Bronchodilators and Other Respiratory Agents

Asthma -Predominantly in boys 2:1 -puberty: occurrence equals out -More females in adult-onset cases -Affects ~25 million people (7 million children) 2

Chronic Obstructive Pulmonary Disease (COPD) -A reactive airway disease -Primarily affects older persons especially smokers and those chronically exposed to pollutants 3

Antigen -> the body, combines with mast cells -> sensitized mast cell When re-exposed to the antigen, there is the formation and release of chemical substances -Histamine -Leukotrienes 4

Acts directly or indirectly  Directly-causes bronchoconstriction  Indirectly-stimulates release of acetylcholine  causes smooth muscle contraction 5

 used to relax and open the airways, open /maintain the bronchial airways Treat several disease syndromes  Chronic obstructive pulmonary disease  Asthma 6

Sympathomimetic agents Xanthine bronchodilators Anticholinergics Leukotriene receptor antagonists 5-lipoxygenase inhibitors Mast cell stabilizers Corticosteroids 7

 Stimulation of β 1 receptors by epinephrine induces a positive chronotropic and inotropic effect on the heart and increases cardiac conduction velocity and automaticity  Stimulation of β 1 receptors on the kidney causes renin release. 8

 Stimulation of β 2 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. 9

Beta 2 -adrenergic receptors Used during the acute phase of asthmatic attacks Quickly reduce airway constriction and restore normal airflow 10

 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 11

 Nonselective adrenergics  Stimulate alpha 1, beta 1 (cardiac), and beta 2 (respiratory) receptors  Example: epinephrine/Primatene or Adrenaline 12

Nonselective beta-adrenergics  Stimulate both beta 1, beta 2 receptors  isoproterenol (Isuprel) Selective beta 2 drugs  albuterol/Proventil or Ventolin  Levalbuterol/Xopenex 13

 Frequent use leads to beta 1 receptors being stimulated  Albuterol loses its action  General side effects  Nausea, increased anxiety, palpitations, tremors, and increased heart rate 14

Chemical class of agents Contain caffeine Oldest class of bronchodilators Used in ancient times Examples: Aminophylline, Theophylline, Theolair, Elixophyllin, Slo-Phyllin, Theo-Dur, Theo24 15

 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 effects 16

 Nausea, vomiting, anorexia  GERD during sleep  Sinus tachycardia, extrasystole (PVC’s), palpitations  Nervousness/restlessness, convulsions  Smokers may require higher and more frequent doses 17

 Monitor patient for tachycardia  Educate: reduce caffeine  Monitor CNS stimulation, changes in cardiac function, seizures  Serum theophylline levels required  Therapeutic Range 10-20mcg/mL 18

Acetylcholine (ACh) causes bronchial constriction. Anticholinergics bind to the ACh receptors, preventing ACh from binding. Result: bronchoconstriction is prevented, airways dilate 19

Ipratropium bromide (Atrovent) Tiotropium bromide (Spiriva HandiHaler) Actions  Local effects  Slow and prolonged action  Used to prevent bronchoconstriction  Not used for acute asthma exacerbations! 20

 Usually not absorbed systemically  If absorbed, may produce:  Dry mouth or dry throat  Gastrointestinal distress  Headache  Coughing  Anxiety 21

 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 22

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 23

Montelukast (Singulair) Zafirlukast (Accolate) Class side effects:  Headache  Nausea  Diarrhea  Liver dysfunction 24

 Use for chronic management of asthma, not acute asthma  Improvement should be seen in about 1 week 25

 New class of LRAs  Action  Inhibit the formation of leukotrienes  Used to inhibit some cancer growth  Outcome  Prevent lung inflammation Example: Zileuton 26

 Prophylactic  Indirect bronchodilator activity  Stabilize cell membranes of inflammatory cells  mast cells, monocytes, macrophages  Prevent release of harmful cellular contents 27

 Adjuncts to the overall management of clients with lung disease  Prevent bronchospasm when exposed to: Cold air Exercise Allergens Dry air 28

 Cromolyn (Nasalcrom, Intal)  Nedocromil (Tilade) Side effects:  Coughing  Taste changes  Sore throat  Dizziness  Rhinitis  Headache  Bronchospasm 29

 Anti-inflammatory  Inhaled forms  Reduce systemic effects  Used for chronic asthma  Does not relieve acute asthma 30

 Stabilize membranes of cells that release harmful bronchoconstricting substances  Also increase responsiveness of bronchial smooth muscle to beta- adrenergic stimulation 31

 Beclomethasone dipropionate (Beclovent, Vanceril)  Triamcinolone acetonide (Azmacort)  Flunisolide (AeroBid) 32

 Pharyngeal irritation  Coughing  Dry mouth  Oral fungal infections: rinse the mouth after administration  Systemic effects are rare 33

Combination product Fluticasone propionate and salmeterol (Advair): a dry powder in a circular discus Salmeterol: long-acting bronchodilator Fluticasone propionate: Corticosteroid: anti-inflammatory agent Used daily Q12hrs 34

 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 occurs 35

 Do not wear perfume of colognes  Do not use talc or baby powder  If patient is on oxygen, safety measures need to be taught 36

 flu and pneumonia vaccination  prompt treatment for any illness  check with health care provider before taking other medications 37