Pharm Exam 3 Respiratory

Kent State Pharmacology 1, exam 3, Respiratory drugs

Upper respiratory tract

The mouth, nose, pharynx, larynx, and trachea (above the clavicles).

Sinusitis

Inflammation or infection of the sinus cavities, often due to blocked fluid drainage.

Oral decongestant example

Pseudoephedrine.

Common decongestant nasal spray

Oxymetazoline.

Centrally acting antitussive example

Dextromethorphan.

Primary use of expectorants

Thin respiratory mucus and aid in its expulsion.

Expectorant medication example

Guaifenesin (Mucinex)

Mucolytic definition

A medication that liquefies thick mucus to ease clearance

e.g., acetylcysteine

Pseudoephedrine effect on nasal passages

It produces systemic vasoconstriction to relieve nasal congestion.

Precaution with oral decongestants

patients with severe hypertension or coronary artery disease extra caution

Common adverse effects of oral decongestants

Hypertension, palpitations, and nervousness.

Non-drowsy alternative to first-generation antihistamines

Second-generation antihistamines (e.g., loratadine) although these are more common for allergies than acute cough.

Primary action of antitussives

To suppress the cough reflex.

Decongestants vs anti-tussives

Decongestants relieve nasal congestion via vasoconstriction, whereas anti-tussives suppress the cough reflex.

Nasal decongestants patients should avoid

caffeine to prevent worsening hypertension

it can increase vasoconstriction.

Primary mediator in allergic reactions

Histamine

Storage of histamine in the body

In mast cells and basophils

Effect of histamine on smooth muscle

It causes constriction, which can lead to bronchoconstriction.

Type I hypersensitivity

Mediated by IgE antibodies causing immediate symptoms

Reactions occur within minutes of exposure

type I hypersensitivity example

Anaphylaxis from a peanut allergy

Type II hypersensitivity

Cytotoxic reactions involving IgG/IgM antibodies that bind to cell surfaces

Type II hypersensitivity example

Seen in reactions to blood transfusions, hemolytic

disease of newborns, and certain drug-induced

reactions.

Type III hypersensitivity

Immune complex reactions where antigen-antibody complexes deposit and triggers inflammatory responses, which can cause tissue damage.

Type III hypersensitivity Example

Serum sickness, commonly occurring after

antibody transfusion or certain medications

Type IV hypersensitivity

Mediated by antigen-specific T cells rather than

antibodies.

Reaction is delayed, typically taking 24-72 hours to

manifest

Example of type IV hypersensitivity reaction

Poison ivy, contact dermatitis, tuberculosis skin tests, and graft rejection

Hypersensitivity types acronym

The four types of hypersensitivity reactions are remembered using the acronym

'ACID' (Anaphylaxis, Cytotoxic, Immune complex, Delayed).

First-generation antihistamines

Work by crossing the blood-brain barrier to block histamine receptors, reducing allergic symptoms.

Example of a first-generation antihistamine

Diphenhydramine (Benadryl).

Second-generation antihistamines

Do not cross the blood-brain barrier and cause less sedation.

Example of a second-generation antihistamine

Loratadine or cetirizine.

Histamine receptor targeted in allergic responses

H1 receptor.

Patient education for antihistamines

Avoid alcohol and know the sedative potential, especially with first-generation agents.

Increase water intake to help counteract the drying effects.

Anticholinergic effects of first-generation antihistamines

Dry mouth, urinary retention, and blurred vision.

Role of antihistamines in allergic rhinitis

To block histamine receptors and alleviate symptoms such as itching, sneezing, and rhinorrhea.

Histamine receptor antagonist

A drug that blocks the effects of histamine at receptor sites, reducing allergic symptoms.

Clinical use of antihistamines

They may also be used for motion sickness or as a sleep aid.

Caution for elderly patients with antihistamines

Due to the risk of confusion, dizziness, and falls.

Signs of histamine release during an allergic reaction

Itching, flushing, wheezing, and increased capillary permeability.

Asthma definition

A chronic inflammatory disease of the airways characterized by bronchoconstriction, airway hyperresponsiveness, and mucus production.

Rescue inhaler vs maintenance inhaler

A rescue inhaler is used for immediate relief during an attack - e.g., albuterol

maintenance inhalers are used daily to control chronic symptoms. - e.g., salmeterol

How short-acting beta-2 agonists work

They stimulate beta-2 receptors to relax bronchial smooth muscle and dilate airways quickly.

Common adverse effects of beta-2 agonists

Tachycardia, tremors, and central nervous system stimulation.

Caution with beta-agonists in heart disease

They can cause cardiac stimulation and worsen arrhythmias.

Role of long-acting beta-2 agonists in asthma treatment

They provide prolonged bronchodilation for maintenance therapy.

Preferred route for delivering bronchodilators in asthma

Inhalation for direct lung targeting.

Proper inhaler technique for MDI

Shake the inhaler, hold it two finger widths from the mouth, press the canister while taking a slow, deep breath, and wait 3-5 minutes between puffs if a second dose is needed.

Mechanism of action for anticholinergic inhalers

They block acetylcholine receptors in the airways to prevent bronchoconstriction and reduce mucus secretion.

Use of inhaled corticosteroids in asthma management

On a daily, long-term basis for controlling airway inflammation.

Leukotriene modifier used for asthma management

Montelukast.

Function of montelukast in asthma therapy

Montelukast helps to reduce inflammation and bronchoconstriction.

Montelukast

It prevents leukotrienes from binding to their receptors, thus reducing inflammation and bronchoconstriction.

Black box warning for montelukast

The risk of neuropsychiatric events such as vivid dreams, agitation, and hallucinations.

True/False: Mast cell stabilizers are effective for the acute relief of asthma symptoms.

False. They are used as a preventive, maintenance treatment.

Status asthmaticus

A life-threatening asthma attack that is unresponsive to usual treatments.

Contraindication for beta-2 agonists

Patients with heart dysrhythmias or severe coronary artery disease.

Common adverse effect of long-term beta-agonist use

Tolerance or possible cardiac stimulation if overused.

First-line rescue drugs during an asthma attack

Short-acting beta-2 agonists.

Example of a combination inhaler

Duovent (combining ipratropium and albuterol).

Indication for systemic corticosteroids

In acute severe asthma, systemic corticosteroids are indicated if inhaled beta-agonists do not relieve distress.

Mechanism of inhaled corticosteroids

They decrease airway inflammation by blocking cytokine release, reducing edema, and repairing epithelial damage.

Effect of beta blockers on beta-2 agonist therapy

Beta blockers can counteract the bronchodilatory effects of beta-2 agonists and lead to bronchospasm.

Nursing consideration for theophylline

Monitoring serum levels closely due to its narrow therapeutic window.

Medication reserved for severe bronchoconstriction

Xanthines e.g., theophylline

Inhaler sequence for optimal drug delivery

Use the bronchodilator first, wait 5-10 minutes, then use the steroid inhaler.

(True/False): Histamine release only affects the respiratory system.

False. It also affects the skin, gastrointestinal tract, and blood vessels.

True/False: Asthma is solely an allergic disease.

False. While IgE-mediated responses are common, many factors (e.g., exercise, stress) can trigger bronchoconstriction.

(True/False): Mast cell stabilizers are effective for the acute relief of asthma symptoms.

False. They are used as a preventive, maintenance treatment.

(True/False): In acute severe asthma, systemic corticosteroids are indicated if inhaled beta-agonists do not relieve distress.

True