Pulmonary Drugs

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Anonymous
ID:
13655
Filename:
Pulmonary Drugs
Updated:
2010-04-09 01:53:11
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Nursing 306
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Exam III
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  1. Short Acting Beta 2 Adrenergic Agonists
    • Albuterol (Proventil)
    • Bitolterol (Tornalate)
    • Levalbuterol (Xopenex)
    • Pirbuterol (Maxair)
  2. Long Acting Beta 2 - Adrenergic Agonists
    • Formeterol (Foradil Aerolizer)
    • Salmeterol (Serevent Diskus)
  3. Oral Beta 2 - Adrenergic Agonists
    • Albuterol (Proventil, Volmax)
    • Terbutaline (Brethine)
  4. Beta 2 - Adrenergic Agonist
    Mechanism of Action
    • Selectively activate beta 2 adrenergic receptors in smooth muscle of the lung
    • 1. causes bronchodilation
    • Supresses histamine release
    • Increases ciliary motility
  5. Long Acting & Oral - Beta 2 Adrenergic Agonists
    • Last up to 12 hrs
    • Prolonged prophylaxis only
    • Should never be used alone to prevent asthma related death
  6. Beta 2 Adrenergic Agonists - Adverse Effects
    tachycardia, angina, tremor

    Long Acting - can cause respiratory arrest, death, severe asthma

    Oral - dysrythmias
  7. Inhalers
    - Metered Dose
    - Dry Powder
    - Nebulizers
    • Metered Dose:
    • 1 minute interval
    • Administer Short acting Beta 2 Agonist before glucocorticoids
  8. Methylxanthines
    • Theophylline oral - Theolair
    • Theophysine IV - emergencies
    • Aminophylline (IV) - Truphylline
  9. Theophylline (oral and IV)
    • Relaxes smooth muscle causing bronchodilation
    • Maintenance therapy for chronic, stable asthma
    • Decreases frequency and severity (though less effective)
  10. Theophylline & Theophylline SR - absorption
    • Do not chew SR (sustained release)
    • SR more stable plasma level
    • SR affected by food

    • Metabolized in liver
    • 10-20 mcg/ml plasma drug level
  11. Theophylline - Toxicity
    • Drug levels between 20-25 mcg/ml
    • Nausea / Vomiting
    • Diarrhea
    • Insomnia
    • Restlessness
  12. Theophylline - drug interactions
    • Caffeine
    • Phenobarbital
    • Phenytoin
    • Rifampin
    • Fluoroquinolone antibiotics (Cipro, Levaquin, Avelox)
  13. Theophylline
    Usual adult dose: 200-300 mg, 2-3 times / day
  14. Anticholinergics
    • Ipratropium (Atrovent HFA)
    • Tiotropium (Spiriva)

    Both inhaled
  15. Ipratropium (Atrovent)
    • Blocks muscarcinic receptors in bronchi
    • Used for COPD
    • Less effective for asthma
    • Additive effects with Beta 2 agonists
    • Not for acute attacks
  16. Ipratropium (Atrovent) - Adverse Effects
    • Common: Dry mouth, irritation of pharynx
    • Rare: increase in intraoccular pressure in patients with glaucoma, urinary retention

    Contraindicated in those allergic to soy / peanuts
  17. Ipratropium (Atrovent) - dosage
    2-4 puffs QID

    Combivent or DuoNeb (Combined with Beta 2 agonists - albuterol)
  18. Tiotropium (Spiriva)
    • blocks muscarcinic receptors in lung - bronchodilation
    • Long acting, approved for COPD bronchospasm
    • Usual dosing: 18 mcg capsules in dry powder inhaler
  19. Tiotropium (Spiriva) - adverse effects
    • Most common: dry mouth
    • teach to suck on sugarless candy for relief
    • Systemic: constipation, urinary retention, tachycardia, blurred vision
  20. Leukotriene Modifiers
    • Montelukast (Singulair)
    • Zafirlukast (Accolate)
    • Zileuton (Zyflo)

    all PO
  21. Montelukast (Singulair)
    • Antiinflammatory - blocks leukotriene receptors
    • Not for quick relief
    • For all patients over 1 yo
    • Once a day dosing (give in evening)
  22. Montelukast (Singulair) - pharmacokinetics
    • Rapidly absorbed: peak in 3-4 hours
    • Maximal effects: 24 hrs
    • Metabolized in liver, excreted in bile
    • Available in standard and chewable tablets, granules
  23. Montelukast (Singulair) - adverse effects
    • CNS: headache, anxiety fatigue
    • Resp: cough
    • GI: abdominal discomfort, diarrhea, nausea, dyspepsia (heartburn)
  24. Zileuton (Zyflo)
    • Antiinflammatory for > 12 yo
    • not for acute asthma

    Asthma prophylaxis and maintenance
  25. Zileuton (Zyflo) - pharmacokinetics
    • with or without food
    • peak in 2-3 hours
    • metabolized in liver
    • excreted in urine
    • usual dosage: 600 mg QID
    • Interacts with theophylline, warfarin, propanolol (Can increase their levels)
    • Adverse Effects: Similar to Singulair
  26. Zafirlukast (Accolate)
    • Antiinflammatory
    • Use for asthma in > 5 yo
  27. Zafirlukast (Accolate) - pharmacokinetics
    • give 1 hr before meals (or 2 hrs after)
    • metabolized in liver
    • excreted in feces
    • usual dosage: 10-20 mg BID
    • interacts with: theophylline, warfarin, propanolol (can increase their levels)
  28. IgE Antagonist - Omalizumba (Xolair)
    • expensive
    • antiinflammatory
    • unknown long term safety
    • for moderate to severe asthma
    • > 12 yo
    • sub-q absorption
    • peak in 7-8 days
    • half-life: 26 days
  29. Omalizumba (Xolair) - adverse effects
    • pain at injection site
    • upper respiratory infections
    • sinusitis
    • headache
    • cancer & anaphylaxis
  30. Mast Cell Stabilizers
    • Cromolyn (Intal)
    • Nedocromil (Tilade)

    by inhalation
  31. Cromolyn (Intal)
    • prophylaxis of asthma
    • not for acute attack
    • exercise induced asthma
    • allergic rhinitis
  32. Cromolyn (Intal) - pharmacokinetics
    • full effects may take several weeks
    • 2-4 puffs QID (MDI, nebulizer)
  33. Nedocromil (Tilade)
    • Usual dosage: 2 puffs daily, MDI
    • Most common adverse effect: unpleasant taste
  34. Glucocorticoids
    • Inhaled
    • - Beclometasone
    • - Budesonide (Pulmicort)
    • - Flunisolide (Aerobid)
    • - Flucticasone propionate (Flovent)
    • - Triamcinolone acetonide (Azmacort)
    • Oral
    • - Prednisone, Prednisolone
  35. Glucocorticoids
    • anti-inflammatory
    • prophylaxis for asthma

    increases beta 2 agonists

    cannot be used in times of stress
  36. Glucocorticoids - adverse effects
    adrenal suppresion

    Most common: bone loss and adrenal supression

    Gargle after use, use spacer

    • Infection
    • Fluid & Electrolyte imbalance
    • Cataracts and glaucoma
    • Mood changes
    • Cushing's Syndrome

    Withdrawl must be done slowly
  37. Glucocorticoids - acute attacks
    • IM, IV, oral
    • not inhaled
  38. Glucocorticoid / Beta 2 Agonist Combination
    • Advair Diskus - flovent & serevent
    • Bronchodilation & antiinflammatory
  39. Glucocorticoid / Beta 2 Agonist Combination
    • Therapeutic uses: Asthma & COPD
    • 50/100 mcg, 50/250 mcg, 50/500 mcg
    • BID inhalation
  40. Allergic Rhinitis Symptoms
    - inflammatory disorder of the airways and eyes

    • Symptoms:
    • sneezing
    • rhinorrhea
    • pruritus
    • nasal congestion
  41. Allergic Rhinitis
    • Seasonal - outdoor allergens (fungi, pollen)
    • Perennial - indoor allergens (dust mites, pet dander)
  42. Drugs for Allergic Rhinitis
    • Oral antihistamines
    • Intranasal glucocorticoids
    • Intranasal cromolyn
    • Sympathomimetics (oral/nasal)
  43. Oral Antihistamines
    • relieve itching, rhinorrhea, sneezine
    • NOT congestion
  44. Oral Antihistamine - adverse effects
    • Sedation
    • Anticholinergic effects:
    • dry mouth, constipation, urinary retention
  45. Intranasal Glucocorticoids
    • antiinflammatory (MDI, QD or BID)
    • suppresses symptoms of allergic rhinitis and congestion
    • adverse effects:
    • drying of nasal mucosa, epistaxis, burning or itching, may suppress adrenal glands
  46. Sympathomimetics (Decongestants)
    • stimulates alpha 1 adrenergic receptors
    • adverse effects:

    rebound congestion, rebound rhinitis
  47. Cough Drugs
    • Antitussives
    • opiod: codeine and hydrocodone
    • nonopiod: dextromethorphan and diphenhydramine
  48. Opiod Antitussives
    • Increases cough threshold
    • Sedation / Drowsiness
    • Dizziness, Fatigue, Dry Mouth, Constipation, Euphoria, Hallucinations, Resp. Depression
  49. Nonopiod Antitussives
    • Dextromethorphan (Robitussin) most effective
    • Diphenhydramine
    • Benzonatate (Tessalon)

    Side Effects: Dizziness, constipation, dry mouth

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