RSPT 2217 Respiratory Care Pharmacology Unit 4 A&B Test #4 PDF

RSPT 2217 RESPIRATORY CARE PHARMACOLOGY UNIT 4 A&B TEST #4 Aerosolized Drugs and Common Names (associated common names and delivery methods ( Oral, SVN, MDI, and DPI) Steroids and Combination Drugs Beclomethasone: Quar: MDI Fluticasone:...

RSPT 2217 RESPIRATORY CARE PHARMACOLOGY UNIT 4 A&B TEST #4 Aerosolized Drugs and Common Names (associated common names and delivery methods ( Oral, SVN, MDI, and DPI) Steroids and Combination Drugs Beclomethasone: Quar: MDI Fluticasone: Flovent: MDI/DPI Budesonide: Pulmicort: DPI, Pulmicort Respules: SVN Mometasone Furoate: Asmanex MDI Ciclesonide: Alvesco MDI Fluticasone/salmeterol: (Advair) MDI or DPI Budesonide/ Formoterol: (Symbicort/Breyna) MDI Mometasone/ Formoterol: (Dulera) MDI Mediator Antagonists Cromolyn Sodium: Inhalation, eye drop solution, nasal solution (Nasalcrom), oral solution (Gastrocrom) Zafirlukast: Accolate (oral) BOD Zileuton: Zyflo (oral) QID Montelukast: Singular (oral) DAILY  Omalizumab: Xolair (SQ) 1. Name three types of corticosteroids naturally occurring in the body. - Glucocorticoid (cortisol) = corticosteroids = “steroids” used commonly in medicine - Mineralocorticoids (aldosterone) - Sex hormones (androgen and estrogen) 2. Explain the effect that oral and aerosolized steroids have on natural cortisol production. - Use of IV/Oral steroid drugs suppresses the natural production of cortisol, and can be seen after one day of oral steroid treatment. This can lead to adrenal crisis or insufficiency with serious symptoms if not appropriately tapered. 3. Discuss the diurnal rhythm of steroid secretion. - The body’s production of cortisol follows a pattern, peak levels occur around 0800, and the lowest levels occur through the night and are the lowest at 0400, a time when many asthmatics awake wheezing. 4. Describe the inflammation process. - Increased vascular permeability: fluid leaks into surrounding area causing localized swelling in response to injury and allergens - WBCs migrate through capillary walls (infiltrate injured/allergic area) - Mediator cascade: histamine and other chemoattractant factors are released at site affected causing inflammatory mediators to be produced. 5. Name the two most common causes of inflammation in the airway. - Bronchitis and asthma 6. Discuss the role T lymphocytes, B cells, and Mast cells play in inflammation. - T lymphocytes: Release cytokines that act on other cells to further the inflammatory process - B Cells: - Mast Cells: Are the major effector cells 7. List the positive effects of long-term steroid use. - Decrease number of inflammatory cells in airways, reduce goblet cell hyperplasia, reduce number of mast cells, inhibit vascular plasma leakage and increased mucus secretion into the airway, and causes neutrophils to leave attachment sites and circulate in the blood (i.e. increased WBCs are often seen in patients on steroids). 8. Explain the mode of action of steroids. - Mode of Action: Steroids enter airway cells & bind to intracellular receptors, induces gene expression for the anti-inflammatory protein lipocortin, and steroids also suppress factors which cause transcription of genes that cause inflammation. 9. Discuss the relationship between steroids and beta adrenergic agents. - Corticosteroids can enhance the activity of beta- adrenergic receptors by increasing their expression and preventing desensitization 10. Explain why aerosolized steroids are so effective. - Good local effect in lungs, less potential for systemic absorption, direct introduction into airway by aerosol, rapid inactivation of drug absorbed into plasma, and intrinsic topical anti-inflammatory effect 11. List the hazards and side effects of aerosolized steroids. - Rarely causes adrenal suppression, possible growth restriction in children, oropharyngeal fungal infections (thrush), cough, bronchospasm, episodes of acute  asthma, and dysphonia. 12. Discuss the use of aerosolized steroids in the treatment of asthma. - Inhaled steroids are considered the most effective long term medication in asthma - Patients should be educated to understand that steroid inhalers do not give immediate relief like B2-agonist do - Dose can be increased when peak flow measurements decrease to prevent use oral steroids 13. Discuss the use of aerosolized steroids in the treatment of COPD. - Recommended by American Thoracic Society and GOLD (Global Initiative for Chronic Obstructive Lung Disease) - Risks vs Rewards (risk of immunosuppression vs rewards of decrease in inflammation) are considered, inhaled steroids may provide less risks but may predispose patients to infections/pneumonia - Steroids are generally used after b -adrenergics (SABAs 2 and LABAs), anticholinergics (ipratropium and tiotropium) and theophylline, when control is still suboptimal 14. Discuss the step approach to asthma therapy with anti-inflammatories. - Step 1: Mild intermittent asthma - no long-term control med - inhaled B2-agonist PRN - Step 2: Mild persistent asthma - either an inhaled steroid, cromolyn, nedocromil, or leukotriene inhibitor inhaled B2-agonist PRN - Step 3: Moderate persistent asthma - inhaled steroid (medium dose) or inhaled steroid (low dose) + long-acting B2-agonist  - inhaled b2-agonist PRN - Step 4: Severe persistent asthma - inhaled steroid (high dose) + long-acting B2 agonist + steroid tablets/ syrup long term - inhaled b2-agonist PRN 15. Differentiate between a long-term control medication and a quick relief medication in asthma therapy. - A long-term control medication for asthma is taken daily to prevent symptoms and inflammation in the airways, while a quick-relief medication is used to rapidly alleviate symptoms during an asthma attack when breathing becomes difficult 16. Differentiate between extrinsic and intrinsic asthma, including the causes of extrinsic asthma - Extrinsic asthma is caused by an external allergen, whereas intrinsic asthma is triggered by internal factors within the body - Extrinsic asthma: Pollen, dust mites, pet dander, mold, cockroach allergens - Intrinsic asthma: Viral infections, stress, exercise, cold air, certain medications like aspirin, smoke, strong emotions 17. Describe adult asthma. - A chronic lung disease that causes inflammation and tightening of the muscles around the airways, making it difficult to breathe 19. List the symptoms manifested by inflammation. - Redness, swelling, heat, and pain 20. For Cromolyn Sodium, discuss the indications, mode of action, forms of delivery, side effects, and efficacy. - Mode of Action: Inhibits mast cell degranulation, prevents release of chemical mediators of  inflammation, and blocks late phase reactions in asthma. - Indications: Prophylactic management of asthma, exercise induced asthma, allergic rhinitis, systemic symptoms (diarrhea, headaches, & nausea), and conjunctivitis. - Forms of Delivery: Inhalation (liquid ampules- 1 ampule QID) (2ml, may require additional diluent for HHN to nebulize, can be mixed with any bronchodilator) , Eye drop solution, Nasal solution (Nasalcrom), and Oral solution (Gastrocrom) 21. For Accolate, Zyflo, and Singulair discuss the indications, mode of action, forms of delivery, side effects, and efficacy. - Accolate (BID) - Mode of Action: Leukotrienes were previously known as “slow-reacting substance of anaphylaxis” (SRS-A), potent stimulants of bronchoconstriction, mucus secretion ands vasodilation, and inhibits asthma caused by cold air, allergens, aspirin and exercise - Side Effects: Headache, respiratory infections, and abdominal effects - Efficacy: Improves morning peak flows, fewer night awakenings, and decreased bronchodilator usage. - Zyflo (QID) - Mode of Action: Effectively blocks the leukotriene contribution to inflammation - Side Effects: Elevation of liver function test results – monitor liver function, headache, pain, loss of strength, increases theophylline serum levels – adjust theophylline dose, and increases clotting and may require an anticoagulant - Efficacy: Effective in preventing asthma from allergens, cold air and aspirin, increases FEV 15 – 1  20%, and patients are often able to decrease bronchodilator and steroid usage - Singulair (DAILY) - Mode of Action: Inhibits the formation of leukotrienes and effectively blocks leukotriene’s contribution to inflammation - Side Effects: stomach pain, heartburn, tiredness, fever, stuffy nose, cough, flu, upper respiratory infection, dizziness, headache, and rash. - Efficacy: In chronic asthma- B-agonist use, asthma attacks, daytime asthma symptoms, nighttime asthma symptoms. In chronic asthma during allergy season- B-agonist use, AM PEFR, daytime asthma symptoms, and discontinuations due to asthma. 22. Monoclonal antibodies (Biologics) mode of action and use in treatment of extrinsic asthma - Mode of Action: Prevents IgE from attaching to mast cells