CHAPTER 35 AND RC 111

THE COURSE OF DRUG ACTION FROM DOSE TO EFFECT COMPRISES 3 STAGES

DRUG ADMINISTRATION

PHARMCOKINETIC PHASE

PHARMCODYNAMIC PHASE

THE DRUG ADMINSTRATION PHASE - IS THE METHOD

MADE AVAILABLE TO THE BODY

DRUGS DIRECTLY TO THE RESP TRACT USE THE INHALATION INHALATION METHOD

LIQIUD SOLUTION

SUSPENSION

DRY POWDER

MOST COMMON DEVIOSES TO ADMINSTER INHALED AERSOLS ARE

MDI

SOFT MIST INHALER (SMI - RESPIMAT)

SVN

DRY POWDER (DPI)

ADVANTAGES OF INHALED AERSOLS

AEROLS DOSES ARE USUALLY SMALLER DOSES FOR SYSTEMIC ADMIN

ONSET OF DRUG IS RAPID

DELIVERY IS TARGETED TO THE ORGAN REQUIRING TREATMENT

SYSTEMIC SIDE EFFECTS ARE OFTEN FEWER AND LESS SEVERE

DISADVANTAGES OF INHALED AERSOLS

THE LACK OF VARIABLE AFFACTING THE DELIVERED DOSE

LACK OF ADEQUETE KNOWLEDGE OF DEVICE PERFORMANCE

USE AMONG PT AND CAREGIVER

PHARMCOKINETIC PHASE DESCRIBES

TIME COURSE AND DISPOSITION OF DRUG IN BOIDY BASED ON ABSORPTION, DISTRIBUTION, METABOLISM, AND EXCRETION.

DOES FULLY IONIZED AERSOL DRUG HAVE ANY SYSTEMIC SIDE EFFCTS

LITTLE IR NONE

NON IONIZED AERSOLS DRUGS ARE

LIPID SOLUBLE

NON AERSOLIZED DRUGS DIFFUSE ACROSS

THE CELL MEMBRANE INTO BLOOD STREAM PRODUCING SYSTEMIC SIDE EFFECTS

L/T RATIO MEANS

LUNG AVAILABILITY/TOTAL SYSTEMIC AVAILABILITY RATIO QUANTIFIES EFFICIENCY OF A DELIVERY TO THE LUNG

PHARMACODYNAMIC PHASE

MECHANISM BY WHICH DRUG ACTION PRODUCES ITS EFFECTS ON THE BODY

DRUG EFFECTS ARE CAUSED BY A COMBINATION

A DRUG MITH AMATCHING RECEPTOR

DRUG SIGNALING MECHANISM INCLUDE

MEDIATION BY G PROTIEN (GUANINE NUCLEOTIDE) LINKED RECEPTOR

ATTACHEMENTS TO INTRACELLULAR RECEPTORS BY LIPD SOLUBLE DRUGS

WHAT IS ANEXAMPLE OF A LIPD SOLUBLE DRUG

CORTICOSTEROIDS

WHAT ARE EXAMPLES OF MEDIATION BY G PROTIEN LINKED RECEPTORS

BETA adrenergic receptors, muscarinic

WHAT TYPE OF RECEPTORS WORK ON THE SYMPATHETIC SYSTEM

ADRENERGIC

WHAT RECEPTORS WORK ON THE PARASYMPATHTEIC

CHOLINERGIC

WHAT IS THE NEUROTRANSMITTER OF PARASYMPATHETIC SYSTEM

ACETYLCHOLINE

WHAT IS TEH NEURTRANSMITTER OF THE SYMPATHETIC SYSTEM

NOREPINEPHRINE

WHAT IS AN AGONIST DRUG

STIMULATING AGENT

WHAT IS AN ANAGONIST

BLOCKING AGENT

WHAT IS AN ADRENGIC DRUG

DRUG THAT STIMULATES A RECEPTOR TO RESPOND TO NOREPHINEPHRINE OR EPINEPHRINE

WHAT IS AN ANTIADRENERGIC DRUG

DRUG THAT BLOCKS THE RECEPTOR FOR NOREPINEPHRINE OR EPINEPHRINE

WHAT IS A CHOLINERGIC DRUG

A DRUG THAT STIMULATES A RECEPTOR FOR ACETYLCHOLINE OR ACTS LIKE ACETYLCHOLINE

WHAT IS AN ANTICHOLINERGIC DRUG

A DRUG THAT BLOCKS A RECEPTOR FOR ACETYLCHOLINE OR ACTS AGAINST ITS ACTIONS

WHAT IS A MUSCARINIC DRUG

A DRUG THAT STIMULATES ACTEYLCHOLINE RECEPTORS SPECIFICALLY AT PARASYMPATHETIC NERVE ENDING SITES

INDICATION FOR USE - ADRENERGIC DRUGS

SHORT ACTING

LONG ACTING

RACEMIC EFFECTS

WHAT DOES A SHORT ACTING ADRENEGIC DRUG DO

FOR RELEIF OF ACUTE REVERSIBLE AIRFLOW OBSTRUCTION

RESCUE AGENTS

WHAT DOES A LONG ACTING ADRENERGIC DRUG DO

FOR MAINTENANCE

FOR MAINTENANCE FOR BRONCHODILATION IN PT WITH OBSTRUCTIVE LUNG DISEASE

WHAT DOES RACEMIC EPI DO

HELPS TO REDUCE AIRWAY SWELLING AFTER EXTUBATION OR DURING CROUP OR EPIGLOTTIS

TO CONTROL AIRWAY BLEEDING DURING ENDOSCOPY

MODE OF ACTION AND EFFECTS OF ADRENERGIC DRUGS

ALPHA RECEPTOR - CAUSES VASOCONSTRICTION AND VASOPRESSOR EFFECT

BETA 1 RECEPTOR - CAUSES INCREASED HEART ARTE AND HEART CONTTRACTATILITY

BETA 2 RECEPTOR - CAUSES RELAXATION OF BRONCHIAL SMOOTH MUSCLE

STIMULATES MUCOCILIARY ACTIVITY AND HAS SOME INHIBITORY ACTION ON INFLAMMATION MEDIATOR RELAESE

3 SUB GROUPS OF ADRENERGIC BRONCHODILATORS

ULTRA SHORT ACTING

SHORT ACTING

LONG ACTING

ULTRA SHORT ACTING EXAMPLES OF ADRENERGIC BRONCHODILATORS ARE

RACEMIC EPI

WHAT DOES THE ULTRA SHORT ACTING ADRENERGIC BROCHODILATOR DO

IT IS METABOLIZED BY COMT

WHAT ARE EXAMPLES OF SHORT ACTING NON-CATECHOLEMINE ADRENERGIC BRONCHODILATORS

ALBUTEROL

LEVALBUTEROL

METAPROTEROL

HOW DOES THE SHORT ACTING NON-CATECHOLIME ADRENERGIC BRONCHODILATOR WORK

USED FOR MAINTENANCE

DURATION OF ACTION IS ABOUT 6 HOURS

WHAT ARE EXAMPLES OF LONG ACTING ADRENERGIC BRONCHODILATORS

SALMETEROL
FORMOTEROL

ARFORMOTEROL

HOW DOES THE LONG ACTING ADRENERGIC BRONCHODILATOR WORK

DURATION OF ACTION IS 12 HOURS WITH THE EXCEPTION OF INDACATEROL, WHICH LASTS 24 HOURS.

MOST COMMON SIDE EFFCTS OF ADRENERGIC BRONCHODILATOR

TREMOR

HEADACHE

INSOMNIA

NERVOUSNESS

ASSESSMENT OF BRONCHODILATOR THERAPY (ADRENEGIC)

BASED ON INDICATIONS FOR AERSOL AGENT

VITALS SIGNS

BREATH SOUNDS

BREATHING PATTERN

PT SUBJECTIVE RESPONSE IS IMPORTANT TO EVALUATE

INIDCATION FOR USE FOR ADRENERGIC BRONCHODILATORS

MAINTENANCE TX IN COPD

COMBINED WITH BETA AGONIST INDICATED FOR USE WITH PT WITH COPD WHO ARE RECIEVING REGULAR TX AND REQUIRE ADDITIONAL BRONCHODILATION FOR RELIEF OF AIRFLOW OBSTRUCTION

WHAT IS THE IEXAMPLES OF ANTICHOLINERGIC BROCHODILATOR

IPATROPIUM BROMIDE

ACIDIUM BROMIDE

TIOTROPIUM BROMIDE

UMCLIDIUM BROMIDE

WHAT ARE EXAMPLES OF A COMBINED ANTICHOLINERGIC AND BETA AGONIST

IPATROPIUM BROMIDE AND ALBUTEROL (DUONEB)

UMECLIDIUM BROMIDE AND VILANTEROL (ANORO ELIPTA)

MODE OF ACTION FOR ANTICHOLINERGERIC BRONCHODILATOR

AGENTS ACT AS COMPETIVE ANTAGONISTS AT FOR ACTEYLCHOLINE ON AIRWAY SMOOTH MUSCLE

ADVERSE EFFECTS OF ANTICHOLINERGIC BRONCHODILATOR

DRY MOUTH

PUPILLARY DILATION

LENS PARALYSIS

INCREASED INTRAOCCULAR PRESSURE

INCREASED HEART RATE

URINARY RETENTION

ALTERED MENTAL STATE

SIDE EFFECTS SEEN WITH ANTICHOLINERGIC AEROSOL AGENTS -

SVN

MDI

DPI

DRY MOUTH

COUGH

SIDE EFFECTS SEEN WITH ANTICHOLINERGIC AEROSOL AGENTS -

MDI

NERVOUSNESS

IRRITAION

DIZZINESS

HEADACHE

PALPATION

RASH

SIDE EFFECTS SEEN WITH ANTICHOLINERGIC AEROSOL AGENTS -

SVN

DPI

PHARYNGITIS

FLU LIKE SYMPTOMS

BRONCHITIS

UPPER RESP INFECTION

NAUSEA

OCCASIONAL BRONCHOCONSTRICTION

EYE PAIN

URINARY RETENTION

MUCUS CONTROLLING AGENTS HOW ARE THE TYPICALLY GIVEN

AEROSL OR DIRECT TRACHEAL INSTILLATION

WHY ARE MUCUS CONTROLLING AGNETS GIVEN

TO REDUCE OF AIRWAY MUCUS

N-ACETYL-L CYSTEINE

MODE OF ACTION FOR MUCUS CONTROLLING AGENTS

NAC SUBSITUTES ITS OWN SULFHYDRYL GROUP FOR DISULFIDE GROUP

WHICH CAUSES, IN THE MUCUS, THE BOND FORMING THE GEL STRUCTURE, TO BREAK DOWN

SIDE AFFECTS OF MUCUS CONTROLLING AGENTS

1. AIRWAY OBSTRUCTION

2. DISAGREEABLE ORDOR DUE TO HYDROGEN SULFIDE

3. INCREASED CONCENTRATION AND TOXICITY OF NEBULIZER SOLUTION TOWARD END OF TX

4. NAUSEA

5. RHINORRHEA

6. STOMATITIS

7. REACTIVITY OF ACETYLCYETINE WITH:

   1. RUBBER

   2. COPPER

   3. IRON

   4. CORK

WHICH DISEASE STATE IS DORNASE USED FOR

CF

WHAT IS THE MODE OF ACTION OF DORNASE

PROTOELTYTIC EMZYME BREAK DOWN DNA MATERLIALIZE FROM NEUTROPHILS FOUND IN PURULENT SECRETIONS

SIDE EFFCTS OF DORNASE (MUCUS CONTROLLING AGENT)

VOICE ALTERATION

PHARGYNITIS

RASH

CHEST PAIN

WHAT ARE CONTRAINDICATIONS FOR DORNASE

HYPERSENSITIVITY TO DORNASE

CHINSES HAMSTER OVARY PRODUCTS

COMPONENTS OF OTHER DRUGS CONTAINING DORNASE

ICS - INDICATIONS AND PURPOSE

ORALLY INHALED PREPATION USED FOR ANTI-INFLAMMATOPRY MAINTENANCE THERAPY OF PERSISTENT ASTHMA AND SEVERE COPD

WHAT IS MODE OF ACTION OF ICS

LIPID SOLUBLE DRUGS THAT ACT ON INTRACELLLAR RECEPTORS

FULL ANTI-INFLAMMATORY EFFECTS REQUIRE HOURS TO DAYS

WILL NOT RPOVIDE IMMEDICATE RELEIF OF DYSPNEA FROM AIRWAY OBSTRUCTION

ICS SYSTEMIC SIDE EFFCTS

ADRENAL INSUFF

EXTRAPULMONARY ALLERGY

ACUTE ASTHMA

HPA SUPPRESSION

GROWTH RETARDATION

OSTEOPOROSIS

ICS LOCAL SISDE EFFCTS

OROPHARYNGEAL FUNGAL INFECTIONS

DYSPHONIA

COUGH AND BRONCHOCONSTRICTION

INCORRECT OF MDI

TYPES OF ICS

QVAR, PULMICORT, FLOVENT

COMBINTION WITH ICS

FLUTICASONE PROPIONATE/SALMETEROL (ADVAIR)

BUDESENIDE/FORMETEROL (SYMBICORT)

MOMETASONE/FORMOTEROL (DULERA)

FLUTICASONE FUROATE/VILANTEROL Breztri Aerosphere)

NON STEROIDAL ANTI-ASTHMA DRUGS

MAST CELLS \STABILIZERS

ANTI-LEUKOTRIENES

MONOCLONAL ANTI-BODIES

EXAMPLE OF MAST CELL STABILIZER

Cromolyn sodium

EXAMPLE OF ANTI-LEUKOTRIENES

Montelukast

ZAFIRUKAST

ZILETON

EXAMPLES OF MONCLONAL ANTIBODIES

Omalizumab

MODE OF ACTION FOR CROMOLYN SODIUM

Cromolyn sodium works by preventing the release of histamine and other inflammatory mediators from mast cells, thus stabilizing the cell membrane and reducing allergic reactions.

MODE OF ACTION OFR ZARFIRUKAST AND MONTELUKAST

Zafirlukast and montelukast are leukotriene receptor antagonists that block the action of leukotrienes, reducing bronchoconstriction and inflammation in asthma and allergic reactions.

ADVERSE EFEFCTS OF ANTILEUKOTRIENES

HEADACHE

DYSPEPSIA

LIVER ENZYME ELEVATION

ADVERSE EFFECTS OF OMALIZUMAB

INJECTION SITE

VIRAL INFECTIONS

HEADACHE

SINUSITIS

PHARYNGITIS

NON-STEROIDAL ANTI-ASTHMA DRUGS

ASSESMENT OF DRUG THERAPY

STRATEGIES SIMILAR TO THOSE USED TO ASSESS INITIAL BRONCHODILATOR THERAPY

CLINICAN SHOULD VERIFY THAT PT UNDERSTANDS THAT MEDICATIONS ARE CONTROLLED DRUGS AND NOT RESCUE DRUGS

AEROLOSIZED ANTI-INFECTIVE MEDS (PENTAMIDINE ISETHIATE) WHAT ARE ITS USES

HAS BEEN USED TO TX PNEUMOCYTITS CARNII PNEUMOINIA BUT MAINLY USED TO TX PNUEMONIA JIROVECIand also indicated for patients with HIV/AIDS.

WHY IS PENTAMIDINE ISETHIOATE NOT USED AS MUCH

LIMITED EFFICACY

SIDE EFFECTS OF THE ANTI-INEFECTIVE DRUG PENTAMIDINE ISETHIOATE

COUGH

BRONCHOSPAM

WHEEZE

DYSPNEA

THE ANTI INFECTIVE DRUG RIBRAVIRIN IS USED FOR WHAT

TO TX SEVERE LOWER RESP TRACT INFECTIONS CAUSED BY RSV

HOW IS THE RIBOVIRIN GIVEN

SPAG

WHAT ARE ADVERSE EFFECTS OF THE ANTI-INFECTIVE DRUG RIBOVIRIN

SKIN RASH

EYE LID ERTHYEMA

CONJUCTIVITIS

INHALED TOBRMYCIN (ANIT-INFECTIVE DRUG)

USED TO MAMAGE CHRONIC INFECTIONS WITH P. AERUGINOSA IN PT WITH CF

WHAT ARE THE SIDE EFFCTS OF THE ANTI-INFECTIVE DRUG TOBRAMYCIN

VOICE ALTERATION

TININITIS

AEROSOLIZED ANTI-INFECTIVE -INHALED AZTREONAM (CAYSTON) HOW DOES IT WORK

Aerosolized medication used to treat Pseudomonas aeruginosa infections in patients with cystic fibrosis.

AEROSOLIZED ANTI-INFECTIVE -INHALED AZTREONAM (CAYSTON) SIDE EFFCTS

BRONCHOSPASM

DECREASED FEV1

ALLERGIC REACTIONS

AESOLIZISED ANTI-INFECTIVE AGENTS - COLISITMETHATE SODIUM WHAT IS IT USED FOR

Used to treat pneumonia caused by multidrug-resistant Gram-negative bacteria.

AESOLIZISED ANTI-INFECTIVE AGENTS - COLISITMETHATE SODIUM IDE EFFECTS

Potential nephrotoxicity and neurotoxicity.

AESOLIZISED ANTI-INFECTIVE AGENTS - INHALED ZANAMIVIR

Used to treat influenza virus infections.

INHALED VASODILATOR (INOMAX) USES

TX NEONATES WITH PERSISTENT PULM HYPERTENSION

IMPROIVES V/Q MISMATCH

RELAXES SMOOTH MUSCLES IN PULM VESSELS