Respiratory Tract Drugs: Asthma and COPD - Ch. 79

Question 1

What is bronchial asthma?

Answer 1

Recurrent and reversible shortness of breath tyhat occurs when airways narrow

Question 2

What causes the airways to narrow during bronchial asthma?

Answer 2

Bronchospams
Inflammation of the bronchial mucosa
-edema

Question 3

What is the name for a prolonged asthma attack?

Answer 3

Status asthmaticus

Question 4

What is COPD?

Answer 4

Chronic obstructive pulmonary disease
-Chronic bronchitis and emphysema

Obstruction always there but can vary in severity

Question 5

What occurs during COPD?

Answer 5

Continuous inflammation of the bronchi and bronchioles

Question 6

What are some respiratory tract drugs?

Answer 6

Bronchodilators
Anti-inflammatory drugs

Question 7

What are the kinds of Bronchodilators?

Answer 7

β2-adrenergic agonists
Anticholinergics
Xanthine derivatives

Question 8

Example of a β2-adrenergic agonist?

Answer 8

Salbutamol (Ventalin or Albuteral)

Question 9

Example of an Anticholinergic?

Answer 9

Ipratropium bromide (Atrovent)

Question 10

Example of a Xanthine derivative?

Answer 10

Theophylline/Aminophylline

Question 11

What are the kinds of respiratory tract anti-inflammatory drugs?

Answer 11

Glucocorticoids
Leukotriene modifiers

Question 12

Examples of glucocorticoids?

Answer 12

Budesonide (Pulmicort)
Fluticasone (Flovent)
combination therapy (Advair diskus)

Question 13

Example of a Leukotriene modifier?

Answer 13

Montelukast (singulair)

Question 14

What are β-adrenergic agonist bronchodilators?

Answer 14

Sympathomimetic bronchodilators
-Stimulate bronchial smooth muscle β2-adrenergic receptors

Question 15

What are the kinds of β-adrenergic agonist bronchodilators?

Answer 15

Short-acting B agonists (SABA)
Long-acting B agonists (LABA)

Question 16

Selective β2 drugs do what?

Answer 16

Activate airway smooth muscle β2 adrenergic receptors

Question 17

Example of a SABA bronchodilator?

Answer 17

Salbutamol

Question 18

Examples of LABA bronchodilator?

Answer 18

Salmeterol
Formoterol

Question 19

β-agonist bronchodilator mechanism of action?

Answer 19

Dilate airways by activating smooth muscle β2-receptors

Question 20

What happens when β-agonists activate smooth muscle β2-receptors?

Answer 20

Smooth muscle relaxes in airways and causes bronchial dilation which increases airflow

Question 21

What are β-agonists used for?

Answer 21

Relief of bronchospasm related to asthma, COPD, and other pulmonary diseases

Question 22

Why is β-agonist treatment used?

Answer 22

Acute attacks
-Quickly reduces airway constriction
Prevents attacks -chronic management

Question 23

What adverse effects are common to all β-agonists?

Answer 23

Cardiac stimulation - tachycardia
Tremors
Restlessness, insomnia (CNS stimulation)

Question 24

Salbutamol β-agonists adverse effects?

Answer 24

β2 receptor effects e.g, muscle tremor, CNS (anxiety, nausea)
Decrease receptor selectivity - stimulates β1-adrenergic receptors in heart
-increased HR, palpitations, chest pains, angina

Question 25

Salbutamol adverse effects are caused by what?

Answer 25

If inhaled form is used too frequently More likely with oral preparations

Question 26

What should the nurse encourage when a client is using β-agonist bronchodilators?

Answer 26

Measures that promote good state of health e.g, Quit smoking, avoid exposure to allergens, stress, pollutants Adequate fluid intake

Question 27

What therapeutic effects should the nurse monitor for when β-agonist bronchodilators are being used?

Answer 27

Decreased dyspnea Decreased wheezing, restlessness and anxiety Improved respiratory patterns with return to normal rate and quality Improved activity tolerance

Question 28

What is the mechanism of action of anticholinergic bronchodilators?

Answer 28

Block the action of ACh. Muscle relaxes, airways open

Question 29

What do anticholergics prevent?

Answer 29

Bronchoconstriction if fixed, scheduled use -Helps with COPD

Question 30

Anticholinergics are not used alone for what?

Answer 30

Acute exacerbations -Used with SABA

Question 31

Adverse effects associated with anticholiergics?

Answer 31

Dry mouth or throat (cough) Minimal systemic effects

Question 32

What is the oral form of methylxanthines?

Answer 32

Theophylline

Question 33

What is the IV form of methylxanthines?

Answer 33

Aminophylline -More water-soluble form of Theophylline

Question 34

What is the mechanism of action of methylxanthines?

Answer 34

Cause an intracellular increase in levels of cAMP and bind to adenosine receptors and cause antagonist effects Have anti-inflammatory properties

Question 35

Methylxanthines provide quick relief for what?

Answer 35

Bronchospasm -Bronchodilation effects, greater airflow

Question 36

What are Methylxanthines (Xanthine derivatives) used for?

Answer 36

Mild to moderate cases of acute asthma ASjunct agent in the management of COPD

Question 37

What adverse effects are associated with Methylxanthines?

Answer 37

CNS stimulation (anxiety, insomnia, seizures) CV stimulation GI distress (nausea, vomiting)

Question 38

What CV adverse effects are cause by Methylxanthines?

Answer 38

Palpitations (increased force of contraction/fast HR) Sinus tachycardia (Increased HR) ventricular dysrhythmias Diureses (increased blood flow to kidneys)

Question 39

What drugs interact with methylxanthine (Theophylline) to increase its effects?

Answer 39

Ciprofloxacin (fluoroquinolone antibiotic) -inhibits CYP Many others

Question 40

Large amounts of what can intensify Methylxanthines' adverse effects?

Answer 40

Caffeine

Question 41

What drugs interact with methylxanthine (Theophylline) to decrease its effects?

Answer 41

Liver enzyme inducers e.g, phenytoin, phenobarbital (antiseizure) -Increases metabolism of theophylline

Question 42

When caring for clients who use Methylxanthines what should be encouraged?

Answer 42

Reporting palpiations, nausea, vomiting, weakness, dizziness, chest pain, convulsions

Question 43

Glucocorticoid drugs have similar action to what?

Answer 43

Cortisol (adrenal steroid hormone)

Question 44

Glucocorticoid structure is based on what?

Answer 44

Cholesterol -Steroid drug

Question 45

What is the high dosing of glucocorticoids used for?

Answer 45

Immunosuppressant effect

Question 46

Inhaled glucocorticoids are used for what?

Answer 46

Chronic asthma and COPD

Question 47

Oral/IV Glucocorticoids are used for what?

Answer 47

Severe/short-term treatment of asthma/COPD

Question 48

Glucocorticoids do not provide what for asthmatic attacks?

Answer 48

Symptomatic relief

Question 49

Inhaled forms of Glucocorticoids reduce what?

Answer 49

Systemic effects

Question 50

How long does it take to see the full therapeutic effects of Glucocorticoids?

Answer 50

Several weeks

Question 51

What is the mechanism of action of Glucocorticoids?

Answer 51

Many mechanisms reduces inflammatory mediators (PGs, LTs, etc) decrease the production of cytokines reduces infiltration and activity of inflammatory cells (e.g. eosinophils, other leukocytes) reduces edema (capillary permeability)

Question 52

Examples of inhaled Glucocorticoids?

Answer 52

Budesonide (Pulmicort) beclomethasone mometasone fluticasone

Question 53

What are Glucocorticoids combined with?

Answer 53

LABAs

Question 54

Examples of Glucocorticoids combination preparations?

Answer 54

Budesonide + formoterol Fluticasone + salmeterol Mometasone + formoterol

Question 55

What is Fluticasone?

Answer 55

When used alone called Flovent When used in combination called Advair diskus (+ salmeterol)

Question 56

Inhaled Glucocorticoids is used in the prophylaxis treatment of what?

Answer 56

Asthma COPD (with LABA)

Question 57

Adverse effects associated with Inhaled Glucocorticoids?

Answer 57

Oral fungal infections Pharyngeal irritation Coughing Dry mouth -Systemic effects are rare bc low doses

Question 58

When should Inhaled Glucocorticoids be avoided?

Answer 58

If candida is present in sputum

Question 59

Inhaled Glucocorticoids may slow what in children?

Answer 59

Slow growth -Doesn't reduce adult height

Question 60

Inhaled Glucocorticoids may cause possible what?

Answer 60

Bone loss

Question 61

How should you administer the doses if a beta-agonist bronchodilator and corticosteroid inhaler are both to be used?

Answer 61

Bronchodilator used several minutes before glucocorticoid to provide bronchodilator before glucocorticoid

Question 62

What should the nurse teach clients to do to prevent oral fungal infections associated with Inhaled Glucocorticoids?

Answer 62

Gargle and rinse the mouth with water afterwards

Question 63

What are Leukotrienes?

Answer 63

Released in immune responses from mast cells, eosinophils, in asthma

Question 64

What do leukotrienes cause?

Answer 64

Inflammation Bronchoconstriction Mucous production Leucocyte recruitment

Question 65

What asthma symtoms do leukotrienes cause?

Answer 65

Coughing, wheezing, shortness of breath

Question 66

What do leukotriene modulators do?

Answer 66

Suppress leukotriene effects -Prevent smooth muscle contraction of bronchiala irways -Decrease mucous secreteion -Prevent vascular permeability -Decrease neutrophil and other leukocyte infiltration to the lungs, preventing inflammation

Question 67

When leukotriene modulators reduce lung inflammation, what happens?

Answer 67

Asthma symptoms relieved

Question 68

What are the kinds of leukotriene modulators?

Answer 68

Leukotriene receptor antagonists Leukotriene synthesis inhibitor

Question 69

Examples of Leukotriene receptor antagonists?

Answer 69

Montelukast (generally well tolerated) Zafirlukast (CYP inhibition, liver injury)

Question 70

Example of Leukotriene synthesis inhibitor?

Answer 70

Zileuton (CYP inhibition, liver injury)

Question 71

What are Leukotriene modulators used for?

Answer 71

Prophylaxis and chronic treatment of asthma in adults and children -Continuous schedule

Question 72

What age children can use montelukast in Canada?

Answer 72

ages 2 and older

Question 73

Leukotriene modulators are not used for what?

Answer 73

Acute asthmatic attacks

Question 74

When using Leukotriene modulators, what improvement should be seen within what time period?

Answer 74

1 day - 1 week