Bronchodilators Lilley Pharmacology Text: Chapter 35

1. Bronchodilators Lilley Pharmacology Text: Chapter 35 Original PPT modified by: Anita A. Kovalsky, R.N., M.N.Ed. Professor of Nursing Original by: Professor Edwards,

4. Alveoli: Antigen: Antibody: Asthma Attack: Bronchial Asthma: Chronic Bronchitis: Emphysema: ADDITIONAL TERMS Acute: Exacerbation: Review of Glossary Terms:Lilley pg. 542

5. Diseases commonly treated with Bronchodilators • Asthma http://www.whatsasthma.org COPD Chronic Bronchitis Emphysema

7. BRONCHODILATOR CLASSIFICATIONS Bronchodilators: • Xanthines Derivatives • Beta-Agonists

8. Xanthine Derivatives(Refer to Prototype List in syllabus, pg. 19) • Prototype Drugs: • Theophylline- Theo-dur • Aminophylline

9. How Do These Drugs Work? • Relieve Bronchoconstriction • Cause bronchodilatation

10. Mechanism of Action • Cause bronchodilation by: • Increasing the levels of the energy producing substance called cAMP • Inhibiting PDE the enzyme that breaks down *cAMP…. • Subsequently, this causes smooth muscle relaxation and broncchodilation; also inhibits release of chemical mediators such as histamine, etc. • *cAMP = cyclic adenosine monophosphate

11. Mechanism of Action contd. • Slow onset of action, so used more as preventative measure, however, also used as a continuous IV infusion to treat reversible bronchospasm in COPD clients who have an exacerbation of symptoms

12. Drug Effects • Relieve bronchopasms by causing airways to dilate, thereby improving air passage into and out of lungs • Stimulates CNS: • Increases contractility of heart (+ inotropic) • Increases heart rate (+chrontropic) • Increases cardiac output, thereby causing a…. • Diuretic effect…what would cause this???????

13. Therapeutic Uses • Dilate airways in asthma, chronic bronchitis and emphysema • Adjunctive agent for treatment of pulmonary edema and dyspnea in left-sided heart failure by increasing cardiac output and increasing bloodflow to kidneys diuresis

14. Lab DiagnosticsCavanaugh Text: pg. 215 Aminophylline/Theophylline Levels: • 10-18ug/ml WNL (within normal limits) • >20ug/ml TOXIC LEVEL

15. Side and Adverse Effects • Nausea • Vomiting • Anorexia • Gastroesophageal reflux CARDIAC!!!!!!!! HIGH ALERT!!!! • Sinus Tachycardia • Palpitations • Ventricular Dysrhythmias • Hyperglycemia (transient) • Increased urinary output (transient)

16. Interactions • Allopurinol • Cimetidine • Erythromycin • Flu Vaccine • Oral Contraceptives • Need blood levels monitored closely

17. Available Theophylline Preparations • Oral • Parenteral (aminophylline infusion) • Rectal

18. Beta-Agonists or Sympathomimetic Bronchodilators(Refer to Prototype List in syllabus, pg. 19 Also listed in Lilley, pg. 548) • Prototype Drugs: (Brand name in parentheses) - Albuterol (Proventil) Beta2 Selective OTHERS: -Ephedrine -Epinephrine (Adrenalin, Primatene, Bronkaid) -Terbutaline (Brethine)

19. When are Beta-Agonists used? • During acute phase of asthmatic attack • To quickly reduce airway constriction and cause bronchodilation WHY ARE THEY CALLED AGONISTS???? • AGONISTS or stimulators of SNS receptors-----> SYMPATHOMIMETIC ACTION WHAT IS THE PRIMARY MECHANISM OF ACTION?? • Imitate the effects of norepinephrine on receptors • Stimulate beta2-adrenergic receptors in the lungs causing dilation within the airways of the lungs (Example: Albuterol/Proventil)

20. Specific ReceptorsRefer to Lilley text, pg. 547 • Nonselective adrenergic: stimulate the alpha, beta1 (cardiac), and beta2- (respiratory) receptors (Example: epinephrine) • Nonselective beta-adrenergic: stimulate both beta1 and beta2 receptors (Example: Isuprel) • Selective beta2: stimulate the beta2 receptors (Example: albuterol)

21. Drug Effects **SELECTIVE BETA2 • Beta2 stimulation causes bronchodilation; also a decreased diastolic B/P, decreased K+ level

22. Mechanism of Action • Begins with specific receptors stimulated and ends with the dilation of airways • cAMP is activated when a beta2-adrenergic receptor is stimulated • Smooth muscles relax and airflow increased

23. Therapeutic Uses of Beta-Agonists • Pulmonary disorders for relief of bronchospasm • Nonselective: Used for hypotension and shock treatment and to relieve nasal congestion and stuffiness

24. Bronchodilators: Beta-Agonists Side Effects Alpha-Beta Beta1 and Beta2 Beta2 (epinephrine) (isoproterenol) (albuterol) Insomnia cardiac stimulation hypotensionrestlessness tremor vascular headacheanorexia anginal paincardiac stimulation vascular headache tremorvascular headache

25. Interactions • Beta-agonist with nonselective beta-adrenergic blocker (beta-blocker) antagonizes the bronchodilation effect!!! • Avoid MAO inhibitors

26. Available Selected Beta-Agonist Preparations • PO • SC • Inhaler • Nebulizer • IM

27. Nursing Considerations for Bronchodilators • Does the client have cardiac disease?? • If so, which type of bronchodilator should be the drug of choice?? • Does the client have diabetes?? • If the client is receiving a xanthine, what blood levels should be monitored???

28. A client is receiving IV aminophylline for a severe exacerbation of COPD. Which of the following would you expect when evaluating for a therapeutic response to the medication?A. DrowsinessB. Increased heart rateC. Dilatation of bronchiolesD. Increased respiratory rate

29. Which of the following side effects is associated with the use of xanthine derivatives?A. BradycardiaB. PalpitationsC. Increase in appetiteD. Constriction of bronchioles

30. Overview of Drugs Affecting the Respiratory System • Bronchodilators • Xanthine derivatives • Beta-agonists • Anticholinergics • Antileukotriene agents • Corticosteroids • Mast cell stabilizers

31. THE END