Respiratory Drugs

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  1. Short Acting Beta 2 (rol)
    • Racemic epinephrine
    • Albuterol
    • Levalbuterol
    • Bitolterol
    • Pirbuterol

    • Prevention of exercised induced bronchospasm.
    • An effect begins within 5 minutes. peaks in 30-60 mintues.
    • Duration may last 2-8 hours.
    • Exercised induced asthma may be inhaled 15 minutes prior to activity as prophylaxis against attack.
    • Used for quick relief known as "reliever"
    • Most effective drugs available for relief of acute bronchoconstriction and bronchospasm associated with asthma and COPD.
    • Sympathetic system (stress, nausea due to decrease peristalsis
    • Angina
    • Hyperglycemia, Hypokalemia.
    • Beta blockers can decrease effectiveness
    • Allow 5 minutes before taking other inhaled medications.
    • Allow 1 minute between puffs.
  2. Racemic epinephrine
    • Given via nebulizer
    • Used mostly with young children.
    • Can result in peripheral vasoconstriction
  3. Albuterol
    • Drug of choice for acute symptoms
    • Hypokalemia
    • Use albuterol before any other medications
  4. Long Acting Beta 2 Agonists
    • Salmeterol
    • Formoterol
    • Advair
    • Used for chronic pulmonary disorders as maintenance treatment.
    • Not indicated for acute symptoms or as a "rescue medication"  May increase the risk of severe asthma and asthma related death.
    • It can protect against bronchospasm over an extended time.
    • Approximately 12 hours
    • Onset of action 15-25 minutes.
    • Should be taken on a fixed schedule and not PRN
  5. Anticholinergics (ium)
    • Ipratropium
    • Tiotropium
    • Combivent, Duoneb (Ipratropium and albuterol)

    • Blocks parasympathetic nervous system.
    • Onset of action is longer than albuterol
    • Affects GI system more.
    • Maintenance therapy of reversible airway obstruction due to COPD
    • Preferred in patients taking beta blockers.

    • Blurred vision
    • Pharyngitis
    • GI irritation
    • Bad taste
    • Hoarseness
    • Cough

    • Contraindicated in patients with glaucoma and bladder obstructions
    • Contraindicated in peant and soy allergies.
  6. Xanthines (Methylxananthines) (ine)
    • Theophylline PO
    • Aminophylline IV. Must be administered slowly. Rapid infusion can cause cardiovascular fatalities
    • It's like a big shot of caffeine.
    • Relaxation of smooth bronchial muscles.
    • Reserved for long term management of persistent asthma that is unresponsive to beta agonists or inhaled corticosteroids.

    • Vasodilation
    • Hypotension
    • Tachycardia
    • Arrythmias
    • S/S of toxicity
    • Diuresis
    • Respiratory arrest
    • Contraindicated for patients with untreated seizure disorders or peptic ulcer disease.  Use with caution in patients with heart disease, liver or kidney dysfunction or severe hypertension.
  7. Mast Cell Stabilizers
    • Chromolyn (Intal)
    • Nedocromil (Tilade)
    • Inhibit the release of histamine from mast cells.  Acts as an anti inflammatory
    • Maximum therapeutic benefit may take several weeks.
    • Used as maintenance therapy
    • Very safe and effective drug for prophylaxis of asthma
    • Not useful in aborting an ongoing episode
    • Not a bronchodilator

    • May cause cough
    • Bitter taste
    • Bronchospasm

    • Inhaled with MDI or mebulizer
    • Take on a regular schedule.
  8. Glucocorticoids (corticosteroids)
    • More potent than mast cells
    • Decreases inflammation and suppresses the immune system.
    • Decreases edema of the airway mucosa
    • Reduce bronchial hyper reactivity and decrease airway mucus production

    • Brush teeth and gargle to prevent oral thrush
    • Dosage must be tapered down

    Used for prophylaxis

    • Cushings Syndrome
    • Osteoporosis
    • Growth retardation
    • Dry mouth
  9. Leukotriene Modifiers
    • Monteluckast (Singulair)
    • Zafirlukast (Accolade)
    • Zileuton (Zyflo)
    • Does not work right away
    • Blocks the inflammatory process in the airways by antagonizing the effects of leukotrienes
    • Has a mild anti inflammatory and bronchodilator effect

    • Maintenance therapy for chronic asthma
    • Used for long term control

    • Elevated Liver enzyme
    • May be toxic to the liver- use cautiously in patients with hepatic impairment and chronic alcoholism
  10. Antihistamines
    • Benadryl
    • Zyrtec
    • Allegra
    • Antagonizes action of histamine
    • Relieves allergy symptoms
    • Does not relieve congestion
    • Can reduce symptoms of mild allergic reactions
    • Most effective when taken prophylactically and less helpful when taken after symptoms have appeared.

    • Urinary retention, constipation
    • Dry mouth
    • Thickening of bronchial secretions
    • Hypotension
    • Respiratory depression
    • Paradoxical excitation

    • Contraindicated with acute asthma episode, impaired GI motility, urinary tract obstruction, heart disease.
    • May cause excitation of the CNS
    • Do not operate heavy equipment
  11. Decongestants (Sympathomimetics)
    • Pseudoephedrine (sudafed)
    • Phenylephrine (Afrin)
    • Neosynephrine (Oxymetazoline)
    • Ephedrine (Pretz-d)
    • Relieve nasal congestion, only relieve stuffiness, they do not reduce rhinorrhea, sneezing or itching.

    • Vasoconstriction: Tacycardia, HTN, cardiac arrythmias
    • Chronic nasal sprays can cause rebound congestion
    • Difficulty voiding

    • Contraindicated: HTN, cardiac arrythmias, CAD
    • These drugs are subject to abuse.
  12. Antitussives
    • Suppress cough reflex
    • Used for dry, hacking, nonproductive cough

    N/V, constipation, excessive suppression of cough reflex

    • Instruct patients to avoid driving
    • Opioid containing products can suppress respirations.
  13. Expectorants
    Liquefies respiratory secretions and allow for easier removal

    Drowsiness, Headache GI upset
  14. Mucolytics
    • Acetylcysteine (Mucomyst)
    • Dornase Alfa (Pulmozyme) - used for thick bronchial secretions: Cystic Fibrosis.
    • Reacts directly with mucus to make it more watery.  This action makes the cough more productive
    • Administered by nebulization

    • Can trigger bronchospasm
    • Sulfur odor
  15. Antimycobacterial agents
    Treatment is always done with 2 or more drugs

    • Isoniazid (INH)
    • Rifampin
    • Pyrazinamide
    • Ethambutol
    • Streptomycin (secondary drug)
  16. Isoniazid (INH)
    • PO/IM daily
    • Hepatoxicity, hepititis.  Give Vitamin B6 to prevent/decrease neuropathy
    • Avoid tyramine foods

    Monitor AST,ALT
  17. Rifampin
    • PO/IV daily
    • Rifamate (INH + rifampin)

    • Orange discoloration of urine and other secretions.
    • Contact discoloration

    Monitor AST,ALT
  18. Pyrazinamide
    • PO
    • Affects kidneys.
    • Hepatoxicity, hyperuricemia arthralgia (joint pain), GI irritation

    Monitor AST,ALT, uric acid
  19. Ethambutol
    • PO twice weekly
    • Affects the eyes

    • Optic neuritis, impaired red green color discrimination.
    • May lead to blindness
  20. Streptomycin
    • IM twice weekly
    • Secondary drug
    • Affects the ears
    • Ototoxicity, nephrotoxicity, hypokalemia
Card Set:
Respiratory Drugs
2014-03-18 23:24:21

Respiratory Drugs
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