Asthma

Question 1

Pathophysiology of asthma

Answer 1

• Symptoms of asthma result from a combination of inflammation and bronchoconstriction, so treatment must address both components

Question 2

Drugs used for Asthma

Answer 2

• anti-inflammatory agents (glucocorticoids)

- Bronchodilators (beta 2 agonists)

Question 3

Glucocorticoids

Answer 3

• include budesonide (entocort) and fluticasone (AeorBid)
• reduce bronchial hyperreactivity and also decrease airway mucus production and increase the number of bronchial beta 2 receptors as well as their responsiveness to beta 2 agonists
• usually administered by inhalation but IV and oral are also options
• MOA is to suppress inflammation (decreased synthesis and release of inflammatory mediators, decreased infiltration and activity of inflammatory cells, and decreased edema of the airway mucosa

Question 4

Adverse Effects of Glucocorticoids

Answer 4

• adrenal insufficiency, osteoporosis and resultant fractures, infection, glucose intolerance, myopathy, and growth retardation

Question 5

Leukotrine Modifiers

Answer 5

• zileuton, Zafirlukast, and Montelukast

- suppresses the effects of leukotrienes but are less effective that inhaled glucocortocoids

Question 6

Cromolun

Answer 6

• used for prophylaxis, not for quick relief
• suppresses inflammation; not a bronchodilator
• adverse effects include a cough and bronchospasm

Question 7

Bronchodilators: Beta 2 Adrenergic Agonists

Answer 7

• include albuterol, salmeterol, and terbutaline
• most effective drugs for relief of acute bronchospasm and prevention of exercise induced bronchospasm
• used in asthma as both quick relief and long term control
• adverse effects include tachycardia, angina, tremor, and tachydysrhythmias
• MOA is the activation of beta 2 receptors in the smooth muscle of the lung, promoting bronchodilation

Question 8

Nursing Management of Beta 2 Adrenergic Agonists

Answer 8

• caution with clients who have a history of cardiac dysrhythmias, coronary insufficiency, hypertension, pheochromocytoma, or a previous intolerance to other sympathomimetic agents
• educate patients on inhaler use, tolerance, and to rinse mouth after inhalation

Question 9

Bronchodilators: Methylxanthines

Answer 9

• theophylline, aminophylline, and dyphylline
• benefits derive primarily from bronchodilation
• relaxes smooth muscle, stimulates cardiac muscle & CNS, and produces diuresis

Question 10

Nursing management of Methylxanthines

Answer 10

• caution with clients who have a history of active gastritis or ulcer, severe cardiac disease, pregnant women, breastfeeding women, or smoking
• Education includes no OTC drugs with Ephedrine for cough, limit caffeine, limit charcoal broiled food, and a constant diet