drug therapy for asthma and bronchoconstriction Flashcards
describe bronchoconstrictive disorder
-airway hyperresponsiveness
-bronchoconstriction
-inflammation, mucousal edema
-excessive mucus production (asthma, bronchitis, emphysema)
describe the etiology of asthma
-type 1 hypersensitivity
-genetic IgE hypersensitivity reaction
-can occur at any age
-more common in African Americans and Hispanics
name some different stimuli for asthma
-viral infections
-environmental irritants
-stress/emotion
-strenuous activity
-temp/weather changes
describe the pathophysiology of asthma
-muscle contraction narrows airways
-inflammatory response (mast cells -> cytokine released -> inflammation)
describe the long term effects of asthma
-mild to moderate asthma is recurrent and reversible
-advanced or severe asthma is less reversible, chronis inflammation, and leads to structural changes
describe the manifestations of asthma
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
what is status asthmaticus
-worst type of flare
-acute severe asthma
-doesnt respond to usual treatments
-severe respiratory distress
-life threatening
describe chronic bronchitis
-frequent productive cough more than 3months/year for two years
-increased mucus leads to airway narrowing, chronic changes
describe emphysema
-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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describe chronic obstructive pulmonary disease (COPD)
-chronic bronchitis AND emphysema (bronchitis can lead to emphysema)
-usually develops with long standing exposure to airway irritants (ex. cigarette smoke)
what are the symptoms of COPD
more constant and less reversible
-dyspnea
-activity intolerance
-air trapping
true or false?
there are no long term effects of 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 of the following?
A) inhaling
B) swallowing
C) coughing
D) exhaling
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)
what is the goal of drug therapy for asthma and bronchoconstriction?
-prevent airway inflammation
-minimize use of “rescue drugs”
what are the main treatments of asthma and bronchoconstriction?
theres 2
-bronchodilators (adrenergics, anticholinergics, xanthines)
-anti-inflammatories (corticosteroids, leukotriene modifiers, mast cell stabilizers, immunosuppressants)
what is the most effective and first choice treatment to relieve acute asthma?
administering bronchodilators by inhalation
what are the two types of inhaled beta2-adrenergic agonists used for asthma management?
-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)
give two examples of beta2-adrenergic agonists
-albuterol (rescue)
-salmeterol (maintenance)
what do beta2-adrenergic agonists do?
-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
describe the use of beta2-adrenergic agonists
-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
what are some adverse effects of beta2-adrenergic agonists
-muscle tremor
-cardiac stimulation
-CNS stimulation
what are some contraindications of beta2-adrenergic agonists
-dysrhythmias
-CAD, HTN
what are some nursing implications r/t beta2-adrenergic agonists
-with beta blockers (olols) may cause bronchospasm
-thryroid hormones, theophylline, cold med, caffeine increase stimulatory effects
describe pt teaching for beta2-adrenergic agonists
-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
give an example of anticholinergics
ipratropium
describe anticholinergics
-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
describe the use of anticholinergics
-prevent bronchoconstriction
-not effective for acute attack
what are some adverse effects of anticholinergics
-cough
-dry mouth
-GI upset
what are some contraindications of anticholinergics
-narrow angle glaucoma
-BPH
give an example of xanthines
theophylline
describe xanthines
-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
what are some adverse effects of xanthines
toxicity:
-anorexia, N/V
-agitation/nervousness
-tachycardia
-convulsions
what are some contraindications of xanthines
-gastritis
-PUD
-seizure disorder
what are some nursing implications r/t xanthines
-many drug-drug interactions
-cigarette smoking may increase metabolism of drug
describe patient teaching with xanthines
-do not exceed dose
-alert MD if stop smoking
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
using the bronchodilator (albuterol) opens the airways and allows better absorption of the other drugs. wait 5 mins between inhalers
name a corticosteroid inhalation
beclomethasone
describe corticosteroid inhalation
-suppress airway inflammation by blocking cytokines
-resulting in:
decreased mucus secretion
decreased airway mucosa edema
repaired epithelium damage
reduced airway reactivity
describe the use of corticosteroid inhalation
-prevention and treatment of asthma and COPD
-long term can be used in combination
-inhaled for local affect to lungs only
what are some adverse effects of corticosteroid inhalation
-HA
-dry mouth, cough
-fungal infection (candidiasis)
what are some contraindications of corticosteroid inhalation
recent nasal/oral surgery
what are some nursing implications of corticosteroid inhalation
-rinse mouth after using
-use lowest dose necessary to control symptoms
describe pt teaching with corticosteroid inhalation
-take on regular schedule
-not a rescue inhaler
-use bronchodilator first, followed in 5 mins by other inhalers
-rinse mouth after use
give an example of leukotriene modifier drugs
montelukast
describe leukotriene modifier drugs
-prevents leukotrines from binding to receptors reducing bronchoconstriction and inflammation
-long term treatment of asthma
-not effective in relieving acute attacks
-PO
describe the use of leukotriene modifier drugs
-prevent acute asthma attacks induced by: allergens, exercise, cold air, hyperventilation, irritants, NSAIDS
-can be used in combination with bronchodilators and corticosteroids
what are soe adverse effects of leukotriene modifier drugs
-HA, N/V/D
black box warning: neuropsychotic events
give an example of mast cell stablizers
cromolyn
describe mast cell stablizers
-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
give an example of monoclonal antibodies
omalizumab
describe monoclonal antibodies
-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
what meds are considered to be relievers
(relives acute problem)
albuterol
what meds are considered to be controllers
(maintenance)
salmeterol, ipratropium
what meds are considered to be preventers
(prevent problems)
-therophylline
-beclomethasone
-montelukast
-cromolyn
-omalizumab
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
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
