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Respiratory System

(General Key Points)

N203 ATI (Unit 8) Respiratory System -

2-Adrenergic Agonists

N203 ATI (Unit 8) Respiratory System -

Proto: albuterol (Proventil) Others: formoterol (Foradil), Expected Action:

salmeterol (Serevent), terbutaline (Brethine)

Selectively activate 2 receptors resulting in bronchodilation: bronchospasm is relieved, histamine release is inhibited, and ciliary motility is
Therapeutic Uses: Adverse Effects:

Albuterol: Inhaled, short-acting and oral, long-acting Terbutaline: Oral, L-A Inhaled: Minimal adverse effects (C) CI: tachydysrhythmias

Formoterol, salmeterol: Inhaled, long-acting

Oral: Tachycardia/angina d/t 1 in / tremors d/t 2 in skeletal muscle


Contraindications/Precautions: Interactions:

-blockers like propanolol negate effects of both TCAs and MAOIs risk of tachycardia and angina
Education:

Inhale 3-5 sec, hold 10 sec, wait 60 sec for next dose

Use inhaled 2-agonist before using inhaled glucocorticoid

Methylxanthines

N203 ATI (Unit 8) Respiratory System -

Expected Action:

Proto: Theophylline (Theolair)

Theophylline relaxes bronchial smooth muscle bronchodilation


Therapeutic Uses: Adverse Effects:

Long-term control of asthma Mild toxicityGI distress & restlessness. Severe reactions

Severe reactions can occur at therapeutic levels and include dysrhythmias and seizures. Effects unlikely @ <20 mcg/mL. Activated charcoal absorption, lidocaine for dysrhythmias and diazepam for seizures.
Contraindications/Precautions: Interactions:

(C)

Caffeine: CNS/ effects of theophylline. Also [theophylline]

Phenobarbital, phenytoin: [theophylline] Cimetidine, ciprofloxacin: [theophylline]

Inhaled Anticholinergics

N203 ATI (Unit 8) Respiratory System -

Expected Action:

Proto: ipratropium (Atrovent) Others: tiotropium (Spiriva)

Block muscarinic receptors on bronchi bronchodilation


Therapeutic Uses:

Relief of bronchospasms associated with COPD

Relief of allergen-induced and exercise-induced asthma.


Adverse Effects:

Local anticholinergic effects (B) CI: Peanut allergy

Contraindications/Precautions:

Caution in narrow-angle glaucoma


Education:

Usual adult dose is 2 puffs (1 minute apart)

If taking two inhaled medications, separate by at least 5 minutes.

Glucocorticoids

N203 ATI (Unit 8) Respiratory System -

Proto: beclomethasone (QVAR) Others: budesonide (Pulmicort), fluticasone (Flovent), triamcinolone (Azmacort), prednisone (Deltasone) Prevent inflammation, suppress airway mucous production, and promote responsiveness of 2-receptors in bronchial tree. Therapeutic Uses: Inhaled: Long-term asthma prophylaxis S-T, oral: Treat symptoms following acute asthma. L-T, oral: Treat chronic asthma 1 adrenocortical insufficiency Promote lung maturity and RDS in fetuses at risk for preterm birth. Adverse Effects: Inhaled: Dysphasia, candidiasis, bone loss Oral (10d): adrenal gland function / bone loss / hyperglycemia / glucosuria / / infection / peptic ulcer disease / myopathy / fluid & electrolyte disturbances. (?) CI: Live virus / systemic fungal infect. Contraindications/Precautions: Interactions: Diuretics: hypokalemia NSAIDs: GI ulceration Glucocorticoids counteract effects of insulin and oral hypoglycemics. Education: Oral are for short-term use, 3-10 days following acute attack Expected Action:

Mast Cell Stabilizers

N203 ATI (Unit 8) Respiratory System -

Expected Action:

Proto: Cromolyn (Intal) Others: nedocromil (Tilade)

Anti-inflammatory: Stabilize mast cells, inhibiting histamine release. Suppress inflammatory cells (e.g. eosinophils, macrophages)
Therapeutic Uses:

Management of chronic asthma

Prophylaxis of exercise-induced and allergen-induced asthma attacks Allergic rhinitis by intranasal route
Adverse Effects:

Safest of all asthma meds / safe for kids (B)

Contraindications/Precautions:

Propellant CI: CAD, dysrhythmias, and status asthmaticus


Education:

Take 15 min before exercise

Long-term prophylaxis may take several weeks

Leukotriene Modifiers

N203 ATI (Unit 8) Respiratory System -

Proto: montelukast (Singulair) Others: zileuton (Zyflo), Expected Action:

zafirlukast (Accolate)

Prevent effects of leukotrienes thus suppressing inflammation, airway edema, bronchoconstriction, and mucus production.
Therapeutic Uses: Adverse Effects:

Long-term asthma therapy in folks 12 YO Liver injury zileuton and zafirlukast. (nausea, anorexia, abdominal pain) (?)

Contraindications/Precautions: Interactions:

Zileuton / zafirlukast inhibit warfarin metabolism [warfarin] Zileuton / zafirlukast inhibit theophylline metabolism theophylline toxicity
Education:

Zileuton given without regard to food. Zafirlukast taken food

Antitussive Opioids

N203 ATI (Unit 8) Respiratory System -

Expected Action:

Proto: codeine Others: hydrocodone

Suppresses cough center in the medulla oblongata.


Therapeutic Uses: Adverse Effects:

Chronic, non-productive cough GI distress (nausea, constipation) take food, fluid/fiber

CNS sedation effects: Respiratory depression (<12/min) naloxone Potential for abuse, schedule II.
Contraindications/Precautions:

(C)

CI: acute asthma, head trauma, liver/renal dysfunction, acute alcoholism

Mucolytics

N203 ATI (Unit 8) Respiratory System -

Expected Action:

Proto: acetylcysteine (Mucomyst) Others: hypertonic saline

Enhance flow of secretions in the respiratory passages


Therapeutic Uses:

Acute & chronic pulmonary disease secretions Acetylcysteine is the antidote for acetaminophen poisoning Aspiration and bronchospasm (B) CI: GI bleeding

Cystic fibrosis
Adverse Effects:

Contraindications/Precautions:

Caution: Peptic ulcers / esophageal varices / severe liver disease


Education:

Has smell of rotten eggs

Dilute in fruit juice

IV: Loading dose, next dose over 4h, last dose over 16h.

Decongestants

N203 ATI (Unit 8) Respiratory System -

Expected Action:

Proto: Phenylephrine Others: Ephedrine, naphazoline, phenylpropanolamine

Stimulate 1-adrenergic receptors inflammation of nasal membranes


Therapeutic Uses: Adverse Effects:

Allergic rhinitis, sinusitis, and common cold Rebound congestion (Max 3-5 days, taper down use) Vasoconstriction CI: Chronic rhinitis

CNS stimulation (rare topical)


Contraindications/Precautions:

(?)

Caution: CAD and hypertension


Education:

Oral do not lead to rebound congestion

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