Block 3 respiratory slides+ SG

Question 1

Respiratory disease includes:

Answer 1

Asthma
COPD 
Lung cancer
Obstructive sleep apnoea
Bronchiectasis
Childhood bronchiolitis
Childhood pneumonia

Question 2

Asthma in New Zealand

Answer 2

• 1 in 9 adults and 1 in 7 children

- Māori are 3.4 times and Pacific peoples 3.9 times more likely to be hospitalised

Question 3

COPD in New Zealand

Answer 3

-4th leading cause of death in NZ
-3.7 times higher for Māori and 2.8 times higher for
Pacific people

Question 4

What is Asthma?

Answer 4

a chronic lung condition. a condition in which the airways are more sensitive than normal and tend to narrow in response to certain triggers

Question 5

the narrowing of airways is due to?

Answer 5

swelling of the lining of the airway
• increased mucous in the airway
• ‘Bronchospasm’

Question 6

what is bronchospasm?

Answer 6

contraction of the muscle layer surrounding the airway

Question 7

COPD refers to?

Answer 7

chronic bronchitis and emphysema. co-existing diseases of the lungs result in narrowing of the airways and potential loss of viable lung tissue

Question 8

what happens when you have COPD?

Answer 8

limitation of the flow of air to and from the lungs and

poor gaseous exchange.progressive lung disease.

Question 9

Pharmacological therapy 2 main groups

Answer 9

Bronchodilators and Anti-inflammatory agents

-aims to improve air flow in and out of lungs, improve gaseous exchange in alveoli, provide o2 & removal of co2

Question 10

Routes of administration

Answer 10

Inhaled (aerosols, nebules), oral (liquid, tablets), IV (injections)

Question 11

what does bronchodilators do?

Answer 11

relieve the constriction of the bronchi allowing air into the lungs for gaseous exchange

Question 12

when do you use bronchodilators?

Answer 12

used in acute situations
when rapid response is required (short acting) and as long-term symptom
controllers/maintenance treatment (long-acting)

Question 13

what are the types of bronchodilators used?

Answer 13

B-adrenergic agonists, antimuscarinics, and

methylxanthines.

Question 14

what is B2-adrenergic agonists?

Answer 14

selectively bind to B2-adrenergic receptors and

stimulate a sympathetic nervous system response leading to bronchodilation.

Question 15

SABA (Short-acting beta-2 agonist) available in inh,nebs,inj

Answer 15

fast acting bronchodilators and are known as relievers. These are used for quick relief of bronchospasm.

• salbutamol
• terbutaline

Question 16

LABA (Long-acting beta-2 agonist)available in inh,nebs,inj

Answer 16

have t½ of 6-12 hours and are administered once or twice daily. They are known as symptom controllers / maintenance
treatment and are to be used in conjunction with inhaled corticosteroids
for asthma
-salmeterol
-formeterol

Question 17

how to use inhalers

Answer 17

pressing down on inhaler, breathing in deeply as soon as medication is released,
holding your breath, exhaling

Question 18

Advantages of Using Spacer

Answer 18

Avoids timing issue
• More drug gets into lungs
• Less drug needed for effective dose
• Fewer adverse effects
• Easier to deliver medication

Question 19

Antimuscarinics- Onset of action slower than b-agonists

Answer 19

drugs block the muscarinic
receptors involved in the parasympathetic stimulation of the
bronchioles

Question 20

Antimuscarinics drugs

Answer 20

Short Acting: ipratropium (Atrovent)

• Long Acting: tiotropium (Spiriva); glycopyrronium (Seebri)

Question 21

Therapeutic Action:

Answer 21

bronchodilation and decreased mucous secretion

Question 22

Adverse effects

Answer 22

dry mouth/throat irritation, blurred vision, tachycardia, urinary retention, constipation

Question 23

Methylxanthines drugs & MOA

-caffeine

Answer 23

• theophylline (Nuelin) (oral) and aminophylline (injection)

- a complex mechanism by inhibiting the enzyme that degrades cAMP (second messenger system)

Question 24

Adverse effects

Answer 24

insomnia, anxiety, tremors,

tachycardia, epigastric pain, nausea (due to lack of specificity, the drugs ↑ cAMP levels in other cells)

Question 25

Anti-Inflammatory Drugs

Answer 25

reduce the inflammatory response, stabilise mast
cells, reduce release of inflammatory mediators (such as histamine,
leukotrienes) and reduce localized oedema and mucous production
-Steroids (systemic or topical)
-Mast cell stabilisers
-Leukotriene receptor antagonists

Question 26

how long does it take for Anti-inflammatory Agents to work?

Answer 26

take time to work and so are used as a preventative measure and will not give a rapid response in an acute situation.

Question 27

Steroidal Anti-inflammatory MOA & drugs

Answer 27

inhibits the rupture of mast cells, decreases the inflammatory mediators, suppresses antibody production and immune cells -Inhaled corticosteroids: fluticasone (Flixotide);
budesonide (Pulmicort); beclometasone
-Systemic corticosteroids: prednisone (tablet);
prednisolone (oral liquid); methylprednisolone (IV)

Question 28

Long term systemic administration has been associated with significant
adverse effects

Answer 28

-fluid& electrolyte imbalance,- nitrogen& calcium balance, immunosuppressive
therefore, there has been a reduction in systemic use in treating asthma.

Question 29

Inhaled corticosteroids

Answer 29

can be used alone or in conjunction with a bronchodilator as this facilitates lung penetration of the inhaled steroid.

Question 30

Systemic steroids

Answer 30

achieve better control during episodes of exacerbation or infection, but in order to avoid problems with adverse effects, they are prescribed in short courses.
-oral

Question 31

Corticosteroids + Bronchodilators Combined Formulations

Answer 31

Seretide -fluticasone and salmeterol

Symbicort- budesonide & eformoterol “SMART” therapy for maintenance &reliever.

Question 32

Mast-cell stabilisers

eg: Sodium cromoglicate
- not for acute attack

Answer 32

inhaled and used as an add-on treatment to prevent release of inflammatory mediators from sensitized mast cells.

Question 33

Adverse effects

Answer 33

minimal throat
irritation, nausea and unpleasant taste
being most common

Question 34

Mast-cell stabilisers used for?

Answer 34

used prophylactically and

reduce the incidence of acute asthma attacks

Question 35

Leukotriene Receptor Antagonists

-montelukast (Singulair)

Answer 35

mediate inflammatory reactions, thus this
class of drug acts by blocking the action of these
inflammation mediators and alleviating the symptoms

Question 36

Adverse effect

Answer 36

headache, GI upset, thirst