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Asthma

shortness of breath, wheezing, an attack may be precipitated by allergans, exercise, and stress
constriction of bronchioles
common in children
inability to exhale

Emphysema

characterized by alveolar destruction with air space enlargement and airway collapse
destruction of alveoli
seen in smoking
1. No gas exchange 2. alveoli lose elasticity

COPD

characterized by irreversible airway obstruction
can be either chronic bronchitis or emphysema
patients will carry oxygen

Chronic bronchitis

a result of chronic inflammation of the airways and excess sputum

Sympathomimetics

adrenergic agonists
produce bronchodialation by stimulation of the B2 receptors in the lungs witha decrease in side effects of the cardiovascular system
used orally or inhalation and parenterally

Epinephrine

an a and b agonist
used parenterally to treat acute asthmatic attacks
emergency by inhalers
fast acting
can cause nervousness, tachycardia, and insomnia

Isoproterenol

non specific B agonist
maybe used orally by inhalation and parenterally
not used frequently

Selective B2 agonist

fewer side effects than with epinephrine
given orally, IM, IV, inhalation
may have some b1 activity
oral doses are daily
inhalation are for emergency situations

Selective B2 agonist drugs

terbutaline, metaproterenol, albuterol, isoetharine

Xanthine derivatives

used to treat chronic asthma and bronchospasm produced with chronic bronchitis and emphysema
may cause CNS and cardiac stimulation, increased secretions, erythromycin drug interactions

Xanthine derivates drugs

Theophylline
Aminophylline (ethophylline/ethalinediamine+theophylline)-more soluble than theophylline
used for severe COPD or bronchitis
narrow therapeutic window

Anticholinergic drugs

atropine is an old remedy for asthma
more severe respiratory disease
can cause xerostomia

Anticholinergic agent drugs

atrovent
can cause dry mouth and bad taste
inhalation only
long term management of COPD or poorly contolled asthmatics

Cromolyn (Intal)

effective only for prophylaxis of asthma and not for treatment of acute attack
least toxic of all asthma medications
biggest therapeutic window
prevention orally, rescue inhalation

Cromolyn drugs

nasalcrom nasal solution- intranasally
Opticrom-opthalmologic preperations

Corticosteroids

used for treatment of asthma by topical aerosol administration, used in combination with b2 agonist improves therapeutic action
oral candidiasis may occur
antiinflammatory properties

Corticosteroids drugs

vanceril and azmacort
may cause oral candidiasis
immunosuppression-->suprainfections
rinse after inhaler use

Leukotriene pathway inhibitors

used to treat asthma, blocks LT produced during inflammation via arachidonic acid pathway
not as effective as steroids, used for refractory cases
similar to ASA or tylenol

Inflammation

arachadonic acid builds cell membrane when inflammation occurs the acid is converted to prostaglandins or leukotrienes

Leukotriene drugs

zileuton-inhibits LT synthesis
zafirlukast- LT receptor antagonist (drug interactions with ASA, theophylline, warfarin, phenytoin, carbemazepine)
not first line drugs
not well controlled asthma

Nasal decongestants

a-adrenergic agents that constrict the blood vessels of the nasal mucous membranes
peripheral mucosal vasoconstriction (less blood flow, less mucous, less congestion)

Nasal decongestant drugs

phenylpropanolamine- used systemically
pseudoephedrine- 75% alpha
phenylephrine-topically 95% alpha
abused as diet drugs

rebound congestion

worse congestion due to chronic use, rotate drugs

Expectorants

drugs that promote release of mucous from the respiratory passages
can cause reflex irritation of the stomach, which stimulates bronchial secretions, thins secretions

Expectorant drugs

guaifenesin (robitussin)
iodinated glycerol
terpin hydrate
ammonium chloride
ipecac syrup- vomitting

Mucolytics

modify secretions, enzymes that are able to digest, destroy or dissolve mucous, decreasing its viscosity

Mucolytics drugs

mucomyst- used for tylenol OD
dornavac (pancreatic dornase)- cystic fibrosis

Antitussives

may be opiod or related agents use for symptomatic relief of nonproductive cough
cough medicines

Antitussives drugs

All opiods
Codeine
Dextromethorpan- opiod relative, suppresses cough without release of histamine
watch excess CNS depressants

Dental concerns

patients prone to developing respiratory failure, if given oxygen alone or with nitrous or CNS depression may produce acute respiratory failure
ASA and erythromycin contrainindicated in asthmatics and erythromycins may alter metabolism of theophylline

GERD

#1 GI disease in US
lifestyle treatment-smaller meals, nothing before bed, raise head of bed, less stomach distension
pharm treatment- acid in stomach, constrict sphincter, speed perastalic wave
poor seal at pyloric sphincter
chronic can lead to hole in esophagus

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