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Let`s start with a definition Pithicism
3/16/14 Partial outline of presentation under construction Michael McPeck, RRT FAARC Director, Clinical Education Westmed, Inc. Tucson AZ Copyright © 2014 Westmed, Inc. All Rights Reserved Let’s start with a definition In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequences of the use of a drug. Copyright © 2014 Westmed, Inc. All Rights Reserved Pithicism One man’s treasure is another man’s trash. One man’s meat is another man’s poison. One man’s ceiling is another man’s floor. The side effect of a drug used for one purpose may be the therapeutic effect of the same drug used for a different purpose. Copyright © 2014 Westmed, Inc. All Rights Reserved 1 3/16/14 Pithicism The side effect of a drug used for one purpose may be the therapeutic effect of the same drug used for a different purpose. Example: diphenhydramine (Benadryl) Used for: reducing mucus membrane secretions in allergy suffers. Side effect: drowsiness. Used for: inducing sleep for insomnia. Side effect: mucus membrane dryness. Copyright © 2014 Westmed, Inc. All Rights Reserved Types of side effects Adverse Drug Reaction (ADR) Paradoxical Reaction Tachyphylaxis Drug-‐‑Drug Interactions Potentiation Copyright © 2014 Westmed, Inc. All Rights Reserved Adverse Drug Reaction (ADR) An adverse drug reac-on (abbreviated ADR) is an expression that describes harm associated with the use of given medica<ons at a normal dosage during normal use. ADRs may occur following a single dose or prolonged administra<on of a drug or result from the combina<on of two or more drugs. The meaning of this expression differs from the meaning of "side effect", as this last expression might also imply that the effects can be beneficial. The study of ADRs is the concern of the field known as pharmacovigilance. An adverse drug event (abbreviated ADE) refers to any injury caused by the drug (at normal dosage and/or due to overdose) and any harm associated with the use of the drug (e.g. discon<nua<on of drug therapy). ADRs are a special type of ADEs. Copyright © 2014 Westmed, Inc. All Rights Reserved 2 3/16/14 Paradoxical Reactions A paradoxical reac-on or paradoxical effect is an effect of medical treatment, usually a drug, opposite to the effect which would normally be expected. An example of a paradoxical reac<on is when a pain relief medica<on causes an increase in pain. Copyright © 2014 Westmed, Inc. All Rights Reserved Tachyphylaxis Tachyphylaxis (Greek ταχύύς, tachys, "ʺrapid"ʺ, and φύύλαξις, phylaxis, "ʺprotection"ʺ) is a medical term describing an acute (sudden) decrease in the response to a drug after its administration. Tachyphylaxis can occur both after an initial dose of medication or after an inoculation with a series of small doses. Increasing the dose of the drug may be able to restore the original response. Effect Administra<ons Time This can some<mes be caused by deple<on or marked reduc<on of the amount of neurotransmiMer responsible for crea<ng the drug's effect, or by the deple<on of receptors available to which the drug or neurotransmiMer can bind. This deple<on is caused by the cells reducing the number of receptors in response to their satura<on. Some examples include amphetamine, ephedrine, and MDMA which act indirectly through the release of neurotransmiMers. Copyright © 2014 Westmed, Inc. All Rights Reserved Drug -‐‑ Drug Interactions An interaction is an additional effect that occurs when two or more drugs are being administered at the same time or are present in the body at the same time, even if administered at different times. Some examples are: • • • • Synergism Poten<a<on Addi<ve effect Antagonism • pharmacological • physiological • disposi<onal • chemical Copyright © 2014 Westmed, Inc. All Rights Reserved 3 3/16/14 Drug-‐‑Drug Synergism Copyright © 2014 Westmed, Inc. All Rights Reserved Drug-‐‑Drug Potentiation Copyright © 2014 Westmed, Inc. All Rights Reserved Drug-‐‑Drug Additive Effect Copyright © 2014 Westmed, Inc. All Rights Reserved 4 3/16/14 Drug-‐‑Drug Antagonism Antagonism: • pharmacological • physiological • dispositional • chemical Copyright © 2014 Westmed, Inc. All Rights Reserved Copyright © 2014 Westmed, Inc. All Rights Reserved Respiratory Pharmacology Concerned with the administra<on of drugs that act upon or influence the respiratory system. Specifically, this would include all of the following … • Central respiratory system s<mulants & depressants that are delivered parenterally. • Neuroparaly-c agents that cause deliberate paralysis for anesthesia and intensive care. • Aerosolized medica-ons that are given topically, by the so-‐ called inhala<on route. Copyright © 2014 Westmed, Inc. All Rights Reserved 5 3/16/14 Classification of Drugs Given via the Inhalation Route Par-culate Drugs (Aerosols) • Bronchodilators • Cor<co-‐Steroids • Mucoly<cs • Hypertonic Agents • An<microbials Copyright © 2014 Westmed, Inc. All Rights Reserved Side Effects of Bronchodilators Copyright © 2014 Westmed, Inc. All Rights Reserved The Autonomic Nervous System To understand the principle aspects of respiratory pharmacology with respect to bronchodilators, you have to understand the autonomic nervous system … Autonomic Nervous System • aka involuntary nervous system • a part of the peripheral nervous system • acts as a control system • func<ons below the level of consciousness • controls visceral (internal organ) func<ons Copyright © 2014 Westmed, Inc. All Rights Reserved 6 3/16/14 Autonomic Functions Autonomic Func-ons • heart rate • diges<on • saliva<on • perspira<on • pupillary dila<on • micturi<on (urina<on) • sexual arousal Respiratory-‐specific Autonomic Func-ons • respiratory rate • bronchomotor tone • mucus secre<on by respiratory epithelial cells and glands Most autonomous functions are involuntary but they can often work in conjunction with the somatic nervous system which gives voluntary control. Everyday examples include breathing, swallowing, and sexual arousal, and in some cases functions such as heart rate. Copyright © 2014 Westmed, Inc. All Rights Reserved Bronchodilators Beta2-‐‑agonists – stimulate beta2 (β2) receptors located in the bronchial and bronchiolar mucosa in order to relax smooth muscle constriction. Examples: albuterol, levalbuterol, terbutaline. Alpha agonists – stimulate alpha receptors located in the walls of the blood vessels that are in the walls of the bronchi and bronchioles to relax, thereby reducing engorgement and mucosal congestion. Examples: racemic epinephrine, neosynephrine. Anticholinergics -‐‑ inhibits or blocks the neurotransmiber acetylcholine in the central and peripheral nervous systems. Examples: ipratropium (Atrovent®), <otropium (Spiriva®) Copyright © 2014 Westmed, Inc. All Rights Reserved Side Effects of … Beta agonists Copyright © 2014 Westmed, Inc. All Rights Reserved 7 3/16/14 Albuterol sulfate Generic name: salbutamol (INN), albuterol (USAN) Brand names: Ventolin, Proventil Type: Short-‐‑acting, selective β2-‐‑receptor agonist Purpose: To relieve bronchial smooth muscle spasm and promote bronchodilation Routes: Oral, intravenous, inhalation Inhalation • pMDI, and specialty inhalers. Delivery • Nebulizer solutions Systems: • Combined with steroids in specialty inhalers to create controller drugs (eg, Advair, Symbicort) Copyright © 2014 Westmed, Inc. All Rights Reserved Albuterol sulfate C3H21NO3 R-‐‑salbutamol S-‐‑salbutamol Copyright © 2014 Westmed, Inc. All Rights Reserved Levalbuterol (Xopenex®) (generics are now available) C13H21NO3 Copyright © 2014 Westmed, Inc. All Rights Reserved 8 3/16/14 Albuterol vs Levalbuterol Controversy vs. Copyright © 2014 Westmed, Inc. All Rights Reserved Side Effects of … Alpha agents Copyright © 2014 Westmed, Inc. All Rights Reserved Side Effects of … Anticholinergics Copyright © 2014 Westmed, Inc. All Rights Reserved 9 3/16/14 Side Effects of … Gluco-‐‑corticosteroids Copyright © 2014 Westmed, Inc. All Rights Reserved Side Effects of … Mucolytics Copyright © 2014 Westmed, Inc. All Rights Reserved Side Effects of … Hypertonic Saline Copyright © 2014 Westmed, Inc. All Rights Reserved 10 3/16/14 Side Effects of … Antimicrobials Copyright © 2014 Westmed, Inc. All Rights Reserved Antimicrobials An antimicrobial or antibiotic is an agent that kills microorganisms or inhibits their growth. Antimicrobial medicines can be grouped according to the microorganisms they act primarily against. For example, antibacterials are used against bacteria and antifungals are used against fungi. They can also be classed according to their function. Antimicrobials that kill microbes are called microbicidal; those that merely inhibit their growth are called microbiostatic. Disinfectants such as bleach are non-‐‑selective antimicrobials. Types • An<bacterials • An<fungals • An<virals • An<parasi<cs Mechanisms of Ac-on Copyright © 2014 Westmed, Inc. All Rights Reserved Side Effects of … Asthma Medications Copyright © 2014 Westmed, Inc. All Rights Reserved 11 3/16/14 Asthma Medications Rescue Drugs: • SABAs Controller Drugs: • LABAs • ICSs Other oft-‐‑used Medications: • Cromolyn • Omalizumab (anti-‐‑IgE) • Leukotriene modifiers • Theophylline Copyright © 2014 Westmed, Inc. All Rights Reserved Asthma Medications Primatene Mist Copyright © 2014 Westmed, Inc. All Rights Reserved Dangers of self-‐‑medicating Copyright © 2014 Westmed, Inc. All Rights Reserved 12 3/16/14 Forget about all the theory and hypotheticals …. What kind of side effects are we really concerned about on a day-‐‑to-‐‑day basis? Copyright © 2014 Westmed, Inc. All Rights Reserved Forget about all the theory and hypotheticals …. • • • • Nebulizer drugs Inhaler drugs Oral drugs Other stuff Copyright © 2014 Westmed, Inc. All Rights Reserved 13
