Monica - Week 10 - Exam 3 Flashcards
what is asthma?
chronic disorder of airway; bronchi/bronchioles become narrowed
what are the characteristics of asthma?
inflammation, swelling, and mucus production; bronchospasm (acute narrowing)
what are the 5 asthma triggers?
o allergens (dust, grass)
o air pollutants (perfume, smoke, exhaust)
o respiratory infections (exacerbate asthma → airway narrowing)
o GERD (exacerbate → weak lower esophageal sphincter → aspirate into bronchioles)
o exercise (loss of heat/H2O, cold/dry air)
characteristics of an asthmatic airway.
relaxed smooth muscles; wall inflamed and thickened
characteristics of an asthmatic airway during attack
tightened smooth muscles, air trapped in alveoli, and wall inflamed and thickened
where are beta-1 receptors located?
the heart
what occurs when beta-1 receptors are activated?
↑ contractility, ↑ HR, ↑ conduction
where are beta-2 receptors located?
kidneys, vascular and non-vascular smooth muscle
***beta-2 blockers affect the lungs
what occurs when beta-2 are activated?
vasodilation
***beta-2 blockers affect the lungs
T/F beta-1 blockers may affect beta-2 receptors
TRUE
what do selective beta-2 adrenergics do?
- stimulates beta-2 receptors → bronchodilation
what are the two selective beta-2 adrenergic drugs?
albuterol and salmeterol diskus
what are two characteristics of albuterol?
- short acting drug
- “rescue medication”
how does albuterol work?
- facilitates mucus drainage
- inhibits release of inflammatory chemicals
how long does albuterol work?
2 - 6 hrs
what are the AEs of albuterol?
nervousness, palpitations, and tremors
T/F: albuterol is the drug of choice in acute bronchospasm
TRUE
salmeterol is a ____ acting drug
long - not used for acute episodes
how long does salmeterol work?
up to 12 hrs
what is the indication for salmeterol diskus?
asthma prophylaxis and long-term therapy for COPD
what do leukotriene receptor antagonists do?
- leukotrienes released w/ exposure to allergens
- brochoconstriction, airway edema
what are leukotrienes?
inflammatory chemicals that cause the airway to tighten
what is the leukotriene receptor antagonist drug?
montelukast
how does montelukast work?
- bind to leukotriene receptors
- vasodilate airway muscles
- ↓ airway edema
what are the indications for montelukast?
- prevention and tx of chronic asthma
- prevention of exercise-induced bronchoconstriction
what ware 5 ways to reduce or avoid triggers that can cause symptoms of attacks?
- Keep windows closed during pollen season
- Clean home environment
- Reduce pet dander
- Cover nose and mouth in cold environments
- Control heartburn and GERD w/ meds
what are the two different types of medications used to manage attacks and when are they used?
- short term: acute attacks
- long term: management
how is chronic obstructive pulmonary disease (COPD) described?
- persistent airflow limitation - chronic bronchitis and emphysema
what are the 2 characteristics of chronic bronchitis?
- cough and sputum production
- occurs for at least 3 mo. in a 2 year period
what are 3 characteristics of emphysema?
- chronic inflammation
- loss of elasticity of bronchioles and damage to alveoli
- air trapping, ↓ perfusion, ↓gas exchange
what are the risk factors for COPD, emphysema, and chronic bronchitis?
- exposure to cigarette smoke, fumes, dust, chemicals, air pollutants
what are all the clinical manifestations of COPD? (10)
- chronic cough
- sputum production
- dyspnea
- barrel-chest
- wheezing
- clubbed fingers
- fatigue and weakness
- activity intolerance
- gas exchange abnormalities
- ↑ susceptibility to infections
- exacerbations
health promotions and lifestyle modification to prevent tx of complications and maintain lung capacity
- Smoking cessation and avoidance of 2nd hand smoke
- Breathing exercises (pursed lip breath)
- Nutrition (takes energy, smaller, frequent meals, high caloric high protein intake; ↑ mucus ↓ taste)
- Increase fluid intake (dehyrdation, liquid secretion)
- Exercise (last in day before meals)
- Prevention (flu /pneumonia shots)
- Low level oxygen therapy (85 - 90% O2 sat)
T/F: COPD pts are accustomed to CO2 drive so too much O2 may stop drive
TRUE
what do anticholinergics target and what do they do?
- acetylcholine receptors on bronchial tree
- acetylcholine binding → bronchial vasoconstriction
what is the short acting anticholinergic?
ipratropium inhaler
when is ipratropium inhaler indicated?
what is it administered with?
how many times is it administered?
o relieves and prevents bronchospasm of asthma/COPD
o administered w/albuterol (DuoNeb)
o up to 4 or more times per day
what is the long acting anticholinergic?
tiotropium dry powder inhaler (DPI)
when is tiotropium dry powder inhaler used? and what is the indication?
- daily dosing
- maintenance/prophylaxis of bronchospasm w/COPD
what are the 3 different inhaler corticosteroids?
fluticasone dry powder inhaler (DPI) + fluticasone/salmeterol (Advair) + fluticasone/vilanterol (Breo)
what are the four characteristics of fluticasone dry powder inhaler (DPI) ?
o anti-inflammatory o ↓ edema and mucus secretion o long-term management of asthma or COPD
o ↓ frequency and severity of asthma attacks
what kind of combo are both fluticasone/salmeterol (Advair) + fluticasone/vilanterol (Breo)?
combo corticosteroid and bronchodilator
what are the AEs of corticosteroid inhalers?
HA, hoarseness, hyperglycemia,
oral/esophageal candidiasis
T/F it’s important to rinse mouth after use of corticosteroid inhalers?
TRUE
what are the names of the systemic corticosteroid drugs?
methylprednisolone (IV → ST)
perdnisone (ST/LT)
what is the indication for systemic corticosteroid?
- anti-inflammatory
- short term tx for acute asthma and COPD
exacerbations
what does systemic corticosteroid do?
↓ mucus production and edema (swelling/↓ airway constriction)
for how long are systemic corticosteroids prescribed?
- prescribed for 5 to 7 days -tapering dose ↓ to prevent adrenal insufficiency
what are the AE of systemic corticosteroids?
hyperglycemia, euphoria, depression, HTN, ↓ wound
healing, ecchymoses, peptic ulceration
what is the purpose for pulmonary function tests? (PFT)
- differentiate b/t obstructive diseases
- disease progression, assess bronchodilator response
- measure lung volumes and airflow
- depends on age, weight, height, gender
what do PFTs measure?
- total lung capacity
- residual volume (air left after expiration)
- forced vital capacity (amt air that can be quickly and forcefully exhaled before taking another breath)
what are the 3 characteristics of acid-base balance?
- metabolic and respiratory processes maintain H+ levels
- pH is a measure of acidity or alkalinity
- imbalances are a sx of an underlying health problem
what are the 3 mechanisms to regulate the acid-base balance?
- buffer system
- respiratory system
- renal system (metabolic system)
how does the buffer system work?
- neutralizing strong acids to weaker
- primary buffers HCO3- and phosphate
how does the respiratory response work?
- CO2 removed during exhalation
- hypoventilation → retain CO2 → acidosis
- hyperventilation → expel CO2 → alkalosis
how does the renal (metabolic) response?
- acidosis → kidneys reabsorb HCO3- and secrete more H+
- alkalosis → kidneys excrete HCO3 and reduce H+ secretion
what are the acidic pH levels?
< 7.35
what are normal pH levels
7.35 - 7.45; NORMAL: 7.4
what are the alkaline pH levels?
> 7.45
what are the acidic CO2 levels?
> 45
what are the normal CO2 levels?
35 - 45
what are the alkalotic CO2 levels?
< 35
what are the acidic HCO3 levels?
< 22
what are the normal HCO3 levels?
22 - 26
what are the alkalotic HCO3 levels?
> 26
T/F : ABGs will also show fully compensated, partially compensated or
uncompensated
TRUE
what are the possible causes of metabolic acidosis?
DKA, Shock, Diarrhea, Salicylate OD, Renal failure , Sepsis
what are the possible causes of metabolic alkalosis?
Loss of gastric secretions
Overuse of antacids
K+-wasting diuretics
what are the possible causes of respiratory acidosis?
Hypoventilation r/t:
COPD Chest trauma Drug OD Airway obstruction
Neuromuscular disorder
what are the possible causes of respiratory alkalosis?
Hyperventilation r/t:
Anxiety
High altitude
Fever