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NR566 Chapter 17 Complete Study Guide - All concepts and terms

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AIT Nursing (NR566)

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Thompson River University (TRU )

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bitolterol
chapter 17 drugs affecting the respiratory system
nr566 chapter 17 complete study guide
short acting beta agonists  albuterol ventolin
metaproterenol alupent
terbutaline brethine

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CHAPTER 17: DRUGS AFFECTING THE RESPIRATORY SYSTEM

SHORT-ACTING BETA AGONISTS
 Albuterol (Ventolin), metaproterenol (Alupent), terbutaline (Brethine), bitolterol (Tornalate),
pirbuterol (Maxair), levalbuterol (Xopenex)

LONG-ACTING BETA AGONISTS
 Arformoterol (Brovana), salmeterol (Serevent), formoterol (Foradil), indacaterol (Arcapta
Neohaler)
 Associated risk for intubation and death.
 Should not be used alone- used in combination with an asthma controller medication such as
inhaled corticosteroid (for peds/adolescents, single preparation both LABA and corticosteroid-
to enhance compliance)- see BLACK BOX WARNING
 Should only be used long-term in patients whose asthma cannot be adequately controlled on
asthma controller medication.

Pharmacodynamics
 act on the smooth muscle of the bronchial tree to reverse bronchospasm, thereby decreasing
airway resistance and residual volume and increasing vital capacity and airflow.
 Beta agonists stimulate beta-2 adrenergic receptors in the lungs to increase production of cyclic
adenosine monophosphate (cAMP) by activation of adenyl cyclase, the enzyme that catalyzes
the conversion of ATP to cAMP.
 Increased cAMP concentrations relax bronchial smooth muscle and inhibit release of mediators
of immediate hypersensitivity from cells, especially from the mast cells.

 ALBUTEROL- selective beta-2 agonist with minor beta-1 activity.
o a.k.a. “Salbutamol”
o can increased HR by stimulating beta-2 receptors in the heart, and beta-2 receptors in
vascular smooth muscles (vasodilation -> decreased DBP -> increased HR)
o has fewer cardiac and CNS effects than other
o drug of choice of FIRST LINE THERAPY
o similar structure: levalbuterol, pirbuterol

 TERBUTALINE- selective beta-2 agonist with minor beta-1 activity (similar to albuterol)
o Also known to inhibit uterine contractions
o To prevent contractions related to preterm labor (off label use).

 SALMETAROL and FORMOTEROL- exert long-lasting bronchoprotection effects against allergen-,
exercise-, histamine-, and methacholine-cause bronchospasm.

Pharmacotherapeutics
 CONTRAINDICATIONS:
o cardiac arrhythmias associated with tachycardia or heart block caused by digitalis
intoxication, angina, narrow-angle glaucoma, organic brain damage, shock during
general anesthesia
o pheochromocytoma (diagnosed or suspected)- may cause severe HTN

,  MONITOR CLOSELY FOR ADVERSE EFFECTS (cardiovascular system): patients with HTN, ischemic
heart disease, coronary insufficiency, CHF, hx of stroke and/or cardiac arrhythmias
 BLACK BOX WARNING: salmeterol and formoterol
o Respiratory-related asthma and asthma-related deaths and risk is higher for African
Americans.

 Patients on digoxin: monitor closely with use of albuterol- increased volume of distribution of
digoxin and can cause up to a 30% decrease in blood digoxin levels.

 All are PREGNANCY CATEGORY C, except -> Terbutaline (pregnancy category B)

Clinical use
 Bronchospasm- asthma, bronchitis, COPD
 Exercise-induced bronchospasm

Drug interactions
 Digitalis glycosides- caution and careful monitoring of patient’s EKG (increased risk of cardiac
arrhythmia)
 Beta-adrenergic blockers- mutual inhibition of therapeutic effects
 TCA and MAOI- may potentiate effects on vascular system when taken with albuterol,
metaproterenol, or terbutaline.
 Beta agonists- coadministration may lead to hypokalemia or EKG changes.

Adverse drug reactions
 Drug-induced hyperglycemia for pts with DM- insulin may need to be increased.
 Overuse may lead to: seizures, hypokalemia, anginal pain, HTN
 Increased HR
 Tremors
 GI upset- take with food for oral forms
 Tachycardia, chest pain, muscle tremors, dizziness, flushing- inform healthcare provider.

XANTHINE DERIVATIVES
 Methylxanthines- have declined in importance in the treatment of asthma
o Caffeine
o Aminophylline

Pharmacodynamics
 Work directly by unknown mechanism believed to be mediated by selective inhibition of specific
phosphodiesterases (PDEs) -> increase in cAMP -> bronchial smooth muscle and pulmonary
vessel relaxation
 Theophylline and Caffeine
o powerful CNS stimulants
o increase gastric acid secretion – may cause n/v
o stimulate skeletal muscles- tremors
o increased renal blood flow -> increased GFR -> increased Urine output (diuresis)

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