Chapter 37: Respiratory Drugs

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Questions and Answers

What is the primary characteristic of Chronic Obstructive Pulmonary Disease (COPD)?

Irreversible airflow obstruction (correct)

Complete absence of symptoms

Intermittent airflow obstruction

Reversible lung damage

Which of the following is a factor that can trigger asthma symptoms?

Exposure to cold air (correct)

Genetic predisposition

Changes in altitude

Nutritional deficiencies

Chronic bronchitis is primarily defined by which of the following symptoms?

Difficulty breathing during exercise

Persistent cough and excessive mucus production (correct)

Recurrent wheezing without cough

Frequent lung infections

How is asthma categorized when there are no known triggers or allergies involved?

Intrinsic asthma Signup and view all the answers

What type of asthma is specifically caused by exposure to certain medications?

Drug-induced asthma Signup and view all the answers

Which cells are involved in the inflammatory response seen in asthma?

Mast cells, eosinophils, and lymphocytes Signup and view all the answers

What distinguishes emphysema from other lung conditions like chronic bronchitis?

Destruction of alveolar elasticity Signup and view all the answers

What is a major feature of COPD compared to asthma?

Progressive lung disease with chronic obstruction Signup and view all the answers

What effect can beta2 agonists have on blood pressure?

They can either decrease or increase blood pressure. Signup and view all the answers

Which of the following is a common central nervous system effect of beta-adrenergic agonists?

Restlessness Signup and view all the answers

What is a major risk when combining beta-adrenergic agonists with nonselective beta blockers?

Decreased efficacy of beta agonists. Signup and view all the answers

Which xanthine derivative is commonly used for bronchodilation?

Theophylline Signup and view all the answers

What is an adverse effect commonly associated with anticholinergic medications?

Dry mouth Signup and view all the answers

Salmeterol is indicated for which role in asthma management?

Long-term maintenance therapy Signup and view all the answers

What is an important consideration when using albuterol?

Overuse can lead to systemic side effects. Signup and view all the answers

Which of the following effects is NOT associated with xanthine derivatives?

Decreased heart rate Signup and view all the answers

What effect do anticholinergics primarily have on airway secretions?

Reduce airway secretions Signup and view all the answers

What is one potential cardiovascular side effect of using xanthine derivatives?

Arrhythmias Signup and view all the answers

What is an indicator for carefully monitoring patients on beta-adrenergic agonists if they have diabetes?

Potential for high blood glucose levels Signup and view all the answers

Which anticholinergic is often described as the oldest and most commonly used?

Ipratropium Signup and view all the answers

Which of the following is a potential adverse effect of both anticholinergics and xanthines?

Dry mouth Signup and view all the answers

Which inhaled corticosteroid is indicated for treating asthma in both adults and children?

Mometasone Signup and view all the answers

What is a primary role of inhaled corticosteroids in asthma management?

To control inflammation in the airways Signup and view all the answers

Inhaled corticosteroids are NOT suitable for patients with which condition?

Fungal infections Signup and view all the answers

What common side effect may occur when starting treatment with inhaled corticosteroids?

Coughing Signup and view all the answers

Which corticosteroid is available in both inhaled and intranasal forms?

Fluticasone Signup and view all the answers

Inhaled corticosteroids may increase the risk of which oral condition?

Oral fungal infections Signup and view all the answers

Which medication is classified as an inhaled corticosteroid specifically for asthma management?

Budesonide Signup and view all the answers

Which of the following medication interactions may decrease the effectiveness of inhaled corticosteroids?

Phenytoin Signup and view all the answers

What is an important aspect of patient education regarding inhaler use?

Check for remaining doses regularly Signup and view all the answers

Which inhaled corticosteroid is known for having a longer duration of action compared to others?

Ciclesonide Signup and view all the answers

What is the therapeutic range for theophylline blood levels ideally recommended by most clinicians?

5 to 15 mcg/mL Signup and view all the answers

Which drug is indicated for use in infants with bradycardia?

Aminophylline Signup and view all the answers

What is the primary action of leukotriene receptor antagonists (LTRAs)?

They prevent leukotrienes from binding to their receptors. Signup and view all the answers

What severe side effects should be monitored in patients taking Montelukast?

Serious mood changes and behaviors Signup and view all the answers

Which of the following is NOT a characteristic of corticosteroids?

They are used for immediate relief of asthma attacks. Signup and view all the answers

In which form is aminophylline administered?

Intravenous Signup and view all the answers

Which class of drugs is primarily used to prevent asthma attacks rather than treating acute symptoms?

Leukotriene Receptor Antagonists Signup and view all the answers

What is an adverse effect commonly associated with leukotriene receptor antagonists?

Headache Signup and view all the answers

Which LTRA is specifically indicated for treating allergic rhinitis symptoms?

Montelukast Signup and view all the answers

How do corticosteroids primarily improve asthma treatment?

By stabilizing leukocytes' membranes Signup and view all the answers

What is the main benefit of inhaled corticosteroids compared to oral corticosteroids?

They have localized effects minimizing systemic side effects. Signup and view all the answers

Which of the following is a potential complication of long-term corticosteroid use?

Adrenal gland suppression Signup and view all the answers

What symptom can bronchoconstriction cause?

Coughing Signup and view all the answers

What effect do leukotriene receptor antagonists have on mucus secretion in the lungs?

Block mucus production. Signup and view all the answers

What is a primary characteristic of chronic bronchitis?

Excessive mucus secretion Signup and view all the answers

Which of the following is a common cause of chronic bronchitis?

Prolonged exposure to bronchial irritants Signup and view all the answers

What is the effect of emphysema on the alveoli?

They are destroyed and enlarged. Signup and view all the answers

How do short-acting beta-agonists (SABAs) primarily function?

They relax bronchial smooth muscle. Signup and view all the answers

What is a notable characteristic of long-acting beta-agonists (LABAs)?

They offer relief lasting 12 hours or more. Signup and view all the answers

In which situation are LABAs not recommended for use?

Acute asthma attacks Signup and view all the answers

Which medication type is indicated for rapid relief during acute asthma attacks?

Short-acting beta-agonists Signup and view all the answers

What mechanism is triggered by beta-adrenergic agonists after binding to the beta2 receptor?

Increased production of cAMP Signup and view all the answers

Which condition can beta-adrenergic agonists be used to treat besides respiratory issues?

Hypotension and shock Signup and view all the answers

What is a contraindication for the use of beta-adrenergic agonists?

Uncontrolled hypertension Signup and view all the answers

What role do anticholinergics play in bronchial treatment?

They block the action of acetylcholine. Signup and view all the answers

What is a primary function of bronchodilators?

Relax bronchial smooth muscle Signup and view all the answers

Which type of adrenergics only stimulate beta2 receptors?

Selective beta2 drugs Signup and view all the answers

Study Notes

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a group of lung diseases that cause airflow obstruction.
It includes chronic bronchitis and emphysema.
Lung damage is generally irreversible.
COPD is characterized by an irreversible airflow obstruction in the lungs.

Bronchial Asthma

Bronchial asthma is a chronic inflammatory disease that causes recurring episodes of wheezing, breathlessness, chest tightness, and coughing.
Airway inflammation, bronchospasm, and mucus hypersecretion lead to airway obstruction.
Asthma can be intrinsic, extrinsic, exercise-induced, or drug-induced.

Chronic Bronchitis

Chronic bronchitis is characterized by persistent inflammation and low-grade infection of the bronchi.
Inflammation leads to excessive mucus secretion and changes in the bronchial structure, causing breathing difficulties.
It often results from exposure to bronchial irritants like cigarette smoke or air pollution.

Emphysema

Emphysema damages the alveoli, the tiny air sacs in the lungs.
It leads to reduced gas exchange and makes it difficult to get enough oxygen.
Symptoms include shortness of breath, wheezing, and chronic cough.

Pharmacologic Overview: Bronchodilators

Bronchodilators relax bronchial smooth muscle, widening the bronchi and bronchioles.
They include beta-adrenergic agonists, anticholinergics, and xanthine derivatives.

Bronchodilators: Beta-Adrenergic Agonists

Short-acting Beta-Agonists (SABAs) provide quick relief from bronchospasm.
- Examples include albuterol.
- They're often used as rescue inhalers.
Long-acting Beta-Agonists (LABAs) provide long-lasting relief from asthma symptoms, lasting for 12 hours or more.
- Examples include salmeterol and formoterol.
- They are for long-term management of asthma symptoms.
Newest LABAs include indacaterol and vilanterol, often available in combination with other medications.
- "Ellipta" refers to a dry powder inhaler delivery system.

Beta-Adrenergic Agonists: Mechanism of Action

Beta-adrenergic agonists stimulate beta2 receptors, leading to bronchodilation.
Stimulation of beta2 receptors triggers the production of cyclic adenosine monophosphate (cAMP).
cAMP relaxes smooth muscle in the airways, improving airflow.

Anticholinergics

Anticholinergics block the action of acetylcholine, a neurotransmitter that constricts bronchioles.
Examples include ipratropium, tiotropium, and aclidinium.
They prevent bronchoconstriction by blocking acetylcholine from binding to muscarinic receptors in the airway, promoting airway relaxation and dilation.

Xanthine Derivatives

Xanthines, such as theophylline, inhibit phosphodiesterase, increasing cAMP levels, leading to bronchodilation.
They stimulate the central nervous system and cardiovascular system.

Nonbronchodilating Respiratory Drugs

Leukotriene Receptor Antagonists (LTRAs) block the action of leukotrienes, substances that cause inflammation, bronchoconstriction, and mucus production.
- Examples include montelukast, zafirlukast, and zileuton.
Corticosteroids reduce inflammation in the airways.
Mast Cell Stabilizers prevent the release of histamine, a substance that causes inflammation and airway constriction in the lungs.

Leukotriene Receptor Antagonists (LTRAs)

They are used to prevent asthma attacks, not to treat acute attacks.
They offer an alternative to traditional asthma medications.

Corticosteroids

They have potent anti-inflammatory effects, reducing inflammation in the airways.
They are crucial for managing chronic asthma, preventing exacerbations.
Oral corticosteroids have systemic effects, while inhaled forms are more localized.

Inhaled Corticosteroids

Examples include beclomethasone dipropionate.
Used for long-term control of asthma.

Inhaled Corticosteroids: Overview

Purpose: Primarily used for long-term asthma control, reducing exacerbations, and treating persistent asthma.
Commonly Used: Budesonide, Ciclesonide, Flunisolide, Fluticasone, Mometasone, Triamcinolone acetonide.
Mechanism: Control inflammation in the airways by suppressing inflammatory cells and mediators.
Administration: Inhaled corticosteroids are delivered directly to the lungs, minimizing systemic effects.

Inhaled Corticosteroids: Contraindications

Drug Allergy: Avoid in patients with known allergy to inhaled corticosteroids.
Acute Asthma Attacks: Not a primary treatment for acute attacks; bronchodilators are used instead.
Hypersensitivity: Contraindicated in those with hypersensitivity to glucocorticoids.
Fungal Infection: Avoid in patients with systemic fungal infections or positive sputum tests for Candida.

Inhaled Corticosteroids: Adverse Effects

Common: Pharyngeal irritation, coughing, dry mouth, oral fungal infections.
Systemic Effects (Rare): Adrenal suppression, osteoporosis, cataracts (with high doses or prolonged use).

Inhaled Corticosteroids: Drug Interactions

Systemic vs. Inhaled: Drug interactions are more likely with systemic corticosteroids; inhaled corticosteroids are generally safe and well-tolerated.
Common Interactions:
- Antidiabetic Drugs: May increase serum glucose levels; dosage adjustments may be needed.
- Cyclosporine & Tacrolimus: Increased risk of infections, especially in renal impairment.
- Itraconazole, Ketoconazole, Strong CYP3A4 inhibitors: Potential increase in adverse effects of inhaled corticosteroids.
- Phenytoin, Phenobarbital, Rifampin: Reduced effectiveness of inhaled corticosteroids.

Inhaler: Patient Education

Inhaler Technique:
- Teach proper technique for effective medication delivery.
- Demonstrate and practice inhaler use.
- Emphasize correct timing of inhalation and activation.
- Provide a spacer for patients with coordination difficulties.
Dose Tracking:
- Ensure patients can monitor their medication use.
- Educate on how to count remaining doses.
- Encourage refilling before running out.
- Advise patients to keep inhalers in a safe, accessible location.

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Description

This quiz covers various chronic lung diseases, including Chronic Obstructive Pulmonary Disease (COPD), bronchial asthma, chronic bronchitis, and emphysema. Learn about their characteristics, causes, and effects on lung function. Test your knowledge on the differences and similarities between these respiratory conditions.