Date post: | 17-Jan-2016 |
Category: |
Documents |
Upload: | caren-fletcher |
View: | 215 times |
Download: | 0 times |
DH206: PharmacologyCH 19:RespiratoryLisa Mayo, RDH, BSDH
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
2Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Respiratory Drugs
Diseases treated with respiratory drugs
1. Asthma
2. COPD: emphysema, bronchitis
3. Upper respiratory infections
3Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
http://www.ispot.tv/ad/7F8P/anoro-air-filled-world
4Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Class of Resp. DiseasesClinic III
Location Acute Chronic
Upper Resp RhinitisSinusitisPharyngitis/TonsillitisFlu
Allergic rhinitis
Lower Resp Acute bronchitisPneumonia
TBAsthmaCOPD Cystic bronchitis
5Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Respiratory DrugsAsthma
• Considered an inflammatory disease• Chronic lung disease• Drug therapy aimed at relieving broncho-spasm & inflammation
Airway ObstructionCaused By:
Notations
Bronchoconstriction Loss lung elasticityMediated through ß-2 receptors
Inflammation Results from mucous productionMediators are histamine, prostaglandins, leukotrienes, cytokines
Loss lung elasticity Results from air sac enlargementTx is difficult (long-term, high dose meds)
6Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
2007 Guidelines for Management of Asthma
ASTHMA TYPE
THERAPY 1st LINE DRUGS 2nd LINE DRUGS
Intermittent No meds Albuterol prn (B2-agonist) ------------
Mild Daily meds Inhaled corticosteroid Leukotriene modifierMethylxanthineMast cell stabilizer
Moderate Daily meds Inhaled corticosteroid OR LABA Leukotriene modifierMethylxanthine
Severe Daily meds Inhaled corticosteroid + LABA Leukotriene modifierMethylxanthine
USE THIS INSTEAD P.221, TABLE 19-1EASIER TO UNDERSTAND THIS WAY
7Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Respiratory Drugs2007 Guidelines for Diagnosis & Management of Asthma• Number & frequency of meds ↑ as severity of asthma worsens• Beginning therapy: start with highest recommendations & stair-
step down as patient needs• Inhaled meds preferred agents
• High concentrations of drug delivered to airways with few systemic side effects
• Severe asthma attacks
1) ß-2 agonist preferred agent (EPI)
2) Corticosteroid tablets to relieve inflammation
3) Oxygen
8Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Respiratory Drugs
Drug Delivery
1. Systemic: oral, parental
2. Inhaled: shorter onset, fewer side effects
1) Nebulizer
2) Dry powder inhaler
3) Metered-dose inhalers (most common delivery system)
9Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Respiratory Drugs
Asthma Medications: 2 classes of medications
1. Quick-relief medications•Reliever/Acute rescue drugs
2. Long-term medications•Control, Maintenance meds•Taken daily•Most have anti-inflammatory effects
10Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Respiratory DrugsAsthma Medications
• 2 classes of medications
1. Quick-relief medications•Reliever/Acute rescue drugs
2. Long-term medications (mild, moderate, severe asthma & COPD)•Control, Maintenance meds•Taken daily•Most have anti-inflammatory effects
11Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Quick-Relief MedsProduce bronchodilationProtype: albuterol(Ventolin, Proventil)Tx acute symptomsNot used for daily preventionPatients need to rinse after use (NBQ)
DRUG CATEGORIES
MECHANISM OF ACTION USES
Beta-Adrenergic Agents (Sympathomimetic Agents)
Stimulate beta-2 adrenergic receptors prn
Anticholinergics Block cholinergic (muscarinic) receptors COPD
Systemic corticosteroids
Emergencies Asthma or COPD
12Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Quick-Relief Meds
1. Beta-Adrenergic Agents (Sympathomimetic Agents)
ß-2 Adrenergic DrugsAlbuterol(Proventil, Ventolin)
Metaproterenol(Alupent)
Levalbuterol(Xopenex)
p. 224
13Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Quick-Relief Meds
1. Beta-Adrenergic Agents (Sympathomimetic Agents)• NON-SELECTIVE (stimulate β-1 & β-2)o2 drugs: Epi & isopreterenol(Isuprel)oWhen used to tx asthma – will also ↑ heart rate
• SELECTIVEoSelective beta-2 drugs are BEST: bronchodilatorsoFewer effects on beta-1
14Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
15Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
β-agonist stimulates enzyme AC to ↑ cAMP levels – results in dilation
16Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Can be difficult for kids to use: use a separate connector – can decrease amt of drug administered
17Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
After which of the following drugs used to treat asthma should the dental hygienist instruct the patient to rinse the mouth?
a. Ipratropiumb. Cromlyn sodiumc. Metaproterenold. Theophylline
18Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
After which of the following drugs used to treat asthma should the dental hygienist instruct the patient to rinse the mouth?
a. Ipratropiumb. Cromlyn sodiumc. Metaproterenold. Theophylline
19Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following drugs is the drug of choice for the quick relief of bronchospasm?
a. Albuterolb. Ipratropiumc. Hydrocortisoned. Salmeterol
20Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following drugs is the drug of choice for the quick relief of bronchospasm?
a. Albuterolb. Ipratropiumc. Hydrocortisoned. Salmeterol
21Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following drugs is classified as a β2-agonist bronchodilator?
a. Albuterolb. Ipratropiumc. Hydrocortisoned. Montelukast
22Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following drugs is classified as a β2-agonist bronchodilator?
a. Albuterolb. Ipratropiumc. Hydrocortisoned. Montelukast
23Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Quick-Relief Drugs
2. Anticholinergic Agents: used for tx COPD, not asthma
DRUG NOTATIONS
Ipratropium bromideHFA(Atrovent) PROTYPENasal spray: useful for rhinitis
Ipratropium bromide + albuterol sulfate(Combivent)
Tiotropium bromide(Spiriva) LONG-TERM, NOT SHORT ACTING FOR TX COPD
p.226
24Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Quick-Relief Drugs2. Anticholinergic Agents
• Action: Inhibit ACH receptors on smooth muscle= bronchodilation
• Protype: ipratropium bromide(Atrovent)• Adverse effects
• Xerostomia• Taste alteration• Instruct pt to rinse mouth after each inhalation (NBQ)
25Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Muscarinic antagonists block effects of ACH & PANS – leads to bronchodilation
26Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Quick-Relief Drugs
3. Systemic corticosteroids• Used when asthma cannot be controlled by bronchodilators alone
• Short-term• Decrease inflammation• Systemic delivery = acute attacks
Inhaled delivery = chronic, long-term therapy
27Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Respiratory DrugsAsthma Medications
• 2 classes of medications
1. Quick-relief medications•Reliever/Acute rescue drugs
2. Long-term medications•Control, Maintenance meds•Taken daily•Most have anti-inflammatory effects
28Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term Meds
Inhaled corticosteroids Asthma
Selective long-acting ß-2 Agonists (LABA)
Asthma or COPD(never used as stand-along therapy, always in combo)
Methylxanthines COPDIV for status asthmaticus
Mast cell stabilizers Asthma
Leukotrienes Modifiers Asthma
Immunomodulators Asthma
29Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term Meds
Inhaled corticosteroids Asthma
Selective long-acting ß-2 Agonists (LABA)
Asthma or COPD(never used as stand-along therapy, always in combo)
Methylxanthines COPDIV for status asthmaticus
Mast cell stabilizers Asthma
Leukotrienes Modifiers Asthma
Immunomodulators Asthma
30Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term Meds
Inhaled corticosteroids• Drug of choice for persistent asthma• 1st line long-term therapy• Potent & effective anti-inflammatory agents• Decrease airway hyper-reactivity & swelling• Rinse mouth after inhaler use (NBQ)
31Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term Meds
Inhaled corticosteroids
Inhaled CorticosteroidsBeclomethasone dipropionate(Beclovent, Vanceril)
Budesonide(Pulmicort)
Flumisolide(Aerobid)
Fluticasone(Flovent, Advair)
Mometasone(Asmanex)
Triamcinolone(Azmacort)
32Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term Meds
Inhaled corticosteroids Asthma
Selective long-acting ß-2 Agonists (LABA)
Asthma or COPD(never used as stand-along therapy, always in combo)
Methylxanthines COPDIV for status asthmaticus
Mast cell stabilizers Asthma
Leukotrienes Modifiers Asthma
Immunomodulators Asthma
33Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term Meds
Selective long-acting ß-2 Agonists (LABA)• Bronchodilators• Not used alone – usually in combo w/corticosteroids• Black box: NOT to be used as stand alone tx – increase risk
of asthma-related deaths
Selective long-acting ß-2 Agonists
Salmeterol(Serevent)
Formoterol(Foradil)
34Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term Meds
Inhaled corticosteroids Asthma
Selective long-acting ß-2 Agonists (LABA)
Asthma or COPD(never used as stand-along therapy, always in combo)
Methylxanthines COPDIV for status asthmaticus
Mast cell stabilizers Asthma
Leukotrienes Modifiers Asthma
Immunomodulators Asthma
35Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term MedsMethylxanthines
• Bronchodilators that relax the airway smooth muscle• COPD• Many drug interactions
• Erythromycin• Clarithromycin• Caffeine: can cause mild bronchodilation in patients with asthma
(100mg which is in a cup of coffee)
Methylxanthines
Theophylline(Slo-Phyllin),TheoDur, Theo-24)
Aminophylline(norphyl)
36Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Theophylline inhibits enzyme PDE, slows inactivation of cAMP, leads to dilation
Theophylline antagonizes adenosine (bronchoconstrictior)
37Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term Meds
Inhaled corticosteroids Asthma
Selective long-acting ß-2 Agonists (LABA)
Asthma or COPD(never used as stand-along therapy, always in combo)
Methylxanthines COPDIV for status asthmaticus
Mast cell stabilizers Asthma
Leukotrienes Modifiers Asthma
Immunomodulators Asthma
38Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term Meds
Mast cell stabilizers p.225, books calls this category cromolyn
• Inhibit release of histamine (decrease inflammation)
Mast Cell Stabilizers
Cromolyn sodium(Intal)
Nedocromil(Tilade)
39Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term Meds
Inhaled corticosteroids Asthma
Selective long-acting ß-2 Agonists (LABA)
Asthma or COPD(never used as stand-along therapy, always in combo)
Methylxanthines COPDIV for status asthmaticus
Mast cell stabilizers Asthma
Leukotrienes Modifiers Asthma
Immunomodulators Asthma
40Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term Meds
Leukotrienes Modifiers• Block activity of arachidonic acid derivatives = decrease
inflammation • P-450 enzyme induction • Drug interactions
• Aspirin• Erythromycin• Increase effect Warfarin
Leukotriene Modifiers
Zafirukast(Accolate)
Montelukast(Singular)
Zileutron(Zyflo)
41Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Zileutron(Zoflo)
zafirlukast(Accolate),
montelukast(Singular)
42Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term Meds
Inhaled corticosteroids Asthma
Selective long-acting ß-2 Agonists (LABA)
Asthma or COPD(never used as stand-along therapy, always in combo)
Methylxanthines COPDIV for status asthmaticus
Mast cell stabilizers Asthma
Leukotrienes Modifiers Asthma
Immunomodulators Asthma
43Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Long-Term Meds
Immunomodulators• Prevent IgE from binding to mast cells
Immunomodulators
Omalizumab(Xolair)
44Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
omalizumab(Xolair)
omalizumab(Xolair)Binds to receptors so allergen cannot
45Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following drugs is preferred for long-term control of asthma?
a. B-1 agonistb. B-2 agonistc. Inhaled corticosteroidd. Oral corticosteroids
46Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following drugs is preferred for long-term control of asthma?
a. B-1 agonistb. B-2 agonistc. Inhaled corticosteroidd. Oral corticosteroids
47Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following drugs is used to control mild persistent asthma?
a. Albuterolb. Ipratropiumc. Inhaled beclomethasoned. Salmeterol
48Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following drugs is used to control mild persistent asthma?
a. Albuterolb. Ipratropiumc. Inhaled beclomethasoned. Salmeterol
49Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
50Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
DH Considerations
• Aspirin & NSAIDs contraindicated in asthmatic patients (can lead to bronchospasm)
• Anticholinergic side effects• Consult MD in SEVERE asthma cases• Inhalers brought to appts• Systemic corticosteroids – pt may need increase dose morning of
apt• Inhalers: advise pt to rinse after to avoid dry mouth & oral
candidiasis
51Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Agents used to manage upper respiratory tract infections
Agents used to manage upper respiratory tract infections1) Nasal Decongestants2) Expectorants & Mucolytics3) Antitussives
52Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Agents used to manage upper respiratory tract infections
1) Nasal Decongestants• Constrict blood vessels in nasal mucous membranes• Chronic use may result in rebound swelling and congestion• Book correction: not all nasal decongestants are α-agonists
(p.226)• Remember: Patanase is a nasal antihistamine, not a
decongestant
53Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Agents used to manage upper respiratory tract infections
Nasal Decongestants
phenylephrine (Neo-Synephrine, Sinex, Allerest) α-agonist
pseudoephedrine(Sudafed, Sucrets, Actifed) α-agonist
Beclomethasone(Beconase,Vancenase) Corticosteroid Nasal spray
Mometasone(Nasonex) Corticosteroid Nasal spray
Fluticasone(Flonase) Corticosteroid Nasal spray
Budesonide(Rhinocort) Corticosteroid Nasal spray
Flunisolide(Nasalide) Corticosteroid Nasal spray
Cromolyn(Nasalcrom) OTC nasal spray
Nedocromil(Tiladle) Nasal spray for asthma & rhinitis
54Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following types of agents are nasal decongestants?
a. B-1 agonistb. B-2 blockersc. Alpha-1 agonistd. Alpha-2 blockers
55Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following types of agents are nasal decongestants?
a. B-1 agonistb. B-2 blockersc. Alpha-1 agonistd. Alpha-2 blockers
56Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Agents used to manage upper respiratory tract infections
2) Expectorants & Mucolytics• Mucolytics
• Promote removal of exudate or mucus from respiratory passages• Liquefying & decrease viscosity of mucus• Acetylcysteine(Mucosil): Useful in cystic fibrosis
• Expectorants• Drugs that facilitate the removal of thickened mucus secretions from
the lungs• Action: ↑ bronchial = liquefy mucus• Guaifenesin(Mucinex) most popular
57Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
58Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Agents used to manage upper respiratory tract infections
3) Antitussives: agents used to suppress coughDrugs Notations
Opioids: (Codeine, Hydrocodone, Hydromorphone)
Narcotic opioidAvoid in asthmatic (cause respiratory depression)
Dextromethorphan(Robitussin, Vicks)
Non-narcoticMany OTC products contain
Benzonatate(Tessalon) Non-narcotic
59Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following terms defines “suppressing a cough?”a. Expectorantb. Antitussivec. Antihistamined. Antiasthma
60Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following terms defines “suppressing a cough?”a. Expectorantb. Antitussivec. Antihistamined. Antiasthma
61Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following drugs MAY be contraindicated in asthmatics?
a. Aspirinb. Acetaminophenc. Vitamin Cd. Folic acid
62Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQ
Which of the following drugs MAY be contraindicated in asthmatics?
a. Aspirinb. Acetaminophenc. Vitamin Cd. Folic acid
63Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.