Airway Pharmacology

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Airway Pharmacology
2011-03-27 18:52:01
Airway Pharmacology

CH 32
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  1. What are the three phases?
    • The Drug Administration Phase.
    • The Pharmakinetic Phase
    • The pharmacodynamic Phase
  2. 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.
  3. The pharmakinetic phase
    Describes the time course and deposition of a drug in teh body based on its absoprtion, distrubution, metabolism, and elimination.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. Racemic epineprine
    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.
  9. a-receptor stimulation
    Causes vasoconstriction and a vaspopressor drug (Increase in blood pressure)

    Racemic Epi.
  10. b1 receptor stimulation
    Causes increased HR and heart contractility
  11. b2 receptor stimulation
    Relaxes broncial smooth muscle, stimulates mucociliary activity.

    ex) Albertol and Xopenex. (Short acting rescue drugs)
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. Mucus controlling agents?
    N-Acetyl L-Cystine (NAC) and Dornase alfa.
  17. 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.
  18. 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.
  19. 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.
  20. Aerosolized Antiinfective Agetns?
    • Pentamindine Isethoate
    • Ribovirin
    • Inhaled Trobomycin
    • Colisthalate Sodium
    • Inhaled Zanamivir
    • Use of aeroslized amphoterium B
  21. What are the inhaled pulmonary vasodilators?
    • Nitric Oxide (Inxomax)
    • Illoprost
  22. Antidiabetic Agents
    • 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
  23. Epineprine
    • Brand name: Adrenalin Cl
    • Receptor preference: a, B
    • Adult dosage: 0.25-0.5ml (2.5-5.0 mg)
  24. Racemic epineprine
    • Brand name: MicroNefrin, Nephron, S2
    • Receptor preference; a, B
    • Adult dosage: 0.25-0.5ml (5.63-11.25 mg)

    Adrenergic Broncodilator
  25. Albuterol
    • Brand name: Proventil, Proventil, HFA, Ventolin, Ventolin HFA, ProAir, AccuNeb
    • Receptor preference: b2
    • Dosage: 0.5ml (2.5 mg)

    Adrenergic Broncodilator
  26. Levalbuterol
    • Brand name: Xopenex, Xopenex HFA
    • Receptor Preference: B2
    • Dosage: 0.63 mg or 1.25 mg

    Adrenergic Broncodilator
  27. Ipratropium bromide
    • Brand name: Atrovent
    • Dosage: 0.2 mg/ml

    Anticholineric Broncodilator
  28. Ipratropium bromide and Albuterol
    • Brand name: Combivent
    • Dosage: .iPRATROPIUM: 0.5mg and Albuterol 2.5mg

    Anticholinergic Broncodilator