Respiratory drug chart PDF

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Respiratory drug chart...

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Disorder and details Allergies

Classification Antihistamines

Histamine on H1 receptors response: Vasodilation & increases capillary permeability ● Flushed face ● Edema ● Constriction of bronchi ● Increase mucous secretions ● Itching ● Pain Mild allergy: o Sneezing o Rhinorrhea o itchy eyes/throat o hives o blood transfusions o mosquito bites

First Generation: ● Sedation common ● Anticholinergic ● less expensive Second Generation: ● less sedating ● < anticholinergic effects ● more expensive

Severe allergy: mediated by more than histamine ● Adjunct only ● Epinephrine drug of choice Special Instructions: ● Take at night ● No driving/using heavy machinery ● Take with food Motion sickness: ● blocks nerve impulses that lead to CTZ in brain Insomnia: ● used often for geriatric population because many sleep aids are high on Beer’s criteria

* on module

Drug and dose *Diphenhydramine (Benadryl) ● lower doses if possible ● PO

Unique characteristics First Generation antihistamineEthanolamines Take qHS to help with sedation (will effect memory/learning) – will develop tolerance to sedation over 2-3 weeks ACUTE TOX: dilated pupils, flushed, hyperpyrexia, tachy, anticholinergic effects coma, CV collapse, death Use lowest dose possibly, do NOT use to sedate children

MOA: block the action of H1 receptors; prevents vasodilation, decrease capillary permeability, blocks receptors in medulla (vomiting center) Uses: mild/severe allergy, motion sickness, insomnia, common cold (decrease rhinorrhea), hives, blood transfusion, itching; Does not treat asthma Effects: increased drowsiness, decreased bronchoconstriction, decreased itching and pain, decreased mucous secretions *not first line with bronchoconstriction Adverse Effects: sedation, dizziness, incoordination, confusion, fatigue, GI upset, anticholinergic, urinary hesitancy (BPH), constipation, palpitations, respiratory depression and local tissue injury (IV promethazine), paradoxical excitation Drug interactions: ETOH, barbs, benzo, opioids, sedatives, CNS depressants, tricyclic antidepressants, MAOI, ototoxic drugs Contraindications: Pregnancy: fetal malformation, avoid in 3rd trimester; Lactation: excreted in breast milk Acute toxicity*: dilated pupils, flushed face, hyperpyrexia, tachycardia, dry mouth, urinary retention; CNS excitation (kids); severe-coma, CV collapse, death Caution with asthma patients (thicken secretions) *Treat symptoms*

Fexofenadine (Allegra) ● PO ● Available OTC

*Cetirizne (Zyrtec) ● PO ● Available OTC

Levocetirizine ● PO ● Available OTC

*Loratadina (Claritin) ● PO ● Available OTC ● Every other day for renal or hepatic impairment *Azelastine (Astelin*/Astepro) ● Intranasal

Second generation-antihistamine Reduce doses in renal failure Avoid fruit juices 4 hours before and 1-2 hours after administration Good combo of efficacy and safety Can give to kids as young as 6 mo. Second generation-antihistamine Reduce doses in renal and hepatic impairment Food delays absorption (may work best on empty stomach) More sedating than other 2nd generations Can give to kids as young as 2 (adjust for infants) Second generation-antihistamine CI: children w/ any renal impairment Reduce dose for mild-moderate renal impairment More sedating than other 2nd generation (like Cetirizine) Take in the evening Take w/ or w/o food (unlike cetirizine) Avoid alcohol and CNS depressants Second generation-antihistamine Food delays absorption Extensive hepatic metabolism Give to children as young as 2 Second generation-antihistamine Astelin: not for children PO/IV ● decreased synthesis and release of inflammatory

MOA: suppress inflammation, reduce bronchial hyperactivity, decrease airway mucus production Uses: ● Inhaled: ● 1st line therapy for asthma ● daily with persistent asthma (more effective and safer than PO) ● PO: ● moderate-severe persistent asthma ● acute exacerbations in asthma and COPD ● treatment as brief as possible

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bronchodilator � beta2 agonist, inhaled, fixed schedule for long-term or PRN for acute attack (tx of sx) Risk Factors

Symptoms ● Wheezing ● Chest tightness ● Cough ● Dyspnea on exertion EDU � ask about meds and exercise, keep rescue meds on you, 15 min warm-up/cool-down, do not exercise with cold or URI, check air quality, breathe through nose, avoid outdoor areas full of allergens, keep doors/windows closed Inhalation Rx Therapy: ● Metered-Dose Inhaler: (MDI) hand held device; inhale before you activate the drug, hold breath 10 seconds after; use spacer if needed ● Dry-powder inhalers (DPIs): do not shake; inhale quick and fast, easier for elderly population to use ● Respimats: drug is in mist; greater amount of drug reaches lung ● Nebulizer

COPD ● Chronic, progressive, mostly irreversible ● Smoking causes an inflammatory rxn ● Same TX ● Use beta-2-agonist and glucocorticoids BEFORE methylxanthines Symptoms: ● Dyspnea ● Wheezing ● Chronic cough ● Poor exercise tolerance

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mediators decrease infiltration and activity of inflammation decrease edema to the airway (decreased vascular permeability)

Leukotriene Modifier

Montelukast (Singulair) Safe for 1 year or older

Bronchodilators Beta2 adrenergic agonists SHORT ACTING

Albuterol (Proventil) ● ●

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Neb if severe MDI � can be 3-4x daily DPI

NOT for stable COPD Symptomatic relief of asthma and COPD Do not alter the underlying inflammation Usually adjunct therapy Monotherapy in mild asthma with infrequent attacks

Bronchodilators LONG ACTING beta-2agonist Can’t stop acute attack; avoid as monotherapy*

Levalbuterol (Xoponex) (SABA) ● MDI: usually ● Nebulized if severe attack ● DPI ● PRN (acute attacks)

Adverse Effects: ● Inhaled: o Adrenal suppression(EMERGENCY, coma , death), oropharyngeal candidiasis (yeast; have patient rinse mouth and gargle with water after), dysphonia (hoarse voice), slow growth (kids), bone loss with long term use (have them on lowest dose; make sure vitamin D and calcium in diet), glaucoma and cataracts (w/ continuous high dose) ● Oral: o No significant adverse effect w/ dose 2x/week, avoid in stable COPD (use LABA) NOT for prophylactic

LABA: Use: Long term control in patients who have frequent asthma attacks, must be combination therapy in asthma*, Stable COPD Adverse Effects: ● Inhaled: increased risk of death in asthma if monotherapy ● PO: angina, tachydysrhythmias, tremor Contraindications: Can’t stop an acute attack-used for long term only, avoid as monotherapy

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Sputum production**

EDU� use short-acting inhaler 15 mins before activity, avoid prolonged sitting, make PA routine QOD, don’t over do it, warm up for 5 mins, cool down, wait 2 hrs after exercise

Allergic Rhinitis Seasonal ● fall and spring ● reaction to outdoor allergens Perennial ● non-seasonal ● reaction to indoor allergens ● dust, cats, dogs Symptoms: ● Pruritis ● Nasal congestion, rhinorrhea ● Asthma, sneezing ● Conjunctivitis ● Sinusitis

Anticholinergic

Intranasal Glucocorticoid

Ipratropium (Atrovent) ● Inhaled

Drug interactions: caffeine, tobacco and marijuana smoke Toxicity: N/V/D, insomnia, restlessness (early); severe sdysrhythmias, convulsion, death (late)—CHECK LABS, STOP DRUG Improve lung function MOA: block muscarinic receptors in the bronchi (bronchoconstriction) FDA approval for COPD, used off-label for asthma Minimal systemic effects Adverse Effects: dry mouth, pharynx irritation Raise HR a little (not as much as albuterol) Good to give it pt. has high HR instead of albuterol

Fluticasone (Flonase) ● Daily, not PRN for most benefit

First line treatment Most effective drug for prevention and treatment of rhinitis Adverse Effects: nasal mucosal drying, burning or itching sensation, sore throat, epistaxis and headache Systemic effects are rare (adrenal suppression, slowing of linear pediatric growth)

You can also take: antihistamine/sympathomimetic combos, antihistamine/glucocorticoid combos, ipratropium, motelukast, or omalizumab Sympathomimetics o Adjunctive therapy

Pseudoephedrine (Sudafed) ● Only PO

*AVOID all of these in children under 4 Ephedrine ● Only PO

CNS stimulation is lower Can be converted to methamphetamine Restriction of amount purchased More effective than phenylephrine Higher incidence of CNS stimulation Can be converted to methamphetamine Restriction of amount purchased More effective than phenylephrine

Pseudoephedrine Intranasal/Topical MOA: rapid and intense vasoconstriction; leads to reduced swelling of membranes and decreased nasal congestion Adverse Effects: rebound congestion Use: Limit up to 3-5 days Route: Drops are preferred for kids, sprays less effective than drops Oral MOA: prolonged and moderate vasoconstriction; leads to reduced swelling of membranes and decreased nasal congestion Systemic effects: restlessness, irritability, anxiety , insomnia and generalized vasoconstriction Contraindication: Avoid in patients with CVD, including HTN

Cough and Cold COLD Symptoms: ● Cough, sneezing, congestion ● Sore throat, hoarseness ● Ha, malaise, myalgia ● Fevers in kids

Antitussives ● Given with an unproductive cough never in productive because they need to cough it up ● CI: COPD patients (need to cough up mucous)

Phenylephrine (Sudafed PE) ● Nasally and PO ● IV (hypotension)

Fast and effective when used topically Not as effective when used PO Not associated with abuse

Opiods

Most effective (Codeine, sometimes mixed with other drugs) Abuse potential is low Monitor for CNS depression and constipation

Dextromethorphan (Delsym)

Most effective OTC Honey effective for children over 1 year old for treating cough Other non-opioids Teslin pearls

Cold remedies (Combination preparations): ● Nasal decongestant ● Antitussive ● Analgesic ● Antihistamine ● Caffeine *usually URI are viral not bacterial *FDA does not recommend OTC cold remedies in kids...