Lower Respiratory Tract Drugs

Question 1

Bronchial Asthma

Answer 1

Recurrent and reversible shortness of breath

Airways narrow due to bronchospasms, inflammation of bronchial mucosa, edema of bronchial mucosa, production of viscous mucus

Symptoms include wheezing, difficulty breathing, tightening of the chest, cough

Question 2

Asthma Categories

Answer 2

Intrinsic (occurring in patients with no history of allergies)

Extrinsic (occurring in patients exposed to a known allergen)

Exercise induced

Drug induced (less common)

Question 3

Status Astmaticus

Answer 3

Prolonged asthma attack that does not respond to typical drug therapy

MEDICAL EMERGENCY

Question 4

Chronic Bronchitis

Answer 4

Continuous inflammation and low-grade infection of bronchi

Excessive secretion of mucus due to a prolonged exposure to bronchial irritants

Question 5

COPD

Answer 5

Chronic, progressive, largely irreversible disorder characterized by airflow restrictions and inflammation

Chronic cough, excessive sputum, wheezing, dyspnea, poor exercise tolerance

Most commonly caused by smoking cigarettes

Question 6

Emphysema

Answer 6

DESTRUCTION OF ALVEOLAR WALLS

SURFACE AREA WHERE GAS EXCHANGE TAKES PLACE IS REDUCED

EFFECTIVE RESPIRATION IS IMPAIRED

Question 7

Bronchodilators

Answer 7

RELAX BRONCHI SMOOTH MUSCLE

Beta-adrenergic agonists, anticholinergics, and xanthine derivatives

Question 8

Short-Acting Beta Agonist Inhalers

Answer 8

ALBUTEROL (VENTOLIN) AND METAPROTERENOL (ALUPENT)

Rapid relief of acute asthma

Question 9

Long-Acting Beta Agonist Inhalers

Answer 9

SALMETEROL (SEREVENT)

Used for prophylactic and maintenance measures

Question 10

Glucocorticoid/LABA Combinations

Answer 10

FLUTICASONE/SALMETEROL (ADVAIR)

BUDESONIDE/FORMOTEROL (SYMBICORT)

Indicated for long-term maintenance in adults and children

Not recommended for initial therapy

Question 11

Beta2 Adrenergic Agonists

Answer 11

Use in asthma and COPD

Question 12

Contraindications of Beta-Adrenergic Agonists

Answer 12

Known drug allergy, uncontrolled hypertension, cardiac dysrhythmias, high risk of stroke (due to vasoconstrictive drug action)

Question 13

Adverse Effects of Beta-Adrenergic Agonists

Answer 13

ALPHA AND BETA: RESTLESSNESS, TREMOR, CARDIAC STIMULATION-TACHYCARDIA

ANGINAL PAIN WITH BETA1 AND BETA2

TREMOR WITH BETA2 (ALBUTEROL)

Question 14

Albuterol (Proventil)

Answer 14

MOST COMMONLY USED DRUG IN THE SHORT-ACTING BETA2 AGONISTS

Must not be used too frequently

Question 15

Salmeterol (Serevent)

Answer 15

Long-acting Beta2 agonist bronchodilator

NEVER TO BE USED FOR ACUTE TREATMENT

Question 16

Anticholinergics

Answer 16

IPRATROPIUM (ATROVENT) AND TIOTROPIUM (SPIRIVA)

Indirectly cause airway relaxation and dilation

Help reduce secretions in COPD patients

Question 17

Indications for Anticholinergics

Answer 17

PREVENTION OF BRONCHOSPASMS ASSOCIATED WITH CHRONIC BRONCHITIS OR EMPHYSEMA

Not used for management of acute symptoms

Question 18

Adverse Effects of Anticholinergics

Answer 18

DRY MOUTH OR THROAT, nasal congestion, heart palpitations, GI distress

Question 19

Xanthine Derivatives

Answer 19

ONLY THEOPHYLINE IS USED AS A BRONCHODILATOR

Question 20

Indications for Xanthine Derivatives

Answer 20

Dilation of airways in asthma, chronic bronchitis, and emphysema

Mild to moderate cases of acute asthma

NOT FOR MANAGEMENT OF ACUTE ASTHMA ATTACK

Not used as frequently because of potential for drug interactions and variables related to drug levels in the blood

Question 21

Theophyline

Answer 21

Most commonly used xanthine derivative

THERAPEUTIC RANGE FOR THEOPHYLINE BLOOD LEVEL IS 10-20 MCG/ML

Question 22

Nonbronchodilating Respiratory Drugs

Answer 22

CORTICOSTEROIDS, leukotriene receptor agonists

Question 23

Leukotriene Receptor Agonist Mechanism of Action

Answer 23

Leukotrienes cause inflammation, bronchoconstriction, and mucus production

LRTAs prevent leukotrienes from attaching to receptors on cells in the lungs and in circulation

Inflammation in the lungs is blocked, and asthma symptoms are relieved (prevent smooth muscle contraction, decrease mucus, prevent vascular permeability, decrease neutrophil and leukocyte infiltration)

MONTELUKAST (SINGULAIR)

Question 24

Indications for LTRAs

Answer 24

Prophylaxis and long-term treatment and prevention of asthma in adults and children 12 years old and older

NOT for management of acute asthmatic attacks

Approved for treatment of allergic rhinitis

Question 25

Corticosteroids

Answer 25

Anti-inflammatory properties Used for CHRONIC ASTHMA, BRONCHITIS, EMPHYSEMA May take several weeks before full effects are seen BECLOMETHASONE (DIPROPIONATE)

Question 26

Indications for Inhaled Corticosteroids

Answer 26

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 beta-adrenergic agonists

Question 27

Contraindications for Inhaled Corticosteroids

Answer 27

Hypersensitivity to glucocorticoids, patients with positive Candida sputum tests, patients with systemic fungal infection

Question 28

Adverse Effects of Inhaled Corticosteroids

Answer 28

Pharyngeal irritation, coughing, dry mouth, oral fungal infections

Question 29

Nursing Implications for Beta-Adrenergic Agonists

Answer 29

Ensure patients take medications exactly as prescribed Frequent use of albuterol makes it lose its beta2-specific functions Report insomnia, jitteriness, restlessness, palpitations, chest pain, or any change in symptoms

Question 30

Nursing Implications for LTRAs

Answer 30

TEACH PATIENT TO TAKE MEDICATIONS EVERY NIGHT ON A CONTINUOUS SCHEDULE, EVEN IF SYMPTOMS IMPROVE Assess liver function before therapy and throughout

Question 31

Nursing Implications for Xanthine Derivatives

Answer 31

Be aware of drug interactions with cimetidine, oral contraceptives, allopurinol, certain antibiotics, influenza vaccine, and others Cigarettes enhance xanthine metabolism

Question 32

Nursing Implications for Inhaled Corticosteroids

Answer 32

Teach patients to gargle and rinse the mouth with lukewarm water