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Chapter 9

Chapter 9. Respiratory Drugs. Chapter 9 Topics. Asthma Emphysema Other Lung Diseases Cough and Cold Smoking Cessation. Learning Objectives. Differentiate the pulmonary diseases Learn the pathophysiology and treatment of asthma Define the goals of asthma treatment

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Chapter 9

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  1. Chapter 9 Respiratory Drugs

  2. Chapter 9 Topics • Asthma • Emphysema • Other Lung Diseases • Cough and Cold • Smoking Cessation

  3. Learning Objectives • Differentiate the pulmonary diseases • Learn the pathophysiology and treatment of asthma • Define the goals of asthma treatment • Discuss the pathophysiology and treatment of emphysema and chronic bronchitis

  4. Learning Objectives • Describe other diseases related to the lungs • Be aware of the reemergence of tuberculosis and of treatment for this disease

  5. Learning Objectives • Understand how the antitussives, expectorants, decongestants, and antihistamines differ, and be able to describe their uses • Know why some drugs are prescribed for their side effects • Outline smoking cessation plans and supportive therapy

  6. Asthma • Inflammatory disease that affects the airways causing a reversible airway obstruction • Intermittent attacks are precipitated by specific triggering events • Causes a decrease in the amount of oxygen and carbon dioxide exchanged

  7. Asthma Classes • Allergic • Present in 35%-55% of patients

  8. Asthma Classes • Allergic • Present in 35%-55% of patients • Exercise Induced

  9. Asthma Classes • Allergic • Present in 35%-55% of patients • Exercise Induced • Nonallergic

  10. Upper and Lower Respiratory Tracts

  11. Exchange of Oxygen and Carbon Dioxide

  12. Asthma • Asthmatic lung is more sensitive to lower doses of allergens • Asthma has shown to have genetic predisposition

  13. Asthma Characteristics • Reversible small airway obstruction • Progressive airway inflammation • Increased airway responsiveness to stimuli These characteristics translate into: • Wheezing • Dyspnea • Acute and Chronic Cough

  14. Asthma Attack – 1st Response • Triggered by an antigen-antibody reaction • Causes degranulation of mast cells: histamine released • Results in bronchospasm and mucus production that plugs the small airways

  15. Asthma Attack – 2nd Response • Bronchoconstriction with delayed, sustained reactions • Causes self-sustaining inflammation

  16. Asthmatic Response

  17. Peak Flow Meter • Assesses severity of disease and aids in determining course of therapy • Measures maximum flow rate in forced expiratory maneuvers

  18. Goals of Asthma Care • Sleep well every night • Be able to go to work or school every day • Be free from wheezing all day • Have good control of coughing • Be able to continue with activities and exercise • Tolerate medicines well

  19. Asthma Therapy • Know the triggers and try to avoid them • Accurately use a Peak Flow Meter regularly • Be aware of status asthmaticus and the treatment for it. **This is a medical emergency.**

  20. Stepwise Approach to Asthma Therapy Step 1. Short-acting oral or inhaled beta-2 agonist (less than once a week); no daily medications

  21. Stepwise Approach to Asthma Therapy Step 1. Short-acting oral or inhaled beta-2 agonist (less than once a week); no daily medications Step 2. Short-acting oral or inhaled beta-2 agonist (not to exceed three to four times in one day); daily medications (e.g., inhaled corticosteroids)

  22. Stepwise Approach to Asthma Therapy Step 3.Short-acting oral or inhaled beta-2 agonist; daily medications (e.g., inhaled corticosteroid and long-acting bronchodilator)

  23. Stepwise Approach to Asthma Therapy Step 3.Short-acting oral or inhaled beta-2 agonist; daily medications (e.g., inhaled corticosteroid and long-acting bronchodilator) Step 4. Short-acting oral or inhaled beta-2 agonist; daily medications; inhaled corticosteroid, long-acting bronchodilator, long-acting beta-2 agonist, and oral corticosteroids long term

  24. Asthma Drug Therapy • Treatment should start at the most appropriate step • Start with an aggressive initial approach • Rescue corticosteroids may be used at any time • Treatment should be reviewed every 3-6 months • For exercise-induced asthma, using terbutaline or albuterol before exercise gives protection for 2 hours

  25. Devices Used in Asthma Therapy • Uses a stream of air that flows through liquid medication to make a fine mist to be inhaled • Very effective • Must be cleaned and taken care of to reduce risk of contamination Nebulizer

  26. Devices Used in Asthma Therapy • Metered Dose Inhaler (MDI) • Contains medication and compressed air • Delivers a specific amount of medication with each puff

  27. Devices Used in Asthma Therapy • Metered Dose Inhaler (MDI) • Contains medication and compressed air • Delivers a specific amount of medication with each puff • Spacer • Used with MDIs to help get medication into the lungs instead of depositing on the back of the throat

  28. Devices Used in Asthma Therapy • Dry powder inhalers • Starting to replace MDIs • The patient turns the dial and a capsule full of powder is punctured • The patient then inhales the powder

  29. Drug List Asthma AgentsBronchodilators • albuterol (Proventil, Proventil HFA, Ventolin, Ventolin HFA) • epinephrine (EpiPen) • formoterol (Foradil) • ipratropium (Atrovent) • ipratropium-albuterol (Combivent) • isoetharine (Beta-2)

  30. Drug List Asthma AgentsBronchodilators • isoproterenol (Isuprel) • levalbuterol (Xopenex) • metaproterenol (Alupent) • pirbuterol (Maxair) • salmeterol (Serevent) • terbutaline (Brethine) • tiotropium (Spiriva)

  31. albuterol (Proventil, Proventil HFA, Ventolin, Ventolin HFA) • Used in cases of airway obstruction • Relaxes bronchial smooth muscle with little effect on heart rate • HFAs do not contain chlorofluorocarbons which deplete the ozone

  32. levalbuterol (Xopenex) • Isomer of albuterol • Has fewer side effects than albuterol • Must be used with a nebulizer • Vials should be stored in foil package; once the foil is opened, vials must be used within 1 to 2 weeks

  33. salmeterol (Serevent) • Indicated for maintenance therapy • Has a long duration of action • Onset of action is 30-60 minutes • Should not be used in rescue situations • Available in MDI and dry powder inhaler

  34. ipratropium (Atrovent) • Blocks ACh in bronchial smooth muscle causing bronchodilation • Used for prevention of attacks, not rescue situations

  35. Atrovent Dispensing Issues • If patient is allergic to peanuts, they may be allergic to the suspending agent in this inhaler Warning!

  36. ipratropium-albuterol (Combivent) • Combination bronchodilator • Should inquire about peanut allergy as well

  37. Drug List Asthma AgentsXanthine Derivatives • aminophylline (Truphylline) • theophylline

  38. Drug List Asthma AgentsLeukotriene Inhibitors • montelukast (Singulair) • zafirlukast (Accolate) • zileuton (Zyflo)

  39. Leukotrienes • Increase edema, mucus, and vascular permeability • 100 to 1,000 times more potent than histamine • Inhibitors block the synthesis of or the body’s response to leukotrienes

  40. montelukast (Singulair) • Indicated for the prophylaxis and chronic treatment of asthma • Do not use to treat acute attacks • Approved for use in children over 12 months • Used once a day • Available in tablet and chewable tablet

  41. Drug List Asthma AgentsCorticosteroids • beclomethasone (Beconase,Vanceril) • budesonide (Pulmicort, Rhinocort) • dexamethasone (Decadron) • flunisolide (AeroBid) • fluticasone (Flonase, Flovent) • hydrocortisone (Solu-Cortef)

  42. Drug List Asthma AgentsCorticosteroids • methylprednisolone (Medrol Dose-Pack, Solu-Medrol) • mometasone furoate (Nasonex) • prednisolone (Orapred, Pediapred) • prednisone (Deltasone) • triamcinolone (Azmacort, Nasacort AQ)

  43. Corticosteroids • Anti-inflammatory agent to suppress the immune response • Inhibit late-phase inflammatory reaction • Reserved for more difficult cases

  44. Corticosteroid Side Effects • Primary: • Oral candidiasis • Irritation and burning of the nasal mucosa • Hoarseness • Dry mouth

  45. Corticosteroid Side Effects • If used for a long period of time, it can cause: • Growth of facial hair in females • Breast development in males • Weight gain • “buffalo hump” – “moon face” • Easy bruising – Edema

  46. Corticosteroid Dispensing Issues • Patient should rinse mouth with water after using these inhalers to prevent oral candidiasis • Patient should be taught how to correctly use these medications Warning!

  47. fluticasone (Flonase, Flovent) • Flonase is a nasal spray used for allergies • Flovent is an MDI that comes in 3 different strengths • May take 2 weeks to reach maximum benefit

  48. budesonide (Entocort EC, Pulmicort Respules, Pulmicort Turbuhaler, Rhinocort) • Pulmicort Turbuhaler – dry powder inhaler that is breath activated and is easier to use • Coughing is a less frequent side effect

  49. mometasone furoate (Nasonex) • Decreases the amount of inflammation- causing chemicals that are released • Reverses dilation and permeability of vessels • May be used in children over 12 to prevent allergy symptoms

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