Part 9-1 (Respiratory Pharmacology)

Question 1

Pulmonary Systemic delivery

Answer 1

Oral or Injection
Travel throughout body, not selective for respiratory tract
Can reach lungs through pulmonary circulation

Question 2

Inhaled Meds

Answer 2

Much better at delivering drug directly to lungs

Local effects…fewer systemic side effects

Question 3

Primary Inhalation Options

Answer 3

Metered dose inhaler
Nebulizer
Dry Powder Inhaler

Question 4

Categories of Respiratory Meds

Answer 4

1. Control of respiratory tract irritation and secretion
2. Brochodilators
3. Control of airway inflammation
4. Other meds

Question 5

Respiratory Tract Irritation and Secretion

Answer 5

Antitussives (Cough medicine)
Antihistamines
Decongestants
Mucolytics/Expectorants

Question 6

Antitussives: Opioids

Answer 6

Suppress cough reflex at brainstem
Ex: Codeine, Dextromethorphane
Often combined with decongestants

Question 7

Antitussives: Benzonatate

Answer 7

Has an anesthetic effect on vagal nerve endings in the airway
-Reduces effects of irritation that starts cough reflex

Question 8

Antitussives primary problems

Answer 8

Sedation
Dizziness
GI Upset

Question 9

Antitussives Rehab concerns

Answer 9

Overuse
Dependence
May limit productive cough effectiveness

Question 10

Cough Meds in children

Answer 10

Cough medications offer no symptomatic relief for acute cough in children and is inappropriate in young children

Question 11

Antihistamines

Answer 11

Block (Histamine) H1 receptor, decreases effects of histamine on upper respiratory tract
Used to treat histamine-mediated coughing, sneezing, irritation
Used for seasonal allergies and colds

Question 12

Old versus New histamines

Answer 12

Old histamines caused profound sedation

New histamines don’t cause as much sedation due to inability to cross blood brain barrier

Question 13

Antihistamines Primary Problems

Answer 13

Sedation
Fatigue
Incoordination
Blurred vision

Question 14

Antihistamine Rehab Concerns

Answer 14

Sedative Effects

Dry out respiratory tract; limit productive cough

Question 15

Decongestants

Answer 15

Stimulate Alpha-1 receptor agonists (Epinephrine)
Vasoconstrict nasal mucosa
Should be administered locally (Spray)
Oral administration may cause serious side effects

Question 16

Decongestants Primary Problems

Answer 16

Headache, Nausea, Nervousness

Cardiovascular Stimulation

Question 17

Mucolytics

Answer 17

Break up, decrease viscosity of mucous

Make it easier to raise and expel secretions

Question 18

Expectorants

Answer 18

Increase production of a thinner, more liquid phlegm

Enhance effects of mucolytics

Question 19

Primary Mucolytic

Answer 19

Acetylcysteine
Breaks up disulfide bonds in mucous, decreases viscosity
Question about efficacy; may get similar benefit from warm saline mist
This drug is an antidote for acetaminophen poisoning

Question 20

Dornase Alfa

Answer 20

Serious Mucolytic
“DNA-ase” breaks up DNA that has been released from inflammatory cells
DNA makes mucous very viscous
Very helpful in cystic fibrosis

Question 21

Primary Expectorants

Answer 21

Guaifenesin: Increases fluid content of phlegm

Found in many OTC products

Question 22

Mucolytics and Expectorants Primary Problems

Answer 22

May have nausea, vomiting, irritation of mouth with excessive use

Question 23

Mucolytics and Expectorants Rehab concerns

Answer 23

No major concerns

Beneficial during postural drainage, vibration, percussion

Question 24

Bronchodilators

Answer 24

Beta-Adrenergic Agonists
Xanthine Derivatives
Anticholinergics

Question 25

Beta-Adrenergic Agonists

Answer 25

Stimulate beta-2 receptors on smooth muscle Increase intracellular production of cAMP cAMP initiates smooth muscle relaxation

Question 26

Types of beta-agonists

Answer 26

Nonselective: Activates all beta receptors (Epinephrine) Selective: Activate beta-2 only (Albuterol)

Question 27

Beta-Adrenergic Agonists problem

Answer 27

Can cause bronchial irritation/constriction Cardiac stimulation CNS stimulation

Question 28

Beta-Adrenergic Agonists Rehab Concerns

Answer 28

Use before postural drainage | Look for signs of overuse

Question 29

Xanthine Derivatives

Answer 29

Drugs that are chemically similar to caffeine Common Examples -Theophylline -Aminophylline

Question 30

Theophylline

Answer 30

``` Powerful bronchodilator Exact mechanism of action unclear -Inhibit cAMP breakdown -Block adenosine stimulation -Inhibit intracellular Calcium release -Anti-inflammatory effects ```

Question 31

Theophylline toxicity

Answer 31

Toxicity begins if plasma levels >15 micrograms/mL;serious if >20 mg/ml Therapeutic range is 10-20 micrograms/ml Signs: Nausea, confusion, irritability, restlessness, cardiac arrhythmias, seizures

Question 32

Theophylline toxicity risk factors

Answer 32

If metabolism is impaired - liver disease - congestive heart failure - pt age >55 - Use of other drugs

Question 33

Anticholinergic drugs

Answer 33

``` Acetylcholine stimulates bronchial smooth mm contraction Drugs block receptors Ex: -Ipratropium -Tiotropium ```

Question 34

Anticholinergic drugs effects

Answer 34

Tolerated well at lower doses (Early stages of COPD) | High doses: Dry mouth, constipation, tachycardia, confusion