Drugs On The Respiratory System

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Diphenhydramine ( Benadryl, others)

Back 1

First generation h1- receptors antagonist whose primary use is to treat minor symptoms of allergy and the common cold such as sneezing , runny nose , and tearing of the eyes . Administered topically to treat rashes, IM and IV forms are available for severe allergic reactions. Other uses are for Parkinson's disease, motion sickness , and insomnia.

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Dyphenhydramine (Benadryl) administration alerts

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Increased risk of anaphylactic shock when administered parentally

Administering IV, inject at a rate 25 mg/min to reduce risk of shock

Administering IM, inject deep into large muscle to minimize tissue irritation.

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Dyphenhydramine (Benadryl) pharmacokinetics

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PO: 15-30 min

Peak: 1-4 h

Duration: 4-7 h

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Dyphenhydramine (Benadryl) adverse effects

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First generation H1- antagonist cause significant drowsiness, occasionally paradoxical CANS stimulation and excitability will be observed rather than drowsiness. Excitation is more frequent in children. Anticholinergic effects such as dry mouth. Tachycardia and mild hypotension. May cause hyperthyroidism.

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Dyphenhydramine ( Benadryl) contraindications

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Hypersensitivity to the drug , benign prostatic hypertrophy (BPH) , narrow -angle glaucoma , and GI obstruction. Used cautiously in patients with asthma or hyperthyroidism.

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Diphenhydramine ( Benadryl) interactions

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Drug - drug - use with CNS depressants like alcohol or opiods can increase sedation. OTC cold preparations may increase anticholinergic side effects. Monoamine oxidase inhibitors may cause hypertensive crisis.

Labs - drug discontinued at least four days before allergy testing , otherwise false negative may results

Herbal/food- henbane may increase anticholinergic effects .

Treatment of overdose - over may cause CNS depression or excitation. No specific treatment for overdose.

Front 7

Diphenhydramine (Benadryl) route and dose

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PO: 20-59 mg tid to qid ( max : 300 mg / day ).

Front 8

Dyphenhydramine( Benadryl) therapeutic class and pharmacologic class

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Therapeutic class- drug to treat allergies

Pharmacologic class- H1 receptor antagonist; antihistamine.

Front 9

Fluticasone (Flonase, veramyst, others) therapeutic class and pharmacologic class

Back 9

Therapeutic class - drug for allergic rhinitis

Pharmacologic class - intranasal corticosteroids.

Front 10

Fluticasone (veramyst, flonase,) actions and uses

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Intranasal corticosteroids to treat allergic rhinitis. Two sprays in each nostril, twice daily , decreases to one dose per day. Acts to decrease local inflammation in nasal passages reducing nasal stuffiness.

Approved for both seasonal and perennial allergic rhinitis.

2012 dymista was approved which combines fluticasone with azelastine, H2-receptor antagonist .

Fluticasone is available in oral inhalation to reduce bronchial inflammation for copd and asthma.

2014 second oral formulation of fluticasone (arnuity ellipta) for maintenance of asthma.

Topical fluticasone treat various inflammation condition including atopic dermatitis, eczema, psoriasis, and contact dermatitis.

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Fluticasone (veramyst flonase) administration alerts

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Instruct pt to carefully follow the directions for use provided by manufacturer.

Pregnancy category C

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Fluticasone ( veramyst flonase) adverse effects

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Swallowing large amounts increase potential for systemic corticosteroids adverse effects. Nasal irritation and epistaxis occur in small number of patients.

Administered intranasally , adverse effects of fluticasone are rare.

When inhaled to treat COPD , most frequent side effects are headache and nasopharyngitis.

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Fluticasone (veramyst flonase) contraindications

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Prior hypersensitivity to drug

Can mask signs of infection

Pts with known MO infections, especially in respiratory tract, should not receive corticosteroids.

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Fluticasone (veramyst flonase) interactions

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Drug -drug concomitant use of intranasal decongestant increase the risk of nasal irritation or bleeding.

Use with ritonavir should be avoided because drug increases plasma fluticasone levels.

Lab test-unknown

Herbal/food- caution with licorice which my potentiate the effects of corticosteroids

Treatment of overdose- no specific treatment

Front 15

Leukotriene modifiers

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Montelukast singular

Therapeutic-anti inflammatory drug for asthma, prophylaxis

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Leukotriene modifiers contraindications

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Hypersensitivity

Rare cases hepatic failure

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Leukotriene modifiers adverse effects

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Headache

Nausea diarrhea

Rare cases - suicidal ideation, hallucinations, aggressiveness, depression

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Leukotriene modifiers administration

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Don't use to terminate acute asthma attacks

Take drug two hours before exercising to prevent exercise-induced bronchospasms.

Pregnancy B

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Leukotriene modifiers action

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Given PO and acts rapidly. Only agent in it's class approved for pediatrics. Available in chewable tablets and granules.

Prevents airway edema and inflammation by blocking leukotriene receptors in the airway.

Front 20

Leukotriene modifiers

Pharmacokinetics

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Rapid 3-4 hours and duration is unknown.

Front 21

Allergic rhinitis of hay fever

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Inflammation of the nasal mucosa die to exposure to allergens.

Symptoms - tearing eyes, sneezing, nasal congestion, postnasal drip, itching of the throat.

Potential complications_-Loss of taste , smell, sinusitis, chronic cough, hoarseness, middle ear infections in children.

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Asthma

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Chronic pulmonary disease with inflammatory and bronchospasms components.

Characteristics-acute bronchospasms, intense breathlessness , coughing , and gasping for air.

Acute inflammatory response stimulates secretion of histamine and other inflammatory mediators , increasing mucus and edema in airways.

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Beta2-adrenergic agonist actions

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Albuterol-saba, relieve bronchospasms of asthma. Rapid onset and excellent for termination of acute bronchospasms.

Facilitates mucus drainage and can inhibit the release of inflammatory chemicals from mast cells.

Inhaled 15-30 min before physical acitivty can prevent excercise induced bronchospasms. Not recommended for asthma prophylaxis.

Front 24

Beta2-adrenergic agonist administration

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Albuterol- use only the actuator that comes with the canister. Observe and instruct patient in proper use.

Pregnancy C

Front 25

Beta2-adrenergic agonist adverse effects

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Uncommon serious effects

Some experience palpations, headaches, restlessness, and tachycardia

Less common - insomnia and dry mouth.

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Beta2-adrenergic agonist contraindications

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Albuterol- contraindicated in patients with hypersensitivity to the drug. Caution required when administering to patient with history of cardiac disease or hypertension.

Front 27

Beta2-adrenergic agonists pharmacokinetics

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5-15 min inhalation , 0.5-2 h for peak and lasts 2-6 h

30 min PO , peak is the same as inhalation, and lasts 8-12 h PO, sustained release.

Front 28

Methylxanthines

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Theophylline and aminophylline

Bronchodilators chemically related to caffeine.

Used as long-term management of persistent asthma that is unresponsive to beta2-adrenergic agonist or inhaled corticosteroids.

Have narrow safety margin

Adverse effects are nausea, vomiting, CANS stimulation, dysrhythmias, can cause nervousness and insomnia.

Administered IV or PO.

Front 29

Inhaled corticosteroids action and therapeutic class

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Beclomethasone qvar-anti-inflammatory drug for asthma and allergic rhinitis.

Available as inhalation for asthma (qvar) or nasal spray(beconase AQ, Qnasl) for allergic rhinitis. Preferred long time management of asthma in children and adults

3-4 weeks of therapy before peak is obtained

Acts by reducing inflammation, decreasing frequency of asthma attacks. Not a bronchodilators and should not be used to terminate asthma attacks in progress.

Front 30

Inhaled corticosteroids administration

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Do not use if patient is experiencing acute asthma attacks

Oral inhalation products and nasal spray products are not to be used interchangeably

Pregnancy C

Front 31

Inhaled corticosteroids pharmacokinetics

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1-4 wk onset, 30-70 min peak, and unknown duration.

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Inhaled corticosteroids adverse effects

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Few systemic adverse effects

Patient should be observed for sign of corticosteroid toxicity.

Local effects may include hoarseness, dry mouth , changes in taste.

Cataract in adults

Long term basis patients may develop oralpharyngeal candidiasis, a fungal infection in the throat.

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Inhaled corticosteroids contraindications

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Can mask signs of infection if an active infection is present.

In those with hypersensitivity to the drug

May reduce growth velocity in some children.

Front 34

Sympathetic nervous system and the respiratory system ?

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Constricts arterioles in the nose , reducing thickness of mucosal layer= wider airway and allow more air to enter.

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Parasympathetic nervous system and the respiratory system ?

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Arterioles dilate and more mucus is produced

Front 36

Administration of sympathomimetic ?

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Will shrink nasal mucosa, relieving nasal stuffiness associated with the common cold.

Front 37

Most common agents for allergic rhinitis ?

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Pollen from weeds, grasses, trees ,molds spores, dust mites , certain foods, and animal dander.

Front 38

Diphenhydramine Benadryl contraindications

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Hypersensitivity to the drug , benign prostatic hypertrophy BPH, narrow-angle glaucoma and GI obstruction. Used cautiously in patients with asthma or hyperthyroidism.

Front 39

Intranasal corticosteroids are also known as what and applied where ?

Back 39

Glucocorticoids and applied directly to the nasal mucosa to prevent symptoms of allergic rhinitis.

Front 40

Intranasal corticosteroids produce virtually no and are often the first line drugs in treatment of allergic rhinitis

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Serious adverse effects

Front 41

When sprayed into the nasal mucosa , corticosteroids decrease?

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Inflammation mediators, reduce tissue edema, and cause mild vasoconstriction.

Front 42

Fluticasone veramyst flonase route and dose

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1 spray in each nostril once (veramyst) twice (Flonase)

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Intranasal sympathomimetic can cause ?

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Rebound congestion.

Front 44

Expectorant route and dose

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Guaifenesin(Mucinex)

PO:200-400 mg q4h(max 2.4 g/day)-drowsiness, headache, GI upset

Extended release PO 600-1200 mg q12h(max 2400 mg/day)- no serious adverse effects

Front 45

Mucolytic route and dose

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Acetylcysteine ( mucomyst )

Inhalation : 1-10 ml of 20 %- unpleasant odor, nausea

Solution q4-6h or 2-20 ml of 10%

Solution q4-6h - severe nausea and vomiting, bronchospasms

Front 46

Antitussives

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Medications that control cough

Front 47

Codeine and hydrocodone are ?

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The most effective opioid antitussives - act by raising the cough threshold in the CNS.

Front 48

Dextromethorphan Deslym Robitussin DM route and dose

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PO 10-20 mg q4h or 30 mg 6-8h(max:120 mg /day)

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Dextromethorphan has the potential abuse in which age group ?

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Teens

Front 50

Define expectorant

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Drugs that reduce the thickness or viscosity of bronchial secretions , thus increasing mucus flow that can be more easily removed by coughing.

Front 51

Mucolytics define

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Break down the chemical structure of mucus molecules. Not OTC and delivered inhalation route. Has an offensive odor resembling rotten eggs.

Administered IV for pts who overdosed on acetaminophen

Front 52

Sympathetic branch on the lower respiratory

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Activated beta2-adrenergic receptors , cause bronchiolar smooth muscle to relax, airway diameter increase, bronchodilation occurs.

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Parasympathetic nervous system on lower respiratory

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Causes bronchiolar smooth muscle to contact, airway diameter to narrow, bronchoconstriction occurs.