Patho-Pharm Exam 1 - Respiratory Flashcards
90% of respiratory illnesses are caused by what?
Smoking
What is a hyperresponsiveness of airways that is usually reversible and considered a disease of inflammation other than obstruction?
Asthma
Is asthma a disease of inflammation or obstruction?
Inflammation
Asthma is a constriction of what?
Bronchial smooth muscle
Hypersecretion of what occurs in asthma?
Mucous
Is asthma considered reversible or irreversible?
Reversible
An allergic response is an immune response T/F?
True
What immunoglobulin in involved in an asthma response?
IgE
What does IgE do to cause an immune response?
Binds to mast cells and drills holes in them to release histamine and leukotrienes.
Where are mast cells located?
In tissues all over the body.
Histamine and leukotrienes are released from what cells?
Mast cells
Edema and inflammation cause the smooth muscle of the bronchioles to do what?
Constrict
What are the usual causes of chronic bronchitis?
Smoking or inhaling irritants
Is the airway inflammation in chronic bronchitis reversible or irreversible?
Irreversible
For people with chronic bronchitis, what takes a lot of energy?
Breathing
Alveolar destruction is responsible for what condition?
Emphysema
In what condition are the “springs” broken”?
Emphysema
Is emphysema reversible or irreversible?
Irreversible
Identify the following conditions as irreversible or reversible:
Asthma
Chronic bronchitis
Emphysema
Asthma - reversible
Chronic bronchitis - irreversible
Emphysema - irreversible
What is the major cause of COPD?
Smoking
What is one bronchodilator?
Beta-adrenergic agonists
How do bronchodilators work?
Reduce airway constriction
Agonists stimulate the adrenergic receptors in what part of the autonomic nervous system?
Sympathetic NS
In what phase of asthma attack are bronchodilators used?
Acute
Which receptors in the lungs are affected by beta-adrenergic agonists?
B2
Which receptors in the heart are affected by beta-adrenergic agonists?
B1
Common side effects of beta-adrenergic agonists?
Palpitaions, tachycardia, tremors
What is the device that is used with an inhaler to deliver the appropriate amount of medication?
A spacer
Corticosteroids are used for what type of asthma?
Chronic
Do corticosteroids relieve acute asthmatic attacks?
No
Inhaled or oral forms of corticosteroids reduce systemic effects?
Inhaled
How long does it take to see effects with a corticosteroid used for asthma?
Several weeks
Corticosteroids stabilize membranes of cells to prevent the release of what stubstances?
Inflammatory substances
Corticosteroids increase the responsiveness of bronchial smooth muscle to what other bronchodilator and are commonly used in conjunction with it?
Beta-adrenergic agonists
What is the suffix for corticosteroids?
-sone or -olone
What form is usually used for a combo corticosteroid/beta-adrenergic agonist treatment?
Powder inhaler
Adverse affects of corticosteroids?
Pharyngeal irritation
Coughing
Dry mouth
Oral fungal infections
Decreased immune response
What is one thing to teach patients after the administration of inhaled steroids?
Rinse and spit after use
What is a spirometer used for?
Encourage deep breathing in patients after surgery or laying in bed
What technique of breathing is used as retraining?
Purse-lip breathing
In COPD, what happens to flatten the diaphragm to make it immobile?
Air gets trapped in the lungs.
CO2 and H2O combine to form what in the lungs and what does it cause?
CO2 and H2O form carbonic acid which increases systemic acidity.
Why is it important to push the stale air out of the lungs in emphysema?
To avoid respiratory acidosis
What breathing exercise contracts the abdominal muscles and forces the diaphragm up and aids in expelling air?
Pursed lip breathing
Weight loss and malnutrition are common with what disease condition?
Emphysema
Patients on long-term oxygen therapy most commonly use what device to deliver oxygen?
A nasal canula
What is the FIO2 of room air?
21%
What is the increase in FIO2 for each L of O2?
3%
What drug has anti-inflammatory properties, is used for chronic asthma, does not relieve acute asthma symptoms and make take several weeks for effects to be seen?
Corticosteroids
What dosage forms are corticosteroids available in?
Oral or inhaled
What is the MOA of corticosteroids?
Turn off inflammation process (immune system)
Are corticosteroids good for long or short term control of asthma?
Long term
What is the inhaled corticosteroid to know for this test?
Fluticasone (Flonase)
What is fluticasone commonly combined with in powdered inhalers to treat persistent asthma?
Beta-adrenergic agonist (fast acting)
Pharyngeal irritation, coughing, dry mouth and what other side effect are the result of inhaled corticosteroids?
Oral fungal infections
Why are oral fungal infections caused by inhaled corticosteroids?
Because they depress the immune system
How many meters of O2 can be administered through a nasal canula?
4 L
When a pt needs more than 4L of oxygen, what device is needed to administer it?
A venturi mask
A pt is prescribed 2 different types of inhaled medication for COPD. How long should the nurse wait to administer the 2nd medication?
Five minutes
The nurse has a prescription to give a client a long-acting beta 2 agonist, two puffs, and a steroid, two puffs by metered-dose inhaler. Which medication should be administered first?
The bronchodilator (beta 2 agonist) should be administered first to open the bronchioles to allow the steroid to get where it needs to go.
In an acute asthma attack, which medication should be given first?
Albuterol (beta adrenergic agonist)
If a pt is being treated with a short-acting inhaled beta 2 agonist, what step in asthma treatment is this?
First step
What is the typical cause of the common cold?
Viruses
Why is excess mucous produced in response to a viral invasion that causes a cold?
From the inflammatory response in the mucosa of the upper respiratory tract to the invasion.
Nasal mucosal irritation causes the release of what substances?
Inflammatory and vasoactive substances
What is the effect of inflammatory and vasoactive substances in the nasal mucosa?
Dilation of the small blood vessels, causing congestion
Treatment of the common cold is what type of therapy?
Empiric - because don’t know the cause, just treating symptoms
What is an antihistamine used to treat symptoms of the common cold?
Diphenhydramine (Benadryl)
In what cells are histamines stored?
Mast cells
Where are mast cells located?
Everywhere - skin, lungs, GI tract
Where are a low level of mast cells located?
Blood plasma
T/F - An allergic release of histamine requires prior exposure to the allergen?
True
Which immunoglobulin is associated with allergic reactions?
IgE
What does IgE do to cause the release of histamine?
Drills hole in mast cell which releases histamine which binds to histamine receptors stimulating further release of histamine.
What substance is responsible for the sneezing, coughing, wheezy, itchy, runny nose of a cold?
Histamine
Vasodilation, increased capillary permeability, bronchoconstriction are the result of the release of what?
Histamine
Vasodilation is associated with bronchoconstriction - T/F?
True
Vasodilation is associated with decreased capillary permeability?
False. Vasodilation is associated with increased capillary permeability.
Histamine acts through what receptor?
H1
What is the MOA of antihistamines?
Block action of histamine at H1 receptor sites
T/R - Diphenhydramine is best used palliative?
False. It is best used prophylactically.
Diphenhydramine is what generation of H1 antagonists?
First generation
Is diphenhydramine water or lipid soluable?
Lipid soluable
What can diphenhydramine do because it’s lipid soluable?
Cross the blood/brain barrier
What are the three properties of antihistamines?
- Antihistaminic
- Anticholinergic (Depressed acetyl choline, a neurotransmitter)
- Sedative
Second generation antihistamines differ from first generation how?
- Much less sedation
- Cross blood-brain barrier poorly
Stimulate saliva, gastric, lacrimal and bronchial secretions are the effects of what substance?
Histamines
Reduced salivation, gastric secretion, lacrimal and bronchial secretions are the effects of what substance?
Antihistamines
What is an anticholinergic effect?
Drying effect that reduces nasal, salivary, lacrimal and nasal secretions
What drug is an anticholinergic?
Diphenhydramine (Benadryl)
Anticholinergic drugs repress what neurotransmitter?
Acetyl choline
What are the effects of anticholinergics?
Mad as a hatter
Red as a beet
Can’t see
Can’t pee
Can’t spit
Can’t shit
What part of the autonomic NS do anticholinergic drugs mimic?
Sympathetic
GI upset can be reduced with anticholinergics by doing what?
Taking it with meals
2 types of coughs?
Production/non-productive
What are the 2 types of antitussives?
Opioid and non-opioid
Which type of cough are antitussives used for?
Non-productive coughs only
Where is the cough center of the brain that is affected by opioids?
Medulla
What is a big side effect of the opioid-based antitussive codeine?
Constipation
Is codeine a good pain reliever?
No
What is a non-opioid antitussive medication?
Dextromethorphan
What is the MOA of dextromethorphan?
Suppress the cough center of the brain in the medulla, just like opioid-based antitussive codeine, only is non-opioid.
Dizziness, nausea and drowsiness are adverse effects of what antitussive?
Dextromethorphan
Sedation, nausea, vomiting, lightheadedness and constipation are adverse effects of what antitussive?
Codeine
What is the MOA of expectorants?
Thin mucus
What should patients taking guaifenesin do?
Drink plenty of water
What drug reduces the viscosity of secretions?
Guaifenesin
What type of laxative is polyethylene glycol?
Hyperosmotic
What is the MOA of hyperosmotic laxatives?
Draws water into bowel from surrounding tissue
What is the brand name of hyperosmotic laxative that is used for bowel cleansing for procedures?
Miralax
How fast does Miralax, a hyperosmotic laxative, work?
30-60 minutes
What is a mild hyperosmotic laxative that is used in children?
Glycerin
