Ch review

29.1 The respiratory system supplies oxygen for the body and provides protection against inhaled organisms
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29.1 The respiratory system supplies oxygen for the body and provides protection against inhaled organisms
The URT warms the incoming air and reacts to particles or pathogens that attempt to enter the body. The LRT brings needed oxygen into the body and removes carbon dioxide through expiration. The process of moving air into and out of the lungs, or ventilation, is distinct from the process of gas exchange across the alveoli, a process known as respiration.
29.2 The inhalation route of drug administration quickly delivers medications directly to their sites of action
Inhalation is frequently used as a route of drug administration for those medications targeted for the respiratory system. Nebulizers, DPIs, and MDIs are used to deliver drugs via the inhalation route.
29.3 Allergic rhinitis is characterized by sneezing, watery eyes, and nasal congestion
Allergic rhinitis, also known as hay fever, is a chronic allergy triggered by a wide variety of antigens. The release of chemicals mediating the immune response can result in seasonal symptoms for some patients, and chronic, continuous symptoms for others.
29.4 Antihistamines are widely used to treat allergic rhinitis and other minor allergies
The H1-receptor blockers, or antihistamines, are used to treat allergies, motion sickness, and insomnia. Newer drugs in this class are nonsedating and offer the advantage of once-a-day dosing.
29.5 Intranasal corticosteroids are first-line drugs for treating allergic rhinitis
Intranasal corticosteroids are the treatment of choice for allergic rhinitis because of their high effectiveness and wide margin of safety. When used by this route, they do not produce the serious adverse effects observed when they are given orally or parenterally.
29.6 Decongestants are used to reduce nasal congestion caused by allergic rhinitis and the common cold
Oral and intranasal sympathomimetics are effective at relieving nasal congestion. The intranasal drugs act more rapidly and are more effective. Use of the intranasal preparations, however, is usually limited to three to five days because of the potential for rebound congestion.
29.7 Antitussives and expectorants are used to treat symptoms of the common cold
Antitussives are effective at inhibiting the cough reflex. Although opioids are the most effective, there is some risk of physical dependence. Guaifenesin is an OTC drug used to increase bronchial secretions so that cough may be more productive. Mucolytics loosen mucus so that it may be more easily removed from the bronchial tree.
29.8 Asthma is a chronic inflammatory disease characterized by bronchospasm
Asthma is a common disease characterized by bronchospasm and chronic airway inflammation. Exposure to a number of factors, including allergens, can cause an acute episode.
29.9 Beta-adrenergic agonists are the most effective drugs for relieving acute bronchospasm
Inhaled beta2-adrenergic drugs are preferred medications for relieving bronchospasm. Anticholinergics are sometimes used for bronchodilation, but fewer are available because of their incidence of adverse effects. Xanthines, once widely used in pulmonary medicine, are now second-choice drugs for relieving bronchospasm because of their higher potential for adverse effects.
29.10 Corticosteroids are the most effective drugs for the long-term prophylaxis of asthma
Inhaled corticosteroids are the drugs of choice for asthma prophylaxis. The inhaled corticosteroids, even when used on a long-term basis, produce few adverse effects compared to oral corticosteroids.
29.11 Mast cell stabilizers and leukotriene modifiers are alternative anti-inflammatory drugs for the prophylaxis of asthmaMast cell stabilizers such as cromolyn are sometimes used for asthma prophylaxis, although they are not as effective as the corticosteroids. The leukotriene modifiers offer another option for the prophylaxis of chronic asthma.29.12 Chronic obstructive pulmonary disease is a progressive disorder treated with multiple drugsChronic bronchitis and emphysema are two disorders of COPD that often require multiple drug therapy. Bronchodilators, expectorants, mucolytics, antibiotics, and oxygen may offer symptomatic relief.32.1 The endocrine system maintains homeostasis by using hormones as chemical messengers.Hormones are secreted by endocrine glands in response to changes in the internal environment. The hormones act on their target cells to return the body to homeostasis. Negative feedback prevents the body from overresponding to internal changes.32.2 The hypothalamus and the pituitary gland secrete hormones that control other endocrine organs.The hypothalamus secretes releasing hormones that signal the anterior pituitary gland to release its hormones. Pituitary hormones travel throughout the body to affect many other organs.32.3 Hormones are used as replacement therapy, as antineoplastics, or as "antihormones" to block endogenous actions.Hormones are often given as replacement therapy to patients who are not able to secrete sufficient quantities of endogenous hormones. In high doses, several hormones may be used as antineoplastics. Hormones may also be used therapeutically to block natural physiologic effects.32.4 Of the many pituitary and hypothalamic hormones, several have clinical applications as drugs.Growth hormone, or somatotropin, is used to increase the height of children with growth hormone deficiencies. ADH, or vasopressin, increases water reabsorption in the kidney and is used to treat diabetes insipidus.32.5 The thyroid gland controls the basal metabolic rate and affects virtually every cell in the body.TSH released from the pituitary gland stimulates release of thyroid hormone. The thyroid gland secretes thyroid hormone, which is essential for normal growth and development. Adequate hormone levels are necessary for infants, children, and adults. Thyroid hormone is a combination of two different hormones, thyroxine and triiodothyronine, both of which require iodine for their synthesis.32.6 Thyroid disorders may be treated by administering thyroid hormone or by decreasing the activity of the thyroid gland.Hypothyroidism produces symptoms such as slowed body metabolism, slurred speech, bradycardia, weight gain, low body temperature, and intolerance to cold environments. Administration of thyroid hormone reverses these effects. Hyperthyroid patients exhibit the opposite symptoms. Hyperthyroidism may be treated with drugs that kill or inactivate thyroid cells.32.7 Corticosteroids are released during periods of stress and influence carbohydrate, lipid, and protein metabolism in most cellsThe adrenal cortex secretes corticosteroids in response to stimulation by ACTH from the pituitary gland. Corticosteroids affect the metabolism of nearly every cell in the body and have potent anti-inflammatory effects.32.8 Corticosteroids are prescribed for adrenocortical insufficiency and to dampen inflammatory and immune responses.Corticosteroids are given to patients whose adrenal glands are unable to produce adequate amounts of these hormones and for a wide variety of other conditions. When used at high doses, oral therapy is limited because of the potential for producing Cushing's syndrome and adrenal atrophy.34.1 The hypothalamus, pituitary, and gonads control reproductive function in both men and women.Estrogens are secreted by ovarian follicles and are responsible for maturation of the sex organs and the secondary sex characteristics of the female. Progestins are secreted by the corpus luteum and prepare the endometrium for implantation. Testosterone is secreted by the testes and is responsible for the growth and maintenance of the male reproductive system. The sex hormones are controlled by GnRH from the hypothalamus and FSH and LH from the pituitary gland.34.2 Oral contraceptives are drugs used in low doses to prevent pregnancy.OCs contain low doses of estrogens and progestins. Nearly 100% effective, these drugs prevent conception by blocking ovulation. Long-term formulations offer greater flexibility of administration. OCs are safe for the large majority of women, but they have some potentially serious adverse effects. Antibiotics, antifungals, barbiturates, and antiseizure medications can interfere with the effectiveness of OCs.34.3 Hormone replacement therapy provides estrogen to treat postmenopausal symptoms, but benefits may not outweigh risks.Estrogen-progestin combinations are used for hormone replacement therapy during and after menopause. Their long-term use may have serious adverse effects including increased risk of MI, stroke, breast cancer, and blood clots.34.4 Conjugated estrogens and progestins are prescribed for dysfunctional uterine bleeding, endometrial cancer, and postmenopausal symptoms.Dysfunctional uterine bleeding is often the result of an imbalance between progesterone and estrogen secretion. Administration of progestins may reestablish a normal cyclic menstrual pattern. Progestins are also used to treat endometrial cancer. Conjugated estrogens treat postmenopausal symptoms.34.5 Oxytocin and tocolytics are drugs that influence uterine contractions and labor.Oxytocics are drugs that stimulate uterine contractions and induce labor. Oxytocin, methylergonovine (ergot alkaloid), and prostaglandins are examples of uterine stimulants. Tocolytics slow uterine contractions to delay labor.34.6 Androgens are used to treat hypogonadism in males.Administration of testosterone promotes the appearance of masculine characteristics, a desirable action in men with hypogonadism. Anabolic steroids are testosterone-like drugs which may produce serious and permanent adverse effects.34.7 Erectile dysfunction is a common disorder successfully treated with drug therapy.Erectile dysfunction is a common disorder with many possible physiologic and psychogenic causes. Sildenafil is effective at promoting more rigid and longer-lasting erections. It is contraindicated in patients taking organic nitrates.34.8 In its early stages, benign prostatic hyperplasia is successfully treated.BPH results in urinary difficulties that may be treated by drug therapy or surgery. Alpha1-blockers relax smooth muscle in the urethra to promote urine flow. 5-Alpha-reductase inhibitors reduce the size of the prostate to reduce pressure on the urethra. Goals are to minimize urinary obstruction, increase urine flow, and to minimize complications.