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Respiratory System

(General Key Points)

N203 ATI (Unit 8) Respiratory System -

β2-Adrenergic Agonists N203 ATI (Unit 8) Respiratory System - .

Expected Action: salmeterol (Serevent).Proto: albuterol (Proventil) — Others: formoterol (Foradil). terbutaline (Brethine) • Selectively activate β2 receptors resulting in bronchodilation: bronchospasm is relieved. wait 60 sec for next dose • Use inhaled β2-agonist before using inhaled glucocorticoid . histamine release is inhibited. hold 10 sec. long-acting • Oral: Tachycardia/angina d/t β1 in ♥ / tremors d/t β2 in skeletal muscle Contraindications/Precautions: Interactions: • • β-blockers like propanolol  negate effects of both • TCAs and MAOIs   risk of tachycardia and angina Education: • Inhale 3-5 sec. long-acting • Terbutaline: Oral. salmeterol: Inhaled. short-acting and oral. L-A • Inhaled: Minimal adverse effects ♀ (C) • CI: tachydysrhythmias • Formoterol. and ciliary motility is  Therapeutic Uses: Adverse Effects: • Albuterol: Inhaled.

Methylxanthines N203 ATI (Unit 8) Respiratory System - .

Contraindications/Precautions: Interactions: ♀ (C) • • Caffeine:  CNS/♥ effects of theophylline.Expected Action: Proto: Theophylline (Theolair) • Theophylline relaxes bronchial smooth muscle  bronchodilation Therapeutic Uses: Adverse Effects: • Long-term control of asthma • Mild toxicityGI distress & restlessness. Effects unlikely @ <20 mcg/mL. ciprofloxacin:  [theophylline] . Activated charcoal  absorption. phenytoin:  [theophylline] • Cimetidine. Severe reactions • Severe reactions can occur at  therapeutic levels and include dysrhythmias and seizures. lidocaine for dysrhythmias and diazepam for seizures. Also [theophylline] • Phenobarbital.

Inhaled Anticholinergics N203 ATI (Unit 8) Respiratory System - .

Expected Action: Proto: ipratropium (Atrovent) — Others: tiotropium (Spiriva) • Block muscarinic receptors on bronchi  bronchodilation Therapeutic Uses: • Relief of bronchospasms associated with COPD • Relief of allergen-induced and exercise-induced asthma. . separate by at least 5 minutes. Adverse Effects: • Local anticholinergic effects ♀ (B) • CI: Peanut allergy Contraindications/Precautions: • Caution in narrow-angle glaucoma Education: • Usual adult dose is 2 puffs (1 minute apart) • If taking two inhaled medications.

Glucocorticoids N203 ATI (Unit 8) Respiratory System - .

candidiasis. prednisone (Deltasone) • Prevent inflammation. Contraindications/Precautions: Interactions: • Diuretics:  hypokalemia • NSAIDs:  GI ulceration • Glucocorticoids counteract effects of insulin and oral hypoglycemics. triamcinolone (Azmacort). bone loss • Oral (≥10d):  adrenal gland function / bone loss / hyperglycemia / glucosuria / / infection / peptic ulcer disease / myopathy / fluid & electrolyte disturbances. Adverse Effects: • Inhaled: Dysphasia.Proto: beclomethasone (QVAR) — Others: budesonide (Pulmicort). and promote responsiveness of β2-receptors in bronchial tree. suppress airway mucous production. Therapeutic Uses: • Inhaled: Long-term asthma prophylaxis • S-T. oral: Treat symptoms following acute asthma. 3-10 days following acute attack Expected Action: . • L-T. ♀ (?) • CI: Live virus / systemic fungal infect. Education: • Oral are for short-term use. oral: Treat chronic asthma • 1º adrenocortical insufficiency • Promote lung maturity and  RDS in fetuses at risk for preterm birth. fluticasone (Flovent).

Mast Cell Stabilizers N203 ATI (Unit 8) Respiratory System - .

Expected Action: Proto: Cromolyn (Intal) — Others: nedocromil (Tilade) • Anti-inflammatory: Stabilize mast cells. eosinophils. inhibiting histamine release. macrophages) Therapeutic Uses: • Management of chronic asthma • Prophylaxis of exercise-induced and allergen-induced asthma attacks • Allergic rhinitis by intranasal route Adverse Effects: • Safest of all asthma meds / safe for kids ♀ (B) Contraindications/Precautions: • Propellant  CI: CAD. and status asthmaticus Education: • Take 15 min before exercise • Long-term prophylaxis may take several weeks . • Suppress inflammatory cells (e.g. dysrhythmias.

Leukotriene Modifiers N203 ATI (Unit 8) Respiratory System - .

airway edema. anorexia. Zafirlukast taken ŝ food .Proto: montelukast (Singulair) — Others: zileuton (Zyflo). bronchoconstriction. Expected Action: zafirlukast (Accolate) • Prevent effects of leukotrienes thus suppressing inflammation. and mucus production. (nausea. abdominal pain) ♀ (?) • Contraindications/Precautions: Interactions: • • Zileuton / zafirlukast inhibit warfarin metabolism   [warfarin] • Zileuton / zafirlukast inhibit theophylline metabolism   theophylline toxicity Education: • Zileuton given without regard to food. Therapeutic Uses: Adverse Effects: • Long-term asthma therapy in folks ≥ 12 YO • Liver injury ĉ zileuton and zafirlukast.

Antitussive – Opioids N203 ATI (Unit 8) Respiratory System - .

Contraindications/Precautions: ♀ (C) • • CI: acute asthma.  fluid/fiber • CNS sedation effects: Respiratory depression (<12/min) – naloxone • Potential for abuse. non-productive cough • GI distress (nausea. head trauma. Therapeutic Uses: Adverse Effects: • Chronic. liver/renal dysfunction. constipation) – take ĉ food. schedule II.Expected Action: Proto: codeine — Others: hydrocodone • Suppresses cough center in the medulla oblongata. acute alcoholism .

Mucolytics N203 ATI (Unit 8) Respiratory System - .

Expected Action: Proto: acetylcysteine (Mucomyst) — Others: hypertonic saline • Enhance flow of secretions in the respiratory passages Therapeutic Uses: • Acute & chronic pulmonary disease ĉ  secretions • Acetylcysteine is the antidote for acetaminophen poisoning • Aspiration and bronchospasm ♀ (B) • CI: GI bleeding • Cystic fibrosis Adverse Effects: Contraindications/Precautions: • Caution: Peptic ulcers / esophageal varices / severe liver disease Education: • Has smell of rotten eggs • Dilute in fruit juice • IV: Loading dose. next dose over 4h. last dose over 16h. .

Decongestants N203 ATI (Unit 8) Respiratory System - .

sinusitis. phenylpropanolamine • Stimulate α1-adrenergic receptors   inflammation of nasal membranes Therapeutic Uses: Adverse Effects: • Allergic rhinitis. and common cold • Rebound congestion (Max 3-5 days.Expected Action: Proto: Phenylephrine Others: Ephedrine. taper down use) • Vasoconstriction • CI: Chronic rhinitis • CNS stimulation (rare ĉ topical) Contraindications/Precautions: ♀ (?) • Caution: CAD and hypertension Education: • Oral do not lead to rebound congestion . naphazoline.