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RESPIRATORY AGENTS

common problem is asthma-----inflammation in the lungs that causes airways to constrict and yields wheezing, dysnea, and cough. allergen may trigger release of histamine from mast cells. bronchodilators--- moa----cause beta2 receptors on smooth muscle

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RESPIRATORY AGENTS

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  1. common problem is asthma-----inflammation in the lungs that causes airways to constrict and yields wheezing, dysnea, and cough. allergen may trigger release of histamine from mast cells. bronchodilators--- moa----cause beta2 receptors on smooth muscle to yield relaxation, decreases bronchospasm, more airflow. beta1 in heart/kidney beta2 in bronchus/uterus/eye/GI/liver beta3 in adipose tissue beta1 receptors have equal affinity for epi and norepi. beta2 receptors prefer epinephrine. RESPIRATORY AGENTS

  2. Xanthine derivatives----xanthine comes from guanine, a precursor to uric acid, caffeine. Commonly used for their effects as mild stimulants and as bronchodilators moa---reverse bronchospasm associated with antigens and irritants. improves contractility of diaphragm. moa-- occurs through multiple molecular mechanisms of action, including at least one unknown mechanism. indications---lung disease that is unresponsive to other medications. consider-----watch xanthine blood levels(kidney stones) may interact with antibiotics. examples--- aminophylline theophylline RESPIRATORY AGENTS

  3. RESPIRATORY AGENTS Bronchodilators--- indications----airway obstruction, COPD, bronchitis, emphysema. adverse reaction----CNS stimulation yields nervousness, tremors, anxiety, tachycardia, arrhythmia considerations----self overmedication. protect ipratropium from light. keep salmeterol room temperature. bronchodilator examples--- albuterol epinephrine formoterol fumarate ipratropium salmeterol terbutaline

  4. RESPIRATORY AGENTS Leukotriene inhibitors moa----block effect of leukotrienes. Leukotriene production is usually accompanied by the production of histamine and prostaglandins, which also act as inflammatory mediators. trigger contractions in the smooth muscles lining the bronchioles indications---prophyalxis and long-term asthma adverse effect-----headache consider-------must be over 6yoa for singulair examples-- montgelukast/singulair zafirukastr/accolate zileuton/zyflo

  5. Corticosteroids moa---stimulate adenylate cyclase and inhibit inflammatory cells. The activation of β1, β2 and β3 receptor activates the enzyme Adenylate cyclase. This in turn leads to the activation of the secondary messenger Cyclic adenosine monophosphate and induces smooth muscle relaxation by interfering with actin/myosin inhaled reactions--oral candidiasis, irritation nasal mucosa, hoarseness,dry mouth. oral medications---female facial hair, male breast, edema, buffalo hump, weight gain, bruising consider---nightmares unless taper off the dosing. RESPIRATORY AGENTS

  6. RESPIRATORY AGENTS corticosteroid examples--- prednisolone triamconolone prednisone fluticasone dexamethasone methylprednisone mometasone

  7. RESPIRATORY AGENTS mast cell stabilizers mao---inhibit inflammatory cells indications---prophylaxis, no use for acute attack reactions----cromolyn may give unpleasant taste, hoarsness, dry mouth, stuffy nose consider----noncompliance… 4 doses/day examples- Cromolyn oral inhaled nedocromil combo---fluticasone-salmeterol

  8. RESPIRATORY AGENTS emphysema----destruction of alveoli. from smoking, pollution, occupational exposure, genetic bronchitis----obstruction of airflow during expiration. from smoke, dust, pollution, infection. cough produces green or blood sputum. excessive mucus, 30ml/day cystic fibrosis----thick, sticky mucus, frequent chest infections, and coughing or shortness of breath with infections. mucolytic agents--- moa--break down gylcoprotein, yields easier removal adverse reaction---unpleasant odor and taste examples-- acetylcysteine domase alfa

  9. RESPIRATORY AGENTS tuberculosis----slow, progressive respiratory disease with weight loss, fever, night sweats, malaise, less appetite. asymptomatic medication is isoniazid for 12 months, maybe several medications if symptomatic. Old west days=consumption. consider-----avoid alcohol examples--- capreomycin ciprofloxin isoniazid ofloxin rifampin streptomycin

  10. RESPIRATORY AGENTS smoking----increased heart disease, COPD, stroke. asthma, impotence, infertility, CO concentration, shortness of breath. cessation agents bupropion nicotine varenicline

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