Repiratory Flashcards
reversible airway obstruction causing inflamed, narrow and swollen bronchi and bronchioles, excessive mucus production
asthma
symptoms of asthma
cough
wheeze
chest tightness
SOB
triggers of asthma
viral infections
air pollutions
strong odours
physical activity (SOB)
allergies
if asthma is left untreated it could lead to
COPD
main cause of COPD
smoking
environmental factors: pollution, dust chemical fumes and gas
genetics
symptoms of COPD
SOB
productive cough
increased phlegm or mucus production
fatigue
chest infections
forms of COPD
emphysema and chronic bronchitis
2 main asthma treatments
bronchodilators and corticosteroids
2 types of bronchodilators
adrenoceptor agonist (selective beta-2 agonist) and antimuscarinic bronchodilators
2 types of selective Beta-agonists and indications
short-acting (SABA) - (reliever)mild and acute asthma or exercise induced asthma with quick onset 5-15 mins
long-acting (LABA) - (preventer) chronic asthma and COPD. long therapeutic effect (12 hours)
SABA pharmacodynamics
beta-2 receptor agonist in smooth muscles of bronchi > stimulation of adenyl cyclase >increasing cAMP which relaxes smooth muscles >bronchodilation effect
SABA meds
salbutamol
terbutaline
SABA contraindications
medications that inhibit beta-1 receptors which inhibits sympathetic nerves (since beta-2 agonist induces sympathetic nerves)
hyperthyroidism
cardiovascular disease and arrhythmias
HTN
diabetes
LABA pharmacodynamics
same as SABA but act as a preventer
MUST use with inhaled corticosteroids or ICS
LABA meds
salmeterol
formoterol
eformoterol
indacaterol
olodaterol
LABA contraindications
hyperthyroidism
hypersensitivity
LABA adverse effects
palpitation
peripheral vasodilation - hypotension
headache
fine muscle tremor
tolerance in beta-2 agonist drugs can
downregulate beta-2 receptors over time
high doses can make the receptors unresponsive
sympathomimetics treatment for asthma - used in emergency situations
ephedrine and adrenaline - promote bronchodilation by activating beta receptors
reduce oedema through pulmonary vasoconstriction by stimulating alpha receptors
SABA and LABA nursing considerations
ALWAYS take bronchodilator FIRST - to dilate airways
WAIT 5 mins
THEN use corticosteroids
RINSE mouth with water after using inhaled bronchodilators or corticosteroids to PREVENT THRUSH (yeast infection)
sodium cromoglycate pharmacodynamics
inhibits inflammatory mediators during inhaled allergens such as histamine and leukotrienes from mast cells
sodium cromoglycate meds
cromolyn
mast cell stabilizers (leukotriene receptor antagonist) pharmacodynamics
inhibits leukotrienes which is produced by the immune system which promotes bronchoconstriction, inflammation, microvascular permeability and mucus secretion in asthma and COPD
anticholinergic pharmacodynamics
blocks parasympathetic nerves which causes the airways to constrict, therefore allows airways to remain open
anticholinergic meds
aclidinium
umeclidinium
ipatropium
tiotropium
anticholinergics indications
bronchospasms in COPD
anticholinergics adverse effects
blurred vision
dysuria
dry mouth
constipation
asthma and COPD treatment that mainly inhibits inflammatory mediators of the immune system
corticosteroids
corticosteroids MoA
suppress recruitment and activation of eosinophils and mast cells in airways > reduce inflammatory response
suppress antibody synthesis and receptor production
inhibits prostaglandin synthesis > reducing oedema, mucus production and inflammation
upregulates beta-receptors > increased therapeutic benefits from beta-2 agonist meds
corticosteroids must be used with ___________ to achieve therapeutic effects and further reduce exacerbations and need of higher doses
beta-2 agonist
inhaled corticosteroids adverse effects
sore throat
hoarse voice
oral candidiasis or thrush
risk of chest infections
inhaled corticosteroids meds
budesonide
smart inhalers are
combination of LABA and inhaled corticosteroids > short term relief
eg. formoterol + budesonide (symbicort)
oral or systemic corticosteroids meds
oral: prednisolone, prednisone, hydrocortisone
IV: methylprednisolone
oral corticosteroids adverse effects
cushing syndrome
hyperglycaemia
osteoporosis
sepsis
depression
HTN
decreased libido
oedema
weight gain
risk of cataracts
excessive use of corticosteroids can cause
cushing syndrome
chronic use of oral corticosteroids can inhibit the function of HPA axis or hypothalamic-pituitary adrenal axis (ACTH) by negative feedback resulting in
adrenal insufficiency - sever fatigue, weakness, weight loss, postural hypotension, low BP, nausea, vomiting, painful muscles and joints
treatment for adrenal suppression and insufficiency
hydrocortisone replacement therapy
nursing consideration for long-term corticosteroid replacement
monitor signs of infection (since corticosteroids are immunosuppressants)
increase Ca diet (corticosteroids can deplete bone density)
increase dose in time of stress (cortisol is decreased)
slowly taper off medications DO NOT STOP ABRUPTLY - it may cause adrenal insufficiency symptoms
antimuscarinic meds MoA
blocks parasympathetic receptors such as ACh and muscarinic to promote smooth muscle relaxation
inhibits cholinergic (Ach) mediated bronchoconstriction and cholinergic production of mucus
antimuscarinic meds should be used with _________ to promote synergistic bronchodilator effects
beta-2 agonists drugs
2 types of antimuscarinics
short-acting muscarinic antagonist (SAMA)
long-acting muscarinic antagonist (SAMA)
indications for SAMA
used for COPD only
symptom relievers (cough, wheezing and SOB)
can be used with salbutamol for severe asthma
SAMA meds
Ipratropium
LAMA indications
persistent COPD
long term treatment for bronchospasm and excessive mucus secretion
LAMA meds
Tiotropium
antimuscarinics adverse effects
dry mouth
urinary retention
pupil dilation
glaucoma
antimuscarinics contraindicated with
glaucoma
prostatic hyperplasia
bladder obstruction
a condition caused by viral infection causing inflammation and swelling of the lining of voice box and windpipe becoming narrowed
croup
croup treatment
mild- oral corticosteroids
severe - hospital treatment, nebulised adrenaline
sympathomimetic medicines that binds to alpha-1 receptors causing blood vessels to constrict
decongestants
decongestants nursing consideration
should not be used more than 5 days as it damages mucosa lining of the nose. High risk of athropic rhinitis
medications that directly travels to lungs
aerosol drugs via
inhalers or puffers and nebulisers
inhalers are more delivered to lungs with the use of
spacers
