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What are the three phases?
- The Drug Administration Phase.
- The Pharmakinetic Phase
- The pharmacodynamic Phase
The Drug Administration Phase
- The method by which drug is made available to the body.
- 1.) Aerosol is the most common route for drug administration to the pulmonary patient.
- 2.) Common devices used to deliver inhaled aerosols are the MDI, SVN, And dry powder inhaler.
- 3.) Advantages of inhaled aerosols:
- - Can use smaller doses as compared to the systemic route.
- - Onset of drug is rapid
- - Delivery is targeted to the organ requiring treatment.
- - Less systemic side effect.
The pharmakinetic phase
Describes the time course and deposition of a drug in teh body based on its absoprtion, distrubution, metabolism, and elimination.
The pharmacodynamic phase
- Describes the mechanism of drug action by which a drug molecule causes its effects in the body.
- Drug effects are caused by combination of a drug with a matching receptor.
What are the airway receptors in teh lung? and what are the neurotransmitters for each receptor?
- Sympathetic (Adrenergic) - The neurotransmitter in the sympathetic is norepineprine (epineprine)
- Parasympathetic (Cholinergic) the neurotransmitter in the parasympathetic is Acetylcholine.
Indication for short acting agents
Short acting b2 agonist such as albuterol and levelbuterol (Xopenex) are indicated for relief of acute reversable airflow obstruction in asthma or other obstructive airway diseases.
Indication for long acting agents
Long acting agents such as salmetrol, formoterol, or arformetrol are indicated for maintenance broncodilation and control of broncospasm and nonctumal symptoms in asthma or other obstructive diseases like COPD.
To reduce airway swelling after extubation or w/ acute upper airway inflammation from CROUP, epiglottitis, or bronchitis.
Often used either by inhaled aerosol or by direct lung instillation for its strong a-adrenergic vasocontricting effect.
Causes vasoconstriction and a vaspopressor drug (Increase in blood pressure)
b1 receptor stimulation
Causes increased HR and heart contractility
b2 receptor stimulation
Relaxes broncial smooth muscle, stimulates mucociliary activity.
ex) Albertol and Xopenex. (Short acting rescue drugs)
Adverse effects for Adrenergic agents?
- Older adrenergic agents such as isoprotemol commonly causes tachycardia, palpitations, and nervousness.
- Newer B2 selective agents are safe, w/ tremor as the primary side effects.
- Tolerance (Tachypalaxis) may occur.
What should you do when you asssess a patient w/ broncodilator therapy?
- Based on teh dindications for the aerosol agent.
- Vital signs, breath sounds, and breathing pattern should be evaulated before and after treatment.
- The patients subjective response is important to evaulate.
Indicators for Anticholinergic broncodilator AND combined anticholinergic b-agonist?
- 1) Indication for anticholinergic broncodilator: Are indicated for maintenance broncodilator therapy for COPD patients.
- 2) Indication for combined anticholinergic and B-Agonist: COPD patients and Asthma patients.
Mode of action and Adverse effect for Anticholinergic broncodilators?
- Mode of Action: These agents act as a competitive antagonist for ACH on airwa smooth muscle.
- Adverse Effect: Ipratropium bromide and tioptripium bromide have fewer systemic side effects since they are fully ionized and are not absorbed.
Mucus controlling agents?
N-Acetyl L-Cystine (NAC) and Dornase alfa.
Indication for Inhaled corticosteroids?
- Orally inhaled preperations are used for antiinflammatory maintenance therapy for persistant asthma and severe COPD.
- The use of nasal steroids is for control of allergic and nonallergic rhinitis.
Three types of nonsteroidal antiasthma drugs?
- Cromolyn (nedocromial sodium) - In tall stablizes your mast cells, they degranulate, release histamine, prevent degranulation.
- Antileukotrines (Zarfirlukast, Zileuton) - Improves inflammation
- Monoclonal antibodies or Anti IGE agents (Omalizmab) - Inflammatory substance.
Indications for Nonsteroidal antiasthma drugs?
- Used for prophlytic management (control) of mild to moderate persistent asthma.
- Used as an alternative to steroids in patients w/ persistent asthma symptoms.
- Offer no benefit for acute (fast acting) airway obstructions in asthma.
Aerosolized Antiinfective Agetns?
- Pentamindine Isethoate
- Inhaled Trobomycin
- Colisthalate Sodium
- Inhaled Zanamivir
- Use of aeroslized amphoterium B
What are the inhaled pulmonary vasodilators?
- Nitric Oxide (Inxomax)
- Exubera is an inhaled insulin
- Used to control hyperglycemia in diabetics
- Should not be used by patients who smoke
- Potential side ffect include cough, dyspenea, pharyngitis, increase sputum, and epistatis
- Brand name: Adrenalin Cl
- Receptor preference: a, B
- Adult dosage: 0.25-0.5ml (2.5-5.0 mg)
- Brand name: MicroNefrin, Nephron, S2
- Receptor preference; a, B
- Adult dosage: 0.25-0.5ml (5.63-11.25 mg)
- Brand name: Proventil, Proventil, HFA, Ventolin, Ventolin HFA, ProAir, AccuNeb
- Receptor preference: b2
- Dosage: 0.5ml (2.5 mg)
- Brand name: Xopenex, Xopenex HFA
- Receptor Preference: B2
- Dosage: 0.63 mg or 1.25 mg
- Brand name: Atrovent
- Dosage: 0.2 mg/ml
Ipratropium bromide and Albuterol
- Brand name: Combivent
- Dosage: .iPRATROPIUM: 0.5mg and Albuterol 2.5mg