Respiratory

Question 1

Three classes of meds used to terminate an asthma attack:

Answer 1

• Beta 2 adrenergic Agonist
• Methylxanthines
• Inhaled anticholinergics

Question 2

Beta2-adrenergic agonists (ex. Salmeterol)

Answer 2

• most frequently prescribed for treatment of bronchoconstriction
• short-acting
• intermediate acting
• long acting
• stimulate the effects of the SNS = bronchodilation

Question 3

Methylxanthines (ex. theophylline)

Answer 3

• long term management
• narrow therapeutic index.
• avoid
• relax smooth muscle

Question 3

Methylxanthines (ex. theophylline)

Answer 3

• long term management
• narrow therapeutic index.
• a phosphodiesterase inhibitor (vasodilates blood vessels, and bronchodilates)
• avoid caffeine -> too much stimulation

Question 4

inhaled anticholinergics (reduce effects of acetylcholine) Ex. atrovent, iprotropium

Answer 4

• promote bronchodilation by blocking muscarinic Ach receptors)

Question 5

Meds to Prevent Asthma attacks in those with chronic asthma (4)

Answer 5

1. Corticosteroids - most effective and most commonly used
2. Mast cell stabilizers
3. Leukotriene modifiers
4. Monoclonal Antibodies

Question 6

Corticosteroids

Answer 6

• reduce inflammation and immune response, thus decreasing frequency of asthma episodes
• risk of masking infections and suppressing inflammatory response
• adverse effects (corticosteroids toxicity)
• increase blood glucose levels: use with caution in diabetics

Question 7

Mast cell stabilizers

Answer 7

• mast cells respond to environmental triggers or allergens by releasing histamine in the body which causes inflammation of bronchi
• mast cell stabilizers prevent histamine release and are used to prevent asthma episodes
• MDI or nebulizer

Question 8

Leukotriene Modifiers

Answer 8

• Reduce inflammation through two mechanisms
• blocking enzyme that controls leukotriene synthesis
• blocking leukotriene receptors
• Leukotrienes cause tightening of airway muscles and the production of excess mucus and fluid.

Question 9

Leukotriene

Answer 9

promote inflammation and recruit WBCs to site of injury

Question 10

Monoclonal Antibodies

Answer 10

• prevent release of histamine by mast cells through a different mechanism from mast cell stabilizer
• last resort

Question 11

3 components of an asthma attack

Answer 11

1. Bronchoconstriction
2. increased production of secretions, an inflammatory response, a very thick and viscous fluid
3. pulmonary capillaries become engorged with blood, because of the inflammatory response they go into edematous state. They vasodilate and release fluid into the lungs which further fills the lung space with fluid.

Question 12

Long-acting:

short-acting:

Answer 12

• salmeterol (Beta2agonist)

- Albuterol Beta2agonist)

Question 13

order of meds taken to terminate an asthma attack important

Answer 13

• short acting bronchodilator first (anticholinergic or beta-adrenergic agonist) and then a long-term corticosteroid

Question 14

MDI - metered dose inhaler

Answer 14

• pressurized devices that deliver a measured dose of drug with each activation
• hand-mouth coordination is required
• when 2 or more puffs are needed, inform the patient that at least 1 minute should be allowed between puffs

Question 15

DPI - Dry powder inhaler

Answer 15

• drugs are in the form of dry micronized power

- no propellant is employed

Question 16

Antitussives

Answer 16

• opioids - raise the cough threshold in CNS because it suppresses the CNS
• non-opioids - raises the cough threshold of the CNS (anesthetizes carina)