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Pharm 1 > drug therapy for asthma and bronchoconstriction > Flashcards

drug therapy for asthma and bronchoconstriction Flashcards

1
Q

describe bronchoconstrictive disorder

A

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

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2
Q

describe the etiology of asthma

A

-type 1 hypersensitivity
-genetic IgE hypersensitivity reaction
-can occur at any age
-more common in African Americans and Hispanics

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3
Q

name some different stimuli for asthma

A

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

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4
Q

describe the pathophysiology of asthma

A

-muscle contraction narrows airways
-inflammatory response (mast cells -> cytokine released -> inflammation)

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5
Q

describe the long term effects of asthma

A

-mild to moderate asthma is recurrent and reversible
-advanced or severe asthma is less reversible, chronis inflammation, and leads to structural changes

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6
Q

describe the manifestations of asthma

A

bronchoconstriction, inflammation, and hyperresponsiveness cause:
-dyspnea
-wheezing
-chronic cough
-peak expiratory flow rate (PEFR) decrease
-vary moderate to severe symptoms
-acute flare lasts minutes to hours

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7
Q

what is status asthmaticus

A

-worst type of flare
-acute severe asthma
-doesnt respond to usual treatments
-severe respiratory distress
-life threatening

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8
Q

describe chronic bronchitis

A

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

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9
Q

describe emphysema

A

-enlargement and destruction of alveoli r/t long term lung damage (usually seen in smokers)
-loss of elasticity and surface area
-carbon dioxide trapping

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10
Q

look at this thing

A
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11
Q

look at this thing

A
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12
Q

describe chronic obstructive pulmonary disease (COPD)

A

-chronic bronchitis AND emphysema (bronchitis can lead to emphysema)
-usually develops with long standing exposure to airway irritants (ex. cigarette smoke)

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13
Q

what are the symptoms of COPD

A

more constant and less reversible
-dyspnea
-activity intolerance
-air trapping

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14
Q

true or false?

there are no long term effects of 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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15
Q

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

A) inhaling
B) swallowing
C) coughing
D) exhaling

A

D) exhaling

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

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16
Q

what is the goal of drug therapy for asthma and bronchoconstriction?

A

-prevent airway inflammation
-minimize use of “rescue drugs”

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17
Q

what are the main treatments of asthma and bronchoconstriction?

theres 2

A

-bronchodilators (adrenergics, anticholinergics, xanthines)
-anti-inflammatories (corticosteroids, leukotriene modifiers, mast cell stabilizers, immunosuppressants)

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18
Q

what is the most effective and first choice treatment to relieve acute asthma?

A

administering bronchodilators by inhalation

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19
Q

what are the two types of inhaled beta2-adrenergic agonists used for asthma management?

A

-rescue inhalant (quick relief, short acting; used during periods of acute sx and exacerbations)
-maintenance inhalant (long term used to achieve and maintain prophylactic control of persistent asthma)

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20
Q

give two examples of beta2-adrenergic agonists

A

-albuterol (rescue)
-salmeterol (maintenance)

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21
Q

what do beta2-adrenergic agonists do?

A

-drugs in this class stimulate beta2-adrenergic receptors in the smooth muscle of the bronchi and bronchioles
-the receptors, in turn, stimulate production of cyclic AMP
-the increased cyclic AMP produces bronchodilation

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22
Q

describe the use of beta2-adrenergic agonists

A

-treat or prevent bronchoconstriction
-can be used in children and older adults
-large doses used in critical care short term
-available as nebulizer, MDI, or oral

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23
Q

what are some adverse effects of beta2-adrenergic agonists

A

-muscle tremor
-cardiac stimulation
-CNS stimulation

24
Q

what are some contraindications of beta2-adrenergic agonists

A

-dysrhythmias
-CAD, HTN

25
Q

what are some nursing implications r/t beta2-adrenergic agonists

A

-with beta blockers (olols) may cause bronchospasm
-thryroid hormones, theophylline, cold med, caffeine increase stimulatory effects

26
Q

describe pt teaching for beta2-adrenergic agonists

A

-use bronchodilator inhaler first
-wait 5 mins between inhalers
-do no overuse rescue inhaler
-do not skip or overuse maintenance inhaler
-proper use of MDI
-no relief from rescue inhaler? -> call 911

27
Q

give an example of anticholinergics

A

ipratropium

28
Q

describe anticholinergics

A

-blocks the action of acetylcholine in bronchial smooth muscle, inhibiting bronchoconstriction and mucus secretion
-maintenance therapy for bronchoconstriction r/t asthma, chronic bronchitis, and emphysema
-available in nebulizer or MDI
-usually used in combination w ither bronchodilator

29
Q

describe the use of anticholinergics

A

-prevent bronchoconstriction
-not effective for acute attack

30
Q

what are some adverse effects of anticholinergics

A

-cough
-dry mouth
-GI upset

31
Q

what are some contraindications of anticholinergics

A

-narrow angle glaucoma
-BPH

32
Q

give an example of xanthines

A

theophylline

33
Q

describe xanthines

A

-works by relaxing the bronchial smooth muscle, promoting bronchodilation. also supresses airway responsiveness
-used as second line treatment in severe cases of chronic bronchoconstriction
-lab values monitored for dosing, can become toxic

34
Q

what are some adverse effects of xanthines

A

toxicity:
-anorexia, N/V
-agitation/nervousness
-tachycardia
-convulsions

35
Q

what are some contraindications of xanthines

A

-gastritis
-PUD
-seizure disorder

36
Q

what are some nursing implications r/t xanthines

A

-many drug-drug interactions
-cigarette smoking may increase metabolism of drug

37
Q

describe patient teaching with xanthines

A

-do not exceed dose
-alert MD if stop smoking

38
Q

a woman begins using an albuterol inhaler and a steroid inhaler for her asthma. the pt asks if it matters which inhaler she uses first?

A) you should use the albuterol first followed in 5-10mins by the steroid inhaler
B) you should use the steroid inhaler first followed in 5-10mins by albuterol
C) the order does not matter
D) you should not use the inhalers one right after the other

A

A

using the bronchodilator (albuterol) opens the airways and allows better absorption of the other drugs. wait 5 mins between inhalers

39
Q

name a corticosteroid inhalation

A

beclomethasone

40
Q

describe corticosteroid inhalation

A

-suppress airway inflammation by blocking cytokines
-resulting in:
decreased mucus secretion
decreased airway mucosa edema
repaired epithelium damage
reduced airway reactivity

41
Q

describe the use 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

42
Q

what are some adverse effects of corticosteroid inhalation

A

-HA
-dry mouth, cough
-fungal infection (candidiasis)

43
Q

what are some contraindications of corticosteroid inhalation

A

recent nasal/oral surgery

44
Q

what are some nursing implications of corticosteroid inhalation

A

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

45
Q

describe pt teaching with corticosteroid inhalation

A

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

46
Q

give an example of leukotriene modifier drugs

A

montelukast

47
Q

describe leukotriene modifier drugs

A

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

48
Q

describe the use of leukotriene modifier drugs

A

-prevent acute asthma attacks induced by: allergens, exercise, cold air, hyperventilation, irritants, NSAIDS
-can be used in combination with bronchodilators and corticosteroids

49
Q

what are soe adverse effects of leukotriene modifier drugs

A

-HA, N/V/D
black box warning: neuropsychotic events

50
Q

give an example of mast cell stablizers

A

cromolyn

51
Q

describe mast cell stablizers

A

-prevent release of bronchoconstrictive and inflammatory substances from mast cells
-second line treatment option
-used in prophylaxis of acute asthma in mild, presistent asthma
-not effective in acute bronchospasm or status asthmaticus

52
Q

give an example of monoclonal antibodies

A

omalizumab

53
Q

describe monoclonal antibodies

A

-binds with IgE blocking receptors so there is less IgE available to start allergic reactions
-adjunct therapy for severe allergic asthma not well controlled

black box warning: only give this drug under medical supervision risk of life threatening anapylaxis

54
Q

what meds are considered to be relievers

(relives acute problem)

A

albuterol

55
Q

what meds are considered to be controllers

(maintenance)

A

salmeterol, ipratropium

56
Q

what meds are considered to be preventers

(prevent problems)

A

-therophylline
-beclomethasone
-montelukast
-cromolyn
-omalizumab

57
Q

true or false?

in acute, severe asthma, a topical corticosteroid is indicated for a patient whose respiratory distress is not relieved by an inhaled beta2 agonist

A

false

a systemic corticosteroid is indicated for a pt whose resp distress is not relieved by an inhaled beta2 agonist. a topical corticosteroid will not be effective against airway inflammation

Pharm 1 (29 decks)

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