Lower Respiratory Agents
Terms
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- Two main categories of lower respiratory tract diseases?
- COPD and restrictive pulmonary disease
- The cause of COPD
- airway obstruction w/ increased airway resistance of airflow to lung tissues
- Four disorders that can cause COPD
-
chronic bronchitis
bronchiectasis
emphysema
asthma - Are chronic bronchitis, brochiectasis, and emphysema are irreversible or reversible lung damage
- irreversible
- Is the lung tissue damage from acute asthmatic attack reversible or irreversible
- reversible but may be irreversible
- The lung test in COPD
- decreased force expiratory volume 1 second
- What is restrictive lung disease?
- cant get air out due to fluid accumulation or loss of elascity
- What causes restrictive lung disease? (6)
-
pulmonary edema
pulmonary fibrosis
pneumonitis
lung tumors
scoliosis
disorders of thoracic wall - What is asthma
- inflammatory disorders that involve hyperresponsiveness of the airways with varying obstruction
- Wheezing related to chronic bronchitis, emphysema, and bronchiectasis
- there is no wheezing
- Chronic bronchitis is caused by:
- smoking or chronic lung infections
- S/S of chronic bronchitis: (2)
-
bronchial inflammation
excessive mucous secretion in airways - Auscultation of chronic bronchitis:
- Can hear inspiratory and expiratory rhonchi
- What leads to respiratory acidosis?
- hypercapnia and hypoxemia
- What is bronchiectasis?
-
abnormal dialation of the bronchi and bronchioles
mucus becomes stuck and obstructs - What patients are commonly seen with tissue fibrosis?
- HIV pts
- What is paroxysmal?
- whooping cough
- What is emphysema?
- progressive lung disease caused by cigarettes, atmosphere, or alpha1-antitrypsin deficiency
- What is alpha1-antitrypsin?
- inhibit proteolytic enzymes that destroy alveoli
- With emphysema what happens to the proteolytic enzymes?
- They are released in the lung by bacteria or phagocytic cells
- With emphysema what happens to the bronchioles?
- become plugged with mucus, causing loss in the fiber & elastin network in the alveoli (enlarge and destroyed)
- With emphysema what happens to the air?
- air becomes trapped in the overexpanded alveoli, leading to inadequate gas exchange
- Is there a cure for COPD
- no, but it is preventable
- How to bronchodilators help COPD
- assist in opening airways
- How do glucocortocoids help COPD
- decrease inflammation
- How do Leukotriene help COPD
- reduce inflammation in the lung tissue
- How do cromolyn and nedocromil help with COPD
- antiinflammatory
- How do expectorants help with COPD
- assist in loosening the mucous
- How do antibiotics help with COPD
- prevent serious complications from bacterial infections
- Characteristics of bronchial asthma
- periods of bronchospasm resulting in wheezing and difficulty in breathing
- Bronchospasm or bronchoconstriction result from:
- lung tissue exposed to extrinsic & intrinsic factors that stimulate a bronchoconstrictive response
- What drugs can trigger asthma? (3)
-
aspirin
indomethacin (arthritis)
ibuprofen - How are mast cells related to asthma attacks
- They are found in CT bc allergens attatch themselves to mast cells resulting in an antigen antibody response in the lungs
- Mast cells stimulate the release of?
- chemical mediators
- Eosinophil are elevated when?
- During an allergic rx, and indicate an inflammatory process
- What do chemical mediators stimulate (3)
-
bronchial constrictions
mucous secretions/congestions
inflammation - What are histamine and ECF-A?
- strong bronchoconstrictors
- What is cyclic adenosine monophosphate
-
cylic amp or cAMP
cellular signaling molecule
maintains bronchodilation - What increase the amount of cAMP
- sympathomimetic (adrenergic) bronchodilators and methylxanthines
- During an asthma attack what is the first line of defense?
- short acting sympathomimetics (beta2-adrenergic agonists)
- How do the short-acting sympathomimetics help defend an asthma attack?
- promote cAMP production and enhance bronchodilation
- What are long-acting sympathomimetics used for?
- maintenance
- Why is epinephrine (adrenalin) administered during an emergency? (2)
-
restore circulation
increase airway patency - High dose or overuse of beta2-adrenergic agents may cause?
- beta1 responses such as nervousness, tremor, and increased pulse rate
- What does the ideal beta2 agonist do? (3)
-
rapid onset
longer duration
few SE - Drug class for abuterol?
- beta2 adrenergic agonist
- Pregnancy category for abulterol
- C
- Contraindications for abuterol? (4)
-
severe cardiac disease
hyperthyroidism
diabetes mellitus
pregnancy - What drugs increase the effect of albuterol (3)
-
sympathomimetics
MAO inhibitors
tricyclic antidepressants - Lab effects because of albuterol?
-
increase glucose
decrease serum potassium - Where is albuterol absorbed
- GI tract
- Albuterol is used for: (4)
-
bronchospasm
asthma
bronchitis
COPD - Mode of action for albuterol:
- stimulates beta2-adrenergic receptors in the lungs, which relaxes the SM
- SE of albuterol: (4)
-
tremor
dizziness
nervousness
restlessness - Adverse Rx of albuterol: (3)
-
palpitations
reflex tachycardia
hallucinations - Life threatening rx to albuterol
- cardia dysrhythmias
- What is the drug class for metaproterenol:
- bronchodialator: adrengic beta2 and some beta1
- Pregnancy category for metaproterenol
- C
- Contraindications of metaproterenol: (2)
-
hypersensitivity
cardiac dysrhythmias - When giving metaproterenol use caution with these patients: (2)
-
narrow-angle glaucoma
cardiac disease - Drug interactions with metaproterenol: (2)
-
Increase action with sympathomimetics
Decrease with beta blockers - Lab interactions with metaproterenol: (1)
- decrease serum potassium
- Therapeautic effects of metaproterenol: (3)
-
bronchospasm
asthma
promote bronchodialation - SE of metaproterenol: (5)
-
nervousness
tremors
restlessness
hyperglycemia
muscle cramping - Adverse rx of metaproterenol:
- cardiac
- Life threatening reactions of metaproterenol: (2)
-
cardiac
paradoxical-bronchoconstriction - What was the first beta-adrenergic agent used to treat bronchospasm:
- isoproterenol
- What does isoproterenol stimulate:
- beta1 and beta2 receptors
- How is isoproterenol administered:
- inhalation or IV for severe asthma attacks
- Why is isoproterenol rarely prescribed:
- severe SE
- Why is a spacer device used?
- to improve delivery to the lungs with less deposition in the mouth
- What happens if the medication is not inhaled properly?
- it will remain in the upper airways
- What are some SE of using an inhalter: (2)
-
dry mouth
throat irritation - Excessive use of an inhaler can result in: (3)
-
tolerance
loss of drug effectiveness
severe:paradoxical airway resistence - Frequent dosing of an inhaler results in: (3)
-
tremors
nervousness
increased heart rate - SE of epinephrine:
-
tremors
dizziness
cardiac - SE of beta2 drugs:
-
tremors
nervousness - Why do diabetes pts need to monitor glucose level with beta2
- it increases blood glucose
- What class is adrenalin under:
- alpha-beta adrenergic
- What class is formoterol fumarate under:
- beta adrenergic
- Serevent is under what classification:
- beta adrenergic
- Brethine is under what classification:
- beta andrenergic
- What classification is Bricanyl under:
- beta adrenergic
- What classification is atrovent under:
- anticholinergics
- What classification is combivent under:
- anticholinergics
- ipratropium works by:
- dilating the bronchioles
- Clients using beta-agonist inhalant should use it _ mins before ipratropium
- 5mins
- How long should iprotropium be used before a steroid or cromolyn:
- 5mins-so that the bronchioles dialate and the steroid can enter
- Ipratropium is combined with what to treat bronchitis:
- albuterol sulfate
- How do ipratropium bromide and albuterol sulftate work together:
- increase FEV1 which is how asthmatics and lung disease are evaluated
- Xanthines stimulate: (4)
-
CNS
Respiration
dilate coronary &pulmonary
cause diuresis - Xanthines are used in the treatment of:
- asthma
- How does theophylline work:
- relaxes SM of bronchi, bronchioles, pulmonary blood vessels by inhibiting phosphodiesterase
- What happens when phosphiesterase in inhibited
- increase in cAMP which promotes bronchodilation
- The therapeutic index and range of theophylline
-
index:low
range:narrow 10-20mcg/ml - Why is theophylline prescribed:
- maintenance therapy for pts w/ chronic stable asthma or COPDS
- How will food and antacids affect theophylline:
- decrease the rate of absorption
- How will large amts of fluid and high protein meals affect theophylline:
- increase rate of absorption
- How does tobacco smoking effect theophylline:
- decreases half life
- SE of theophylline: (4)
-
anorexia
gastric pain
nervousness
dizziness - adverse effects of theophylline is: (4)
-
intestinal bleeding
cardiac
hyperreflexia
seizures - To avoid SE what medication should not be taken with theophylline:
- xanthines
- Toxicity of theophylline can result in: (3)
-
hyperglycemia
reduced clotting time
increased WBC - Patients should avoid what products when taking theophylline:
- caffeinated products
- What drugs increase the affect theophylline? (3)
-
betablockers
cimetidine
propandol & erythromycin - What drugs decrease the effect of theophylline:
- barbiturate and carbamazepine
- How does theophylline affect digitalis
- increases risk of toxicity
- How does theophylline affect lithium:
- decreases its effects
- What happens if theophylline and beta-adrenergic agonist were given together:
- synergistic affect can occur along with cardiac dysrhythmias
- What is leukotriene:
- chemical mediator that can cause inflammatory changes in the lungs
- What does leukotriene promote: (3)
-
increase eosinophil migration
mucous production
airway wall edema (bronchoconstriction) - What are LT receptor antagonists & LT synthesis (leukotriene modifiers) affect:
- reduce inflammatory symptoms of asthma triggered by allergic & environmental stimuli---not for acute asthma
- What classification is zafirlukast:
- leukotriene modifiers
- How does zafirlukast work:
- acts as an LT receptor antagonist reducing inflmmatory & decreasing bronchoconstriction
- How is zafirlukast administered:
- oral
- What is the half life of zafirlukast:
- moderately long life
- How many times is zafirlukast given a day:
- twice
- What is Zileuton:
- LT synthesis inhibitor
- How does zileuton work:
- it decreases the inflammatory process and bronchoconstriction
- How many times is zileuton administered a day:
- 4
- What ages can take zafirlukast and zileuton:
- adults and children older than 12
- What are glucocoricoids used for:
- treat respiratory disorders particularly asthma
- When are glucocorticoids used:
- if asthma is unresponsive to bronchodilator therapy or if client has an asthma attack while taking theophylline or adrenergic drugs
- Why are inhaled glucocortocoids not helpful treating severe asthma attacks:
- may take 1-4wks for full effect
- Who are given IV glucocorticoids:
- COPD
- What classification is accolate under:
- leukotriene modifiers not for acute asthmatic attack
- What classification is zyflo under:
- leukotriene modifiers not for acute asthmatic attack
- What classification is flonase under:
-
glucocorticoids
glucocorticoids & beta2 agonist combination - What classification is flovent under:
- glucocorticoids
- What classification is Intal under:
-
Cromolyn and Nedocromil
Not use for actue asthma attacks - What classification is Tilade under:
-
Cromolyn and Nedocromil
Not used for acute asthma attacks - What doesn't work on acute asthma attacks?
- glucocorticoids
- What drug class is montelukast under?
- bronochdialator: leukotriene receptor antagonist
- Trade name for monelukast:
- singulair
- Pregnancy category for monelukast?
- B
- Contraindications for monelukast:
-
hypersensitivity
severe asthma attack
status asthmaticus - Use caution w/ montelukast when:
- pt has severe liver disease
- Montelukast lab interactions:
- abnormal liver function test (ALT, AST)
- Excretion of montelukast:
- feces
- Side effects of montelukast: (11)
-
fever
dizziness
fatigue
nasal congestion
cough
sore throat
dental pain
influenza
dyspepsia
abdominal pain
rash - Glucocorticoids can irritate:
- gastric mucosa, take w/ food
- What is Advair diskus:
- glucocorticoid fluticasone propionate 100mcg & salmeterol 50mcg, effective in keep asthma in check
- How is advair used:
- q day inhalation in am & pm
- Advair should not substitute:
- fast acting inhalers
- Purpose of Advair:
- alleviate airway constriction & inflammation
- SE of orally inhaled glucocorticoids:
- local, with fungal infections
- Candida albicans can be prevented with:
- use of spacer, rinsing mouth w/ h2o after each use, & washing apparatus daily with water
- When are adverse SE seen with glucocorticoids:
- 2wks
- Oral and IV steroids are used for:
- prolonged use
- SE of oral & IV steroids:
-
fluid retention
thinning of the skin
purpura
abnormal fat distribution
increased blood sugar
impaired immune
hyperglycemia (oral) - Cromolyn(Intal)is used for:
- prophylactic tx of bronchial asthma and must be taken daily
- Cromolyn should not be used for:
- acute asthmatic attacks
- How does cromolyn sodium acts by:
- inhibiting the release of histamine
- SE of cromolyn :
- cough & bad taste- can be eliminated by drinking water before and after inhalation
- Cromolyn can be used with:
- beta adrenergics and xanthine derivatives
- What is a serious SE of cromolyn:
- bronchospasm
- How does nedocromil work:
- antiinflammatory effect & supresses the release of histamine, leukotrienes, & mediators from mast cells
- When to use nedocromil:
- not during an asthma attack but to prevent bronchospasm & acute asthmatic attack
- Which is more effective cromolyn or nedocromil:
- nedocromil
- Medications used to treat inflammatory effects in children:
- cromolyn & nedocromil
- Medications used to treat asthma attacks in children:
- oral glucocorticoids
- Medications to treat severe athma attacks in children:
- oral beta2-adrenergic agonist
- Frequent use of glucocorticoids can cause _ in old ppl:
-
increase risk of:
cataracts
osteoporosis
diabetes mellitus - If a theophylline drug is ordered for an older person what should happen:
- glucocorticoids are decreased
- Mucolytics work by:
- detergents by liquefying & loosening thick mucous secretions & work like an expectorant
- How is mucomyst administered:
- nebulization
- Mucomyst can be administered w/ ___ for what purpose:
- bronchodilator for asthma or hyperactive airway disease bc increased secretions may obstruct bronchial airway
- If giving mucolytic when should the bronchodialator be used:
- bronchodialator should be given 5mins before
- SE of mucolytics: (2)
-
stomatitis (oral ulcers)
runny nose - Mucomyst can be used as an antidote for:
- acetaminophen if given w/in 12-24h-diluted in juice or soft drinks
- What is pulmozyme:
- enzyme that digests the DNA in thick sputum secretions of clients with cystic fibrosis
- What does pulmozyme do:
- reduce respiratory infections & improves pulmonary function
- When does pulmozyme work:
- w/ 3-7 days
- SE of pulmozyme:
-
chest pain
sore throat
laryngitis
hoarsenss - PEF or FEV/PEF variability of severe persistent asthma attack:
- <60%/>30%
- Treatment for severe persistent asthma attack:
- high-dose inhaled corticosteroids, long acting inhaled beta2 agonists, possibly corticosteroids tab/syrup 2mg/day
- Symptoms of moderate persistent:
- daily/>1night/wk
- PEF or FEV/ PEF variability of moderate persistent:
- >60%to<80%/ >30%
- Tx for moderate persistent:
- low-med inhaled corticosteroids & long acting inhaled beta2 agonists
- Alternative tx for moderate persistent:
- increase inhaled corticosteroids w/ low dose w/ leukotriene modifier or theophylline
- Symptoms with mild persistent:
- >2/wk but <1day/>2nights/mo
- PEF or FEV/PEF varibility for mild persistent:
- >80%/20-30%
- Tx of mild persistent:
- low-dose inhaled corticosteroids
- Alternative tx for mild persistent:
- cromolyn, leukotriene modifier, nedocromil or sustained release theophylline to serum concentration of 5-15mcg/ml
- Symptoms for mild intermittent:
- <2days/wk/ <2nights/mo
- PEF or FEV/ PEF variability:
- >80%/<20%
- Tx for mild intermittent:
-
no daily meds
course of systemic corticosteroids - Quick relief of asthma attacks:
- short acting bronchodialators: 2-4 puffs short acting inhaled beta2 agonists PRN, up to 3Tx at 20min intervals or single nebulizer Tx PRN, maybe course of systemic corticosteroids
- What indicates the need for long term therapy for asthma:
- use of short acting beta2 agonists > 2times/wk in intermittent asthma (daily or increasing use)