96 terms

Respiratory Drugs

UCLA "Respiratory Drugs" packet
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Classes used to treat respiratory emergencies
1. bronchodilators
2. anticholinergics
3. methylxanthines
4. anti-inflammatory agents
5. antihistamines
6. decongestants
7. antitussives
8. expectorants & mucolytics
3 major concerns with chronic pulmonary diseases
1. bronchoconstriction (asthma)
2. mucus hypersecretion (COPD)
3. mucosal inflammation (asthma and COPD)
Irritants cause___
1. histamine release
2. more inflammation
3. more mucus production
Goblet cells in the respiratory tract produce
mucus (gel-like)
Bronchial glands in the respiratory tract produce
watery respiratory secretions aka SOL. we produce 150cc of Sol per day.
Parasympathetic stimulation and irritants cause
LOTS of secretions in the respiratory tract
the tracheobronchial tree is
1. smooth muscle
2. double-helix shaped
Bronchoconstriction causes___
1. decrease in both diameter and length
NOTE: whatever is in there, is now overflowing with constriction
Parasympathetic causes___
1. bronchoconstriction
2. sympathetic stimulation of A1 causes bronchoconstriction
3. sympathetic stimulation of B2 causes bronchodilation
4. 3 times as many B2s as B1s, and very few A1s in the lungs
Treatment of bronchoconstriction- Relaxing bronchial smooth muscle
1. B2 agonists
2. methylxanthines (bronchodilators)
3. anticholinergics (atropine)
Treatment of bronchoconstriction- Inhibiting release of mediators
1. corticosteriods
2. antihistamines
B2 agonists drugs are
1. albuterol (Proventil) B2 selective
2. levalbuterol (Xopenex)
3. metaproterenol (Alupent)
4. terbutaline (Breathine,Breathair)
5. isoetharine (Bronkosol)
NOTE: Sympathomimetics
Nonselective Alpha and Beta bronchodilators
1. epinephrine (Adrenalin)
2. racemic epinephrine
NOTE: Sympathomimetic, also cause vasoconstriction, decreased histamine response and decreased inflammation
Methylxanthine bronchodilators
theophylline (TheoDur)
aminophylline (Aminophylline)
Anticholinergic bronchodilator
ipratropium bromide (Atrovent) like Atropine
Anti-inflammatory agents
Glucocorticoids
inhaled Glucocorticoids
Inhaled:
1. beclomethasone (Beclovent)
2. flucticasone (Flovent)
3. flucticasone with solmeterol (Advair)
oral Glucocorticoids
Oral:
Prednisolone (Deltasone) and many more
injected Glucocorticoids
Injected:
1. methylprednisolone (Solu-Medrol)
2. dexamethasone (Decadron)
Nonselective B1 and B2 Bronchodilator
isoproterenol (Isuprel)= no jump in BP
mechanism of action and indication for B2 specific bronchodilators
MOA-Bronchodilations for bronchospasms. routes of adminstration by nebulizer except terbutaline (Breathine,Breathair)
trade name for racemic epinephrine
Vaponefrin, Micronefrin
Classification for racemic epinephrine (Vaponefrin, Micronefrin)
Sympathomimetic bronchodilator
Mechanism of action for racemic epinephrine (Vaponefrin, Micronefrin)
1. stimulates bronchial smooth muscle relaxation
2. affects both Alpha and Beta adrenergic receptors
Indications for racemic epinephrine (Vaponefrin, Micronefrin)
1. Croup
2. bronchospasms
contraindications for racemic epinephrine (Vaponefrin, Micronefrin)
Epiglottis (life threatening)
Route of admin. for racemic epinephrine (Vaponefrin, Micronefrin)
inhalation (nebulizer)
classification for racemic epinephrine (Vaponefrin, Micronefrin), epinephrine (Adrenalin), isoproterenol (Isuprel)
Sympathomimetic and bronchodilator
mechanism of action for epinephrine (Adrenlin)
Alpha and beta receptors; increased bronchial smooth muscle dilation
indications for epinephrine (Adrenalin)
anaphylaxis or severe allergic reaction
severe reactive airway disease
indication for isoproterenol (Isuprel)
not often used in field for bronchoconstriction.
Route of Admin. for isoproterenol (Isuprel)
IVPB
Anticholinegics aka parasympatholytics decrease_____
secretions and make them hard to expectorate
Anticholinegics bronchodilation last___
3-5 minutes, temporary
2 Anticholinegics used for bronchodilation
1. atropine
2. ipratropium (Atrovent)
classification for atropine sulfate
1. parasympatholytic/anti-cholinergic
2. bronchodilator
mechanism of action for atropine sulfate
1. decreases action of the parasympathetic nervous system by blocking cholinergic receptors
2. causes bronchodilation and reduces respiratory secretions
indications for atropine sulfate
bronchospasms
classification for ipratropium (Atrovent)
1. parasympatholytic/anti-cholinergic
2. bronchodilator
mechanism of action for ipratropium (Atrovent)
1. inhibits acetycholine at receptor sites of bronchial smooth muscle, causing bronchodilations
2. decreases respiratory secretions
indications for ipratropium (Atrovent)
bronchospasms
What are Xanthine Derivitives
Metabolites of
1. caffeine
2. theophylline
3. theobromide
4. phosphodiesterase inhibitor
Effects of Xanthine Derivitives
1. relax bronchial smooth muscle
2. stimulate cardiac and CNS (caffeine effect)
3. mild diuretic
where are Theophylline and aminophylline used
both prehospital and ER settings
trade name for theophylline
1. Theo-Dur (by mouth)
2. Aerodyn (inhaler)
classification for theophylline (Theo-Dur, Aerodyn)
1. bronchodilator
2. methyl-xanthine bronchodilator
indications for theophylline (Theo-Dur, Aerodyn)
1. bronchospasms
2. mild CHF and Pulmonary edema (mild diuretic)
Corticosteroids improve ____
responsiveness of airway muscles to beta agonists
Corticosteroids stabilize____
membranes to reduce histamine effects.
Anti-inflammatory (not bronchodilator) increases internal diameter
Corticosteroids onset of action
it is longer which means less prehospital use
Aerosolized steroids can___
worsen acute bronchoconstriction
examples:
beclomethasone (Beclovent)
budesonide (Pulmicort)
traimcinolone (Azmacort)
fluticasone w/ solumeterol (Advair)
Corticosteroid prototype drug
methylprednisolone (Solu-Medrol)
classification for methylprednisolone (Solu-Medrol)
corticosteroid, anti-inflammatory
mechanism of action for methylprednisolone (Solu-Medrol)
decreases inflammation
indications for methylprednisolone (Solu-Medrol)
second line drug for anaphylaxis, status asthmatics, and exacerbated COPD
Route of admin for methylprednisolone (Solu-Medrol)
IV for acute asthma
trade name for hydrocortisone
Solu-Cortef, Cortisol
classification for hydrocortisone (Solu-Cortef, Cortisol)
corticosteroid, anti-inflammatory
mechanism of action for hydrocortisone (Solu-Cortef, Cortisol)
decreases inflammation
indications for hydrocortisone (Solu-Cortef, Cortisol)
anaphylaxis, status asthmatics
trade name for dexamethasone
Decadron
classification for dexamethasone (Decadron)
corticosteroid, anti-inflammatory
mechanism of action for dexamethasone (Decadron)
decreases inflammation
indications for dexamethasone (Decadron)
anaphylaxis, status asthmatics
Antihistamine Mast cells do what____
mast cells are the site of histamine production and storage
Antihistamines are especially abundant in ___
small blood vessels and bronchial smooth muscle
H1 and H2 receptors cause:
1. Increased local blood flow
2. increased capillary permeability
3. edema
4. vasodilation
5. bronchoconstriction
6. increased GI acid production
7. motion sickness
name 2 antihistamines
diphenhydramine (Benadryl)
montelukast (Singular) "leukotrine blocker"/does the same as Benadryl
trade name for diphenhydramine
Benadryl
classification for diphenhydramine (Benadryl)
antihistamine
mechanism of action for diphenhydramine (Benadryl)
competes with histamines at receptor sites
indications for diphenhydramine (Benadryl)
1. Anaphalaxis (after Epi)
2. mild to moderate allergic reactions
Class of Mucolytics do what
promote coughing and spitting to remove airway exudate
Mucolytics are used for
bronchopulmonary disease, no cilia
1. cystic fibrosis
2. atelectasis
been in near drowning, geriatrics
most common mucolytic used in the field
Acetylcysteine
NOTE: Also used for Tylenol overdose
trade name for acetylcysteine
Mucomyst
indications for acetylcysteine (Mucomyst)
Acute and chronic bronchitis, emphysema, pneumonia, TB, atlectasis, cystic fibrosis
2 types of cough suppressants
1. Antitussives= cough suppressant
2. Expectorants (helps you cough something out)
2 types of antussives
1. Opiods - codeine, hydrocodone
2. Non-opiods- Dextromethorphan (DM)
albuterol
Proventil, Ventolin
levalbuterol
Xopenex
metaproterenol
Alupent, Metaprel
isoetharine
Bronkosol
terbutaline
Brethine, BreathAir
racemic epinephrine
Vaponefrin, Micronefrin
epinephrine
Adrenalin
isoproterenol
Isuprel
atropine sulfate
Atropine
ipratropium
Atrovent
theophylline
Theo-Dur, Aerodyn
methylprednisolone
Solu-Medrol
hydrocortisone
Solu-Cortef, Cortisol
dexamethasone
Decadron
diphenhydramine
Benadryl
montelukast
Singular
acetylcysteine
Mucomyst