respiratory tract drugs-pharm

Note that when a spacer is used more medication

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Unformatted text preview: pired air 37 Impact of a spacer device on the distribution of inhaled medication. Note that, when a spacer is used, more medication reaches its site of action in the lungs, and less is deposited in the mouth and throat. 38 38 39 39 Example of a metered-dose inhaler, open nebulizer, closed nebulizer, and air jet nebulizer. air 40 41 41 Anti-Inflammatory Drugs Anti-Inflammatory Foundation of asthma therapy Taken daily for long-term control Principal anti-inflammatory drugs are the Principal glucocorticoids glucocorticoids 42 Anti-Inflammatory Drugs – Glucocorticoids Glucocorticoids Include budesonide (Pulmicort/Symbicort) Include and fluticasone (Flovent), triamcinolone (Azmacort) “-cort” (Azmacort) Considered the most effective antiasthma Considered drugs available drugs Usually administered by inhalation, but IV Usually and oral are also options and Common side effects: oropharyngeal Common candidiasis and dysphonia – gargle after and use spacer and 43 Anti-Inflammatory Drugs – Glucocorticoids Glucocorticoids Mechanism of action--suppress inflammation – Decreased synthesis and release of inflammatory mediators – Decreased infiltration and activity of inflammatory cells – Decreased edema of the airway mucosa Adverse effects: – Minor when taken acutely – Can be severe when used long-term (adrenal suppression, Can osteoporosis, hyperglycemia, and others) osteoporosis, – Long term – bone loss in premenopausal women 44 Anti-Inflammatory Drugs – Leukotriene Modifiers Leukotriene Suppress effects of leukotrienes Less effective than inhaled glucocorticoids Available agents: – Zileuton (Zyflo) – Zafirlukast (Accolate) – Montelukast (Singulair) 45 Anti-Inflammatory Drugs – Cromolyn Cromolyn Used for prophylaxis, not quick relief Suppresses inflammation; not a Suppresses bronchodilator bronchodilator Route – inhalation: Route inhalation: – Nebulizer – MDI Adverse effects – Safest of all antiasthma medications – Cough – Bronchospasm 46 Bronchodilators Bronchodilators Provide symptomatic relief but do not alter Provide the underlying disease process (inflammation) (inflammation) In almost all cases, patient taking a In bronchodilator should also be taking a glucocorticoid for long-term suppression of inflammation inflammation Principal bronchodilators are the beta2adrenergic agonists 47 Bronchodilators – Beta2-Adrenergic Bronchodilators -Adrenergic Agonists Agonists Include albuterol (Proventil/Ventolin), Include salmeterol, terbutaline, levalbuterol (Xopenex) (Xopenex) – “-terol” Most effective drugs for relief of acute Most bronchospasm and prevention of exercise-induced bronchospasm exercise-induced Use in asthma: both quick relief and Use long-term control long-term 48 Bronchodilators – Beta2-Adrenergic Bronchodilators -Adrenergic Agonists Agonists Mechanism of action – Activate beta2 receptors in smooth muscle of lung, promoting bronchodilation and thereby relieving bronchospasm bronchospasm – Also suppress histamine release in lung and Also increase ciliary motility increase Adverse effects – Inhaled preparations Systemic effects – tachycardia, angina, and tremor – Oral preparations Excessive dosage – angina pectoris, tachydysrhythmias Tremor 49 Bronchodilators – Methylxanthines Bronchodilators Theophylline – Benefits derive primarily from bronchodilation – Narrow therapeutic index – Plasma level 10 to 20 mcg/mL – Toxicity is related to theop...
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