drug therapy for asthma and bronchoconstriction Flashcards
bronchoconstrictive disorder
airway hyperresponsiveness, bronchoconstriction, inflammation, mucosal edema, excessive mucus production (asthma, bronchitis, emphysema)
asthma is caused by
genetic IgE hypersensitivity reaction, can occur at any age, more common in African American and hispanics
asthma is stimulated by
viral infections, environmental irritants, stress/ emotion, strenuous activity, temp/weather changes
pathophysiology of asthma
muscle constriction narrows airways, inflammatory response (mast cells, cytokines releases, inflammation)
what is considered mild to moderate asthma
recurrent and reversible
what is considered advanced or severe asthma
less revisable, chronic inflammation, structural changes
s/sx of asthma attack (bronchoconstriction, inflammation, hyperresponsiveness)
dyspnea, wheezing, chronic cough, peak expiratory flow rate decrease (PEFR), vary moderate to severe symptoms, acute flare lasts mins-hrs
what is status asthmaticus
acute severe asthma, doesn’t respond to usual treatments, severe respiratory distress, life threatening
two other bronchocontrictiive disorders similar to asthma are
chronic bronchitis and emphysema
what is chronic bronchitis
frequent productive cough more than 3 months/year x2 years, increased mucus leads to airway narrowing, chronic changes
what is emphysema
enlargement and destruction of alveoli r/t long term lung damage, loss of elasticity and surface area, carbon dioxide trapping
s/sx of chronic bronchitis
airway flow problem, cyanotic, recurrent cough & increased sputum production, hypoxia, hypercapnia (increased pCO2), respiratory acidosis, increased hub, high RR,
s/sx of emphysema
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
chronic obstructive pulmonary disease (COPD) is what
a combination of chronic bronchitis and emphysema, usually develops with long standing exposure to airway irritants (ex. cigarette smoke)
symptoms of COPD
more constant/ less reversible, dyspnea, activity intolerance, air trapping in lungs
T or F. there re no long term side effects from asthma
false; chronic asthma leads to structural changes (fibrosis, enlarged smooth muscle cells, enlarged mucous glands) known as airway remodeling
patients with bronchoconstrictive disorders will report difficulty with which if the following?
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)
goals for bronchoconstrictive disorders
prevent airway inflammation, minimize use of “rescue drugs”
main treatments for bronchoconstrictive disorders
bronchodilators and anti-inflammatory
examples of bronchodilators
adrenergic, anticholinergics, xanthines
examples of anti-inflammatory
corticosteroids, leukotriene modifiers, most cell stabilizes, immunosuppressants
administering bronchodilators is most effective by
inhalation, and the treatment of first choice to relieve acute asthma
bronchoconstrictive disorder drugs used for asthma management
beta 2 adrenergic agonists
two general types of inhaled beta 2 adrenergic agonists
rescue inhalant and maintenance inhalant
what are rescue inhalants
medications used during periods of acute symptoms and exacerbations (quick relief, short acting drugs)
what are maintenance inhalants
medications used to achieve and maintain prophylactic control of persistent asthma (long term control drug)
example meds of beta 2 adrenergic agonists
albuterol (rescue) and salmeterol (maintenance)
beta 2 adrenergic agonists stimulate
beta adrenergic receptors in the smooth muscle of bronchi and bronchioles, stimulate production of cyclic AMP, the increase cyclic AMP produces bronchodilation
uses of beta 2 adrenergic agonists
treat or prevent bronchoconstriction, can be use din children and adults, large doses used In critical care short term, available as nebulizer/ MDI/ oral
adverse effects of beta 2 adrenergic agonists
muscle tremor, cardiac stimulation(tachycardia), CNS stimulation (insomnia, anxiety)
contraindications for beta 2 adrenergic agonists
dysrhythmias, CAD, HTN
nursing considerations for beta 2 adrenergic agonists
with beta blockers may cause bronchospasm, thyroid hormones, theophylline, cold meds, caffeine increase stimulatory effects
patient teaching for beta 2 adrenergic agonists
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
anticholinergics examples meds
ipratropium
how does ipratropium work
block the action of acetylcholine in bronchial smooth muscle, inhibiting bronchoconstriction and mucus secretion
ipratropium is what kind of therapy
maintenance for bronchoconstriction r/t asthma, chronic bronchitis and emphysema
ipratropium is available in what forms
nebulizer or MDI
uses of anticholinergics
prevent bronchoconstriction, not effective for acute attack
adverse effects of anticholinergics
dry mouth, cough, GI upset
contraindications of anticholinergics
narrow angle glaucoma, BPH
drug class xanthines example meds
theophylline
mechanism of action of xanthines
works by relaxing the bronchial smooth muscle, promoting bronchodilator. also suppresses airway responsiveness
uses of xanthines
as a second line treatment in severe cases pf chronic bronchoconstriction
adverse effects of xanthines
toxicity; s/sx of toxicity are anorexia, N/V, agitation, nervousness, tachycardia, convulsions
contraindications of xanthines
gastritis, PUD, seizure disorder
nursing implications for xanthines
many drug to drug interactions, cigarette smoking may increase metabolism of drug
patient teaching for xanthines
do not exceed dose, alert MD if stop smoking
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
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
corticosteroid inhalation example meds
beclomethasone
what does beclomethasone do
decrease airway inflammation by blocking cytokines resulting in blocking mucus secretion, blocks airway mucosa edema, repaired epithelium damage, reduced airway reactivity
uses of corticosteroid inhalation
prevention and treatment of asthma and COPD, long term can be used in combination, inhaled for local affect to lungs only
adverse effects of corticosteroid inhalation
HA, dry mouth, cough, fungal infection on tongue(candidiasis)
contraindications of corticosteroid inhalation
recent nasal, oral surgery (will slow down healing process)
meds that end in ONE are
steroids
nursing implications for corticosteroid inhalation
rinse mouth after using, use lowest dose necessary to control symptoms
patient teaching for corticosteroid inhalation
take on a regular schedule, not a rescue inhaler, use bronchodilator first followed in 5 mins by other inhalers, rinse mouth after use
leukotriene modifier drug example meds
montelukast
uses of leukotriene modifier drug
prevents leukotrienes from binding to receptors reducing bronchoconstriction and inflammation, long term treatment of asthma, not effective in relieving acute attacks, PO
uses of leukotriene modifier drug simplified
prevent acute asthma attacks induced by allergens, exercise, cold air, hyperventilation, irritants, NSAIDs (can be used in combo with bronchodilators and corticosteroids)
adverse effects of leukotriene modifier drug
HA, N/V/D, BLACK BOX warning: neuropsychotic events
mast cell stabilizer example meds
cromolyn
mechanism of action of mast cell stabilizer
prevent release of bronchoconstrictive and inflammatory substances from mast cells
uses of mast cell stabilizer
second line treatment option, prophylaxis of acute asthma in mild, persistent asthma, not effective in acute bronchospasm or status asthmaticus
monoclonal antibodies example meds
omalizumab
mechanism of action of monoclonal antibodies
binds with IgE blocking receptors so there is less IgE available to start allergic reactions
adverse effects of monoclonal antibodies
BLACK BOX warning: only give this drug under medical supervision risk of life threatening anaphylaxis
organization of meds: relievers (acute problem)
albuterol
organization of meds: controllers (maintenance)
salmeterol, ipratropium
organization of meds: preventer (prevent problems)
theophylline, beclomethasone, montelukast, cromolyn, omalizumab
organization of meds: preventer (prevent problems)
theophylline, beclomethasone, montelukast, cromolyn, omalizumab
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
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
