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30 Cards in this Set
- Front
- Back
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Antitussive Drugs
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-Antitussives are drugs that suppress the cough reflex.
-Coughing is a reflexive, but persistent coughing can be exhausting, cause muscle strain, and further irritate the respiratory tract. Antitussive drugs include -Nonopioid: dextromethorphan -Opioid: codeine, and hydrocodone |
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Nonopioid Antitussive:
Dextromethorphan |
-Used for treating chronic, nonproductive cough
-Mainly the drug works by affecting the cough center in the medulla -Not for treating chronic choughs resulting from emphysema and asthma -Drug effects are rare: nausea and vomiting, drowsiness, dizziness, irritability, restlessness -Available in a variety of forms. -Absorbed rapidly from the GI tract -Undergoes extensive hepatic metabolism -Related to the opiates |
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Opioid Antitussive: Codeine
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-Controlled substance used in treating cough
-Schedule V -Works directly on the medullary center to suppress the cough reflex -More sedating than dextromethorphan and also may induce respiratory depression -Cautious use: pregnant, breast-feeding, head injuries, chronic cough, addictions; adverse effects include sedation, dry mouth, nausea or vomiting, and constipation |
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Opioid Antitussive:Hydrocodone
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-A controlled substance
-A derivative of codeine -Acts directly on the cough reflex center in the medulla -More sedating than codeine -Same properties, contraindications, and adverse effects. |
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Decongestant Drugs
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-Sympathomimetic agent used to decrease nasal congestion
-Activates alpha1 adrenergic receptors on nasal blood vessels -Can be administered orally or topically -The prototype decongestant is pseudoephedrine (Sudafed), an orally administered decongestant |
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Decongestant:Pseudoephedrine (Sudafed)
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-Reduces the volume of nasal mucus
-Relieves the pressure of otitis media by promoting drainage -Absorbed readily from the GI tract -Duration: 4-6 hours for regular formulations and 8 to 12 hours in extended-release preparations -Mimics the actions of the sympathetic nervous system -Adverse effects: related to the sympathomimetic effects CNS, CV -Contraindications: severe hypertension and CAD -Special caution: diabetes, thyrotoxicosis, BPH, and increased intraocular pressure (IOP) |
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Ephedrine (Kondon’s Nasal)
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Powerful alpha-adrenergic stimulant found in many OTC topical preparations
-Can cause serious effects when absorbed systemically |
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Decongestant:Oxymetazoline (Afrin)
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-Topical decongestant
-Stimulates alpha-adrenergic receptors -Action similar to pseudoephedrine, its route of administration is topical -Patient education: Use greater than 5 continuous days can lead to rebound congestion -Use as directed to avoid systemic effects |
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Phenylephrine (Neo-Synephrine)
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-Powerful alpha-adrenergic stimulant
-Avoid use in abraded nasal membranes -May cause rebound congestion |
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Drugs for Allergic Rhinitis
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-Inflammatory disorder that affects the upper airway, lower airway and eyes
-Symptoms: sneezing, rhinorrhea, pruritis and nasal congestion -Triggered by allergens; bind to IgE on mast cells; release of histamine, leukotrienes and prostaglandins -Treatment: oral antihistamines, intranasal glucocorticoids, sympathomimetics (decongestants) |
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Antihistamines
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-Used to relieve symptoms of allergies
-May be separated into first generation and second generation -1st generation Diphenhydramine (Benedryl) Promehtazine (Phenergan) Hydroxyzine (Vistaril, Atarax) -2nd Generation Allegra, Claritin, Zyrtec, Astelin |
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Antihistamines:
Diphenhydramine (Benadryl) |
-First generation antihistamine
-Significant anitmuscarinic activity and produce marked sedation in most patients -Adv. Eff.: sedation, dizziness, incoordination, fatigue, confusion, Paradoxical effect, anticholinergic effects -Also effective in relieving nausea, vomiting, and vertigo associated with motion sickness, is used to treat extrapyramidal symptoms |
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Antihistamine: Fexofenadine (Allegra)
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-Used to relieve symptoms associated with seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria, and angioedema
-Most effective if used before the onset of symptoms -Taken orally and absorbed rapidly; slightly metabolized in the liver; excreted in feces mostly -Selective blocks the effects of histamine at the H1-receptor sites -Has some anticholinergic and antipruritic effects. -2nd generation: less sedation and anticholinergic effects -Contraindications: hypersensitivity, children younger than 12 years old, pregnant or lactating women, patients with renal failure, use with other CNS depressants -Two second generation antihistamines removed from market (Seldane and Hismanal) due to increased risk of cardiac abnormalities); monitor patient for this; fexofenadine has not been shown to cause cardiac problems |
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Intranasal Glucocorticoids
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-Six agents available
-Most effective drugs for the prevention and treatment of seasonal and perennial rhinitis -Treat all of the major symptoms -Adv. Eff.: drying, burning, itching of nasal mucosa, sore throat, epistaxis, HA -Systemic effects possible: adrenal suppression and slowing of growth in children |
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Expectorant Drugs
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-Drugs that liquefy lower respiratory tract secretions
-Found in many OTC preparations -Guaifenesin (Robitussin, Mucinex, Humabid, Tussin) is the prototype expectorant drug |
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Expectorant: Guaifenesin (Robitussin)
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Taken orally and absorbed readily from GI tract
Duration of action is 4 to 6 hour Eliminated by the kidneys Enhances the output of respiratory tract fluids by reducing the adhesiveness and surface tension of the respiratory fluids; the result of the thinning of secretions is a more productive cough Adverse effects: nausea, vomiting, and anorexia |
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Expectorant: Iodine Preparations
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Used for many years to stimulate an increase in the fluid produced by the lungs
Are used as an adjunctive treatment in respiratory tract conditions such as cystic fibrosis, chronic sinusitis Bitter flavor limits their popularity Must be used with caution because of their effect on the thyroid gland |
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Mucolytic Drugs
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Break down mucus to help the high-risk respiratory patient cough up thick, tenacious secretions to improve breathing and air flow.
Administered by a nebulizer or through and endotrachal tube or tracheostomy. |
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Mucolytic: Acetylcysteine (Mucomyst)
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Used for: COPD, cystic fibrosis, pneumonia, and TB, development of atelactasis, diagnostic bronchoscopy, acetaminophen-induced hepatotoxicity
Onset occurs within 1 minute, peak effect occurring within 5 to10 minutes Contraindications and cautious use: respiratory disease and asthma (can cause bronchospasm and asthmatics dont have copious amts of sputum) Adverse effects: bronchospasm, bronchoconstriction, chest tightness, a burning feeling in the upper airway, and rhinorrhea Initial disagreeable odor Suction equipment should be kept available |
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Asthma Overview
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Common, chronic, inflammatory, immune mediated respiratory condition
Signs/symptoms: dyspnea, chest tightness, wheezing, cough Treatment aimed at controlling bronchoconstriction and inflammation Beta2 agonists glucocorticoids and cromolyn |
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Bronchodilator Classes
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Used to facilitate respiration by dilating the airways
Sympathomimetics beta-2-adrenergic agonists (albuterol) Anticholinergics ipratropiuim bromide Xanthine derivatives theophylline |
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Bronchodilator: Beta2-Agonists (Sympathomimetics)
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Two subtypes of beta-receptors in the body: beta-1 and beta-2
Beta-2 receptors are more predominant in the lungs, beta-1 receptors are more predominant in the heart Formulations Short acting, Long acting inhalers oral Albuterol (Proventil, Ventolin) is the prototypical beta-agonist agent |
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Bronchodilator: Albuterol (Proventil)
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Used for COPD and asthma
Administered: tablet, liquid and by inhalation (MDI or nebulizer) Bronchodilation occurs within 5-15 minutes (inhalation) and within 30 minutes (tablet or liquid) Adv. Effects: related to sympathomimetc activity, tachycardia, dysrhythmias, angina pectoris, tremor Contraindications and precautions: hypersensitivity and hypertension, cardiac disease, cardiac arrhythmias, ischemic heart disease, hyperthyroidism, diabetes mellitus, and seizures. Overuse of albuterol may induce rebound bronchoconstriction, regardless of administration Patient education: rescue drug, proper use of inhaler, frequency of inhaler use, limit caffeine, and refrain certain OTC medications |
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Respiratory Anticholinergic Agents
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Anticholinergic agents diminish the effect of acetylcholine, their terminal neurotransmitter in the parasympathetic nervous system
Use of inhaled anticholinergic drugs stops the bronchoconstriction that is caused by stimulation of the parasympathetic nervous system Ipratropium bromide (Atrovent) is the prototypical respiratory anticholinergic agent |
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Bronchodilator: Ipratropium Bromide (Atrovent)
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Used for maintenance treatment of bronchospasm associated bronchitis, pulmonary emphysema, or COPD, off label use with asthma
Administered through oral inhalation or intranasal spray Antagonizes the action of acetylcholine by blocking muscarinic cholinergic receptors. Contraindications: soya lecithin hypersensitivity, peanut oil, legumes, and soybean hypersensitivity; atropine, bromide, or fluorocarbon sensitivity Cautious use: bladder obstruction, prostatic hypertrophy, closed-angle glaucoma Adverse effects: rare, paradoxic acute bronchospasm—usually seen with the first inhalation from a newly opened MDI; patient should “test-spray” three times before using a new MDI for the first time; anaphylactoid reaction; cough, hoarseness, throat irritation, or dysgeusia Patient teaching: will not abort an asthma attack in progress |
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Bronchodilator: Xanthine Derivatives
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The xanthine derivatives, including theophylline, aminophylline, diphylline, and caffeine, come from a variety of naturally occurring sources.
Theophylline is the prototype xanthine derivative bronchodilator |
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Bronchodilator: Theophylline
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Is indicated for the symptomatic relief or prevention of bronchial asthma and reversal of bronchospasm associated with COPD
Unlabeled use: treatment of apnea and bradycardia in premature infants Well absorbed when given orally (can be given IV) Directly relaxes the smooth muscle of the respiratory tract Contraindications: hypersensitivity, status asthmaticus, peptic ulcer Cautious use: cardiac problems due to stimulatory effects, renal or hepatic disease Adverse effects: related to serum level; normal serum level 10-20 micrograms/ml; greater than 30 micrograms/ml may result in death Many drug interactions: particularly H2 blockers (cimetidine/Tagamet or rantidine/Zantac) and antibiotics Smoking cigarettes may decrease serum theophylline levels, requiring dosages of up to 50% more |
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Anti-inflammatory: Glucocorticoid Steroids
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The most effective anti-inflammatory drugs available for the management for respiratory disorders
May be given orally, parenterally, or by inhalation Peak effect in 1 to 2 week of regular use Used for maintenance drugs, not for acute respiratory symptoms Cautious use: active infection Adverse effects: sore throat, hoarseness, coughing, dry mouth, and pharyngeal and laryngeal fungal infections Patient teaching: rinsing of mouth after use; use spacer; use daily Commonly used inhaled glucocorticoid steroids: beclomethasone dipropionate (Beclovent, Vanceril), dexamethasone (Decadron Phosphate), flunisolide (AeroBid), fluticasone propionate (Flovent), and triamcinolone acetonide (Azmacort) |
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Mast Cell Stabilizer: Cromolyn Sodium (Intal)
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Used as a prophylactic agent in the treatment of mild to moderate asthma; as a nasal inhaler to treat seasonal allergic rhinitis; as an ophthalmic solution to treat allergic conjunctivitis
Improvement of symptoms takes several weeks of therapy Prevents breakdown of mast cell, which prevents release of histamine Contraindications: aerosol preparations in those with CAD or cardiac dysrhythmias Adverse effect: bronchospasm throat irritation, and cough; lactose intolerance symptoms in oral preparations Patient teaching: use 15 to 20 minutes prior to engaging in precipitant to bronchospasm Nedrocromil (Tilade) mast cell stabilizer similar to cromolyn |
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Leukotriene Receptor Antagonists
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Have been identified as important mediators in the pathology and symptomatology of both acute and chronic asthma
Action Decrease inflammation Decrease bronchoconstriction Decrease edema Decrease mucus production Decrease recruitment of inflammatory cells Used as prophylaxis for the treatment of chronic asthma; unlabeled use: chronic idiopathic urticaria and dermatographism Relatively new; therapeutic niche has not been firmly established Zileuton (Zyflo), Zafirlukast (Accolate), Montelukast (Singulair) Given orally Zileuton and zafirlukast may cause liver failure Zileuton inhibits leukotriene synthesis, zafirlukast and montelukast block leukotriene receptors Prevents the formation of potent leukotrienes; this mechanism of action may be beneficial to disorders such as asthma, rheumatoid arthritis, and ulcerative colitis, is is only approved for the management of asthma at this time |
