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Egan's Ch. 32

Airway Pharmacology

What are the three phases of drug action? drug administration phase, pharmacokinetic phase, pharmacodynamic phase
drug administration phase method by which a drug dose is made available to the body; (How are we going to deliver it?)
What is the most common route of drug administration to a pulmonary patient? aerosol therapy
What are the three most common devices used to administer inhaled aerosols? MDI (metered-dose inhaler), SVN (small volume nebulizer), DPI (dry-powder inhaler)
What are the ADVANTAGES of inhaled aerosols? can use smaller doses (as compared to the systemic route), onset of drug is rapid, delivery is targeted to specific organ needing treatment, less systemic side effects
What are the DISADVANTAGES of inhaled aerosols? the number of variables affecting the delivered dose AND lack of knowledge of device performance by patients & caregivers
pharmacokinetic phase time course & disposition of drug in body based on its absorption, distribution, metabolism & elimination
Inhaled bronchoactive aerosols are intended for local effects in the airway; UNDESIRED systemic effects result from what? absorption and distribution throughout the body
What is the difference between a fully ionized aerosol drug and a non-ionized aerosol drug? A fully ionized drug has little or NO systemic side effects (it is not absorbed across lipid membranes) whereas a non-ionized drug produces systemic side effects (it is lipid soluble & diffuses across cell membranes and into bloodstream)
What is an example of a fully ionized aerosol drug? Ipratropium
What is an example a non-ionized aerosol drug? Atropine (side effects: mydriasis: dilation of pupils AND blurred vision)
What is the L/T ratio? Lung availability/total systemic availability; quantifies efficiency of aerosol drug to lung; L/T ratio=Lung availability/(Lung + GI Availability)
Using the L/T ratio, which aerosol delivery method is more efficient? MDI (46%) works a little better than DPI (23%)
Pharmacodynamic phase describes the MECHANISM OF ACTION by which a drug molecule causes its effects in the body
What are drug effects caused by? the combination of a drug with a matching receptor
The nervous system is divided into what two paths? Central & Peripheral
Central Nervous System brain & spinal cord
Peripheral Nervous System sensory (receives impulses), somatic (sends voluntary impulses: ex: putting hand in fire and pulling it out), autonomic (sends involuntary impulses ex: breathing)
What three things make up the autonomic (involuntary) system? parasympathetic, muscarinic (M3), Sympathetic
Parasympathetic receptors CHOLINERGIC: acetylcholine> cGMP> bronchoconstriction
Sympathetic receptors ADRENERGIC: norepinephrine (epinephrine)> cAMP> bronchodilation
What is cAMP constantly being degraded by? phosphodiesterase
Muscarinic (M3) acts like parasympathetic; stimulates acetylcholine receptors specifically at parasympathetic nerve-ending sites
What is the usual neurotransmitter in the sympathetic system? norepinephrine (epinephrine), aka adrenaline
What is the usual neurotransmitter in the parasympathetic system? acetylcholine
Adrenergic directly dilates what? the bronchial tree; antiadrenergic blocks receptor for epinephrine
Cholinergic causes what? bronchoconstriction; Don't want that, so you need and anti-cholinergic drug that BLOCKS the constriction (Atrovent-would never give by itself)
indications for Adrenergic short-acting agents rescue drugs good for about 4 hours; for relief of acute obstructive airflow obstruction; albuterol and levalbuterol
Albuterol 2.5 mg qid (4 times a day); Beta-2
Indications for Adrenergic long-acting agents drugs that will last 12 hours (bid), in MDIs and DPI; salmeterol, formoterol, arformoterol; for maintenance of bronchodilation with obstructive lung disease
What is the most common use of adrenergic bronchodilators? improve the flow rates in asthma & exercise induced asthma, acute and chronic bronchitis, emphysema, bronchiectasis, cystic fibrosis and other obstructive airway states
Racemic epinephrine adrenergic bronchodilator; reduces airway swelling after extubation or with acute upper airway inflammation from croup, epiglottitis or bronchiolitis or to control airway bleeding during endoscopy
alpa-receptor stimulation causes vasoconstriction and a vasopressor effect (increased blood pressure)
beta-1-receptor stimulation causes increased heart rate and myocardial contractility
beta-2-receptor stimulation relaxes bronchial smooth muscle, stimulates mucociliary activity, and has some inhibitory action on inflammatory mediator release
Why would you choose Xopenex over Albuterol? When patient comes in with a high heart rate
Levalbuterol 1.25 (.63) mg TID/QID; beta-2
What is the main side effect of beta-2 selective agents? tremor
What are the potential adverse effects with use of adrenergic bronchodilators? dizziness, hypokalemia, worsening ventilation/perfusion ratio (decrease in PaO2/SpO2)
What are the specific actions suggested to evaluate patient response to bronchodilator therapy? pre & post bronchodilator studies, ABG or pulse oximetry, blood glucose & potassium (if available), and blood pressure
What are the two inhaled anticholinergic bronchodilators? Ipratropium and tiotropium (both used for COPD)
What is combined anticholinergic and beta-agonist indicated for? Ipratropium bromide & albuterol (Duoneb) is indicated for patients with COPD or asthma
What is the mode of action of anticholinergic bronchodilators? act as competitive antagonists for acetylcholine on airway smooth muscle
What are the adverse effects of anticholinergic bronchodilators? atrovent produces side effects and eyes can accidentally be sprayed by MDI or nebulizer mask
What are the side effects seen with anticholinergic aerosol agents? cough & dry mouth
What are the two mucus-controlling agents? N-acetyl-cysteine (called Muco Mist) and Dornase alfa
N-acetyl cysteine (NAC) comes in what two concentrations? 10% and 20%
How is NAC given to patient? either by nebulization or by direct tracheal installation
How does NAC work? breaks down disulfide bonds of the mucus, thinning it, so patient can cough it out themselves
What can NAC cause? bronchospasm due to irritating side effects (reason why you never give it without bronchodilator- Albuterol)
What patients get treated with Dornase alfa? Patients with Cystic Fibrosis
What is the mode of action of Dornase alfa? It breaks down protein bonds (DNA) and thins it
What is the other name for Dornase alfa? Pulmozyme
Inhaled corticosteroids will help reduce swelling if it is ________, it wont help if it's _________ Inflammatory; bronchoconstriction
What is the mode of action of inhaled corticosteroids? they act on intracellular receptors
What are the three types of drugs that prevent asthma from happening? (1) Cromolyn sodium (2) Antileukotrienes (3) Monoclonal antibodies or anti-IgE agents REMEMBER THESE 3 ARE NOT RESCUE DRUGS
What are the indications for use of nonsteroidal antiasthma drugs? Prophylatic management of asthma; offers NO BENEFIT for acute airway obstruction in asthma
Pentamindine isethionate treats pneumonia caused by pneumocystis jiroveci which is seen in patients with AIDS
Ribavirin treats respiratory syncytial virus using SPAG generator
Inhaled tobramycin used to fight pseudomonas aeruginosa in patients with cystic fibrosis
Inhaled zanamivir treats influenza A; Tamiflu
Nitric oxide treatment of pulmonary hypertension most common side effect: hypotension
Created by: 639924815