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83 terms

Pharm Respiratory Agents II

STUDY
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restrictive pulmonary disease leads to a:
DECREASE in total lung capacity
this is due to fluid accumulation/loss of lung elasticity
what are examples of restrictive pulmonary disease?
pulmonary edema, lung tumors, scoliosis (thoracic deformities), myasthenia gravis, pulmonary fibrosis
what is the effect stimulated alpha 1 receptors?
1. increased contractility of the heart
2. vasoconstriction, which increases venous return, and increases BP
3. mydriasis (pupil dilation)
what is the effect of stimulated alpha 2 receptors?
1. reduced norepinephrine
2. decreased BP
3. dilates blood vessels
4. decreases gatric motility
what is the effect of stimulated beta 1 receptors?
1. increased heart rate and constriction
2. increases renin secretion
what is the effect of stimulated beta 2 receptors?
1. bronchodilation
2. increased blood sugar
in an acute asthma attack, what is the first line of defense?
beta 2 adrenergic agonists (short acting sympathomimetics)
what do beta 2 adrenergic agonists promote?
cAMP production and enhance bronchodilation
sympathomimetics are also knowns as
adrenergics
what are four adrenergic bronchodilators?
epinephrine (adrenalin)
isopoterenol (isuprel)
metaproterenol (alupent)
albuterol (proventil, ventolin)
what is the prototype selective beta 2 adrenergic drug?
albuterol (proventil, ventolin)
high doses or overuse of beta 2 adrenergic agent may cause some degree of _____ response
beta 1
what is beta 1 response?
nervousness, tremor, increased HR, dysrhythmias, palpitations, angina, dizziness
what is the therapeutic use of albuterol?
treats, and controls: bronchospasm, asthma, bronchitis, and oher COPD
side effects of albuterol
tremor, dizziness, nervousness, restlessness
adverse effects of albuterol
palpitations, reflex tachycardia, hallucinations, cardiac dysrhythmias
how long do you wait after using MDI with adrenergic (like albuterol) if using steroid inhaler?
5 minutes
metaproterenol (alupent) effects what recepts?
mostly beta 2, but some beta 1 effects
excessive use of aerosol sympathomimetic oral inhalation can lead to
tolerance and paradoxic bronchoconstriction
isoproterenol (isuprel) is a ______ beta agonist
nonselective
it stimulates both beta 1 and bota 2 receptors
epinephrine is a ______ agonist
nonselective alpha, beta 1, and beta 2 agonist
what is epinephrine used for?
relief for acute bronchoconstriction, and anaphylactic reaction
when is epinephrine given SQ?
promote bronchodilation and increase BP
when is epinephrine given IV?
emergency restoration of circulation, and increase in airway patency
what drugs are included in the methylxanthine derivatives?
theophylline
aminophylline
caffeine
how do methylxanthines operate?
1. stimulate CNS and respiration
2. dilate coronary and pulmonary vessels
3. cause diuresis by increasing blood flow to kidney
what is the prototype xanthine derivative?
theophylline (theo-dur, slo-bid)
what was the first theophylline preparation?
aminophylline
theophylline has a _____therapeutic index and range
low
10-20 micrograms/ml
what precaution must one take with theophylline
serum/plasma levels should be frequently monitored
what is theophylline mainly prescribed for now a day?
maintenance therapy in clients with chronic stable asthma and other COPD
contraindications for theophylline
1. uncontrolled seizure disorder
2. severe cardiac dysrhythmias/disease
3. renal disease
4. liver disease

it requires VERY close monitoring!
how should IV theophylline preparations be administered?
slowly via an infusion pump
rapid administration of aminophylline leads to what?
dizziness, flushing, hypotension, severe bradycardia, and palpitations
theophylline toxicity most likely occurs when serum concentrations exceed:
20 mcg/ml
what are life-threatening adverse reactions of theophylline:
seizures, cardiac dysrhythmias, convulsions
what are theophylline adverse reactions?
irritability
tremors
tachycardia
palpitations
urticaria
what age range of individuals is most susceptible to adverse CNS reactions to theophylline?
children
what are leukotrienes?
chemical mediators that cause inflammatory changes
leukotrienes promote an increase in what?
eosinophil migration, mucus production, airway wall edema, which result in bronchoconstriction
LT modifiers do what?
suppress leukotriene synthesis or block their receptrs
which drugs are not recommended for the treatment of acute asthma attack?
leukotrient modifiers
leukotriene modifiers are used for what kind of asthma?
exercise induced

prevention and maintenance
what is an example of a leukotriene modifier?
montelukast sodium (singulair)
_______ are used to treat respiratory disorders, especially asthma
glucorticoids
when are glucocorticoids indicated?
if asthma is unresponsive to bronchodilator therapy
OR
if client has asthma attack while on maximum doses of theophylline or adrenergic drug
glucocorticoids may have synergistic effects if given with?
beta 2 agonist
Glucocorticoids can be given by MDI inhaler, which si used for what?
maintenance
how long does it take for an inhaled steroid to reach its full effect?
1-4 weeks
inhaled glucocorticoids are perferred over what kind of preperation?
oral
inhaled glucocorticoids are more useful at controling bronchial hyperresponsiveness than?
beta 2 agonists
injection/IV glucocorticoids are given when?
during an acute attack
tablet glucocorticoids are given when?
after an acute attack
which form of glucocorticoids have fewer systemic effects?
inhaler
with a single dose, or short term use, glucorticoids may be discontinued when?
abruptly after symtpoms are controlled
with prolonged glucocorticoid therapy, what can happen if therapy is abruptly disccontinued?
exacerbation of asthma symptoms and suppression of adrenal fx
glucocorticoids can irritate what tissue?
gastic mucosa, so should be taken with food to avoid ulceration
inhaled glucocorticoids run the risk of what infection?
oropharygeal and laryngeal fungal infections?
what can be done to avoid fungal infections with glucocorticoids?
use of spacer
rinsing mouth and throat with water after each dose
washing apparatus daily with warm water
side effects with inhaled glucorticoids are generally:
local
what are the side effects of inhaled glucocoticoids?
throat irritation, hoarseness, dry mouth, coughing
when used long term, oral and injectible glucocorticoids have what kind of side effets?
numerous side effects
most adverse reactions are seen within ___ weeks of glucocorticoid therapy
2

they are reversible
long term po/injectible glucocorticoid therapy can lead to what eefects?
fluid retention (puffy eyelids, edema in lower extremities, moon face, weight gain)
electrolyte imbalance
hypertension
thinning of skin
purpura
hyperglycemia
abnormal fat distribution
impaired immune response
what does an advair diskus consist of?
steroid (fluticasone)
long acting beta 2 agonist (salmeterol)
advair diskus is not used for what kind of asthma?
acute attacks
allow for how many hours in between doses of advair diskus?
12
advair diskus is ____ acting
long
cromolyn is administered how?
inhalation
how often should cromolyn be used?
daily
cromolyn is used for ______ treatment of _______ asthma
prophylactic
bronchial
how does cromolyn act?
it released by inhibiting the release of histamine
what are common side effects of cromolyn?
bad taste and cough
how does one counter the bad effects of cromolyn?
drink water before, and after administration
why should cromolyn not be used for an acute asthma attack?
it is not a bronchodilator
what is believed to be more effective than cromolyn?
nedocromil sodium
nedocromil sodium has an ______ effect
anti-inflammatory
_____ act like detergents to liquefy and loosen thick secretions so they can be expectorated
mucolytics
_______ is a mucolytic administered by neulization
acetylcysteine (mucomyst)
what is one thing one should never do with acetylcysteine (mucomyst)
mixed with other drugs
when clients produce increased secretions, what can be done with mucomyst?
mucomyst can be given with a bronchodilator
how does one administer a bronchodilator and mucomyst?
give bronchodilator 5 minutes before mucolytic
how should cromolyn be discontinued?
NOT abrubtly because rebound asthma can occur