Respiratory System (Pharm Made Easy 3.0)

Front 1

Drugs to treat Airflow disorders

Back 1

•Beta 2 adrenergic agonist

•Inhaled anticholinergic

•Methylxanthines

•Glucocorticoid

•Mast cell stabilizers

•Leukotriene modifiers

Front 2

Beta 2 adrenergic agonists

Back 2

•Treats: short and long term management of asthma, prevention of exercise induced asthma and treatment of ongoing asthma exacerbations

•Examples:

-Albuterol

-Salmeterol

-Terbutaline

•Beta 2 adrenergic agonist promote Bronchodilation, relieve Bronchospasm and is valuable in the treatment of asthma

•Side effects:

-Tachycardia

-Heart palpitation

-Tremors

-Angina (chest pain/report to provider)

•Avoid caffeine!

•Do not give beta 2 adrenergic agonist to patients who are allergic

•Do not give to patients with tachydysrhythmias

•Do not give to patients that experienced tachycardia due to digitalis

Front 3

Inhaled anticholinergics

Back 3

•Treat: relief of Bronchospasm in patients with C.O.P.D and treatment for allergen and exercise induced asthma

•Examples:

-Ipratropium

-Tiotropium

•Inhaled anticholinergics block muscarinic receptors in the bronchi which causes bronchodilation

•Side effects:

-Dry mouth

-Hoarseness

-Increases I.O.P

-Urinary retention

•Unpleasant taste after administration, allow patient to rinse mouth

•DELAY use of other inhalants for 5 minutes

•Take precaution with these patients:

-Patient with prostatic hypertrophy

-Patient with bladder neck obstruction

-Patient with glaucoma

•If patient is ALLERGIC to soya lecithin, soybean or peanuts do NOT give the inhaled anticholinergic

Front 4

Methylxanthines

Back 4

•Treat: long term management of chronic asthma, chronic bronchitis and emphysema

•Examples:

-Theophylline

•Relaxes smooth muscles of the bronchi & pulmonary blood vessels

•Side effects:

When blood exceeds therapeutic level it causes

-Restlessness

-Insomnia

-G.I symptoms (nausea, vomiting and diarrhea)

When blood level reaches toxic level

-Seizures

-Dysrhythmias

•Monitor theophylline levels PERIODICALLY! (give activated CHARCOAL to decrease absorption of theophylline)

•Monitor heart rhythm for dysrhythmias (E.C.G)

•Reduce or eliminate caffeine intake

•Do NOT give to patients that can NOT WITHSTAND myocardial stimulation!

Front 5

Glucocorticoids

Back 5

•Treat: long term management of chronic asthma, short term management of post exacerbation symptoms and reduces inflammation and prevent & treat rhinitis

•Examples:

-Beclomethasone dipropionate (QVAR/ inhaled by nebulizer)

-Prednisone (P.O route)

-Beclomethasone (nasal route)

•Suppress inflammation by preventing the release of inflammation mediators (leukotrienes, prostaglandin & histamine) and decrease edema of the airway

•Side effects (Inhaled, P.O & nasal)

Inhaled steroid (side effects)

-Oral candidiasis

-Hoarseness

-Difficulty speaking

P.O (side effects)

-Suppression of adrenal gland

-Muscle wasting & osteoporosis

-HYPERglycemia

-Peptic ulcer disease

-Infections

-Electrolytes imbalances (weight gain is indicative of edema or fluid retention)

Nasal (side effects)

-Dry mucus membrane

-Epistaxis (nosebleeds)

-Sore throat

-Headache

•Do not give NSAIDs if P.O glucocorticoids (NSAIDs & P.O glucocorticoid INCREASE RISK for stomach bleeding) INSTEAD, prescribed give instead acetaminophen (Tylenol)

•Therapeutic effects take 2 to 3 weeks (nasal glucocorticoid)

Front 6

Mast Cell stabilizers

Back 6

•Treats: long term treatment of allergy-related asthma, prophylaxis for exercise induced asthma and seasonal allergy symptoms and management of allergic rhinitis

•Examples:

-Cromolyn

-Nedocromil sodium

•Suppress inflammation by preventing inflammation mediator release and activity

•Side effects:

-Allergic reaction (ANAPHYLAXIS! give EPINEPHRINE immediately 0.3 mL to 0.5 mL of a 1 mg per mL vial)

-Dry mouth

-Headache

-Bitter aftertaste

-Cough, tingling or burning of the throat and trachea after inhalation

•Use cromolyn 15 minutes BEFORE exercise

•DO NOT use cromolyn or any mast cell stabilizer to relief an acute asthma attack (use ALBUTEROL instead)

•Do NOT give to patients with:

-Coronary artery disease

-Cardiac dysrhythmias

-Status asthmaticus

Front 7

Leukotrienes modifiers

Back 7

•Treat: long term treatment of chronic asthma, prophylaxis for exercise induced bronchospasm, and management of allergic rhinitis

•Examples:

-Montelukast

-Zileuton

-Zafirlukast

•Suppress inflammation by inhibiting the release of leukotrienes

•Side effects:

-Liver damage or Hepatotoxicity (zileuton & Zafirlukast) ☆

-Headache (montelukast)

•Monitor liver function for zileuton & zafirlukast (report abdominal tenderness, nausea or anorexia; check ALT & AST liver function test)

•Do NOT give leukotrienes modifiers for

-Acute asthma exacerbation

-Status asthmaticus

Front 8

Sedating Antihistamines

Back 8

•Treat: management of mild allergic reactions, management of severe anaphylaxis reactions and treatment of motion sickness and insomnia

•Examples:

-Diphenhydramine

-Dimenhydrinate

•Blocks H 1 receptors which blocks release of histamine, this also causes mild cholinergic blocking effects like dry mouth, constipation and urinary retention)

•Side effects:

-Drowsiness

-Dizziness

-Dry mouth, urinary retention, constipation

-G.I effects (nausea & vomiting)

-Acute toxicity adults: high fever, tachycardia, urinary retention, dry mouth and children: excitation, hallucinations and seizures (give CHARCOAL as an antidote)

•Give 30 minutes before MOTION SICKNESS

•Do NOT give with alcohol and other CNS depressants

•Do NOT give to these patients:

-Newborns and children under 2 years

-Breastfeeding women

-Patients with narrow glaucoma ☆

-Prostatic hypertrophy

-Acute asthma exacerbation

Front 9

Non-sedating Antihistamines

Back 9

•Treat: Allergic rhinitis and idiopathic (no known cause) urticaria/hives

•Examples:

-Loratadine

-Fexofenadine

-Desloratadine

•Binds to H1 receptor and block the release of histamine

•Side effects

-Drowsiness (rare)

-Mild anticholinergic effects: dry mouth, constipation and urinary retention) (rare)

•Do NOT give with other antihistamines!

•Expect dose to be lower in patients with compromised renal or hepatic function

•Do not give to infants UNDER 6 months

•Do not give to women breastfeeding

Front 10

Sympathomimetics

Back 10

•Treat: Nasal congestion caused by allergic rhinitis, sinusitis and common cold

•Examples:

-Pseudoephedrine

-Ephedrine

•Activate alpha 1 adrenergic receptors in the nose which causes VASOCONSTRICTION of blood vessels and opens nasal passages

•Side effects:

-Insomnia

-Rebound nasal congestion (abrupt stop after long term use)

-Potential for abuse

-Systemic vasoconstriction (tachycardia, hypertension and heart palpitations/this may indicate overdosage/REPORT)

•Avoid using this drug for more than 3 to 5 days because of rebound congestion

•Do not use in patient with:

-Chronic rhinitis

-Narrow angle glaucoma ☆

-Uncontrolled heart disease

-Hypertension

-Dysrhythmias

Front 11

Antitussives

Back 11

•Treat: suppress chronic non-productive cough

•Examples:

-Codeine

-Dextromethorphan

-Benzonatate

•Suppress cough reflex in the brain (medulla)

•Side effects:

Opioid Antitussive (Side effects)

-CNS depression

-Dizziness

-Constipation

-Respiratory depression

-Potential for abuse

-G.I effects (nausea & vomiting)

•Non-opioids Antitussive (Side effects)

-Potential for abuse

-G.I effects (nausea & vomiting)

•Only use for short term basis, lowest dose and only when necessary

•Do not give to these patients with these conditions (opioid antitussive):

-Acute asthma

-Liver and renal disease

-Acute alcoholism

-Head trauma ☆

Front 12

Expectorants

Back 12

•Treat: colds and upper respiratory infections and bronchitis

•Example:

-Guaifenesin

•Reduces surface tension of secretions and thins thick mucus and can be cough out and drain out of nose and sinuses

•Side effects:

-Dizziness

-Drowsiness

-G.I distress (nausea and diarrhea)

-Allergic reaction (rash-give benedryl to relieve and stop the drug)

•INCREASE fluid intake ☆

•Notify provider if cough worsens or high fever develops

•Do NOT give to patients with COUGH due to heart failure

•Do NOT give to patients on A.C.E inhibitor therapy

Front 13

Mucolytics

Back 13

•Treat: bronchopulmonary disease and cystic fibrosis and REVERSES acetaminophen overdose (acetylcysteine)

•Example:

-Acetylcysteine

•Break disulfide linkages of protein in mucus, this decreases viscosity of mucus and allow mucus to be expectorated

•Side effects:

-Bronchospasm

-Aspiration of excessive secretions

-G.I distress (ROTTEN EGG smell, INGESTION of SECRETIONS)

•Monitor respiratory status (auscultate lungs for fluid)

•Administer a bronchodilator as needed

•SUCTION BEFORE giving the nebulizer (Acetylcysteine)

•Acetylcysteine is used as an antidote for acetaminophen overdose

•Do NOT give to patients with G.I bleeding or at RISK for bleeding