Exam II Respiratory Drugs Flashcards by Sel M

Moving the air into and out of the lungs, also called “ventilation”

Breathing

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Exchanging gases between the air in the lungs and the blood

External respiration

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Transport of oxygen to the body cells and return of carbon dioxide

Gas Transport by Blood

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Exchanging gases between the blood and the body cells

Internal Respiration

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Using the oxygen in cell processes and the production of carbon dioxide

Cellular Respiration

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Hemoglobin in red blood cells bind ________. Oxygen delivered to ____________.
Oxygen saturation is measured with a __________

oxygen
tissues
pulse oximeter

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_________ is a medical that indirectly measures the oxygen saturation of a patients blood (as opposed to measuring oxygen saturation directly through a blood sample) and changes in blood volume in the skin.

A pulse oximeter

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Blood-oxygen monitor displays what?

The percentage of arterial hemoglobin in the oxyhemoglobin configuration.

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Acceptable normal ranges are from ______ to ______ % although values down to ______ are common.

95 to 100 %

- 90%

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What are the upper types of respiratory disorders?

1) infections
2) sinusitis
3) common cold

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What are the types of lower respiratory disorders?

1) asthma
2) bronchitis
3) emphysema

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What is a sinusitis?

Symptoms:

Acute or chronic in nature

Symptoms:

1) Nasal obstruction
2) fevers
3) chills
4) mid-face pain
5) referred pain to teeth

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What is the 2012 criteria for diagnosis of acute bacterial sinusitis according to the Infectious diseases society of America?

1) Persistent symptoms for a least 10 days without improvement
2) Severe symptoms: fever, facial pain, purulent nasal discharge for 3-4 consecutive days at beginning of illness.
3) duration of illness aline is unreliable
4) CAT scans or radiographs do not differentiate viral from bacterial sinusitis= imaging not routinely recommended.

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(2012 guidelines):

Most cases of acute rhinosinusitis are ________ (98%).
Bacterial sinus infections = _________________
Overcomes _______________
Treats H. influenzae; may be ineffective ________________
If penicillin allergic, then give ____________ or _____________. __________ may be second line agent)
Avoid ________, _________,___________
Treat for ________ days for adults and _____ for children.
Avoid ___________ and ____________.
____________ with sterile saline solution
Inhaled ____________ if also allergic rhinitis

viral
amoxicillin-clavulanate (augmentin)
resistance
Strep. pneumoniae
levofloxacin
clindamycin
doxycycline
azithromycin -clarithromycin -sulf combos
5-7 days
10-14 days
decongestants and antihistamines
irrigation
corticosteroids

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What are the drugs for sinusitis/allergic rhinos?

1) Pseudoephedrine (vasoconstrictor mucous membrane)
2) antihistamines
3) analgesics (Ibuprofen-if sinusitis)
4) Antibiotics if bacterial infection

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What is an important dental drug interaction associated with nasal decongestants?

Epinephrine (vasoconstrictor)
Use w/ caution w/ decongestants, these drugs are sympathomimetics.
They may enhance cardiac stimulation (tachycardia) and elevated blood pressure

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Which drug was newly FDA approved 3/26/2012 as a nasal aerosol corticosteroid?

QNASL Nasal Aerosol (beclomethasone dipropionate)

- New, dry nasal aerosol corticosteroid

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What is QNASL used for?

1) Seasonal and year round nasal allergy symptoms

2) Allergic rhinitis affects 1 in 5 people (spring or fall seasons)

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Which diseases are caused by an increase in resistance to airflow moving in and out of the lungs (inadequate alveolar ventilation) ?

Obstructive diseases

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What are some examples of obstructive diseases?

1) asthma

2) COPD
a) chronic bronchitis
b) emphysema
c) neoplastic diseases

What is the pathophysiology of Asthma?

1) Intermittent respiratory disorder

2) recurrent brochaial sooth muscle spasm, inflmmation, swelling of bronchial mucosa, hyper secretion of mucous

What does asthma result in?

1) widespread narrowing of airways
2) decreased ventilation w/ increased airway resistance
3) decreased expiratory outflow

Etiology of asthma:

__________–> most common form

inhaled _________ allergens, _______, ________ and __________.
usually seen in _______ and ________.
______________ response relationship between allergen exposure and _______ mediated sensitization, positive skin test, family Hx

Extrinsic
seasonal
pollen
dust mites
animal dander
young children and adults
DOSE
IgE

Etiology of asthma:

Describe the major biochemical assault

1) bradykinins, histamine, leukotrienes, prostaglandins
2) histamine = bronchonconstriction; increased vascular permeability ; attack
3) Eosinophils into airway
4) eosinophils into airway
5) Platelet activating factor= bronchial hyper-responsiveness
6) Recruit leukocytes to airway wall
7) INCREASED tissue edema, mucous secretions, T lymphocytes prolog inflammatory response.

Intrinsic asthma : occurs ______ % of cases. Seldom associated w/ ________ of _____ or to a known cause.

- 30% - family history - allergy

With intrinsic asthma: patients are ____________ to ______ testing. IgE levels are __________ seen with __________ aged adults. It is associated with ________ causes : ________ and ____________

``` non-responsive skin normal middle-aged endogenous emotional stess GERD ```

List the drug-induced asthma?

1) aspirin 2) NSAIDS 3) cholinergics 4) beta blockers 5) ACE inhibitors 6) barbiturates 7) opiates

Asthmatics are more likely to have _______________ reaction to aspirin (5-15% of the time)

hypersensitivity

What is the aspirin hypersensitivity triad?

1) aspirin 2) asthma 3) nasal polyps

What is the mechanism of aspirin allergy?

1) inhibits bronchodilating PGE2 | 2) formation of leukotrienes (bronchoconstrictors)

In asthmatics aspirin sensitivity develops over about ___ exposures

There is a _______ hypersensitivity between ______ and ________

cross aspirin NSAIDS

Regarding Asthma food substances serve as what ? | Example?

Triggers | Ex: nuts, shellfish, strawberries, milk, food dyes

________ found in vasoconstrictors cause what ?

- Sulfite preservatives | - wheezing when metabolic levels of sulfite oxidase are low

Sulfite dioxide produced when?

In absence of sulfite oxidase = precipitate acute attack

Exercise induce asthma is caused by what?

1) Exertion 2) thermal changes in air during inhalation provoke mucosal irritation and airway hyperactivity 3) children and young adults most affected

Describe the asthma caused by bronchial constriction and increased airway resistance due to inflammatory response of bronchi to infection

Infectious asthma

What organisms can lead to asthma? | TX does what?

1) viruses 2) bacteria 3) fungi 4) mycoplasma TX: improves pulmonary symptoms

What is status asthmaticus?

1) persistent life-threatening bronchospasm despite drug therapy/intervention 2) attack lasts for more than 24 hours ○ dyspnea, cyanosis, fall in systolic pressure with inspiration ``` ○ end points: ■ exhaustion ■ severe dehydration ■ peripheral vascular collapse ■ death without intervention ```

What are the symptoms of asthma?

1) shortness of breath 2) wheezing 3) expanded chest 4) sinusitis often co-exists 5) failure to grow 6) thick stringy mucous

With asthma: you get sudden ________of attacks. respiration ___________ in difficulty leading to _______________ and ___________ _______ and ___________ expirations

``` onset increase expiratory wheezing tachypnea prolonged ```

Termination of attack is accompanied by ___________________: ________ , _______. Episodes are ________

``` productive cough thick stringy mucous self-liming ```

Describe the classification of asthma?

1) Mild ■ symptoms only when exposed to trigger and last less than an hour 2) Moderate ■ symptoms more than twice a week, affecting sleep and activity levels and on occasions requires energy care (FEV > 805) 3) Severe ■ ongoing symptoms that limit activity ■ frequent attacks

What are the Medication considerations of asthma and other chronic respiratory disease? (COPD, emphysema, allergies)

1) Beta adrenergic stimulants 2) Steroids (adrenal glucocorticocoids) 3) leukotriene-altering medications 4) mast cell inhibitors 5) expectorants 6) anti-tussive drugs

What are the medication considerations for mild intermittent asthma?

mild intermittent asthma = | rescue bronchodilator

What are the medication considerations for mild persistent asthma?

= mild persistent asthma = anti-inflammatory drug with low dose inhaled corticosteroid

What are the medication considerations for moderate persistent asthma?

= One medium dose of inhaled corticosteroid or two daily medications ● low to medium dose inhaled corticosteroid

What are the medication considerations for severe persistent asthma?

= daily medications | ● high dose inhaled corticosteroid with long acting bronchodilator

Misuse of asthma medications: Asthma is ___________

undertreated