Bronchodilators Lilley Pharmacology Text: Chapter 35

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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 TermsLilley 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
• Xanthines Derivatives
• 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 effectwhat 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)
• gt20ug/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-----gt
  
• 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
  headacheanorexia anginal
  pain cardiac stimulation vascular headache
  tremorvascular 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