bronchodilators and other respiratory agents. asthma -predominantly in boys 2:1 -puberty: occurrence...
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Bronchodilators and Other Respiratory Agents
Asthma -Predominantly in boys 2:1 -puberty: occurrence equals out -More females in adult-onset
cases -Affects ~25 million people (7
million children)2
Chronic Obstructive Pulmonary Disease (COPD)
-A reactive airway disease -Primarily affects older persons
especially smokers and those chronically
exposed to pollutants
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Antigen -> the body, combines with mast cells
-> sensitized mast cellWhen re-exposed to the antigen, there
is the formation and release of chemical substances
-Histamine -Leukotrienes
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Acts directly or indirectly Directly-causes
bronchoconstriction Indirectly-stimulates release
of acetylcholine causes smooth muscle contraction
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used to relax and open the airways, open /maintain the bronchial airways
Treat several disease syndromes Chronic obstructive pulmonary disease
Asthma6
Sympathomimetic agentsXanthine bronchodilators Anticholinergics Leukotriene receptor antagonists5-lipoxygenase inhibitorsMast cell stabilizersCorticosteroids
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Stimulation of β1 receptors by epinephrine induces a positive chronotropic and inotropic effect on the heart and increases cardiac conduction velocity and automaticity
Stimulation of β1 receptors on the kidney causes renin release.
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Stimulation of β2 receptors induces smooth muscle relaxation (resulting in vasodilation and bronchodilation amongst other actions), induces tremor in skeletal muscle, and increases glycogenolysis in the liver and skeletal muscle.
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Beta2-adrenergic receptors
Used during the acute phase of asthmatic attacks
Quickly reduce airway constriction and restore normal airflow
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Treat acute attacks/prevent attacks Quickly reduce airway constriction Relief of bronchospasm, bronchial
asthma, bronchitis, and other pulmonary diseases
Treat hypotension and shock Produce uterine relaxation to
prevent premature labor
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Nonselective adrenergics Stimulate alpha1, beta1
(cardiac), and beta2 (respiratory) receptors
Example: epinephrine/Primatene or Adrenaline
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Nonselective beta-adrenergics Stimulate both beta1, beta2
receptors isoproterenol (Isuprel)
Selective beta2 drugs albuterol/Proventil or Ventolin Levalbuterol/Xopenex
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Frequent use leads to beta1 receptors being stimulated Albuterol loses its action
General side effects Nausea, increased anxiety, palpitations, tremors, and increased heart rate
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Chemical class of agentsContain caffeine
Oldest class of bronchodilatorsUsed in ancient times
Examples: Aminophylline , Theophylline, Theolair, Elixophyllin, Slo-Phyllin, Theo-Dur, Theo24
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Increase levels of energy-producing cAMP
Inhibit phosphodiesterase Enzyme that breaks down cAMP
Result: Smooth muscle relaxation Bronchodilation Increase airflow (oxygen/carbon dioxide) in the lungs
cardiac life-threatening side effects16
Nausea, vomiting, anorexia GERD during sleep Sinus tachycardia, extrasystole
(PVC’s), palpitations Nervousness/restlessness,
convulsions Smokers may require higher and
more frequent doses17
Monitor patient for tachycardia Educate: reduce caffeine Monitor CNS stimulation, changes
in cardiac function, seizures Serum theophylline levels required
Therapeutic Range 10-20mcg/mL
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Acetylcholine (ACh) causes bronchial constriction.
Anticholinergics bind to the ACh receptors, preventing ACh from binding.
Result: bronchoconstriction is prevented, airways dilate
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Ipratropium bromide (Atrovent)Tiotropium bromide (Spiriva HandiHaler)Actions
Local effects Slow and prolonged action Used to prevent bronchoconstriction Not used for acute asthma exacerbations!
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Usually not absorbed systemically
If absorbed, may produce: Dry mouth or dry throat Gastrointestinal distress Headache Coughing Anxiety
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Directly prevent bronchoconstriction Developed to treat asthma; popular
and effective Leukotrienes are inflammatory
molecules Released by mast cells Cause the bronchioles to contract Development of edema in the lungs
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By blocking leukotrienes: Prevent smooth muscle contraction of the bronchial airways
Decrease mucus secretion Prevent vascular permeability Decrease neutrophil and leukocyte infiltration to the lungs
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Montelukast (Singulair)
Zafirlukast (Accolate)
Class side effects:
Headache Nausea Diarrhea Liver dysfunction
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Use for chronic management of asthma, not acute asthma
Improvement should be seen in about 1 week
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New class of LRAs Action
Inhibit the formation of leukotrienes
Used to inhibit some cancer growth
Outcome Prevent lung inflammation
Example: Zileuton26
Prophylactic Indirect bronchodilator activity Stabilize cell membranes of
inflammatory cells mast cells, monocytes,
macrophages
Prevent release of harmful cellular contents
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Adjuncts to the overall management of clients with lung disease
Prevent bronchospasm when exposed to:Cold airExerciseAllergens Dry air
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Cromolyn (Nasalcrom, Intal)
Nedocromil (Tilade)
Side effects: Coughing Taste changes Sore throat Dizziness Rhinitis Headache Bronchospasm
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Anti-inflammatory Inhaled forms
Reduce systemic effects Used for chronic asthma
Does not relieve acute asthma
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Stabilize membranes of cells that release harmful bronchoconstricting substances
Also increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation
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Beclomethasone dipropionate (Beclovent, Vanceril)
Triamcinolone acetonide (Azmacort)
Flunisolide (AeroBid)
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Pharyngeal irritation Coughing Dry mouth Oral fungal infections: rinse the
mouth after administration Systemic effects are rare
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Combination productFluticasone propionate and salmeterol (Advair): a dry powder in a circular discus
Salmeterol: long-acting bronchodilatorFluticasone propionate: Corticosteroid: anti-inflammatory agentUsed daily Q12hrs
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Assess: respiratory distress?, cardiac status
Frequent mouth care Education: meds, proper use of
inhalers, breathing control, avoidance of respiratory infections, reduce of environmental pollutants
Take with food if GI upset occurs35
Do not wear perfume of colognes Do not use talc or baby powder If patient is on oxygen, safety
measures need to be taught
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flu and pneumonia vaccination prompt treatment for any
illness check with health care
provider before taking other medications
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