2. Respiratory Agents
Pharmacology
Clinical Management of Diseases
of the Lungs

4. Pathology Of Asthma
 Increased responsiveness of trachea &
bronchi to various stimuli which trigger….
 Constriction of airways
 Increased mucous secretions
 Increased inflammation & edema causing..
– Recurrent/episodic bouts of SOB, wheeze, tight
chest
 Reversible!

6. Symptoms Goals of Care
 Wheezing  Function in daily life
 Cough  Freedom from
 Dyspnea wheezing
 Acute and chronic  Control of coughing
 Tolerate medications
 5-10% asthmatics are
hypersensitive to
aspirin

10. Chemical Components of Cigarettes
Chemical Standard Use
Carbon Monoxide Car exhaust
Nicotine Pesticides
Ammonia Floor cleaners
Arsenic White ant poison
Butane Lighter fuel
Hydrogen cyanide Poison used in gas
chambers
Toluene Industrial solvent
DDT Insecticides

11. Time of Last Cigarette & Effect
Within 20 minutes BP/P returns to normal
Temp hands/feet increase back to
normal Stops polluting the air
After 8 hours Blood carbon monoxide drops
Blood O2 returns to normal
After 24 hours Chance of heart attack
decreases
Within 48 hours Nerve endings re-adjust sense of
smell/taste enhanced
After 72 hours Bronchial tubes relax lung
capacity increases

12. 2 weeks to 3 months Circulation/walking improve
Lung function up 30%
1 month to 9 months Cilia re-grow, handle mucus &
clean lungs reduce infection
Energy level increases
1 year Heart dz death rate halfway
back to that of a non-smoker
5 years Heart dz death rate drops to rate for
non-smokers; lung CA death rate
decreases halfway to non-smoker
10 year projection Lung CA rate almost same for non
smoker, precancerous cell replaced,
incidence mouth, larynx, esophag,
bladder, kidney, pancreas CA dec.

13. Reasons People Smoke
Top FIVE
 It’s a habit
 I’m addicted
 It relaxes me
 I enjoy it
 Something to do with my hands

14. Reasons Why Smokers Do Not Try
to Quit
 Fear of withdrawal
 Cravings
 Loss of way to handle stress
 Cost of medicines
 Fear cannot quit

15. Five MYTHS about quitting smoking
 Smoking is just a bad habit.
– Fact: Tobacco use is an addiction.
 Quitting is just a matter of will power.
– Fact: Quitting is difficult.
 If you can’t quit the 1st time, you will never.
– Fact: Quitting is hard & usually takes 2-3 tries.
 The best way to quit is ‘cold turkey’.
– Fact: Most effective way is a combination of
counseling & nicotine replacement therapy

16.  Quitting is expensive.
– Fact: Treatments cost $3-14 per day. A pack a
day smoker spends almost $1200 per year.
Many health insurances cover medication &
counseling.

21. Clinical Management of Respiratory
Diseases
 Acute Care
 Reliever
 Chronic Care – Acute
 Stepped Care  Controller
 Peak Flow Meter – Maintenance
– Chronic
 Spacer
– Prophylactic
 Oxygen

22. Stepwise Pharmacologic
Therapy
 Step 1 Mild intermittent  Step 3 Moderate
– Symptoms < 2x/wk persistent
 Step 2 Mild persistent – Daily symptoms affect
– Symptoms >2x/wk activity
– Exacerbations >2x/wk
 Step 4 Severe
persistent
– Continual symptoms

24. OVERVIEW Therapeutic Agents
 Mast Cell Stabilizers
– Cromolyn
 Xanthine Derivatives
– Aminophylline
 Bronchodilators ( short & long acting)
– Sympathomimetics (albuterol)
 Anti-Muscarinic
– Ipratropium (Atrovent)
 Corticosteroids
 Leukotriene Inhibitors (Singulair, Accolate)

25. Xanthine Derivatives
 Methylxanthines
– Theophylline
– Aminophylline
 MOA
 Toxicity

26. Bronchodilators
 Sympathomimetics
– Ephedrine
– Epinephrine
– Beta-2 agents
 Albuterol
 Salmeterol
 Metaproterenol
– MOA
– Toxicity
– Dependence

27. Bronchodilators
 Anti-Cholinergics
– Anti-Muscarinics
 Atropine
 Ipratropium Bromide (Atrovent)
 MOA
 Toxicity

29. Corticosteroids
Mast Cell Stabilizers
 Corticosteroids  Mast Cell Stabilizers
– Beclomethasone – Cromolyn (Intal)
– Budesonide (Pulmicort)  MOA
– Fluticasone(Flovent)  Toxicity
– Triamcinolone
(Azmacort)
– Mometasone (Nasonex)
 MOA
 Toxicity
– Oral candidiasis

30. Leukotriene Inhibitors
 Leukotriene Pathway
Inhibitors
– Monelukast (Singulair)
– Zafirlukast (Accolate)
 MOA
 Toxicity

31. Summary Slide
 Clinical Management of Respiratory
Diseases
 Stepwise Pharmacologic Therapy
 Pharmacologic Agents
– Xanthine Derivatives
– Bronchodilators
– Leukotriene Inhibitors
– Corticosteroids
Mast Cell Stabilizers

33. Smoking Cessation
 Behavior Modification & Reward Abstinence
– Set a date, inform friends, family, coworkers to
understand and support.
 Avoid triggers
– Remove cigarettes from environment & avoid
where smoking is prevalent.
 Anticipate challenges
– Critical first few weeks of withdrawal effects.
– Nicotine replacement and concurrent therapy.

34. Common Agents
 Nicotine Replacement
– Gum/Patch
– Inhaler/Nasal Spray
– Lozenge/Water
 Antidepressant
– Bupropion (Zyban,
Wellbutrin)
 Support
1-800 NO BUTTS

35. CASE STUDY Antibiotics and
Respiratory

36.  TL is a 29-year-old female, 59 kg, who
presents at clinic with a 2-week history of
abdominal pain, nocturia and frequency of
urination. PE is unremarkable except some
lower abdominal tenderness. A clean catch
midstream urine sample is collected. The
results are 10-25 WBC/HPF with a few
gram-positive cocci in clusters and gram
negative rods. She is empirically started on
Macrobid 100mg bid x 7 days. TL returns to
clinic 3 days later with a productive cough,
wheezing, and heaviness on her chest and
shaking chills. She is severely nauseous.
Her breathing is labored with rales and
wheezing. Pregnancy results are positive.

37. Points to Ponder
 Discuss her symptoms and relate them
to a possible health problem.
 Discuss the antibiotic empiric
treatment. Should it be changed?
 Consider the relationship between
pregnancy and UTI.
 What respiratory therapy would you
consider?