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Drug Classes

Drug Classes

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Drug Classes – Asthma Management  Quick-Relief  Short-acting beta2-adrenergic agonists (SABA)  Bronchodilators  Choice drug

for acute sx  Anticholinergics  Bronchodilators  Alternate drug for those who CANNOT tolerate SABAs  Corticosteroids: systemic  Anti-Inflammatory  Not rapid acting The physiology of the respiratory system involves two main processes: perfusion and ventilation. Perfusion is the blood flow through the lungs, which allows for gas exchange across the capillaries. Ventilation is the process of moving air into and out of the lungs. The airway diameter is regulated by the autonomic nervous system, which can cause the airway to dilate or constrict.

Asthma is a chronic disease that has both inflammatory and bronchospasm components. The inflammatory component of asthma involves an increase in airway edema coupled with increased mucus secretions that contribute to airway obstruction. Bronchospasm may be induced by various triggers. Acute dyspnea and wheezing are common signs of asthma. Drugs are used to prevent asthmatic attacks and to terminate an attack in progress.

Inhalation is a common route of administration for pulmonary drugs because it delivers drugs directly to the sites of action. The inhalation route is used to deliver medications directly and safely to the respiratory system. Aerosol medications are those delivered as very small liquid droplets or fine, dry particles. Nebulizers, MDIs, and DPIs are types of devices used for aerosol therapies.

The goals of asthma pharmacotherapy are to terminate acute bronchospasms and to reduce the frequency of asthma attacks. National Asthma Education and Prevention (NAEPP) guidelines are used in asthma management. These guidelines initiate therapy in a stepwise approach based on the severity of asthma symptoms. The goals of asthma therapy are to terminate acute bronchospasms and to prevent asthma attacks. Medications used in asthma management are classified as quick-relief agents or long-term control agents.

Beta2-adrenergic agonists are the most effective drugs for relieving acute bronchospasm. Beta agonists activate beta2 receptors in bronchial smooth muscle to cause bronchodilation. The short-acting beta agonists have a rapid onset of action and are used to terminate acute bronchospasm. The long-acting beta agonists are prescribed for asthma prophylaxis, usually when corticosteroids fail to achieve symptom control.

The inhaled anticholinergics are used for preventing bronchospasm. Ipratropium and tiotropium act by blocking cholinergic receptors in bronchial smooth muscle. Ipratropium is used as an alternative drug for asthma prophylaxis and intranasally as a decongestant. Tiotropium is used to prevent bronchospasm in patients with chronic bronchitis or emphysema.

Inhaled corticosteroids are the most effective drugs for the long-term control of asthma. Corticosteroids are the most potent natural anti-inflammatory substances known. Inhaled corticosteroids are the drugs of choice for the prevention of asthmatic attacks and the management of chronic asthma. Oral corticosteroids may be used for the short-term management of acute asthma exacerbations.

Mast cell stabilizers are used for the prophylaxis of asthma and act by preventing the release of histamine. Mast cells contain inflammatory granules, such as histamine, that mediate inflammatory and allergic reactions. When these cells are sensitized, they release the inflammatory substances into the body where they initiate an inflammatory response. Mast cell stabilizers are considered alternate drugs for the prophylaxis of mild to moderate asthma symptoms.

The leukotriene modifiers, which are primarily used for asthma prophylaxis, act by reducing the inflammatory component of asthma. Leukotriene modifiers are medications that reduce inflammation and are considered alternate drugs in the prophylaxis of persistent asthma. Zileuton acts by blocking lipoxygenase, the enzyme that controls leukotriene synthesis. Montelukast and zafirlukast block leukotriene receptors. They are not considered bronchodilators, although they do reduce bronchoconstriction indirectly.

Methylxanthines were once the mainstay of asthma pharmacotherapy but are now rarely prescribed for that disorder. Methylxanthines such as theophylline are less effective, have a narrow therapeutic index, and produce more adverse effects than the beta agonists. They are primarily reserved for the long-term management of persistent asthma that is unresponsive to beta agonists or inhaled corticosteroids.

Monoclonal antibodies are a newer form of therapy for the prevention of asthma symptoms. Omalizumab is the only biologic therapy for asthma management. The drug binds to IgE, preventing the release of chemical mediators of inflammation. It is used for treating moderate to severe, persistent asthma that cannot be controlled with inhaled corticosteroids.

Chronic obstructive pulmonary disease (COPD) may be treated with bronchodilators, anti-inflammatory agents, and mucolytics. COPD is a progressive disorder characterized by chronic and recurrent obstruction of airflow. The two most common conditions that cause chronic pulmonary obstruction are chronic bronchitis and emphysema. The goals of the pharmacotherapy of COPD are to relieve symptoms and avoid complications of the condition. Multiple

pulmonary drugs such as bronchodilators, anti-inflammatory agents, expectorants, mucolytics, antibiotics, and oxygen may offer symptomatic relief.

Causes of bronchial asthma-Bronchospmasma, Inflammation, Edema, Viscid mucus Bronchial asthma -Alveolar ducts/alveoli are open but airflow to them is obstructed Status asthmaticus -^^^^^^^^DOES NOT respond to typical drug therapy

Emphysema -^^^^^^^^Air spaces enlarge bc of alveolar wall destruction Reduced gas exchange area

Long term asthma tx (3) -Leukotriene receptor antagonists, Inhaled steroids, Long-acting beta2-agonists

Quick relief asthma tx (2) -IV corticosteroids, Short-acting inhaled beta2-agonists

Bronchodilator drug types (2) -Beta-adrenergic agonists, Xanthine derivatives

Beta-agonists -ACUTE asthma attacks, Smooth muscle relaxation,Airway dilation

Sympathomimetics

Beta-agonist types (3) -Non-selective adrenergics, Non-selective beta-adrenergics, Selective beta2 drugs

Non-selective adrenergics (2) -^^^^^^^^Beta-agonists

Stimulate alpha, beta1, beta2

Metaprel) Selective beta2 drugs (5 -rols & 1 weirdo) -^^^^^^^^Beta-agonists. Ventolin) Formoterol (Foradil.Epinephrine (Adrenalin) Ephedrine Non-selective beta-adrenergics (1) -^^^^^^^^Beta-agonists Stimulates beta1 and beta2 Metaproterenol (Alupent. Perforomist) Levalbuterol (Xopenex) Pirbuterol (Maxair) Salmeterol (Serevent) Terbutaline (Brethine) Beta-agonists: indications -^^^^^^^^Bronchospasm r/t asthma. bronchitis Prevent ACUTE attacks Hypotension Shock Uterine relaxation to prevent early labor Non-selective adrenergics: AEs -^^^^^^^^Cardiac stimulation Tremor Vascular headache Insomnia Restlessness Anorexia Hyperglycemia Non-selective beta-adrenergics: AEs -^^^^^^^^Cardiac stimulation . Stimulates beta2 ONLY Albuterol (Proventil.

& caffeine Get prompt tx for flu and other illnesses Assessment Take as prescribed Beta-agonists: therapeutic effects -^^^^^^^^Decreased dyspnea Decreased wheezing. extreme temps.Tremor Vascular headache Anginal pain Hypotension Selective Beta2 drugs: AEs -^^^^^^^^Tremor Vascular headache Hypo. & anxiety Better respiratory patterns Better activity tolerance Increased ease of breathing Beta-agonists: assessment -^^^^^^^^Skin color Baseline vitals RR O2 sat Sputum production Allergies History of resp issues Albuterol -^^^^^^^^Proventil .OR Hypertension Beta-agonists: implications -^^^^^^^^Avoid conditions that cause bronchospasm Fluids! Compliance AVOID excessive fatigue. restlessness.

anxiety. tremors. soybeans. prolonged action Bind to ACh receptors & PREVENT bronchoconstriction Bronchodilation NOT for ACUTE asthma Ipratropium bromide (Atrovent) Tiotropium (Spiriva) Anticholinergics: implications -^^^^^^^^ALLERGY to peanuts. or other legumes Force fluids! Ipatropium bromide -^^^^^^^^Atrovent Anticholinergic Tiotropium -^^^^^^^^Spiriva .Selective beta 2 beta-agonist PC: C AEs: nausea. increased HR Loses beta2-specific actions if used too much Salmeterol -^^^^^^^^Serevent Selective beta 2 beta-agonist Long-acting NOT for ACUTE asthma Anticholinergics -^^^^^^^^Slow. palpitations.

theobromine Synthetic .theophylline*. & emphysema Mild/moderate ACUTE asthma COPD mgmt . dyphilline Xanthine derivatives: drug effects -^^^^^^^^CV stimulation Increased force of contraction Increased HR Increased CO Increased blood flow to kidneys (diuretic) CNS stimulation Xanthine derivatives: indications -^^^^^^^^Asthma.aminophylline. bronchitis. caffeine.Anticholinergic Once-daily dosing Anticholinergics: AEs -^^^^^^^^Dry mouth/throat Nasal congestion Palpitations GI distress Headache Coughing Anxiety Xanthine Derivatives -^^^^^^^^Bronchodilators Smooth muscle relaxation Bronchodilation Increased airflow Plant alkaloids .

-^^^^^^^^Chest pain Palpitations Weakness Convulsions NV Dizziness Xanthine derivatives: interactions -^^^^^^^^Cimetidine Oral contraceptives Allopurinol Macrolide antibiotics Quinolones Flu vaccine INCREASE xanthine levels . & smoking decrease THEOPHYLLINE levels AVOID caffeine bc exacerbates CNS stimulation IVs not too fast bc can cause hypotension. high-protein. charcoaled meats. tachy. & cardiac arrest Xanthine derivatives: REPORT. John's Wort Low-carb.Xanthine derivatives: AEs -^^^^^^^^ANV GER during sleep Tachycardia Extrasystole Palpitations Ventricular dysrhythmias Increased urination Xanthine derivatives: implications -^^^^^^^^CIs: history of PUD CAUTION: cardiac disease Timed-release NOT used with GI issues DO NOT use with St... seizures.

Theophylline -^^^^^^^^Theo-Dur. & mucus LRTAs prevent leukotrines from binding to receptors Relieve asthma symptoms Decrease neutrophil & leukocyte infiltration LRTAs: indications -^^^^^^^^Prophylaxis & chronic asthma NOT for ACUTE asthma attacks Montelukast -^^^^^^^^Singulair LRTA PC: B Allergic rhinitis OK for kids 2 & up AEs: fewer than other LRTAs Zileuton AEs -^^^^^^^^Zyflo LRTA . bronchoconstriction. Elixophyllin Xanthine derivative PC: C Leukotreine receptor antagonist drugs (LTRAs) (3) -^^^^^^^^Montelukast (Singulair) Zafirlukast (Accolate) Zileuton (Zyflo) LTRAs -^^^^^^^^Leukotrines cause inflammation.

dyspepsia. Flovent) Budesonide (Pulmocort Turbuhaler) Flunisolide (AeroBid) Inhaled corticosteroids: indications -^^^^^^^^Bronchospastic disorders not controlled by normal bronchodilators . nausea. liver dysfunction LRTAs: implications -^^^^^^^^CHRONIC asthma Give at NIGHT Improvement should be within 1 week Assess liver function Continuous schedule even if symptoms improve Corticosteroids -^^^^^^^^Anti-inflammatory effects Increase response of smooth muscle to Beta-adrenergics CHRONIC asthma DOES NOT help ACUTE asthma Oral & inhaled forms Inhaled reduces systemic effects May take weeks to see effects Inhaled corticosteroids (6) -^^^^^^^^Beclomethasone diproprionate (Beclovent. dizziness.AEs: headache. ND. insomnia. Vanceril) Triamcinolone acetonide (Azmacort) Dexamethasone sodium phosphate (Decadron Phosphate Respihaler) Fluticasone (Flonase. liver dysfunction Zafirlukast -^^^^^^^^Accolate LRTA AEs: headache.

fungal infections. AIDS.NOT first-line for ACUTE asthma attacks or status asthmaticus Inhaled corticosteroids: AEs -^^^^^^^^Pharyngeal irritation Coughing Dry mouth Oral funal infections Rare systemic effects bc low doses Inhaled corticosteroids: implications -^^^^^^^^CIs: psychosis. Solu-Medrol) Corticosteroid PC: C Omalizumab -^^^^^^^^(Xolair) Monoclonal antibody antiasthmatic . TB Must be weaned slowly bc can increase BG levels Can slow bone growth in kids Gargle and rise with lukewarm water Bronchodilator before corticosteroid Teach pts about peak flow meter Encourage spacer to ensure successful inhalations Teach how to clean equipment Fluticasone proprionate -^^^^^^^^(Flonase. Flovent) Corticosteroid PC: C Methylprednisolone -^^^^^^^^(Medrol.

Antigen -^^^^^^^^substance. Histamine -^^^^^^^^substance that interacts with tissues to produce most of the symptoms of allergy. Antiallergic -^^^^^^^^drug that prevents mast cells from relaeasing histamine and other vasoactive substances. often a result of capillary dilation Excoriation -^^^^^^^^an abrasion of the epidermis (skin) usually from a mechanical (not chemical) cause. wheezing. usually protein or carbohydrate. Angioedema -^^^^^^^^edema and swelling beneath the skin. Antibody -^^^^^^^^a specialized protein (immunoglobulin) that recognizes the antigen that triggered its production. and edema. and edematous vesicular formations. a scartch. that is capable of stimulating an immune response. Dermatitis -^^^^^^^^inflammatory condition of the skin associated with itching. burning. also called urticaria . Asthma -^^^^^^^^inflammation of the bronchioles associated with constriction of smooth muscle. Hives -^^^^^^^^a skin condition characterized by intensely itching wheals caused by an allergic reaction. Eczematoid Dermatitis -^^^^^^^^condition in which lessons on the skin ooze and develop scaly crusts.Binds IgE AEs: hypersensitivity reactions Allergen -^^^^^^^^a substance capable of producing an allergic reaction. Antihistaminic -^^^^^^^^drug that blocks the action of histamine at the target organ. Erythema -^^^^^^^^redness of the skin.

rather than serous material. Emphysema -^^^^^^^^disease process causing destruction of the walls of the alveoli Expectorant -^^^^^^^^drug that helps clear the lungs of respiratory secretions. elevated swelling of the skin often pale red in color and itchy. Selective -^^^^^^^^interacts with one subtype of receptor over others. Nonselective -^^^^^^^^interacts with any subtype receptor. Urticaria -^^^^^^^^intensely itching raised areas of skin caused by an allergic reaction. Wheal -^^^^^^^^a firm. hives. Prophylactic -^^^^^^^^process or drug that prevents the onset of symptoms (or disease) as a result of exposure before the reactive process can take place. Bronchodilator -^^^^^^^^drug that relaxes bronchial smooth muscle and dilates the lower respiratory passages. Sensitize -^^^^^^^^to induce or develop a reaction to naturally occuring substances (allergens) as a result of repeated exposure. usually caused by emphysema and chronic bronchitis. . a sign of allergy. engorgement. Xerostomia -^^^^^^^^dryness of the oral cavity resulting from inhibition of the natural moistening action of salivary gland secretions or increased secretion of salivary mucus. Chronic Bronchitis -^^^^^^^^respiratory condition caused by chronic irration that increasessecretion of mucus and causes degeneration of the respiratory lining. COPD -^^^^^^^^Chronic Obstructive Pulmonary Diesase.Hyperemia -^^^^^^^^increased blood flow to a body part like the eye. Chemical Mediator -^^^^^^^^substance released from mast cells and white blood cells during inflammatory and allergic reactions.

Abortifacient -^^^^^^^^substance that induces abortion. Acid Rebound -^^^^^^^^effect in which a great volume of acid is secreted by the stomach in response to the reduced acid environment caused by antacidneutralization. GERD -^^^^^^^^gastroesphageal refluex disease. Antisecretory -^^^^^^^^substance that inhibits secretion of digestive enzymes. Mucolytic -^^^^^^^^drug that liquefies bronchial secretions. hormones. Emesis -^^^^^^^^vomiting.Leukotrienes -^^^^^^^^chemical mediators involved in inflammation and asthma. Prostaglandins -^^^^^^^^chemical mediators released from mast and other cells involved in inflammatory and allergic conditions. Chyme -^^^^^^^^partially digested food and gastric secretions that move into the stomach by peristalsis. Heartburn (Acid Indigestion) -^^^^^^^^a painful burning feeling behindthe sternum that occurs when stomach and backs up into the esophagus. Enterochromaffin-Like Cells (ECL) -^^^^^^^^celsl that synthesize and release histamine. Antacid -^^^^^^^^drug that neutralizes hydrochloric acid (HCI) secreted by stomach. or acid. Dyspepsia -^^^^^^^^indigestion. . Digestion -^^^^^^^^mechanical and chemical breakdown of foods into smaller units. Absorption -^^^^^^^^the uptake of nutrients from the GI tract.

causing chloride ions to cross membranes. pH less than 1) in the stomach. Hypercalcemia -^^^^^^^^elevated concentration of calcium ions in the circulating blood. Hyperchlorhydria -^^^^^^^^excess hydrochloricacid in the stomach. Proteolytic -^^^^^^^^action that causes the decomposition or destruction of proteins. such as a break in the intestinal wall. Perforation -^^^^^^^^opening in a hollow organ. . Cathartic -^^^^^^^^pharmacological substance that stimulates defecation. Hypophosphatemia -^^^^^^^^abnormally low concentrations of phosphate in thecirculating blood. Parietal (Oxyntic) Cell -^^^^^^^^cell that synthesizes and releases hydrocholoric acid (HCI) into thestomach lumen. Pepsin -^^^^^^^^enzyme that digests protein in the stomach. Chloride Channel Activators -^^^^^^^^a novel class of drugs that stimulate pare-forming receptors in the intestine. Hyperacidity -^^^^^^^^abnormally highdegree of acidity (for example.Heaptic Microsomal Metabolism -^^^^^^^^specific enzymes in the liver (p450 family) that meabolize somedrugs and can be increased (stimulated) by some medications or decreased (inhibited) by other medications so that therapeutic drug blood levels are altered. Ulcer -^^^^^^^^open sore in the mucous membranes or mucosal linings of the body. Hypermotility -^^^^^^^^increase in muscle tone or contractions causing faster clearance ofsubstances through the GI tract. Ulcerogenic -^^^^^^^^capable of producing minor irritation or lesions to an integral break in the mucosal lining (Ulcer) Absordent -^^^^^^^^substance that has the ability to attach other substances to its surface.

. potassium.Constipation -^^^^^^^^a decrese in stool frequency. such as sodium. bloating. IBS (Irritable Bowel Syndrome) -^^^^^^^^a functional disorder of the colon with abdominal pain. cramping. Mu-Opioid Receptor Antagonist -^^^^^^^^drugs that block the mu protein receptor for opioids. diarrhea. for example. Osmolality -^^^^^^^^the concentration of particles dissolved in a fluid. Hyponatremia -^^^^^^^^decrease in the normal concentration of sodium in the blood. or chloride. Laxative -^^^^^^^^a substance that promotes bowel movements. Osmosis -^^^^^^^^process in which water moves across membranes following the movementof sodium ions. Defecation -^^^^^^^^process of discharging the contents of the intestines. Hypokalemia -^^^^^^^^decrease in the normal concentration of potassium in the blood. intestinal tissue pushing outside the abdominal cavity. Electrolyte -^^^^^^^^ion in solution. Hernia -^^^^^^^^protusion of an organ through the tissue usually containing it. pushing into the diaphragm (hiatal heria). in which cirular contraction and relaxation propel the contents toward the rectum. Peristalsis -^^^^^^^^movement characteristic of the intestines. that is capable of mediating conduction (passing impulses in the tissues). Evacuation -^^^^^^^^process of removal of waste material from the bowel. Emollient -^^^^^^^^substance that is soothing to mucous membranes or skin. or stomach. Diarrhea -^^^^^^^^abnormal looseness of the stool or watery stool. as feces. and/or constipation. which may be accompanied by a change in stool frequency or volume.

Somatostatin -^^^^^^^^an inhibitory hormone that blocks the release of somatotropin (GH) and thyroidstimulating hormone (TSH). Ductless Glands -^^^^^^^^containing no duct. and testes. endocrine glands that secrete hormones directly into the blood or lyumph without goingthrough a duct.Transit Time -^^^^^^^^amount of time it takes for food to travel from the mouth to the anus. lungs. Dwarfism -^^^^^^^^inadequate secretion of growth hormone during childhood. Gonads -^^^^^^^^organs that produce male (testes) or female (ovaries) sex cells. Acromegaly -^^^^^^^^condition usually in middle-aged adults from hypersecretion of growth hormone. characterized by abnormally short statue and normal body proportions. causing excessive growth and height. Endocrine -^^^^^^^^pertaining to gland that secrete substances directly into the blood. Gigantism -^^^^^^^^increased secretion of growth hormone in childhood. or ova. Hormone -^^^^^^^^substance produced within one organ and secreted directly into the circulation to exert its effects at a distant location. ovaries. Cretinism -^^^^^^^^condition in which the development of the body and brain has been inhibited. sperm. Somatomedins -^^^^^^^^peptides in the plasma that stimulate cellular growth and have insulin-like activity. Target Organ -^^^^^^^^specific tissue for growth hormone (GH) . Carcinoid Tumor -^^^^^^^^a slow-growing type of cancer that can arise in the gastrointestinal tract. Insulin-Like Growth Factor (IGF) -^^^^^^^^stimulator of cell growth and proliferation.

a slat concentration of 0.Tropic Hormone -^^^^^^^^hormone secreted by the anterior pituitory that binds to a receptor on another endocrine gland. a repeatable 24-hour cycle of physiological activity. such as amino and fatty acids.9 percent. Native -^^^^^^^^natural substance in the body. Lyysosome -^^^^^^^^part of a cell that contains enzymes capable of digesting or destroying tissue/proteins. Glucocorticoid -^^^^^^^^steriod produced within the adrenal cortex (or a synthetic drug) that directly influences carbohydrate metabolism and inhibits the inflammatory process. Mineralocorticoid -^^^^^^^^steroid produced within the adrenal cortex that directly influences sodium and potassium metabolism. usually associated with energy release. ADT -^^^^^^^^Alternate-Day Therapy. . Intra-Articular (IA) -^^^^^^^^joint space into which drug is injected. Gluconeogensis -^^^^^^^^the synthesis of glucose from molecules that are not carbohydrates. Lymphokine -^^^^^^^^a substance secreted by T-Cells that signals other immune cells like macrophages to aggregate. Isotonic -^^^^^^^^Normal salt concentration of most body fluids. Addison's Disease -^^^^^^^^inadequate secretion of gluocoriticoids and mineralcorticoids. Proinflammatory -^^^^^^^^tending to cause inflammation. Circadian Rhyrhm -^^^^^^^^internal biological clock. Catabolism -^^^^^^^^process in which complex compounds are broken down into simpler molecules.

Allegra -^^^^^^^^allergies Benadryl -^^^^^^^^allergies Claratin -^^^^^^^^allergies Zyrtec -^^^^^^^^allergies Delsym -^^^^^^^^antitussive Tessalon Pexles -^^^^^^^^antitussive Tussionex -^^^^^^^^antitussive Sudafed -^^^^^^^^decongestent Robitussin -^^^^^^^^expectorant Atrovent -^^^^^^^^asthma Proventil -^^^^^^^^asthma Combivent -^^^^^^^^asthma Flonasc -^^^^^^^^asthma . Repository Preparation -^^^^^^^^preparation of a drug. usually fro intramusclar or subcutaneous injection. Steroid -^^^^^^^^member of a large family of chemical substances (hormones.Replacement Therapy -^^^^^^^^administration of a naturally occuring substance that the body is not able to produce inadequate amounts to maintain normal function. that is intends to leach out from the site of injection slowly so that the duration of drug action is prolonged.drugs) containing a structure similar to cortisone (tetracyclic cyclopenta-a-phenanthrene).

dry mouth. mid-expiratory flow rate.MOA -^^^^^^^^relaxes bronchial smooth muscle by action on β₂ receptors w/ little effect on HR Albuterol . sweating. tremor.Class -^^^^^^^^short acting β agonist Albuterol . chest pain or heavy feeling.Contraindications -^^^^^^^^hypersensitivity overdose can be fatal! Overdose symptoms may include nervousness.What is the first line treatment for asthma. .k. nausea.Pregnancy -^^^^^^^^Cat C albuterol is the preferred short acting β agonist for use in asthma during pregnancy Albuterol . dizziness. rapid or uneven heart rate. quick relief? -^^^^^^^^short acting β agonist (albuterol) anticholinergics (ipratropium) Systemic corticosteroids What is the second line treatment for asthma. and vital capacity -Increased cAMP inhibits the release of mediators from mast cells in the airways. headache. prevention of exercise-induced bronchospasm Albuterol .a. controllers? -^^^^^^^^inhaled corticosteroids (aerobid) long acting β agonist (salmeterol) leukotriene receptor antagonists (montelukast) Theophylline or cromolyn may also be considered First line: How does the short acting β agonist work on the body? -^^^^^^^^-Sympathomimetic that results in smooth airway muscle relaxation -Bronchodilation reduces airway resistance as shown by increased FEV1. feeling light-headed or fainting. seizure (convulsions).k. a. pain spreading to the arm or shoulder. producing a mild antiinflammatory effect Albuterol .Indication -^^^^^^^^treatment or prevention of bronchospasm in pt's w/ reversible obstructive airway dz. a.a.

stimulate the CNS. Because leukotriene binding to these sites is what causes bronchoconstriction. back pain. If a patient is taking inhaled steroids. dizziness. & prostatic hyperplasia/bladder neck obstructions Binds to mast cells and prevents mast cell rupture and degranulation. HA. bradykinin. *use w/ caution in pt's with glaucoma as β agonists can ↑ intraocular pressure ∗use w/ caution in pt's with hyperthyroidism as β agonists can ↑ thyroid activity ∗use w/ caution in pt's with hypokalemia as β agonists can ↓ serum K⁺ ∗use w/ caution in pt's with seizure disorders as β agonists can stimulate the CNS *Albuterol . Ipratropium (Atrovent) . and ↑ risk of arrhythmias. hoarseness. dizziness. bronchoconstriction occurs. Glucocorticoid steroids given orally have the potential to cause more adverse effects because they are systemic. Betaadrenergic agonists are sympathomimetic agents. paradoxical bronchospasm may occur Albuterol . dyspnea. an anticholinergic inhaler. they cause fewer adverse effects. This med should only be used in acute exacerbations of asthma IN CONJUNCTION WITH a short acting β agonist for acute episodes use with caution in pt's w/ narrow angle glaucoma. It will open the bronchial tree. and a beta-adrenergic agonist inhaler. . commonly used in combination with a beta 2 bronchodilator such as albuterol* blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation* ipratropium (atrovent)* drug of choice for beta-blocker induced bronchospasms*ok for pregnant women suffering w/ severe asthma exacerbations*hypersensitivity to ipratropium or atropine*adverse effects -uri. such as cromolyn sodium.Adverse effects -^^^^^^^^chest pain.PK/PD -^^^^^^^^Absorption: Mean bioavailability is 7% (inhalation). tremor. epithelial cells and platelets to interfere with the release of inflammatory mediators and cytokines. paradoxical bronchospasm may occur Ipratropium (Atrovent) . bronchoconstrictive substances such as histamine. eosinophils. thus keeping the bronchioles open. uti. serotonin.7-6h first line: how do anticholinergic bronchodilators work on the body? -block the nerve responses (parasympathetic) that normally cause narrowing of airways. sinusitis. nausea. ↑ sputum. Ipratropium is not readily absorbed. Cromolyn sodium works by stabilizing the mast cell. When the mast cell ruptures in response to an antigen. thus. diarrhea. HA. Steroids given by inhalation have a local action. Anticholinergic agents block the action of acetylcysteine. they decrease the effectiveness of inflammatory cells.” Which of the anti -inflammatory agents is the most effective? Glucocorticosteroids are the most powerful anti-inflammatory agents. In managing lower respiratory tract disorders.Binds to receptors on monocytes. palpitations. ↑ BP. ok for pregnant women suffering w/ severe asthma exacerbations hypersensitivity to ipratropium or atropine Adverse effects -^^^^^^^^URI. In the lungs. That means the drugs mimic the action of norepinephrine. ↑ HR. runny nose.Precautions -^^^^^^^^NOT FOR RESCUE THERAPY. this med should only be used in acute exacerbations of asthma in conjunction with a short acting β agonist fo r acute episodes*use with caution in pt's w/ narrow angle glaucoma. insomnia. back pain. such as acetylcysteine. which results in smooth-muscle relaxation in both the bronchi and vasculature. dyspepsia. Leukotriene antagonists block the ability of leukotrienes to bind to their receptor sites. the bronchi do not constrict. dizziness. which inhaler would you tell the patient to use first? The beta-adrenergic agonist inhaler should be used first because it has the fastest onset. bronchodilators. cough. What is the difference between glucocorticoid steroids given orally and by inhalation? Both drugs are effective in reducing inflammation. bronchitis. palpitations.precautions -not for rescue therapy. norepinephrine stimulates bronchodilation. muscle pain. such as albuterol. when its action is blocked. They are referred to as “rescue drugs. the drug prevents release of these substances. dyspnea.Metabolism & Excretion -Metabolism: liver extensively. cough. *use w/ caution in pt's with DM as β agonists can ↑ serum glucose.PK/PD -^^^^^^^^Absorption: Mean bioavailability is 7% (inhalation). myasthenia gravis. sore throat. ↑ sputum. Theophylline acts by stimulating two prostaglandins. flu-like syndrome rarely. such as theophylline. feces. ha. cough. Glucocorticoid steroids have a multitude of actions. Half-life: 2. thus. myasthenia gravis. have the quickest onset of action. cp. nausea. bronchitis. paradoxical bronchospasm may occur*ipratropium (atrovent) . rhinitis. rhinitis. UTI. When acetylcysteine stimulates the lungs. bronchoconstriction is blocked. sinusitis. flu-like syndrome*rarely.Albuterol . By stabilizing the mast cell. In a patient with acute respiratory distress. hypokalemia. & prostatic hyperplasia/bladder neck obstructions Ipratropium (Atrovent) . and leukotrienes are released. rarely.Precautions -∗use w/ caution in pt's with CV dz as β agonists can ↑ BP. Ipratropium is not readily absorbed. so that the other drugs can be dispersed farther into the lungs to exert their action. dyspepsia. drymouth & throat. pharyngitis. CP. which of the bronchodilators would be most effective? Beta-adrenergic agonists. In the lungs. nervousness. pharyngitis. palpitations. Excretion: urine primarily. which main classes of drugs are used*Drugs can be grouped into mucolytic agents. and anti-inflammatory drugs.

This med should only be used in acute exacerbations of asthma IN CONJUNCTION WITH a short acting β agonist for acute episodes use with caution in pt's w/ narrow angle glaucoma. . & prostatic hyperplasia/bladder neck obstructions Ipratropium (Atrovent) .Contraindications -^^^^^^^^hypersensitivity to ipratropium or atropine Ipratropium (Atrovent) .Adverse effects -^^^^^^^^URI. HA. pharyngitis.Pregnancy -^^^^^^^^Cat B ok for pregnant women suffering w/ severe asthma exacerbations Ipratropium (Atrovent) . ↑ sputum. Ipratropium is not readily absorbed. back pain. cough. myasthenia gravis. UTI. & emphysema (& asthma exacerbations but is more effective in COPD than asthma) Drug of choice for beta-blocker induced bronchospasms Ipratropium (Atrovent) . dizziness.MOA -^^^^^^^^blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation Drug of choice for beta-blocker induced bronchospasms Ipratropium (Atrovent) . flu-like syndrome rarely. sinusitis. dyspnea. rhinitis. bronchitis. dyspepsia. paradoxical bronchospasm may occur Ipratropium (Atrovent) .Ipratropium (Atrovent)* Drug of choice for beta-blocker induced bronchospasms Ipratropium (Atrovent) . CP. bronchitis. nausea.PK/PD -^^^^^^^^Absorption: Mean bioavailability is 7% (inhalation). palpitations.Precautions -^^^^^^^^NOT FOR RESCUE THERAPY.Indication -^^^^^^^^anticholinergic bronchodilator used in bronchospasm associated w/ COPD.

Mometasone furoate (Nasonex). Aerobid is also indicated for asthma patients who require systemic corticosteroid administration. hospitalizations.monitor for adrenal insufficiency∗Inhaled corticosteroids (ICS) provide local therapeutic action with minimal systemic ICS are in both Asthma/COPD and Upper Respiratory Infections I will only include Flunisolide (Aerobid) here because it is oral. The other five ICS are nasal and I will group them together under URI as it is done on the professor's slides [Budesonide (Rhinocort). & Triamcinolone acetonide (Nasacort)] TWO Flunisolides .Aerobid & Nasarel. quick-relief medications. all severity levels* ∗Most potent /effective controller asthma medication∗Broad action on inflammatory processes∗MDI.Class -^^^^^^^^inhaled corticosteroids Flunisolide (Aerobid) . where adding Aerobid may reduce or eliminate the need for the systemic corticosteroids. Following IV administration. Metabolism: Partially metabolized. methylprednisone*Second line: How do inhaled corticosteroids (ICS) work on the body? *reduce airflow obstruction by reducing airway inflammation in the bronchioles*Why would you use ICS? -^^^^^^^^∗Management of persistent asthma. Flunisolide (Aerobid) . prednisolone. Ipratropium (Atrovent) . Fluticasone propionate (Flonase). Flunisolide (Nasarel). may cause temporary blurring of vision First line: Systemic corticosteroids *prednisone. DPI.Pt education -^^^^^^^^Avoid contact with eyes.Distribution: 0 to 9% is protein bound.Indication -^^^^^^^^Long-term prevention of bronchospasm in patients with asthma Aerobid (flunisolide) Inhaler is indicated in the maintenance treatment of asthma as prophylactic therapy. Excretion: The t ½ is approximately 2 h (inhalation or IV). emergency care. oral CS)∗Reduces airway hyperresponsiveness: ∗HPA suppression is noted in adults receiving 32 puffs/day of an inhaled steroid over a period of 1 month . pulmonary function∗Reduces exacerbations (urgent visits. nebulizer solution∗Improves symptoms. . approximately half of the dose is excreted unchanged in the urine.

including suppression of bone growth in children. adrenocortical insufficiency. & maintenance treatment of bronchospasm associated with COPD*Salmeterol (Serevent) .Pt Education -^^^^^^^^∗ Rinse mouth after use ∗ use at regular intervals for effectiveness ∗ do not use as emergency therapy for asthma attacks ∗ Do not abruptly stop medication administration ∗ Discard canister when doses should have been used. CP.Pregnancy -^^^^^^^^Cat C Flunisolide (Aerobid) . URI. bruising Corticosteroids may mask infection or predispose to infection. Slowly cleared from body so effects are long lasting (onset of action is also longer). subcapsular cataracts. Flunisolide (Aerobid) . nasal congestion.MOA -^^^^^^^^relaxes bronchial smooth muscle by selective action on β₂ receptors w/ little effect . Flunisolide (Aerobid) . edema. glaucoma. Particular care should be taken in post-op pt's or during periods of stress for ↓ in adrenal function.Aerobid Inhaler is NOT indicated for the relief of acute bronchospasm. candida infection. HA.Contraindications -^^^^^^^^hypersensitivity Flunisolide (Aerobid) . psychic derangements.MOA -^^^^^^^^↓ inflammation by suppression of migration of polymorphonuclear leukocytes & reversal of ↑ capillary permeability. reactivation of tuberculosis Flunisolide (Aerobid) . to include pt's w/ sxs of nocturnal asthma. especially fungal. nervous.Adverse effects -^^^^^^^^n/v/d dyspepsia. prevention of exerciseinduced bronchospasm. Not used in acute asthma attack*How do long acting β agonists and corticosteroids complement each other? -^^^^^^^^Corticosteroids increase b2-receptor synthesis and decrease b2 desensitization*LABAs prime glucocorticoid receptors for steroiddependent activation*Salmeterol (Serevent) . unpleasant taste. abd pain. does not depress hypothalamus Flunisolide (Aerobid) . diabetes mellitus. ↓ appetite. palpitations. flu like symptoms sore throat.Precautions -^^^^^^^^pts treated w/ Aerobid (flunisolide) should be observed for any systemic corticosteroid effect. Also safety issues: bone density. canister cannot be accurately checked Second line: How do long acting β agonists work on the body? -cause relaxation of bronchial smooth muscle. fever.Class -^^^^^^^^long acting β agonist*Salmeterol (Serevent) Indication -^^^^^^^^maintenance treatment of asthma & prevention of bronchospasm (as concomitant therapy) in pt's with reversible obstructive airway dz. GI bleeding. dizziness.

Adverse effects -^^^^^^^^Arrhythmias and/or tachycardia.do not use salmeterol as monotherapy. abd pain. HA. which causes bradycardia*In large doses. hyperglycemia.use only if clearly needed. cardiac arrest.best taken 1 hour before meals or 2 hours after*Caution patient with asthma that medication is not to be used to treat acute asthma attacks. relief of symptoms of seasonal allergic rhinitis & perennial allergic rhinitis. epistaxis. muscle cramps.precautions -^^^^^^^^will not interrupt the bronchoconstrictor response to ASA or NSAIDs. increases intracellular cAMP*Act as a direct central nervous system stimulant.class leukotriene receptor antagonist*Montelukast sodium (Singulair) . weakness. headache. nasal congestion. palpitations. Instruct patient to always have a short-acting betaagonist available for acute treatment of asthma symptoms*May be used as an alternative to inhaled corticosteroids in patients with mild persistent or aspirin-sensitive asthma*Effect is weaker than that of low-dose inhaled corticosteroids*Usually used as add-on therapy in asthma Why use theophylline or cromolyn? -^^^^^^^^Theophylline may be used either as an adjunctive therapy in conjunction with ICS or as an alternative agent. including salmeterol . death. prevention of exerciseinduced bronchospasm*Montelukast sodium (Singulair) . gastroenteritis. Second line: How do leukotriene receptor agonists work on the body? -^^^^^^^^block the production or action of inflammatory mediators called leukotrienes. psychomotor hyperactivity. resulting in vasoconstriction and stimulation of the vagal center. URI. fatigue. somnolence. thirst. low. use caution with those drugs*rarely. paradoxical bronchospasm may occur*Salmeterol (Serevent) .*Salmeterol (Serevent) . there may be an increase in asthma-related deaths.Precautions -^^^^^^^^When added to usual asthma therapy.on HR.Contraindications -^^^^^^^^hypersensitivity*monotherapy! it should never be used alone to treat asthma*Salmeterol (Serevent) .indication -^^^^^^^^prophylaxis and chronic treatment of asthma. ↑ LFTs. sinusitis. tremor rarely. hypokalemia.to medium-dose inhaled corticosteroids) or whose disease severity clearly warrants initiation of treatment with 2 maintenance therapies. fever. dyspepsia.Pregnancy -^^^^^^^^Cat C*β-agonists may interfere with uterine contractility if administered during labor . Only use salmeterol as additional therapy for patient not adequately controlled on other asthma-controller medications (eg. tricyclic antidepressants: May increase CV effects of salmeterol. Available in IV form for used in acute asthma attack* treatment of symptoms and reversible airway obstruction due to chronic asthma or other chronic lung diseases* Promote bronchodilation by competitively inhibiting phosphodiesterase. reducing inflammation and relaxing airway smooth muscle and reducing mucus production*Not used for acute attack*Montelukast sodium (Singulair) . but is not recommended as a preferred therapy*Cromolyn sodium is an alternative option*What are methylxanthines used for? -^^^^^^^^Cause relaxation of bronchial smooth muscle by blocking action of chemicals that cause contraction. which in turn.drug/drug interactions -^^^^^^^^Beta-adrenergic blockers: Pulmonary effects of salmeterol may be blocked and may produce severe bronchospasm in patients with COPD*Diuretics: ECG changes and hypokalemia associated with diuretics may worsen with coadministration*MAOIs. They are however irritating to the stomach. salmeterol acts locally in the lung*Salmeterol (Serevent) . the enzyme that degrades cAMP. vomiting*Montelukast sodium (Singulair) . rash. it DID go into the nose!)*Salmeterol (Serevent) . prolongation of the QTc interval.MOA -^^^^^^^^selective leukotriene receptor antagonist that inhibits the cysteinyl leukotriene receptor (these receptors have been correlated with the pathophys of asthma and allergic rhinitis)* pregnancy -^^^^^^^^Cat B*adverse effects -^^^^^^^^dizziness. dental pain. cause a positive . can cause systemic eosinophilia and vasculitis or behavorial changes*pt education -^^^^^^^^Advise patient with asthma or asthma and allergic rhinitis to take prescribed dose once daily in the evening .Pt education ^^^^^^^^∗ do not use for acute exacerbations of asthma* NEVER use a spacer device ∗ daily use is required to manage sxs∗ do not exceed prescribed does (yes. Oral slow release theophylline is used to long term control.*Salmeterol (Serevent) .

inotropic effect on myocardium and a positive chronotropic effect on SA node*a mild to moderate bronchodilator used as alternative, not preferred, therapy for step 2 care (for mild persistent asthma) or as adjunctive therapy with ICS in patients > 5 years of age* PregCat C*Contrain-hypersens or allergy to corn as the premixed injection may contain corn-derived dextrose*Adverse eff^vomiting, insomnia, restlessness, seizures, increased heart rate, or a headache* have mild anti-inflammatory effects. Monitoring of serum theophylline concentration is essential* Therapeutic index is low - think toxicity*Monitoring Parameters serum drug levels, q24h during infusion*Many drugs and physiologic variables affect theophylline metabolism, and dosage adjustment is required*Pt ed^Extended-release capsules should be taken 1 hour before or 2 hours after meals; immediate-release forms can be taken with food if GI upset occurs*Dont change brands theophylline w/0 consulting provider*Notify if nausea, vomiting, insomnia, jitteriness, headache, rash, severe GI pain, restlessness, convulsions, or irregular heartbeat occurs*Avoid caffeine-containing beverages and other stimulants

Why use a nonsteroidal antiallergic? -^^^^^^^^to block the release or action of inflammatory chemicals in the body reducing symptoms of inflammation. Block degranulation of the mast cell. Not for acute attack. and for Asthma prophylaxis. Prevention of bronchoconstriction before exposure to a known precipitant

Cromolyn (Intal) - Class -^^^^^^^^nonsteroidal antiallergic - mast cell stabilizer

Note - Cromolyn is another double drug on this test, as Intal here (nebulizer) and later on as NasalCrom (nasal spray)

Cromolyn (Intal) - Indication -^^^^^^^^may be used as an adjunct in the prophylaxis of allergic disorders, including asthma; prevention of exercise-induced bronchospasm

Cromolyn (Intal) - MOA -^^^^^^^^prevents the mast cell release of histamine, leukotrienes, and slow-reacting substance of anaphylaxis by inhibiting degranulation after contact with antigens

Cromolyn (Intal) - Pregnancy -^^^^^^^^Cat B

Cromolyn (Intal) - Contraindications -^^^^^^^^hypersensitivity, acute asthma attacks

Cromolyn (Intal) - Adverse effects -^^^^^^^^Bronchospasm, throat irritation, bad taste, cough, wheezing, nasal congestion, anaphylaxis

Cromolyn (Intal) - Precautions -^^^^^^^^use w/ caution in pt's with a h/o arrhythmias, hepatic or renal impairment

need to be tapered off

now only available in Nebulizer form, the inhalers were discontinued

Cromolyn (Intal) - Pt education -^^^^^^^^take 30 min before meals. clear as much mucus as possible before use. Rinse mouth after use to ↓ unpleasant aftertaste.

What drugs are used for mild COPD? -^^^^^^^^short acting β agonist

What drugs are used for moderate COPD? -^^^^^^^^in addition to those used in mild dz, add on:

anticholinergic long acting β agonist

What drugs are used for severe COPD? -^^^^^^^^in addition to those used in mild & moderate dz, add on:

inhaled corticosteroid

What drugs are used for very severe COPD? -^^^^^^^^in addition to those used in mild, moderate, & severe dz; add on:

O2, consider surgery

What other drug might you consider for COPD? -^^^^^^^^theophylline

Bronchodilators & the older adult -^^^^^^^^Bronchodilators may cause increased adverse reactions; some older adults may not tolerate side effects such as tachycardia

Theophylline & the older adult -^^^^^^^^Theophylline clearance is reduced in the older adult, causing increased risk of drug toxicity and interaction

Corticosteroids & the older adult -^^^^^^^^High-dose inhaled corticosteroids and oral corticosteroids that are often used in COPD may cause or worsen osteoporosis in the older adult

Nebulization & the older adult -^^^^^^^^Nebulization treatment may be useful when older adults are unable to use inhalers correctly

Corticosteroids & pregnancy -^^^^^^^^ICS does not increase the risks of major malformations, preterm delivery, low birth weight, and pregnancy-induced hypertension

Cat B drugs -^^^^^^^^ipratropium, mast cell stabilizers, budesonide, montelukast and zafirlukast, and terbutaline, cromolyn

Cat C drugs -^^^^^^^^β-Adrenergic agonists (except terbutaline), theophylline, tiotropium, corticosteroids (except budesonide), zileuton, albuterol, aerobid, salmeterol

Theophylline & breastfeeding -^^^^^^^^Breastfeeding may have to be discontinued because the drug can cause serious toxicity in nursing infants

How do you treat mild, intermittent symptoms of allergic rhinitis? -^^^^^^^^Antihistamine, preferably nonsedating, or a decongestant

If the pt is unable to take an oral antihistamine, consider the use of a nasal antihistamine, intranasal cromolyn, or a leukotriene receptor antagonist

How do you treat moderate, frequent symptoms of allergic rhinitis? -^^^^^^^^Regular- to high-dose intranasal corticosteroid

Add an oral or nasal antihistamine and decongestant if necessary

How do you treat moderate, persistant symptoms of allergic rhinitis? -^^^^^^^^Combination regimen consisting of intranasal corticosteroids plus a nonsedating or intranasal antihistamine and decongestant if necessary

How do you treat severe symptoms of allergic rhinitis? -^^^^^^^^Combination regimen consisting of a nonsedating antihistamine with or without a decongestant and intranasal corticosteroid

Consider the use of an oral steroid for 5 days and the use of oxymetazoline as needed for no longer than 3 days

Which antihistamines are sedating? -^^^^^^^^benadryl, Chlor-Trimeton, ethanolamine: diphenhydramine; clemastine fumarate, alkylamine: chlorpheniramine maleate

Which antihistamines are low-sedating? -^^^^^^^^zyrtec

loratadine HCl. blood vessels. breast-feeding.Class -^^^^^^^^Histamine H1 Antagonist.MOA -^^^^^^^^Competes with histamine for H1-receptor sites on effector cells in the gastrointestinal tract. not the antihistamine of choice for allergic rhinitis. poison oak. first gen ethanolamine derivative Diphenhydramine (Benadryl) . use as a local anesthetic (injection) she mentioned breast feeding like 4 times with this one . acute asthma. and respiratory tract.Indication -^^^^^^^^Symptomatic relief of allergic symptoms caused by histamine release including nasal allergies and allergic dermatosis Adjunct to epinephrine in the treatment of anaphylaxis Nighttime sleep aid Prevention or treatment of motion sickness Antitussive Management of Parkinsonian syndrome including drug-induced extrapyramidal symptoms Topically for relief of pain and itching associated with insect bites. or rashes due to poison ivy. n.piperadine: cetirizine HCl Which antihistamines are nonsedating? -^^^^^^^^allegra.Contraindications -^^^^^^^^Hypersensitivity. or v in pregnancy Diphenhydramine (Benadryl) . desloratadine What are two 1st generation antihistamines that are OTC and on our test? -^^^^^^^^Diphenhydramine (Benadryl) & chlorpheniramine maleate (Chlor-Trimeton) Diphenhydramine (Benadryl) .Pregnancy -^^^^^^^^Cat B some toxicity seen in newborns if mom was taking a lot. claritin fexofenadine HCl. anticholinergic and sedative effects are also seen Diphenhydramine (Benadryl) . and poison sumac Diphenhydramine (Benadryl) . neonates or premature infants. minor cuts and burns.

significant first-pass effect Bioavailability: Oral: ~40% to 70% Half-life elimination: 2-10 hours. n. Elderly: 13. serum: 2-4 hours Excretion: Urine (as unchanged drug Diphenhydramine (Benadryl) . or thyroid dysfunction Diphenhydramine (Benadryl) . or expectorating.Contraindications -^^^^^^^^Hypersensitivity to any component of the formulation . blood vessels. It may cause drowsiness or dizziness (use caution when driving or need to be alert). nausea. thickening of bronchial secretions.PK/PD -^^^^^^^^PK: Onset of action: Maximum sedative effect: 1-3 hours Duration: 4-7 hours Metabolism: Extensively hepatic via CYP2D6. dry mouth/throat.Pt education -^^^^^^^^Avoid use of other depressants. blurred vision Diphenhydramine (Benadryl) . blurred vision.MOA -^^^^^^^^competes w/ histamine for H₁ receptor sites on effector cells in the GI tract. CV dz. respiratory difficulty. or sleepinducing medications unless approved by prescriber. alcohol. dizzy. sleepiness. 2C9 and 2C19. prostatic hyperplasia/GU obstruction.5 hours Time to peak. stuffiness.Diphenhydramine (Benadryl) . or agitation.Adverse effects -^^^^^^^^sedation. or dry mouth. changes in urinary pattern.Class -^^^^^^^^Histamine H1 Antagonist. first gen alkylamine derivative Chlorpheniramine maleate (Chlor-Trimeton) .Precautions -^^^^^^^^use w/ caution in those that have asthma. sore throat. or vomiting. urinary retenion or frequency. anaphylaxis.Pregnancy -^^^^^^^^Cat C Chlorpheniramine maleate (Chlor-Trimeton) . confusion. minor CYP1A2. or lack of improvement or worsening or condition Chlorpheniramine maleate (Chlor-Trimeton) . & resp tract Chlorpheniramine maleate (Chlor-Trimeton) . glaucoma. v. smaller degrees in pulmonary and renal systems.Indication -^^^^^^^^Perennial and seasonal allergic rhinitis and other allergic symptoms including urticaria Chlorpheniramine maleate (Chlor-Trimeton) . pyloroduodenal obstruction. Report persistent sedation.

the anticholinergic action may cause significant confusional symptoms.PK/PD -^^^^^^^^PK: Half-life elimination. or problems voiding urine. diplopia. or thyroid dysfunction Chlorpheniramine maleate (Chlor-Trimeton) .Precautions -^^^^^^^^watch for CNS depression use w/ caution in those w/ CV dz. asthma or chronic breathing disorders. HA. urinary retention. polyuria. dizzy. What are some intranasal steroids that will be on the test? -^^^^^^^^Traimcinolone acetonide (Nasacort) Fluticasone propionate (Flonase) Budesonide (Rhinocort) Flunisolide (Nasarel) Mometasone furoate (Nasonex) And what is an intranasal mast cell stabilizer that will be on the test? -^^^^^^^^Cromolyn sodium (NasalCrom) this drug was covered above in asthma (Intal the nebulizer) so I'm only going to highlight the differences here (NasalCrom is a nasal spray) And what is a Leukotriene Receptor Antagonist that will be on the test? -^^^^^^^^montelukast sodium (Singulair) .Narrow-angle glaucoma bladder neck obstruction or symptomatic prostate hypertrophy during acute asthmatic attacks stenosing peptic ulcer or pyloroduodenal obstruction In elderly pts. constipation.. wt gain & appetite increase. arthralgia. weakness Chlorpheniramine maleate (Chlor-Trimeton) . Chlorpheniramine maleate (Chlor-Trimeton) . pharyngitis. 3A4 (major). serum: 20-24 hours Metabolism: Substrate of CYP2D6 (minor). ↑ intraocular pressure. prostatic hyperplasia/GU obstruction.Adverse effects -^^^^^^^^drowsiness. thickening of bronchial secretions.. Inhibits CYP2D6 (weak) On to more classes of drugs for allergic rhinitis. diarrhea. n.

and cytokines Exert direct local antiinflammatory effects with minimal systemic effects Effectively control the four major symptoms of allergic rhinitis—rhinorrhea.Indication -^^^^^^^^Vasomotor rhinitis and relief of symptoms of seasonal or perennial rhinitis when effectiveness of antihistamines or tolerance to treatment develops Intranasal Steroids . congestion. lymphocytes. sneezing.only major difference is dosing When should NasalCrom be started? -^^^^^^^^Should be started 3 to 4 weeks before a peak allergy season occurs What is the effect of NasalCrom on the nose? -^^^^^^^^Their effect on the nose is short acting and makes compliance more difficult in that several doses are needed per day What should you monitor for with NasalCrom? -^^^^^^^^Instruct patients to notify health care provider of any stinging effect after nasal instillation Now on to the five intranasal steroids. including mast cells.Effectiveness -^^^^^^^^The most effective agents for the management of allergic rhinitis because of their direct reduction of nasal inflammation and their ability to reduce nasal hyperreactivity Should be used for at least 3-4 weeks before a decision is made as to whether they are effective (1 inhaler) Can be used with asthmatic patients and with those who have comorbid nasal polyposis. eosinophils. and nasal itch Intranasal Steroids . neutrophils. leukotrienes.this was covered above in asthma so I'm not going to do another drug card here as it is in the same form and everything . macrophages.MOA -^^^^^^^^Potent glucocorticoid and weak mineralocorticoid activity Inhibit cells. nasal pruritus..Benefits -^^^^^^^^Relieve sneezing. and mediators such as histamine.. and reactive mucosal edema Minimal systemic absorption Effectiveness depends on regular use and adequate nasal airway for delivery Most do not alleviate ocular symptoms . -^^^^^^^^exciting!!!!! Intranasal Steroids . rhinorrhea. Intranasal steroids may help shrink nasal polyps Intranasal Steroids .

glaucoma (STUDY CONCLUSION: No increase risk of cataract in patients taking INS) Intranasal Steroids . fluticasone.Pregnancy -^^^^^^^^Cat B .budesonide Cat C . results require regular use and may take up to 7 days Intranasal Steroids .Precautions -^^^^^^^^avoid in pts w/ adrenal suppression.Pt education -^^^^^^^^Use patient information provided with product on how to use nebulizer. fluticasone. triamcinolone. mometasone twice a day (or more) spray . easy bruising or bleeding.which would be budesonide (Rhinocort) . delayed wound healing. tired feeling. nosebleeds Cataracts. fever. immunosupression.Side effects -^^^^^^^^Pharyngitis. epistaxis. trauma.Dosing differences -^^^^^^^^once a day spray . triamcinolone. weight loss. mometasone Intranasal Steroids .flunisolide Intranasal Steroids .Intranasal Steroids .differences -^^^^^^^^there aren't a lot of differences. I highly suspect this is one of those "which one is safe for pregnant women?" ones . nausea. or seeing halos around lights Intranasal Steroids . or s/p nasal surgery Intranasal Steroids .Common concerns -^^^^^^^^Steroid phobia Aversion of nasal sprays (Discomfort.budesonide. cough. white patches or sores inside your nose or mouth. inhaler Do not exceed recommended dosage Clear secretions from nasal passages before using. or ocular dz especially in nasal infection. infections. Addiction) Local irritation. or blurred vision. unusual weakness. weakness. chills. loss of appetite.flunisolide. mucosal changes. use decongestants if necessary Effects are not immediate. or on your lips. headache. body aches. flu symptoms. eye pain.

Corticosteriod For Asthma. DONT TAKE W/. Narcotic Used for: cough supression. acts directly on the cough center to suppress cough. tract. *Lungs H2 receptors -^^^^^^^^mediate heart acceleration and gastric acid secretion *Bowel/intestines Histamine -^^^^^^^^chemical alarm signal released by mast cells that causes blood vessels to dilate during an inflammatory response Antitussives -^^^^^^^^relieve or suppress coughing Codeine -^^^^^^^^Antitussive. Pregnancy Cat: C . Detromethorphan (Robitussin DM) -^^^^^^^^Antitussives. and Bronchitis Uses:Antiinflammatory H1 Receptors -^^^^^^^^mediate smooth muscle contraction and dilate capillaries. inhibits ciliary action. Used for: allergic rhinitis. do NOT inhibit ciliary action. allergy symptoms Bind to H1 receptors to block histamine effects. Non-Narcotic Used for: cough supression. Fexofenadine (Allegra) -^^^^^^^^Antihistamine H1 Blocker.MAO's or SSRI's Guiafenesin (Mucinex) -^^^^^^^^Respiratory Expectorants Used for: nonproductive cough to stimulate the resp.Ipratropium (Atrovent) -^^^^^^^^Decongestent. Anticholinergic For conditions needing bronchodilation Inhibits PSNS controlled bronchoconstriction Fluticasone (Flonase or Flovent) -^^^^^^^^Decongestent.

Metered-Dose Inhaler -^^^^^^^^Press canister toward mouthpeice to deliver measured dose or puff of medication.Leutotriene Receptor Antagonsists (LTRA's) Prophylaxes and treatment for chronic asthma in adults and kids 2+years. stress Mixed Asthma -^^^^^^^^Mixture of intrinsic and extrinsic factors. attacks are usually triggered by infections. NOT for acute attacks. respiratory irritants. Timing of drug delivery and inhalation doesn't matter Nebulizer -^^^^^^^^Machine that delivers a fine mist through a face mask or other hand-held device. Also decreases MAST cell mediator release to helps prevent mucus build up Therapeutic level is 10-20mcg/ml smokers need increased doses. between puffs. some emphysema. exercise. cold air. Extrinsic Asthma -^^^^^^^^due to factors outside the body like allergens or air pollution Intrinsic Asthma -^^^^^^^^idiopathic asthma. Inhibits phosphodiesterase which allows cyclic AMP to breakdown. . Montelukast (Singulair) Zileuton (Zyflo) Zarirlukast (Accolate) -^^^^^^^^Antileukotrienes-. and effect Methylxanthines (Theophylline) -^^^^^^^^Bronchodilator-. triggers. Long term control. asthma. Used for: Acute bronchospasm Teach use of MDI (metered dose inhalers) wait 10-15 sec. bronchitis. Takes approx 30 min for treatment.Asthma -^^^^^^^^condition w/ sensitive airways causing bronchoconstriction. delivers a fine dry powder. Take w/ water to decrease GI upset Albuterol (Proventil) B2 Selective -^^^^^^^^Bronchodilator--Sympathomimetic Beta Agonist FAST ACTING RESCUE INHALER ^ flight or fight.long term control Used for: reversible bronchoconstriction. Dry powder inhaler -^^^^^^^^Activated when the patient inhales through the mouthpiece.

Allergen -^^^^^^^^. cardiac arrhythmias.. Allergic rhinitis -^^^^^^^^.. gi upset.. .Rebound Effect -^^^^^^^^Excessive use of nasal decongestants can lead to greater congestion b/c of __________? Antihistamines -^^^^^^^^block the release or action of histamine Drugs for COPD -^^^^^^^^includes: Bronchodilators. Bronchospasm -^^^^^^^^Rapid constriction of the airways.inhaled steroids. local irriation Aerosol -^^^^^^^^Suspension of minute liquid droplets or fine solid particles in a gas. CNS effects. Leukotriene receptor blockers and other anti-asthma drugs Decongestants -^^^^^^^^utilized to decrease the blood flow to the upper respiratory tract and decrease the excessive production of secretions Expectorants -^^^^^^^^used to decrease the viscosity of sputum to produce effective cough Anti-Histamine contraindications -^^^^^^^^CNS-drowsiness. Asthma -^^^^^^^^Chronic inflammatory disease of the lungs characterized by airway obstruction. and sedation Fatigue Anticholinergic effects Skin dryness Rhinitis -^^^^^^^^inflammation of the mucous membrane of the nose Xanthines Pharmacodynamics/contraindications -^^^^^^^^Stimulate the CNS such that respiration is stimulated..

Nebulizer -^^^^^^^^Device used to convert liquid drugs into a fine mist for the purpose of inhalation. Mast cells -^^^^^^^^Connective tissue cell located in tissue spaces that releases histamine following injury. Chronic obstructive pulmonary disease (COPD) -^^^^^^^^Generic term used to describe several pulmonary conditions characterized by cough. H2 receptor -^^^^^^^^Site located on cells of the digestive system that is stimulated by histamine to produce gastric acid. also. Leukotrienes -^^^^^^^^Chemical mediator of inflammation stored and released by mast cells. Rebound congestion -^^^^^^^^.. Metered dose inhaler (MDI) -^^^^^^^^Device used to deliver a precise amount of drug to the respiratory system. the process of deriving energy from metabolic reactions. tissue swelling. and coughing. effects are similar to those of histamine. and impaired gas exchange. and itching. bronchoconstriction.Chronic bronchitis -^^^^^^^^Recurrent disease of the lungs characterized by excess mucus production. H1 receptor -^^^^^^^^Site located on smooth muscle cells in the bronchial tree and blood vessels that is stimulated by histamine to produce bronchodilation and vasodilation. Histamine -^^^^^^^^Chemical released by mast cells in response to an antigen that causes dilation of blood vessels. Perfusion -^^^^^^^^Blood flow through a tissue or organ. inflammation.. mucus production. . Dry powder inhaler (DPI) -^^^^^^^^Device used to convert a solid drug to a fine powder for the purpose of inhalation. Respiration -^^^^^^^^Exchange of oxygen and carbon dioxide in the lungs. Emphysema -^^^^^^^^Terminal lung disease characterized by permanent dilation of the alveoli.

mucus... -^^^^^^^^airway reactive disorder Asthma is either .. inhalation . -^^^^^^^^intrinsic. Ab attach to . and slow reacting substance of anaphylaxis(SRS-A) -^^^^^^^^mast.Ventilation -^^^^^^^^Process by which air is moved into and out of the lungs.. bronchoconstriction In an extrinsic rxn.. infection or exercised induced Extrinsic. swelling. IV..non-allergic..... -^^^^^^^^emphysema Asthma is also called.95-1 Airway is the size of your .. -^^^^^^^^increased airway resistance(swelling/mucus/ decreased ciliary action/bronchospasms) Loss of elastic recoil of lungs(emphysema..... cystic fibrosis) Emphysema causes your alveoli to... cells. -^^^^^^^^puff up. -^^^^^^^^oral.allergy/hypersensitive...... should be about . and become destroyed due to air being trapped and lung size increase Pink puffers is a condition of. -^^^^^^^^mechanical V/Q ratio is . Ab/allergen rxn. -^^^^^^^^the amount of air reaching the alveoli to the amount of blood reaching the alveoli. -^^^^^^^^medulla oblongata Process of gas exchange is called -^^^^^^^^respiration Process of ventilation is.. inhalant(Metered Dose Inhaler).. nasal spray. -^^^^^^^^pinky Inadequate ventilation/Oxygen means .histamine Drug administration for lung problems can be. Repiratory center is the . which rupture and release .

expensive.. min. current smokers... -^^^^^^^^whiskey+lemon+honey and wild cherry . then rinse mouth(thrush/bacterial/yeast infection if don't) Spacer is used if can't. inconvenient.. hydrocodone. -^^^^^^^^shake. don't know when you are out Nebulizer's advantages/disadvantages are? -^^^^^^^^Advantages= for children/elderly/emrgency. systemic absorbed Metered dose inhalers are. sedation. Benylin Benzonatate(Tessalon) is similar to... non-invasive Scientists discovered that inhalants. -^^^^^^^^medulla Antitussive medicines. side effects. paradoxical excitement Some long acting antitussive medications are. take deep breath while inhaling. anesthetizing stretch receptors in lungs(if receptors aren't stretch. drug packaging varies. and drug abusers to. rash... in tablets or syrup. dose required. -^^^^^^^^depress cough center in medulla. nausea. cause post nasal drip Some antitussive drugs are... need power source Antitussive is a .Side effects are.. breath normally Disadvantages=bulky. avoids hepatic first pass. cheap Disadvantages: don't take it right How you use inhalers is . drug nebulized into a mist. -^^^^^^^^hold breath What are the disadvantages/advantages of dry powder? -^^^^^^^^Advantages= no propellant.. wait 30 seconds. expensive. -^^^^^^^^local anesthetic..Inhaled drugs were known by ancient civilizations.. limited doses.. just inhale Disadvantages= bulky. then can't cough. increased secretion. -^^^^^^^^narcotics: codeine.. Robutussin-DM. -^^^^^^^^cough suppressant Cough center is in the .... long tx time(10-15min)... -^^^^^^^^act quickly.. cause drowsiness Non-narcotics: dextromethorphan. -^^^^^^^^advantages: portable. -^^^^^^^^goes directly into lungs.. min.

e Robutussin-stimulate secretions) Antihistimines ... blocks effects of histamine(runny nose... -^^^^^^^^decrease inflammation and edema. -^^^^^^^^work on mast/macrophage/neutrophils/eosinophils cell's to prevent release of histamines. itching. -^^^^^^^^zafir lukast(accolate) or monte lukast (Singular). Head above body when sleep. ^^^^^^^^asthma. side effects are headache. congestion.. must observe mouth for thrush Some corticosteroid medications are -^^^^^^^^beclomethasone(Beclovert) and fluticasone propionate(Flonase).. pressure and photosensitivity.. storm.. increase blood pressure. oral candida infection(suppress normal flora of mouth). -^^^^^^^^cromolyn sodium(Ital).. -^^^^^^^^dry you up. smells like rotton eggs Some mucolytic drugs are. and may trigger .... liquid cough medicine. running Some Inflammatory cell stabilizer medicines are. and prednisone given typically via inhalation and intranasal . consistency of sputum.. -^^^^^^^^promote the cough... not antihistamines.... -^^^^^^^^cough Expectorant is.HR. slow acting and po. -^^^^^^^^lysis tenacious secretion...Thyroid(too much).. increase risk for seizures (avoid driving)... side effects are hoarseness.. decrease inflammation.. coughing.. -^^^^^^^^sputum Antitussive agents . motion sickness. -^^^^^^^^acetylcysteine-liquefies Some nursing considerations of antitussives are.. attack.Halls menthalarem cause . or smoothing action on mucosa by increasing amount if liquid in repiratory tract (i. -^^^^^^^^adequate fluid intake(except milk). nausea/vomiting Corticosteroids... have short half life Antiinflammatory leukotriene receptor antagonist drugs are. promotes bronchorelaxation. side effects are sedation. improves wheezing.. increase . intraocular Mucolytic's do what.. some side effects are bronchospasms.. allergic reaction.... note color. because cause post nasal drip.. avoid caffeine Inflammatory cell(mast cell) stabilizer's . urinary hesitency(anticholinergic) Antihistimines also can cause an .. dyspnea. give before exercising. increase ... dry mouth..

-^^^^^^^^initial therapy.e.. -^^^^^^^^better control of inflammation becuase inhaled steroid can't formation of cysteinyl leukotrienes Non-selective Bronchodilators are. inhaled form most effective with least side effects -increase cAMP Terbutaline.. ^^^^^^^^smooth. blurred vision.. stops bronchoconstriction.. metered dose requires 2 puffs(wait 1min b/w puffs) 1... paradoxical effect Bronchodilator Xanthine(caffeine) acts directly on . inhalation[preterm labor relaxes bronch].quiet environment. hoarseness. nausea. epinephrine(potent). A1 and A2) Ipratroprium and *Teotroprium (longer acting) -^^^^^^^^Muscarinic antagonist -not first line for rescue. dry mouth.Vaponephrine(racemic epinephrine). cough. constipation. -^^^^^^^^albutrol(ventolin) po inhalation. percuss side and back to expel mucus plug then give aerosol. muscle of bronchus and inhibits release of . Rescue from acute Bronchoconstriction 2... Medhale-Epi.Singular with inhaled steroid provides.. upright position. terbutaline. anxiety. terbutaline(Brethine) po injection. side effects are palpitation.. Prevent recurrent episodes 3. Theophylline by IV and Thoedor(sustained release). flushing. side effects are glaucoma. metroproternol(Alupent) po inhalation. tremor Anticholinergic bronchodilators are. urinary retention. has narrow margin of safety of 10-20 ug/ml Nursing considerations of bronchodilators. tachycardia. -^^^^^^^^sympathamimic. Epinephrine -^^^^^^^^Systemic B2 agonists -not as specific (hits B1. (i. -^^^^^^^^ipothropiaum bromide(atrovent). use with inhaled B2 agonist . Primatine mist(OTC).. hypertension. pirbuterol. irritation. SRS-A.. bitolterol -^^^^^^^^Primary rescue agent.Pseudoephedrine(sudafed) Selective bronchodilators(Beta2 agonists) are. headache. stay with patient. Treat hyper-responsiveness caused by inflammation (prevent remodeling) -^^^^^^^^3 Approaches to Management of Asthma B2 Agonist (albuterol.

Inhibit 5-lipoxygenase (can't make LT's) 2. persistent asthma) Inhibit PLA-2 > decreased AA>>decreased Leukotrienes and Prostaglandins -Basically decrease inflammatory mediators -^^^^^^^^MOA of steroids Cromolyn and Nedocromil -^^^^^^^^Prevent de-granulation of Mast cells and Eosinophils -can use to treat periodic asthma (esp Cold-induced asthma) 1. Budesonide -^^^^^^^^Inhaled steroids Prednisone. Block LTD-4 receptors (LT's can't act on SM) -^^^^^^^^2 MOA's of Leukotriene modifiers Zileuton -^^^^^^^^Inhibits 5-lipoxygenase Zarfirlukast and Montelukast -^^^^^^^^Block LTD-4 receptors AA (arachidonic acid) is a precursor for both Prostaglandins (via COX) andLT's(via lipoxygenase) --Block COX. Fluticasone.-use more in COPD Corticosteroids -^^^^^^^^Used as systemic short course to establish control when starting bronchodilator therapy Steroid anti-inflammatories -^^^^^^^^Primary agent to prevent recurrent episodes (daily prophylaxis) Flunisolide. Triamcinolone. -^^^^^^^^10% of asthmatics are sensitive to Aspirin (bronchospasm). What's the mechanism? (remember Leukotrienes are very potent bronchioconstrictors) Theophylline/Aminophylline -^^^^^^^^-Inhibits PDE (which breaks down cAMP) -block adenosine receptors on SM -Adjuvant to steroid for nocturnal symptoms CNS stimulation and Narrow TI -^^^^^^^^Side effects of Theophylline . Methylprednisolone -^^^^^^^^Oral steroids (for severe. more substrate for lipoxygenase and more leukotriene production.

H1) -^^^^^^^^Respiratory effect of histamine -gastric acid secretion (H2) -^^^^^^^^GI effects of histamine H1 receptors -^^^^^^^^located on SM of vessels and bronchi. endothelium and sensory nerve endings -especially prominent in nasal cavity -Gq coupled H2 receptors -^^^^^^^^located primarily on gastric parietal cells -Gs coupled to cAMP elevation H3 receptors -^^^^^^^^located on presynaptic nerves in brain -Gi coupled to N-type calcium channels H4 -^^^^^^^^located on blood cells in BM and blood (eosinos and neutros) .Salmeterol -^^^^^^^^Long-acting B2 agonist .P (H1) -Increased HR (H2) -edema and increased cap.must be used in combo with inhaled steroids Histamine -^^^^^^^^primary mediator involved in upper airway allergies -locally acting hormone (autacoid) -found in Mast cells and Basophils -decreased B. permeability -heat and redness -^^^^^^^^Cardiovascular effects of histamine -pain and itching (H1) -inhibition of NT release (H3) -Cutaneous Triple Response -^^^^^^^^Nervous effects of histamine -Bronchoconstriction (H1) -Watery secretions (nasal.

what is their major shortfall? .-Gi coupled to cAMP and IC calcium decrease 1. Redness (local) 2. Dimenhydrinate) -^^^^^^^^-Block muscarinic receptors -cross BBB (may cause sedation due to anti-cholinergic) -short duration of action 2nd Generation anti-histamines (Loratidine. at some separate lct) -^^^^^^^^Components of the Cutaneous Triple Response Type I Allergic reaction (immediate) -activation of IgE -^^^^^^^^primary cause of histamine release produce effect opposite to that produced by histamine -^^^^^^^^What is the goal of a physiological histamine antagonist? Physiological antagonists to histamine -^^^^^^^^-Bronchodilators (B2 agonist) -Vasoconstrictors (alpha agonists) -degranulation inhibitors Cromolyn and Nedocromil -^^^^^^^^degranulation inhibitors -used primarily for prophylactic tx of periodic allergies/asthma (example brought on by cold) anti-histamines (1st or 2nd generation) -^^^^^^^^competitive H1 receptor blockers 1st Generation anti-histamines (Diphenhydramine. Edematous wheal (local endothelial contraction) 3. Red flare (axon reflex. Fexofenadine) -^^^^^^^^-No muscarinic block -No cross BBB (no sedation) -longer duration of action Not effective as Decongestant -^^^^^^^^While anti-histamines can do a lot of good for Allergic rhinitis and urticaria.

usually less than six months. Bronchodilator -^^^^^^^^Drug that increases the vital capacity of the lungs by dilating the bronchi and relaxing the smooth muscles. need to cough up mucus plugs Acute -^^^^^^^^Short term. Antihistamine -^^^^^^^^Drug that counteracts the effects of histamine. Pseudoephedrine. may be temporary or fatal. Alveoli -^^^^^^^^Tiny air sacs in the lungs that permit the exchange of oxygen and carbon dioxide through capillary walls. Hydrocodone -^^^^^^^^Antitussives -at high dose can have PCP-like effect Guaifenesin -^^^^^^^^Expectorant --careful when inhibiting expectorant cough. Bronchiole -^^^^^^^^Branch of the bronchi leading to alveolar ducts. Bronchopulmonary -^^^^^^^^Pertaining to the lungs and the air passages. Antitussive -^^^^^^^^Drug that decreases coughing. . Codeine. what sort of drug do you need to treat it? Phenylephrine. relieving allergy symptoms. Oxymetazoline -^^^^^^^^common decongestants Medulla Oblongata -^^^^^^^^where does the cough reflex originate? Dextromethorphan. Apnea -^^^^^^^^Stoppage of breathing.Diphenhydramine -^^^^^^^^1st generation anti-histamine sometimes used for motion sickness and as a sleep aid Vasoconstrictor -^^^^^^^^Many mediators apart from Histamine are involved in the production of congestion. Bronchi -^^^^^^^^Air passages leading from the trachea to the bronchioles in the lungs.

Mucolytic -^^^^^^^^Drug that liquefies or breaks down tenacious mucus so it can be coughed up more easily. Decongestant -^^^^^^^^Drug that reduces congestion or swelling. usually more than six months. especially in nasal passages. joins the pharynx with the trachea. Emphysema -^^^^^^^^Condition in which the air sacs dilate and are unable to contract to their original size. Hypoxia -^^^^^^^^Absence or decrease in oxygen. Hemoptysis -^^^^^^^^Spitting of blood. . by constricting blood vessels and restricting blood flow to the area. Epiglottis -^^^^^^^^Leaf-shaped structure on top of the larynx that seals off the air passages to the lungs during swallowing. which is brought on by tobacco products. causing residual air to be trapped in them. Influenza -^^^^^^^^Flu Inhaler -^^^^^^^^Handheld and pocketsize device used to administer a breathing treatment. Expectorant -^^^^^^^^Drug that breaks down mucus to enable the patient to cough it up more easily. Fowler's Position -^^^^^^^^Position in which the patient's upper body is raised 45° to 60° by means of pillows or by adjusting the head of the bed. Nicotine Dependence -^^^^^^^^A physical vulnerability of the body to the chemical nicotine. the alveoli lose their elasticity. Hyperpnea -^^^^^^^^Breathing too rapidly or deeply.Chronic -^^^^^^^^Long term. Larynx -^^^^^^^^Voice box. Dyspnea -^^^^^^^^Labored or difficult breathing.

the blood. pus. Sputum -^^^^^^^^Abnormally thick fluid formed in the lower respiratory tract that may contain blood. Postural Drainage -^^^^^^^^Physical therapy for respiratory patients. Pulse Oximeter -^^^^^^^^A device that monitors the oxygen saturation by placing a probe on the finger. serves as both respiratory and digestive tracts. tapping of various body organs and structures. when a patient with asthma forcefully blows into the device. Semi-Fowler's Position -^^^^^^^^Position in which the patient's upper body is elevated to 30°. toe. Pleura -^^^^^^^^Membranes lining the lungs and lung cavities. Peak Flow Meter -^^^^^^^^A device that measures the air flowing out of the lungs. and trachea. Productive cough -^^^^^^^^Cough that brings up large amounts of mucus. Rebound Effect -^^^^^^^^Reappearance of symptoms in even stronger form after a drug dose has worn off. or the bridge of the nose.Orthopnea -^^^^^^^^Abnormal condition in which the patient must sit or stand to breathe deeply and comfortably. . or bacteria. Pharynx -^^^^^^^^Tube like structure that extends from the base of the skull to the esophagus. called the peak expiratory flow rate (PEFR). Pulmonary -^^^^^^^^Pertaining to the lungs. Percussion -^^^^^^^^Physical therapy for respiratory patients. forehead. Respiration -^^^^^^^^Breathing. bronchi. Pneumococcal Disease -^^^^^^^^Serious disease leading to infections of the lungs. use of positioning along with vibration and percussion to drain secretions from specific areas of the lungs. and the meninges. ear.

musical sound that occurs through a narrowed airway. and lungs of secretions and irritants. Tachypnea -^^^^^^^^Rapid breathing. Coughing -^^^^^^^^Protective reflex to clear the trachea. Connects larynx to bronchi. Pneumonia -^^^^^^^^Infection of the lower respiratory tract. bronchi. Ventilator -^^^^^^^^Machine that assists breathing. Vibration -^^^^^^^^Physical therapy for respiratory patients. B1: heart. Unproductive Cough -^^^^^^^^Cough that brings nothing up from the lungs. a fine.Stethoscope -^^^^^^^^Instrument for listening to the heartbeat and breathing sounds. shaking pressure applied to the chest wall during exhalation. Sympathomimetic -^^^^^^^^mimics the sympathetic nervous system Sympathetic Neuro-Receptors -^^^^^^^^Alpha: arteries and arterioles. Wheezing -^^^^^^^^High-pitched. a dry cough. Viscosity -^^^^^^^^Thickness. Trachea -^^^^^^^^Windpipe. Short duration Albuterol -^^^^^^^^Most common short acting bronchodilator Levalbuterol -^^^^^^^^Single Isomer form of Albuterol (R Isomer) . Tachycardia. Skeletal Muscle Tremors. B2: Lungs Nor epinephrine -^^^^^^^^Sympathetic Nuero-transmitter Adrenergic Bronchodilators -^^^^^^^^Drug class that directly stimulates Sympathetic Receptors Effects of Epinephrine -^^^^^^^^Increased BP.

63 mg/3ml) MDI: 45 MCG/puff Long Acting Bronchodilators -^^^^^^^^For maintenance. duration 12hrs. Adrenergic AKA -^^^^^^^^Sympathomitmetic AKA Muscarinic M2. Levalbuterol Dose -^^^^^^^^SVN: 1.31 &. Often used in combination w/ Corticosteroids Long Acting Bronchodilator Rx <ADVair> -^^^^^^^^Salmeterol (Serevent) + Fluticasone (a synthetic corticosteroid. MDI 90 MCG/puff. M3 -^^^^^^^^Parasympathetic Receptors in the airways Atropine -^^^^^^^^Non-selective Parasympathalitic Agent (a muscarinic receptor antagonist) Anticholinergic agents -^^^^^^^^block acetylcholine receptors & act as cholinergic anatgonists Cholinergic agents -^^^^^^^^uses acetylcholine as its neurotransmitter.5mg/3ml (unit dose). Theophylline and Theobromine .)= Advair Advair -^^^^^^^^a bronchodilator and corticosteroid combination used to treat and prevent the symptoms of asthma. antiadrenergic -^^^^^^^^an antagonist of the Sympathetic Nervous System Sympatholitic Agents -^^^^^^^^an agent blocking the effect of the Sympathetic Nervous System Antiadrenergic AKA -^^^^^^^^Sympatholytic AKA Sympathomimetic Agents -^^^^^^^^mimics the sympathetic system Methylated Xanthines (CH3) -^^^^^^^^Caffeine.Albuterol Dose -^^^^^^^^SVN: 2.25mg/3ml (.

Airway drying. Atmosphere pollutants Mucolytics -^^^^^^^^agents that destroy or dissolve mucus. degrade mucin. Cigarrette Smoking. Brovana(Arformoterol) Fluticasone + Salmeterol= -^^^^^^^^Advair Diskus (dpi) 50mcg /Seretide Formoterol +Budesonide= -^^^^^^^^Symbicort Albuterol + Ipratropium= -^^^^^^^^Combivent or DUOneb Purpose of Mucus in physiology -^^^^^^^^effective lubricant.Clinical Indications for use of Xanthines -^^^^^^^^Considered the primary agent of choice for Apnea of Prematurity Cholinesterase -^^^^^^^^The enzyme that degrades the parasympathetic neuro-transmitter COMT/MAO -^^^^^^^^the enzymes that degrades the sympathetic neuro-transmitter Synergism -^^^^^^^^two or more agents working on the same target organ. helpful in opening airways . Narcotics. resulting in a product greater than the sum of its parts Additivity -^^^^^^^^two agents working together resulting in a sum equal to both parts Therapeutic Index -^^^^^^^^The appropriate dose that reduces risk of overdosing or underdosing Riboviran -^^^^^^^^Drug used in extreme cases of RSV. Foradil(Formoterol). Delivered via (SPAG) Small Particle Aerosol Generator Albuterol inhalers -^^^^^^^^Ventolin. Proventil.CF). Airway Trauma. protective barrier. and sticky trap for foreign particles and microorganisms Factors that slow mucus clearance -^^^^^^^^lung disease(COPD. Pro-Air (trade names) Long -Acting Bronchodilators(12 hrs) -^^^^^^^^Serevent(Salmetrol) .

mood changes Three Classifications of Antiinflammatory Agents -^^^^^^^^Corticosteroids. Leukotriene Antagonists. BenzaPRIL Angiotensins effect on Blood Pressure -^^^^^^^^Blood vessels constrict and raise blood pressures Angiotensin Converting Enzyme Inhibitors Mode of Action(ACE Inhibitors) -^^^^^^^^Blocks the conversion of Angiotensin I to Angiotension II bradykinin defined -^^^^^^^^substance released by damaged tissue that promotes inflammation Antithrombotics defined -^^^^^^^^Prophylactic Drug to treat Formation of Clots (blood thinners) Drugs used to treat Thrombosis -^^^^^^^^Coumadin. Lovenox Leukotrienes -^^^^^^^^Initiate and mediate the inflammatory response (singulair is a Leukotriene Antagonist) . effective in CF Bronchoalveolar Lavage (BAL) -^^^^^^^^bronchoscope passed through mouth or nose into the lungs.Mucomyst generic name -^^^^^^^^N. a fluid is squirted into a small part of the lung and then recollected for examination.(Pulmozyme) disrupts DNA polymers. LisinoPRIL. limited shelf life (refrig) Dornase Alfa -^^^^^^^^mucolytic. EnalaPRIL. Heparin.(mucomyst) may cause bronchospasm (use w/bronchdilator). Acetylcysteine -^^^^^^^^mucolytic. Acetylcysteine trade name Pulmozyme generic name -^^^^^^^^the trade name or Dornase alfa-used with CF N. adrenal suppresion. Chronotropic Drugs mode of action -^^^^^^^^Drugs that change the HR by affecting signals to the SA node Ionotropic Drug's mode of action -^^^^^^^^Drugs that affect the myocardial contractility Side effects to corticosteroid use -^^^^^^^^Osteoporosis. and Mast Cell Stabilizers Common ACE inhibitors -^^^^^^^^CaptroPRIL.

35-7. or combine 2 controller inhalers into one. Cut 'em up and fold 'em 3. Chronotropics which increase Heart Rate -^^^^^^^^Atropine and Isoproternol Chronotropics which decrease Heart Rate -^^^^^^^^Adenosine and Metoprolol (Beta Blockers) Combined Inhaled Medicines Defined -^^^^^^^^Bronchodilators that combine a controller inhaler and a quick relief inhaler. Pharmacodynamic Defined -^^^^^^^^The drugs affect on the Body Pharmacokinetic Defined -^^^^^^^^The Body's affect on the Drug Tachyphylaxis Defined -^^^^^^^^rapidly decreasing response to a drug following administration of initial doses 20% increase to heart rate over baseline -^^^^^^^^Considerations to stop treatment of SABA (Sign of Side Effect) Adrenergic Antagonists -^^^^^^^^The most common Sympatholytic Agent (Drugs that inhibit the actions of the sympathetic nervous system by any mechanism) Flashcard Print x Close Window Instructions » 1. Study! Normal ABG Values pH PaO2 7.45 80-100 35-45 . Print This Set 2.Mast Cell Stabilizers -^^^^^^^^inhibit the release of inflammatory chemicals from mast cells and make the airways less likely to narrow.

PaCO2 O2 Sat HCO3 Base Excess 95-100 22-26 +_2 Hypoventilation Drug Overdose Pulmonary Edema What are some causes of Respiratory acidosis? Chest Trauma Neuromuscular Disease Airway Obstruction COPD Diabetic Ketoacidosis Salicylate OD What are some causes of Metabolic Acidosis? Shock Sepsis Severe Diarrhea Renal Failure Hyperventilation Initial Stage of Pulmonary Emboli Anxiety What are some Causes of Respiratory Alkalosis? Hypoxia Fever Pregnancy High Altitude Overuse of Antacids What are some Causes of Metabolic .

Dyspnea. decreased respiration.   Emphysema Pathophysiology and Manifestation         Significant and progressive reduction in expiratory outflow Hyperinflation of lungs. bullae formation (can rupture and form a pneumothorax) Small airway collapse Dyspnea on exertion Chronic (minimum) cough and sputum productoin Barrel chest Speak in short jerky sentences Anxious Thin appearance Purse lip Breathing What will the lungs of a patient with emphysema sound like? What will the skin color of a patient with Hollow and Resonant. increased agitation. Wheezing. stupor.Alkalosis? Loss of Gastric Juices (vomiting. Rigidity of airway due to chronic inflammation and scarring. Prolonged Expiratory Time. bradycardia. Barrel Chest. dyspnea. Loss of elasticity of alveoli Inflammation and structural changes of airways. stridor. They will have minimal cyanosis. altered LOC Late: increased restlessness. tachycardia. retractions. dyspnea. feeding problems Destruction and Enlargment of Air Spaces. Use of Accessory Muscles. There will be hyperresonance on chest percussion. Pink because they do not retain CO2 well. Pursed Lip breathing. grunting. tachypnea. Cor Pulmonale (late in disease). somnolence. . airway narrowing due to hyper-responsiveness and bronchoconstriction Easily Fatigued. Chronic Cough. Frequent Respiratory Infections. diaphoresis. Orthopneic. cyanosis Kids: nares flaring. Thin in Appearance Hyperinflation and loss of elasticity of alveoli. NG tube) Potassium Wasting Diuretics (Increase loss of H+) Hypoxia Signs of Hypoxia Emphysema Chronic Bronchitis Asthma COPD--Picture S&S Inadequate amounts of oxygen available for Cellular Metabolism Early: restless. Digital Clubbing.

What is the Pathology of Chronic Bronchitis & its' manifestations    Thick.  What is the Pathology of Bronchial Asthma and its Manifestations? dyspnea .emphysema look like? Explain the complications of Emphsema Pts and Emphysema patients have exertional dyspnea. dusky to cyanotic Clubbing of fingers Breath sounds: crackles. REVERSIBLE airflow obstruction caused by inflammation and constriction of airway when exposed to irritant. Productive cough for 3 months in each of 2 consecutive years AND air flow obstruction 2. wheezing Productive cough JVD (late sign=cor pulmonale) What will be found on a physical exam of a pt with Chronic Bronchitis? Hypoxia Hypercapnia Increased Respiratory Rate Cardiac Enlargment Use of Accessor Muscles to Breathe (Makes the right side of the heart work harder to pum blood into the lungs. FEV==less than 70% Pink PuFUHer/Blue Em FUH syma/Bronchitis BLOATER Skin color: blue bloater. copious mucus production Chronic COUGH Hypoxemia and hypercapnea (respiratory aciosis) Diagnosis of Chronic Bronchitis 1. rhonchi. Exercise Results from exposure of airways to irritants. As a result there will be scarring and rigidity of airway walls.

An anti-inflammatory/corticosteroid agent for IV. 2. An anti-inflammatory/corticosteroid agent for Oral. 3. 1. Flovent Diskus) beclomethsone (Qvar) budesondie (Pulmicort Turbohaler) mometasone (Asmanex Twisthaler) Prednison What is it? Name four Antiinflammatory/Corticosteroid Inhalers . An anti-inflammatory/corticosteroid agent for IV or Oral. It is used for maintenance prophylaxis and long term managment of asthma.    wheezing cough increased mucus production S/S mostly in early morning or night Anxious Breath Sounds: Expiratory wheezing. tight Cough Bronchial Asthma-Physical Findings Asymptomatic between attacks Increase Mucus Production Shortness of Breath Prolonged Expiration Retractions ASA and NSAIDs should be given with caution to patients Asthma with which respiratory condition? Budesonide (Pulmoicort)--Class. fluticasone (Flovent HFA. Solu-Medrol) What is it? It is an anti-inflammatory and anti-allergy medication used to decrease or prevent the respiratory tissue response to the inflammatory process. Use hydrocortisone (Solu-Cortef) What is it? methylprednisolone (Medrol. 4.

Ventolin HFA.Name the Short acting and Long Acting Anticholinergic Drug Short: ipatropium (Atrovent HFA) NEB or MDI Long: tiotropium (Spiriva Handihaler) DPI albuterol (Proventil HFA. VQ mismatch 1. Xopenex HFA) pirbuterol (Maxair Autohaler) COPD. but not asthma. ProAir HFA. Capillary Walls Become Leaky Name the LABA Pathophysiology of Pneumonia 4. Inflammatory Response 3. Inhalation--mycoplasma and fungal 3. Aspiration How does bad stuff get in the lungs to cause pneumonia? 2. Exposure to foreign mattter 2. New Onset . salmeterol (Serevent) formoterol (Foradil Aerolizer. Should When can LABAs be used With be used with inhaled steroids when in monotherapy? treating asthma. Perforomist) arformoterol (Brovana) 1. Alveoli fill with fluid 6. Fluid shifts from capillaries to interstitial space and then to alveoli 5. AccuNeb. Hematogenous Spread-Staph aureus What qualifies as a HCAP? 1. Lungs lse compliance 7. VoSpire ER [oral only) Name the SABA levalbuterol (Xopenex.

PURULENT OR RUST COLORED SPUTUM. Streptamycin treatment What are the three mechanisms by whic the body regulates acid-base balance? 1. FEVER CHILLS. maybe bloody). Attended a hospital or hemodalysis clinic RALES. Fever. ELEVATED WBCS. Weight Loss. RHONCHI AND DIMINISHED BREATH SOUNDS. PRODUCTIVE COUGH. Nausea. secretion of small amounts of free hydrogen into the renal tubule 2. combination of H+ with NH3 to form ammonium (NH4+ 3. Renal 1. or wound care within past 30 days 5. Dull Chest pain. Lethargy. Possible crackles. DYSPNEA ON EXERTION. Rifampin. Received IV ABO therapy. Night Sweats. Chest tightness. person was hospitalized in a cute care hospital for 2 days or longer withing 90 days of the infection 3. Productive Cough (white frothy. Anorexia. Ethambutol. Pyrazinamide. Excretion of weak acids Respiratory Acidosis (carbonic acid excess) is Respiratory alkalosis occurs when there is hypoventilation Too much CO2=too much H+ occurs whenever there is hyperventilation . chemotherapy. Lungs--excrete CO2 and water 3.2. Resided in LTCF 4. ABN ABGS          PNEUMONA Pleurisy Pleural Effusion Atelectasis Bacteremia Lung Abscess Empyema Pericarditis Meningitis Endocarditis What are some complications of Pneumonia? Assessment Findings: Progressive fatigue. wheezing Tuberculosis For Tuberculosis Isoniazid (INH). Buffer system--FAST 2. DEHYDRATION. ABN CXR.

little CO2=little H+ occurs when an acid other than carbonic acid accumulates in the body or when bicarbonate is lost from body fluids Pleural Effusion Pleural Effusion occurs secondary to: Clinical Manifestations of a pleural effusion occurs when a loss of acid (prolonged vomiting or gastric suction) or a gain in bicarbonate occurs abnormal accumulation of fluid in the pleural space (normal is 5 to 15 mL)      altered hydrostatic or oncotic pressure fluid collection bleeding into the space decreased lymphatic clearance of pleural fluid infection     dyspnea decreased movement on the affected side of chest wall pleuritic pain absent or distant breath sounds over affected side inflammation of the pleura Pleurisy & manifestations Atelectasis   pain is aggravated by inspiration shallow and rapid breathing o pleural friction rub (ausculatated) lung condition characterized by collapse airless alveoli an abnormal accumulation of fluid in the alveoli and interstitial spaces of the lung.(carbonic acid deficit) Metabolic acidosis (base bicarbonate deficit) Metabolic alkalosis (base bicarbonate excess) Too much oxygen. The most common cause is Left Sided Heart Failure. Pulmonary Edema Other Causes:     Overhydration from IV Hypoalbuminemia Altered capillar permeability of lungs Malignancies of lymph system o Respiratory distress syndrome TOO. TOO much oxygen gets Gets rid of nitrogen causing alveolar rid of what causing what? collapse. A complication of various heart and lung disease. .

tenacious secretions Pharmacodynamics * Splits disulfide bonds that are responsible for holding the mucous material together. What are other uses for Acetylcysteine (Mucomys) besides liquifying secretions? *Acetaminophen antidote * Diagnostic studies .Exam 2 Amy B Mon Feb 23 10:59:31 CST 2009 What is the prototype for mucolytic drugs? Acetylcysteine (mucomyst) Acetylcysteine (Mucomyst): Pharmacotherapeutics Pharmacodynamics Pharmacotherapeutics * Liquefy thick.x Close Window 1. Print This Note Lower Respiratory Tract Drugs.

bronchospasm. Ventolin) Albuterol (Proventil. rhinorrhea IV-anaphylactoid reaction What is the usually the "rescue drug" with acute episodes with asthma? Beta 2 agonists (vasodilates and relieves bronchospasm) What is the prototype drug for Beta agonists that cause bronchodilation? Albuterol (Proventil. . chest tightness.Diagnostic bronchoscopy How do you maximize therapeutic effects with Acetylcysteine (Mucomyst)? Administer inhaled beta agonist first to dilate bronchial tree Oral mix with diet soda When is Acetylcysteine (Mucomyst) contraindicated? Respiratory compromise and asthma Pregnancy/lactation What are the adverse effects of Acetylecysteine (Mucomyst)? Inhaled-bronchoconstriction.. Ventolin): Pharmacotherapeutics Pharmacodynamics * Bronchodilator—CAL and asthma * Moderate selective-2 agonist. burning in upper airway.Prevent contrast-induced renal complications of high risk patients .

DPI or nebulizer What are the first-line drugs for CAL whose symptoms have become persistent? Respiratory Anticholinergic Agents (such as Atrovent) What is the prototype for Respiratory Anticholinergic Agents (that stops bronchoconstriction)? ipratropium bromide (Atrovent) ipratropium bromide (Atrovent): Pharmacotherapeutic Pharmacodynamics Pharmacotherapeutics . palpitations. anxiety. and increase vital capacity What are the adverse effects of albuterol? * More if orally taken Inhaled: Throat irritation. muscle cramps. Teach how to use the MDI.It selectively stimulates receptors of smooth muscle in the lungs. headache. and gastrointestinal (GI) symptoms What can overuse of albuterol cause? Rebound broncho-constriction What is the important client teaching with albuterol? Limit caffeine intake can increase the adverse effects “Rescue drug” first drug to use when symptoms of an acute attack occur. and the vasculature that supplies skeletal muscle. anxiety and tremors Oral: Tachycardia. reduces airway resistance facilitates mucous drainage. the uterus. insomnia. palpitations. Relieves bronchospasm. tremors.

Pharmacodynamics Believed that bronchodilation is caused by inhibition of phosphodiesterase. Atrovent is used prophylactically to reduce the frequency and severity of asthma attacks Must be taken daily despite the absence of symptoms It will not abort an asthma attack What is the prototype for Xanthine Derivatives (bronchodilator)? Theophylline (Slo-Phyllin) Theophylline (Slo-Phyllin): Pharmacotherapeutics Pharmacodynamics Pharmacotherapeutics Indicated for the symptomatic relief or prevention of bronchial asthma and reversal of bronchospasm associated with CAL. throat irriation. dysgeusia Rare-dry mouth. hoarseness. urinary retention. constipation. .Maintenance therapy for asthma or CAL Pharmacodynamics Antagonizes the action of acetylcholine by blocking muscarinic cholinergic receptors Decrease contraction of smooth muscle Reducing bronchospasm What are the adverse effects of ipratropium bromide (Atrovent)? Most common: Cough. blurred vision (anticholinergic) Rare-paradoxical acute bronchospasm What is the important client teaching w/ ipratropium bromide (Atrovent)? Overuse may induce adverse effects.

& pregnancy What are the adverse effects of Theophylline? >20 to 25 mcg/mL: GI-N.decreases serum levels.V.What are the contraindications for Theophylline? xanthines. and may need up to 50% increase in dose What is the important client teaching with Theophylline? Avoid large intake of caffeine foods and beverages Administer immediate-release with a meal to decrease GI distress Sustained-release on an empty stomach Smoking decrease serum levels Diet affects elimination of the drug How does diet affect the elimination of Theophylline? High carbs. status asthmaticus. & PUD. insomnia. irritability Serious: seizure and arrhythmias What is the main drug interaction w/ Theophylline? Smoking. low carb diets increase elimination What are the main anti-inflammatory agents? Glucocorticoids Mast cell stabilizers Leukotriene receptor antagonist . diarrhea CNS-headache. low protein diets decrease elimination and high protein.

Reduce the migration/activity of the inflammatory cells Increase the number and enhance the responsiveness of beta receptors in airways Decrease mucous production. When is Flunisolide (Aerobid) contraindicated? with active systemic fungal infections What are the adverse effects of Flunisolide (Aerobid)? limited Sore throat. dry mouth. Daily ICS—dysphonia and oropharyngeal Candida albicans What is the important client teaching with Flunisolide (Aerobid)? Rinse mouth after administration or ICS Signs of candidiasis (white patches) Smoking decreases effectiveness . coughing. hoarseness. pharyngeal and laryngeal fungal infections.What is the prototype for Inhaled Glucocorticoid Steroids (ICS)? Flunisolide (Aerobid) Flunisolide (Aerobid): Pharmacotherapeutics Pharmacodynamics Pharmacotherapeutics Used to prevent bronchospasm with asthma and CAL Maintenance drug not acute attacks Pharmacodynamics Inhibit production of leukotrienes and prostaglandins through interference with arachidonic acid metabolism.

these substances cause an inflammatory response. What pathological events leads up to an acute asthma attack? Vasoactive substances. bronchospasm. and leukotrienes. such as histamine. When the mast cell ruptures. serotonin. are located within the mast cell. cough Oral: lactose intolerance .Importance of daily use Use of beta-2 agonist before dilates the bronchial tree increases dispersion of the drug. bradykinin. such as bronchial constriction What is the prototype for mast cell stabilizers? cromolyn sodium cromolyn sodium: Pharmacotherapeutics Pharmacodynamics Pharmacotherapeutics Prophylactic agents for mild to moderate asthma Acute bronchospasm induced by exercise Pharmacodynamics Works at the surface of the mast cell to inhibit mast cell rupture and degranulation after contact with an antigen Prevents the release of histamine and SRS-A mediators When is cromolyn sodium contraindicated? With lactose intolerance What are the adverse effects of cromolyn sodium? Throat irritation.

pregnancy. & NOT for kids . bronchoconstriction. not a "rescue drug" What are leukotrienes? Leukotrienes are inflammatory mediators released from mast and t-cells. Leukotrienes have been identified as important mediators in the pathology and symptomatology of asthma Result in airway hyperreactivity. and hypersecretion What is the prototype for Leukotriene Receptor Agonists? Zafirlukast (Accolate) Zafirlukast (Accolate): Pharmacotherapeutics Pharmacokinetics Pharmacodynamics Pharmacotherapeutics Prophylaxis or treatment of chronic asthma Pharmacokinetics Oral/food decrease bioavailability 1 hour before or 2 hours after Pharmacodynamics Blocks receptors for leukotrienes bound to amino acid cysteine (very potent vasoconstrictor) What are contraindications for Zafirlukast (Accolate)? Povidone. Leukotrienes are powerful bronchoconstrictors and vasodilators. lactose.What is important client teaching with cromolyn sodium? Take daily. hepatic insufficiency.

” Which of the antiinflammatory agents is the most effective? Glucocorticosteroids are the most powerful anti-inflammatory agents. bronchoconstriction occurs. Theophylline acts by stimulating two prostaglandins. bradykinin. Cromolyn sodium works by stabilizing the mast cell. erythromycin How is Singulair (Montelukast) different from Zafirlukast (Accolate)? Once a day dosing. pharyngitis. the bronchi do not constrict. By . which main classes of drugs are used*Drugs can be grouped into mucolytic agents. SQ. thus. when its action is blocked. That means the drugs mimic the action of norepinephrine. rhinitis What are main drug interactions w/ Zafirlukast (Accolate)? Drugs metabolized through P-450 system. thus. doesn't inhibit cytochrome isoenzymes Why has omalizumab (Xolair) gotten a lot of TV press? What is important to remember when administering? How does it work? First monoclonal antibody directed against immunoglobulin E (IgE) and first biological therapy developed to treat asthma. and anti-inflammatory drugs. When acetylcysteine stimulates the lungs. such as acetylcysteine. In a patient with acute respiratory distress. bronchodilators. Binds to mast cells and prevents mast cell rupture and degranulation. serotonin. warfarin. What is the difference between glucocorticoid steroids given orally and by inhalation? Both drugs are effective in reducing inflammation. In managing lower respiratory tract disorders. have the quickest onset of action. such as cromolyn sodium.What are adverse effects of Zafirlukast (Accolate)? h/a. such as albuterol. eosinophils. which of the bronchodilators would be most effective? Beta-adrenergic agonists. Anticholinergic agents block the action of acetylcysteine. Steroids given by inhalation have a local action. bronchoconstrictive substances such as histamine. aspirin. they cause fewer adverse effects. such as theophylline. They are referred to as “rescue drugs.Binds to receptors on monocytes. theophylline. In the lungs. Beta-adrenergic agonists are sympathomimetic agents. Glucocorticoid steroids given orally have the potential to cause more adverse effects because they are systemic. Wait 20 minutes to ensure powder dissolves. and leukotrienes are released. epithelial cells and platelets to interfere with the release of inflammatory mediators and cytokines. approved for kids > 2yrs. gastritis. When the mast cell ruptures in response to an antigen. norepinephrine stimulates bronchodilation. which results in smooth-muscle relaxation in both the bronchi and vasculature.

NULL }] Your Results for "NCLEX-RN® Review" Print this page Student results on this activity were sent to the Grade Tracker. they do not work quickly and are used for prevention of inflammation. A client with asthma asks which of the prescribed medications should be used in the event of an acute episode of bronchospasm. 2012 at 5:46 PM (UTC/GMT) 72% Correct of 10 questions 13 correct: 5 incorrect: 28% 72% 2 questions contain multiple pairs. thus keeping the bronchioles open. The nurse will instruct the client to use: Your Answer: Albuterol. Option 4 is incorrect . an anticholinergic inhaler. so that the other drugs can be dispersed farther into the lungs to exert their action. More information about scoring 1. Go to Grade Tracker. Note that it may take a few moments for the score to appear. they decrease the effectiveness of inflammatory cells. Rationale: There are two important items to consider: (1) the medication and (2) the route. the drug prevents release of these substances. Because leukotriene binding to these sites is what causes bronchoconstriction. It will open the bronchial tree. Summary of Results for Litta Oglesby Site Title: MyNursingKit for Pharmacology: Connections to Nursing Practice Book Title: Pharmacology: Connections to Nursing Practice Book Author: Adams Location on Unit X > Chapter 73 > Student Home > Site: NCLEX-RN® Review Submitted: March 31. A drug to abort bronchospasm should be given by inhalation in order to ensure rapid action directly at the site. by inhalation.stabilizing the mast cell. An inhaled beta agonist such as albuterol meets both criteria. Glucocorticoid steroids have a multitude of actions. which inhaler would you tell the patient to use first? The beta-adrenergic agonist inhaler should be used first because it has the fastest onset. and a beta-adrenergic agonist inhaler. Option 2 is incorrect because although inhalants are delivered directly. bronchoconstriction is blocked. a beta agonist bronchodilator. scored for a total of 10 questions. In the lungs. Leukotriene antagonists block the ability of leukotrienes to bind to their receptor sites. If a patient is taking inhaled steroids. Option 3 is incorrect because this anticholinergic is not approved as rescue therapy for treatment of acute bronchospasm.

. Correct. Rinsing the mouth removes any glucocorticoid drug deposited there. Nursing Process: Implementation 3. Client Need: Safe. The nurse should monitor the client who is taking corticosteroids for evidence of: Select all that apply. Nursing Process: Implementation 4. A client is prescribed beclomethasone (Beclovent).. Your Answers: Infection. Client Need: Safe.” Rationale: Glucocorticoids can decrease the beneficial oral flora that will allow for an overgrowth of fungal infections such as candida. Thus it decreases the likelihood of toxicity through systemic absorption.g. xanthine derivatives) have an adverse effect on heart rate elevation and palpitations. not glucocorticoids. Education by the nurse will include: Your Answer: “Rinse your mouth out well after each use.g. The nurse should inform the client who is prescribed a nebulizer treatment with a bronchodilator agent that a common adverse effect is: Your Answer: An increased heart rate with palpitations. Effective Care Management. Nursing Process: Implementation 2. a glucocorticoid inhaler. not the glucocorticoids. . It would not be restricted with a glucocorticoid.g. Effective Care Management. this is uncommon and the question asks for a common adverse effect.g. Option 4 is incorrect because it is the bronchodilators (e. anticholinergics. not for treatment of acute bronchospasm. Hyperglycemia. aminophylline and theophylline) that are chemically related to caffeine. Option 3 is incorrect because bronchodilator increase alertness. Option 4 is incorrect because bronchodilators relieve dyspnea. Option 1 is incorrect because it is the bronchodilators (e. Cognitive Level: Analysis. Furthermore. Option 2 is incorrect because bronchodilators do not decrease the immune response the way certain anti-inflammatory agents do. adrenergic agonists. anticholinergics. While some bronchodilators have been known to cause unexpected problems and paradoxical bronchospasm. Correct. and xanthines) that are likely to cause tachycardia. Effective Care Management. and prevents it from being being swallowed. Cognitive Level: Application.because leukotriene modifiers are indicated for prevention of respiratory problems. beta agonists... Cognitive Level: Comprehension. Client Need: Safe. anticholinergics. giving a medication PO would not be appropriate when treating acute bronchospasm. and xanthines) that are likely to cause the client to feel shaky and nervous. Option 2 is incorrect because it is the xanthines (e. Rationale: Bronchodilators (e. adrenergic agonists.

Client Need: Health Promotion and Maintenance. Anticholinergic agents do not cause problems resulting in liver enlargement (option 2). The health care provider would not need to be contacted because the client has difficulty learning. . Rationale: Beta agonists are agents that are used in the management of asthma that may be given to children younger than 5. Nursing Process: Planning 6. Caffeine is not contraindicated for clients taking anticholinergic agents (option 1). and are available in formulations suitable for nebulizer treatments. The appropriate nursing intervention includes: Your Answer: Assessing for an enlarged liver. Cognitive Level: Application Client Need: Health Promotion and Maintenance Nursing Process: Implementation 8. Although urinary retention is uncommon with inhalant medications. but it is not the priority for an immediate solution to the problem (option 1). the client is unable to return a proper demonstration on the training inhaler. and 4 do not meet one or more of the criteria listed above. The best action for the nurse to take is to: Your Answer: Provide a spacer for use with the inhaler. A 60-year-old man is prescribed ipratropium (Atrovent) for the treatment of asthma. Substitution of an oral form of drug is not in the nursing scope of practice and. 3. The type of medication most likely to be given for asthma management is a: Your Answer: Beta agonist. not diarrhea (option 4). The client is becoming frustrated. an oral formulation would not be a suitable substitute because the onset of action would be delayed (option 4). The spacer has additional advantages because it results in a more effective delivery of the drug to the site of action and less drug deposition in the mouth and oropharynx. In these instances. Cognitive Level: Analysis. Cognitive Level: Analysis. Anticholinergics can cause urinary retention.5. Match each prototype on the left to the category of drug it represents. Despite repeated demonstrations of proper inhaler use by the nurse. Rationale: Some clients have difficulty mastering the coordination between inhalation and activation of the medication. Nursing Process: Planning 7. provided that a solution is readily available (option 2). Additional practice may help in the long term. A 4-year-old child with respiratory distress secondary to asthma has an order for a nebulizer treatment. a spacer will hold the medication cloud so that this is not a concern. clients should be aware of this potential side effect. Rationale: Ipratropium in an anticholinergic agent. even if it were. Correct Answer: Teaching the client to report the inability to urinate. Client Need: Health Promotion and Maintenance. The agents in options 2. These agents are more likely to cause constipation.

1 8. Volmax) C. Anti-inflammatory agent C.Option Your Answer D. Anti-inflammatory agent F. Rationale: Smoking increases the clearance of the theophylline. ipratropium (Atrovent) B.2 10. Vanceril) A.3 8. the dosage is one that is adequate and safe.3 10. zafirlukast (Accolate) 8.1 10. Smoking would not contribute to the likelihood of theophylline toxicity (option 3) or systemic side effects (option 4). a larger than usual dose may be required to maintain a therapeutic level of medication. The nurse knows that this will pose what complication? Your Answer: The dose may be inadequate to manage symptoms. beclomethasone (Beclovent. Beconase. Anti-Inflammatory Agent B. Bronchodilator E. Match each category of drug with its primary effect as a bronchodilator or anti-inflammatory agent.5 10. Cognitive Level: Knowledge Client Need: Health Promotion and Maintenance Nursing Process: Implementation . Bronchodilator E. Anti-Inflammatory Agent F. Anti-inflammatory agent B. A client who is prescribed 400 mg/day of theophylline smokes two packs of cigarettes per day. Bronchodilator D.6 Corticosteroids Methylxanthines Mast cell stabilizers Anticholinergic corticosteroids Leukotriene modifiers Beta-adrenergic agonists Rationale: Each category has a specific effect that plays a role in management of pulmonary disorders. Ventolin. Bronchodilator D. Anti-inflammatory agent C. Vancenase. Smoking does not increase the stimulant effect (option 1). albuterol (Proventil. Bronchodilator 10.4 10. Bronchodilator Correct Answer A.4 Beta-adrenergic agonists Anticholinergic corticosteroids Corticosteroids Leukotriene modifiers 9. Option Your Answer A.2 8. Otherwise. therefore. Cognitive Level: Knowledge Client Need: Health Promotion and Maintenance Nursing Process: Planning 10.

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