Respiratory Pharmacology

Question 1

What does the Respiratory System do?

Answer 1

Mediates Gas exchange between the external environment and the blood stream.

The Upper respiratory tract conducts air to the lower tract and humidifies/conditions the air

Protects the lungs from harmful substances

Question 2

What is the Common Cold? What are the signs and symptoms? What is the treatment?

Answer 2

Virus that invades mucosa of upper respirator tract, nose, pharynx/larynx

Signs/Symptoms: excessive mucus production-> sore throat, coughing, upset stomach.

Treatment: Reduce symptoms

Question 3

Antihistamines, where does it work?

Answer 3

Act directly on histamine receptor sites; H1 blockers

Question 4

What is histamine?

Answer 4

Endogenous chemical involved in various allergic reactions.

Question 5

What are the sedating antihistamines?

Answer 5

H1 Antihistamine

• Chlorphenramine
• Diphenhydramine (Benadryl)
• Hydroxyzine

Question 6

Benadryl Action/Adverse Effcts

Answer 6

Antagonizes the effect of histamine at H1 receptor sites

ADE: CNS depressant, drowsiness, dizziness, hypotension, dry mouth

Question 7

What are the Non-Sedating Antihistamines?

Answer 7

Claritin, Allegra, Zyrtec

Question 8

What are three types of decongestants and what are the routes of administration?

Answer 8

Adrenergic, Anticholinergic, Corticosteroids

Routes: Oral for systemic, Inhaled (right to the lungs, some systemic), Nasal: Local some systemic

Question 9

Adrenergic Nasal Drugs; Where is it applied, what is the main side effect, and drug name

Answer 9

• Topical application directly into Nares.
• Has a rebound effect (only use for 72 hours, congestion will get worse if taken more than this) -
• Oxymetazoline/Afrin
• Phenylephrine/Neo-synephrine

Question 10

Intranasal Steroids, what are they used for, what is the action, what are some examples?

Answer 10

Used prophylactically to prevent nasal congestion in patients with chronic Upper Resp. Infections

Action: Aimed at anti-inflammatory Response

Examples: Nasacort (Triamcinolone), Flonase (Fluticasone), Nasalide (Flunisolide)

Question 11

Oral Forms of Decongestants and Side Effects

Answer 11

Pseudoephedrine (Sudafed)

S/E: Headache, dizziness, nervousness, nausea, cardiovascular irregularities (increased BP/palpitations)

Question 12

What drugs are used to treat cough? (general categories)

Answer 12

Antitussive: suppresses cough (opiod, non-opiod) Sedation, dizziness, GI upset

Mucolytics

Expectorants

Question 13

Antitussive Drugs Action and Adverse Effects (Opioids)

Answer 13

All opiods have antitussive effects. (Codeine is only opioid used as cough medicine)

Action: Suppress cough reflex by acting on cough center in Medulla

Advsere Effects: CNS and respiratory depression/additive potential

Question 14

Antitussive Drugs (non-opioid)

Answer 14

Generic: Dextromethorpan

Trade Name: Vicks, Robitussin DM

Safe, Non-addicting, no CNS/respiratory depression

Question 15

Mucolytics/Expectorants Action and Side Effects

Answer 15

Mucolytics: decrease viscosity of respiratory secretions

Expectorants: facilitate production/ejection of mucus

Action: loosening/thinning secretions

Side effects: GI, take with food

Question 16

Expectorants Trade Name, Therepeutic Effect

Answer 16

Guaifenesin

Trade name: Robitussin, Humibid, Guiatuss

Therapeutic Effect: Relief of resiratory congestions and cough suppression.

Question 17

Mucolytics: How it works, administration and Side Effects

Answer 17

Acetylcysteine (Mucomyst): Primary mucolytic drug

Work by splitting the disulfide bonds of mucoproteins

Administered by inhalation/intratracheal instillation

S/E: N/V, inflammation, rhinorrhea

Question 18

Obstructive Pulmonary Disease: Types, Characterization, Treatment Goals, Medication Classes

Answer 18

Bronchial Asthma, COPD

Characterized by Bronchospasm, airway inflamm, mucous plugging

Treatment goals: prevent/reverse bronchial constriction/obstruction of airways

Medication Classes:

• Bronchodilators:Beta agonists, Xanthine derivatives, anticholinergics
• Anti-inflamm: corticosteroids, Chromolyn sodium

Question 19

Beta-Adrenergic Agonists: What do they do

Answer 19

Stimulation of beta-2 receptors result in relaxation of bronchiole smooth muscle-> used to prevent/inhibit airway obstructions

Question 20

Specific Beta-Adrenergic Agonists

Answer 20

Albuterol: Short Acting

Long Acting: salmeterol, formoterol, bambuterol, metaproterenol

Question 21

Albuterol General Action, Use, Administration

Answer 21

Relax bronchial smooth muscle,

First line therapy for SOB,

Adminsitered via Inhaler/nebulizer,

Very safe

Question 22

Albuteral Action, Indication, Contraindications

Answer 22

Sympathomimetic

Actions: Beta 2 adrenergic agonist, relaxes bronchial smooth muscle, minimal cardiac SE

Indications: Treatment of bronchospasm associated with asthma, chronic bronchitis, emphysema; prevention of exercise induced bronchospasm.

Contraindications: Hypersensitivity to sympathomimetics, cardiac arrhythmia, tachycardia/tachyarrhythmias

Question 23

Albuterol Adverse Reactions, Precautions

Answer 23

• Adverse:
  
  • Paradoxical bronchospasm,
  • tachycardia, palpitations,
  • angina,
  • PVCs,
  • hypo/hypertension,
  • tremor,
  • hyperglycemia,
  • peripheral vasodilation,
  • nervousness,
  • nausea/vomiting
• Precautions: Diabetes, hyperthyroidism, seizures

Question 24

Metaproterenol Sulfate Actions, Indications, Contraindications

Answer 24

Action: Agonist for Beta 2, acts on smooth muscle

Indications: relieve bronchospasm of COPD/Asthma

Contraindications:

• Hypersensitivity to sympathomimetics
• Hyperthyroidism
• Cerebrovascular/cardiovascular disorders
• Tachycardia/tachydysrhythmias

Question 25

Metaproterenol Sulfate Adverse Reactions

Answer 25

Dose-related tachycardia, palpitations, nervousness, HTN, tremors, headaches, N/V

Question 26

Xanthine Derivatives: Theophylline Actions, Adverse Reactions, Indications

Answer 26

Action: Beta 2 Agonist: directly relaxes bronchial smooth muscle, dilates pulomary/coronary arterioles, Mild diureticrespiratory center stimulant Adverse Rxn: Toxicity b/w levels of 15-20mcg/ml, Toxicity: nausea, confusion, irritability, restlessness, cardiac arrhythmias, seizures Indications: relieve bronchospasm, management of CHF, pulmonary edema, adminstered orally as tablet

Question 27

Nonselective sympathomimetics

Answer 27

Stimulates both beta 1/2 and akpha not used to treat asthma since they increase peripheral resistance and increased risk for tachycardia Includes: epinephrine, ephedrine

Question 28

Methylxanthines

Answer 28

CNS stimulants that also bronchodilate Used only when beta 2 specifcs don't work Chief S/E: N/V, insomnia, restlessness, dysrhythmias.

Question 29

Anticholinergics

Answer 29

Ipratropium: atropine derivative Causes Bronchodilation Inhaled, no systemic effects S/E: dry mouth

Question 30

Glucocorticoids

Answer 30

Anti-inflamm. Lowers production of inflamm. substance Inhaled type: Beclomethasone Oral: Prednisone Preventative Few S/E when inhaled; long periods of admin can lead to adrenal suppression/hyperglycemia

Question 31

Cromolyn

Answer 31

Safest of all anti-asthma S/E: coughing/wheezing Used for preventing asthma in adults/children

Question 32

Leukotriene Antagonists

Answer 32

Leukotrienes contribute to both inflamm and bronchoconstriction Zyflo blocks synthesis of leukotrienes, Accolate blocks the receptors S/E: headache, stomachache, flu-like symptoms for children

Question 33

Considerations in Rehabilitation

Answer 33

RTs play a critial role in preventing pulmonary mucus accumulation Program of Chest PT most effecive when administered 30 minutes to 1 hour after agents administered. Cardiac S/E of Beta-adrenergic/xanthine should be considered.