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PHARM EXAM 2 > lower respiratory disorders > Flashcards

lower respiratory disorders Flashcards

1
Q

What are the two umbrella terms that are lower respiratory diseases?

A

COPD and Restrictive lung disease

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2
Q

What is COPD?

A

Airway obstruction with increased airway resistance of airflow to lung tissues caused by inflammation, bronchoconstriction, and increased secretions

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3
Q

What is restrictive lung disease?

A

These diseases don’t allow the lungs to expand properly

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4
Q

What diseases are under COPD?

A

Chronic bronchitis, Bronchiectasis, Emphysema, Asthma

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5
Q

What diseases fall under restrictive lung disease?

A

Pulmonary edema, Pulmonary fibrosis, Pneumonitis, Lung tumors, Thoracic disorders (scoliosis, kyphosis)

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6
Q

What drugs are used to treat COPD?

A

Bronchodilators (sympathomimetics, Beta 2 adrenergic agonists), Methylxanthines, Leukotriene antagonists, Glucocorticoids (steroids), Cromolyn, Anticholinergics, Mucolytics

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7
Q

What is asthma?

A

Inflammatory disorder with varying amounts of airway characterized by bronchospasm

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8
Q

What are asthma triggers?

A

Stress, allergens, pollutants

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9
Q

What occurs that leads to airway constriction and obstruction in asthma?

A

Inflamed and edematous airways cause constriction, and the bronchial cells produce more mucus which causes obstruction

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10
Q

What are signs and symptoms of asthma?

A

Wheezing, SOB, cough (at first dry but then after the attack becomes productive), chest tightness (mostly at night and in the morning)

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11
Q

What is chronic bronchitis?

A

Progressive lung disease caused by smoking or chronic lung infections

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12
Q

What occurs that leads to airway obstruction in chronic bronchitis?

A

Bronchial inflammation and excessive mucus production

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13
Q

What can be heard during auscultation of chronic bronchitis?

A

Productive cough with rhonchi

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14
Q

What can chronic bronchitis cause?

A

Hypercapnia, hypoxemia, respiratory acidosis

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15
Q

What are preventative and treatment measures for COPD?

A

Prevent exacerbations by reducing environmental exposure to irritants, stop smoking, filter allergens from air, remove rugs in home, avoid exposure to known irritants/allergens, open the conducting airways using bronchodilators, decrease the effects of inflammation on the airway lining

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16
Q

What type of drug are sympathomimetics?

A

Bronchodilators, alpha and beta 2 adrenergic agonists

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17
Q

What is epinephrine?

A

A non-selective sympathomimetic that promotes bronchodilation and elevated BP in emergency situations

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18
Q

What is a bronchospasm selective beta 2 adrenergic agonist?

A

Given as aerosol/tablet and has less side effects than the non-selective

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19
Q

What are sympathomimetic medications?

A

Albuterol, Proventil, Ventolin, Metaproterenol

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20
Q

What drug class is albuterol?

A

Sympathomimetic beta 2 adrenergic

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21
Q

What is albuterol indicated for?

A

Acute asthma attacks, to control asthma, for exercise induced asthma

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22
Q

Albuterol is the only med considered a…

A

Rescue med

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23
Q

What is the onset of albuterol?

A

30 minutes

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24
Q

What pregnancy category is albuterol?

A

Pregnancy category C

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25
Q

What meds are considered the same as albuterol?

A

Ventolin, Proventil, Xopenex

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26
Q

What is Xopenex good for?

A

Patients with AFIB or tachycardia because it causes a less rapid HR

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27
Q

What are the two types of aerosol inhalers?

A

Metered dose inhaler and dry powder inhaler

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28
Q

How is an aerosol inhaler used?

A

Test spray the inhaler if it hasn’t been used recently, insert the canister into plastic mouthpiece, shake before using and remove the cap from mouthpiece, breathe out the mouth and place mouthpiece 1-2 inches from mouth, take a slow deep breath while pressing the top of the canister once, hold breath for a few seconds and exhale slowly through pursed lips, wait 2 minutes and repeat starting from shaking again.

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29
Q

What should be administered first, a bronchodilator or a steroid inhaler?

A

Bronchodilator because it helps open the airways so the steroid inhaler can work, wait 5 minutes before administering steroid inhaler

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30
Q

What med is the prototype for anticholinergics?

A

Ipratropium (Spiriva)

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31
Q

What is Ipratropium (Spiriva) indicated for?

A

Maintenance of bronchospasm associated with COPD

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32
Q

How does Ipratropium (Spiriva) work?

A

Relaxes smooth muscle of the bronchioles

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33
Q

Does Ipratropium (Spiriva) have systemic effects?

A

Very few when administered by aerosol

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34
Q

If also using a sympathomimetic, steroids, or cromolyn, which should be given first?

A

Administer the sympathomimetic first, wait 5 minutes, then administer Ipratropium (Spiriva), or the steroid, or cromolyn

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35
Q

What are side effects of Ipratropium (Spiriva)?

A

Hoarseness and dry mouth

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36
Q

What are the adverse effects of Ipratropium (Spiriva)?

A

Angioedema, dehydration, hyperglycemia

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37
Q

What are the contraindications of Ipratropium (Spiriva)?

A

Peanut allergy, pregnancy

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38
Q

Who should we take caution with when giving Ipratropium (Spiriva)?

A

Patients with lactose sensitivity, hypersensitivity, breastfeeding, narrow-angle glaucoma

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39
Q

What are methylxanthines used for?

A

Treatment of asthma

40
Q

How do methylxanthines work?

A

Stimulate CNS and respiration, dilate coronary and pulmonary vessels, cause diuresis

41
Q

What is the therapeutic range of methylxanthines?

A

10-20 mcg/mL

42
Q

What meds are considered methylxanthines?

A

Theophylline, aminophylline, and caffeine

43
Q

What are contraindications of Theophylline?

A

GI problems, coronary disease, respiratory dysfunction, renal/hepatic disease, alcoholism, hyperthyroidism

44
Q

What are adverse effects of theophylline?

A

More side effects will occur with higher levels of theophylline in the blood (>20 mcg/mL), side effects include GI upset, nausea, irritability, tachycardia, seizure, brain damage, and death

45
Q

What is leukotriene?

A

Chemical mediator that causes inflammatory changes in the lungs

46
Q

What do leukotriene antagonists do?

A

Promote an increase of eosinophil migration, mucus production, and airway wall edema, resulting in bronchoconstriction

47
Q

What are leukotriene antagonists used for?

A

Only used for exercise induced asthma

48
Q

What are medications that are leukotriene antagonists?

A

Montelukast sodium (Singulair), Zafirlust (Accolate), Zileuton (Zyflo CR)

49
Q

What pregnancy category is Montelukast Sodium (Singulair)?

A

Pregnancy category C

50
Q

What are the indications of Montelukast Sodium (Singulair)?

A

Prevention and maintenance treatment of asthma

51
Q

How does Montelukast Sodium (Singulair) work?

A

Binds with leukotriene receptors to inhibit smooth muscle contraction and bronchoconstriction

52
Q

How is Montelukast Sodium (Singulair) given?

A

PO NOT inhaled

53
Q

What are contraindications of Montelukast Sodium (Singulair)?

A

Hypersensitivity, severe asthma attack, status asthmaticus

54
Q

What are the side effects of Montelukast Sodium (Singulair)?

A

Fever, HA, dizziness, fatigue, nasal congestion, cough, sore throat

55
Q

Who should we take caution in when giving Montelukast Sodium (Singulair)?

A

Patients with severe liver disease

56
Q

Why is Montelukast Sodium (Singulair) a black box warning?

A

It can cause depression, agitation, and suicidal ideas in children

57
Q

What are glucocorticoids (steroids) used for?

A

To treat respiratory disorders specifically asthma

58
Q

What type of action do glucocorticoids (steroids) have?

A

Anti-inflammatory action

59
Q

What are indications of glucocorticoids (steroids)?

A

If the patient’s asthma is unresponsive to a bronchodilator, or if the patient still experiences asthma attacks on the highest doses of theophylline

60
Q

What type of effect do glucocorticoids (steroids) have when given with sympathomimetics?

A

Synergistic effect

61
Q

How are glucocorticoids (steroids) given?

A

MDI, tablet, or IV

62
Q

How long does the MDI take for full effect?

A

1-4 weeks and it’s not effective for a severe asthma attack

63
Q

Which route helps improve system control and decrease attacks?

A

MDI

64
Q

What does the MDI reduce the risk of?

A

Adrenal suppression associated with systemic steroid

65
Q

Which route is preferred for glucocorticoids (steroids)?

A

MDI

66
Q

How would you administer glucocorticoids (steroids) for an acute asthma exacerbation?

A

IV for rapid effectiveness, then tablet doses

67
Q

How should the PO version of glucocorticoids (steroids) be taken?

A

Taken with food to avoid gastric ulcers

68
Q

What is Advair?

A

A combination of fluticasone propionate and salmeterol, used to alleviate constriction

69
Q

What are side effects of the PO version of glucocorticoids (steroids)?

A

Generally local effects, throat irritation, hoarseness, dry mouth, oral and pharyngeal fungal infections that are reversed with discontinuation of glucocorticoids (steroids) and antifungal treatment

70
Q

What are candida albicans?

A

An oral infection that can be prevented by rinsing mouth with water after using inhaler, and washing apparatus daily

71
Q

What are the indications of Cromolyn (Intal)?

A

Prophylactic treatment of bronchial asthma, not for acute asthma attacks

72
Q

How is Cromolyn (Intal) given?

A

Given by inhalation and must be taken daily

73
Q

How does Cromolyn (Intal) work?

A

Inhibits the release of histamine to prevent asthma reaction

74
Q

What are the side effects of Cromolyn (Intal)?

A

Bad taste and rebound bronchospasm

75
Q

Why should we not discontinue Cromolyn (Intal) abruptly?

A

It can cause a rebound asthma attack

76
Q

How does Nedocromil work?

A

Suppresses the release of histamine, leukotrienes, and mediators from mast cells

77
Q

What is Nedocromil not used for?

A

Acute asthma attacks

78
Q

What are the side effects of Nedocromil?

A

Bad taste

79
Q

Which is more effective, Cromolyn or Nedocromil?

A

Nedocromil

80
Q

How do mucolytics work?

A

Liquify and loosen thick mucus secretions so they can be expectorated

81
Q

What are the indications of mucolytics?

A

Patients with active airway disease or asthma have excess secretions, pt who has difficulty coughing up secretions, pt who has atelectasis, pt undergoing diagnostic bronchoscopy, post op patients, pts with tracheostomies

82
Q

For which one of these patients would we use the mucolytic AND a bronchodilator?

A

Asthma and active airway disease pt

83
Q

Which one would be taken first, the mucolytic or the bronchodilator?

A

The mucolytic should be taken 5 minutes after the bronchodilator

84
Q

How are mucolytics given?

A

Nebulizer, PO (diluted with water or juice), or direct instillation into trachea

85
Q

Take caution when giving mucolytics to who?

A

Patients with acute bronchospasm, peptic ulcer, and esophageal varices

86
Q

What are side effects of mucolytics?

A

N/V, stomatitis, runny nose, rash, bronchospasm

87
Q

Mucolytics are the antidote for what?

A

Acetaminophen overdose if given within 12-24 hours

88
Q

What are the indications for Mucomyst (Acetylcysteine)?

A

Adjunctive therapy for abnormal, thick mucus secretions in acute and chronic bronchopulmonary disorders. To lessen hepatic injury in cases of acetaminophen toxicity

89
Q

How does Mucomyst (Acetylcysteine) work?

A

Breaks the links in the mucoproteins contained in the respiratory mucus secretions, decreases the viscosity of the secretions, and protects liver cells from acetaminophen toxicity

90
Q

How is Mucomyst (Acetylcysteine) given?

A

Instillation, inhalation, PO

91
Q

What is the onset for installation/inhalation of Mucomyst (Acetylcysteine)?

A

1 minute

92
Q

What is the peak for installation/inhalation of Mucomyst (Acetylcysteine)?

A

5-10 minutes

93
Q

What is the duration for installation/inhalation of Mucomyst (Acetylcysteine)?

A

2-3 hours

94
Q

What is the onset for PO of Mucomyst (Acetylcysteine)?

A

30 - 60 minutes

95
Q

What is the peak for PO of Mucomyst (Acetylcysteine)?

A

1-2 hours

PHARM EXAM 2 (10 decks)

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