COPD; Asthma

Question 0

Albuterol

Answer 0

Selective Beta 2 agonist (short acting)

Question 1

Sympathetic Agonists (Beta Agonists) "Activation of beta
MOA

Answer 1

Activation of B2 receptors activates cAMP, which relaxes smooth muscles of the airway resulting in:
Direct relaxation of bronchial smooth muscle
Increase ciliary motility
Suppress histamine release in lung

Used for quick relief (rescue inhaler) or long term control

Question 2

Albuterol (Side Effects)

Answer 2

tachycardia, bc we get too much SNS stimulation, tremors, hyperglycemia in Diabetics

Question 3

Salmeterol

Answer 3

Long acting Selective Beta 2 Agonist

Question 4

Salmeterol side effects?

Answer 4

Build up tolerance

Tremor, tachycardia, hyperglycemia in diabetics

Question 5

ipatropium (Atrovent)
Parasympathetic ANtagonist (Anticholinergic) MOA

Answer 5

Block the parasympathetic effect on the bronchioles resulting in:
Bronchodilation and decreased mucus production (does not relax the bronchioles like B2 does.

Question 6

What patients is ipatropium (Atrovent) preferred for?

Answer 6

Cardiac patients

Approved for COPD but used for Asthma

Question 7

Ipatropium (Atrovent) Side effects?

Answer 7

dry mouth; irritation of pharynx

Question 8

Bronchodilator’s Management

Answer 8

Avoid exposure to conditions that cause bronchospasms (allergens, smoking, stress, air, pollutants)
Ensure patients know how to use inhalers, and Metered dose inhalers (MDI’s) DEMONSTRATE proper use of device

Question 9

How to monitor for therapeutic effects of bronchodilators?

Answer 9

Decreased symptoms and increased ease of breathing
Improved activity tolerance

**Make sure pts know which is a short acting inhaler for emergency use

Question 10

Proventil

Xopenex

Answer 10

Short Acting MDI (for emergency use)

Nebulizer

Question 11

Phosphodiesterase Inhibitors Axanthine Derivatives: Methylxanthines; theophylline (Amniophylline): MOA

Answer 11

Inhibits phosphodiesterase (PDE) - enzyme that breaks down cAMP

Question 12

cAMP: cyclic adenosine monophosphate Action?

Answer 12

Increasing levels of cAMP allow smooth muscle relaxation resulting in:

• bronchial relaxation
• improved contractility of diaphragm
• Increased ciliary clearance dilation of pulmonary vessels
• decrease mast cell degranulation

Question 13

Methylxanthines: theophylline (Aminophylline) Administration ?

Answer 13

IV intermittent, or continous drip

Oral: Long acting

Question 14

theophylline (Aminophylline) Side effects?

Answer 14

CNS: restlessness, insomnia, tremor
CV: tachycardia, palpitations
GI: N,V,D
GU: increased urinary output
Endocrine: hyperglycemia

Question 15

Nursing Management for theophylline (Aminophylline)

Answer 15

Multiple drug interactions
-Smoking increases metabolism and therefore decreases half life
(most pts need more b/c most COPD pts are smokers)
-Increases digoxin effects= toxicity
-Narrow Therapeutic Index:
serum levels done: therapeutic = 10-20 mcg/mL (NEED TO GET LEVELS)

Question 16

Corticosteroids: Glucocorticoids; MOA

Answer 16

Stabilize membranes of cells that release bronchoconstricting substances
Increase responsiveness of bronchial smooth muscle to B-adrengeric stimulation

Question 17

fluticasone (Flovent): Glucocorticoids

Answer 17

Prophylaxis of airway inflammation; no systemic effects

Question 18

How long does it take for fluticasone or (Flovent) to work?

Answer 18

Not a quick acting effect
1-4 weeks for effect

Note* If not working (refractory) then systemic might be necessary(oral drug)

Question 19

What are the side effects of fluticasone (Flovent)?

Answer 19

hoarseness, oropharyngeal fungal infections (Thrush)

Question 20

Corticosteroid inhaler patient teaching

Answer 20

Rinse mouth with lukewarm water after use to prevent the development of oral fungal infections

If a B-agonist bronchodilator also ordered: use bronchodilator inhaler first, wait 5 minutes then steroid

Question 21

Leukotriene Receptor Antagonist montelukast (Singulair): MOA

Answer 21

blocks synthesis of leukotrienes in the cell from arachidonic acid and 5-Lipoxegenase resulting in:
prevention of airway edema, mucous production, smooth muscle relaxation of bronchiole
For prophylaxis and Long Term Control

Question 22

montelukast (Singulair) -oral Side effects?

Answer 22

dizziness, abdominal pain, myalgia

Question 23

montelukast (Singulair) Patient teaching

Answer 23

Meds should be taken every night on a continuous schedule, even if symptoms improve
-Improvements should be seen in about 1 week

Question 24

Mast Cell Stabilizers (cromolyn) (intal)- Dry Powder Inhaler MOA:

Answer 24

block a calcium channel essential for mast cell degranulation resulting in: - preventing the release of histamine and related mediators - 1st line prophylaxis for allergic asthma

Question 25

cromolyn (Intal)- DPI side effects?

Answer 25

mucosal irritation bronchospasm weird taste

Question 26

Cromolyn (Intal)-DPI patient teaching

Answer 26

2-4 weks for full therapeutic effects Gargle and rinse mouth after use use ideally 10-15 mins before known exposure no earlier than 60 mins in advance (exercise induced asthma)

Question 27

Pharmalogic goals to Asthma mgmt

Answer 27

Minimal or NO: chronic symptoms day or nightExacerbations Limitations on activities work or school missed use of short acting/emergency inhaled beta 2 agonists minimal or no adverse rxs from meds

Question 28

Management of Patients using inhalers

Answer 28

``` Do a Pre/Post assessment Patient teaching: -How to use: Physical Technique with or without spacer Waiting time Checking amount available after use Bronchodilators first; steroids last Rinse mouth after use of steroids; mast cell stabilizers When to use: Daily or Emergency? (is it short acting) ```

Question 29

5-Lipooxygenase Inhibitors; zileuton (Zyflo): oral, extended release MOA:

Answer 29

inhibitor of 5-lipoxygenase, the enzyme that breaks down the formation of leukotrienes from arachidonic acid Prophylaxis-Chronic Asthma