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Fundamentals Of Respiratory Care > Module 7: Airway Pharmacology > Flashcards

Module 7: Airway Pharmacology Flashcards

(67 cards)

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1
Q

Albuterol Sulfate

A

Proventil
Ventolin
ProAir
AccuNeb
Vospire

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2
Q

The course of drug action from dose to effect comprises three phrases:

A

Drug administration phase
Pharmacokinetic phase
Pharmacodynamic phase

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3
Q

Drug Administration Phase

A

Method by which drug is made available to body

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4
Q

Most common devices used to administer inhaled aerosols are:

A

Metered-Dose Inhaler (MDI)
Soft-Mist Inhaler (Respimat)
Small-Volume Nebulizer (SVN)
Dry-powder Inhaler (DPI)

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5
Q

Advantages of Inhaled Aerosols

A

Aerosol doses are usually smaller than doses for systemic administration
Onset of drug action is rapid (immediate onset)
Delivery is targeted to the organ requiring treatment
Systemic side effects are often fewer and less severe
Most drugs can be self-administered by the patient

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6
Q

Disadvantages of Inhaled Aerosols

A

The number of variables affecting the delivered dose
Lack of adequate knowledge of device performance
Use among patients and caregivers

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7
Q

Pharmacokinetic Phase

A

Describes time course and disposition of drug in body based on its absorption, distribution, metabolism, and elimination

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8
Q

Pharmacodynamic Phase

A

Describes the 3 mechanisms of drug action by which a drug molecule causes its effects in the body through drug receptor site interactions

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9
Q

Sympathetic (adrenergic) receptor stimulation

A

Uses norepinephrine as a neurotransmitter, similar to epinephrine
Stimulation causes bronchodilation in the lungs 🫁

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10
Q

Parasympathetic (cholinergic) receptor stimulation

A

Uses Acetylcholine as a neurotransmitter
Stimulation causes bronchoconstriction in the lungs

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11
Q

Agonists (stimulating agent)

A

EX: Benadryl (anti-histamine)
A chemical that binds to a receptor site (has affinity) and blocks another chemical from activation which causes no response (no efficacy)

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12
Q

Adrenergic

A

Drug that stimulates a receptor responding to norepinephrine or epinephrine

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13
Q

What causes bronchodilation of the smooth muscle of the lungs?

A

Stimulation of the beta-2 adrenergic receptor site causes bronchodilation of the smooth muscle of the lungs

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14
Q

Stimulation of the muscarinic-3 cholinergic receptor site causes?

A

Bronchoconstriction of the smooth muscle of the lungs

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15
Q

Anti-cholinergic

A

Drug that blocks a receptor for acetylcholine

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16
Q

Adrenergic Bronchodilators

A

This class of drug is compromised of the largest single group of drugs amount aerosolized agents used for inhalation

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17
Q

Indications for use

A

Short-acting beta-2 agonists (SABA)

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18
Q

Short-acting beta-2 agonists (SABA)

A

Treatment of acute reversible airflow obstruction
Improve flow rates for asthma, acute, and chronic bronchitis, emphysema, bronchiectasis, cystic fibrosis, and other obstructive airways states
The National Asthma Education and Prevention Programs considers SABAs as rescue bronchodilators

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19
Q

Long Acting Beta-2 Agonists (LABA)

A

For maintenance bronchodilation in patients with obstructive lung disease, commonly referred to as control drugs

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20
Q

Ultra Short Acting Agents

A

Ultra Short Acting Agents catecholamine (strong alpha 1) resulting in vasoconstriction of the bronchial blood vessels
To reduce airway swelling after extubation, during croup, or epiglottitis
To control airway bleeding during endoscopy

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21
Q

What are the mechanisms and effects of Adrenergic Bronchodilators?

A

Alpha-receptor stimulation: causes vasoconstriction and vasopressin effect
Beta-1 receptor stimulation: causes increased heart rate and heart contractility
Beta-2 receptor stimulation: relaxes bronchial smooth muscle, stimulates mucociliary activity, and has some inhibitory action on inflammatory mediator release

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22
Q

Most common adverse effects of adrenergic bronchodilators?

A

Tremors
Headache
Nervousness
Insomnia
Hypokalemia

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23
Q

What are the side effects seen with anticholinergic aerosol agents?

A

SVN, MDI, and DPI (COMMON)
-Cough, dry mouth

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24
Q

What is the assessment for anticholinergic bronchodilators?

A

Vital signs, breath sounds, and breathing pattern should be evaluated before and after treatment
Patient’s subjective response is important to evaluate

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25
How is N-Acetyl-L-Cysteine (NAC) a.k.a (Mucomyst) delivered?
Given by aerosol or direct tracheal instillation
26
What are the indications for N-Acetyl-L-Cysteine (NAC) a.k.a Mucomyst?
Acute bronchitis, bronchiectasis, COPD, and also acetaminophen overdose
27
Why is N-Acetyl-Lystine (NAC) a.k.a Mucomyst given?
Given to reduce accumulation of excessive, viscous airway mucus secretions
28
What are the side effects of N-Acetyl-L-cysteine (NAC) a.k.a (Mucomyst)?
May cause bronchospasm due to irritating side effects Prophylactic therapy is recommended to reduce the irritant effects of Mucomyst, pre-treatment administration of an adrenergic bronchodilator
29
What is the assessment during administration for Mucus-Controlling Agents?
Breathing pattern and rate Monitor peak flow changes and peak expiratory flow rates (PEFR) Patient’s reaction to the treatment
30
What are the side effects of N-Acetyl-L-Cysteine (NAC)?
Airway Obstruction due to rapid liquefaction of secretions Disagreeable odor due to hydrogen sulfide Incompatibility with certain antibiotics when administered together
31
What are the indications and purposes of inhaled corticosteroids? `
Orally inhaled preparations used for anti inflammatory maintenance therapy of persistent asthma and severe COPD
32
Mechanism of action for inhaled corticosteroids?
Full anti inflammatory effects require hours to days Will not provide immediate relief of dyspnea from airways obstruction
33
Inhaled corticosteroids adverse effects?
Adrenal insufficiency Extrapulmonary allergy Acute asthma HPA suppression (minimal dose suppression) Growth retardation Osteoporosis
34
What are the local adverse effects of inhaled corticosteroids?
Cough, bronchoconstricion
35
What are the two most common types of combined inhaled corticosteroid drugs?
Fluticasone propionate/salmeterol (Advair Diskus) Budesonide/formoterol fumarate HFA (Symbicort)
36
Inhaled Tobramycin goals? (TOBI)
Intended to manage chronic infection with Pseudomonas aeruginosa in patients with cystic fibrosis Goal is to treat/prevent early colonization, and associated with a high rate of bacterial resistance Prevents deterioration of lung function due to recurrent infections
37
Both ___ and ___ are approved by the U.S Food and Drug Administration (FDA)?
IIoprost and Preprostenil
38
What is aerosol?
A suspension of solid or liquid particles in gas
39
Aerosol output?
Mass of fluid or drug contained in aerosol Output rate is mass of aerosol generated per unit of time
40
How is particle size determined in aerosol output?
Depends on three factors 1. Substance being nebulizer 2.Method used to generate the aerosol 3. Environmental conditions
41
What does MMAD mean?
Mass median aerodynamic diameter
42
Partical measurements correspond to the most typical settling _____?
Behavior of an aerosol
43
What are the three pulmonary deposition factors?
Size of the particles Shape and motion of the particles Physical characteristics of the airway
44
Sedimentation
Represents primary mechanism for deposition of small particles (1-5 m) Breath holding for 10 seconds on peak inspiration after inhalation of aerosol increases sedimentation and distribution of lungs
45
Brownian Diffusion
Primary deposition mechanism for very small particles (less than 3 m) deep within the alveoli of the lungs
46
Aerosol Drug Delivery Systems:
MDI SVN DPI USN Atomizers and nasal spray Vibrating mesh nebulizer
47
Pressurized Metered Dose Inhalers
Pressurized canister containing prescribed drug in volatile propellant combined with surfactant and dispersing agent
48
How is PMDI usually prescribed?
Most commonly prescribed (preferred method) of aerosol therapy delivery in both the spontaneously breathing, and the intubated/mechanically ventilated patients
49
How are PMDIs convenient?
Portable, compact, and easy to use Provides multidose convenience Has serious limitation
50
What are the aerosol delivery characteristics of a PMDI?
PMDIs can produce particles in respirable range (MMAD 2-6 m) About 80% of aerosol deposits in oropharynx Pulmonary deposition ranges between 10% and 20% in adults and larger children 10-20% of the aerosol deposits in the Oropharynx without a spacer or the two finger technique
51
What is the technique for use of pMDI?
Most patients do not use proper technique THOROUGH EDUCATION OF PATIENT CAN TAKE UP TO 30 MINUTES
52
What is the PROPER technique for use of the pMDI?
MDI without a space should be actuated immediately after beginning a slow inspiration with mouthpiece held 4 cm in front of open mouth This is called the two finger technique ALTHOUGH THE USE OF A SPACER IS RECOMMENDED Spacer is 1st choice but the two-finger technique is convenient
53
Approximately 60-80% of an MDI output (spray) is propellant with only 1% being active drug (50mcg-5mg) ____
Depending on the drug formula
54
How can you minimize Candida (Thrush) infection when using a pMDI?
It is important to have the patient rinse their mouths and gargle or the use of a spacer when using corticosteroid administration
55
How to ensure proper drug delivery?
MDIs not used for two days or more shod have first dose “wasted” to clear the valve stem and also new MDIs should be primed Warm the canister to the hand or body temperature and shake vigorously before use
56
Who are most likely to have difficulty using an MDI?
Patients inn acute respiratory distress, infants, and young children and the elderly. (Due to not being cooperative)
57
Dry powder inhalers
Breath-actuated dosing systems
58
How does patient create aerosol? (DPI)
By drawing air through dose of finely milled drug powder -There is no flow-
59
What is the expected patients inspiratory flow rate or effort when using a DPI?
>60 L/MIN
60
Does not se propellants and does not require hand-breath ____
Coordination needed for PMDIs
61
All DPIs are ____?
Maintenance or control drugs
62
Patients with adequate flow rates are recommended to use either a ___?
DPI or MDI with a spacer
63
What is the technique use for DPI?
Patients must generate inspiratory flow rate of at least 40-60 L/min to produce respirable power aerosol DPIs should not be used by infants, small children, those who cannot follow instructions, and patients with severe airway obstruction Requires cleaning in accordance with product label
64
What is the proper technique for Small Volume Nebulizers?
Slow inspiratory flow optimizes SVN aerosol deposition Selection of delivery method (mask or mouthpiece) i based on patient ability, reference and comfort
65
Infection control issues in terms of DPIs?
Nebulizers should be cleaned and disinfected or rinsed with sterile water and air dried between uses
66
Assessing effectiveness of aerosol delivery
(SUBJECTIVE DATA) Patients technique when using the device Patients response to and compliance with the procedure
67
Objective measurements in terms of assessing effectiveness of aerosol therapy?
Peak flowmeter (PEFR) Bedside Spirometry (FEV1/FVC Ratio)

Fundamentals Of Respiratory Care (8 decks)

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