Respiratory Tract Drugs

What is asthma?

A common chronic disorder that occurs in 1 in 11 children and 1 in 12 adults in the US.

What are the characteristic signs and symptoms of asthma?

Breathlessness, tightness in the chest, wheezing, dyspnea, and cough.

What is Chronic Obstructive Pulmonary Disease (COPD)?

A chronic, progressive, largely irreversible disorder characterized by airflow restrictions and inflammation.

What are the symptoms of COPD?

Chronic cough, excessive sputum production, wheezing, dyspnea, and poor exercise tolerance.

What is the usual cause of COPD?

Cigarette smoking.

What are the two main pharmacologic classes of drugs for asthma and COPD?

Inflammatory Agents (glucocorticoids) and Bronchodilators (beta2 agonists).

What are the advantages of administering drugs by inhalation for asthma?

Enhanced therapeutic effects, minimized systemic effects, and rapid relief of acute attacks.

What are common side effects of inhaled anti-asthmatic drugs?

Tachycardia and shakiness.

What are metered-dose inhalers (MDIs)?

Small hand-held, pressurized devices that deliver a measured dose of drug with each actuation.

What is the purpose of spacers in inhalation therapy?

To increase delivery of drug to the lungs and minimize drug swallowed in the oropharynx.

What are Respimats?

Inhalers that deliver drugs as a very fine mist, activated by the user.

What is the benefit of Respimats regarding drug delivery?

Extremely small particle size ensures greater delivery of drug to the lungs and decreased deposition in the mouth.

What are Dry-Powder Inhalers (DPIs)?

Devices used to deliver drugs in the form of a dry micronized powder directly to the lungs.

How are Dry-Powder Inhalers activated?

They are breath activated.

How do Dry-Powder Inhalers compare to Metered-Dose Inhalers in drug delivery?

DPIs deliver more drug to the lungs compared to MDIs.

What are nebulizers used for?

Nebulizers convert a drug solution into a mist for inhalation.

How do nebulizers compare to inhalers?

Nebulizers produce finer droplets and increase delivery to the lungs.

What is the primary use of inhaled glucocorticoids?

They are the foundation of asthma and COPD therapy for long-term control.

Are glucocorticoids meant for rescue during an asthma attack?

No, they are not meant for rescue.

What is the mechanism of glucocorticoids in asthma treatment?

They reduce asthma symptoms by suppressing inflammation.

What are the effects of glucocorticoids on inflammatory mediators?

They decrease synthesis and release of inflammatory mediators.

What is the role of glucocorticoids in chronic asthma?

They are used for prophylaxis on a fixed dosing schedule.

Can glucocorticoids abort an asthma attack?

No, they cannot be used to abort an attack.

What is the first-line therapy for managing asthma's inflammatory component?

Inhaled glucocorticoids.

What are the adverse effects of long-term glucocorticoid use?

Adrenal suppression, oropharyngeal candidiasis, and dysphonia.

What should patients do after using inhaled glucocorticoids?

Rinse the mouth with water and gargle after each administration.

What are the potential effects of inhaled glucocorticoids on children?

They can slow growth in children and adolescents.

What are the risks associated with long-term use of inhaled glucocorticoids?

They may promote bone loss and cause cataracts and glaucoma.

What should be done when discontinuing oral glucocorticoids?

Decrease the dose gradually.

What side effect can occur with oral glucocorticoids?

Nausea, especially if taken on an empty stomach.

What are leukotriene modifiers used for?

They suppress the effects of leukotrienes, decreasing bronchoconstriction and inflammatory responses in patients with asthma.

What are the three currently available leukotriene modifiers?

Zileuton, Zafirlukast, and Montelukast.

What is the mechanism of action of Zileuton?

It blocks leukotriene synthesis.

What is the mechanism of action of Zafirlukast and Montelukast?

They block leukotriene receptors.

What is the administration route for leukotriene modifiers?

All are oral.

What is the therapeutic classification of leukotriene modifiers?

They are second-line therapy or an add-on.

What are some potential adverse effects of leukotriene modifiers?

They can cause neuropsychiatric effects including depression, suicidal thinking, and suicidal behavior.

What is Cromolyn used for?

It is an inhalational agent that suppresses bronchial inflammation for prophylaxis, not quick relief.

How is Cromolyn administered?

It is used by nebulizer.

What is Omalizumab?

A monoclonal antibody that antagonizes IgE, used as a second-line agent for allergy-related asthma.

What is Roflumilast and its mechanism of action?

It is a phosphodiesterase type 4 (PDE4) inhibitor that decreases the release of inflammatory products.

What is the therapeutic use of Roflumilast?

It is approved for the treatment of severe COPD with a chronic bronchitis component.

What do bronchodilators do?

They provide symptomatic relief in patients with asthma and COPD but do not alter the underlying inflammation.

What are Beta2-Adrenergic Agonists used for?

They are the most effective drugs for relieving acute bronchospasm and are considered first-line drugs.

What is the effect of activating beta2-adrenergic receptors?

It promotes bronchodilation and relieves bronchospasm.

What is an example of a short-acting bronchodilator?

Albuterol (ProAir).

What are methylxanthines used for?

They cause central nervous system excitation and bronchodilation.

What is the principal methylxanthine used in asthma?

Theophylline

What is a key characteristic of theophylline's therapeutic range?

It has a narrow therapeutic range.

How can theophylline be administered?

It can be given orally or intravenously.

What is the mechanism of action of theophylline?

It produces bronchodilation by relaxing smooth muscle of the bronchi.

What are some symptoms of toxicity from theophylline?

Nausea, vomiting, diarrhea, insomnia, restlessness.

What severe effects can occur with severe toxicity of theophylline?

Severe dysrhythmias and convulsions.

What is aminophylline?

A more soluble methylxanthine with identical properties to theophylline.

What is the function of anticholinergic drugs in respiratory therapy?

They improve lung function by blocking muscarinic receptors in the bronchi.

Name two anticholinergic agents used in respiratory therapy.

Ipratropium and tiotropium.

What is the brand name of ipratropium?

Atrovent HFA

What is tiotropium used for?

Maintenance therapy of bronchospasm associated with COPD.

What is aclidinium used for?

Management of bronchospasm associated with COPD.

What is umeclidinium indicated for?

Management of bronchospasm associated with COPD.

What are glucocorticoid-long-acting beta2-agonist combinations not recommended for?

Initial therapy.

Name a glucocorticoid-long-acting beta2-agonist combination.

Budesonide/formoterol (Symbicort)

What is a beta2-adrenergic agonist-anticholinergic combination?

Ipratropium/albuterol (DuoNeb)