Civility Clause….
Students are expected to behave toward
lecturers and fellow students with courtesy
and consideration. Th...
Trigger Mechanism
Respiratory infection Inflammatory response
produces bronchial
hyperresponsiveness; IgE
induction by som...
http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/
http://nursingcrib.com/wp-content/
Asthma COPD
Early onset; family history Mid-life onset
Variable or seasonal symptoms;
symptoms worse at night or
early mor...
Goals of therapy in acute asthma
• Rapid reversal of airway obstruction
• Correction of significant hypoxemia
• Restoratio...
http://www.uptodate.com/patients/content/image.do?imageKey=PULM%2F23550
http://www.uptodateonline.com/patients/content/image.do?imageKey=PULM%2F22761
Drugs used to treat asthma
• Bronchodilators
– Beta 2 agonists
– Anticholinergics
• Antiinflammatory agents
– Corticostero...
Beta-2 agonists
Albuterol (Ventolin® Proventil® Accuneb® )
Levalbuterol (Xopenex®)
Fluticasone / salmeterol (Advair®)
Mome...
Beta-2 agonists
• Contraindications
–Allergy
–Uncontrolled cardiac dysrhythmias
(especially tachyarrhythmias)
Beta-2 agonists
• Adverse effects – serious
– Urticaria
– Arrhythmia, QT prolongation, angina,
hypokalemia
– Paradoxical b...
Methylxanthines
Theophylline (Theo-Dur®)
Aminophylline (various)
Pharmacology
(Mechanism of action)
Block
phosphodiesteras...
Anticholinergics
Ipratropium bromide (Atrovent®)
Tiotropium bromide (Spiriva Handihaler®)
Pharmacology
(Mechanism of actio...
N3HC
CH
CH3
CH3
O C
O
CH
OH
Br-
Ipratropium bromide
Anticholinergics
• Contraindicated in
– Allergy to atropine or components of the
preparation
– Myasthenia gravis, narrow a...
Corticosteroids
Beclomethasone (Beclovent® Vanceril® QVAR80® )
Budesonide (Pulmicort®)
Fluticasone / salmeterol (Advair®)
...
Corticosteroids
• Adverse effects – serious (most are rare
when inhaled)
– Adrenal suppression
– Osteoporosis / growth sup...
Leukotriene receptor antagonists
Montelukast (Singulair®)
Zileuton (Zyflo®)
Zafirlukast (Accolate®)
Pharmacology
(Mechanis...
Arachidonic acid
Lipoxygenase products
lipoxygenase
LTC4 and LTD4
TXA2
COX
Bronchoconstriction
and inflammation
Montelukas...
Leukotriene modifiers
• Adverse effects – serious
– Angioedema
– Anaphylaxis
– Churg-Strauss syndrome (coincidental?)
• Ad...
Mast Cell Stabilizers
Cromolyn sodium (Nasalcrom® , Intal®)
Pharmacology
(Mechanism of action)
Prevent the release of
hist...
Monoclonal antibody preparations
Omalizumab (Xolair®)
Pharmacology
(Mechanism of action)
inhibits IgE binding to
receptors...
Upper Respiratory Medications
• Antihistamines, decongestants and other
nasal agents
• Common, available OTC and Rx
• Alon...
Antihistamines
1st
generation OTC 2nd
generation OTC
Dimenhydrinate (Dramamine ®) Cetirizine (Zyrtec ®)
Diphenhydramine HC...
Decongestants
Topical (intranasal) OTC Systemic OTC
Oxymetazoline (Afrin®, Allerest®) Pseudoephedrine (Sudafed®)
Phenyleph...
Decongestants
• Contraindicated in patients with
– Hypertension or CAD
– Do not use concurrently with TCAs, beta
blockers,...
Intranasal antiinflammatory agents
Corticosteroids - Rx
Triamcinolone acetonide (Nasacort ®)
Budesonide (Rhinocort®)
Fluti...
Agents used to treat cough
• Antitussives – prevent coughing
• Expectorants – thin mucus secretions,
making it easier to c...
Expectorants
Guaifenesin (Robitussin, Mucinex)
Pharmacology
(Mechanism of action)
Decreases the viscosity
of mucus to aid ...
Antitussives
Dextromethorphan (Robitussin-DM, Mucinex-DM, Delsym)
Pharmacology
(Mechanism of action)
Depresses medullary
c...
dextromethorphan
Levophoranol (Levo-Dromoran)
Antitussives – Rx
codeine containing and derivatives
(Tussionex, Tussi-organidin)
Pharmacology
(Mechanism of action)
Depre...
Antitussives – Rx
Non-codeine derivatives
Benzonatate (Tessalon Perles)
Pharmacology
(Mechanism of action)
Local anestheti...
NRSG351 Respiratory Agents in Asthma, COPD, Cough, Cold and Allergy
NRSG351 Respiratory Agents in Asthma, COPD, Cough, Cold and Allergy
NRSG351 Respiratory Agents in Asthma, COPD, Cough, Cold and Allergy
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NRSG351 Respiratory Agents in Asthma, COPD, Cough, Cold and Allergy

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powerpoint presentation for nursing students, Nell Hodgson Woodruff School of Nursing, Emory University, spring 2014

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NRSG351 Respiratory Agents in Asthma, COPD, Cough, Cold and Allergy

  1. 1. Civility Clause…. Students are expected to behave toward lecturers and fellow students with courtesy and consideration. This means that talking and disruptive behavior will be kept to a minimum. Cell phones, pagers, and other electronic devices should be silenced in the classroom. I reserve the right to end a class at any time, for any reason, including the disruptive or rude behavior of anyone in the classroom.
  2. 2. Trigger Mechanism Respiratory infection Inflammatory response produces bronchial hyperresponsiveness; IgE induction by some viruses; eosinophil activation by some viruses Allergens Classic allergic pathway Environment / occupational stimuli Epithelial damage; inflammation Emotions Excess parasympathetic activation of bronchial tissue Exercise Heat loss and water loss from airways; Drugs , foods Sulfite preservatives stimulate inflammation; aspirin and NSAIDS inhibit cyclooxygenase
  3. 3. http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/
  4. 4. http://nursingcrib.com/wp-content/
  5. 5. Asthma COPD Early onset; family history Mid-life onset Variable or seasonal symptoms; symptoms worse at night or early morning Slowly progressing symptoms Associated with allergies / rhinitis; eczema; dermatitis History of smoking REVERSIBLE airway obstruction IRREVERSIBLE (or variably reversible) airway obstruction
  6. 6. Goals of therapy in acute asthma • Rapid reversal of airway obstruction • Correction of significant hypoxemia • Restoration of normal lung function • Reduction of asthma symptoms • Development of a plan for future attacks
  7. 7. http://www.uptodate.com/patients/content/image.do?imageKey=PULM%2F23550
  8. 8. http://www.uptodateonline.com/patients/content/image.do?imageKey=PULM%2F22761
  9. 9. Drugs used to treat asthma • Bronchodilators – Beta 2 agonists – Anticholinergics • Antiinflammatory agents – Corticosteroids – Leukotriene modifiers – Mast cell stabilizers – Monoclonal antibodies Agents can be used systemically or via inhalation
  10. 10. Beta-2 agonists Albuterol (Ventolin® Proventil® Accuneb® ) Levalbuterol (Xopenex®) Fluticasone / salmeterol (Advair®) Mometasone furoate / formoterol fumarate (Dulera®) Formoterol fumarate (Foradil®) Pharmacology (Mechanism of action) Stimulates b-2 receptors Activates adenylate cyclase and increases cAMP cAMP produces relaxation of smooth muscle and bronchodilation Adverse Effects Pharmacokinetics Short-acting Long-acting
  11. 11. Beta-2 agonists • Contraindications –Allergy –Uncontrolled cardiac dysrhythmias (especially tachyarrhythmias)
  12. 12. Beta-2 agonists • Adverse effects – serious – Urticaria – Arrhythmia, QT prolongation, angina, hypokalemia – Paradoxical bronchospasm • Adverse effects – common – Nervousness, tremor, palpitations, tachycardia – Bad taste – Throat irritation
  13. 13. Methylxanthines Theophylline (Theo-Dur®) Aminophylline (various) Pharmacology (Mechanism of action) Block phosphodiesterase enzymes, which leads to increased cAMP in bronchial tissue Increased cAMP leads to smooth muscle relaxation Adverse Effects Pharmacokinetics
  14. 14. Anticholinergics Ipratropium bromide (Atrovent®) Tiotropium bromide (Spiriva Handihaler®) Pharmacology (Mechanism of action) Blocks post ganglionic vagal pathways Decreased vagal tone produces bronchodilation Adverse Effects Pharmacokinetics
  15. 15. N3HC CH CH3 CH3 O C O CH OH Br- Ipratropium bromide
  16. 16. Anticholinergics • Contraindicated in – Allergy to atropine or components of the preparation – Myasthenia gravis, narrow angle glaucoma – Tiotropium should not be used with ipratropium • Adverse effects – common – Nausea, vomiting, diarrhea – Nasal congestion, dyspnea
  17. 17. Corticosteroids Beclomethasone (Beclovent® Vanceril® QVAR80® ) Budesonide (Pulmicort®) Fluticasone / salmeterol (Advair®) Triamcinolone acetonide (Azmacort®) Pharmacology (Mechanism of action) Inhibits neutrophil and eosinophil invasion Inhibits synthesis of prostaglandins, histamines and leukotrienes Adverse Effects Pharmacokinetics http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandPr
  18. 18. Corticosteroids • Adverse effects – serious (most are rare when inhaled) – Adrenal suppression – Osteoporosis / growth suppression in children – Bronchospasm – Peptic ulcers • Adverse effects – common – Sinusitis, rhinitis, hoarseness – Headache, nausea, diarrhea – Oral candidiasis
  19. 19. Leukotriene receptor antagonists Montelukast (Singulair®) Zileuton (Zyflo®) Zafirlukast (Accolate®) Pharmacology (Mechanism of action) blocks leukotriene receptors Prevents leukotrienes from participating in inflammatory responses Adverse Effects Pharmacokinetics
  20. 20. Arachidonic acid Lipoxygenase products lipoxygenase LTC4 and LTD4 TXA2 COX Bronchoconstriction and inflammation Montelukast, zafirlukast (receptor antagonists) act here Zileuton act here
  21. 21. Leukotriene modifiers • Adverse effects – serious – Angioedema – Anaphylaxis – Churg-Strauss syndrome (coincidental?) • Adverse effects – common – Flu like symptoms (cough, fatigue, headache, abdominal pain) – Adverse effects have not been well documented and these agents are believed to be very safe
  22. 22. Mast Cell Stabilizers Cromolyn sodium (Nasalcrom® , Intal®) Pharmacology (Mechanism of action) Prevent the release of histamine and inflammatory mediators by mast cells by stabilizing their membranes; Reduced release of inflammatory and bronchoconstrictive substances reduces bronchoconstriction Adverse Effects Pharmacokinetics
  23. 23. Monoclonal antibody preparations Omalizumab (Xolair®) Pharmacology (Mechanism of action) inhibits IgE binding to receptors on mast cells and basophils, preventing degranulation Reduces release of allergic response mediators Adverse Effects Pharmacokinetics
  24. 24. Upper Respiratory Medications • Antihistamines, decongestants and other nasal agents • Common, available OTC and Rx • Alone and in combination • Use in children is discouraged
  25. 25. Antihistamines 1st generation OTC 2nd generation OTC Dimenhydrinate (Dramamine ®) Cetirizine (Zyrtec ®) Diphenhydramine HCl (Benadryl®) loratidine (Claritin®, Chlorpheniramine (Chlor-Trimeton®) des-loratidine (Clarinex®) fexofenadine (Allegra®, Allegra-D®) Pharmacology (Mechanism of action) Blocks H1 receptors Histamine cannot bind, produce responses associated with allergic responses (No effect to decrease histamine release) Adverse Effects Pharmacokinetics
  26. 26. Decongestants Topical (intranasal) OTC Systemic OTC Oxymetazoline (Afrin®, Allerest®) Pseudoephedrine (Sudafed®) Phenylephrine (Neo-synephrine®) Xylometazoline (Otrivin ®) Pharmacology (Mechanism of action) a1 stimulation produces vasoconstriction Vasoconstriction leads to decreased swelling, edema and stuffy nasal passages Adverse Effects Pharmacokinetics
  27. 27. Decongestants • Contraindicated in patients with – Hypertension or CAD – Do not use concurrently with TCAs, beta blockers, MAOIs • Adverse effects include – Tachycardia, increased BP, arrhythmias – Restlessness, insomnia, anxiety, tremor – Rebound phenomenon
  28. 28. Intranasal antiinflammatory agents Corticosteroids - Rx Triamcinolone acetonide (Nasacort ®) Budesonide (Rhinocort®) Fluticasone (Flonase®) Pharmacology (Mechanism of action) Decreases the release of inflammatory mediators Adverse Effects Pharmacokinetics
  29. 29. Agents used to treat cough • Antitussives – prevent coughing • Expectorants – thin mucus secretions, making it easier to cough
  30. 30. Expectorants Guaifenesin (Robitussin, Mucinex) Pharmacology (Mechanism of action) Decreases the viscosity of mucus to aid in its elimination Adverse Effects Pharmacokinetics
  31. 31. Antitussives Dextromethorphan (Robitussin-DM, Mucinex-DM, Delsym) Pharmacology (Mechanism of action) Depresses medullary cough center Adverse Effects Pharmacokinetics
  32. 32. dextromethorphan Levophoranol (Levo-Dromoran)
  33. 33. Antitussives – Rx codeine containing and derivatives (Tussionex, Tussi-organidin) Pharmacology (Mechanism of action) Depresses medullary cough center Adverse Effects Pharmacokinetics
  34. 34. Antitussives – Rx Non-codeine derivatives Benzonatate (Tessalon Perles) Pharmacology (Mechanism of action) Local anesthetic action on the respiratory passageways and stretch receptors of the lung; decreases cough reflex Adverse Effects Pharmacokinetics

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