Exam 3 - Adrenergics, Cholinergics, Pulmonary

albuterol drug class

short acting beta-2 adrenergic agonist (bronchodilator, SABA)

albuterol MOA

smooth muscle relaxation (mainly bronchodilation), binds to and activates beta-2 receptors on bronchial smooth muscle

albuterol indications

respiratory illnesses/conditions, short-term and immediate relief of asthma symptoms/bronchoconstriction

albuterol administration

- inhaled (MDI): mainly works with lungs

- nebulized

- PO (rare): longer duration, can cross blood-brain barrier and cause headaches

albuterol ADRs (usually with higher doses)

- tremors

- tachycardia

- headache

- throat irritation (when inhaled)

- nervousness

- restlessness

- angina

- seizures

- allergic reactions

epinephrine drug class

non-selective adrenergic alpha and beta-agonist (catecholamine)

epinephrine MOA

acts directly on alpha and beta adrenergic receptors of tissues innervated by the SNS, stimulates both alpha and beta receptors

epinephrine indications

anaphylactic shock, cardiac arrest (code blue)

epinephrine administration

topical or injected (usually IM)

epinephrine ADRs

vasoconstriction, increased contractility/HR, bronchodilation, pupillary dilation, palpitations

epinephrine drug interactions

alpha-adrenergic blockers, beta-adrenergic blockers, MAO inhibitors, tricyclic antidepressants

epi-pen dosage

0.3 mg for individuals >66 lbs, 0.15 mg for individuals 33-66 lbs

epi-pen

auto-injector, spring loaded, single use device for anaphylaxis

epi-pen contraindications

severe hypertension

prazosin drug class

alpha-1 adrenergic antagonist

prazosin MOA

inhibits vasoconstriction (peripheral vasculature), inhibits alpha-1 receptors to cause vasodilation and smooth muscle relaxation

prazosin indications

HTN, BPH, raynaud's disease

prazosin administration

oral (PO)

prazosin ADRs

- first-dose orthostatic hypotension

- nasal congestion

- sexual dysfunction

- reflex tachycardia

metoprolol drug class

beta-1 adrenergic antagonist

metoprolol MOA

decreases HR and contractility, cardioselective beta-blocker

metoprolol indications

HTN, angina, HF, MI

metoprolol administration

PO, IV (cardiac monitor due to rapid decrease in HR or AV block)

metoprolol ADRs

- educate diabetics

- taper off

- bradycardia

- thombocytopenia

- AV block

- HF

propranolol drug class

nonselective adrenergic beta-blocker

propranolol MOA

inhibits both beta-1 and beta-2

propranolol indications

- tachydysrhythmias

- subaortic stenosis

- migraine headaches

- essential tremor

- angina

- HTN

propranolol administration

oral and injectable

propranolol contraindications

- asthma/COPD

- pulmonary fibrosis

- albuterol/other beta-agonists ineffective

- AV block

- pregnancy

- bradycardia

bethanecol drug class

direct-acting muscarinic/cholinergic agonist

bethanecol MOA

binds reversibly to muscarinic receptors to cause activation of PSNS which promotes contraction and squeeze in smooth muscle of urinary bladder, promotes relaxation of urethral opening

bethanecol indications

urinary retention (common in post-op and post-partum patients)

bethanecol contraindications

pregnancy category C

bethanecol ADRs

- bradycardia

- hypotension

- GI upset

- increased salivation

- heartburn

- diarrhea

- abdominal cramping

- nausea

donepezil drug class

indirect acting muscarinic/cholinergic agonist

donepezil MOA

inhibits cholinesterase in the brain which inhibits destruction of acetylcholine

donepezil indications

mild to moderate alzheimer's (helps cognitive functions)

donepezil administration

IR tablets, ER weekly patch

donepezil ADRs

- bradycardia

- urinary incontinence

- diarrhea

- depression

donepezil therapeutic effects take how long?

up to 6 weeks

atropine drug class

anti-cholinergic/muscarinic antagonist

atropine MOA

blocks action of acetylcholine to increase HR and relax smooth muscle

atropine ADRs

- xerostomia (dry mouth)

- blurred vision

- increased intraocular pressure

- urinary retention

- constipation

- tachycardia

- confusion

atropine indications

symptomatic bradycardia (code), ventricular asystole (flatline), cholinergic overdose

atropine contraindications

angle-closure glaucoma, advanced hepatic/renal dysfunction

oxybutynin drug class

anti-cholinergic/muscarinic antagonist

oxybutynin MOA

blocks muscarinic receptors on the bladder detrusor, inhibiting (involuntary) contractions and the urge to void

oxybutynin indications

overactive bladder

oxybutynin dosing

short half-life, requires frequent dosing

oxybutynin ADRs

- dry eyes/mouth

- constipation

- tachycardia

- angioedema/hypersensitivity (stop the drug)

scopolamine drug class

anti-cholinergic/muscarinic antagonist

scopolamine MOA

blocks action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and CNS; blocks muscarinic receptors to reduce secretions

scopolamine effects

dries secretions, suppresses emesis and motion sickness

scopolamine indications

nausea, motion sickness

scopolamine contraindications

open-angle glaucoma, elderly population (increases delirium and confusion)

scopolamine onset

- oral/IM: 0.5-1 hour

- IV: 10 minutes

- transdermal: 6-8 hours

scopolamine ADRs

- dry mouth

- confusion/sedation

- increased HR

- bronchodilation, decreased secretion

- smooth muscle relaxation

- dry eyes

- ciliary muscle/iris relaxation

ipratropium bromide drug class

anti-cholinergic/muscarinic antagonist

ipratropium bromide MOA

blocks action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation (blocks bronchoconstriction)

ipratropium bromide indications

asthma, COPD, allergies, cold symptoms (acute relief of bronchospasm)

ipratropium bromide ADRs (minimal because not systemic absorption)

- dry mouth/throat

- nasal congestion

- heart palpitations

- GI distress

- headache

- coughing

- anxiety

ipratropium bromide contraindications

pregnancy category B, not yet approved for use

ipratropium bromide administration

local application to nasal mucosa inhibits serous and seromucous gland secretion

anti-cholinergic toxicity symptoms

antidote is physostigmine

- hyperthermia

- dry skin

- flushed skin

- mydiasis/pupillary dilation

- delirium

cholinergic crisis symptoms

antidote is atropine

- sweating/salivation

- lacrimation

- urination

- diarrhea

- GI pain

- emesis

asthma definition

bronchial hyperresponsiveness that causes bronchoconstriction and airway inflammation (chronic disease, part of COPD)

types of asthma

intrinsic, extrinsic, exercise-induced, drug-induced, status asthmaticus

intrinsic asthma

non-allergic asthma

extrinsic asthma

environmental causes

status asthmaticus

emergent/life-threatening, medications no longer working

- increased HR, RR, BP, and decreased SpO2

signs and symptoms of asthma

wheezing, coughing, shortness of breath, chest tightness/pain

rhonchi indicates what

congestion

wheezing indicates what

bronchoconstriction

treatment for intermittent asthma

PRN SABA (e.g. albuterol)

treatment for mild persistent asthma

low dose inhaled corticosteroid (fluticasone), SABA (albuterol)

treatment for moderate persistent asthma

low dose inhaled corticosteroid (fluticasone) + LABA (salmeterol) OR medium dose inhaled corticosteroid (fluticasone), SABA (albuterol)

treatment for moderate to severe persistent asthma

medium dose inhaled corticosteroid (fluticasone) + leukotriene receptor antagonist (montelukast) OR theophylline, SABA (albuterol)

treatment for severe persistent asthma

high dose inhaled corticosteroid (fluticasone) + leukotriene receptor antagonist (montelukast), SABA (albuterol)

purpose of inhaled drugs

enhanced therapeutic effect localized to lungs, minimized systemic effects, rapid relief/onset

when can albuterol be used for exercise-induced asthma?

before exercising (preventatively)

salmeterol drug class

long-acting beta agonist/bronchodilator (LABA)

salmeterol MOA

activates beta-2 receptors in bronchial smooth muscle to cause bronchodilation

salmeterol indications

long-term control of asthma/COPD (use alongside inhaled corticosteroid for asthma)

salmeterol administration

- inhaled (DPI)

- nebulized

- PO

salmeterol ADRs

- headaches

- throat irritation (when inhaled)

- nervousness

- restlessness

- tachycardia

- angina

- seizures

- allergic reactions

salmeterol and albuterol contraindications

history of dysrhythmias, history of MI, children under 6, women who are breastfeeding

fluticasone drug class

corticosteroid (glucocorticoid)

fluticasone MOA

suppresses (airway) inflammation; decreased synthesis and release of inflammatory mediators, decreased infiltration and activity of inflammation cells, decreased edema of the airway mucosa

fluticasone indications

decrease frequency of asthma attacks (long-term prevention not acute treatment)

fluticasone ADRs

oropharyngeal candidiasis (thrush, with DPI), immunosuppression, agitation, insomnia, increased HR, hyperglycemia

fluticasone contraindications

vaccines, NSAIDs

prednisone drug class

corticosteroid

montelukast drug class

leukotriene modifier (receptor antagonist)

montelukast MOA

prevents airway edema and inflammation by blocking leukotriene receptors in airways

montelukast indications

prophylaxis of persistent/chronic asthma (PO), treats allergic rhinitis

montelukast ADRs

headache, nausea, diarrhea, neuropsychiatric effects (depression, suicidal ideations)

theophylline drug class

methylxanthine

theophylline MOA

reduces airway response to histamine/allergies to keep bronchioles open

theophylline indications

long-term prophylaxis of asthma that is unresponsive to beta-agonists or corticosteroids

theophylline ADRs

nausea, vomiting, CNS stimulation