LOWER RESPIRATORY DISORDERS REP 21

Question 1

LOWER RESPIRATORY DISORDERS

Anatomy & Physiology

Answer 1

Trachea
Bronch
Lungs
Alveoli

Question 2

Types of COPD:

• progressive lung disease caused by smoking or chronic lung infection

Answer 2

Chronic bronchitis

Question 3

Types of COPD:

• dilation of the bronchi and bronchioles is abnormal secondary to frequent
  infection and inflammation, “blue bloaters”

Answer 3

Bronchiectasis

Question 4

Types of COPD:

• progressive lung disease caused by cigarette smoking, atmospheric
  contaminants, “pink puffers”

Answer 4

Emphysema

Question 5

Types of COPD:

• inflammatory disorder of the airway walls associated with a varying amount of
  airway obstruction, with wheezing

Answer 5

Asthma

Question 6

Mast cells stimulate the release of chemical mediators

Answer 6

(histamines, cytokines,
serotonin, eosinophil factor of anaphylaxis (ECF-A), and leukotrienes.

Question 7

Cyclic adenosine monophosphate (cyclic AMP, or CAMP)

Answer 7

• maintain
  bronchodilation

Question 8

Albuterol
l

Answer 8

● treatment and control of asthma by bronchodilation with long duration of
action

SE: restlessness, tremors, palpitations
*Overuse may cause beta 1 response such as nervousness, tremor and
increased pulse rate.

Question 8

Anticholinergics
Methylxanthine -

Answer 8

• bronchodilators used to treat asthma is the methylxanthine (xanthine)
  examples: aminophylline, theophylline, and caffeine
  SE AR: nausea, vomiting, gastric pain, bleeding, dysrhythmias

Question 8

Anticholinergics
Theophylline

Answer 8

• relaxes the smooth muscles of the bronchi, bronchioles, and pulmonary
  blood vessels by inhibiting the enzyme phosphodiesterase, resulting in an increase in cAMP,
  which promotes bronchodilation.

Question 8

Theophylline
range
side effects

Answer 8

therapeutic range is 5-15 mcg/mL

:20 mcg/mL

cause hyperglycemia, decreased clotting time, and, rarely, leukocytosis

avoid caffeinated products

Question 8

Anticholinergics

Leukotriene Receptor Antagonists and Synthesis Inhibitors

Question 9

Leukotriene Receptor
Antagonist

Answer 9

Zafirlukast (Accolate)

prophylaxis and maintenance therapy for chronic asthma and
inflammation within bronchial airways
Emphasis: It is used to prevent but not to treat active asthma

Question 9

Combination Drug:
Glucocorticoid and
Beta-2 Agonist

Answer 9

Fluticasone Propionate
and Salmeterol

asthma but not to treat acute asthmatic attack .
● long-term maintenance of COPD including bronchitis and
emphysema

Question 10

Glucocorticoids (Steroids) – treat asthma
- act as an anti-inflammatory agent.
Can be given using the following methods:

Answer 10

be given using the following methods:
● MDI inhaler: Beclomethasone
● Tablet: Dexamethasone, Prednisone
● Intravenous: Dexamethasone
➔ Inhaled glucocorticoids are ineffective vs severe asthmatic attacks because
they take 1-4 weeks to reach full effect

Question 10

Cromolyn Sodium
(Gastrocrom)

Answer 10

chronic and prophylactic use, suppresses inflammation in bronchial
tubes and prevents release of histamines
● maintenance therapy in mild to moderate asthma and suppress
release of histamine

Question 11

Glucocorticoids (Steroids)

Answer 11

– treat asthma
- act as an anti-inflammatory agent.

Question 12

3 S of Steroids:

Answer 12

Salt Mineralocorticoids – Aldosterone – water retention – ↑ BP
Sex Androgens – sex hormone
Sugar Glucocorticoids – cortisol – increased blood sugar
Emphasize the 3S: that will remind students of the side effects of steroids

Question 13

Cromolyn (Cromolyn sodium)

Answer 13

• prophylactic treatment of bronchial asthma. Cromolyn
• must be taken daily
• inhibits the release of histamine and inflammatory mediators from mast cells.

Question 14

Drug Therapy for Asthma According to Age
Young Children

Answer 14

1. Cromolyn - is used to treat inflammatory effects of asthma in children.
2. Oral glucocorticoids - to control a moderate to severe asthmatic state.
   ➢ An inhalation dose should be about 1 to 2 inhalations 4 times a day.
3. Oral Beta2-adrenergic agonists - for severe conditions of asthma in selected young
   children.

Question 15

Older Adults
Beta2-adrenergic agonists and methylxanthines such as theophylline can
cause:

Answer 15

● Tachycardia – COMMON!
● Nervousness
● Tremors
Frequent use of glucocorticoids can increase risk of developing:
● Cataracts
● Osteoporosis
● Diabetes mellitus

Question 16

Mucolytics

Answer 16

Act as detergent to liquefy and loosen thick, mucous secretions so they can be
expectorated

Question 16

Mucolytics

Acetylcysteine

Answer 16

• is administered by nebulization for bronchopulmonary disorders.

Question 16

Mucolytics

Dornasa Alfa

Answer 16

enzyme that digests DNA in thick sputum secretions of patients with
cystic fibrosis

❖ Helps reduce respiratory infections and improve
pulmonary functions.
❖ Improvement usually occurs in 3 to 7 days with its use.
❖ SE: chest pain, sore throat, laryngitis and hoarseness.