1
Q
what are some examples of disorders of the respiratory tract
A
- asthma
- chronic obstructive pulmonary disease (bronchitis and emphysema)
- allergic rhinitis, cough and cold
2
Q
what are smooth muscles and bronchioles controlled by
A
- ANS
- sympathetic nervous system is activated during stressful situations -> bronchiolar smooth muscle relaxes and bronchodilation results
- more air enters the alveoli -> increasing the oxygen supply to the body during stress or exercise
3
Q
what is pathogenesis and diagnosis of asthma like
A
- chronic lung disease
- inflammation of the airways
- bronchoconstriction
- improves either spontaneously or with tx
4
Q
how many Canadians deal with asthma and how many children
A
- 8.4% of Canadian population, 12% of children
5
Q
when does asthma begin
A
- usually in childhood but can occur at any age
- less than 12% of all children younger than 18 reported having asthma attacks
- approximately 156,000 emergency department visits and 10 deaths per week
6
Q
what is the pathogenesis of asthma
A
- airway inflammation (mucosal edema and mucous secretions)
- release of inflammatory mediators (histamine, prostaglandins, leukotrienes and other cytokines)
- triggered by exposure to allergens: dust, plant pollen, smoke, and animal dander; exercise,; stress; changes in weather; and upper respiratory viral infections
- these inflammatory mediators cause swelling of the airways and provoke contraction of the airway smooth muscle -> airway obstruction
7
Q
what occurs during an asthma attack
A
- cough, shortness of breath, wheezing. hyper responsiveness and subsequent airway obstruction
- bronchospasm – mediated through the beta 2 receptors located on the bronchioles. may be rapidly relieved by inhaled bronchodilators. occurs within minutes, while inflammation (mucous secretions) is slower in onset, taking hours
8
Q
when does asthma get worse and what are some symptoms
A
- may worsen at night
- upon wakening in the morning
- during exercise
- with colds or exposure to allergens
- symptoms: wheezing, prolonged or troublesome cough, difficulty breathing, breathlessness (dyspnea), chest tightens
9
Q
what are the classifications of asthma
A
- mild intermittent
- mild persistent
- moderate persistent
- severe persistent
10
Q
what is mild intermittent asthma like (signs)
A
- 2 days a week or less/and awakenings less than 2 times a month
11
Q
what is mild persistent asthma like (signs)
A
- more than 2 days a week but less than one time a day; awakenings 2x a month or more
12
Q
what is moderate persistent asthma like (signs)
A
- every day
13
Q
what is severe persistent asthma like (signs)
A
- most of the time
14
Q
what are asthma therapy goals
A
- decrease the frequency of asthma attacks
- terminate attacks progress
- drug regimens are tailored to the pattern, severity and triggers
15
Q
what are the classifications of asthma medications
A
- long term control medications
- quick relief medications
- inhaled corticosteroids
16
Q
what are long term control medications for asthma
A
- also referred to as long term preventive, controller or maintenance medications
- taken daily on a long term basis in order to achieve and maintain control of persistent asthma
- antiinflammatory effects
17
Q
what are quick relief medications for asthma
A
- also referred to as reliever or acute rescue medications
- quick reversal of acute airflow obstruction and relief of bronchospasm
18
Q
what are inhaled corticosteroids
A
- the drugs of choice to for persistent asthma
- safe and high efficacy
- reduce hospitalizations and complications with regular use
19
Q
what is used for moderate to severe asthma
A
- inhaled corticosteroid and a long acting beta 2 agonist (LABA) for adults and children over 5 years of age
20
Q
what are other long-term preventive medications for asthma
A
- cromolyn sodium (intal) stabilizes the mast cell and prevent rupture and the release of mediators = mast cell stabilizers
- leukotriene receptor blockers (montelukast) are alternative tx -> block action of leukotrienes
- methylxantines (theophylline) cause bronchospasm
21
Q
what is step up/step down
A
- as the severity of asthma increases -> increase amount and frequency of medications (step up)
- as the severity of asthma decreases -> decrease amount and frequency of medications (step down)
- goal is to keep asthma under control with no symptoms
- cough is usually first sign of lack of control
22
Q
what are some adverse effects of inhaled corticosteroids
A
- cough, oral candidiasis (thrush) and with high doses, growth suppression
- lesions appear white on the mucosa and rub off when wiped with gauze
- patient should brush teeth and rinse mouth with water after every inhalation dose to prevent fungal infections
- when a Pte uses inhaler with spacer, the incidence of oral candidiasis drops markedly
23
Q
what are the guidelines for patients taking inhaled corticosteroids
A
- monitor for fungal infection in the oral cavity
- the patient should brush their teeth and rinse with water after inhalation dose
- may require fluoride tx at home for dry mouth
- hoarseness may develop.
24
Q
what are long acting beta 2 selective agonists
A
- laba
- bronchodilators causing the airway smooth muscles to relax
- long duration of action up to 12 hours or more
- used with a low or medium dosage of an inhaled corticosteroid to improve asthma control and should not be used alone
- ex: salmeterol
25
what are adverse effects of laba
- xerostomia, tachycardia (increased heart rate) headache, tremor, nausea
- used alone = overstimulation of the beta-agonist receptors -> makes the short acting beta agonists less effective
- use of LABAs as a rescue medication has resulted in complications of altered heart rhythm and death
26
what are some guideline for patients taking salmeterol
- assess salivary flow; assess need for fluoride rinse
- stress importance of good oral hygiene
- monitor vital signs, especially patients with heart disease
- keep patient in a semisupine position
27
what are methylxanthines
- theophylline and aminophylline
- bronchodilators that relax the airway smooth muscle to control asthmatic symptoms
- no longer recommended for acute exacerbations or as a drug of choice for asthma
28
what are mast cell stabilizers
- cromolyn sodium and nedocromil sodium
- anti-inflammatory actions that inhibit the release of histamine and other medicators of allergic reactions that lead to airway inflammation
- both medications are administered by inhalation
- may be alternative tx in mild persistent asthma
29
what are leukotriene modifiers
- may be alternative first line tx for mild persist asthma
- may serve as adjuncts to inhaled corticosteroids for more severe disease
- montelukast is one of the most prescribed because of its once a day dosing and approval for young children
30
what are some other agents for asthma
- combination therapy of ipratropium bromide and salbutamol can be helpful for COPD
- fluticasone and salmeterol is beneficial for patients with moderate or severe asthma who benefit from the addition of a bronchodilator, rather than increasing the anti inflammatory therapy
31
what are some quick relief medications for bronchospasm
- used for prompt relief of bronchospasm and associated symptoms including cough, chest tightness, and wheezing
- drugs: short acting beta 2 receptor selective agonists, anticholinergics, systemic corticosteroids
32
what are bronchodilators
- when inhaled, the beta 2 agonists provide the quickest onset (5-15 mins) and relief of symptoms by bronchodilation (relaxation of bronchiole smooth muscle)
- short acting beta 2 receptor selective agonist = salbutamol
- regular daily use is not generally recommended because tachyphylaxis (drug tolerance) due to overstimulation of the receptors may reduce their effectiveness
33
what are some guidelines for patients on salbutamol
- may leave patient in a semisupine chair position'
- after each inhalation, the patient should rinse mouth with water to prevent dryness
- may need daily fluoride tx at home if dry mouth is persistent
- use salivary substitutes if dry mouth is persistent
- have inhalant on bracket table during dental tx
- inhaled beta-adrenergic agonists produce little systemic toxicity because only small amounts of the drug are absorbed
- epi is primarily used in an emergency situation for severe bronchoconstriction or in some cases of croup
34
what are bronchodilators
- used for quick relief
- anticholinergic agents
- cholinergic innervation is an important factor in the regulation of airway smooth muscle tone
- for patients who cannot tolerate beta 2 agonists or as an adjunct to beta 2 agonists for additional relief of bronchoconstriction
- ex: ipratropium bromide HFA
35
what are corticosteroids
- suppress inflammation
- systemic corticosteroids are used when asthma cannot be controlled by bronchodilators alone
- corticosteroids taken orally take more than 4 hours to have a therapeutic effect by reducing inflammation
- usual = 30 mg (6 tablets of 5 mg) x 5 days
36
what are some guidelines for patients taking systemic corticosteroids
- monitor patients for oral candidiasis (thrush; white areas that do not rub off)
- monitor salivary flow
- patients taking steroids more than 20 mg more than 2 weeks may require additional doses for stressful dental procedures; consult with a physician
- avoid aspirin because of GI problems
- frequent oral prophylaxis
37
what are the 3 routes of drug administration for inhaled devices
- nebulizer
- dry powder inhaler (DPI)
- metered dose inhalers (MDI)
38
what is COPD
- chronic obstructive pulmonary disease (COPD)
- includes chronic bronchitis, emphysema
- no cure
- medication management involves a variety of steps by step treatment regimens similar to that for asthma
- addition of oxygen for emphysema
- addition of antibiotics and atrovent for bronchitis
39
what is rhinitis
- inflammation of the nasal mucosa (mucous membranes in the nasal cavities) is most frequently caused by allergic reactions to allergens
- 2 types: allergic rhinitis, seasonal rhinitis
40
what are clinical features of rhinitis
- nasal congestion
- rhinorrhea (runny nose)
- itching
- sneezing
- mucus production
- vasodilation and airway narrowing
41
what are histamine receptors
- symptoms are due to the release of histamine from mast cells and basophils
42
what are histamine 1 receptors
- located on the smooth muscle of the bronchi, veins, capillaries, heart and GI tract
- involved in allergic reactions that cause rhinitis
- activation causes bronchoconstriction, vasodilation, and constriction of the intestinal smooth muscle, itching, pain
- antihistamine are react with these receptors
43
what are histamine 2 receptors
- located on the brain, stomach, heart and blood vessels
- activation of these receptors causes an increase in gastric acid production in the stomach
- not primarily involved in allergic reactions and drugs that bind to these receptors are used for the tx of ulcers
- ER uses ranitidine, a histamine 2 blocker (Zantac) as part of anaphylaxis protocol
44
what are the 5 classifications of drugs used to treat rhinitis
- antihistamines (oral)
- alpha adrenergic agonists (decongestants)
- topical corticosteroids (nasal sprays)
- mast cell stabilizers (nasal sprays)
- antibiotics are not useful for treating colds because they kill bacteria
45
what are antihistamines
- block the histamine 1 receptors
- eliminate the symptoms (sneezing, itching, rhinorrhea) associated with rhinitis
- ineffective in treating the common cold
- contraindicated in: narrow angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer disease and bladder obstruction)
46
what are histamine 1 blockers
- treat allergic reactions (allergic rhinitis) and motion sickness
- first generation: Benadryl: anticholinergic side effects: xerostomia, sedation, urine retention
- second generation: non sedating antihistamines, ferofenadine (allegra), cetirizine (reaxctine) and loratadine (claritin)
47
what are guidelines for patients taking antihistamines
- anticholinergic side effects (dry mouth) are common
- consider home fluoride applications
- monitor for caries
- stress meticulous oral hygiene
48
what are nasal decongestants
- alpha adrenoceptor agonists
- constricting blood vessels in the nasal mucosa
- reduce blood supply to the nose and decrease edema
- ex: otrivin, neo-synephrine, dristan
- prolonged use (3-5 days) causes rebound congestions
- oral (systemic) forms should not be used or used with caution in Ptes with: hypertension, hyperthyroidism, diabetes, cardiovascular disease, glaucoma, urinary obstruction or taking beta-blocker drug or MAOIs
49
what are topical (intranasal) corticosteroids
- reduce inflammation of the nasal mucosa
- effective drugs for relieving symptoms of sneezing, itching, congestion, rhinorrhea (runny nose)
- administering as nasal sprays: beclomerthaspone, mometasone, fluticasone, budesonide
50
what is viral rhinitis
- called the common cold
- a self limiting condition best treated conservatively
- nasal decongestants (eg pseudoephedrine) may be needed
51
what is a cough
- initial stimulus for cough most likely starts in the mucosa from the nose through the branching points in the tracheobronchial tree
- reflex
- defense mechanism
52
what are antitussives
- used to suppress a cough
| - opioids, including codeine, hydrocodone and hydromorphone
53
what are expectorants
- acts as local irritants in the airways or the GI tract
- stimulate cough
- thin sputum through increased secretion of water
- ex: guaifenesin
54
how can ptes avoid dry moiuth
- drink plenty of water
- avoid alcohol
- avoid alcohol containing mouth rinses
- antihistamines frequently used during the year increased dry mouth incidence
55
asthma = ?
- bronchospasm + inflammatory component
Pharmacology
flashcards
Decks in class (21)
# Cards
-
Introduction and terminology35
-
Prescription writing12
-
Drug regulation and discovery in canada30
-
Forms and routes22
-
Kinetics and dynamics30
-
Drug reactions25
-
Autonomic drugs60
-
Non opioid analgesics64
-
Opioids46
-
Antibiotics54
-
Antiviral and antifungal agents21
-
Cardiovascular drugs96
-
Medical emergencies21
-
Anaesthetics73
-
Neuro29
-
Antineoplastics19
-
Endocrine48
-
Herbal35
-
Psychotropics44
-
Respiratory55
-
GI Drugs54
