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112 Cards in this Set
- Front
- Back
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What are 3 selective beta 2 agonists?
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Terbutaline
Albuterol Clenbuterol |
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What is selectivity of a drug? Specificity of drug?
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Selectivity: preferentially produces one effect on a receptor
Specificity: affinity for a receptor in different locations in the body- effects it has on body |
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What is the pathophysiologic mechanism of coughing?
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Afferent signaling to brain, elicits a response, when inspire bronchostriction happens and increases pressure and when pressure over comes that pressure there’s an explosion =coughing
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What are 2 functions of respiratory system?
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1) Gas exchange
2) thermoregulatory |
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What are 2 defense mechanisms of the respiratory system?
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1) Mucociliary elevator
2) Immune response |
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What are the parasympathetic nervous system effects on the respiratory tract smooth muscle?
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Baseline tone and mild bronchoconstriction ---> Ach
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What are the sympathetic nervous system effects on the respiratory tract smooth muscle?
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Balance of bronchodilation--> beta2 receptors
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What are the 3 innervations of the respiratory tract smooth muscle?
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1) Parasympathetic NS
2) Sympathetic 3) Irritant receptors |
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What are the 2 intracellular mechanisms of respiratory pharmaceuticals?
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1) Neurotransmitters from nervous system
2) Secondary messengers -Cyclic adenosine monophosphate -Cyclic guanosine monophosphate |
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What is the definition of asthma?
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Pathologic state of chronic inflammatory disorder of the airways in which many cellular elements play a role
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What are the 6 roles of mediators in the pathogenesis of asthma?
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1) Bronchoconstriction
2) Vascular permeability 3) Vasodilation 4) Mucus secretion 5) Chemotaxis 6) Bronchodilation |
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What are the 6 clinical signs of asthma?
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1) Inflammation
2) Wheeze 3) Cough 4) Mucus 5) Shortness of breath/ dyspnea 6) Hyperpnea |
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What are the effects of increased cAMP?
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Get relaxation
-cGMP increase= contraction |
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One of the general principles of respiratory therapy is to break the ________ cycle.
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Inflammatory
-Anti-inflammatory agents |
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What are 6 general principles to respiratory therapy?
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1) Break inflammatory cycle
2) Alleviate bronchoconstriction 3) Reducing volume & viscosity of secretions 4) Control infection 5) Hydration 6) Immunizations |
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What are adrenergic drugs?
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Amine substances that cause physiologic responses similar to those evoked by endogenous adrenergic mediators.
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What is the pathogenesis of asthma?
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Degranulation of leukocytes (mast cells=major contributors) cause release of mediators (5HT, PG's, leukotrienes) which cause decreased cAMP and increased cGMP==> contraction
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What causes hypersensitivity of the airways so that it is susceptible to stimulation by Ach?
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Histamine, then Ach binds===> contraction
-Mechanism involved with asthma |
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What are 3 examples of adrenergic drugs?
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1) Epinephrine
2) Norepinephrine 3) Isoproterenol -Also called sympathomimetics |
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What are the two types of adrenergic receptors? Where are they located?
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Alpha
-Alpha 1: blood vessels -Alpha2: blood vessels Beta -Beta1: myocardium -Beta2: lungs (vasodilation) |
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What happens when alpha1 and alpha2 receptors are activated?
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Vasoconstriction of bronchi
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What is the beneficial pharmacological action of beta-adrenergic agonists?
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Bronchodilation during bronchoconstriction
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What is the mechanism of action of beta-adrenergic agonists?
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Beta2 agonist + receptor in bronchial smooth muscle==> conformation change of receptor---> activates adenylate cyclase--> increased cAMP--> bronchodilation (Relaxation)
-Mast cells: stimulation--> decreased release of inflammatory mediators -Promotes mucocilliary clearance |
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What is the mechanism of action of Epinephrine?
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Beta and alpha-adrenergic agonist
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What is the therapeutic indication of epinephrine?
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Emergency treatment of life-threatening bronchoconstriction
Vet: primarily for anaphalaxis or cardiac resuscitation |
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What are the adverse effects of epinephrine?
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Induce anxiety/fear, tremor, excitability, vomiting, hypertension, arrhythmias, hyperuricemia, lactic acidosis, necrosis at injection site
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What are 3 contraindications of epinephrine?
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1) Narrow angle glaucoma
2) Cardiac dilation or coronary insufficiency 3) Caution w/ prefibrillatory cardiac rhythm |
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What are 3 anticholinergic drugs used for respiratory issues?
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1) Atropine
2) Ipratropium bromide 3) Glycopyrrolate |
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What should you monitor after giving an animal epinephrine (IV, SC or IM)?
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Cardiac rate, rhythm, repiratory rate, BP, blood gases
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What are 6 drugs that interact with epinephrine?
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1) Other sympathomimetics (i.e. isoproterenol)
2) Digoxin (risk of arrhythmia) 3) Nitrates (lose pressor effects) 4) Levothyroxine (potentiated) 5) Beta blockers 6) Alpha blockers |
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What is the mechanism of action of ephedrine?
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Sympathomimetic bronchodilator that indirectly stimulates alpha, beta1 & 2 receptors by causing release of norepinphrine
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What are 2 indications for ephedrine?
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Bronchodilator
Nasal congestion in small animals |
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What are 6 adverse effects of ephedrine?
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1) Restlessness
2) Irritability 3) Tachycardia 4) Hypertension 5) Possible anorexia 6) Tachyphylaxis |
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What are 6 health conditions you need to use caution in using ephedrine?
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1) CV disease (arrhythmia)
2) Glaucoma 3) Prostatic hypertrophy 4) Hyperthyroidism 5) Hypertension 6) Diabetes |
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What is the mechanism of action of isoproterenol?
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Potent nonselective beta receptor agonist
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What is the therapeutic indication of isoproterenol?
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Infrequent use in emergency relief of bronchoconstriction in horses
Dogs/cats: sinoatrial arrest, sinus bradycardiac, complete AV node block |
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How long do the effects of isoproterenol last?
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Onset is immediate iV, but effects end shortly after discontinued
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What are 7 adverse effects of isoproterenol?
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1) Tachycardia
2) Anxiety 3) Tremors 4) Excitability 5) Head ache 6) Weakness 7) Vomit |
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What is the mechanism of action of terbutaline (Brethine)?
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Beta1 & 2 receptor agonist
-selective beta2 agonist |
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What is the indication of terbutaline?
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Bronchodilator usually seen as adjunct therapy in small animals
-Cardiopulmonary disease: tracheobronchitis, pulmonary edema, allergic bronchitis |
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What are 5 adverse effects of terbutaline?
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1) Tachycardia
2) Increased HR 3) Tremors 4) Nervousness 5) Dizziness |
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What are 2 reasons to use caution with terbutaline (brethine)?
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Hypokalemia
Heart disease |
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What is the mechanism of action of albuterol?
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Beta2 agonist
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What are the indications of albuterol?
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Bronchodilator for dogs/cats/horses for symptomatic relief in bronchospasm or cough
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The adverse effects of albuterol is similar to that of other sympathomimetics, but what adverse effect is unique to albuterol in cats?
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Increase in airway inflammation
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What is the therapeutic indication for clenbuterol?
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Managmenet as bronchodilator for recurrent airway obstruction in horses
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What 3 systems are impacted by chronic use of clenbuterol?
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Endocrine
Immune Reproductive systems |
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What are the signs of adverse effects of clenbuterol?
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Sympathomimetic w/ urticaria, sweating, CK elevation, rare ataxia
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What are 2 situations where you need to use caution using clenbuterol?
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Pregnant mares
Cardiovascular impairment (tachycardia) |
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What are 2 methylxanthines?
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1) Theophylline
2) Aminophylline |
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What is the therapeutic use for methylxanthines (theophylline, aminophylline)?
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Bronchodilation
-Beneficial in myocardial failure or pulmonary edema |
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What is the mechanism of action of methylxanthines (5)?
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1) Competitively inhibits phosphodiesterase--> increase cAMP (relaxation)
2) Antagonist of adenosine (adenosine inhibits adenylate cyclase) 3) Inhibition of calcium mobilization to smooth muscle 4) Inhibits mast cell degranulation 5) Increase mucociliary transport |
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What is a therapeutic indication of methylxanthines in dogs/cats?
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Cardiac and respiratory diseases
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Which methylxanthine is absorbed per os profoundly?
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Theophylline
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Do methylxanthines have a broad or narrow therapeutic window?
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Narrow-so monitor plasma concentrations
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What are 3 adverse reactions of methylxanthines?
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1) GI
2) CNS 3) Arrhythmia |
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What are 2 toxicity signs of methylxanthines?
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Cardiac dysrhythmias
Seizures |
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How do methylxanthines affect other drugs?
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Induces cyt p450 so can increase/decrease drug levels
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Anticholinergic drugs= ______.
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Parasympatholytic
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What is the mechanism of action of anticholinergic drugs?
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Compete with ACh at muscarinic receptor sites
-Reduce sensitivity of irritant receptors -Inhibition of vagally mediated cholinergic smooth muscle tone in respiratory tract |
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What is the indication for atropine use?
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Primary to facilitate bronchodilation in acutely dyspenic animals
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What is the treatment of choice for life-threatening respiratory distress induced by anticholinesterases?
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Atropine
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Combination therapy of atropine with _______ may be helpful.
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Beta agonist/glucocorticoid
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What are 3 adverse effects of atropine?
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Secretions
Urinary GI |
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What are 4 cautions of atropine use?
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1) GI infection
2) Geriatric 3) Induction of colic cases 4) Narrow angle glaucoma |
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What are the therapeutic indications of ipratropium bromide (atrovent)?
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Adjunct in bronchospasm
-Recurrent airway obstruction and heaves in horses |
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How is ipratropium bromide administered?
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Local (inhaled)-minimal absorption systemically
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What is a adverse effect of ipratropium bromide?
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Coughing
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What is the main goal of glucocorticoid use?
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Use as little and shortest amount of time possible
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What are 3 non-selective beta agonists?
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Ephedrine
Isoproterenol Epinephrine |
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What is the mechanism of action of glucocorticoids?
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Stops release of inflammatory mediators from macrophages and eosinophils
-Decreases synthesis of PGs, leukotrienes, PAF |
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What is the relative dose of glucocorticoids used for respiratory issues?
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Using for inflammation so a lower dose compared to immunosuppression
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What are 5 adverse drug reactions of glucocorticoids?
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1) Gluconeogenesis
2) GI 3) Behavioral changes 4) Weight gain 5) Reduced ability to fight infection |
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What are 2 drugs that are mast cell stabilizers?
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Cromolyn Sodium
Nedocromil |
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What is the mechanism of action of mast cell stabilizers?
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Chloride-channel blockers that modulate mast cell mediator release and eosinophil recruitment
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What are the uses of mast cell stabilizers?
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-May provide reduction in airway hyperactivity; airway inflammatory disease; recurrent airway obstruction/ heaves in horses
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What are the adverse drug reactions of mast cell stabilizers?
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None, relatively safe profile
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What are 2 antileukotrienes?
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Zafirlukast and montelukast
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What is the mechanism of action of antileukotrienes?
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Leukotriene receptor antagonist
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What are 4 therapeutic indications of antileukotrienes?
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1) Feline asthma
2) Atopic dermatitis 3) Inflammatory bowel disease 4) upper respiratory disease/ heartworm upper respiratory disease |
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What are the adverse drug reactions of antileukotrienes?
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Relatively safe
-Vomiting in dogs -Head ache in humans |
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True or false. Antihistamines are commonly used in respiratory therapy.
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False, use is limited in respiratory therapy
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What is the mechanism of action of antihistamines?
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Competitively compete for histamine receptors (H1); they do not prevent release of histamine
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What are 6 antihistamines?
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1) Chlorpheniramine
2) Ceterizine (Zyrtec) 3) Clematine 4) Diphenhydramine 5) Hydroxyzine 6) Tripelennamine |
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What is chlorpheneramine used for?
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Antipruritic
Sedation (occassional) |
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What is ceterizine used for?
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Pruritic conditions in dogs/cats
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What are 4 uses of diphenhydramine?
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Antihistamine, sedation, pruritis, antiemetic (small animals)
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What are 3 uses of hydroxyzine?
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Antipruritic, sedative, atopic patients
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What is tripelennamine used for?
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Injectable to reduce/ prevent ADR antihistamine
-Stimulant for cows |
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What are 2 potential adjunct therapies to use in asthmatic felines?
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1) Cyproheptadine
2) Cyclosporine |
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What is the mechanism of action of cyproheptadine?
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H1 receptor antagonist serotonin antagonist
-Serotonin plays role in allergen-induced bronchoconstriction in cats |
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What are the 3 adverse drug reactions of cyproheptadine?
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Weight gain/increased appetite
Lethargy Depression |
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What is the mechanism of action of cyclosporine?
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Negative effect on active T lymphocytes
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What is tussigon (antitussive) used for?
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Canine antitussive for cough secondary to trachea collapse, bronchitis, upper respiratory tract infection
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What is the mechanism of action of tussigon?
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Direct suppression of the cough reflex on the cough center in medulla
-Hydrocodone has drying effect on respiratory tract |
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What are 2 adverse drug reactions of tussigon?
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Sedation
Constipation |
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What is the therapeutic indication of torbutrol?
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Chronic non-productive cough
-Preanesthetic |
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What are 2 antitussives?
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Tussigon
Torbutrol (butorphanol) |
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What is the mechanism of action of torbutrol?
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Kappa and sigma receptors in the limbic system
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What are 3 cautions when using torbutrol?
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1) Liver disease
2) Lower respiratory tract w/ mucous 3) Heartworm disease in dogs |
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What are 6 adverse drug reactions of torbutrol?
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1) Sedation
2) Excitement 3) Respiratory depression 4) Ataxia 5) Anorexia 6) Decrease GI motility |
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What are 2 expectorants?
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1) Potassium Iodide
2) Guaifenesin |
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What is the mechanism of action of potassium iodide?
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Increase fluidity of respiratory secretions through gastric mucosa irritation eliciting reflex
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What is the mechanism of action of Guaifenesin?
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Centrally acting muscle relaxant that may also have an expectorant effect
-May stimulate bronchial secretions via vagal pathways -Volume & viscosity of bronchial secretions doesn't change, particle clearance from airways may accelerate |
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What drug is a mucolytic?
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N-acetylcysteine
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What is the therapeutic use of N-acetylcysteine?
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Increase clearance of bronchial exudate
-Acetaminophen toxicity |
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What is the mechanism of action of N-acetylcysteine?
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Sulfhydryl groups on compound interact w/ disulfide bonds on mucoprotein--> breaks down respiratory mucus and enhance clearance
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What are 2 adverse drug reactions of N-acetylcysteine?
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Reflex bronchoconstriction
Vomit at higher doses |
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What drug is a decongestant?
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Pseudoephedrine
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What is the mechanism of pseudoephedrine?
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Alpha-adrenergic agonist
-Causes local vasoconstriction in mucous membranes which reduces swelling & edema |
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What is the therapeutic use for doxapram (respiratory stimulant)?
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Primary for emergency situations during anesthesia or to decrease the respiratory depressant effects of opiates, barbiturates
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What is the mechanism of action of Doxapram?
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Stimulates the medullary respiratory center and the chemoreceptors of the carotid artery and aorta to increase tidal volume
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