bronchodilators lilley pharmacology text: chapter 35 original ppt modified by: anita a. kovalsky,...
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Bronchodilators Lilley Pharmacology Text: Chapter 35
Original PPT modified by:
Anita A. Kovalsky, R.N., M.N.Ed.
Professor of Nursing
Original by: Professor Edwards,
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Review of Glossary Terms:Lilley pg. 542
• Alveoli:• Antigen:• Antibody:• Asthma Attack:• Bronchial Asthma:• Chronic Bronchitis:• Emphysema:
ADDITIONAL TERMS• Acute:• Exacerbation:
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Diseases commonly treated with Bronchodilators
• Asthma
http://www.whatsasthma.org
COPD
Chronic Bronchitis
Emphysema
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BRONCHODILATOR CLASSIFICATIONS
Bronchodilators:
1) Xanthines Derivatives
2) Beta-Agonists
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Xanthine Derivatives(Refer to Prototype List in syllabus, pg. 19)
• Prototype Drugs:
– Theophylline- Theo-dur
– Aminophylline
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How Do These Drugs Work?
• Relieve Bronchoconstriction
• Cause bronchodilatation
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Mechanism of Action• Cause bronchodilation by:
– Increasing the levels of the energy producing substance called cAMP
– Inhibiting PDE the enzyme that breaks down *cAMP….
– Subsequently, this causes smooth muscle relaxation and broncchodilation; also inhibits release of chemical mediators such as histamine, etc.
– *cAMP = cyclic adenosine monophosphate
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Mechanism of Action contd.
• Slow onset of action, so used more as preventative measure, however, also used as a continuous IV infusion to treat reversible bronchospasm in COPD clients who have an exacerbation of symptoms
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Drug Effects• Relieve bronchopasms by
causing airways to dilate, thereby improving air passage into and out of lungs
• Stimulates CNS:– Increases contractility of
heart (+ inotropic)– Increases heart rate
(+chrontropic)– Increases cardiac output,
thereby causing a….– Diuretic effect…what would
cause this???????
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Therapeutic Uses
• Dilate airways in asthma, chronic bronchitis and emphysema
• Adjunctive agent for treatment of pulmonary edema and dyspnea in left-sided heart failure by increasing cardiac output and increasing bloodflow to kidneys diuresis
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Lab DiagnosticsCavanaugh Text: pg. 215
Aminophylline/Theophylline Levels:
–10-18ug/ml WNL (within normal limits)–>20ug/ml TOXIC LEVEL
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Side and Adverse Effects• Nausea• Vomiting• Anorexia• Gastroesophageal reflux
CARDIAC!!!!!!!! HIGH ALERT!!!!• Sinus Tachycardia• Palpitations• Ventricular Dysrhythmias
• Hyperglycemia (transient)• Increased urinary output (transient)
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Interactions
• Allopurinol• Cimetidine• Erythromycin• Flu Vaccine• Oral Contraceptives
• Need blood levels monitored closely
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Available Theophylline Preparations
–Oral
–Parenteral
(aminophylline infusion)
–Rectal
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Beta-Agonists or Sympathomimetic
Bronchodilators (Refer to Prototype List in syllabus, pg. 19 Also listed in Lilley, pg. 548)
• Prototype Drugs: (Brand name in parentheses) - Albuterol (Proventil) Beta2 Selective
OTHERS:
-Ephedrine
-Epinephrine (Adrenalin, Primatene, Bronkaid)
-Terbutaline (Brethine)
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When are Beta-Agonists used?• During acute phase of asthmatic attack• To quickly reduce airway constriction and cause bronchodilation
WHY ARE THEY CALLED AGONISTS????• AGONISTS or stimulators of SNS receptors-----> SYMPATHOMIMETIC ACTION
WHAT IS THE PRIMARY MECHANISM OF ACTION??• Imitate the effects of norepinephrine on receptors
• Stimulate beta2-adrenergic receptors in the lungs causing dilation within the airways of the lungs (Example: Albuterol/Proventil)
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Specific ReceptorsRefer to Lilley text, pg. 547
• Nonselective adrenergic: stimulate the alpha, beta1 (cardiac), and beta2- (respiratory) receptors (Example: epinephrine)
• Nonselective beta-adrenergic: stimulate both beta1 and beta2 receptors (Example: Isuprel)
• Selective beta2: stimulate the beta2 receptors (Example: albuterol)
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Drug Effects
**SELECTIVE BETA2
• Beta2 stimulation causes bronchodilation; also a decreased diastolic B/P, decreased K+ level
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Mechanism of Action
• Begins with specific receptors stimulated and ends with the dilation of airways
• cAMP is activated when a beta2-adrenergic receptor is stimulated
• Smooth muscles relax and airflow increased
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Therapeutic Uses of Beta-Agonists
• Pulmonary disorders for relief of bronchospasm
• Nonselective: Used for hypotension and shock treatment and to relieve nasal congestion and stuffiness
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Bronchodilators: Beta-Agonists Side Effects
Alpha-Beta Beta1 and Beta2 Beta2
(epinephrine) (isoproterenol) (albuterol)
Insomnia cardiac stimulation hypotensionrestlessness tremor vascular headache
anorexia anginal paincardiac stimulation vascular headache tremor
vascular headache
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Interactions
• Beta-agonist with nonselective beta-adrenergic blocker (beta-blocker) antagonizes the bronchodilation effect!!!
• Avoid MAO inhibitors
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Available Selected Beta-Agonist Preparations
• PO
• SC
• Inhaler
• Nebulizer
• IM
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Nursing Considerations for Bronchodilators
• Does the client have cardiac disease??
• If so, which type of bronchodilator should be the drug of choice??
• Does the client have diabetes??
• If the client is receiving a xanthine, what blood levels should be monitored???
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A client is receiving IV aminophylline for a severe exacerbation of COPD. Which of the following would you expect when evaluating for a therapeutic response to the medication?
A. DrowsinessB. Increased heart rateC. Dilatation of bronchiolesD. Increased respiratory rate
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Which of the following side effects is associated with the use of xanthine derivatives?
A. BradycardiaB. PalpitationsC. Increase in appetiteD. Constriction of bronchioles
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Overview of Drugs Affecting the Respiratory System
• Bronchodilators– Xanthine derivatives– Beta-agonists
• Anticholinergics
• Antileukotriene agents
• Corticosteroids
• Mast cell stabilizers
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THE END