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respiratory drugs Flashcards

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1
Q

cellular respiration

A

gas exchange that occurs at the alveoli

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2
Q

ventilation

A

movement of air in and out of the lungs
controlled by CNS

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3
Q

3 respiration phases

A

ventilation
perfusion
diffusion

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4
Q

lung compliance

A

lung volume based on unit of pressure in the alveoli
influenced by connective tissue, surface tension

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5
Q

bronshial smooth muscle

A

contraction will constrict the airways
parasympathetic NS releases acetylcholine which causes constriction
sympathetic NS releases epinephrine which stimulates beta 2 receptors causing dilation

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6
Q

diseases of lower airways

A

acute bronchitis
asthma
COPD: chronic bronchitis, emphysema, repeated, severe asthma attacks
pneumonia
cystic fibrosis

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7
Q

asthma triggers

A

allergens, cold air, exercise, irritants, infection, emotions

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8
Q

asthma patho

A

airway hyper-responsiveness
exposure to antigen causes a rapid inflammatory reaction
release of histamines, serotonin, leukotrienes, eosinophils, macrophages
these cause sever bronchoconstriction and increased mucus production
airway obstruction increases pressure and fluid moves through tissue, causing more obstruction
bronchospasm and inflammation

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9
Q

asthma airway obstruction

A

largely reversible
chronic inflammation can lead to COPD

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10
Q

intermittent asthma

A

2 times per week or less during day
1-2 times per month

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11
Q

mild persistant asthma

A

day 3-4 times per week
2-4 times per month

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12
Q

moderate persistent asdthma

A

day more than 4 time per week or daily
nigh 4 times or more per moth

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13
Q

sever persistant asthma

A

day continous
night frequent

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14
Q

chronic asthma management

A

reduce exposure to allergens (dust mites, pets, cockroaches, mold) and trigger (tobacco, smoke, wood smoke, household sprays

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15
Q

acute sever exacerbation treatment

A

needs immediate attention
oxygen
systemic glucocorticoid
high dose SABA- broncho 2 dilation
nebulized ipratropium

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16
Q

exercise induced asthma drugs

A

caused by bronchospasm due to loss of heat and/ or water from lung
starts during/ immediately after exercise
SABA and/or cromolyn given prophylactically

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17
Q

COPD

A

progressibe and irreversible airflow limitation

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18
Q

COPD related lung disease

A

chronic bornchitis
emphysema
one predominates, but most have both
caused by smoking cigarettes

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19
Q

COPD patho

A

inflammation
edema
fibrosis of bronshial walls
hypertrophy os subcumosal glands, impared ciliary function and hypersecretion of mucs
loss of elastic lung fibers
destruction of alveolar tissue

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20
Q

COPD disease process

A

bronchioles become thick and edematous
upper resp defense mechanisms destroyed
constant irritation and inflammation
alveolit enlarge and collapse, fewer alveoli decrease surface area available for gas exchange
destruction of lung leads to hyperinflation due to loss of elastic recoil
as air is trapped, increasing amounts of energy required to move air
lungs over inflate and barrel chest develops
person is fatigued from poor oxygenation and from increased energy required to breath

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21
Q

COPD S/S

A

chronic cough
excessive sputum production
wheezing
dyspnea
poor exercise tolerance

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22
Q

COPD medications

A

bronchodilators
anti-inflammatories

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23
Q

autonomic nervous system

A

controls rate and depth though smooth muscle contraction/ relaxation

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24
Q

cholinergic receptors

A

parasympathetic: rest and digest

Bronchconstriction

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25
adrenergic receptors
sympathetic: fight or flight bronchodilation alpha and beta beta 1 and beta 2
26
bronchodilators
beta adrenergic agonists xanthine derivatives anticholinergics
27
beta adrenergi agonists
P- albuterol levalbuterol salmeterol
28
xanthine derivatives
P- theophylline aminophylline
29
anticholinergics
P- ipratropium totropium
30
short acting Beta 2 adrenergy Agonists
used PRN "rescue inhalers albuterol levalbuterol pirbuterol metaproterenol
31
long acting beta 2 adrenegruc agonists
more for control or maintenance salmeterol formoterol
32
Beta 2 adrenergic Agonists MOA
mimic sympathetic nervous system Beta 2 receptors in lungs (can stimulate beta 1 receptors) stimulates receptors in smooth muscles of lungs (also uterus and vasculature) relaxing bronchial smooth muscles relieve bronchospasms, increase dilation, reduces airway resistance, facilitates mucus drainage have no anti-inflammatory action
33
Beta 2 adrenergic Agonists kinetics
absorbed well though both GI and resp tracts fast acting onset, 5-15 min via inhalation when PO, bronchodilation occurs in 30 minutes renal excretion
34
Beta 2 adrenergic Agonists adverse effects
tachycardia, palpitations hypertension cough N/V when taken PO arrhythmias tremor, nervousness dizziness bronchospasms throat irritation overuse can cause rebound bronchoconstriction
35
Beta 2 adrenergic Agonists cautions
hypersensitivity cardiovascular disease diabetes hyperthyroidism seizure disorders tolerance can develop with frequent use leading to treatment failure
36
Beta 2 adrenergic Agonists education
teach fast acting is a rescue drug how to use an inhaler correctly limit caffeine intake
37
Xanthine derivatives Adverse effects
fever rash tachypnea tachycardia arrhythmias hypotension irritability nausea vomiting hyperglycemia headache seizures diuresis insomnia
38
Xanthin derivatives MOA
direct effect on smooth muscle in lungs and blood vessels causing relaxation
39
Xanthine derivatives kinetics
good oral absorption (food can alter) metabolized in liver, excreted renally therapeutic range for theophylline 5-20 mcg/ml clearance in influenced by smoking not used for acute attack used for chronic asthma
40
Xanthine derivatives toxicity
therapeutic range 5-20 mcg/ml Mild 20-25 mcg/ml: N/V, headache, insomnia, nervousness serious (more than 30): tachy, convulsions, irritability
41
Xanthine derivatives cautions
heart disease seizuree disease peptic ulcer disease liver disease renal disease cardiac arrhythmias
42
Xanthine derivatives drugs that increase theophylline levels
alcohol allopurinel beta blockers caffeine calcium channel blocker cimetidine coticosteroids estrogen macrolides infleunze virsu vaccine quinolones thyroid hormones
43
Xanthine derivatives: drugs that decrease therophylline levels
barbituated charcoal tobacco/ marijuana ketoconazole phenytoin rifampin
44
Xanthine derivatives : drugs that can decrease/increase therophylline levels
carbamazepine isoniazid loop diuretics
45
Xanthine derivatives education
make a list of all prescriptions and OTC and show provider instruct pt to avoid consuming large quantities of caffeine containing foods (chocolate) or beverages read OTC labels for caffeine and other ingredients instruct that low carb, high protein diet and charcoaled-broiled beef can increase theo elimination smoking can also decrease levels not used for an acute attack
46
Anticholinergics
ipratropium tiotropium aclidinium
47
Anticholinergics MOA
antagonism of muscularinic receptors which reduce production of cGMP which causes decrease in contractility of smooth muscles and is a mediator of bronchoconstriction cause bronchodilation no inflammatory action
48
Anticholinergics kinetics
no oral absorption good respiratory absorption partial hepatic metabolism renal excretion longer duration that adrenergic agonist
49
Anticholinergics adverse effects
dries the body out headache dizziness palpitations dry mouth constipation urinary retention worsening of narrow angle glaucoma anxiety
50
Anticholinergics cautions
bladder obstruction, prostatic hyperterophy closed angle glaucoma contraindicated in soybean or peanuts allergiuies do not use as single agent for bronchospasm
51
anti-inflammatory drugs
mast cell stabilizers leukotriene receptor antagonsist corticosteroids
52
Mast cell stabilizers
P- cromolyn Sodium )Intal) nedocromil (Tilade) omalizub (xolair)- though it worked a bit differently
53
Mast cell stabilizers MOa
exact mechanism not known somhow inhibits mast cells from rupture or stabilzes membrane of mast cells inhibit release of inflammatory mediators freom mast cells including histamine and leukotrienes no a bronchodilator, used for prophylaxis
54
Mast cell stabilizers kinetics
very low oral absroption good resp tract absorption exreted unchanges in feces takes 2-4 weeks for therapeutic effect
55
Mast cell stabilizers cautions
do not use for acute bronchospasms or status asthmaticus bc prophylaxis cardiac pts lactose intolerant pts
56
Mast cell stabilizers adverse effects
headache nausea cough rhinitis dizziness irritation of oropharynx bad taste bronchospasms eosinophilic pneumonia
57
Mast cell stabilizers education
teach them this is not for managing acute symptoms only prophylaxis must take daily, whether they have symptoms or not take 15-20 min before engaging in activity that will induce bronchospasm or prior to exposure of antigen
58
xolair
different MOA from other mast cell stabilizers blocks immunoglobulin for use in pts 12 yo and older with moderate to severe asthma that is allergy related an not controlled by ICS
59
Xolair adverse effects
injections site reaction viral infection URI headache malignancy life threatening anaphylaxis
60
leukotriene receptor antagonists
P- zafirlukast motelukast zileuton
61
leukotriene receptor antagonists (zafirlukast and montelukast) MOA
blocks receptors for leukotrienes bound to amino acid cysteine cysteine are potent bronchoconstrictors (much more potent than histamines)
62
leukotriene receptor antagonists zileuton MOA
inhibits enzyme in the lipoxygenase pathway causing a decrease in production of leukotrienes
63
leukotriene receptor antagonists general MOA
promote smooth muscle constriction promote blood vessel permeability promote inflammatory responses through direct action and recruitment of eosinophils and other inflammatory cells can reduce bronchoconstriction and inflammatory responses such as edema and muscle secretion
64
leukotriene receptor antagonists adverse effects
fever rash anaphylaxis Increased LFTs both zafirlukast an zileuton headache, dizziness: zafirlukast
65
leukotriene receptor antagonists cautions
with live disease: montelukast is best choice neuropsychiatric events
66
corticosteroids
flunisolide fluticasone beclomethasone prednisone methylprednisolone
67
68
corticosteroids effects
effects ADH- causes edema, hang on to sodium and water
69
corticosteroids glucose
stimulates production by breaking down proteins into amino acids and sugar
70
corticosteroids proteins
suppress protein synthesis and decreases muscles mass, bone matrix, thin skin etc
71
corticosteroids lipids
increase lipids- breakdown adipose tissue into fatty acids
72
corticosteroids other effects
facilitate general sympathetic (stress) response stimulate CNS- insomnia, irritability regulates BP decrease protection of GI mucus- PUD
73
corticosteroids bronchioles
maintains open airways but not a bronchodilator stabilizes mast cells from releasing bronchoconstrictive chemicals
74
high dose corticosteroids effectsd
immunosuppressive and decreases WBC anti-inflammatory- inhibit release of inflammatory chemicals (histamines, prostaglandins, kinins, etc)
75
coming off corticosteroids
taper dosage gradually over 7 days switch from multiple doses to single dose monitor for signs of insufficiency
76
corticosteroids MOA
suppresses cytokine production -leukotriene and prostaglandin -airway eosinophil recruitment suppresses release of inflammatory mediators which - decreases capillary dilation -decreases edema and mucous -decrease migration and activation of white blood cells - decreased inflammation increase number of beta 2 receptors
77
corticosteroids uses
many inflammatory disorders: ashma, COPD< tendoitis, bursitis rheumoatoid arthritis systemic lupus erythematosus inflammatory bowel disease organ transplant pts allergic condition skin disorders
78
corticosteroids kinetics
good absorption through GI and resp tracts highly protein bound hepatically metabolized some renal clearance used continuously not dilators, not used for acute attacks
79
inhaled corticosteroids
first line therapy for inflammatory component of asthma asthma pts should use daily very effective
80
oral/IV corticosteroids
for mod to severs asthma or acute exacerbations of athma/ COPD treatment should be as brief as possible potential for toxicity
81
inhaled corticosteroids adverse effects
oral fungal infections oral, laryngeal, pharyngeal irritation dry mough, hoarseness, coughing resp infections oral candidiasis long term use in children could delay growth patterns adrenal suppression
82
corticosteroids adverse effects (gen)
anxiety seizures insomnia glucose intolerance hyperglycemia hyperlipidemia hirsutism obesity moon faces amenorrhea edema CHF pancreatitis ulcers N/V fluid and electrolyte imbalance osteoporosis infection acne striae adrenal suppression cataracts glaucoma
83
corticosteroids cautions
contraindicated to systemic fungal infections and live viruses vaccines in hypertension diabetes osteoporosis renal insufficiency resp tract infection ocular herpes simplex CHF PUD
84
corticosteroids drug interactions
azole antifungal- prednisone clearance possibly decreased barbiturates oral anticoagulants contraceptives diuretics salicylates: ASA theophylline warfarin
85
inhaled corticosteroids education
good oral hygiene signs and symptoms of oropharyngeal candidiasis rinsing mouth to decrease fungal infections can not abruptly discontinue medication as it can cause serious consequences for all corticosteroids
86
combo drugs
advair- (fluticasone/salmeterol) symbicort-(budesonide/formoterol) dulera- (mometasone/formoterol)
87
inhalation drug therapy advantages
therapeutic effects are enhanced systemic effects are minimized relief of acute attacks is rapid
88
types of inhalation devices
metered dose inhalers respimats dry powder inhalers nebulizers
89
inhalers education
clean weekly- check manufacturers direction check expiration date make sure patient knows how to use inhaler ensure pts knows correct time intervals for inhalers -for some 30 sec to 1 min between puffs - for others 2-5 min between puffs
90

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