Pharmacology class notes 3:

This was one of the most dense lectures yet! There is a huge amount of content and in some areas it is a little discontinuous. This may be an area to look over again in the book or on your slides. Take a look I hope that it can help you.

-Peter

Pharm

class 3

Respiratory Pharmacology

    1. asthma is a disorder causing reversible airway inflammation
      1. true
    2. what 4 things are inflammatory components particular in the patho of asthma?
      1. Histamines
      2. Leukotrienes and RBCs
  • histamines, leukotrienes, prostaglandins, interleukins
  1. if we cause beta receptor stim by epi what happens? to pulse.
    1. higher pulse
  2. what is the critical intervention to help prevent asthma attacks
    1. adherence to medication regimen
  3. what is the first medication that should be prescribed for an asthmatic?
    1. albuterol
  4. Which med is the most critical for prevention of  asthma?
    1. Glucocorticoid
  5. ms. jones is taking and OTC cold med and her PB is high. which medication can cause high BP
    1. Pseudoephedrine
  6. how do antihistamine stop coughs
    1. stops the post nasal drip
  7. 3 yo boy w/ cough how to teach parent about cold meds?
    1. Do not use cough meds in children under 6yo
  8. pt w/ tb comes in and shows bottle of INH what do you ask him
    1. Where are your other med bottles?
    • Relate the information that you know from patho and if something doesn’t make sense go back to patho and re learn the info
    • Asthma: bronchospasm and tightening (bronchoconstriction) , swollen and inflamed
      • s/s wheezing, cough, dypsnea
      • immune mediated
        • IgE mediated
      • Inflammation
        • Edema, mucus, Sm muscle hypertrophy, Bronchial hyperreactivity
          • we will try to prevent all these things w/ pharm
      • histamine – body produces in response to allergen
      • know the triggers of asthma
      • we want bronchodilation!
        • Beta2- agonists! (albuterol)
          • Epinephrine, albuterol, levalbuterol, -terol
          • bronchodilators,
  • Give this drug before the anti-inflammatory so the second drug can get to a higher % of the lungs
        • immediate symptom relief
        • can be used alone for minor intermittent asthma  
        • sites of action:
          • Lungs, legs, liver
        • Albuterol: Beta 2 – agonist
          • Long acting beta agonist
          • dilation, relaxes smooth mm
          • 5-30 min onset
          • peak 30-60min
          • duration 3-5 hours
          • adverse effects
            • hypergly, tremors, cardiac tachy and dysrhythmias
            • Theophylline (Uniphyl)
              • not first line, many side effects
                • lots of drug interactions
              • narrow TR
                • toxicity – seizures, Ventricular dysrhythmias  
        • Caffeine is a cousin to this drug and can relieve some symptoms
      • Anticholinergics
        • blocks Ach receptors causing bronchodilation
        • Tiotropium (Spiriva)
        • Aclidinium (Tudorza)
        • Approved for COPD only
        • anti- inflammatory
            • glucocorticoids (prednisone)-sone -lone
            • Prevention of acute asthma attack
            • foundation, taken daily
            • very effective
            • increase the # of beta 2 receptors
              • a lot of drugs have a tolerance building effect but these have the opposite effect?
        • first line agents for maintenance
            • Long term control
          • Leukotriene – modifiers. (zafirlukast(Accolate), montelukast(Singulair))
        • suppress effects of leukotrienes
        • preventive, not a rescue
        • blocks leukotriene receptors
        • alternatives to the inhaled steroids
        • side effects
          • boring: HA, and GI upset
      • OMALIZUMAB (Xolair)
        • expensive
        • antagonizes IgE

Approach to asthma

  • using a stepwise approach to increase the medication types as the Dx becomes more severe

MDI – 10% reaches lungs

  • spacer increases dose to lungs to about 21%
  • needs a propellant

Advair and symbicort

COPD

  • GOLD: global initiative for COPD
    • Reduce s/s improve health
    • reduce risks and mortality by preventing progression and exacerbation
  • Bronchodilators: LABA, (SABA in exacerbation)
  • glucocorticoids: w/ LABA

Rhinitis

  • inflammation of the nose
  • s/s sneezing, itching, watery eyes
  • Allergic reaction
    • histamine from allergen and IgE
  • Use antihistamines: H1 antagonists
    • 1st gen causes sedation (crosses BBB)
    • 2nd gen non-sedating
    • Mechanism of action: binds H1 receptors throughout body
      • blocks effects of histamine
    • blocks itching, blocks mucus secretions (thickens)
      • (will thicken secretions in asthma)

Non- alergic Rhinitis

  • common cold
  • Sympathomimetics/ decongestants
    • activates A-1 adrenergic receptors on nasal blood vessels -> vasoconstriction
    • high abuse potential
      • Pseudoephedrine, phenylephrine, Oxymetazoline
    • caution w/ HTN and COPD

Mucokinetic agents

  • dilute secretion, break down thick mucus
    • water or normal saline
  • acetylcysteine (musomyst)
    • unpleasant odor
    • for COPD, cystic fibrosis
    • quick onset <1min

expectorant

  • decrease viscosity of mucus, promotes secretions in the airways
  • Guaifenesin – found in many OTC
    • Not proven to be effective!!

Antitussive

  • relieve or prevent cough
    • dextromethorphan
      • effect cough center of medulla
      • abuse potential

TB – Mycobacteria

    • acid fast bacilli, waxy layer protects bacteria, slow growing
    • necrosis and cavitation of pockets of tissue
    • droplet transmission
    • drug therapy
      • 8 weeks INH, RIF, PZA, EMB
      • then: INH and RIF 2-3 times a week for 6 months or 12 in HIV patients
    • there is drug resistant TB and the drug therapy lasts 2 years
    • INH – isoniazid – kills active and latent sensitive TB
      • lots of side effects and they last for the whole 6 months
      • visual side effects KNOW SIDE EFFECTS FUUUUUCCCCKKK!!!
        • Hepatotoxicity: s/s of hepatitis• Peripheral neuropathies• GI distress, dry mouth, weakness• CNS: Sz, dizziness, ataxia,
    • Rifampin:
  • brown discoloration of body fluids, will stain contact lenses
  • Pyrazinamide
    • Ethambutol – only effective w/ actively dividing mycobacteria
  • decreased ability to see red and green
  • Commercial truck drivers will have issues with this and may not be able to work
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