Drugs acting on the lower respiratory system

Question 1

Drug effects

Answer 1

What is the therapeutic effect of the drug on the body

Question 2

Mechanism of action

Answer 2

How does the drug cause that effect

Question 3

Indications

Answer 3

What conditions are treated with this drug

Question 4

Agonists

Answer 4

Drugs that occupy receptors and activate them

Question 5

Antagonists

Answer 5

Drugs that occupy receptors but to not activate them; antagonists block receptor activation by agonists

Question 6

Bronchodilators

Answer 6

Relax smooth muscle, which causes dilation of the bronchi and bronchioles that are narrowed as a result of the disease process

Question 7

3 classes of bronchodilators

Answer 7

beta-adrenergic agonists, anticholinergics, and xanthine derivatives

Question 8

types of anti-inflammatory respiratory drugs

Answer 8

Leukotriene receptor antagonists, corticosteroids

Question 9

Short-acting beta agonists inhaler that you need to know

Answer 9

Albuterol (Ventolin, prosit)

Question 10

Albuterol

Answer 10

Short acting beta2 specific bronchodilating agonists- available as inhaler and oral
- Most commonly used drug in this class, must not be used be used too frequently

Question 11

Long acting beta agonists that you need to do

Answer 11

Salmerterol (servant)

Question 12

Salmeterol

Answer 12

Available only has an inhalant- Long-acting beta2 agonists bronchodilator inhalers
- Never use for acute treatment
; used for the maintenance treatment of asthma and COPD and is used I conjunction with an inhaled corticosteroid; should never be given more than twice daily nor should the maximum daily dose

Question 13

Beta-adrenergic agonists

Answer 13

Used during acute phase of asthma attacks; quickly reduces airway constriction and restore normal airflow by activating beta 2 receptors which relaxes smooth muscle in the airway.
Agonists or stimulators of the adrenergic receptors in the sympathetic nervous system.

Question 14

Beta-adrenergic agonists indications

Answer 14

• relief of bronchospasm related to asthma, bronchitis and other pulmonary diseases
• Used in treatment and prevention of acute attacks
• Used in hypotension and shock

Question 15

Beta adrenergic agonists contraindications

Answer 15

KDA, uncontrolled hypertension, cardiac dysrhythmias, high risk of stroke (bc of the vasoconstrictive drug action), Conditions that would be aggravated by the sympathetic stimulation

Question 16

Beta-adrenergic agonists adverse effects beta1 and beta 2 (metaproterenol)

Answer 16

Cardiac stimulation, tremor, anginal pain, vascular headache, hypotension

Question 17

Beta2 (albuterol) adverse effects

Answer 17

Hypotension or hypertension, vascular headache, tremor

Question 18

Beta-adrenergic agonists interactions

Answer 18

Diminished bronchodilator when nonselective beta blockers are used with the beta agonist bronchodilators; monamine oxidase inhibitors; sympathomimetics; monitor patients with diabetes- an increase in blood glucose levels can occur

Question 19

Anticholinergics MOA

Answer 19

ACh causes bronchial constriction and narrowing of the airways.
Anticholinergics bind to the Ash receptors on the vagus nerve, preventing EACh from binding thus blocking the stimulation of smooth muscle therefore bronchoconstriction is prevented-
Not as effective sympathomimetics but can provide some relief to those patients who cannot tolerate the other drugs. Also directly causes airway relaxation and dilation, helps reduce secretions in COPD patients

Question 20

Anticholinergics Indications

Answer 20

Prevention of the bronchospasm associated with chronic bronchitis or emphysema; not for the management of acute symptoms

Question 21

Anticholinergics you need to know

Answer 21

Ipratropium (atrovent) and tiotropium (spiriva)

Question 22

Anticholinergics adverse effects

Answer 22

Dry mouth or throat, nasal congestion, heart palpitations, GI distress, headache, coughing, anxiety, dizziness, fatigue, urinary retention

Question 23

Ipratropium (atrovent)

Answer 23

Oldest and most commonly used anticholinergic bronchodilator; available both as a liquid aerosol for inhalation and as a multi dose inhaler (usually dosed twice daily)

Question 24

Anticholinergics similar to ipratropium

Answer 24

Tiotropium (Spiriva)
Aclidinium (tudorza)
Umeclidinium (incruse elliptic)

Question 25

Types of LRTAs

Answer 25

montelukast (Singulair)
Zafirlukast

Question 26

Types of corticosteroids

Answer 26

Beclemothasone, dexamethasone, fluticasone

Question 27

LTRAS MOA

Answer 27

Prevent leukotrienes from attacking to receptors on cells in the lungs and in circulation; inflammation in the lungs is blocked, and asthma symptoms are relieved

Question 28

LTRAS drug effects

Answer 28

Prevent smooth muscle contraction of bronchial airways, decrease mucus secretions, prevent vascular permeability, decrease neutrophil and leukocyte infiltration to the lungs, preventing inflammation, Prevent the immune system affect that occurs during an asthma attack

Question 29

LTRAS indications

Answer 29

prophylaxis and long-term treatment and prevention of asthma in adults and children 12 years of age and older- not meant for management of acute attacks

Question 30

LTRAS contradictions

Answer 30

KDA, previous drug reaction, allergy to provide, lactose, titanium dioxide, or cellulose derivatives (all inactive ingredients)
Should not be used for patients with hepatic or renal impairment

Question 31

LTRAS adverse effects

Answer 31

Headache, nausea, dizziness, insomnia, diarrhea

Question 32

Corticosteroids

Answer 32

Anti-inflammatory properties, used for chronic asthma and does not relieve symptoms of acute asthma attacks. Can be given IV, oral, or inhaled

Question 33

Corticosteroids MOA

Answer 33

Stabilize membranes of cells that release harmful bronchoconstricting substances. Increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation. Dual effect of both reducing inflammation and enhancing the activity of beta agonists

Question 34

Types of inhaled corticosteroids

Answer 34

Beclomesthasone dipropionate (beclovent), fluticasone (Flovent)

Question 35

Types of oral corticosteroids

Answer 35

Prednisone (prednisone, intense, rayos), prednisolone (prelone)

Question 36

Corticosteroids indications

Answer 36

Primary treatment of bronchospastic disorders to control the inflammatory responses that are believed to be the cause of these disorders’ persistent asthma, often used concurrently with the beta-adrenergic agonists

Question 37

Corticosteroids contraindications

Answer 37

KDA, not intended as sole therapy for acute asthma attacks, hypersensitivity to glucocorticoids, patients whose sputum tests positive for candida organisms, patients with systemic fungal infections

Question 38

Corticosteroids adverse effects

Answer 38

Pharyngeal irritation, coughing, dry mouth, oral fungal infections, systemic effects for inhalation therapy are are bc or low doses, long-term oral therapy can lead to bone loss, osteroprorsis, and broken bones

Question 39

Corticosteroids drug interactions

Answer 39

Drug interactions are more likely to occur with systemic (versus inhaled) corticosteroids, may increase serum glucose levels, possible requiring adjustments, in dosages of anti diabetic drugs, cyclosporine and tacrolimus, itraconazole, phenytoin, phenobarbital, and rifampin

Question 40

Advair

Answer 40

Fixed combo of fluticasone and salmeterol

Question 41

Combivent

Answer 41

ipratroprium and albuterol fixed combo

Question 42

Symbicort

Answer 42

Budesonide and formoterol fixed combo

Question 43

Breo ellipta

Answer 43

Fluticasone and vilanterol fixed combo

Question 44

Nursing implications for bronchodilators

Answer 44

Avoid exposure to conditions that precipitate bronchospasm (allergens, smoking, stress, air pollutant),
Adequate fluid intake, avoid excessive fatigue, heat, extremes in temperature, and caffeine, get flu vax, teach patients to take bronchodilators exactly as prescribed, demonstrate use of inhalers, monitor for adverse effects

Question 45

Monitoring bronchodilators for effectiveness

Answer 45

Decreased dyspnea, decreased wheezing, restlessness, and anxiety, improved respiratory patterns with return to normal rate and quality, improved activity tolerance, decreased symptoms and increased ease of breathing

Question 46

Nursing implications for beta-adrenergic agonists

Answer 46

Albuterol cannot be used too frequently, ensure patients take medications exactly as prescribed with no omissions or double doses, inform pt’s to report insomnia, jitteriness, restlessness, palpitations, chest pain, or any change in symptoms, increase in anxiety is expected

Question 47

Nursing implications for LTRAS

Answer 47

Ensure that the drug is being used for chronic management of asthma, not acute asthma, teach the patient the purpose of the therapy, improvement should be seen in about 1 week, advise patients to check with prescriber before taking OTC or prescribed medications to determine drug interactions, Assess liver function before therapy and throughout, teach patients to take medications every night on a continuous schedule even if symptoms improved

Question 48

Nursing implication corticosteroids

Answer 48

Teach patients to gargle and rinse the mouth with lukewarm water afterward to prevent the development of oral fungal infections, bronchodilator should be used several minutes before corticosteroids to provide bronchodilator before administration of the corticosteroid, teach patients to monitor disease with a peak flow meter.