Repiratory

Question 1

reversible airway obstruction causing inflamed, narrow and swollen bronchi and bronchioles, excessive mucus production

Answer 1

asthma

Question 2

symptoms of asthma

Answer 2

cough
wheeze
chest tightness
SOB

Question 3

triggers of asthma

Answer 3

viral infections
air pollutions
strong odours
physical activity (SOB)
allergies

Question 4

if asthma is left untreated it could lead to

Answer 4

COPD

Question 5

main cause of COPD

Answer 5

smoking
environmental factors: pollution, dust chemical fumes and gas
genetics

Question 6

symptoms of COPD

Answer 6

SOB
productive cough
increased phlegm or mucus production
fatigue
chest infections

Question 7

forms of COPD

Answer 7

emphysema and chronic bronchitis

Question 8

2 main asthma treatments

Answer 8

bronchodilators and corticosteroids

Question 9

2 types of bronchodilators

Answer 9

adrenoceptor agonist (selective beta-2 agonist) and antimuscarinic bronchodilators

Question 10

2 types of selective Beta-agonists and indications

Answer 10

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)

Question 11

SABA pharmacodynamics

Answer 11

beta-2 receptor agonist in smooth muscles of bronchi > stimulation of adenyl cyclase >increasing cAMP which relaxes smooth muscles >bronchodilation effect

Question 12

SABA meds

Answer 12

salbutamol
terbutaline

Question 13

SABA contraindications

Answer 13

medications that inhibit beta-1 receptors which inhibits sympathetic nerves (since beta-2 agonist induces sympathetic nerves)
hyperthyroidism
cardiovascular disease and arrhythmias
HTN
diabetes

Question 14

LABA pharmacodynamics

Answer 14

same as SABA but act as a preventer
MUST use with inhaled corticosteroids or ICS

Question 15

LABA meds

Answer 15

salmeterol
formoterol
eformoterol
indacaterol
olodaterol

Question 16

LABA contraindications

Answer 16

hyperthyroidism
hypersensitivity

Question 17

LABA adverse effects

Answer 17

palpitation
peripheral vasodilation - hypotension
headache
fine muscle tremor

Question 18

tolerance in beta-2 agonist drugs can

Answer 18

downregulate beta-2 receptors over time
high doses can make the receptors unresponsive

Question 19

sympathomimetics treatment for asthma - used in emergency situations

Answer 19

ephedrine and adrenaline - promote bronchodilation by activating beta receptors
reduce oedema through pulmonary vasoconstriction by stimulating alpha receptors

Question 20

SABA and LABA nursing considerations

Answer 20

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)

Question 21

sodium cromoglycate pharmacodynamics

Answer 21

inhibits inflammatory mediators during inhaled allergens such as histamine and leukotrienes from mast cells

Question 22

sodium cromoglycate meds

Answer 22

cromolyn

Question 23

mast cell stabilizers (leukotriene receptor antagonist) pharmacodynamics

Answer 23

inhibits leukotrienes which is produced by the immune system which promotes bronchoconstriction, inflammation, microvascular permeability and mucus secretion in asthma and COPD

Question 24

anticholinergic pharmacodynamics

Answer 24

blocks parasympathetic nerves which causes the airways to constrict, therefore allows airways to remain open

Question 25

anticholinergic meds

Answer 25

aclidinium umeclidinium ipatropium tiotropium

Question 26

anticholinergics indications

Answer 26

bronchospasms in COPD

Question 27

anticholinergics adverse effects

Answer 27

blurred vision dysuria dry mouth constipation

Question 28

asthma and COPD treatment that mainly inhibits inflammatory mediators of the immune system

Answer 28

corticosteroids

Question 29

corticosteroids MoA

Answer 29

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

Question 30

corticosteroids must be used with ___________ to achieve therapeutic effects and further reduce exacerbations and need of higher doses

Answer 30

beta-2 agonist

Question 31

inhaled corticosteroids adverse effects

Answer 31

sore throat hoarse voice oral candidiasis or thrush risk of chest infections

Question 32

inhaled corticosteroids meds

Answer 32

budesonide

Question 33

smart inhalers are

Answer 33

combination of LABA and inhaled corticosteroids > short term relief eg. formoterol + budesonide (symbicort)

Question 34

oral or systemic corticosteroids meds

Answer 34

oral: prednisolone, prednisone, hydrocortisone IV: methylprednisolone

Question 35

oral corticosteroids adverse effects

Answer 35

cushing syndrome hyperglycaemia osteoporosis sepsis depression HTN decreased libido oedema weight gain risk of cataracts

Question 36

excessive use of corticosteroids can cause

Answer 36

cushing syndrome

Question 37

chronic use of oral corticosteroids can inhibit the function of HPA axis or hypothalamic-pituitary adrenal axis (ACTH) by negative feedback resulting in

Answer 37

adrenal insufficiency - sever fatigue, weakness, weight loss, postural hypotension, low BP, nausea, vomiting, painful muscles and joints

Question 38

treatment for adrenal suppression and insufficiency

Answer 38

hydrocortisone replacement therapy

Question 39

nursing consideration for long-term corticosteroid replacement

Answer 39

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

Question 40

antimuscarinic meds MoA

Answer 40

blocks parasympathetic receptors such as ACh and muscarinic to promote smooth muscle relaxation inhibits cholinergic (Ach) mediated bronchoconstriction and cholinergic production of mucus

Question 41

antimuscarinic meds should be used with _________ to promote synergistic bronchodilator effects

Answer 41

beta-2 agonists drugs

Question 42

2 types of antimuscarinics

Answer 42

short-acting muscarinic antagonist (SAMA) long-acting muscarinic antagonist (SAMA)

Question 43

indications for SAMA

Answer 43

used for COPD only symptom relievers (cough, wheezing and SOB) can be used with salbutamol for severe asthma

Question 44

SAMA meds

Answer 44

Ipratropium

Question 45

LAMA indications

Answer 45

persistent COPD long term treatment for bronchospasm and excessive mucus secretion

Question 46

LAMA meds

Answer 46

Tiotropium

Question 47

antimuscarinics adverse effects

Answer 47

dry mouth urinary retention pupil dilation glaucoma

Question 48

antimuscarinics contraindicated with

Answer 48

glaucoma prostatic hyperplasia bladder obstruction

Question 49

a condition caused by viral infection causing inflammation and swelling of the lining of voice box and windpipe becoming narrowed

Answer 49

croup

Question 50

croup treatment

Answer 50

mild- oral corticosteroids severe - hospital treatment, nebulised adrenaline

Question 51

sympathomimetic medicines that binds to alpha-1 receptors causing blood vessels to constrict

Answer 51

decongestants

Question 52

decongestants nursing consideration

Answer 52

should not be used more than 5 days as it damages mucosa lining of the nose. High risk of athropic rhinitis

Question 53

medications that directly travels to lungs

Answer 53

aerosol drugs via inhalers or puffers and nebulisers

Question 54

inhalers are more delivered to lungs with the use of

Answer 54

spacers