Chapter 6 Adrenergic Bronchodialators

Question 1

What is alpha receptor stimulation?

Answer 1

Causes vasoconstriction and vasopressor effect.

Can provide decongestion in nasal passage

Question 2

What is the asthma paradox?

What are theories of it?

Answer 2

Increased asthma morbidity despite advances in asthma research.

• patient feels improvement but doesn’t maintain it and starts approaching triggers
• misuse of beta adrenergic drugs in lieu of corticosteroid to treat asthma

Question 3

What is a beta 1-receptor stimulation?

Answer 3

Increased heart rate and contractility

Question 4

What is a beta 2 stimulation?

Answer 4

• Bronchodilation
• some inhibition of inflammatory mediators
• stimulation of mucous clearance.

Question 5

What is a bronchospasm?

Answer 5

Narrowing of the bronchial airways

Question 6

What is a catecholamine?

Answer 6

Compound similar to epinephrine

-sympathomimetic

Question 7

What is down regulation?

Answer 7

Desensitization to beta agonists at beta receptor sites. causes by reduction of beta receptor sites

Question 8

Why do we use adrenergic bronchodilators?

Answer 8

To relax the airway smooth muscle in the presence of reversible airflow obstruction associated with acute and chronic asthma, bronchitis, emphysema, bronchiectsis

Question 9

What should you use for ACUTE reversible airflow obstruction?

Answer 9

SABA

Question 10

When would you use a LABA?

Answer 10

• Maintenance of bronchodilation
• control of bronchospasm
• night symptoms of asthma

Question 11

When would you use a racemic epinephrine?

4 reasons

Answer 11

Vasoconstriction effects for

• croup
• post extubation swelling
• control airway bleeding
• bronchiolitis

Question 12

How long do ultra short acting beta agonists last?

Answer 12

3 hours or less

Question 13

How long do short acting beta agonists last?

Answer 13

4 to 6 hours

Question 14

How long do long acting beta agonists last?

Answer 14

12 hours

Question 15

Describe the isomer of a beta adrenergic bronchodilator.

Answer 15

There is a left and a right isomer

• right isomer is active on beta airway receptors
• left isomer is inert, also called the sinister isomer.

Question 16

What is the drug that is the first single isomer adrenergic bronchodilator?
Describe the isomer.

Answer 16

Levalbuterol

Its a single right isomer.

Question 17

What does epinephrine drug excite in the body?

What are some issues with it?

Answer 17

• stimulates alpha and beta receptors
• not beta specific, high chance of side effects
• rapid onset due to COMT metabolization

Question 18

What is the beta 2 keyhole specificity theory?

Answer 18

The larger the side chain of the catechol base, the better the more beta 2 specific it is.

Question 19

What inactivates catecholamines?

Answer 19

COMT

Question 20

Why isn’t it advisable to take catecholamines orally?

Answer 20

Because of rapid inactivation of COMT. Which is found in the liver and kidneys.
-it’s inactivates by the gut and liver.

Question 21

What is a resorcinol agent?

Give an example

Answer 21

It is a non-catacholamine. It is a modified catacholamine that is not inactivated by COMT.
-metaproterinol

Question 22

What is a saligenin?

Give some examples

Answer 22

It is a non-catacholamine agent, modified from a catacholamine.
But is a more beta 2 specific drug. Less side effects.
-albuterol
-pirbuterol
-levalbuterol

Question 23

What is an adrenergic bronchodilator?

Answer 23

Agent that stimulates sympathetic nervous fibers
-which allows relaxation of lung smooth muscle
beta 2 agonist

Question 24

Is albuterol only a SABA?

Answer 24

No
-there is an “Extended release” albuterol tablet.

Called Vospire ER

Question 25

Drugs included in the saligenin class

4 drugs

Answer 25

1) albuterol (proventil, ventolin)
2) pirbuterol (Maxair)
3) salmeterol (Serevent)
4) levalbuterol (xopenex)

Question 26

How long is the onset for catecholamines?

Answer 26

1-3 mins

Question 27

How long is the onset for non-catecholamines like resorcinols and saligenins?
With 1 exception…

Answer 27

5-15 mins

Except for salmuterol (more than 20 mins)

Question 28

How do you assess if beta agonist therapy would be effective for your patient?

Answer 28

• presence of reversible airflow resulting from primary bronchospasm
• obstruction secondary to an inflammatory response or secretion either acute or chronic

Question 29

How can you test a patient’s susceptibility to beta agonist therapy?
Pre therapy 3 things

Answer 29

• Measure flowrates with the peak flow
• perform respiratory assessment auscultations
• assess pulse before during and after treatment. 20% increase is not good

Question 30

Contraindications to beta agonist therapy

3 reasons

Answer 30

• regular long-term use of Saba and LABA not recommended
• patients with cystic fibrosis, COPD, and asthma may be less responsive
• patients with heart problems should be monitored

Question 31

What is the mechanism of action for racemic epinephrine?

3 things

Answer 31

• Racemic epinephrine works by stimulation of the α-adrenergic receptors (mucosal vasoconstriction)
• decreased fluid in the airway (subglottic edema) and
• by stimulation of the β-adrenergic receptors causing relaxation of the bronchial smooth muscle.