Lower Respiratory Drugs

Question 1

Prototypes:

Answer 1

Bronchodilator’s:
— albuterol (inhaler)
— salmeterol (inhaler)
— ipratropium (inhaler)
— theophylline/aminophylline
Anti-inflammatories:
— fluticasone (inhaler)
— montelukast

Question 2

What is Alpha 1-Adrenergic AGONIST?

Answer 2

— sympathomimetic: mimics function of SNS
— mimics the action of epinephrine and norepinephrine
— causes smooth muscle and vessel constriction
— used as a decongestant

Question 3

What is a Beta2-Adrenergic AGONIST?

Answer 3

— sympathomimetic
— mimics effects of SNS
— dilation of bronchi with increased rate and depth of respiration
Ex: albuterol

Question 4

ANTI-cholinergics:

Answer 4

— substance that BLOCKS neurotransmitter acetylcholine in CNS & PNS
— effects the vagus nerve to relax bronchial smooth muscle
— promotes bronchodilation
Ex: asthma therapy (inhaler)

Question 5

What are medication cautions exacerbated by sympathetic activity?

Answer 5

— glaucoma
— hypertension
— coronary artery disease
— peripheral artery disease
— diabetes (increased glucose)
— hyperthyroidism (increased HR)
— prostate hypertrophy

Question 6

What are medication cautions exacerbated by anticholinergic effects (parasympathetic)?

Answer 6

— constipation
— prostate hypertrophy
— hypertension
— tachycardia
— dementia

Question 7

What are characteristics of asthma (triggers)?

Answer 7

Bronchoconstriction, inflammation, mucous production

Question 8

Respiratory characteristics of COPD?

Answer 8

— chronic cough
— mucous production
— expiratory airway collapse with air trapping

Question 9

Characteristics of pneumonia:

Answer 9

— bronchitis
— emphysema
— inflammation
— infection

Question 10

What are some clinical manifestations of asthma, COPD, and pneumonia?

Answer 10

— shortness of breath/dyspnea
— increased work of breathing, use of accessory muscles
— sputum production
— hypoxia

Question 11

What is the role of histamine?

Answer 11

Stimulates larger bronchi to cause smooth muscle spasms, inflammation, and edema

Question 12

Medication used as a “rescue inhaler”:

Answer 12

Sympathomimetic: beta2-Adrenergic agonist
— albuterol
— short acting beta agonist
— used on acute onset; used 4-6 hours PRN

Question 13

What medication is used as a “maintenance inhaler”:

Answer 13

Sympathomimetic: beta2-adrenergic agonist
— salmeterol
— long acting beta agonist
— prevention of bronchospasms; used twice a day

Question 14

What is albuterol and what does it do?

Answer 14

Adrenergic AGONIST:
— rescue inhaler
— short acting beta agonist (SABA)
— promotes bronchodilation
— inhaler; onset: 5-15 minutes

Question 15

What are adverse effects of albtuerol?

Answer 15

Sympathomimetic stimulation:
— cardiac arrhythmias
— HTN
— sweating
— tremors
— worsened bronchospasms
Receptors are not targeted perfectly
— some patients can have the opposite effects and make things worse

Question 16

What is salmeterol and what does it do?

Answer 16

Adrenergic AGONIST:
— inhaler
— used for maintenance
— long acting; used on schedule
— promotes bronchodilation

Question 17

What are contradictions to salmeterol?

Answer 17

Increased risk for asthma-related deaths
— inhaled corticosteroids to decrease risk

Question 18

What is ipratropium (atrovent) and what does it do?

Answer 18

Respiratory ANTI-cholinergic
— used for maintenance; asthma prevention
— BLOCKS acetylcholine; promotes airway dilation
— inhaler; scheduled drug

Question 19

What are some adverse effects of ipratropium (atrovent)?

Answer 19

— dry mouth
— nasal congestion
— heart palpitations

Question 20

What is fluticasone (Flovent) and what does it do?

Answer 20

Inhaled corticosteroid:
— decrease inflammatory response to airways
— maintenance; prevention and treatment of asthma
— inhaler; scheduled medication

Question 21

What are adverse effects to fluticasone (Flovent)?

Answer 21

— sore throat
— hoarseness
— coughing
— dry mouth
— fungal infections
Nursing: rinse mouth after inhalation to reduce fungal infections

Question 22

Positive effects of combination respiratory drugs?

Answer 22

Greater control over symptoms by approaching disorder from two different pathways
— must consider BOTH adverse effect profiles

Question 23

Inhaler education:

Answer 23

— promote use of spacer
— clean weekly
— rinse mouth after inhaler use (especially with corticosteroid)
— timing of administration (rescue, or maintenance)

Question 24

What is the sequence for using multiple inhalers?

Answer 24

1. Bronchodilator’s
   — beta agonist agents
   — wait 1 minute between puffs
   — wait 5 minutes before administering next medication
2. Corticosteroids
   — always administer AFTER bronchodilator’s
   — wait 1 minute between puffs
   — rise mouth afterwards to prevent fungal infection

Question 25

What is montelukast (singulair) and what does it do?

Answer 25

Leukotriene receptor ANTAGONIST:
— blocks production of inflammation
— blocks receptors for production of leukotrienes (inflammatory)
— oral medication; prophylaxis for asthma in adults & children
— maintenance medication

Question 26

What are some adverse affects of montelukast (singulair)?

Answer 26

Headache, nausea, diarrhea

Question 27

What is theophylline/aminophylline and what does it do?

Answer 27

Xanthine derivatives; HIGH RISK: not commonly used
— theophylline: oral; prevention of bronchospasm
— aminophylline: IV; reversal of bronchospasm
— rescue medication
— direct effect on smooth muscles of respiratory tract
— metabolizes to caffeine; leads to toxic effects very fast
— NARROW therapeutic window; low margin of safety

Question 28

What are some adverse effects of theophylline/aminophylline?

Answer 28

— GI upset
— nausea
— irritability
— tachycardia
— seizure
— brain damage
— possible death
Contradiction: cardiovascular disease