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Pharmacology > Chapter 37 Respiratory Drugs > Flashcards

Chapter 37 Respiratory Drugs Flashcards

1
Q

The LRT is located almost entirely within the thorax and is composed of the?

A

trachea, all segments of the bronchial tree, and the lungs.

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2
Q

Diseases that affect the URT include colds, rhinitis, and hay fever. The major diseases that impair the function of the LRT include?

A

asthma, emphysema, and chronic bronchitis. All of these diseases have one feature in common, they all involve the obstruction of airflow through the airways.

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3
Q

Bronchial asthma is defined as a recurrent and reversible shortness of breath and occurs when the?

A

airways of the lung become narrow as a result of bronchospasm, inflammation and edema of the bronchial mucosa, and the production of viscous mucus.

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4
Q

Allergic asthma, or extrinsic asthma, is caused by a hypersensitivity to an allergen or allergens in the environment.
• Intrinsic, or idiopathic, asthma does not have a specific cause but certain factors have been noted to precipitate asthma attacks including?

A

respiratory infections, stress, and cold weather.

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5
Q

Chronic bronchitis is a continuous inflammation and low-grade infection of the bronchi. The inflammation in the bronchioles is responsible for?

A

most of the airflow obstruction.

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6
Q

Emphysema is a condition in which the air spaces enlarge as a result of the destruction of the alveolar walls, caused by the effect of proteolytic enzymes released from leukocytes in response to?

A

alveolar inflammation.

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7
Q

In the past, the treatment of asthma and other chronic obstructive pulmonary diseases (COPDs) was focused primarily on the use of drugs that cause the airways to dilate; now the focus has shifted from the bronchoconstriction component of the disease to the?

A

inflammatory component.

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8
Q

Bronchodilators relax bronchial smooth muscle, which causes dilation of the bronchi and bronchioles that are narrowed as a result of the disease process. There are three classes of such drugs:

A

(1) beta-adrenergic agonists
(2) anticholinergics
(3) xanthine derivatives

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9
Q

The beta-adrenergic agonists are commonly used during?

A

acute phase of an asthmatic attack to quickly reduce airway constriction and restore airflow to normal. They are agonists, or stimulators, of the adrenergic receptors in the sympathetic nervous system.

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10
Q

Short-acting beta agonist (SABA) inhalers include albuterol (e.g., Ventolin), levalbuterol (Xopenex), pirbuterol (Maxair), terbutaline (Brethine), and metaproterenol (Alupent).

A

.

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11
Q

Long-acting beta agonist (LABA) inhalers include arformoterol (Brovana), formoterol (Foradil, Perforomist), and salmeterol (Serevent). Because the LABAs have a longer onset of action, they must never be used for acute treatment.

A

.

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12
Q

The newest LABA are indacterol (Arcapta Neohaler); vilanterol in conjunction with fluticasone (Breo Ellipta); and vilanterol in conjunction with the anticholingeric, umeclidinium (Anoro Ellipta). The term Ellipta refers to a new delivery system. Because the LABAs have a longer onset of action, they must never be used for acute treatment.

A

.

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13
Q

Nonselective adrenergic drugs, such as?

A

epinephrine, stimulate the beta, beta1 (cardiac), and beta2 (respiratory) receptors.

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14
Q

Nonselective beta-adrenergic drugs, such as?

A

metaproterenol, stimulate both beta1 and beta2 receptors

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15
Q

Selective beta2 drugs, such as?

A

albuterol, primarily stimulate the beta2 receptors.

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16
Q

The primary therapeutic effect of the beta agonists is the?

A

prevention or relief of bronchospasm related to bronchial asthma, bronchitis, and other pulmonary diseases. However, they are also used for effects outside the respiratory system.

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17
Q

The broncchioles are surrounded by smooth muscle. When the smooth muscle contracts, the airways are narrowed and the amount of oxygen and carbon dioxide exchanged is reduced. The action of beta agonist bronchodilators begins at the?

A

Specific receptor stimulated and ends with the relaxation and dilation of the airways. Many reactions must take place at the cellular level for bronchodilation to occur. When a beta 2 adregnergic receptor is stimulated by a beta agonist, adenylate cyclase is activated and produces cyclic adenosine monophosphate (cAMP). Adenylate cyclase is an enzyme needed to make cAMP. the increased levels of cAMP cause bronchial smooth muscles to relax, which results in bronchial dilation and increased airflow into and out of the lungs.

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18
Q

Non-selective adrenergic agonist drugs such as epinephrine also stimulate?

A

Alpha-adrenergic receptors, causing constriction w/in blood vessels. This vasoconstriction reduces the amount of edema or swelling in the mucous membranes & limits the quantity of secretions produced by these membranes.
-in addition these drugs stimulate beta 1 receptors resulting in cardiovascular effect such as Increase in HR, force of contraction, and BP, as well as CNS effects such as nervousness and tremor

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19
Q

Drugs such as albuterol that predominantly stimulate the?

A

beta 2 receptors have more specific drug effects and cause less AEs. By primarily stimulating the beta 2-adrenergic receptors of the bronchial and vascular smooth muscles, they cause bronchodilation & may also have dilating effect on the peripheral vasculature

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20
Q

Beta-Adrenergic agonists indications

A

Prevention or relief of bronchospasm related to bronchial asthma, bronchitis, and other pulmonary diseases. Also used for effects outside the respiratory system. Because some of these drugs have the ability to stimulate both beta 1 and alpha adrenergic receptors, they may be used to treat hypotension and shock

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21
Q

Beta-Adrenergic agonists Contraindications

A

known drug allergy, uncontrolled hypertension or cardiac dysrhythmias, and high risk of stroke (because of the vasoconstrictive drug action)

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22
Q

Beta-Adrenergic agonists adverse effects

A

Mixed alpha/beta agonists produce the most adverse effects, including insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, and vascular headache.

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23
Q

The adverse effects of the nonselective beta agonists are

limited to?

A

beta-adrenergic effects, including cardiac stimulation,

tremor, anginal pain, and vascular headache.

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24
Q

The beta2 drugs can cause?

A

hypertension and hypotension, vascular headaches, and tremor.

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25
Q

Overdose management of Beta-adrenergic agonist drugs

A

Careful administration of beta blocker while patient under close observation due to risk for bronchospasm.

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26
Q

Beta-Adrenergic agonists interactions

A
  • when nonselective beta blockers used w/beta agonist the bronchodilation from the agonist is diminished
  • MAOIs and other sympathomimetics should be avoided because the enhanced risk for HTN
  • diabetics may require adjustment in dosage of their hypoglycemic drugs, especially pt’s receiving epinephrine, because of the increase in blood glucose levels can occur
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27
Q

Beta Adrenergic Agonist Drug: Albuterol (Proventil)

A
  • short-acting, beta 2-specific, bronchodilating, beta agonist
  • If used too frequently, dose-related AEs may be seen, because it loses its beta 2 specific actions, especially at larger doses. As a consequence, the beta 1 receptors are stimulated, which causes nausea, increased anxiety, palpitations, tremors, and an increased HR
  • oral & inhalation (metered dose inhaler MDI, solutions)
  • levorotatory isomeric form of albuteral sometimes used as alternative for pt’s w/certain risk factors (tachycardia, including tachycardia associated with albuterol Tx)
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28
Q

Anticholinergic drugs are used for?

A

maintenance and not for relief of acute bronchospasm and work by blocking the bronchoconstrictive effects of acetylcholine ACh.

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29
Q

Mechanism of action for anticholinergic drugs: On the surface of the bronchial tree are receptors for acetylcholine (ACh), the neurotransmitter for the PNS. When PNS releases ACh from its nerve endings, it binds to ACh receptors on the surface of the bronchial tree, resulting in bronchial constriction and narrowing of the airways. Anticholinergic drugs?

A

block these ACh receptors to prevent bronchoconstriction. This indirectly causes airway relaxation and dilation. Anticholinergic agents also help reduce secretions in COPD pt’s

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30
Q

Anticholinergic drugs indications

A

Because their actions are slow and prolonged, anticholinergics are used for prevention of the bronchospasm associated with chronic bronchitis or emphysema.

31
Q

Anticholinergic drugs contraindications

A

-drug allergy, including allergy to atropine.
In the past, an allergy to peanuts or soy was listed as a
contraindication to ipratropium inhalers. This was related to the propellant used and the new HFA inhalers have eliminated the concern. Thus, there is no contraindication using ipratropium in patients with peanut or soy allergies. - Caution necessary with acute narrow-angle glaucoma
and prostate enlargement.

32
Q

Anticholinergic drugs Adverse effects

A

The most commonly reported adverse effects of ipratropium and tiotropium therapy are related to the drugs’ anticholinergic effects and include dry mouth or throat, nasal congestion, heart palpitations, gastrointestinal (GI) distress, urinary retention, increased intraocular pressure, headache, coughing, and anxiety.

33
Q

Anticholinergic drugs interactions

A

Additive toxicity when given with other anticholinergic drugs

34
Q

Anticholinergic drug: Ipratropium (Atrovent)

A
  • liquid aerosol for inhalation and multidose inhaler; both dosed twice daily
  • many benefit taking both a beta 2 agonist and an anticholinergic, most popular combination being albuterol and ipratropium
35
Q

Natural xanthines consist of?

Synthetic xanthines include?

A

-Natural xanthines consist of the plant alkaloids caffeine,
theobromine, and theophylline; theophylline and caffeine
are used.
-Synthetic xanthines include aminophylline and dyphylline

36
Q

Xanthines, such as theophylline, help to relax the smooth muscles of the bronchioles by?

A

inhibiting phosphodiesterase. Phosphodiesterase breaks down cAMP, which is needed to relax smooth muscles. They do this by competively inhibiting phosphodiesterase (enzyme responsible for breaking down cAMP). In pt’s w/COPD, cAMP plays huge role in maintenance of open airways. Higher intracellular levels of cAMP contribute to smooth muscle relaxation and also inhibit IgE-induced release of the chemical mediators that drive allergic reactions (histamine, slow-reacting substance of anaphylaxis, and others)

37
Q

Theophylline is metabolized to?

aminophylline is metabolized to?

A

Theophylline is metabolized to caffeine in the body, aminophylline is metabolized to theophylline.

38
Q

Theophylline and other xanthines also stimulate the CNS

but to a lesser degree than caffeine. This stimulation of then CNS has the beneficial effect of?

A

acting directly on the medullary respiratory center to enhance respiratory drive.

39
Q

Theophylline and other xanthines also stimulate the CNS

but to a lesser degree than caffeine. This stimulation of then CNS has the beneficial effect of?

A

acting directly on the medullary respiratory center to enhance respiratory drive. in larger doses, theophylline may stimulate the cardiovascular system, resulting in both an increased force of contraction (positive inotropy) and an increased HR (positive chronotropy). Increased force of contraction raises cardiac output and hence blood flow to the kidneys. This, in combination w/ability of xanthines to dilate blood vessels in and around the kidney, increases glomerular filtration rate, which produces a diuretic effect

40
Q

Xanthines are used to?

A

dilate the airways in patients with asthma, chronic bronchitis, or emphysema. They may be used in mild-to-moderate cases of acute asthma and as an adjunct drug in the management of COPD.

41
Q

Xanthines are now deemphasized as treatment for milder

asthma because of their?

A

greater potential for drug interactions and the greater interpatient variability in therapeutic drug levels in the blood.
-due to their slow onset of action, they are used for prevention of asthmatic symptoms and COPD, NOT for the relief of acute asthma attacks

42
Q

Caffeine is used without prescription as a CNS stimulant or to?

A

promote alertness. Also used as a cardiac stimulant in infants w/bradycardia and for enhancement of respiratory drive in infants

43
Q

Contraindications for therapy with xanthine derivatives

A

Known drug allergy, uncontrolled cardiac dysrhythmias, seizure disorder, hyperthyroidism, peptic ulcer

44
Q

The common adverse effects of the xanthine derivatives

include?

A

nausea, vomiting, anorexia, and gastroesophageal

reflux during sleep.

45
Q

Xanthine derivative drug: theophylline

A
  • oral, rectal, injectable (as aminophylline), topical
  • aminophylline is used clinically for Tx of bronchoconstriction
  • aminophylline given IV to pt’s w/status asthmaticus who have not responded to fast acting beta agonists (epinephrine)
  • therapeutic range: 10-20 mcg/mL or 5-15
46
Q

Other drugs are effective in suppressing the various underlying causes of some of the respiratory illnesses, including leukotriene receptor antagonists (LTRAs; montelukast, zafirlukast,
and zileuton) and corticosteroids (beclomethasone,
budesonide, dexamethasone, flunisolide, fluticasone, ciclesonide,
and triamcinolone).

A

.

47
Q

In people with asthma, leukotrienes cause?

A

inflammation, bronchoconstriction, and mucus production. This in turn leads to coughing, wheezing, and shortness of breath.

48
Q

LTRAs prevent leukotrienes from attaching to receptors

located on circulating immune cells as well as local immune cells within the lungs. This reduces?

A

inflammation in the lungs.

49
Q

The LTRAs montelukast, zafirlukast, and zileuton are used for the?

A

prophylaxis and long-term treatment and prevention
of asthma in adults and children 12 years of age and older.
-These drugs are not meant for the management of acute
asthmatic attacks.

50
Q

Adverse effects for the nonbronchodilating Leukoterine receptor antagonist

A

Adverse effects include headache, dizziness, insomnia, and dyspepsia. The most common adverse effects of

51
Q

Leukoterine receptor antagonist drug: Montelukast (Singulair)

A
  • Block leukotriene D4 receptors to augment the inflammatory response
  • approved for children 2 yrs & older
  • fewer AEs & drug interactions
  • oral use only
52
Q

Corticosteroids, also known as glucocorticoids, are either

naturally occurring or synthetic drugs used in the treatment of?

A

pulmonary diseases for their anti-inflammatory effects.

53
Q

Corticosteroids have the dual effects of reducing inflammation and enhancing the activity of beta agonists.
• Corticosteroids have also been shown to restore or increase the?

A

responsiveness of bronchial smooth muscle to beta adrenergic receptor stimulation, which results in more pronounced stimulation of the beta2 receptors by beta agonist drugs such as albuterol.

54
Q

The main undesirable effects of inhaled corticosteroids include?

A

pharyngeal irritation, coughing, dry mouth, and oral fungal infections.
-Instruct patients to rinse their mouths after use of an inhaled corticosteroid.

55
Q

When patients are switched to inhaled corticosteroids after receiving systemic corticosteroids, especially at high dosages for an extended period, adrenal suppression (Addisonian crisis) may occur when the systemically administered corticosteroid is not tapered slowly. Patient deaths have been reported due to adrenal gland failure in such cases when the switch is made quickly and the dosage of corticosteroids is not reduced gradually.

A

.

56
Q

There is evidence that bone growth is suppressed in?

A

children and adolescents taking corticosteroids.

57
Q

Assess the patient for the presence of any of the following for respiration drugs:

A

sternal retractions, cyanosis, restlessness, activity intolerance, cardiac irregularities, palpations, hypertension, tachycardia, and use of accessory muscles to breathe, indicating significant respiratory compromise.

58
Q

Assess the patient’s intake of caffeine and use of over-the-counter medications containing caffeine. The intake of caffeine is important because of its?

A

sympathomimetic effects and possible potentiation of adverse effects associated with albuterol and other beta agonists.

59
Q

With use of the nonselective adrenergic agonist drug EpiPen or EpiPen Jr Auto-Injectors, assess for the main indication, which is?

A

emergency use with severe allergic reactions caused by allergens, exercise, and unknown triggers and for those who are at increased risk.

60
Q

For patients taking anticholinergics, include any history of ?

A

heart palpitations, GI distress, benign prostatic hyperplasia and/or urinary retention, and glaucoma due to the adverse effects of the drugs, leading to potentiation of these conditions or symptoms.

61
Q

In patients taking xanthine derivatives, perform a careful cardiovascular assessment, noting?

A

heart rate, blood pressure, and history of cardiac disease, because of the adverse effects of sinus tachycardia and palpitations. GI reflux may also occur with these drugs, so perform an assessment for bowel patterns and pre-existing disease.

62
Q

With corticosteroids, perform a baseline assessment of vital signs, breath sounds, and heart sounds. Assessment for underlying?

A

adrenal disorders is important because of the adrenal suppression that occurs with the use of these medications

63
Q

The use of metered-dose inhalers requires coordination to inhale the medication correctly and to obtain approximately 10% of drug delivery to the lungs. If a second puff of the same drug is ordered, instruct the patient to?

A

wait 1 to 2 minutes between puffs. If a second inhaled drug is ordered, instruct the patient to wait 2 to 5 minutes between the medications or as prescribed.

64
Q

Beta agonists must be taken exactly as prescribed because overdosage may be life threatening. Educate patients not to?

A

crush or chew oral sustained-release tablets and to take them with food to decrease GI upset.

65
Q

For pediatric patients, use of systemic forms of corticosteroids is a concern, possibly leading to?

A

suppression of the hypothalamic-pituitary-adrenal axis and subsequent growth stunting

66
Q

The therapeutic theophylline level is?

A

10 to 20 mcg/mL.

67
Q 
Discharge teaching to a patient receiving a beta-agonist bronchodilator should emphasize reporting which side effect?
  Tachycardia
  Nonproductive cough
  Hypoglycemia
  Sedation.
A

Tachycardia
A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia, and increased alertness.

68
Q

St. John’s wort has been shown to enhance the rate of theophylline metabolism, thus decreasing serum levels.

A

.

69
Q

Nonselective adrenergic agonist bronchodilators stimulate beta1 receptors in the heart and beta2 receptors in the lungs. Stimulation of beta1 receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in clients with coronary artery disease.

A

.

70
Q

LTRAs drugs block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat?

A

acute asthma attacks. Diarrhea, not constipation, is a common adverse effect of montelukast and zafirlukast

71
Q

What is the role of corticosteroids in the treatment of acute respiratory disorders?
They decrease inflammation.
They directly dilate the bronchi.
They stimulate the immune system.
They increase gas exchange in the alveoli.

A

They decrease inflammation.
Corticosteroids can suppress the immune system. They do not directly affect bronchodilation but rather prevent bronchoconstriction as a response to inflammation.

72
Q

Which statement by a client best indicates an understanding of the teaching on flunisolide (AeroBid)?
“I will rinse my mouth with water after each use.”
“I will wash the plastic inhaler casing once a month.”
“I will take two puffs to treat an acute asthma attack.”
“I will not use my albuterol inhaler while I am taking AeroBid.”

A

“I will rinse my mouth with water after each use.”

Flunisolide is an inhaled corticosteroid. Rinsing the mouth immediately after each use of the inhaler or nebulizer will help prevent oral candidal infections. It is not used to treat an acute asthma attack and should be taken with the client’s bronchodilator medications. The plastic inhaler casing is washed in warm, soapy water every week.

73
Q

The nurse performs discharge teaching with a client who is prescribed the anticholinergic inhaler ipratropium bromide (Atrovent). Which statement by the client indicates to the nurse that teaching has been successful?
“I will not drink grapefruit juice while taking this drug.”
“I may gain weight as a result of taking this medication.”
“This inhaler is not to be used alone to treat an acute asthma attack.”
“Nausea and vomiting are common adverse effects of this medication.”

A

“This inhaler is not to be used alone to treat an acute asthma attack.”

Although ipratropium works to prevent bronchoconstriction and thus secondarily leads to bronchodilation, a direct-acting bronchodilator is needed to treat an acute asthma attack.

74
Q 
Before administering an LTRA medication, the nurse would assess the client for allergies to which substance? (Select all that apply.)
  Latex
  Lactose
  Cellulose
  Povidone
  Chlorhexidine
A

Lactose
Cellulose
Povidone
Allergies to povidone, lactose, titanium dioxide, or cellulose derivatives are important to note because these are inactive ingredients in LTRAs.

Pharmacology (28 decks)

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