Respiratory Drugs and Antihistamines

Question 1

Respiratory Drugs

Answer 1

Anticholinergics
Adrenergic agonists
Membrane Stabilizers
Xanthines
Related Drugs: Tocolytics
Corticosteroids

Question 2

Anticholinergics

Answer 2

Atropine
Ipratropium
Tiotropium
Aclidinium

Question 3

Atropine

Answer 3

-Antagonies ACh effects on airway smooth muscle via muscarinic receptors in large and medium sized airways that respond to vagal stimulation
-Decreases airway resistance
Increases dead space

Question 4

Anticholinergics: Ipratropium

Answer 4

• most common anticholinergic used for aerosol administration
• Synthetic quaternary ammonium congener
• Most effective in treating bronchospasm due to beta antagonists or psychogenic stimuli
• slower onset and less effective than beta agonists in treating bronchial asthma
• More effective than beta agonists in chronic bronchitis or emphysema (M3 receptors)
• May use in combo with beta agnoists for asthma
• Paradoxical bronchospasm may occur due to M2 blockade
• Limited absorption results in prolonged local site effect
• Tolerance has not been observed to the bronchodilator effect

Question 5

Anticholinergics: Tiotropium (Spiriva)

Answer 5

• Long-acting anticholinergic bronchodilator
• Long term once daily dosing
  mainetenance treatment of bronchospasm associated with COPD including chronic bronchitis and emphysema
  -Blocks muscarinic receptor subtypes M1 and M3
  Facilitates bronchodilation
  -reduces mucous secretion
  -Administered as dry powder by inhalation

Question 6

Aclidinium (Tudorza)

Answer 6

-Similar to spiriva
-given twice daily vs. once daily
faster onset to peak

Question 7

Adrenergic Agents

Answer 7

Beta Agonists

• Ephedrine
• Isoproterenol
• Albuterol
• Terbutaline

Question 8

Adrenergic Agnoists (indirect acting) Ephedrine

Answer 8

• Indirect acting synthetic non-catecholamine that stimulates alpha and beta receptors
• Can be used as a chronic oral medication to treat bronchial asthma due to its bronchodilating effects from activation of beta2 receptors

Question 9

Adrenergic Agnoists (Direct Acting) Non-selective Beta Sympathomimetics
Isoproterenol

Answer 9

Non-selective sympathomimetic (goes to beta 1 and beta 2)
Uses:
- Bronchodilator (aerosol or IV)
Increase HR (IV infusion)
Decrease pulmonary vasculature resistance in patients with pulmonary hypertension (IV)

Question 10

Adrenergic Agnoists: Direct Acting: Beta2 selective sympathomimetics

Answer 10

• Relax bronchial and uterine smooth muscle (Beta 2)
  _ Lack stimulating (Beta 1) effects on the heart
• Structure makes them resistant to COMT
• Contributes to their sustained duration of action
  Uses:
  preferred treatment for acute episodes of asthma
• prevention of exercise-induced asthma
• Improve airflow and exercise tolerance in patients with COPD
  Tocolytic to stop premature uterine contractions
  Classes:
• Intermediate acting (3-6 hours))
• Long acting (>12 hours)