Pharmacology – Chapter 16 – Selected Agents of Pulmonary Value

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Drugs Used to Prevent Respiratory Disorders
A-1 proteinase inhibitors
Nicotine replacement
Pulmonary vasodilators – used for PPHN (persistent pulmonary hypertension of newborn) (Nitric Oxide)
Orally inhaled insulin – Exubera

Emphysema
Spherical sacs (alveoli) in the lungs become severely enlarged and rupture and deteriorate.
Bullous Emphysema – medical condition
Patients experience chest pain, coughing, dyspnea, related to lack of O2 in blood, can cause one or both lungs to collapse requiring surgery.

Types of Emphysema
Distal Acinar or Paraseptal Emphysema, Centriacinar,
and Panacinar

Distal Acinar
or Paraseptal Emphysema
Involves distal airway structures which includes alveolar ducts and sacs. Localized around the septum of the lungs or the pleura. Mostly in the apices which lead to spontaneous pneumothoraxes.
Emphysema is a process of alveolar wall destruction.

Centriacinar Emphysema (centrilobar)
Associated with long standing cigarette smoking.
Located in respiratory bronchioles. Spreads peripherally. Predominately involved in the upper half of the lungs. Can be weaved through normal lung tissue.

Panacinar Emphysema (panlobar)
Main emphysema associated with A-1 antitrypsin deficiency. Destroys entire alveolar uniformly. Involves lower half of lungs. Can be observed in patients who are smokers.

A-1 Antitrypsin
Genetic defect of chromosome 14 that can lead to panacinar emphysema.
Treated – A-1 proteinase inhibitors (aralast, prolastin, & zemaira). All drugs derived from human plasma. Side effects include flu-like symptoms.

Nicotine
Naturally occurring alkaloid capable of stimulating acetylcholine receptors.
Nicotine tolerance occurs quickly. Highly addictive.

Sympathetic involvement of Nicotine
Hypertension
Tachycardia
Peripheral vasoconstriction

Parasympathetic involvement of Nicotine
Nausea
Vomiting
Diarrhea
Urination

Nicotine Side Effects on Brain
Sense of euphoria.
Enhances concentration
Increases alertness
Decreases anxiety

Nicotine Withdrawal Effects
Cravings for nicotine
Nervousness
Irritability
Anxiety
Drowsiness
Sleep disturbances
Impaired concentration
Increased appetite
Weight gain

Nicotine Replacement Therapy
Provides aid with smoking cessation. Used for those with high physical addiction.
Transdermal patch
Chewing gum (Nicorette)
Lozenge (Commit)
Nasal spray (Nicotrol)
Inhaler (Nicotrol)
Zyban tablets (antidepressant)
Chantix tablets

Precautions with Nicotine Replacement Therapy
In combination with smoking can cause nicotine toxicity.
Dependency to NRT
NRT should all be stopped by 3 months
Patients with cardio problems
Risk of exposure for healthcare workers – use gloves, wash only with water.
Proper disposal

Nitric Oxide
Nitric Oxide is a vasodilator used to lower PVR in PPHN & ARDS. Dosage – 20 ppm up to 14 days. (higher doses see no increased benefit). Special ventilator to deliver dose. Side effects are Methemoglobinemia and increased No2 levels.
Rebound effects – Condition which was treated comes back stronger than it was. Increased negative symptoms when effect of drug is passed or patient no longer responds to it.

Insulin
Not recommended for patients with lung disease. Used for type I and type II Diabetes Melitis.
Side effects – bronchospasm, decreased lung function.

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