Chapter 35 & 48 (Learning Outcomes) Flashcards
What are some examples of respiratory conditions that affect the patient’s ability to move air into and out of the lungs?
- Pneumonia
- Bronchitis
- Chronic obstructive pulmonary disease
- Cystic fibrosis
Why is the lower respiratory tract basically sterile?
Because of the various defense mechanisms of the upper respiratory systems
What are the three layers of the bronchial tubes?
- Cartilage
- Muscle
- Epithelial cells
What do all of the tubes in the lower airway produce?
Mucus
- to entrap any particles that may have escaped the upper airway protective mechanisms
What is perfusion?
Blood delivery to the alveoli
What is respiration?
Exchange of gases at the alveolar level
- oxygen and carbon dioxide
What is ventilation?
The act of breathing
What does stimulation of the sympathetic nervous system do to breathing?
Increases rate and depth of respiration
- dilates the bronchi to allow freer airflow through the system
What is CAL (chronic airway limitation)?
An umbrella term that describes gradually progressive, degenerative diseases
(Chronic bronchitis, emphysema, repeated asthma attacks)
What happens to the airways during chronic bronchitits?
Continuous inflammation of the bronchial tree
- destroyed the cells
- cilia are absent
- defense mechanism against invading foreign material is lost
What happens to the airways during emphysema?
Abnormal distention of the lungs with air
- loss or degeneration of elastic tissue
- breakdown of alveolar walls
What is the role of mucolytic drugs?
Break down mucus and help the high-risk respiratory patients cough up thick, tenacious secretions
What is the prototype drug for mucolytics?
Acetylcysteine (Mucomyst)
What drug is used for patients that have developed atelectasis (b/c of thick mucus secretions)?
Acetylcysteine
Describe the pharmacodynamics of Acetylcysteine
Affects the mucoproteins in the respiratory secretions
- splits disulfide bonds that are responsible for holding the mucous material together
What is the result of using Acetylcysteine (Mucolytics) on secretions?
Decrease in the tenacity and viscosity of the secretions
What are the benefits of using acetylcysteine on the liver?
Protects against episodes of Tylenol toxicity
How does Acetylcysteine prevent Tylenol toxicity?
Binds with the reactive hepatotoxic metabolite of acetaminophen
In order to maximize the effects of acetylcysteine, what should you administer first?
Inhaled beta agonist
- to dilate the bronchial tree and enable the drug to permeate the entire tree
What are bronchodilators used to facilitate?
Respiration
- by dilating the airways
What is the bronchodilator (selective beta-2 agonist) used in managing CAL and asthma?
Albuterol (Ventolin)
What dietary component increases the risk of adverse effects of albuterol?
Caffeine
- tea, soda, cocoa, candy and chocolate should also be moderated
What drug is the drugs of choice for patients in the ER that are experiencing an acute asthma attack?
Albuterol
What is a common adverse effect of inhaled and oral albuterol (Ventolin)?
Palpitations
What is an indication that a patient may need to use an aerochamber (spacer) with their MDI (metered dose inhaler)?
If the patient has difficulty synchronizing the MDI with their inspiration
What drugs are considered first-line treatment for patients with CAL whose symptoms have become persistent (chronic)?
Inhaled anticholinergic drugs
- Ipratropium bromide (Atrovent)
What are the contraindications for Ipratropium Bromide (Atrovent) (4)?
- Sensitivity to ipratropium and atropine
- Bladder obstruction
- Prostatic hypertrophy
- Closed-angle glaucoma
- could precipitate urinary retention and increase intraocular pressure
What are the classic adverse effects of Ipratropium bromide (Atrovent) (4)?
- Dry mouth
- Constipation
- Urinary retention
- Blurred vision
What is important to know for patient education regarding Ipratropium Bromide?
It will NOT abort an acute asthma attack
What is the therapeutic response expected from the theophylline drugs (Xanthine derivative?
Symptomatic relief or prevention of bronchial asthma and reversal of bronchospasm assoicated with CAL
- excellent bronchodilators
- don’t work as fast as beta-adrenergic agonist drugs (Albuterol)
What are the most common adverse effects of Theophylline?
Nausea, vomiting, headache and insomnia
What is the most effective anti-inflammatory drug available for managing respiratory disorders?
Glucocorticoid steroids
What is the prototype drug for inhaled corticosteroid (ICS) agents?
Flunisolide (AeroBid)
What is a technique patients can use to know when their inhaler canister is empty?
Count their uses and keep track
What does Flunisolide inhibit?
Production of leukotrienes and prostaglandins
In what circumstance is Flunisolide contraindicated?
In patients with an active infection
- b/c it suppresses the immune response
What is a common adverse effect of Flunisolide?
Candida albicans infections
- associated with daily use
What should be done after administering Flunisolide?
Rinsing the mouth
- prevents thrush
- decreases amount of drug swallowed
What are some things that we should education our patients on regarding Flunisolide (5)?
- Oral hygiene
- Proper use of MDI
- S/S oropharyngeal candidiasis (white spots and painful swallowing)
- Rinsing mouth after
- Daily use (regardless of absence of symptoms)
What happens when mast cells rupture?
Release histamine, serotonin, bradykinin, and leukotrienes
- cause an inflammatory response
- such as bronchial constriction
What is the prototype drug for mast cell stabilizers?
Cromolyn Sodium
What is Cromolyn Sodium used for?
Prophylactically in treating mild to moderate asthma and acute bronchospasm
- induced by exercise, environmental pollutants and known antigens
Describe the pharmacodynamics of Cromolyn Sodium
Works at the surface of mast cells to inhibit rupturing and degranulation after contact with an antigen
What is an absolute contraindication for Cromolyn Sodium?
Patients that have a demonstrated hypersensitivity
- anaphylaxis can occur
Other than hypersensitivity to Cromolyn Sodium, what are other contraindicators?
- For treating acute bronchospasm or status asthmasticus
- In patients with CAD or cardiac dysrhythmias
- Patients that have a lactose intolerance
What is the prototype drug for Leukotriene receptor antagonsits?
Zafirlukast (Accolate)
What is Zafirlukast used for?
Treating chronic asthma
How can you maximize the effects of Zafirlukast?
Take 1 hour before or 2 hours after a meal to increase the bio-availability of the drug
When should Zafirlukast not be used?
During an acute asthma attack
What should the patient report if using Zafirlukast and hepatic injury is suscepted?
- abdominal pain
- jaundice
- nausea
- vomiting
- dark urine
A patient prescribed an inhaled corticosteriod (ICS) for daily use need to be monitored for …?
Dysphonia and oropharyngeal Candida Albicans infection
What is acteylcysteine (Mucomyst) used to treat?
Cystic fibrosis
What are the two main categories of drugs used to manage CAL?
- Bronchodilators
2. Anti-inflammatories
What is the only type of drug used to treat acute asthma attacks?
Short-acting beta-agonist drugs
What is the adrenal cortex primarily involved in?
Synthesis and secretion of glucocorticoids and mineralcorticoids
What do the metabolic effects of glucocorticoids result in?
- increase in circulating amino acids
- overall depletion of muscle proteins
- mobilization of fatty acids for energy
What are three factors that are important in regulating ACTH secretion?
- circulating cortisol levels
- stress levels
- circadian rhythms
What is the most prevalent naturally occuring mineralcorticoid in the body?
Aldosterone
What are the two forms of adrenal insufficiency?
- Primary
2. Secondary
What is an example of a disease that is a primary adrenal insufficiency?
Addison’s disease
- destruction of adrenal cortex by infection or hemorrhage
What happens if there is a sudden withdrawal from long-term therapy of a glucocorticoid drug?
Secondary adrenal insufficiency
What adrenal cortex disorder is associated with hirsutism?
Cushing’s Syndrome
- increased adrenocortical secretion of cortisol
What are the two primary endogenous glucocorticoids produced by the adrenal gland?
- Cortisol (Hydrocortisone)
2. Cortisone
What are cortisol and cortisone used for?
Replacement therapy in patients with adrenal insufficiency
- no role in anti-inflammatory regimen
What is the prototype drug for glucocorticoids?
Prednisone
How do you prevent secondary adrenal insufficiency if you stop taking glucocorticoids?
Wean patients off of them
What is prednisone used for?
Anti-inflammatory effects and immunosuppressive effects
Specifically, which clinical manifestations is prednisone used to treat?
- asthma
- allergies
- RA
- ulcerative colitis
- skin disorders
- leukemia
- acute gout
- prevents organ transplant rejection
What are the two kinds of therapy that can be used with Prednisone?
- Short-term (acute allergic reactions)
- Long-term (COPD, asthma, ulcerative colitis)
How does Prednisone cause edema and hypertension?
It can cause salt and water retention leading to edema and hypertension
What are the immunosuppressant effects of prednisone attributable to?
- Suppression of phagocytosis
- Decrease in # of circulating eosinophils and lymphocytes
- Decrease in antigen-antibody tissue reactions
- Decrease in plasma immunoglobulins
If you have a patient that is on a long-term prednisone therapy, what should they be aware of?
That they should wear medical indentification so that any emergency medical personnel will know about the drug therapy
What should you recommend to your patient if they forgot to take his daily dose (5 mg) of prednisone - what would you instruct him to do?
Take the missed dose as soon as possible then resume the regular schedule
Name 4 physical characteristics of Cushingoid that occur above the shoulders
- Moon face
- Glaucoma and cataract formation
- Hirsutism and masculinization
- Cervicodorsal fat (buffalo hump)
Name 4 physical characteristics of Cushingoid that occur at the trunk region
- Abdominal striae (purple)
- Protuberant abdomen
- Truncal obesity
- Extremity thinning and atrophy (arms)
Name 2 physcial characteristics of Cushingoid that occur below the waist (legs)?
- Swelling (fluid retention and edema)
2. Brittle bones (osteoporosis)
State the pharmacologic classification of the glucocorticoid Prednisone.
A synthetic analogue of cortisone
- the prototype glucocorticoid
What are the long-term or high-dose effects of prednisone therapy on the musculoskeletal system?
Osteroporosis
- due to its association with increased bone mineral density loss
- putting the patient at a higher risk for fracture
- enhances calcium loss
True or False:
There is a direct correlation between the extent of bone loss and the duration of prednisone therapy
True
An older adult patient on long-term prednisone therapy should be instructed to …?
Take measures to minimize the risk of falls
- there is an increased risk of bone fractures on long-term prednisone therapy
What is the naturally occurring mineralocorticoid in the body?
Aldosterone
What is the prototype drug for mineralocorticoids?
Fludrocortisone (Florinef Acetate)
True or False:
Fludrocortisone is 20x more potent than hydrocortisone
False
- only 15x more potent
What is Fludrocortisone used for?
- partial replacement therapy for primary and secondary adrenocortical insufficiency in Addison’s disease
- for treating salt-losing adrenogenital syndrome
What are the adverse effects of Fludrocortisone in small doses (3)?
- *sodium retention
- *increased urinary potassium excretion
- rise in blood pressure
What are the adverse effects of Fludrocortisone in larger doses?
- inhibits endogenous adrenal cortical secretion and pituitary corticotropin excretion
- promotes deposition of liver glycogen
What are corticosteroids used for?
- anti-inflammatory properties
- reduce inflammation and swelling
- anti-allergenic
- immuno-suppressive
What are short-term glucocorticoid therapies used for?
Treating acute allergic reactions
What are long-term glucocorticoid therapies used for?
Acute exacerbation of chronic diseases (COPD, asthma, ulcerative colitis)
Describe the pharmacodynamics of Fludrocortisone
Acts on the distal tubule to enhance the reabsorption of sodium and to increase the urinary excretion of both potassium and hydrogen ions
(increases sodium = water retention)
