Respiratory and Mental Health Medications

• Medications for respiratory and mental health

Bronchodilators

• Adrenergics
• Anticholinergics
• Methylxanthines

Glucocorticoids

• Can be administered orally or through inhalation

Anti-inflammatory Agents

• Inhaled corticosteroids
• Leukotriene
• Mast Cells

Inhaled Corticosteroid

• Includes pulmicort and Flunisolide-AeroBid as prototypes
• Patients transitioning from oral to inhaled corticosteroids have an increased risk of adrenal insufficiency, especially if they experience trauma, surgery, or infections, particularly gastroenteritis.

Leukotriene

• Zafirlukat (Accolate) is a prototype
• Singular
• Used as a prophylactic and for anti-inflammatory purposes
• Not recommended for acute asthma attacks
• Suitable for chronic asthma management
• Interacts with theophylline, potentially increasing its drug level

LABA (Long-Acting Beta Agonist)

• Salmeterol
• Not intended for abortive therapy as it is long-acting

Antihistamines

• First-generation antihistamine: Benadryl is used for sleep, motion sickness, and as an antiemetic
• Contraindicated if the patient has glaucoma
• Anticholinergic effects

Second-Generation Antihistamines

• Loratadine is taken once daily on an empty stomach
• Absorption is affected by apple, grapefruit, and orange juice, as well as rifampin
• Allegra

SABA (Short-Acting Beta Agonist)

• Albuterol
• Used for acute asthma attacks
• Frequent use (more than 2-3 times per week) indicates poor asthma control
• Overuse can lead to rebound bronchoconstriction

Methylxanthines

• Theophylline has a narrow therapeutic range (5-15) requiring close monitoring
• No antidote for toxicity
• Toxicity signs at 20mcg, seizures at 30mcg, hyperglycemia, hypotension, brain damage
• Requires diet, OTC drugs, smoking habits, and adherence to be screened if levels decrease
• Tobacco increases theophylline's half-life by 50%; smoking may necessitate increased theophylline dosage
• Caffeine, including from OTC drugs, can increase theophylline levels
• Decreases the effects of lithium

Stages of COPD Treatment and Guidelines

• SABA PRN to manage acute episodes
• SABA plus long-acting anticholinergic (ipratropium); use bronchodilator and consider theophylline for breakthrough symptoms
• Add inhaled steroid (Pulmocort)
• Administer oxygen
• Inhaled steroids decrease frequency of exacerbation

Mast Cell Stabilizers

• Cromolyn used as a prophylactic anti-inflammatory agent, not a bronchodilator
• May cause a bitter taste in the mouth after administration

Salmeterol

• Long-acting bronchodilator
• Contraindicated with beta-blockers
• Serevent Diskus brand
• Used for chronic maintenance of asthma and COPD
• Not for PRN use
• Do not administer more than twice a day

Ipratropium

• Anticholinergic, long-acting anticholinergic (Atrovent)
• First-line treatment for COPD
• Prescribed either orally or nasally
• Administer last after other inhalers and 5 minutes before steroids
• Not first choice in acute situations due to its long-acting properties
• May cause paradoxical bronchospasm with a newly opened MDI
• MDI: use 2 sprays before use

Antidepressants: SSRIs

• Indicated for depression and are considered first-line treatment
• Examples include fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and fluvoxamine
• Adverse effects: sexual dysfunction, mania
• Serotonin syndrome may develop within 6-8 hours of initiation or increasing the dose
• Contraindicated for clients taking MAOIs; wait five weeks after discontinuation before starting an SSRI
• Administer with caution for clients taking anticoagulants due to protein binding
• Avoid breastfeeding

Tricyclic Antidepressants

• Taken once daily
• Examples include Imipramine (Tofranil), Desipramine (Norpramin), Amitriptyline, Doxipine, and Nortriptyline (Pamelor)
• Indicated for eating disorders and insomnia
• Adverse effects: cardiac conduction disorders
• Monitor drug levels