Respiratory agents


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Respiratory agents

  1. 1. Respiratory Agents PharmacologyClinical Management of Diseases of the Lungs
  2. 2. Pathology Of Asthma Increased responsiveness of trachea & bronchi to various stimuli which trigger…. Constriction of airways Increased mucous secretions Increased inflammation & edema causing.. – Recurrent/episodic bouts of SOB, wheeze, tight chest Reversible!
  3. 3. Symptoms Goals of Care Wheezing  Function in daily life Cough  Freedom from Dyspnea wheezing Acute and chronic  Control of coughing  Tolerate medications  5-10% asthmatics are hypersensitive to aspirin
  4. 4. Chemical Components of Cigarettes Chemical Standard Use Carbon Monoxide Car exhaust Nicotine Pesticides Ammonia Floor cleaners Arsenic White ant poison Butane Lighter fuel Hydrogen cyanide Poison used in gas chambers Toluene Industrial solvent DDT Insecticides
  5. 5. Time of Last Cigarette & EffectWithin 20 minutes BP/P returns to normal Temp hands/feet increase back to normal Stops polluting the airAfter 8 hours Blood carbon monoxide drops Blood O2 returns to normalAfter 24 hours Chance of heart attack decreasesWithin 48 hours Nerve endings re-adjust sense of smell/taste enhancedAfter 72 hours Bronchial tubes relax lung capacity increases
  6. 6. 2 weeks to 3 months Circulation/walking improve Lung function up 30%1 month to 9 months Cilia re-grow, handle mucus & clean lungs reduce infection Energy level increases1 year Heart dz death rate halfway back to that of a non-smoker5 years Heart dz death rate drops to rate for non-smokers; lung CA death rate decreases halfway to non-smoker10 year projection Lung CA rate almost same for non smoker, precancerous cell replaced, incidence mouth, larynx, esophag, bladder, kidney, pancreas CA dec.
  7. 7. Reasons People Smoke Top FIVE It’s a habit I’m addicted It relaxes me I enjoy it Something to do with my hands
  8. 8. Reasons Why Smokers Do Not Try to Quit Fear of withdrawal Cravings Loss of way to handle stress Cost of medicines Fear cannot quit
  9. 9. Five MYTHS about quitting smoking Smoking is just a bad habit. – Fact: Tobacco use is an addiction. Quitting is just a matter of will power. – Fact: Quitting is difficult. If you can’t quit the 1st time, you will never. – Fact: Quitting is hard & usually takes 2-3 tries. The best way to quit is ‘cold turkey’. – Fact: Most effective way is a combination of counseling & nicotine replacement therapy
  10. 10.  Quitting is expensive. – Fact: Treatments cost $3-14 per day. A pack a day smoker spends almost $1200 per year. Many health insurances cover medication & counseling.
  11. 11. Clinical Management of Respiratory Diseases Acute Care  Reliever Chronic Care – Acute Stepped Care  Controller Peak Flow Meter – Maintenance – Chronic Spacer – Prophylactic Oxygen
  12. 12. Stepwise Pharmacologic Therapy Step 1 Mild intermittent  Step 3 Moderate – Symptoms < 2x/wk persistent Step 2 Mild persistent – Daily symptoms affect – Symptoms >2x/wk activity – Exacerbations >2x/wk  Step 4 Severe persistent – Continual symptoms
  13. 13. OVERVIEW Therapeutic Agents Mast Cell Stabilizers – Cromolyn Xanthine Derivatives – Aminophylline Bronchodilators ( short & long acting) – Sympathomimetics (albuterol) Anti-Muscarinic – Ipratropium (Atrovent) Corticosteroids Leukotriene Inhibitors (Singulair, Accolate)
  14. 14. Xanthine Derivatives Methylxanthines – Theophylline – Aminophylline MOA Toxicity
  15. 15. Bronchodilators  Sympathomimetics – Ephedrine – Epinephrine – Beta-2 agents  Albuterol  Salmeterol  Metaproterenol – MOA – Toxicity – Dependence
  16. 16. Bronchodilators Anti-Cholinergics – Anti-Muscarinics  Atropine  Ipratropium Bromide (Atrovent) MOA Toxicity
  17. 17. Corticosteroids Mast Cell Stabilizers Corticosteroids  Mast Cell Stabilizers – Beclomethasone – Cromolyn (Intal) – Budesonide (Pulmicort)  MOA – Fluticasone(Flovent)  Toxicity – Triamcinolone (Azmacort) – Mometasone (Nasonex) MOA Toxicity – Oral candidiasis
  18. 18. Leukotriene Inhibitors  Leukotriene Pathway Inhibitors – Monelukast (Singulair) – Zafirlukast (Accolate)  MOA  Toxicity
  19. 19. Summary Slide Clinical Management of Respiratory Diseases Stepwise Pharmacologic Therapy Pharmacologic Agents – Xanthine Derivatives – Bronchodilators – Leukotriene Inhibitors – Corticosteroids Mast Cell Stabilizers
  20. 20. Smoking Cessation Behavior Modification & Reward Abstinence – Set a date, inform friends, family, coworkers to understand and support. Avoid triggers – Remove cigarettes from environment & avoid where smoking is prevalent. Anticipate challenges – Critical first few weeks of withdrawal effects. – Nicotine replacement and concurrent therapy.
  21. 21. Common Agents Nicotine Replacement – Gum/Patch – Inhaler/Nasal Spray – Lozenge/Water Antidepressant – Bupropion (Zyban, Wellbutrin) Support 1-800 NO BUTTS
  22. 22. CASE STUDY Antibiotics and Respiratory
  23. 23.  TL is a 29-year-old female, 59 kg, who presents at clinic with a 2-week history of abdominal pain, nocturia and frequency of urination. PE is unremarkable except some lower abdominal tenderness. A clean catch midstream urine sample is collected. The results are 10-25 WBC/HPF with a few gram-positive cocci in clusters and gram negative rods. She is empirically started on Macrobid 100mg bid x 7 days. TL returns to clinic 3 days later with a productive cough, wheezing, and heaviness on her chest and shaking chills. She is severely nauseous. Her breathing is labored with rales and wheezing. Pregnancy results are positive.
  24. 24. Points to Ponder Discuss her symptoms and relate them to a possible health problem. Discuss the antibiotic empiric treatment. Should it be changed? Consider the relationship between pregnancy and UTI. What respiratory therapy would you consider?