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Questions and Answers
What is the primary mechanism by which anticholinergics function as bronchodilators?
What is the primary mechanism by which anticholinergics function as bronchodilators?
Which medication has a rapid onset of action and is noted for its long duration?
Which medication has a rapid onset of action and is noted for its long duration?
Which condition should be approached with caution when prescribing anticholinergics?
Which condition should be approached with caution when prescribing anticholinergics?
What is a common adverse effect related to the systemic absorption of anticholinergics?
What is a common adverse effect related to the systemic absorption of anticholinergics?
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What role do inhaled steroids play in treating obstructive pulmonary disorders?
What role do inhaled steroids play in treating obstructive pulmonary disorders?
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Which of the following is NOT a contraindication for the use of ipratropium?
Which of the following is NOT a contraindication for the use of ipratropium?
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How quickly does ipratropium take effect when inhaled?
How quickly does ipratropium take effect when inhaled?
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Which of the following treatments directly alters the inflammatory process in obstructive pulmonary disorders?
Which of the following treatments directly alters the inflammatory process in obstructive pulmonary disorders?
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What is the primary route of administration for glucocorticoids?
What is the primary route of administration for glucocorticoids?
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Which of the following is NOT a common side effect of inhaled steroids?
Which of the following is NOT a common side effect of inhaled steroids?
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How long does it typically take for inhaled steroids to reach effective levels?
How long does it typically take for inhaled steroids to reach effective levels?
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In what scenario should inhaled steroids be avoided?
In what scenario should inhaled steroids be avoided?
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What is a potential risk associated with the use of leukotriene receptor antagonists during pregnancy?
What is a potential risk associated with the use of leukotriene receptor antagonists during pregnancy?
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Which leukotriene receptor antagonist is primarily excreted in feces after metabolism?
Which leukotriene receptor antagonist is primarily excreted in feces after metabolism?
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What should patients be monitored for when using leukotriene receptor antagonists?
What should patients be monitored for when using leukotriene receptor antagonists?
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Which of the following actions do leukotriene receptor antagonists perform?
Which of the following actions do leukotriene receptor antagonists perform?
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What is the primary action of the sympathetic nervous system regarding bronchi?
What is the primary action of the sympathetic nervous system regarding bronchi?
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Which type of adrenergic receptors do beta2-selective sympathomimetics primarily target in the bronchi?
Which type of adrenergic receptors do beta2-selective sympathomimetics primarily target in the bronchi?
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What effect do sympathomimetics have on blood pressure?
What effect do sympathomimetics have on blood pressure?
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Which drug is considered the prototype sympathomimetic for treating acute bronchospasm?
Which drug is considered the prototype sympathomimetic for treating acute bronchospasm?
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What is a common adverse effect associated with sympathomimetics?
What is a common adverse effect associated with sympathomimetics?
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Which drug is NOT typically used in a parenteral form?
Which drug is NOT typically used in a parenteral form?
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Which of the following conditions warrants caution when using sympathomimetics?
Which of the following conditions warrants caution when using sympathomimetics?
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What is one alternative for patients who cannot tolerate the sympathomimetic effects?
What is one alternative for patients who cannot tolerate the sympathomimetic effects?
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Study Notes
Respiratory System Overview
- The respiratory system comprises the upper and lower respiratory tracts.
- The upper tract includes the nose, pharynx, larynx, and trachea.
- The lower tract includes the bronchial tree and alveoli.
- Inflammation in the upper respiratory tract can cause common cold, seasonal rhinitis, sinusitis, pharyngitis, and laryngitis.
- Inflammation of the lower tract can lead to serious conditions like bronchitis and pneumonia, impacting gas exchange.
- Obstructive disorders hinder gas delivery to alveoli due to airway blockages (e.g., asthma, COPD).
- Drugs affecting the respiratory system maintain open airways and efficient gas movement.
Cough Remedies (Antitussives)
- Antitussives suppress the cough reflex by acting on the brain's cough center.
- These drugs are often used for nonproductive coughs (e.g., common cold, sinusitis).
- Persistent coughing can cause muscle strain and further respiratory irritation.
- Examples of antitussives include benzonatate (Tessalon), codeine, dextromethorphan (Benylin), and hydrocodone (Hycodan).
Pharmacokinetics (Antitussives)
- Codeine, hydrocodone, and dextromethorphan are rapidly absorbed, metabolized in the liver, and excreted in urine.
- They cross the placenta and enter breast milk.
- Benzonatate is also metabolized in the liver and excreted in urine.
Contraindications/Cautions (Antitussives)
- Antitussives should be used carefully in patients requiring a cough to clear airways.
- Patients with asthma or emphysema may develop secretion buildup with cough suppression.
- Use caution in patients with hypersensitivity to narcotics or a history of addiction to narcotics.
- Avoid use during pregnancy and lactation.
Adverse Effects (Antitussives)
- Traditional antitussives dry mucous membranes and increase respiratory tract secretions' viscosity.
- Central nervous system (CNS) effects like drowsiness and sedation can occur due to brain center impact.
- Dry mouth, nausea, constipation, and GI upset are other associated side effects.
- Local antitussives may cause headaches, congestion, and dizziness.
Expectorants (e.g., Guaifenesin)
- Expectorants reduce respiratory tract fluid adhesiveness and surface tension, improving secretion movement and thus facilitating a more productive cough.
- Expectorants are indicated for symptomatic relief of dry, nonproductive coughs (e.g., common cold, acute bronchitis, influenza).
- Guaifenesin is rapidly absorbed (onset 30 minutes), with a duration of 4-6 hrs.
Adverse effects (Expectorants)
- Common adverse effects include gastrointestinal (GI) symptoms (nausea, vomiting, anorexia).
- Less common effects include headache, dizziness, and a possible mild rash.
Mucolytics (e.g., Acetylcysteine, Dornase Alfa)
- Mucolytics increase or liquefy respiratory secretions to aid in airway clearance.
- Acetylcysteine affects mucoproteins to decrease secretion viscosity.
- Dornase alfa selectively breaks down respiratory mucus by separating DNA from proteins and used in cystic fibrosis cases (characterized by thick tenacious mucus).
Pharmacokinetics (Mucolytics)
- Mucolytic administration may be via nebulization or direct tracheal instillation.
Contraindications/Cautions (Mucolytics)
- Mucolytics should be used cautiously in acute bronchospasm, peptic ulcer, esophageal varices as increased secretions worsen these problems.
Bronchodilators/Antianthmatics (Asthma/COPD)
- Bronchodilators/Antianthmatics relax airway smooth muscle, enhancing breathing and preventing/treating bronchospasm associated with asthma and COPD.
- Some are administered orally, leading to increased systemic effects.
- Others (e.g., nebulizers) are administered directly into the airways, reducing systemic effects.
- Include xanthines, sympathomimetics, and anticholinergics.
Xanthines (e.g., Aminophylline, Caffeine, Theophylline)
- Xanthines directly affect smooth muscle in the respiratory tract and blood vessels.
- They inhibit slow-reaction substance (SRS-A) and histamine release. Reducing airway swelling and narrowing.
- Aminophylline, caffeine, dyphylline, theophylline are examples.
Pharmacokinetics (Xanthines)
- Rapidly absorbed from the gastrointestinal (GI) tract (oral) and via intravenous (IV) injection.
- Widely distributed, metabolized in the liver, excreted in urine.
- Cross placenta, enter breast milk.
Contraindications/Cautions (Xanthines)
- Use caution in patients with GI problems, coronary disease, respiratory dysfunction, renal/hepatic disease, alcoholism, or hyperthyroidism.
- Systemic side effects can exacerbate these conditions.
Adverse Effects (Xanthines)
- Adverse effects are related to theophylline blood levels.
- Therapeutic levels range from 10-20 mcg/mL.
- Adverse effects increase with higher levels, including GI upset, nausea, irritability, tachycardia, seizures, and even death.
- Nicotine increases xanthine metabolism in the liver. Increase doses may be necessary in smokers if treatment continues.
Sympathomimetics (e.g., Epinephrine, Albuterol, Formoterol)
- Act directly on beta2-receptors in bronchi (increasing respiration rate and depth).
- Beta2-selectivity is lost at higher levels, leading to systemic effects.
Anticholinergics (e.g., Ipratropium, Tiotropium)
- Anticholinergics block neurotransmitter acetylcholine actions at vagus-mediated receptor sites.
- Prevents smooth muscle contraction and thus improve airflow.
- These medications are often used when patients cannot tolerate sympathetic effects of sympathomimetics.
Drugs Affecting Inflammation (e.g., Inhaled Steroids, Leukotriene Receptor Antagonists, Mast Cell Stabilizer)
- Steroids, leukotriene inhibitors, mast cell stabilizers target inflammatory processes.
- These affect airway inflammation, mucus production, and bronchoconstriction that arises from inflammation.
Inhaled Steroids
- Inhaled steroids effectively treat bronchospasm by reducing airway inflammation.
- They decrease the inflammatory cells' effectiveness.
Leukotriene Receptor Antagonists
- These block or antagonize leukotriene receptors responsible for asthma symptoms like constriction, edema, mucus secretion, and neutrophil aggregation.
Mast Cell Stabilizer (e.g., Cromolyn Sodium)
- Mast cell stabilizers prevent the release of substances that cause inflammation and bronchoconstriction from mast cells.
Pharmacokinetics (Inhaled Steroids)
- Rapid absorption, but takes weeks to reach effective levels.
- Metabolized in the liver, excreted in urine.
- Cross placenta, enter breast milk.
Contraindications/Cautions (Inhaled Steroids)
- Not used for acute asthma attack or status asthmaticus.
- Use with caution during pregnancy and lactation (risk-benefit assessment required).
- Caution in active respiratory infections, as suppression of the inflammatory response can be dangerous.
Adverse Effects (All)
- Adverse effects are often limited, due to localized administration (inhaled).
- But possible side effects include local irritation (throat soreness), hoarseness, dry mouth, coughing, pharyngeal/laryngeal fungal infections.
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Description
This quiz covers the anatomy and function of the respiratory system, including the upper and lower tracts. It also discusses common respiratory disorders and their treatments, particularly focusing on antitussives for cough relief. Test your knowledge on how these systems work and how medications manage respiratory issues.
