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What does half life mean on a prescription?
Length of time when 1/2 the dosage is still active in the body
What does additive effect mean?
The effect of 2 chemicals acting simultaneously is the sum of the effects that they would have if it were acting alone
What does tachyphylaxis mean?
Rapidly developing tolerance to a drug
What are the 5 prescription requirements?
- PTs name
- Drug name
- Frequency (times a day)
- Route of administration (po, pr etc)
What are some normal routes of administration? (6)
- IV (intravenous)
- Inhaled (aerosol to lung)
- IM (intramuscular)
- Sub Q (subcataneous injection)
- Topical (ointment)
What are the 3 most common devices used to administer inhaled aerosols?
- MDI (metered dose inhaler)
- SVN (small volume nebulizer)
- DPI (dry powder inhaler)
What are some advantages of inhaled aerosols? (4)
- Can use smaller doses as compared to the systemic route
- Onset of drug is rapid
- Delivery is to the specific organ needing Tx
- Less systemic side effects
What is the pharmacokinetic phase?
The time course and disposition of a drug in the body based on its absorption, distribution, metabolism and elimination
What is the pharmacodynamic phase?
Describes the mechanisms of drug action by which a drug molecule causes its effects in the body
Which 2 receptors are in the lungs?
- Sympathetic adrenergic
- Parasympathetic cholinergic
What neurotransmitter is in the sympathetic system? What does it do?
- Norepinephrine (epinephrine) AKA adrenaline
- Fight or flight
- Dilates pupils
- Dilates bronchioles
- Increased HR
What neurotransmitter is in the parasympathetic system? What does it do?
- Constricts pupils
- Constricts bronchioles
- Decreased HR
What are antagonists?
What are agonist?
What are the 3 receptor preferences and define each
- Alpha - located in peripheral blood vessels; causes vasoconstriction and vasopressor effect
- Beta 1 - located in the heart; causes increased HR and heart contractility
- Beta 2 - located in bronchial smooth muscles; stimulates mucocilliary action
What is an adrenergic drug?
Drug that stimulates a receptor responding to norepinephrine or epinephrine
What is an antiadrenergic drug?
Drug that blocks a receptor for epinephrine or norepinephrine
What is a cholinergic drug?
Drug that stimulates a receptor for acetylcholine
What is a anticholinergic drug?
Drug that blocks a receptor for acetylcholine
What is a muscarinic drug?
Drug that stimulates acetylcholine receptors specifically at parasympathetic nerve-ending sites
What are the 3 Adrenergic bronchodilators?
- Short acting agents -For relief of acute reversible airflow obstruction. Albuterol
- Long acting agents - For maintenance bronchodilation in PTs with obstructive lung disease. Salmeterol
- Racemic epinephrine - Reduces the airway swelling after extubation or with acute upper airway inflammation from croup. Micronefrin
What are some adverse effects of andrenergic bronchodilators?
- Isoproterenol commonly caused tachycardia, palpitations and nervouseness
- Newer B2 selective agents are safe with tremor as the primary side effect
- Tolerance to the drug may occur
What are the 2 anticholinergic bronchodilators?
Ipratropium bromide and Tiotropium bromide
What is the mode of action for anticholinergic bronchodilators?
These agents act as competitive antagonsits for acetylcholine on airway smooth muscle
What are the adverse effects for anticholinergic bronchodilators?
Ipatropium and tiotropium bormide have few systemic side effects since they are both fully ionized and not absorbed
What are the 3 mucoactive contorlling agents?
- Acetylcysteine 10%
- Acetylcysteine 20%
- Dornase alfa
What is Acetylcysteine or mucomyst used for PTs with?
What is dornase alfa or pulmozyme used for PTs with?
What is a common side effect with Acetylcysteine or mucomyst?
Bronchospasm so give albuterol first
What is the mode of action for Acetylcysteine or mucosil?
- Breaks down disulfide groups, smells like sulphur
- Given to reduce accumulation of airway mucus
What is the mode of action for dornase alfa or pulmozyne?
breaks down DNA
What kind of PTs should you NOT use mucoactive agents on?
Neuromuscular PTs. they do not have the Vt cough, they dont have a problem with mucus
What are the 3 different inhaled corticosteroids?
- Fluticasone propionate - Flovent
- Budesonide - Pulmicort turbuhaler
- Fluticasone propionate/salmeterol - Advair
What is an inhaled corticosteroid?
Maintenance drugs, antiinflamatory
What is the mode of action for corticosteroids?
- Lipid soluble drugs that act on interacellular receptors
- Full antiinflammatory effects require hours to days
Why must PTs rinse their mouth out after usuing steroidal drugs?
Thrush can develop
What are the 3 Nonsteroidal antiasthma drugs?
- Comolyn - like agents (cromolyn, nedocromil sodium)
- Antileukotrines (zafirlukast, zileuton)
- Monoclonial antibodies or anti-IgE agents (omalizumab)
What are the 4 antiinfective inhaled agents?
- Pentamidine isethionate - Nebupent
- Ribavirin - Virazole
- Tobramycin - TOBI
- Zanamivir - Relenza
Which 2 antiinfective agents have antiviral modes of action?
- Inhaled Zanamivir
Which 3 antiinfective agents have antibiotic modes of action?
- Colistimethate sodium
- Amphotericin B
Which antiinfective agent has an antiprotozol mode of action?
What are the 2 most dangerous aerosolized medications?
- Pentamidine Isethionate
What are the 2 inhaled pulmonary vasodilators and Tx's?
- Nitric Oxide (INOmax) - Tx of neonates <34 wks with hypoxic resp. failure and pulmonary hypertension
- Iloprost - Tx of pulmonary hypertension
What are the 2 antidiabetic agents?
- Exubera - inhaled insulin used to control hyperglycemia in diabetics
- Xanthines - inhibits phosphodiesterase which maintains cyclic 3,5 amp used with asthmatics and COPD PTs
What are the 2 different Xanthines?