Respiratory Medications and Management

Respiratory Medications and Management

• Respiratory medications are prescribed to manage patients with pulmonary diseases.

• Each medication has a unique mechanism of action, and understanding these individual differences is crucial for safe and effective patient care.

Common Respiratory Medications

• Cough suppressants:

  • Suppress the coughing reflex.
  • Most are narcotics like codeine, acting on the medulla oblongata of the brain to prevent coughing.

• Bronchodilators:

  • Treat breathing difficulty in conditions like asthma.
  • Relax the muscles surrounding the airways that constrict in airway disorders, relieving constriction.

• Expectorants:

  • Increase the amount and thin bronchial secretions, making coughs more productive.
  • This aids in clearing the airways and eases breathing.

• Decongestants:

  • Treat allergies, sneezing, and runny nose.
  • Reduce swelling and edema by causing local constriction of blood vessels.

• Antibiotics:

  • Prescribed for true bacterial infections that worsen existing airway diseases.
  • Not always necessary for inflammatory airway diseases.

• Anti-inflammatory drugs:

  • Corticosteroids (glucocorticoids) prevent the release of inflammatory chemicals.
  • Control inflammation of the airways.
  • Suppress the immune system.

Asthma

• A non-communicable disease, commonly affecting both children and adults.
• Characterized by chronic inflammation and narrowing of the small airways in the lungs.
• Symptoms include cough, wheeze, shortness of breath, and chest tightness.

Asthma Triggers

• Common triggers include allergies, stress, cold air, exercise, gastroesophageal reflux disease, pollution, smoking, bacteria/viruses, pets, household chemicals, and dust.
• Individuals can have more than one trigger.

Facts about Asthma

• Asthma can change over time, requiring regular doctor visits to track symptoms and adjust medications accordingly.

• The type and dosage of asthma medications depend on symptoms and age.

Asthma Treatments

• Inhalers: The most common treatment for asthma. Devices for breathing in medicine.
• Tablets and other treatments: Required for severe asthma.

Asthma Inhalers

• Devices containing medicine that is taken by inhaling (breathing in).
• Primarily used for treating asthma to control symptoms.
• The medicine goes directly into the airways, requiring much smaller doses than oral medications.
• Contain various compositions, usually including corticosteroids and bronchodilators.

Inhalers for Asthma (Continued)

• Examples of combination inhalers:
  • Fostair® (formoterol and beclometasone)
  • Seretide® (salmeterol and fluticasone)
  • Symbicort® (formoterol and budesonide)

Side Effects of Asthma Inhalers

• Side effects are minimal compared to liquid or tablet medications.
• Some potential side effects include sore throat, cough, and oral thrush (fungal infection).

Chronic Obstructive Pulmonary Disease (COPD)

• A group of lung conditions causing breathing difficulties, including:
  • Emphysema: Damage to the air sacs in the lungs.
  • Chronic Bronchitis: Long-term inflammation of the airways.

COPD Symptoms

• Shortness of breath, especially during activity.
• Persistent chesty cough with phlegm.
• Chest infections.
• Wheezing.
• Chest tightness.
• Fatigue.
• Weight loss.

COPD Risk Factors

• Smoking (most common)
• Air pollution.
• Chemical fumes.
• Dust.
• Family history of COPD.
• Age.
• Certain genetic conditions.

COPD Treatments

• No cure exists, but treatment focuses on controlling symptoms and slowing progression.
• It includes:
  • Inhalers and tablets: Make breathing easier.
  • Stopping smoking: Crucial for patients.
  • Pulmonary rehabilitation: Exercise and education programs organized by healthcare workers.
  • Surgery or lung transplant: Options for a small number of patients.

Stopping Smoking and COPD

• Quitting smoking is the most effective way to prevent COPD from worsening.
• Cessation can help prevent further damage to the lungs and airways.
• Many patients require oxygen machines to assist with breathing in everyday activities to maintain normal blood oxygen levels.

Short-Acting Bronchodilator Inhalers for COPD

• First treatment used for most people with COPD.
• Used when shortness of breath occurs, up to a maximum of four times a day.
• Deliver medicine directly into the lungs when breathing in.
• The inhaler contains bronchodilators that relax and widen the airways, making breathing easier.
• Two types:
  • Beta-2 agonist inhalers: Salbutamol and terbutaline.
  • Antimuscarinic inhalers: Ipratropium.

Long-Acting Bronchodilator Inhalers for COPD

• For patients experiencing regular symptoms despite short-acting bronchodilators.
• A single dose lasts for at least 12 hours, requiring use once or twice a day.
• Two types:
  • Beta-2 agonist inhalers: Salmeterol, formoterol, and indacaterol.
  • Antimuscarinic inhalers: Tiotropium, glycopyronium, and aclidinium.

Steroid Inhalers for COPD

• For patients experiencing shortness of breath even when using a long-acting inhaler or who develop frequent flare-ups (exacerbations).
• Includes a steroid inhaler as part of treatment.
• Steroids reduce inflammation in the airways and are often prescribed in combination with long-acting medication.

Theophylline Tablets or Capsules for COPD

• Used for patients whose symptoms are not controlled with inhalers.
• Theophylline is usually taken twice a day as tablets or capsules.
• Exact mechanism is unclear but seems to reduce swelling (inflammation) and relax airway muscles.
• Regular blood tests are required to monitor theophylline levels in the blood.

Possible Side Effects of Theophylline

• Slow, fast, or irregular heartbeat.
• Pounding or rapid pulse.
• Fainting.
• Chest pain.
• Increased urine volume.
• Persistent vomiting.

Steroid Tablets for COPD

• Prescribed for patients with particularly bad flare-ups (exacerbations).
• Typically a 5-day course of treatment is recommended to reduce airway inflammation.
• Long-term use can lead to troublesome side effects:
  • Weight gain.
  • Mood swings.
  • Weakened bones (osteoporosis)

Mucolytic Medicines for COPD

• Used for patients with persistent chesty cough and thick phlegm.
• Might require carbocisteine, a mucolytic medicine, to help thin phlegm and make it easier to cough up.
• Carbocisteine is available as tablets or capsules and is typically taken three or four times a day.
• If carbocisteine doesn't help, acetylcysteine, an alternative mucolytic medicine, is available.

Antibiotics for COPD

• May be prescribed for signs and symptoms of chest infection like:
  • Increased breathlessness.
  • Increased coughing.
  • Changes in sputum color (yellow, green, brown) and/or consistency (thicker).

Drugs for Cough

• Dry cough: A preparation containing an antitussive like dextromethorphan.

• Chesty cough: A preparation containing an expectorant like guaifenesin.

• Antitussives: -Suppress the urge to cough.

  • Coughing is a natural reflex.
  • Antitussives prevent cough by acting on the part of the brain controlling the action.

• Expectorants:

  • Thin mucus.
  • Help cough up mucus during a productive cough.
  • Ideal for coughs that produce thick mucus.

Antibiotics (Continued)

• First-choice antibiotics for adults aged 18 years and over include:
  • Doxycycline: 200 mg on day 1, then 100mg daily for four days (5-day course).
• Alternative choices:
  • Amoxicillin: 500mg three times daily for 5 days.
  • Clarithromycin: 250-500mg twice daily for 5 days.
  • Erythromycin: 250-500mg four times daily, or 500-1000mg twice daily for 5 days.

Side Effects of Taking Too Much Cough Medicine

• Antibiotics are not recommended for uncomplicated acute bronchitis.

Drugs for Treating Allergic Respiratory Disorders

• Expectorants (e.g., Guaifenesin): Help clear mucus or phlegm from the chest during a cold or flu. Thins mucus in the lungs.
• Decongestants (e.g., Pseudoephedrine): Provide short-term relief for blocked or stuffy noses. Reduce swelling in the blood vessels of the nose, opening the airways. Ease symptoms of colds and flu.
• Theophylline: A bronchodilator that widens airways by relaxing muscles in the lungs. Sometimes found in medications that also contain guaifenesin.

Toxicity of Theophylline

• Toxic levels: Above 20 µg/mL.
• Adverse effects can occur within the therapeutic range, especially in elderly patients.
• Severe complications include:
  • Cardiac dysrhythmias (abnormal heartbeat).
  • Seizures.
• Levels of 80-100 µg/mL can be fatal.

Recommended Therapeutic Plasma Level for Theophylline

• The reference range for theophylline in treating acute bronchospasm in adults is around 10-15 µg/mL.

Theophylline in Neonatal Apnea

• Theophylline is used to treat neonatal apnea, which is the absence of breathing in a newborn for more than 15 seconds.
• The reference range of theophylline in neonates is 6-11 µg/mL.
• A neonate is a child under 28 days of age.

Why Blood Test for Theophylline is Necessary

• Blood tests help determine the correct dosage of theophylline.
• Too much theophylline can be life-threatening.
• Theophylline has a narrow therapeutic window, meaning the difference between the effective dose and the toxic dose is small.
• Doctors monitor the heart rate, central nervous system effects (headache, insomnia, irritability), and respiratory rate of patients taking theophylline.

How to Test for Theophylline

• Theophylline blood tests are used to monitor the amount of theophylline in the blood.
• The test is usually requested as a trough level, which is measured just before the next dose.
• The trough level is when the blood concentration is expected to be at its lowest.

Respiratory Medications

• Used to manage pulmonary diseases
• Each medication has a unique mechanism of action
• Important to understand implications of each medication for patients
• Goal is to provide effective and safe treatment

Commonly Used Medications

• Cough Suppressants: Suppress cough reflex, often narcotics acting on the medulla oblongata
• Bronchodilators: Relax muscles surrounding airways to relieve constriction in airway disorders
• Expectorants: Increase and thin bronchial secretions, making coughs more productive
• Decongestants: Reduce swelling and edema, cause local vasoconstriction
• Antibiotics: Used for bacterial infections, may not be necessary for inflammatory airway diseases
• Anti-Inflammatory Drugs: Corticosteroids like glucocorticoids suppress inflammation and immune response

Asthma

• Non-communicable disease, common chronic disease in children and adults
• Caused by inflammation and narrowing of the airways
• Symptoms include cough, wheeze, shortness of breath, and chest tightness

Triggers of Asthma

• Allergic asthma is common
• Other triggers include:
  • Stress
  • Cold air
  • Exercise
  • Gastroesophageal reflux disease
• People can have multiple triggers

More Triggers of Asthma

• Pollution
• Smoking
• Bacteria and viruses
• Genetic predisposition
• Pets
• Household chemicals
• Dust

Facts About Asthma

• Asthma can change over time
• Consult a doctor to track symptoms and adjust medications
• Medication type and dosage depend on symptoms and age

Treatment of Asthma

• Most common treatment is inhalers
• Tablets and other treatments may be needed for severe asthma
• Follow a personalized action plan advised by a doctor

Asthma Inhalers

• Devices containing medicine inhaled for treatment
• Deliver medicine directly to airways
• Require smaller doses than oral medications

Medicines in Asthma Inhalers

• Contain a corticosteroid and/or a bronchodilator
• Generic names refer to the medicine, brand names specify the manufacturer
• Different companies may use the same generic medicine

Side Effects of Asthma Medications

• Drowsiness
• Dizziness
• Blurred vision
• Coma
• Constipation
• Seizures
• Blue fingernails and lips
• Slow or labored breathing, shallow breathing, no breathing (especially in young children)

Allergic Respiratory Disorders

• Include asthma, chronic rhinosinusitis, and allergic rhinitis
• No cure for respiratory allergies, but avoiding triggers is crucial
• Medications like antihistamines help control symptoms

Antihistamines for Respiratory Allergies

• Block histamine, a key chemical in allergic reactions
• Common antihistamines include:
  • Cetirizine (Zyrtec)
  • Desloratadine (Clarinex)
  • Fexofenadine (Allegra)
  • Levocetirizine (Xyzal)
  • Loratadine (Claritin)

Medicine for Allergy Cough

• Antihistamines block histamine-induced allergic symptoms, including cough
• Common medications include fexofenadine (Allegra) and loratadine (Claritin)
• Antibiotics do not cure allergic cough

Theophylline

• Medication used to treat asthma and other respiratory conditions
• Narrow therapeutic window, requiring blood tests to monitor dosage
• Side effects can be serious, requiring careful monitoring
• Theophylline levels are monitored to ensure effective treatment and avoid toxicity

Monitoring Theophylline Levels

• Blood tests measure theophylline concentration
• Trough levels are measured just before the next dose
• Monitoring helps adjust dosage and prevent overdose

Theophylline Testing

• High-performance liquid chromatography (HPLC) with ultraviolet detection is a common method
• Method is simple, sensitive, and selective for quantifying theophylline

HPLC Method

• Separates components of a sample based on their chemical structure
• Uses a mobile phase and a stationary phase (column)
• Different components elute at different times, allowing for separation
• DAD (diode array detector) is a sensitive detection technique that collects data at multiple wavelengths

Advantages of HPLC

• Separates a wide variety of compounds
• Accurate peak identification by comparing to reference standards
• Quantification based on peak size
• Less expensive
• Columns can be reused after cleaning
• Non-destructive, allowing for further testing

What is Asthma?

• A chronic condition that causes inflammation and narrowing of the airways in the lungs
• Symptoms may include episodes of wheezing, coughing, shortness of breath, and chest tightness
• Triggered by various factors like allergens, irritants, exercise, and cold air

Asthma

• Asthma is a chronic lung disease that affects people of all ages.
• The disease is caused by inflammation and narrowing of the airways in the lungs.

Asthma Inhalers

• Contain medicine that is inhaled.
• Used to treat asthma and control asthma symptoms.
• Medicine in inhalers goes directly into the airways.
• Require smaller doses of medicine compared to oral medication.

Types of Inhalers

• Many types of inhalers are available.
• Generic name is the official name of the drug/medicine.
• Different companies use the same generic medicine to produce different brands.
• Most inhalers contain a combination of a corticosteroid and a bronchodilator.

Drugs for Treating Asthma

• Drowsiness, dizziness, blurred vision, coma, constipation, seizures, bluish-colored fingernails and lips, slow and labored breathing, shallow breathing, no breathing (especially in young children) are potential symptoms related to asthma medication.

Allergic Respiratory Diseases (ARD)

• Includes asthma, chronic rhinosinusitis, and allergic rhinitis.

Chronic Rhinosinusitis

• Swelling of the lining of the sinuses due to inflammation.

Allergic Rhinitis

• Inflammation with redness and swelling inside the nose.

Cure for Respiratory Allergies

• There may not be a cure for respiratory allergies.
• Avoiding allergic triggers is important to prevent symptoms.
• Medications like antihistamines can help control symptoms.

Antihistamines for Respiratory Allergies

• Cetirizine (Zyrtec), Desloratadine (Clarinex), Fexofenadine (Allegra), Levocetirizine (Xyzal), and Loratadine (Claritin) are common antihistamines used.

Medicine for Allergy Cough

• Antihistamines block histamine, which causes allergic symptoms.
• Antihistamines help relieve allergy coughs.
• Fexofenadine (Allegra) and loratadine (Claritin) are commonly used.
• Antibiotics are not recommended for uncomplicated acute bronchitis.

Expectorants

• Guaifenesin is an example of an expectorant.
• It helps clear mucus or phlegm from the chest during a cold or flu.
• Works by thinning mucus or phlegm in the lungs.

Decongestants

• Pseudoephedrine is an example of a decongestant.
• Provides short-term relief for blocked or stuffy noses.
• Reduces swelling of blood vessels in the nose, opening the airways.
• Helps ease symptoms associated with colds and flu.

Theophylline

• A bronchodilator that makes breathing easier by relaxing lung muscles and widening airways.
• Present in some medications containing other bronchodilators, such as theophylline.

Theophylline Toxicity

• Toxic levels are considered to be higher than 20 µg/mL.
• Adverse effects can occur within the normal therapeutic range, especially in elderly patients.
• Severe complications include cardiac dysrhythmias, seizures, and death can be observed at levels of around 80-100 µg/mL.

Theophylline Recommended Therapeutic Plasma Levels

• For acute bronchospasm in adults: 10-15 µg/mL.
• For neonatal apnea: 6-11 µg/mL.

Why Blood Tests for Theophylline are Necessary

• Help doctors determine the correct dose.
• Indicate if the patient has too much theophylline in their body.
• Too much theophylline can be life-threatening.
• Theophylline levels need to be monitored due to its narrow therapeutic window and side effects.
• Doctors commonly monitor the patient's heart rate, central nervous system effects, and respiratory rate.

How to Test for Theophylline

• Theophylline test measures the amount of theophylline in the blood.
• Usually requested as a trough level, measured just before the next dose.
• This is when the blood concentration is expected to be at its lowest level.

Method of Theophylline Analysis

• High performance liquid chromatography (HPLC) with ultraviolet detection (272 nm) is a common method for testing.
• It's a simple, sensitive, and selective laboratory method.
• Developed for quantifying theophylline in plasma.

Characteristics of HPLC

• Used in pharmacology for quantitative drug analysis and separating components in mixed drug substances.
• Sample separation occurs when the drug distribution occurs between a mobile phase and stationary phase within the column.
• The time the sample spends on the stationary phase determines by the intermolecular interactions (or polarity) between the molecules and the column packing material.
• Different elements of the drug sample are eluted at different time intervals.

DAD Detector

• Also called photodiode-array (PDA) detector.
• One of the most popular techniques for HPLC.
• Unlike other UV detection methods, DAD collects data at multiple wavelengths simultaneously.
• The molecular structure of target analytes absorb light at different wavelengths on the electromagnetic spectrum.
• DAD allows for tunability of the detection wavelength allowing for the detection of thousands of target analytes.

Advantages of HPLC

• Powerful for separating nearly any soluble compound, including vitamins, amino acids, and other biological compounds.
• Comparing target peaks to certified reference standards ensures accurate signal identification.
• Computational mathematics quantifies the target analyte based on peak size.
• Less expensive.
• Reuse of cleaned columns is possible.
• Further sample testing is possible.
• HPLC testing with DAD doesn't destroy analytical samples.

This quiz covers various respiratory medications and their management, focusing on their mechanisms of action. Understanding the differences in treatments such as cough suppressants, bronchodilators, expectorants, and decongestants is essential for effective patient care. Test your knowledge in respiratory pharmacology and improve your clinical skills.