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125 Cards in this Set
- Front
- Back
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Sympathetic nervous system nuerotransmitter
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Epinehprine or norepinephrine
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Stimulates the sympathetic nervous system
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Adrenergic
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Nervous system that promotes bronchodilation
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sympathetic (adrenergic)
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Parasympathetic nervous system neurotransmitter
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acetylcholine
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Stimulates the parasympathetic nervous system
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Cholinergic
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Blocks the parasympathetic system actions
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Anticholinergic, Parasympatholytic
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Nervous system that promotes bronchoconstriction
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Parasympathetic (cholinergic, parasympathomimic)
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Constitutes the three phases of drug administration
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1. Administration route
2. Pharmacokinetic phase - Mode of action 3. Pharmacodynamics - how drug reaches reaction site, (drug signaling) |
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Indication for use of adrenergic bronchodilator
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Reversible airflow obstruction
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Indication for short acting agents
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relief of acute reversible airflow obstruction
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Indication for long-acting adrenergic bronchodilators
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maintenance bronchodilation and control of bronchospasm and nocturnal symptoms
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Indication for Racemic Epinephrine
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strong vasoconstrictor; used for airway swelling (after extubation, during epiglottitis, croup or bronchiolitis; control bleeding during endoscopy
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catecholamines - side effects; and examples
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lack beta 2 specificity; cause cardiac effects; examples epinephrine, isoproternol & isoetharine
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Three receptors that can be stimulated by adrenergic agonists
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alpha - causes vasoconstriction
beta 1 - increases HR & contractility beta 2 - bronchodilaton, increased mucociliary activity |
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Common adverse effects of inhaled medications that are beta 2 specific
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tremor (#1)
headache insomnia nervousness |
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anticholinergics act to
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block bronchoconstriction; resulting in bronchiol relaxation
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what indicataes bronchospasm is reversible
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a 15% or > improvement in flow rates
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Examples of Quick Relief Adrenergic Bronchodilator Drugs (a.k.a. Rescue Agents)
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Metaproterenol/Alupent
Albuterol/Proventil, Ventolin Levalbuterol/Xopenex |
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Examples of Maintenance Adrenergic Bronchodilator Drugs (a.k.a long acting agents)
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Salmeterol/Serevent
Formoterol/Foradil Arformoterol/Brovana |
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Four Advantages of inhalation route of medication administration
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1. doses smaller
2. quick onset of drug action 3. targeted delivery 4. fewer side effects/less severe |
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What is the primary use of racemic epinephrine?
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Strong vasoconstrictor; used to reduce airway swelling
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Why is Ipratropium used? It is indicated for use in what type of patients?
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bronchodilators for maintenance treatment in COPD - including chronic bronchitis & Emphysema
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Ipratropium bromide brand name and class
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Atrovent
anticholinergic bronchodilator |
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Ipratropium/Atrovent
Onset, Peak Effect & Duration |
Onset: 15 min
Peak: 1-2 hour Duration: 4-6 hr |
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What medication contains both ipratropium and albuterol?
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Combivent
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Ipratropium Bromide/Atrovent
Class Time Course |
Anticholinergic bronchodilator
Onset: 15 min Peak: 1-2 hr Duration: 4-6 hr |
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Tiotropium bromide/Spiriva
Class Time Course |
Anticholinergic bronchodilator
Onset: 30 min. Peak: 3 hr. Duration: 24 hr. |
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Albuterol/Proventil, Ventolin
Class Time Course |
Adrenergic Bronchodilator
Onset: 15 min Peak: 30-60 min Duration: 5-8 hr |
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Levalbuterol/Xopenex
Class Time Course |
Adrenergic Bronchodilator
Onset: 15 min Peak: 30-60 min Duration:5-8 hr |
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Salmeterol/Serevent
Class Time Course |
Adrenergic Bronchodilator
Onset: 20 min Peak: 3-5 hr Duration: 12 hr |
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Formoterol/Foradil
Class Time Course |
Adrenergic Bronchodilator
Onset: 15min Peak:30-60 min Duration: 12 hr |
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Arformoterol/Brovana
Class Time Course |
Adrenergic Bronchodilator
Onset: 15 min Peak: 30-60 min Duration: 12 hr |
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Acetylcysteine 10%
class brand name dosage |
Mucoactive Agent
Mucomyst, Mucosil-10 SVN 3-5 ml |
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Acetylcystein 20%
class brand name dosage |
Mucoactive Agent
Mucomyst, Mucosil-20 SVN 3-5 ml |
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Dornase alfa
class brand name dosage |
Mucoactive Agent
Pulmozyme SVN: 2.5mg/ampule (1 ampule daily) |
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NAC
name indication |
N-Acetyl-Cystein
given by SVN or instillation reduces accumulation of airway secretions |
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Dornase alfa is mostly used/indicated for:
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CF Patients
reduces frequency of Respiratory infections. |
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Dornase alfa
Mode of Action |
Dornase alfa is a proteolytic enzyme; brk. down DNA in neutrophils found in purulent sputum, reducing viscosity
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Dornase alfa
Side effects |
pharyngitis, voice alteration, laryngitis, rash, chest pain, and conjuctivitis
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N-Acetyl-Cystein (NAC)
Mode of Action |
Thins secretions;
can help remove mucus plugs by direct bronchial instillation during bronchoscopy |
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Dornase alfa/Pulmozyme
Side Effects |
Primarily Bronchospasm; pretreat w/bronchodilator
Incompatible w/certain antibiotics; airway obstruction due to rapid liquefication of secretions |
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Bland Aerosols are used to:
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Mucoactive agents; improve mobilization of secretions and cause productive coughing
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How do expectorants work differently then other agents as a mucoactive
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Expectorants stimulate production & clearence of airway secretions rather than cause mucolysis
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Examples of common expectorants
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guaifenesin (a.k.a. glyceryl guaiacolate) found in many OTC medications (Mucinex)
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Contraindications of Mucuactive therapy
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GERD
inability to clear mucus once thinned worsening airflow |
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what is a common side effect of mucus controlling agents?
How would you treat? |
Bronchospasm is common Side effect.
Administer bronchodilator prior to mucolytic |
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Indications & purposes of inhaled corticosteroids
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antiinflammatory maintenance therapy of persistent asthma and severe COPD
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Inhaled Corticosteroid
Effect and course of action |
Full antiinflammatory effects takes hours to days; patient must understand they will not receive immediate relieve
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Oral corticosteroids can be used in an asthma excacerbation to:
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initially clear the airway or "burst" therapy to control asthma exacerbations
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Most common local effect of steroids, and way to prevent
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Candidiasis and dysphonia
Rinse mouth after treatment |
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List some common corticosteroids used for oral inhalation
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Triamcinolone acetonide/Azmacort
Flunisolide/AeroBid Fluticasone propionate/Flonase Budesonide/Pulmicort |
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List some combination steroids used for oral inhalation
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Fluticasone/salmeterol = Advair (steroid/adrenergic)
Budesonide/formeterol = Symbicort (steroid/adrenergic) |
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Nonsteroidal Antiasthma Medications
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Cromolyn-like agents
Antileukotrienes Monoclonal Antibody |
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Indication for use of nonsteroidal antiasthma medications
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prophylatic management of mild to moderate persistent asthma (step2 or greater)
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What is particulary used in children instead of introducing a steroid to their therapy?
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Cromolyn Sodium/Intal or
Nedocromil sodium/Tilade |
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Cromolyn like agents work by
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stabilizing the mast cells
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Antileukotrienes work by
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blocking a phase in the inflammatory process to prevent inflammation
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Monoclonal Antibodies work by
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Tieing up the IgE and preventing an over exaggerated response as seen in asthma
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Nonsteroidal antiasthma medications
mode of action |
All agents are considered controllers;
can take up to 3 weeks of tx when patient is asymptomatic to reach desired effect |
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Cromolyn like Agents
Examples Mode of action |
Cromolyn/Intal
Nedocromil/Tilade Mast cell stabilizers |
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Antileukotrienes
Examples Mode of action |
Zafirlukast/Accolate
Montelukast/Singulair Zileuton/Zyflo Blk phase of inflammatory process |
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Monoclonal Antibody
Examples Mode of action |
Omalizumab/Xolair
Ties of IgE & prevents over exaggerated response |
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Inhaled Anti-infective agents
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Pentamidine/Nebupent
Ribavirin/Virazole Tobramycin/TOBI Zanamivir/Relenza |
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Most common idication of pentamidine/Nebupent
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Used in patients with severely immunocompromised systems. Commonly tx of PCP in aids patients
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Most common idication of Ribavirin/Virazole
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Used to treat RSV in children and infants
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Most common indication of Tobramycin/TOBI
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used to treat pseudomonas aeriginosa in CF patients and COPD patients
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Most common indication of Zanamivir/Relenza
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treat flu virus in people 7 and older who have been symptomatic for no more then 2 days
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Antifungal therapy and the FDA
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no FDA approved antifungal drugs available for inhalation
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Only 2 FDA approved vasodilators for inhaltion therapy are:
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Nitric oxide gas
iloprost |
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Nitic Oxide (INOmax) indications of use
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nitric xocide is indicated in treatment of neonates >34weeks w/hypoxic RF
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When is nitric oxide contrindicated?
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In infants with dependent right to left shunts
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what is the only inhaled antidiabetic form of insulin?
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Exubera
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How is Pentamidine/nebupent administered?
What is dosage? |
administerd by Respigard II, which has 1 way valves
Dose: 300 mg in 6ml sterile water once a month |
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How is Ribavirin administered?
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SPAG (small particle aerosol generator)
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What is Colistimethate Sodium indicated for?
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Treat patients with CF who have a pseudomonas a. infection that is shown resistant to typical antibiotics
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Acetylcysteine/Mucomyst is often used in the ER but not as a mucoactive agent. What is its other use?
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Reverses the effects of acetaminophen overdose
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Hypotonic solution concentration of bland aerosol and its action
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hypotonic = 0.45
absorbs into lungs and bloodstrem and increases blood volume |
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Hypertonic solution concentration of bland aerosol and its action
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hypertonic = 5-10%
decreases the blood volume; water moves out of the lungs and blood |
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Isotonic solution concentration of bland aerosol and its action
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0.9% = isotonic
does not effect blood volume |
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Which drugs can cause serious eye pain and injury if gotten into the eye?
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Anticholinergics
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What anticholinergics are given as maintenance therapy in COPD?
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Ipratoropium/Atrovent MDI q: 4-6hr
Tiotropium/Spiriva DPI q: 24 hr |
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What is the benefit of using both adrenergic and anticholinergic agents together?
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Adrenergic agents dilate smaller airways
Anticholinergic agents dilate midsize airways Both manage secretions |
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Anticholinergics block what nervous system and have what kind of effect?
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Block parasympathetic
speed up HR cause bronchodilation Decrease mucus production |
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Parasympathetic stimulation causes:
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Body - SLUD
Lungs - bronchoconstriction, increased mucus production Heart - decreases heart rate |
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What should be monitored when administering any drugs by the aerosol route?
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RR & pattern
BP Pulse Breath sounds SPO2 |
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What specific tests can be obtained to monitor the effects of bronchodilator therapy?
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Flowrates - peak flow meter
PFT's for volumes & capacities portable spirometry Lab reports (ABG's) |
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Common side effects of Anticholinergic agents
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cough and dry mouth
MDI - nervousness, headache SVN - Pharyngitis, dyspnea |
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Colistimethate Sodium (a.k.a. Colistin) is used for:
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Nebulized for gram negative bugs
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What is used to treat aspergillus
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amphotericin B
Bronchospasm is common, pretreat w/albuterol |
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Ipratropium and tiotropium block the action of acetylcholine at what receptor?
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M3 receptor in the airway which reverses bronchoconstriction due to cholinergic activity
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Short Acting (Rescue Agents)Adrengergic Bronchodilators
and their duration |
2-6 hr duration
Metaproterenol/Alupent 5-8 hr duration Albuterol/Proventil, Ventolin Levalbuterol/Xopenex Pirbuterol/Maxair |
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Long Acting (Controller/Maintenance) Adrenergic Bronchodilators
and their duration |
12 hour duration
Salmeterol/Serevent Formoterol/Foradil Arformoterol/Bovana |
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Ultra-Short Acting Adrenergic Bronchodilators and their duration
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Onset: 3-5 min. Duration 1-3hr
Epinephrine/Adrenalin Cl or Primatene Mist Racemic Epinephrine/MicroNefrin or Nephron,S2 Isoetharine, Bronchosal |
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Short Acting (Rescue Agents)
Anticholinergic Bronchodilators and their duration |
onset 15 min; duration: 4-6hr
Ipratropium bromide/Atrovent Ipratropium & Albuterol/Combivent |
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Long Acting (Controller/maintenance) Anticholinergic and its duration
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onset 30min: duration 24hr
Tiotropium bromide |
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Mucoactive Agents
Given as SVN |
Acetylcystein 10% & 20%/Mucomyst
Dornase alfa/Pulmozyme Aqueous Solutions: water, saline (0.45%,0.9%, 5-10%) |
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Acetylcystein 10% & 20%/Mucomyst administration and dosage
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both 10% and 20% solution given by SVN
Dosage: 3-5 ml |
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Corticosteroids administered by MDI
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Triamcinolone/Azmacort
Flunisolide/AeroBid Budesonide & formoterol = Symbicort (steroid/adrenergic) |
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Corticosteroids administered by DPI
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Budesonide/Pulmicort
Fluticasone & salmeterol = Advair (steroid/adrenergic) |
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List Corticosteroids
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Triamcinolone/Azmacort
Fluticasone/Flovent Budesonide/Pulmicort Flunisolide/AeroBid Fluticasone & Salmeterol = Advair Diskus Budesonide & formoterol = Symbicort |
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Nonsteroidal Antiasthma Agents (Controller/Maintenance Drug)
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Cromolyn/Intal
Nedocromil/Tilade Zafirlukast/Accolate Montelukast/Singulair Zileuton/Zyflo Omalizumab/Xolair |
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Nonsteroidal Antiasthma (Controller/maintenance drug)
Cromolyn-like Agents |
Cromolyn/Intal (MDI,SVN,nasal spray)
Nedocromil/Tilade (MDI) |
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Nonsteroidal Antiasthma (Controller/maintenance drug)
Antileukotrienes |
Zafirlukast/Accolate
Montelukast/Singulair Zileuton/Zyflo (tablets/granules) |
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Nonsteroidal Antiasthma (Controller/maintenance drug)
Monoclonal Antibody |
Omalizumab/Xolair
(IM every 4 weeks) |
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Inhaled Antiinfective Agents
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Pentamidine/Nebupent
Ribavirin/Virazole Tobramycin/TOBI Zanamivir/Relenza |
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Pentamidine/Nebupent
Formulation & Dosage |
300mg powder in 6ml sterile water; 300mg every 4 week
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Antiviral given for RSV or bronchiolitis
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Ribavirin/Virazole
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Antibiotic used to treat P.aeruginosa in CF;
COPD |
Tobramycin/TOBI
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Antiinfective used to treat influenza
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Zanamivir/Relenza
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Inhaled Pulmonary Vasodilators
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Nitric Oxide (INOmax)
iloprost (Ventavis) |
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B-agonists & anticholinergic bronchodilators are used to:
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reverse or improve airflow obstruction
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Mucolytics are used to:
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reduce mucus visocsity and improve mucociliary clearance
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Corticosteroids & nonsteroidal antiasthma agents are used to:
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reduce or prevent airway inflammation in asthma
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B agonists mode of action
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relax smooth muscle
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anticholinergic agents
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block cholinergic (muscarinic) receptors in the airway to prevent bronchoconstriction
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mucolytics mode of action
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lyse mucus
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corticosteroids mode of action
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modify cell nuclear transcription to cause an antiinflammatory effect
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cromolyn like agents mode of action
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Inhibit inflammatory mediator release or action
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leukotreines mode of action
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block IgE receptors
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Antiinfectives mode of action
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inhibit particular infecting organisms
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Long term controll agents
(from all classes) |
salmeterol/serevent
formoterol/foradil arformoterol/Brovana all inhaled corticosteroids nonsteroidal antiasthma drugs |
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Repeated respiratory infection requiring antibiotics/hospitalization causing decline in lung function in a CF patient is an indication for the use of:
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Dornase alfa/Pulmozyme
or Tobramycin/TOBI |
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Anticholinergic (antimuscarinic) bronchodilators are only effective if:
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bronchoconstriction is due to cholinergic activity
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What is the difference in action of adrenergic agents and anticholinergic agents?
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adrenergic work by an active stimulatory action
and anticholinergics work by a passive blockade |
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Anticholinergic (antimuscarinic) agents
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Rescue - Fast acting:
Ipratropium bromide/Atrovent Controller - Maintenance: Tiotropium bromide/Spiriva |
