Bronchodilators and Other Respiratory Drugs

Question 1

Explain the Mechanism of Action of Beta-Adrenergic Agonists when used as a bronchodilator.

Answer 1

The beta agonists dilate airways by stimulating the beta2-adrenergic receptors located throughout the lungs.

Question 2

What are the 3 subtypes of beta-adrenergic agonist bronchodilators?

Answer 2

1) Non-Selective Adrenergic Drugs - stimulates the alpha, beta1 (cardiac), and beta2 (respiratory) receptors.
2) Non-Selective Beta-Adrenergic Drugs - Stimulate both beta1 and beta2 receptors.
3) Selective Beta2 Drugs - Primarily stimulate beta2 receptors.

Question 3

What are the effects of stimulating the beta1 cardiac receptors?

Answer 3

1) ⬆ heart rate
2) ⬆ force of contraction
3) ⬆ BP
4) Nervousness
5) Tremor

Question 4

What is the indication of the Beta-Adrenergic Agonist Bronchodilators?

Answer 4

Relief of bronchospasms

Question 5

What are the contraindications to the use of Beta-Adrenergic Agonist Bronchodilators?

Answer 5

1) Cardiac dysrhythmias

2) ⬆ risk of stroke (because of vasoconstriction)

Question 6

What are some of the common adverse effects of Beta-Adrenergic Agonists Broncholdilators?

Answer 6

1) Beta/Alpha - Insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, and vascular headache.
2) Beta1/Beta2 - Cardiac stimulation, tremor, anginal pain, vascular headache.
3) Beta2 - Hypotension, hypertension, vascular headaches ad tremor.

Question 7

Why may patients with diabetes, who are taking Beta-Adrenergic Agonist Bronchodilators, require an adjustment in the dosage of their hypoglycemic drugs.

Answer 7

Because these drugs may increase the blood glucose levels

Question 8

What is the mechanism of action of Anticholinergics when used as respiratory drugs?

Answer 8

Antiholinergic drugs block Ach receptors to prevent bronchoconstriction.

Question 9

What are the indications for the use of Anticholinergics as Respiratory drugs?

Answer 9

Because their actions are slow and prolonged, Anticholinergics are used for prevention of the bronchospasm associated with chronic bronchitis or emphysema and not for the management of acute symptoms.

Question 10

What are some contraindications to the use of Anticholinergics?

Answer 10

1) Allergy to atropine
2) Allergy to Soy Lecithin
3) Allergy to peanuts, soybean, and other legumes

Question 11

What are some of the common adverse effects of Anticholinergics?

Answer 11

1) Dry mouth and/or throat
2) Urinary retention
3) ⬆ Intraocular pressure
4) Headache
5) Coughing
6) Anxiety

Question 12

What is the Mechanism of Action of Xanthine Derivatives?

Answer 12

Xanthines cause bronchodilation by increasing the levels of the energy producing substance cAMP. They do this by competitively inhibiting phosphodiesterase, the enzyme responsible for breakig down cAMP.

Question 13

What are the indications of Xanthines

Answer 13

Used to dilate the airways of patients with:

1) Emphysema
2) Asthma
3) Bronchitis
3) Adjuncts in managing COPD

Question 14

What are the contraindications to the use of Xanthines?

Answer 14

1) Cardiac dysrhythmias
2) Seizure disorders
3) Hyperthyroidism
4) Peptic ulcers

Question 15

What are the common adverse effects of Xanthines?

Answer 15

1) Nausea, vomiting and anorexia
2) Gastroesophageal reflux in sleeping PTs
3) Tachycardia, extrasystole, palpitations & ventricular dysrhythmias

Question 16

How are overdose and toxicity of Xanthines treated?

Answer 16

With repeated administration of doses of activated charcoal

Question 17

What kinds of foods can reduce serum levels of Xanthines through various metabolic mechanisms?

Answer 17

1) Charcoal-broiled foods
2) High-protein foods
3) Low-carbohydrate foods

Question 18

What is the effect of smoking on the metabolism of Xanthines?

Answer 18

Smoking enhances the metabolism of the drug, therefore, higher doses may be needed.

Question 19

What human response are Leukotrienes responsible for in asthmatic patients?

Answer 19

The molecules known as leukotrienes cause inflammation, bronchoconstriction, and mucous production.

Question 20

What are the 2 different Mechanisms of Action by which Leukotriene Receptor Antagonists work to block the inflammatory process in asthma?

Answer 20

1) Indirect - Inhibits the enzyme 5-lypoxygenase, which is necessary for Leukotriene synthesis.
2) Direct - Binds directly to the Leukotriene receptor in the respiratory tract tissues and organs.

Question 21

What are the indications of LTRAs? Can they be used to treat acute asthmatic attacks?

Answer 21

1) LTRAs are used for the prophylaxis and long-term treatment of asthma in adults and children over the age of 12.
2) No, these drugs are not meant for the management of acute asthmatic attacks. Improvement with their use is typically seen in about a week.

Question 22

What are some of the contraindications to the use of LTRAs?

Answer 22

1) Allergy to povidone
2) Allergy to lactose
3) Allergy to titanium dioxide
4) Allergy cellulose derivatives

Question 23

What are the indications for the use of corticosteroids as a respiratory drug?

Answer 23

1) Inhaled corticosteroids are now used for the primary treatment of bronchospastic disorders to control the inflammatory responses that are believed to be the cause of these disorders.
2) In respiratory illnesses, systemic corticosteroids are used only to treat acute exacerbation, or severe asthma.

Question 24

What are some of the contraindications to the use of Corticosteroids?

Answer 24

1) Hypersensitivity to glucocorticoids
2) PTs whose sputum test positive for Candida organisms
3) PTs with systemic fungal infection

Question 25

What are the main undesirable local effects of typical doses of inhaled corticosteroids in the respiratory system and how can they be prevented?

Answer 25

Adverse effects include pharyngeal irritation, dry mouth and oral fungal infections. Patients should be instructed to rinse the mouth after use of an inhaled corticosteroid.

Question 26

What is important for the nurse to assess when giving inhaled forms of Beta-Agonists?

Answer 26

1) Allergies to flourocarbon propellant in inhaled dosage forms
2) Intake of caffeine
3) Educational level and readiness to learn (instruction on use of MDIs).

Question 27

What should the nurse assess when giving Anticholinergic drugs?

Answer 27

1) Hx of GI disorders, heart palpitations, BPH, or glaucoma.

2) Allergy to soy lecithin, peanuts, soybeans or other legumes.

Question 28

What should the nurse assess before giving Xanthine derivatives?

Answer 28

1) Neurologic assessment (CV and CNS stimulation may occur with these drugs).
2) Bowel patterns, GERD and ulcers (GI reflux may occur).
3) Renal and liver functions
4) Dietary assessment (Low-carb, high-protein, and intake of charcoal-broil meat may lead to theophyline elimination and decreased therapeutic levels of the drug).

Question 29

What is important for the nurse to assess when giving Corticosteroids?

Answer 29

1) Age should be noted, because corticosteroids may be problematic for the pediatric patient if long-term therapy and/or high dosage amounts are used. The systemic impact on the pediatric patient is suppressed growth.

Question 30

If using a MDI and second puff of the drug is ordered, how long should the PT wait between puffs? If a second puff of a different drug is ordered, how long should the patient wait between puffs?

Answer 30

1) 2 puffs of the same drug - wait 1 to 2 mins between puffs

2) 1 puff of each drug (2 puffs total) - wait 2 to 5 mins

Question 31

(T/F) Oral forms of Xanthine derivatives should be taken with food?

Answer 31

True - Decreases GI upset.

Question 32

What are the only 2 class of drugs that we covered that can be used for ACUTE cases of Asthma?

Answer 32

1) Beta-Adrenergic Agonists

2) Systemic Corticosteroids