Airway Receptors
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Pharmacology in MS Advanced Practice Management
Pharmacology in MS Advanced Practice Management Heidi Maloni APRN, BC [email protected] Objectives • Discuss basic principles of pharmacology, pharmacokinetics and pharmacodynamics. • Describe the pharmacotherapeutics of drugs used in MS • Identify the role of advanced practice nurse in MS pharmacological management. Advanced Practice Pharmacology Background • Pharmacology: study of a drug’s effects within a living system • Each drug is identified by 3 names: chemical, generic, trade or marketing name N-4-(hydroxyphenyl) acetamide; acetaminophen; Tylenol sodium hypochlorite; bleach; Clorox 4-(diethylamino)-2-butynl ester hydrochloride; oxybutynin chloride; Ditropan • Drugs are derived from: plants, humans, animals, minerals, and chemical substances • Drugs are classified by clinical indication or body system APN Role Safe drug administration Nurses are professionally, legally, morally, and personally responsible for every dose of medication they prescribe or administer Know the usual dose Know usual route of administration Know significant side effects Know major drug interactions Know major contraindication Use the nursing process Pregnancy Safety • Teratogenicity: ability to produce an abnormality in the fetus (thalidomide) • Mutogenicity: ability to produce a genetic mutation (diethylstilbestrol, methotrexate) Pregnancy Safety Categories • A: studies indicate no risk to the fetus (levothyroxan; low dose vitamins, insulin) • B: studies indicate no risk to animal fetus; information in humans is not available (naproxen;acetaminophen; glatiramer -
Maximum Expiratory Flow Rates in Induced Bronchoconstriction in Man
Maximum expiratory flow rates in induced bronchoconstriction in man A. Bouhuys, … , B. M. Kim, A. Zapletal J Clin Invest. 1969;48(6):1159-1168. https://doi.org/10.1172/JCI106073. Research Article We evaluated changes of maximum expiratory flow-volume (MEFV) curves and of partial expiratory flow-volume (PEFV) curves caused by bronchoconstrictor drugs and dust, and compared these to the reverse changes induced by a bronchodilator drug in previously bronchoconstricted subjects. Measurements of maximum flow at constant lung inflation (i.e. liters thoracic gas volume) showed larger changes, both after constriction and after dilation, than measurements of peak expiratory flow rate, 1 sec forced expiratory volume and the slope of the effort-independent portion of MEFV curves. Changes of flow rates on PEFV curves (made after inspiration to mid-vital capacity) were usually larger than those of flow rates on MEFV curves (made after inspiration to total lung capacity). The decreased maximum flow rates after constrictor agents are not caused by changes in lung static recoil force and are attributed to narrowing of small airways, i.e., airways which are uncompressed during forced expirations. Changes of maximum expiratory flow rates at constant lung inflation (e.g. 60% of the control total lung capacity) provide an objective and sensitive measurement of changes in airway caliber which remains valid if total lung capacity is altered during treatment. Find the latest version: https://jci.me/106073/pdf Maximum Expiratory Flow Rates in Induced Bronchoconstriction in Man A. Bouiuys, V. R. HuNTr, B. M. Kim, and A. ZAPLETAL From the John B. Pierce Foundation Laboratory and the Yale University School of Medicine, New Haven, Connecticut 06510 A B S T R A C T We evaluated changes of maximum ex- rates are best studied as a function of lung volume. -
Bronchoconstriction in Normal and Asthmatic Subjects
Thorax: first published as 10.1136/thx.43.11.890 on 1 November 1988. Downloaded from Thorax 1988;43:890-895 The nasal response to exercise and exercise induced bronchoconstriction in normal and asthmatic subjects KINGMAN P STROHL, MICHAEL J DECKER, LESLIE G OLSON, TOD A FLAK, PETER L HOEKJE Airway Disease Center, Departments ofMedicine, University Hospitals ofCleveland; and Case Western Reserve University, Cleveland, Ohio, USA ABSTRACT Two studies were carried out to test the hypothesis that the fall and recovery of nasal resistance after exercise in asthmatic and non-asthmatic subjects are related to the development of bronchoconstriction after exercise. In study 1 nasal resistance (posterior rhinomanometry) and specific airway resistance (sRaw) were measured before challenge and one, five, 10 and 30 minutes after four minutes of exhausting legwork exercise in nine asthmatic subjects and nine age matched healthy subjects. One minute after exercise there was a reduction in nasal resistance of49% (SD 15%) from baseline in the healthy subjects and of 66% (17%) in the asthmatic subjects. This response and the subsequent return ofnasal resistance to baseline values did not differ significantly between the two groups despite a substantial difference in the change in sRaw, an increase of 74% (45%) in the asthmatic subjects 10 minutes after exercise, and no change in the non-asthmatic subjects. In study 2, nasal and specific airway resistances were monitored according to the same measurement protocolcopyright. in six subjects with increased airway reactivity. Subjects exercised on two occasions, wearing a noseclip, once while breathing cold, dry air and once while breathing warm, humid air. -
Exercise Induced Bronchoconstriction (EIB) What Is Exercise Induced Bronchoconstriction Testing?
Exercise Induced Bronchoconstriction (EIB) What is Exercise Induced Bronchoconstriction testing? Exercise induced bronchoconstriction or EIB, is a combined breathing and exercise test. The test can help identify what type of breathing trouble you have, if any, when you exercise. A spirometry breathing test is done before and after you exercise on a treadmill. Spirometry can show how much air you can breathe in and out. It also shows how fast you can breathe in and out. The spirometry results are compared before and after you exercise to see what changes there are in your breathing. A laryngoscopy may be scheduled after the EIB test. A laryngoscopy is often done to identify if your vocal cords may be causing you to have trouble breathing with exercise. How do you get ready for the test? Please follow these directions when getting ready for this test. These medicines will affect the results of some of these tests and may need to be stopped before the testing is done. If the medicine is not stopped, as your doctor says, before the test we will not be able to complete the test. • Stop these inhaled medicines for 48 hours before your appointment: ◦ Anora® (umeclidinium and vilanterol) ◦ Bevespi® (glycopyrrolate and formoterol) ◦ Stiolto® (olodaterol and tiotropium) ◦ Utibron® (indacaterol and glycopyrrolate) ◦ Trelegy® (fluticasone, umeclidinium and vilanterol) • Stop these inhaled medicines for 24 hours before your appointment: ◦ Incruse® (umeclidinium) ◦ Seebri® (glycopyrrolate) ◦ Spiriva® (tiotropium) ◦ Tudorza® (aclidinium) • Stop these -
Comparison of Different Alpha-Blocker Combinations in Male Hypertensives with Refractory Lower Urinary Tract Symptoms
대한남성과학회지:제 29 권 제 3 호 2011년 12월 Korean J Androl. Vol. 29, No. 3, December 2011 http://dx.doi.org/10.5534/kja.2011.29.3.242 Comparison of Different Alpha-blocker Combinations in Male Hypertensives with Refractory Lower Urinary Tract Symptoms Keon Cheol Lee1, Jong Gu Kim2, Sung Yong Cho1, Joon Sung Jeon1, In Rae Cho1 Department of Urology, 1Inje University Ilsanpaik Hospital, Goyang, 2Happy Urology Clinic, Ansan, Korea =Abstract= Purpose: We compared the efficacy and safety profiles of dose increase, traditional combination methods, and combining different alpha blockers in hypertensive males with lower urinary tract symptom (LUTS) refractory to an initial dose of 4 mg doxazosin. Materials and Methods: Between 2000 and 2005, 374 male patients with LUTS and hypertension unresponsive to 4 weeks of 4 mg doxazosin were enrolled. The subjects were randomly classified into 3 groups, 8 mg/day of doxazosin (D group), 4 mg of doxazosin plus 0.2 mg/day of tamsulosin (DT group), and 4 mg doxazosin plus 5 mg/day finasteride (DF group). Patients were evaluated based on their International Prostate Symptom Score (IPSS), quality of life (QOL), uroflowmetry and blood pressure (BP) and adverse events (AEs) at the baseline and 3 and 12 months after treatment. Results: The 269 patients (71.9%) were followed for at least 1 year (D group n=84, DT group n=115, and DF group n=70). The clinical parameters before and after initial 4 mg/day doxazosin were not different among the 3 groups. IPSS improvement after 3 months and maximal flow rate (Qmax) improvement after 3 and 12 months were significantly higher in the D and DT groups than the DF group (p<0.05). -
Exercise-Induced Bronchoconstriction
American Thoracic Society Documents An Official American Thoracic Society Clinical Practice Guideline: Exercise-induced Bronchoconstriction Jonathan P. Parsons, Teal S. Hallstrand, John G. Mastronarde, David A. Kaminsky, Kenneth W. Rundell, James H. Hull, William W. Storms, John M. Weiler, Fern M. Cheek, Kevin C. Wilson, and Sandra D. Anderson; on behalf of the American Thoracic Society Subcommittee on Exercise-induced Bronchoconstriction THIS OFFICIAL CLINICAL PRACTICE GUIDELINE OF THE AMERICAN THORACIC SOCIETYWASAPPROVEDBYTHEATS BOARD OF DIRECTORS, DECEMBER 2012 CONTENTS proportion of patients with asthma experience exercise-induced respiratory symptoms. EIB has also been shown to occur in sub- Executive Summary jects without a known diagnosis of asthma. Introduction Methods Diagnosis Pathogenesis Role of the Environment d The diagnosis of EIB is established by changes in lung Diagnosis function provoked by exercise, not on the basis of Measuring and Quantifying EIB symptoms. Exercise Challenge Testing to Identify EIB d Serial lung function measurements after a specific exercise Surrogates for Exercise to Identify EIB or hyperpnea challenge are used to determine if EIB is Treatment present and to quantify the severity of the disorder. It is Questions and Recommendations preferable to assess FEV1, because this measurement has General Comments Regarding Therapy better repeatability and is more discriminating than peak Screening for EIB expiratory flow rate. Exercise, Asthma, and Doping d The airway response is expressed as the percent fall in Background: Exercise-induced bronchoconstriction (EIB) describes FEV1 from the baseline value. The difference between acute airway narrowing that occurs as a result of exercise. EIB occurs the pre-exercise FEV1 value and the lowest FEV1 value in a substantial proportion of patients with asthma, but may also recorded within 30 minutes after exercise is expressed as occur in individuals without known asthma. -
Standardisation of Spirometry
Eur Respir J 2005; 26: 319–338 DOI: 10.1183/09031936.05.00034805 CopyrightßERS Journals Ltd 2005 SERIES ‘‘ATS/ERS TASK FORCE: STANDARDISATION OF LUNG FUNCTION TESTING’’ Edited by V. Brusasco, R. Crapo and G. Viegi Number 2 in this Series Standardisation of spirometry M.R. Miller, J. Hankinson, V. Brusasco, F. Burgos, R. Casaburi, A. Coates, R. Crapo, P. Enright, C.P.M. van der Grinten, P. Gustafsson, R. Jensen, D.C. Johnson, N. MacIntyre, R. McKay, D. Navajas, O.F. Pedersen, R. Pellegrino, G. Viegi and J. Wanger CONTENTS AFFILIATIONS Background ............................................................... 320 For affiliations, please see Acknowledgements section FEV1 and FVC manoeuvre .................................................... 321 Definitions . 321 CORRESPONDENCE Equipment . 321 V. Brusasco Requirements . 321 Internal Medicine University of Genoa Display . 321 V.le Benedetto XV, 6 Validation . 322 I-16132 Genova Quality control . 322 Italy Quality control for volume-measuring devices . 322 Fax: 39 103537690 E-mail: [email protected] Quality control for flow-measuring devices . 323 Test procedure . 323 Received: Within-manoeuvre evaluation . 324 March 23 2005 Start of test criteria. 324 Accepted after revision: April 05 2005 End of test criteria . 324 Additional criteria . 324 Summary of acceptable blow criteria . 325 Between-manoeuvre evaluation . 325 Manoeuvre repeatability . 325 Maximum number of manoeuvres . 326 Test result selection . 326 Other derived indices . 326 FEVt .................................................................. 326 Standardisation of FEV1 for expired volume, FEV1/FVC and FEV1/VC.................... 326 FEF25–75% .............................................................. 326 PEF.................................................................. 326 Maximal expiratory flow–volume loops . 326 Definitions. 326 Equipment . 327 Test procedure . 327 Within- and between-manoeuvre evaluation . 327 Flow–volume loop examples. 327 Reversibility testing . 327 Method . -
Spirometry Nitric Oxide Exchange in a Pattern Distinct
Exercise-induced bronchoconstriction alters airway nitric oxide exchange in a pattern distinct from spirometry Hye-Won Shin, Christina D. Schwindt, Anna S. Aledia, Christine M. Rose-Gottron, Jennifer K. Larson, Robert L. Newcomb, Dan M. Cooper and Steven C. George Am J Physiol Regulatory Integrative Comp Physiol 291:1741-1748, 2006. First published Jul 13, 2006; doi:10.1152/ajpregu.00178.2006 You might find this additional information useful... This article cites 57 articles, 35 of which you can access free at: http://ajpregu.physiology.org/cgi/content/full/291/6/R1741#BIBL Updated information and services including high-resolution figures, can be found at: http://ajpregu.physiology.org/cgi/content/full/291/6/R1741 Additional material and information about American Journal of Physiology - Regulatory, Integrative Downloaded from and Comparative Physiology can be found at: http://www.the-aps.org/publications/ajpregu This information is current as of November 29, 2006 . ajpregu.physiology.org on November 29, 2006 The American Journal of Physiology - Regulatory, Integrative and Comparative Physiology publishes original investigations that illuminate normal or abnormal regulation and integration of physiological mechanisms at all levels of biological organization, ranging from molecules to humans, including clinical investigations. It is published 12 times a year (monthly) by the American Physiological Society, 9650 Rockville Pike, Bethesda MD 20814-3991. Copyright © 2005 by the American Physiological Society. ISSN: 0363-6119, ESSN: 1522-1490. Visit our website at http://www.the-aps.org/. Am J Physiol Regul Integr Comp Physiol 291: R1741–R1748, 2006. First published July 13, 2006; doi:10.1152/ajpregu.00178.2006. -
Keeping Children with Exercise-Induced Asthma Active
Keeping Children With Exercise-induced Asthma Active Henry Milgrom, MD, and Lynn M. Taussig, MD ABSTRACT. Exercise-induced bronchospasm, exercise- prophylactically and do not require continuous therapy.13 induced bronchoconstriction, and exercise-induced Most asthma medications, even some unconventional asthma (EIA) are all terms used to describe the phenom- ones such as heparin, furosemide, calcium channel enon of transient airflow obstruction associated with blockers, and terfenadine, given before exercise, sup- physical exertion. It is a prominent finding in children press EIA.14,15 McFadden accounts for the efficacy of these and young adults because of their greater participation in disparate classes of drugs by their potential effect on the vigorous activities.1 The symptoms—shortness of breath, bronchial vasculature that modulates the cooling and/or cough, chest tightness, and wheezing—normally follow rewarming phases of the reaction.16 Short-acting b-ago- the brief period of bronchodilation present early in the nists provide protection in 80% to 95% of affected indi- course of exercise. Bronchospasm typically arises within viduals with insignificant side effects and have been 10 to 15 minutes of beginning exercise, peaks 8 to 15 regarded for many years as first-line therapy.17 Two long- minutes after the exertion is concluded, and resolves acting bronchodilators, salmeterol and formoterol, have 2 about 60 minutes later, but it also may appear during 18–21 3 been found effective in the prevention of EIA. A sustained exertion. EIA occurs in up to 90% of asthmat- single 50-mg dose of salmeterol protects against EIA for 9 ics and 40% of patients with allergic rhinitis; among hours; its duration appears to wane in the course of daily athletes and in the general population its prevalence is therapy.22–24 Cromolyn sodium is highly effective in 70% between 6% and 13%.4,5 to 87% of those diagnosed with EIA and has minimal EIA frequently goes undiagnosed. -
Provider- Pain Quick Reference Guide
A QUICK REFERENCE GUIDE (2019) PBM Academic Detailing Service Posttraumatic Stress Disorder A VA Clinician's Guide to Optimal Treatment of Posttraumatic Stress Disorder (PTSD) VA PBM Academic Detailing Service Real Provider Resources Real Patient Results Your Partner in Enhancing Veteran Health Outcomes VA PBM Academic Detailing Service Email Group [email protected] VA PBM Academic Detailing Service SharePoint Site https://vaww.portal2.va.gov/sites/ad VA PBM Academic Detailing Public Website http://www.pbm.va.gov/PBM/academicdetailingservicehome.asp Table of Contents Abbreviations . 1 PTSD Treatment Decision Aid . 3 VA/DoD 2017 Clinical Practice Guideline: Treatment of PTSD . 4 First-Line Treatment: Trauma-focused Psychotherapies with the Strongest Evidence . 5 First-Line Treatment: Trauma-Focused Psychotherapies with Sufficient Evidence . 6 Comparison of Antidepressants Studied in PTSD . 7 Recommended Antidepressant For PTSD: Dosing . 9 Additional Medications Studied in PTSD: Dosing . 11 Switching Antidepressants . 12 Antidepressants and Sexual Dysfunction . 14 i TOC (continued) Sexual Dysfunction Treatment Strategies . 16 Antidepressants and Hyponatremia . 17 Additional Pharmacotherapy Options for Veterans Refractory to Standard Treatments . 19 Discussing Benzodiazepine Withdrawal . 21 Prazosin Tips . 25 Prazosin Precautions . 26 Managing PTSD Nightmares in Veterans with LUTS Associated with BPH . 27 Other Medications Studied in PTSD-Related Nightmares . 29 References . 30 ii Abbreviations Anti-Ach = anticholinergic -
Oral Phentolamine: an Alpha-1, Alpha-2 Adrenergic Antagonist for the Treatment of Erectile Dysfunction
International Journal of Impotence Research (2000) 12, Suppl 1, S75±S80 ß 2000 Macmillan Publishers Ltd All rights reserved 0955-9930/00 $15.00 www.nature.com/ijir Oral phentolamine: an alpha-1, alpha-2 adrenergic antagonist for the treatment of erectile dysfunction I Goldstein1 1Department of Urology, Boston University School of Medicine, Boston, MA, USA Phentolamine mesylate is an alpha-1 and alpha-2 selective adrenergic receptor antagonist which has undergone clinical trials for erectile dysfunction treatment. Biochemical and physiological studies in human erectile tissue have revealed a high af®nity of phentolamine for alpha-1 and alpha-2 adrenergic receptors. Based on pharmacokinetic studies, it is suggested that 30±40 min following oral ingestion of 40 or 80 mg of phentolamine (Vasomax), the mean plasma phentolamine concentrations are suf®cient to occupy the alpha-1 and -2 adrenergic receptors in erectile tissue and thereby result in inhibition of adrenergic-mediated physiologic activity. In large multi-center, placebo-controlled pivotal phase III clinical trials, the mean change in the erectile function domain of the International Index of Erectile Function scores (Questions 1±5 and 15) from screening to the end of treatment was signi®cantly higher following use of active drug (40 mg and 80 mg) compared to placebo. Three to four times as many patients receiving phentolamine reported being satis®ed or very satis®ed compared with those receiving placebo. At doses of 40 mg and 80 mg respectively, 55% and 59% of men were able to achieve vaginal penetration with 51% and 53% achieving penetration on 75% of attempts. -
Effect of Acute Alterations in Inspired Oxygen Tension on Methacholine
Thorax 1997;52:453±457 453 EVect of acute alterations in inspired oxygen Thorax: first published as 10.1136/thx.52.5.453 on 1 May 1997. Downloaded from tension on methacholine induced bronchoconstriction in patients with asthma Kenneth D Dagg, Lorna J Thomson, Robert A Clayton, Scott G Ramsay, Neil C Thomson Abstract mild to moderate patients with stable Background ± Recent in vitro and in vivo asthma. studies in animals have suggested that am- (Thorax 1997;52:453±457) bient oxygen tension may in¯uence airway responsiveness to bronchoconstrictor Keywords: hyperoxia, hypoxia, bronchoconstriction, stimuli. These observations may have rel- methacholine, asthma. evance to the management of acute ex- acerbations of asthma. The present studies were designed to examine the in¯uence Little is known about the eVect of acute alter- of inspired oxygen tension (Fio2 1.0, 0.21, ations in oxygen tension on the responsiveness 0.15) on methacholine induced broncho- of the airways to bronchoconstrictor stimuli. constriction in patients with asthma. Recent in vitro and in vivo studies in animals Methods ± In a dual study two groups of suggest that hypoxia potentiates and hyperoxia asthmatic patients performed metha- attenuates the airway constrictor response to choline inhalation challenges breathing certain stimuli.12 Similar in vivo studies in man, 3±5 either air (Fio2 0.21) or a hypoxic gas mix- however, have produced con¯icting ®ndings. ture (Fio2 0.15) in study 1 and air (Fio2 If airway responsiveness is increased by a fall 0.21) or hyperoxia (Fio2 1.0) in study 2. in oxygen tension during acute exacerbations The gases were administered through a of asthma, then the administration of high closed breathing circuit in a randomised concentrations of inspired oxygen may act to http://thorax.bmj.com/ double blind fashion.