Respiratory Drugs Random Flashcards

Respiratory Drugs

IgE (Immunoglobulin E)

• Type of antibody primarily involved in allergic reactions and defense against parasitic infections.

Upper Respiratory Tract (URT)

• Major function:
  • Warms and humidifies air going to the lungs.
  • Cleans air.
    • Mass cells, plasma cells.
    • Release IgE (Immunoglobulin E) and histamine.
  • Mucus binds up stuff.
    • Cilia in nose moves mucus.
• Sympathetic Driven
  • Constrict arterioles.
  • Increasing space, increase airflow.
  • To achieve bronchial dilation.
  • Thins mucus.
  • Take alpha one agonist, with a cold.
• Parasympathetic
  • Increases dilation of arterioles.
  • Increases mucus.
  • Increase runny nose.

Nose Mucus

• Body produces 1Qt of mucus a day.
• Rich in IgE.

Allergic Rhinitis (Hay Fever)

• Symptoms:
  • Teary eyes.
  • Red eyes.
  • Nasal congestion.
  • Postnasal drip.
  • Itchy throat.
  • Warm feeling in face.
  • Red Face.
  • Histamine reaction driven by mast cells.
• Allergic Rhinitis in kids can cause an ear infection.

Common Irritants

• Pollen.
• Pet dander.
• Dust mites.
• Mold.

Hypersensitivity

• Immediate hypersensitivity
  • Driven by mass cells and basophils.
• Delayed hypersensitivity
  • Same cells, but reaction occurs 4-8 hours after exposure.

Prevention/Treatment

• Antihistamines.
• Intranasal corticosteroids.
• Mass cell stabilizers.
• Sympathomimetic – Alpha 1 agonist.

Antihistamines

• All H1 – Antagonists.
  • OTC.
    • Diphenhydramine (Benadryl)
      • Causes drowsiness.
    • Cetirizine (Zyrtec), Fexofenadine (Allegra), Loratadine (Claritin)
      • 2nd Generation, long-lasting, well-tolerated.
      • Do not use with ethanol or CNS depressants.
      • If needed use with caution.
      • Other uses:
        • Vertigo.
        • Motion sickness.
        • Insomnia.
        • Skin rash.
        • Parkinson because of Anticholinergic effects.

Intranasal Cortical Steroids

• Avoid the systemic effects.
• Decrease inflammatory mediators.
• Helps with mild congestions.
• Can dry the nose out.
• Can get bloody noses.
• Effects can take up to 3 weeks.
• Fluticasone (Flonase).

Mass Cell Modular

• Cromolyn (NasalCrom)
  • Prevents mast cell H1 release.

Decongestants

• Alpha 1 – use of greater than 3-5 days gets rebound effect.
  • Rebound effects can be sever congestion, with increased mucus secretions.
  • Intranasal work immediately.
  • Oral do not offer immediate relief, but no rebound effect, so it is a trade off.
  • Increase systemic effects.
    • Including insomnia.
    • Including anxiety.
  • Pseudoephedrine (Sudafed)
    • Used to be used to make meth.

Antitussives (Control Coughing)

• Coughing is good it clears the lungs.
• Codeine
  • SCHEDULED III, IV, OR V depending on concentration.
  • Serious coughing only.
  • Work by increasing cough threshold in your brain, act centrally.
• Dextromethorphan (Robitussin DM)
  • OTC.
  • Work by increasing cough threshold in your brain, act centrally.
  • Large amount, like LOTS, you will get hallucinations, slurred speech, dizziness, drowsiness, euphoria, decreases motor coordination.

Expectorant

• OTC.
• Decrease in mucus.
• Increase mucus flow.
• Potassium will do the same thing.
• Guaifenesin (Mucinex)
  • MOA ??
• Acetylcysteine (Mucomyst)
  • Directly loosens mucus.
  • Breaks down mucus.
  • Foul smelling, smells like sulfur.
  • Also used for acetaminophen toxicity.

Respiration

• Respiration eg breathing – HE WILL ASK A QUESTION 18 per min
• Bronchial smooth muscle is stimulated by sympathetic nervous system on B2 receptors
  • Increases dilation.
  • Parasympathetic input
    • Decreases dilation.
    • Increases constriction.
• Bronchial Spasm
  • Gasping for air.
  • Spasm of smooth muscle.

Metered Dose Inhaler (MDI)

• 10-50% of drug gets into lungs.

Dry Powder Inhaler (DPI)

Asthma

• Inflammatory condition with bronchial spasms.
• Impacts 20 M Americans.
• Different Kinds
  • Exercise induced.
  • Cold Air induced.
  • Allergen Induced.
  • Status asthmaticus
    • Prolonged form of Asthma.
    • Severe asthma exacerbation that doesn't respond to initial treatment can lead to respiratory failure.
• Quick Relief
  • Short acting Beta agonist, (SABA)
  • Anticholinergics
  • Systemic steroids
• Long Acting
  • Inhaled corticosteroids
  • Leukotrienes
  • Methimazole
  • Immunomodulators
• Beta Antagonist
  • Albuterol (Proventi)
    • SABA effect 2-6 Hours.
    • Long-acting effect up to 12 hours.
    • Decrease TNF Alpha in the lungs.
    • Can get tolerance with constant use.
    • If you get tolerance increase dose or add second drug.
  • Ipratropium (Atrovent HFA)
    • Anticholinergic.
    • Most commonly used.
    • Less bronchial dilation.
    • Often combined with a beta antagonist.
    • Combivent (Respimat) On List?
      • Mainly for COPD, emphysema, chronic bronchitis.
  • Methylxanthines
    • Theophylline
      • Not used much.
      • Narrow TI??

Corticosteroids

• Inhaled has a less systemic effect similar to nasal.
• It takes 3-5 days to work, like Flonase.
• Systemic
  • Quick acting.
  • Inhale with Long-Acting beta,
  • Symptoms improve in 1-2 weeks, may need for 4-8 weeks, Use daily.
  • Does not replace a rescue inhaler.

Leukotrienes

• LTC4 10,000 times more potent than histamine.
• Severe bronchial constriction.
• Zileuton
  • Inhibits SLOV.
• Montelukast (Singulair)
  • LT Leukotrienes blocker.
  • Test Question?
    • EPA can compete with arachidonic for the same enzymes and it makes less active projects.
• Omalizumeh (Xolair) On list?
  • Anti IGE antibody.