal muscle tremors, insomnia, dizziness, hypokalemia, hyperglycemia, and nervousness.
- Administer with caution to patients with CV disorders, diabetes, hyperthyroidism, seizure disorders, and the elderly.
How would you instruct a patient to use an Albuterol inhaler?
- Patient should be instructed to thoroughly shake the inhaler for 5 to 10 seconds. Breathe out to the end of a normal breath. Hold the inhaler system upright, place the mouthpiece into the mouth, close the lips tightly and tilt the head back slightly. While activating the inhaler, take a slow, deep breath for 3 to 5 seconds, hold the breath for about 10 seconds, and exhale slowly. Allow 1 minute or more between inhalations (allows the bronchi do dilate and get a deeper penetration with the second inhalation). Rinse mouth after water after each use and do not exceed recommended dose.
What drug class does Guaifenesin belong to?
Guaifenesin is an expectorant found in many cough syrups (Robitussin).
What is the indication for Guaifensin?
- It is claimed to decrease mucus viscosity and convert a nonproductive cough into a productive one. It is listed for relief of cough associated with respiratory tract infections and “temporary control of nonproductive cough.”
- There is a lack of convincing studies to document efficacy. (Termed GRAS - –Generally Recognized As Safe)
What are the side effects of Guaifenesin?
Side effects are nausea, vomiting & GI discomfort. (Some suggest that the nausea increases secretions.)
What are hypersensitivity reactions?
Hypersensitivity reactions are pathologic processes that result from specific interactions between antigens and either humoral antibodies or sensitized lymphocytes.
How do you treat hypersensitivity reactions?
Treatment may include avoidance, desensitization, or treatment with:
- Antihistamines
- Epinephrine is required if anaphylaxis occurs.
- Aminophylline
- Glucocorticoids
What drug class does Montelukast (Singulair) belong to?
- LEUKOTRIENE 4 RECEPTOR ANTAGONISTS
- Montelukast is the currently recommended drug.
What is the MOA of Montelukast?
Montelukast is a LTD4 antagonist, blocking the cysteinyl leukotriene receptor (LTD4). LTD4 is an inflammatory substance
Montelukast is considered the leukotriene blocker of choice for patients with persistent asthma.
What are the indications for Montelukast?
Montelukast, a non-steroidal oral anti-inflammatory drug is indicated for the prophylaxis and chronic treatment of asthma in individuals over 1 year. It is also approved for the relief of symptoms of seasonal allergic rhinitis in adults and children as young as 2 years of age and for perennial allergic rhinitis in patients 6 months and older.
It is used for mild persistent asthma as an alternative to inhaled steroids. It may provide an additive effect to inhaled steroids and may decrease the needed dose of inhaled steroids while maintaining control of symptoms.
What are adverse effects of Montelukast?
Adverse effects include fatigue, fever, dyspnea, and nasal congestion (none significantly different from placebo). Post marketing adverse events include suicidal thoughts.
Pregnancy Category B: Animal studies show no risks, but there are no controlled studies onpregnant women
When should Montelukast be taken?
It is taken once daily in the evening with or without food. It is given at bedtime to produce the highest serum level during the night and early morning when asthma symptoms are the worst.
As monotherapy it is less effective than inhaled steroids but it may improve asthma control and permit a reduction in steroid dosage
What class of drugs doesTiotropium inhaler belong to?
It is a antimuscarinic quaternary bronchodilator
inhaled anticholinergic
What is the MOA of Tiotropium [Spiriva Handihaler}
is a quaternary ammonium compound that binds with high affinity to muscarinic receptors in airway smooth muscle cells and mucus glands, inhibiting the bronchoconstrictive and secretory effects of acetylcholine.
Upon inhalation, the bronchodilator effect begins in about 30 minutes, reaches a peak in 3 hours, and persists for more than 24 hours.
Inspiration of tiotropium from the Handihaler depends on the strength of the patient’s breath intake to deliver the drug to the lungs;
What is Tiotropium indicated for?
It is indicated for once daily treatment of bronchospasm associated with chronic obstructive pulmonary disease (It is not indicated for asthma although some studies have shown that it is as effective as a long-acting beta-2 agonist.).
It is not metabolized; 74% of a dose is excreted unchanged in the urine. The terminal half-life is 5-6 days following inhalation
What are the side effects of Tiotropium?
Systemic anticholinergic effects are minimal. The tiotropium literature has warnings of about paradoxical bronchospasm, narrow angle glaucoma and urinary retention. Dry mouth was the most commonly reported adverse reaction (precipitation of the drug in the mouth on inhalation).
What class of drugs does Loratadine (Claritin) belong to?
Histamine-1 receptor antagonists (antihistamine)
Antihistamines are divided into 1st & 2nd generation agents. All are useful in treating allergic rhinitis and extrinsic asthma. Loratadine is a 2nd generation.
