Respiratory Drugs 2023.pdf

Respiratory Tract Drugs—Drugs for Asthma & COPD Basic chronic inflammatory disease with narrowed airways Considerations Signs and symptoms—dyspnea, wheezing, chest tightness, cough and sputum production, & “breathlessness” and dyspnea. Patho Use peak expiratory flow (PEF) to measure severity of airw...

Respiratory Tract Drugs—Drugs for Asthma & COPD Basic chronic inflammatory disease with narrowed airways Considerations Signs and symptoms—dyspnea, wheezing, chest tightness, cough and sputum production, & “breathlessness” and dyspnea. Patho Use peak expiratory flow (PEF) to measure severity of airway constriction. Breathe out into a physiology flow meter to determine maximum rate of airflow during expiration. Based on personal best. 652 Helps to avoid triggers for better symptom control Overview of Two main pharmacologic classes: Drugs for Anti-inflammatory agents—especially glucocorticoids, usually on a fixed schedule Asthma Bronchodilators—relax bronchial smooth muscle; fixed schedule or PRN to manage acute attacks Administration Inhalation provides the medication directly to site of action, minimizes systemic effects, and by Inhalation rapid relief of acute attacks. Metered Dose Inhalers (MDI)—hand held devices. Must inhale before activating the device. Only about 9% of drug gets to lungs unless using a spacer (improves to 21%). Dry Powder Inhalers (DPI)—breath activated so easier to use (no spacer needed) Nebulizers—converts a drug solution into a mist, can be used at home Anti-inflammatory Drugs, 647, 650 Bronchodilators, 657 --Glucocorticoids (corticosteroids)—for long term --Beta-2 Adrenergic Agonists—sympathomimetics control; oral and inhalation; Prevents chronic asthma. albuterol Adverse effects: candidiasis, hoarseness and speaking Oral: selectivity is relative, so can stimulate Beta1 difficulty Inhaled: short acting: s/e: tachycardia, angina, tremor -- Leukotriene Modifiers—suppress leukotrienes which : long acting: s/e: causes asthma promote constriction; generally second line drugs --Methylxanthines-sustained release allows longer montelukast—prophylaxis and maintenance; prevents duration of action, but not used much any more exercise induced asthma --Anticholinergics—recall that these dry up secretions; --Cromolyn—stabilizes mast cells to prevent but can use Prototype: ipratropium inflammation (also used for allergic rhinitis) Drugs for Allergic Rhinitis, Cough, and Cold Three main categories (don’t forget cromolyn is also used) 1. Prototype: pseudoephedrine Nasal decongestants—sympathomimetics Oral and intranasal Signs/ Relief of stuffiness, but not rhinorrhea or itching Symptoms: Adverse effects: hypotension, dysrhythmia, vertigo, rebound congestion, CNS stimulation such as Sneezing insomnia, restlessness Rhinorrhea Pruritis 2. Intranasal glucocorticoids—sprays First generation: beclomethasone These are now usually initial treatment Drugs for Allergic Rhinitis Second generation—decreased systemic absorption Examples: fluticasone 3. Antihistamines (H1 receptor antagonists)—best if taken to prevent Oral—first generation—diphenhydramine Oral—second generation—fexofenadine, cetirizine, loratidine Drugs for Cough Antitussive—suppress nonpurposeful cough Opioid—codeine Nonopioid—Prototype: dextromethorphan very effective Other: benzonatate Expectorants—makes cough more productive Prototype: guaifenesin Mucolytics—makes mucus less viscous, so cough is more productive Prototype: acetylcysteine 2023