Bronchodilators and Other Respiratory Agents. Asthma -Predominantly in boys 2:1 -puberty: occurrence...
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Transcript of Bronchodilators and Other Respiratory Agents. Asthma -Predominantly in boys 2:1 -puberty: occurrence...
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Bronchodilators and Other Respiratory Agents
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Asthma -Predominantly in boys 2:1 -puberty: occurrence equals out -More females in adult-onset
cases -Affects ~25 million people (7
million children)2
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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
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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
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Nausea, vomiting, anorexia GERD during sleep Sinus tachycardia, extrasystole
(PVC’s), palpitations Nervousness/restlessness,
convulsions Smokers may require higher and
more frequent doses17
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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
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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
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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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