Bronchodilators

Question 1

Where are beta 2 adrenergic receptors located?

Answer 1

lungs, uterus, select arterioles, liver, and skeletal muscle

Question 2

Therapeutic use of short-acting beta 2 agonist (SABA) Albuterol?

Answer 2

QUICK RELIEF agent for ASTHMA → acute bronchospasm and for prevention of exercise-induced bronchospasm.

Question 3

Example of a SABA?

Answer 3

Albuterol (Proventil HFA, Ventolin HFA, ProAir)

Question 4

MOA of Albuterol?

Answer 4

Stimulates beta 2 adrenergic receptors in the smooth msl of the bronchi and bronchioles → bronchodilation

Question 5

Adverse effects of albuterol?

Answer 5

Nervousness, restlessness, tremor, CP, insomnia, arrhythmias, HTN, hypokalemia, paradoxical bronchospasm

Question 6

Route for albuterol?

Answer 6

oral- long acting (long-term control)

inhaled- short acting

Question 7

Contraindications for albuterol?

Answer 7

hypersensitivity

Question 8

Precautions for albuterol?

Answer 8

Be cautious if you have cardiac disease, HTN, hyperthyroidism, diabetes, excess inhaler use may lead to tolerance and paradoxical bronchospasm.

Question 9

Drug interactions with albuterol?

Answer 9

Beta adrenergic blockers; MAOIs, tricyclics, and caffeine products can increase HR; Theophylline; some cold products (Naproxen or Ibuprofen)

Question 10

How do we evaluate the effectiveness of the albuterol?

Answer 10

peak expiratory flow rate (PEF), symptom frequency, and SABA use

Question 11

T/F. Albuterol is the only rescue inhaler to be used during asthma attacks

Answer 11

True

Question 12

For an acute asthma attack what are the next two medications that should be administered?

Answer 12

Ipratropium (Atrovent) and Methyl prednisolone (Solu-Medrol)

Question 13

Onset of action for Ipratropium?

Answer 13

short acting; 1-3 minutes

Question 14

Route of administration for Ipratropium?

Answer 14

inhalant and intranasal

Question 15

Therapeutic uses of Ipratropium (Atrovent)?

Answer 15

• MAINTENANCE therapy of reversible airway obstruction d/t COPD
• off label use for asthma exacerbations with albuterol

Question 16

MOA of Ipratropium (Atrovent)?

Answer 16

Anticholinergic agent; muscarinic antagonist; blocks the muscarinic receptors in the bronchi to block the action of Ach

Question 17

Adverse effects of IpratropIum (Atrovent)? Hint: anticholinergic

Answer 17

dry mouth, Irritation of pharynx, Increased intraocular pressure

Question 18

Ipratropium (Atrovent) contraindications?

Answer 18

hypersensitivity to ipratropium, atropine, belladonna alkaloids, or bromide.

Question 19

Precautions for Ipratropium? (PUG)

Answer 19

use cautiously in patients with prostatic hyperplasia, glaucoma, or urinary retention

Question 20

Therapeutic use for a long-acting beta 2 agonist (LABA)? Salmeterol

Answer 20

• Long-term control of asthma but not the 1st choice.
• Asthma and bronchospasms (as concomitant therapy with an inhaled corticosteroid).
• Exercise induced asthma

Question 21

LABA prototype?

Answer 21

Salmeterol (Serevent diskus)

Question 22

MOA of Salmeterol?

Answer 22

stimulates adenyl cyclase resulting in increased intracellular cyclic AMP level at the beta 2 receptors which in turn triggers bronchial smooth muscles relaxation.

Question 23

T/F. long acting agents like Salmeterol are not to be used alone but prescribed in combination with an inhaled glucocorticoid

Answer 23

True

Question 24

How often is Salmeterol dosed?

Answer 24

Q12h

Question 25

Adverse effects of Salmeterol?

Answer 25

HA, asthma related death when used alone

Question 26

What class of agent is Theophylline (Elixophyllin, Theo-24)?

Answer 26

Xanthine; Methylxanthines; bronchodilator

Question 27

MOA of Theophylline?

Answer 27

relaxes smooth msls of the bronchi

Question 28

Therapeutic use of Theophylline?

Answer 28

second line agent for long-term control of chronic asthma or COPD

Question 29

Adverse effects of TheoPhylliNe?

Answer 29

ANXIETY, tachycardia, N/V, HA, palpitations, tremors, anorexia, seizures, arrhythmias

Question 30

Precautions to take with Theophylline? Hint: toxicity

Answer 30

cautious use in patients with cardiac arrhythmias, heart failure, liver or kidney dysfunction

Question 31

Drug interactions with Theophylline?

Answer 31

multiple (caffeine). "CRANKY drug"

Question 32

Route of administration-Theophylline?

Answer 32

oral or IV

Question 33

Example of long-acting muscarinic antagonist?

Answer 33

Tiotropium (Spiriva) inhalation

Question 34

MOA of Spiriva?

Answer 34

causes bronchial dilation by selectively and reversibly inhibiting acetylcholine at type 3 muscarinic receptors

Question 35

Therapeutic use of Tiotropium (Spiriva)? Hint: anticholinergic, LAMA

Answer 35

MAINTENANCE therapy of bronchoconstriction associated with COPD

Question 36

Adverse effects of Tiotropium (Spiriva)?

Answer 36

dry mouth, glaucoma, and angioedema

Question 37

Spiriva drug class?

Answer 37

Anticholinergic, antimuscarinic, and bronchodilator

Question 38

Patient education for Tiotropium (spiriva)? Hint: anticholinergic

Answer 38

Notify provider of angioedema or glaucoma

Question 39

What is the most common combination of drugs for COPD?

Answer 39

SABA and short acting anticholinergic

Question 40

What is the black box warning for LABA and corticosteroid combination?

Answer 40

can possibly increase asthma severity/asthma related deaths

Question 41

What are the goals for asthma tx?

Answer 41

reducing impairment and reducing risk

Question 42

What are the goals for COPD tx?

Answer 42

reduce sx and reduce risk and mortality

Question 43

What type of medications are used to manage stable COPD?

Answer 43

LABA, LAMA, ICS, and PDE4 inhibitors

Question 44

What medications are used to mange COPD exacerbations?

Answer 44

SABA, SAMA, systemic glucocorticoids, antibodies, and supplemental oxygen