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pharm exam 3 > drug therapy for asthma and bronchoconstriction > Flashcards

drug therapy for asthma and bronchoconstriction Flashcards

1
Q

bronchoconstrictive disorder

A

airway hyperresponsiveness, bronchoconstriction, inflammation, mucosal edema, excessive mucus production (asthma, bronchitis, emphysema)

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2
Q

asthma is caused by

A

genetic IgE hypersensitivity reaction, can occur at any age, more common in African American and hispanics

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3
Q

asthma is stimulated by

A

viral infections, environmental irritants, stress/ emotion, strenuous activity, temp/weather changes

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4
Q

pathophysiology of asthma

A

muscle constriction narrows airways, inflammatory response (mast cells, cytokines releases, inflammation)

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5
Q

what is considered mild to moderate asthma

A

recurrent and reversible

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6
Q

what is considered advanced or severe asthma

A

less revisable, chronic inflammation, structural changes

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7
Q

s/sx of asthma attack (bronchoconstriction, inflammation, hyperresponsiveness)

A

dyspnea, wheezing, chronic cough, peak expiratory flow rate decrease (PEFR), vary moderate to severe symptoms, acute flare lasts mins-hrs

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8
Q

what is status asthmaticus

A

acute severe asthma, doesn’t respond to usual treatments, severe respiratory distress, life threatening

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9
Q

two other bronchocontrictiive disorders similar to asthma are

A

chronic bronchitis and emphysema

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10
Q

what is chronic bronchitis

A

frequent productive cough more than 3 months/year x2 years, increased mucus leads to airway narrowing, chronic changes

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11
Q

what is emphysema

A

enlargement and destruction of alveoli r/t long term lung damage, loss of elasticity and surface area, carbon dioxide trapping

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12
Q

s/sx of chronic bronchitis

A

airway flow problem, cyanotic, recurrent cough & increased sputum production, hypoxia, hypercapnia (increased pCO2), respiratory acidosis, increased hub, high RR,

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13
Q

s/sx of emphysema

A

increase CO2 retention, minimal cyanosis, purse lip breathing, dyspnea, barrel chest, speaks in short jerky sentences, anxious, use of accessory muscles to breathe, thin appearance

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14
Q

chronic obstructive pulmonary disease (COPD) is what

A

a combination of chronic bronchitis and emphysema, usually develops with long standing exposure to airway irritants (ex. cigarette smoke)

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15
Q

symptoms of COPD

A

more constant/ less reversible, dyspnea, activity intolerance, air trapping in lungs

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16
Q

T or F. there re no long term side effects from asthma

A

false; chronic asthma leads to structural changes (fibrosis, enlarged smooth muscle cells, enlarged mucous glands) known as airway remodeling

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17
Q

patients with bronchoconstrictive disorders will report difficulty with which if the following?

A

exhaling; bronchoconstrictive disorders are known to make exhalation difficult because excess mucus and airway narrowing from inflammation makes it difficult for air to exit the alveoli (air trapping)

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18
Q

goals for bronchoconstrictive disorders

A

prevent airway inflammation, minimize use of “rescue drugs”

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19
Q

main treatments for bronchoconstrictive disorders

A

bronchodilators and anti-inflammatory

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20
Q

examples of bronchodilators

A

adrenergic, anticholinergics, xanthines

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21
Q

examples of anti-inflammatory

A

corticosteroids, leukotriene modifiers, most cell stabilizes, immunosuppressants

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22
Q

administering bronchodilators is most effective by

A

inhalation, and the treatment of first choice to relieve acute asthma

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23
Q

bronchoconstrictive disorder drugs used for asthma management

A

beta 2 adrenergic agonists

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24
Q

two general types of inhaled beta 2 adrenergic agonists

A

rescue inhalant and maintenance inhalant

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25
Q

what are rescue inhalants

A

medications used during periods of acute symptoms and exacerbations (quick relief, short acting drugs)

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26
Q

what are maintenance inhalants

A

medications used to achieve and maintain prophylactic control of persistent asthma (long term control drug)

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27
Q

example meds of beta 2 adrenergic agonists

A

albuterol (rescue) and salmeterol (maintenance)

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28
Q

beta 2 adrenergic agonists stimulate

A

beta adrenergic receptors in the smooth muscle of bronchi and bronchioles, stimulate production of cyclic AMP, the increase cyclic AMP produces bronchodilation

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29
Q

uses of beta 2 adrenergic agonists

A

treat or prevent bronchoconstriction, can be use din children and adults, large doses used In critical care short term, available as nebulizer/ MDI/ oral

30
Q

adverse effects of beta 2 adrenergic agonists

A

muscle tremor, cardiac stimulation(tachycardia), CNS stimulation (insomnia, anxiety)

31
Q

contraindications for beta 2 adrenergic agonists

A

dysrhythmias, CAD, HTN

32
Q

nursing considerations for beta 2 adrenergic agonists

A

with beta blockers may cause bronchospasm, thyroid hormones, theophylline, cold meds, caffeine increase stimulatory effects

33
Q

patient teaching for beta 2 adrenergic agonists

A

use bronchodilator inhaler first, wait 5 mins between inhalers, do not overuse rescue inhaler, do not skip or over maintenance inhalers, proper use of MDI

34
Q

anticholinergics examples meds

A

ipratropium

35
Q

how does ipratropium work

A

block the action of acetylcholine in bronchial smooth muscle, inhibiting bronchoconstriction and mucus secretion

36
Q

ipratropium is what kind of therapy

A

maintenance for bronchoconstriction r/t asthma, chronic bronchitis and emphysema

37
Q

ipratropium is available in what forms

A

nebulizer or MDI

38
Q

uses of anticholinergics

A

prevent bronchoconstriction, not effective for acute attack

39
Q

adverse effects of anticholinergics

A

dry mouth, cough, GI upset

40
Q

contraindications of anticholinergics

A

narrow angle glaucoma, BPH

41
Q

drug class xanthines example meds

A

theophylline

42
Q

mechanism of action of xanthines

A

works by relaxing the bronchial smooth muscle, promoting bronchodilator. also suppresses airway responsiveness

43
Q

uses of xanthines

A

as a second line treatment in severe cases pf chronic bronchoconstriction

44
Q

adverse effects of xanthines

A

toxicity; s/sx of toxicity are anorexia, N/V, agitation, nervousness, tachycardia, convulsions

45
Q

contraindications of xanthines

A

gastritis, PUD, seizure disorder

46
Q

nursing implications for xanthines

A

many drug to drug interactions, cigarette smoking may increase metabolism of drug

47
Q

patient teaching for xanthines

A

do not exceed dose, alert MD if stop smoking

48
Q

a woman begins using albuterol inhaler and a steroid inhaler for her asthma. The patient asks if it matters which inhaler should she use first

A

you should use the albuterol first followed in 5-10 minutes by the steroid inhaler; albuterol opens the airways and allows for better absorption of the other drugs

49
Q

corticosteroid inhalation example meds

A

beclomethasone

50
Q

what does beclomethasone do

A

decrease airway inflammation by blocking cytokines resulting in blocking mucus secretion, blocks airway mucosa edema, repaired epithelium damage, reduced airway reactivity

51
Q

uses of corticosteroid inhalation

A

prevention and treatment of asthma and COPD, long term can be used in combination, inhaled for local affect to lungs only

52
Q

adverse effects of corticosteroid inhalation

A

HA, dry mouth, cough, fungal infection on tongue(candidiasis)

53
Q

contraindications of corticosteroid inhalation

A

recent nasal, oral surgery (will slow down healing process)

54
Q

meds that end in ONE are

A

steroids

55
Q

nursing implications for corticosteroid inhalation

A

rinse mouth after using, use lowest dose necessary to control symptoms

56
Q

patient teaching for corticosteroid inhalation

A

take on a regular schedule, not a rescue inhaler, use bronchodilator first followed in 5 mins by other inhalers, rinse mouth after use

57
Q

leukotriene modifier drug example meds

A

montelukast

58
Q

uses of leukotriene modifier drug

A

prevents leukotrienes from binding to receptors reducing bronchoconstriction and inflammation, long term treatment of asthma, not effective in relieving acute attacks, PO

59
Q

uses of leukotriene modifier drug simplified

A

prevent acute asthma attacks induced by allergens, exercise, cold air, hyperventilation, irritants, NSAIDs (can be used in combo with bronchodilators and corticosteroids)

60
Q

adverse effects of leukotriene modifier drug

A

HA, N/V/D, BLACK BOX warning: neuropsychotic events

61
Q

mast cell stabilizer example meds

A

cromolyn

62
Q

mechanism of action of mast cell stabilizer

A

prevent release of bronchoconstrictive and inflammatory substances from mast cells

63
Q

uses of mast cell stabilizer

A

second line treatment option, prophylaxis of acute asthma in mild, persistent asthma, not effective in acute bronchospasm or status asthmaticus

64
Q

monoclonal antibodies example meds

A

omalizumab

65
Q

mechanism of action of monoclonal antibodies

A

binds with IgE blocking receptors so there is less IgE available to start allergic reactions

66
Q

adverse effects of monoclonal antibodies

A

BLACK BOX warning: only give this drug under medical supervision risk of life threatening anaphylaxis

67
Q

organization of meds: relievers (acute problem)

A

albuterol

68
Q

organization of meds: controllers (maintenance)

A

salmeterol, ipratropium

69
Q

organization of meds: preventer (prevent problems)

A

theophylline, beclomethasone, montelukast, cromolyn, omalizumab

69
Q

organization of meds: preventer (prevent problems)

A

theophylline, beclomethasone, montelukast, cromolyn, omalizumab

70
Q

T or F. in acute, severe asthma, a topical corticosteroid is indicated for a patient whose respiratory distress is not relieved by an inhaled beta 2 agonist

A

false; in acute, severe asthma, a systemic corticorsteroid is indicated for a patient whose respiratory distress is not relieved by an inhaled beta 2 agonist. A topical corticosteroid will not be effective against airway inflammation

pharm exam 3 (5 decks)

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