-
define chronotropic
changes HR
-
define iontropic
changes myocardial contractility
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drug family that inhibits break down of cAMP?
effect of having more cAMP?
name of enzyme inhibited?
- methylxanthanies
- more cAMP = bronchodilation
enzyme: phosphodiesterase
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how does methylxanthines' therapeutic window influence their current use?
narrow ther. window --> dangerous
not used much except in severe asthma
-
"... phylline" drugs are what class of drug?
name the drugs.
class: methylxanthine
- theophylline
- aminophylline
- oxtriphylline
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caffeine is what class of drug r/t respiratory disorders?
methylxanthines
-
drug used as IV drip in neonates to prevent neonatal apnea
caffeine
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how does smoking (tobacco or weed) interact with methylxanthines?
increases drug elimination, decreases serum concentration
-
methylxanthine SFX
- GI
- CNS: restlessness, irritability, anxiety, insomnia, HA
- CV: tachycardia, palpitations, hypotension
- hyperglycemia
- mild diuresis
-
do methylxanthines cross breast milk?
yes --> baby can have tachycardia or vomit
-
4 ways that methylxanthines help tx resp disorders
- 1. decrease airway reactivity (bronchodilation)
- 2. inhibit mast cell degeneration (stops release of histamine, leukotrienes)
- 3. stimulate ciliary apparatus (gets rid of secretions)
- 4. in COPD pts - increases sensitivity of resp center to CO2
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best respiratory drug used to tx acute attacks
beta agonists - albuterol [Proventil, Ventolin, VoSpire]
*anticholinergics are a possible alternative/addition, but they are much less potent bronchodilators
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drug family that promotes production of cAMP?
effect of having more cAMP?
name of enzyme activated
- beta agonists
- increased caMP = bronchodilation
activate adenylate cyclase
-
resp drug family that is sympathomimetic
beta agonists
(mimic FX of SNS: vasoconstriction, ^HR, etc.)
-
non-selective beta agonist FX on beta 1 receptors? on beta 2? on alpha?
- beta1: positive chronotropic, positive ionotropic
- beta2: bronchodilation
- alpha: vasoconstriction (in bronchiole vessels, decreasing mucosal edema)
-
SFX of beta agonists stemming from beta 1 agonism? beta 2? alpha?
SFX unique to Severent?
- beta 1: arrhythmias, tachycardia, palpitations, HA, insomnia
- beta 2: nervousness, restless, tremors
- alpha: insomnia, restlessness, anorexia, tremors, HA, cardiac stimulations
Severent: URI (upper resp infection), angioedema
-
mast cell inhibitors' (aka mast cell stabilizers) mechanism of action
stabilize cell membranes, preventing release of bronchoconstrictors, like histamine
-
names of 2 true mast cell inhibitors
- cromolyn [Intal]
- nedocromil [Tilade]
-
med that is an IgG Ab that binds to IgE receptors sites, stabilizing mast cell cell mebranes; like a mast cell inhibitors, but with different mechanism of action
omalizumab [Xolair]
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can mast cell inhibitors/stabilizers be used for acute bronchospasm?
NO! only beta agonists (and possibly anticholinergics) can tx acute bronchospasm
used for prophylaxis only
-
SFX of mast cell inhibitors
- -cough, sore throat, rhinitis
- -taste changes
- -dizziness and HA
- -pss bronchospasm
-
"mast cell inhibitor" that is given SC? SFX?
omalizumab [Xolair]
- SFX:
- local injection site irritation
- resp infection
- HA
- arthralgia
- fatigue
-
name the 2 anticholinergics used to tx asthma
- ipratropium [Atrovent]
- tiotropium [Spiriva]
-
drug class that may be combined with beta agonists to provide acute bronchodilation
anticholinergic
-
anticholinergic mechanism of action on resp system
causes local bronchodilation by blocking cholinergic receptors in bronchial smooth muscle, leading to decreased concentration of cGMP
blocks PSNS
-
SFX of anticholinergics
ipratropium [Atrovent], tiotropium [Spiriva]
- dry mouth
- GI
- HA
- cough
- anxiety
-
drug interactions of most respiratory drugs
minimal
b/c resp drugs usually absorbed in the lungs (site of action), so limited systemic absorption
-
why pts are switched from systemic to inhaled corticosteroids asap
- long-term corticosteroid use leads to decreased bone growth
- -osteoporosis in adults
- -stunted bone growth & height in kids
-
3 corticosteroids
- beclomethasone [Qvar, Beclovent, Vanceril]
- flunisolide [AeroBid]
- triamcinolone [Azmacort]
-
SFX of inhaled corticosteroids and how to decrease their occurrence
oral fungal infection, sore throat, cough, dry mouth
rinse mouth after using inhaler
-
interaction of corticosteroids with beta agonists
sensitize bronchial smooth muscl eto be more response to beta agonist stimulation --> corticosteroids aren't brochodilators, but they interact with beta agonists to cause more bronchodilation than beta agonists alone
-
name 3 leukotriene antagonists and frequency
- zafirlukast [Accolate] - BID
- zileuton [Zyflo] - QID
- monteleukast [Singulair] - qday
-
what are leukotrienes?
what kinds of cells produce them?
mediators of immune and inflammtory responses; products of arachidonic acid breakdown
- produced by:
- mast cells
- basophils
- neutrophils
- eosinophils
- macrophages
- monocytes
-
administration route of leukotriene antagonists?
how should it be taken in relation to meal times?
PO
take on empty stomach b/c food decreases bioavailability of drug
-
are leukotrienes used for treating acute asthma attacks?
no! prophylaxis only
-
how do leukotrienes antagonists indirectly cause bronchodilation?
inhibiting leukotriene's normal FX (via receptor antagonism): promotion of inflammation, edema, and hypersecretion of mucus
-
zafirlukast [Accolate] drug interactions
- coumadin: increases PT (anticoagulates)
- erythromycin: decreases Accolate
- ASA: ^ Accolate
- also interacts with phenytoin and CBBs, increasing their concentrations
-
SFX of zafirlukast [Accolate]
- HA
- resp infections, esp. in elderly
- nausea
- Churg-Strauss syndrome: pulmonary infiltrates, eosinophilia, cardiomyopathy
-
monteleukast [Singulair]
- leukotriene receptor antagonist
- approved for kids 1 y/o+
-
serious SE of zileuton [Zyflo] and drug contraindications
potential liver damage (increases liver enzymes, need to do baseline labs)
contraindicated in pts with liver disease
-
which of the 3 leukotriene antagonists inhibits leukotriene synthesis by inhibiting enzyme? (other 2 block leukotriene receptors)
zileuton [Zyflo]
-
drug used to tx genetic emphysema?
mechanism of action?
alpha 1 proteinase inhibitor: antitrypsin, [Prolastin].
prevents destruction of elastase, enabling lungs to continue expanding and contracting, and keeping alveoli open
-
name 3 expectorants used to facilitate movement of mucus
- -guafenesin [Robitussin] - first choice expectorant to tx dry, hacking cough
- -iodides (more toxic)
- -terpin hydrate (has lots of ETOH)
-
what type of tx should follow the administration of a mucolytic?
chest PT, to get rid of the mucus
-
name of only mucolytic, also used to tx acetaminophen OD. cons to using the med?
acetylcysteine [Mucomyst]
- oodles of drug interactions
- rotten egg odor, causing nausea
- stomatitis
- n/v
- rhinorrhea
- bronchospasm, esp. in asthmatic pts
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