resp

What drugs are Antitussives (suppress cough reflex)?

Dextromethorphan

What is the action of dextromethorphan?

Acts on the central nervous system (specifically the medulla) to suppress the cough reflex

What are the contraindications/cautions for dextromethorphan?

-Use caution in patients who need to cough to clear out their airways

-Postoperative patients and those with asthma or emphysema

What are the adverse effects of dextromethorphan?

-Central nervous system effects like drowsiness and sedation

-Potential for addiction

What drugs are Topical Decongestants?

Tetrahydrozoline

What is the classification of Tetrahydrozoline?

-Sympathomimetic

-stimulate the alpha-adrenergic receptors

What is the action of tetrahydrozoline?

-Imitate the effects of the SNS causing vasoconstriction

-Decreasing edema and inflammation of the nasal membranes

What is the contraindications/cautions for tetrahydrozoline?

-local lesion may lead systemic absorption

-conditions that are exacerbated by the sympathetic nervous system

-hypertension, glaucoma, or coronary disease

What are the adverse effects of tetrahydrozoline?

-Rebound congestion: if used longer 3-5 days , causes cycle needing more med

-Watch SNS effects due potential systemic effect.

What are the drug-drug interactions of tetrahydrozoline?

Watch with other meds that affect SNS

What drugs are Oral Decongestants?

Pseudoephedrine

How is pseudoephedrine accquired?

Behind the counter

What is the action of pseudoephedrine?

-Shrinks the nasal mucous membrane by stimulating alpha-adrenergic receptors

-decreases congestion and promotes sinus drainage

What is the contraindications/cautions of pseudoephedrine?

-adrenergic medication

-watch patients with conditions that are exacerbated by the sympathetic nervous system

-glaucoma, hypertension, and cardiac issues

What are the adverse effects of pseudoephedrine?

-Systemic sympathetic nervous system effects

-Anxiety, hypertension, and tremors

-Rebound congestion can happen if used longer than 3-5 days

What is the drug-drug interaction for pseudoephedrine?

Watch contents of OTC meds for colds and flu, allergies sinus, etc.

What drugs are Steroid Nasal Decongestants?

Flunisolide

What is the action of Flunisolide?

-Steroid that provides a direct local anti-inflammatory effect

-Blocking the complex reactions responsible for the inflammatory response

What is the contraindications/cautions for Flunisolide?

-Interferes with anti-inflammatory and immune responses

-Use caution if an acute infection is present

What is the adverse effects of Flunisolide?

Local burning, stinging, dryness of the mucosa, and headache

What drugs are Antihistamines?

Diphenhydramine (Benadryl)

What is the action of diphenhydramine?

-Selectively blocks the effects of histamine at histamine-1 receptor sites to decrease the allergic response

-It has antipruritic (anti-itch) and anticholinergic effects

What are the contraindications for diphenhydramine?

patients taking first-generation antihistamines who have a history of arrhythmia

What are the adverse effects of diphenhydramine?

Drowsiness, sedation, and anticholinergic effects such as dry respiratory and gastrointestinal mucous membranes

What are expectorants?

liquefy the lower respiratory tract secretions, easier for patients to cough secretions up and out.

What drugs are expectorants?

Guaifenesin

What is the action of guaifenesin?

-thins mucous secretions

-enhances output respiratory tract fluids by reducing the adhesiveness and surface tension of fluids

-easier movement of less viscous secretions

-More productive cough, open airways

What drugs are mucolytics?

Acetylcysteine

What is the action of Acetylcysteine?

-Decreases the tenacity and viscosity of mucoproteins in respiratory secretions

-Increase / liquify respiratory secretions , clear airways in high risk respiratory patients with thick tenacious secretions

-It also protects liver cells from acetaminophen toxicity

What are the contraindications for acetylcysteine?

Use caution in patients with asthma due to the potential for bronchospasm

What drugs are Bronchodilators/Xanthines?

Theophylline

What is the action of theophylline?

Dilates smooth muscle in the airways and decreases swelling

What are the contraindications for theophylline?

-Narrow margin of safety

-Watch blood levels

What are the adverse effects of theophylline?

-CNS irritability, restlessness, dizziness

-Palpitations, life-threatening arrhythmias

What the unlabeled use for theophylline?

Cheyne Stokes respiration, breathing pattern, apneic periods with tachypnea, seen at the end of life

What drugs are sympathomimetics?

Albuterol

What are the actions of albuterol?

-Beta-selective adrenergic agonis

-Dilates bronchioles

What are the adverse effects of albuterol?

CNS/SNS stimulation (tachycardia, restlessness, palpitations, nausea)

What are the drug-drug interactions of albuterol?

-Watch with other heart and BP meds, and general anesthetics

-Beta-blockers decrease its action

What drugs are Anticholinergics/Parasympatholytic?

Ipratropium

What are the other Anticholinergics?

-Scopolamine

-Atropine

-Meclizine

What is the action of Ipratropium?

Blocks acetylcholine at vagal-mediated receptor sites to cause bronchodilation

What are the adverse effects of ipratropium?

dry mouth, nervousness, palpitations

What are the drug-drug interactions with Ipratropium?

other anticholinergic medications

What drugs are Immune Modulators?

Omalizumab

What is the action of Omalizumab?

Antibodies that bind to IgE receptors to change the immune system's effectiveness

What is Omalizumab used to treat?

chronic asthma, not for acute attacks

What is the contraindications for omalizumab?

Boxed warning for anaphylaxis

What are the drug-drug interactions for Omalizumab?

-Watch with corticosteroids

-Wean treatments

What are the adverse effects of omalizumab?

Arthralgia (joint pain), upper respiratory infections, fever, and anaphylaxis

What drugs are Inhaled Steroids/Inflammation?

Budesonide

What are the actions of Budesonide?

-Decrease inflammatory response, increasing airflow and aiding respiration.

-Decrease swelling, and promote beta adrenergic receptor activity

What are the contraindications for Budesonide?

Not for acute asthma attacks or "stat" use (takes 2-3 weeks to reach therapeutic levels

What are leukotrienes?

-Inflammatory molecules produced and released by certain immune cells to trigger an inflammatory response

-Can be interfered or blocked.

What drugs are Leukotriene Receptor Antagonists or Modifiers?

Zafirlukast

What is Zafirlukast used to treat?

-Nasal congestion and inflammation associated with allergic rhinitis

-Narrowing and obstruction of the airways in obstructive lung diseases

-Chronic asthma, COPD

What are the actions of Zafirlukast?

Interferes with leukotrienes to reduce airway inflammation and vasoconstriction

What are the contraindications for Zafirlukast?

Slower acting; do not use during acute asthma attacks

What are the drug-drug interactions for Zafirlukast?

-phenytoin

-theophylline

What drugs are Lung Surfactants?

Beractant

What are the actions of Beractant?

Lipoprotein mixture that reduces surface tension in the alveoli for lung expansion

What are the adverse effects of Beractant?

Related to prematurity (bradycardia, pneumothorax, patent ductus arteriosus)

Chronic Obstructive Pulmonary disease (COPD)

permanent, chronic obstruction of the airways, often related to cigarette smoking.

What are the two related disorders that characterize COPD?

-emphysema

-chronic bronchitis

Emphysema

loss of the elastic tissue of the lungs, destruction of alveolar walls, and resultant alveolar hyperinflation with tendency to collapse with expiration.

What is "pink puffer" when you have emphysema?

difficult catch breathe so face becomes red , use large amount energy to breathe, and breathe through pursed lips

Chronic bronchitis

permanent inflammation of the airways with mucus secretion, edema, and post inflammatory defenses.

What are blue bloaters with chronic bronchitis?

blue colored lips and skin, large barrel chest, cyanotic nail beds, peripheral edema

What is Allergic Rhinitis?

a local defense mechanism in the nasal airways to help prevent irritants and allergens from entering the lungs

What are irritants for allergic rhinitis?

cigarette smoke and cold air cause short-term rhinitis

What are the symptoms of allergic rhinitis?

Rhinorrhea or "runny nose", nasal congestion, postnasal drainage, repetitive sneezing.

What are the treatments for allergic rhinitis?

Antihistamines, corticosteroids, saline, leukotriene receptor antagonists, no pets, etc.

What are boxed warnings?

-Formerly known as Black Box Warnings, these are the highest safety-related warnings that medications can have, as assigned by the FDA.

-There are over 400 medications with boxed warnings.

-They typically apply to an entire cohort or class of drugs rather than just one specific medication

Why are boxed warnings in place?

-Boxed warnings are intended to immediately bring the consumer and healthcare provider's attention to the major, severe risks of a drug.

-These severe risks are typically associated with the drug's mechanism of action and its undesired systemic effects on the body.

-For example, the immune modulator Omalizumab carries a boxed warning because it can trigger acute, life-threatening anaphylaxis

What is asthma?

Chronic inflammatory disease of the airways

Factors influence development: Asthma

-Allergy is the strongest predisposing factor .

-Chronic exposure to Irritant. can be seasonal (grass, tree, and weed pollens) or perennial (mold, dust, roaches, animal dander).

-Exercise. Too much exercise can cause.

-Stress/ Emotional upset. Trigger constriction of the airway

-Medications. Certain medications can trigger

When can asthma occur?

Most chronic disease childhood, can begin at any age.

Asthma - Clinical Manifestations

-Cough. May be only symptom at times.

-Dyspnea. General tightness may occur which leads to dyspnea.

-Wheezing. May be wheezing, first on expiration, and then possibly during inspiration as well

Asthma complications

Respiratory failure, pneumonia, and status asthmaticus.

Respiratory Infections

-Common cold

-Seasonal rhinitis

-Sinusitis

-Pharyngitis, laryngitis, bronchitis

-Tuberculosis

-Bronchitis

-Pneumonia

Risk factors of Respiratory Infections

-Stress

-Age

-Respiratory dysfunction

-Poor health

What is common cold?

viral - cause inflammatory response in UR

What is Seasonal rhinitis

hay fever-inflammatory response to a specific antigen

What is Sinusitis?

epithelial lining sinus cavities inflamed, can lead to bacterial infection

What is Pharyngitis and laryngitis associated with?

-influenza

-viral or bacterial

What is Bronchitis?

-acute or chronic

-viral or bacterial

-irritation noxious stimuli and recurrent infection

-bronchi, or the larger airways. Older children and adults

What is Pneumonia?

-inflammation of the lungs

-viral or bacterial

-aspiration foreign substance

-rapid inflammatory response

-dyspnea, fatigue, noisy breath sounds , poor oxygenation

What is Tuberculosis?

-Mycobacterium tuberculosis - more resistant

-droplet spread

-Cough, fatigue, SOA, fever

What is Bronchitis and bronchiolitis

virus causes both conditions, which target the airways in lungs

What is bronchiolitis?

smaller airways (bronchioles).- common younger children

Ventilation and Gas Exchange Disorders (Lower Respiratory Diseases)

-Atelectasis

-Bronchiectasis

-Asthma

-COPD

-Respiratory distress syndrome (RDS)

-ARDS (Acute)

What are the Upper Respiratory diseases?

-Common Cold & Seasonal Rhinitis

-Sinusitis

-Allergic Rhinitis

What is atelectasis?

-Incomplete expansion or collapse of the alveoli

-Can be caused by outside pressure (tumor, pneumothorax), blockage (mucous plug), or low surfactant levels

What is Asthma?

-Reversible bronchospasm, inflammation, and hyperactive airways

-Wheezing, SOA, chest tightness, cough

What is Bronchiectasis?

-A chronic disease marked by dilation of the bronchiole tree, chronic infection, and scar tissue formation

-Scar tissue forms bronchiole epithelial cells, usually underlying medical condition, ex., immune suppression, cystic fibrosis.

What is Respiratory Distress Syndrome (RDS/ARDS)?

-Obstruction of the alveoli and progressive loss of lung compliance

-Seen in premature infants lacking surfactant or adults suffering severe trauma

The upper respiratory tract

-nose, mouth, pharynx, larynx, trachea

-consists of conducting airways responsible for warming, filtering, and moistening ventilation air

The lower respiratory tract

-bronchi, lobules, alveoli

-primarily responsible for gas exchange

Upper respiratory infections are

predominantly viral (though they can turn bacterial)

Lower respiratory infections are

mainly bacterial, viral, mycoplasma, or chlamydia