Pharm Exam 2 Respiratory Drugs

what is allergic rhinitis?

inflammation of nasal mucosa

sneezing, watery eyes and nasal congestion

what are the preventers of allergic rhinitis?

antihistamines, intranasal corticosteroids, and mast cell stabilizers

what are relievers of allergic rhinitis?

oral and intranasal decongestants

what is histamine?

chemical mediator of inflammatory respose

what does histamine interact with?

histamine 1 and 2 receptors

what are histamine 1 receptors?

found in smooth muscle of the vascular system and bronchial tree

what histamine receptors cause many symptoms of allergic rhinits?

histamine 1 receptors

where are histamine 2 receptors?

found in stomach, responsible for peptic ulcers

what drug is a H1-receptor antagonist?

diphenhydramine (Benydryl)

what is the mechanism of action for diphenhydramine?

histamine (H1) receptor blocker

is a 1st generation H1 Receptor antagonist sedating or non sedating?

sedating

is a 2nd generation H1 Receptor antagonist sedating or non sedating?

non-sedating

what is the primary use of diphenhydramine?

to treat minor symptoms of allergy or common cold

what are the adverse effects of diphenhydramine?

paradoxical excitation, sedation/drowsiness, hypersensitivity reactions, hypotension and dry mouth

what may increase the effects of sedation of diphenhydramine?

use with alcohol or opioids

what herb may increase anticholinergic effects of diphenhydramine?

henbane

what drug is an intranasal corticosteroids?

fluctiasone — flonase

what are the drugs of choice for allergic rhinitis?

intranasal corticosteroids

what is the mechanism of action of flonase?

decrease local inflammation in nasal passages thus reduces nasal stiffness

when must flonase be adminstered?

2-3 weeks prior to allergen exposure

how does flonase work?

decreases secretion of inflammatory mediators which reduces tissue edema

what is an alternative therapy for flonase?

mast cell stabilizers

what are adverse effects of flonase?

nasal irritation and epitaxis

what herb may potentate the effects of flonase?

licorice

what drug is a decongestant?

oxymetazoline — afrin

what is the mechanism of action of afrin?

stimulates alpha-adrenegeric receptors in sympathetic nervous system which causes arterioles in nasal passages to constrict, dries out mucous membranes

what are the adverse effects of intranasal decongestants?

rebound congestion when used for longer than 3-5 days

what is the adverse effects of oral decongestants?

hypertension

what is true of intranasal decongestants?

more efficacious, fast response time, has few systemic effects

what is true of oral decongestants?

have more systemic effects, response time is slower, less effective in relieving severe congestion

oxymetazoline is contraindicated with what conditions?

hypertension, thyroid conditions, diabetes and heart conditions

should be taken under supervision with clinicians

what do antitussives do in regards to cough?

inhibit cough

what is used to inhibit severe cough?

opioids

what do expectorants do?

inhibit mucus production

what do mucolytics do?

lossen thick bronchial secretions

what drugs are antitussives?

dextromethorphan - delsym

what is the mechanism of action for dextromethorphan - delsym?

acts on medulla to inhibit cough reflex

what is the primary use for dextromethorphan - delsym ?

as a component in most OTC severe cold and flu preparations

what are the adverse effects of dextromethorphan - delsym?

sedation, constipation, dizziness, drowsiness, GI upset, respiratory depression

when is dextromethorphan - delsym contraindicated?

for chornic cough

who should not use dextromethorphan - delsym?

children younger than 12

what should those taking dextromethorphan - delsym avoid?

eating grapefruit or grapefruit juice

what drug is an expectroants?

guaifenesin

what drug is a mucolytic?

acetylcysteine

what do expectroants and mucolytics do?

help loosen thick bronchial secretions — breaks down mucus molecule which makes mucus thinner and easier to remove by coughing

what conditions are expectorants and mucolytics used for?

cystic fibrosis, chronic bronchitis, or other diseases producing thick mucus

what do patients using expectorants and mucolytics need to increase?

fluid intake

how are lower respiratory drugs admistered?

via inhalation or orally

what is true of inhalation drug administrtaion for respiratory conditions?

common route of administration

rapid and efficient due to rick blood supply

delivers drugs directly to sites of action

what is true of oral drugs for respiratory conditions?

longer duration of action

frequent side effects

tolerance may develop

what does aerosol therapy do?

suspension of droplets or particle in a gas, onset of action is slmost immediate

what are aerosol drugs administered for?

local effect

what is true of side effects with aerosol therapy?

side effects are reduced but systemic effects can still occur

what are the disadvantages of aerosol therapy?

difficult to measure precise dose

usually only 10-50% of drug is places

instruction may be complicated for some patients

side effects occur if patient swallows drug or does not rinse mouth after

what are the three devices or aerosol therapy?

nebulizer, metered dose inhaler and dry powder inhaler

how does a nebulizer work?

vaporizes liquid drug into fine mist, uses small machine and face mask

how does a metered dose inhaler work?

propellant delivers measured dose of drug, patient times inhalation to puffs of drugs

how does dry powder inhaler work?

patient inhales powdered drug and device is activated by inhalation

what are the components of asthma?

inflammatory and bronchospasm

what are drugs used to do in regards to asthma?

to prevent asthmatic attacks or terminate attack in progress

what are the quick relief medications for asthma?

beta 2-adrenergic agonists, anticholinergics, systemic corticosteroids

what drug is a beta-adrenergic agonist for asthma?

albuterol

what is albuterol (beta-adrenegric agonist) most effective drug for?

relieving acute bronchospasm

how does albuterol (beta-adrenergic agonist) work?

activates beta 2 receptors in bronchial smooth muscle to cause bronchodialation

what are adverse effects for albuterol?

headaches, throat irritation, nervousness, restlessness, tachycardia, chest pain, allergic reactions

what should patients using albuterol avoid?

caffeine

what drug will inhibit bronchodilation effect of albuterol?

concurrent use with beta blockers

what should be monitored with patients taking albuterol?

assess vital signs before administration

do not give if patient has a history of dysrhythmia or MI

no recommended for women breastfeeding

what are the anticholinergics drugs for asthma?

ipratropium — atrovent

what is the MOA of ipratropium — atrovent?

causes bronchodilation by blocking muscarinic receptors in bronchial smooth muscle

what conditions are ipratropium — atrovent used for?

COPD and asthma adjunct

what is the primary use of ipratropium — atrovent?

relief of acute bronchospasm

what do ipratropium — atrovent do?

block parasympathetic nervous system with bronchodilator effect

what is ipratropium — atrovent occasionally used as?

alternative to beta agonists

what is the first line of defense to treat bronchospasms caused by COPD?

ipratropium — atrovent

what are the adverse effects for ipratropium — atrovent ?

cough, drying of nasal mucosa, hoarseness, dry mouth bitter taste

who is contraindicated for use of ipratropium — atrovent?

patients with hypersensitivity to soya lecithin

what are the monitoring points for anticholinergic asthma drugs?

assess respiratory rate before and after

vital signs

what conditions are contraindicated for anticholinergic asthma drugs?

assess for history of narrow angle glaucoma, BPH, renal disorders, urinary bladder obstruction and elderly

what drug is a methylxanthines?

theophylline

what are methylxanthines?

group of bronchodialators related to caffeine via PDE inhibition

what are some downfalls to methylxanthines?

narrow therapeutic range, interact with numerous drugs and have side effects

how are methylxanthines administered?

ivtravenous or oral routes

what are methylxanthines primarily used for?

long term prophylaxis or asthma unresponsive to beta agonists or corticosteroids

what needs to be monitored in patients using methylxanthines?

vital signs, theophyline levels, nausea and seizures

what are the contraindications for methylxanthines?

Coronary artery disease, angina pectoris, severe renal or liver disorders, peptic ulcer, benign prostatic hyperplasia, diabetes mellitus

what drug is a corticosteroid for asthma?

beclomethasone

what class of drugs are the most potent anti-inflammatory?

corticosteroids, beclomethasone

what is the MOA of beclomethasone?

reduces inflammation

what is the primary use for beclomethasone?

decrease frequency of asthma attacks

how is beclomethasone adminsitered?

inhaled, the drugs of choice for long term prophylaxis of asthma

when shoule corticosteroids for asthma not be used?

to terminate an asthma attack in progress

what are the adverse effects of beclomethasone?

oropharyngeal candidiasis (rinse mouth after to avoid thrush)

when is beclomethasone contraindicated?

if patient has active infection

what drug is a leukotriene modifier?

montelukast

what are leukotrines?

mediators of immune response

what are leukotriene modifiers used for?

asthma, chronic allergies, asthma prophylaxis

what is the MOA of montelukast?

prevents airway edema and inflammation by blocking leukotriene receptor in airways

what is the primary use of montelukast?

prophylaxis or persistent chronic asthma

what are adverse effects of montelukast?

headache nausea and diarrhea