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Methylxanthines
- –Decrease airway reactivity
- •Inhibit phosphediesterase -> more cycle AMP
- •-> bronchodilation
- – inhibit mast cell degranulation
- –Stimulate ciliary apparatus
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Methylxanthines Drugs (Lline & Caffein)
- •Theophylline [theo-Dur] po. Smoking & pot increases elimination
- •aminophylline IV
- •Oxtriphylline [Choledyl]
- •Caffeine- Crosses BBB, mainly used for Neonates to stimulate breathing. Strong coffee can help with asthma attack.
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Methylaxanthines Adverse Reactions
- -GI :Diarrhea, cramps, insomnia
- -CNS: Restlessness, Irritability, Anxiety, Insomnia
- –CV: tachycardia, palpitations, hypotension
- –Hyperglycemia
- –Mild diuresis
- –Crosses breast milk, Baby will get SE.
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What does Beta Agonist Do?
- •Mimic SNS
- •Stimulate beta2 (Lungs) receptors -> activation of adenylate cyclase -> increased cAMP -> bronchodilation
- •Beta 1 (Heart) = positive chronotropic/positive inotropic
- •Beta 2 = bronchodilation Selective only work on Lungs
- •Alpha = vasoconstriction in brocho blood vessels, decreased brocho edema
- Non-selective work on both lungs and heart & Stimulation of Alpha receptors
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Beta Agnoists Side Effects
- -Beta 2 (Lungs): Nervousness, restlessness, tremor
- -Beta 1 (Hearts): arrhythmias, tachycardia, palpitations, HA, insomnia
- -Alpha: Insomnia, restlessness, anorexia, tremor, HA, Cardiac Stimulation
- Interactions: Aviod Other sympathomimetics
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What does Anticholinergics do?
-Inhibit cholinergic receptors in brocho smooth muscles->decreased concentration of cGMP
cGMP=brochoconstriction. If you have less cGMP causes Brochodilation.
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What are Anticholinergics drugs?
- -PIUM
- -Ipratropium
- -Tiotropium
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SE for Anticholinergics?
- -Dry mouth, GI problems, HA, Cough, Anxiety
- no interactions known
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What Does Corticosteroids do?
- -Antiimflammatory Stabilize cell membranes to prevent release of histamine that causes bronchoconstricution
- -Help restore responsiveness to beta agnoists
- -Systemic vs Inhaled
- -Problem with longterm steroids shuts down your own adrenal glands & doesn't produce steriods, MOONFACE! ;)
- -When taken by inhalation you can remove SE!
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What are the SE to corticosteroids?
Oral Fungal Infections (thrush) to aviod rinse your mouth, sore throat, cough, dry mouth
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What drugs are corticosteroids?
- -Beclomethasone
- -Flunisolide
- -Triamcinolone
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What do Leukotriene (Bronchoconstrictors) Antagonists?
- -Zafirlukast=selective leukotriene receptor antagonist (Prototype drug)
- -Helps mild to mod asthma
- -Take on empty stomach
- -Take BID, food helps absorb all of drugs
- -Eliminated in feces, Avoid constipation!
- -NOT for acute attack, Peak 13-14 days
- -Produce lots of mucos
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Leukotriene Antagonists Zafirlukast SE?
- •HA, infection (people over 55), nausea
- •Churg-Strauss syndrome:
- –Pulmonary infiltrates
- –Eosinophilia
- –Cardiomyopathy
- –Interactions: coumadin (Bleeding), phenytoin, Ca channel
- blockers, erythromycin, ASA
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Leukotriene Antagonist Zileuton Do?
- •Zileuton [Zyflo]
- –Inhibits leukotriene synthesis by inhibiting enzyme
- –Contraindicated in acute liver disease
- -Used for Prevention ONLY!
- -Use less of inhaled steriods, this is PO
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What are SE Zileuton?
- -Inc Liver enzymes, check ALT
- -Dyspepsia
- -Take QID
- -Peak effect weeks to months!
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Leukotriene Antagonists Monteleukast [Singulair]?
- -Receptro Antagonist
- -Selective inhibitor of CysLT1 receptors (Don't need to remember)
- -Once daily dosing-Take in evening so that peak effect is at 3-4am. Approved for use of children
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Mast Cell Inhibitors does?
- -Stabilize Cell membranes
- -Prophylaxis Only! Ask how many attacks do they have on a daily basis? Are they having fewer attacks now?
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Mast Cell SE?
- -Cough, Sore Throat, Rhinitis, bronchospasm
- -Taste Changes
- -Dizziness, HA
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Mast Cell Drugs?
- -Cromolyn: inhaler, PO main drug, powerful oral inhalation. Onset 1 month
- -Nedocromil: Inhaler
- -Omalizumab-IgG antibody binds to IgE receptor Site & stabilizes mast cells by binding. Given SQ every 2-4 weeks.
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Alpha 1 Proteinase (Prolastin, Antitrypsin) Deficiency
- -Prevents destruction of elastase
- -SE: uncommon
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Expectorants:
- Facilitate movement of mucus
- Best & cheapest expectorant is WATER. Don't need to drink 8 glasses of water it's a myth.
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Expectorants Drugs
- –Guafenesin [Robitussin] – OTC, makes you spit out dry mucos/cough
- –Iodides: Organidin, SSKI (Taste Horrible-OJ)
- –Terpin hydrate
- –Interactions: coumadin
- –Adverse: rare with guafenesin
- –Iodides can -> iodism
- -Terpin hydrate - drowsiness
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Mucolytic: Acetylcysteine (Mucomyst):
- -Alters molecular composition of mucus
- -Given via Nebulizer
- -Interaction: many
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Mucolytic Adverse Reactions:
- -Rotten Egg odor-> nausea
- -stomatits, N/V
- -Rhinorrhea
- -bronchospasm=have albuterol just incase if you cause bronchospasms
- -Allergies
- Antibotics for respiratory tract infections
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