Respiratory Flashcards
What are two Obstructive lung disease?
Asthma and COPD
The definition of Asthma
Inflammation and bronchospasm and Immune mediated and hypersensitivity response to chemical mediators such as,-Histamine
-leukotrienes
-prostaglandins
-eosinophils
what are two patho processes that make up to get COPD?
chronic bronchitis and emphysema
Asthma sx
SOA, cough, decreased exercise intolerance
COPD sx
dyspnea, cough, hypoxemia, hypercapnia and activity intolerance
_________ leads to bronchospasms and _________ leads to airway obstruction and air trapping
Asthma and COPD
Difference between Asthma and COPD?
Asthma leads to bronchospasms and COPD leads to airway obstruction and air trapping
what stands out with Chronic bronchitis?
chronic cough and excessive sputum
What leads to bronchospasm in asthma?
3 symptoms
-cough
-SOA
-decreased exercise tolerance
what immune-related airway inflammations does asthma have?
4 items
-Histamine
-leukotrienes
-prostaglandins
-eosinophils
what leads to airway obstruction and air trapping in COPD?
5 items
-dyspnea
-cough
-hypoxemia and hypercapnia
-activity intolerance
what inflammatory mechanism is COPD?
-exaggerated inflammatory response to cig smoking
-chronic bronchitis
-emphysema
what class are these?
SABA
LABA
Methylxanthines
Anticholinergics
Bronchodilators
what class are these?
-Inhaled glucocorticoids
-Oral glucocorticoids
-Leukotriene receptor antagonists
-Mast cell stabilizers
-Immunoglobulin E antagonists
-Phosphodietsterase-4 inhibitors
Anti-inflammatories
MDI
metered dose inhaler
what does an MDI require?
-hand/breath coordination
- with or without an aero chamber
who would have difficulty with an MDI?
elderly or child d/t how to use the mdi
DPI
dry powder inhaler that delivers more drugs to lungs because there is no space
what does a nebulizer deliver?
What inhaler delivers a mist
how does a metered dose inhaler MDI work?
-preset amt of drugs to puff.
-depress inhalation during inhalation
how does DPI work?
it is breath activated
what are short acting beta agonists?
what are the
beta 2-adrenergic agonists?
What are the bronchodilators in saba?
2 items
-Albuterol (Ventolin)
-Levalbuterol (Xopenex)
what does SABA stand for?
short acting beta agonists
what is the MOA of SABA?
The MOA that:
-activate BETA 2 adrenergic receptors
- cause bronchodilation
-oral and inhaled (MDI and nebulized)
what does SABA cause?
bronchodilation
how is SABA used? How is albuterol used for PRN?
-PRN puffs for flare ups
2 puffs every 4-6 hrs
- Preventative for exercise induced asthma (EIA)
2 puffs 30 minutes before activity
what would a person use before activity if they have asthma?
2 puffs 30 minutes before activity (albuterol)
what are the AE of SABA’s?
Albuterol and levalbuterol
tachycardia (increased HR) , tremors, nervousness and jitters
these are temp and may last 15 minutes
does Xopenex have less AE’s?
yes. Xopenex has less AEs
how to educate a pt on using a MDI?
wait one minute between puffs, inhale before activating the device, and a spacer is needed.
how are chronic asthma and stable COPD how are glucocosteroids or needed PRN managed on a schedule?
What type of schedule?
fixed schedule
how is a nebulizer administered?
2 ways
face mask or mouth piece and can take several minutes
what are LABA’s?
Long acting BETA agonists
-Salmeterol (Serevent)
-Formoterol (Foradil)
-Arformoterol (Brovana)
what are some examples of LABA’s?
-Salmeterol (Serevent)
-Formoterol (Foradil)
-Arformoterol (Brovana)
What is the MOA of LABA’s?
activate BETA 2 adrenergic receptors
- cause bronchodilation
-oral and inhaled (MDI and nebulized)
what is the main goal of using LABA?
Uses:
-maintenance therapy
-NOT for acute relief
- BID dosing
what is the Black Box warning for using the long acting beta agonists?
DO NOT use alone.
what are the direct bronchodilators?
B- adrenergic agonists?
-albuterol (inhaled, short acting), levalbuterol (Xopexex)
-salmeterol (inhaled, long acting), formoterol (foradil), arformoterol (brovana.
Methylxanthines (Theophylline )theo-24), aminophylline
what do patients add with a bronchodilator for COPD?
inhaled glucocorticoids for long term suppression of inflammation
what prominent action is Methylxanthines?
What med is the prominent action of
central nervous system
-excitation
- bronchodilation
what is the MOA of Methylxanthines?
MOA:
bronchodilation via blocking adenosine receptors
what examples are Methylxanthines?
Bronchodilator meds in what class:
-Theophylline (Theo)
-Aminophylline
how are Methylxanthines administered?
Different administration of med. capsule, tablet, oral solution, IV
what is Methylxanthines and LABAs used for, indications?
Which bronchodilators are used for maintenance therapy
what are some AE of Methylxanthines?
tremors, palpitations , tachycardia
what are some drug interactions of Methylxanthines?
caffeine, tobacco, marijuana, and others
these will exacerbate sx
what do you monitor when taking Methylxanthines?
-NTI drug
-5-15 mcg/ml
-3 days to steady state
-sx/PFTs (pulmonary function test)
-Toxicity
what is the AE toxicity of Methylxanthines?
-n/v/d
-DYSRYTHMIAS
-SEIZURES
-DEATH
what to educate a patient who smokes and takes Methylxanthines?
the dose may have to be increased to get the same effect or if you quit or reduce smoking, the dose may have to decreased
What med and why does the dose change when smoking on Methylxanthines?
because metabolism impacts smokers. Smoking breaks down theophylline from the body.
what is the therapeutic goal of Methylxanthines
Med is the therapeutic goal to decrease the intensity and frequency of mod to severe asthma attacks and control COPD exacerbations.
how do you monitor a patient on Methylxanthines
What medics to monitor on patients—HR and rhythm and therapeutic range of meds
what therapeutic index if theophylline?
Narrow therapeutic index
what is an anticholinergic?
a parasympathetic- rest and digest
what MOA is anticholinergic?
-block cholinergic response
-blocks muscarinic receptor activity
( muscarinic antagonists)
what indications are needed to take an anticholinergic?
LAma
Sama
COPD and off label Asthma
what are anticholinergics?
LAMAS AND SAMAS
what patient is contraindicated with Methylxanthines?
untreated seizures and peptic ulcer disease., heart disease
what drugs reduce theophylline levels (Methylxanthines)?
phenobarbital, phenytoin, rifampin,
what drugs increase theophylline levels (Methylxanthines)?
cimetidine, fluoroquinolone, antibiotics
how to manage toxicity levels of theophylline levels (Methylxanthines)?
stop drug, give charcoal, and give cathartic.
what is the patient misses a theophylline (Methylxanthines) dose?
do not double up and swallow and don’t chew tab
what is the AE of theophylline (Methylxanthines) toxic levels?
n/v, abdominal discomfort, diarrhea, insomnia, restlessness, palpitations
what are SAMA’s?
short acting muscarinic antagonists
Ipratropium (atrovent)
-MDI & Nebulizer
* 2 puffs or single neb QID
what are the AE for Ipratropium (atrovent)?
Adverse Effects for all:
* Dry mouth
* Oral irritation
*minimal systemic AE
what are LAMAs?
Long acting muscarinic antagonists
these are Maintenace therapy.
Aclidinium (Tudorza): DPI
* One inhalation BID
Tiotropium (Spiriva): DPI
* Once inhalation once daily
Umeclidinium (Incruse Ellipta): DPI
* Once inhalation once daily
What AE are with Aclidinium (Tudorza),
Tiotropium (Spiriva), and
Umeclidinium (Incruse Ellipta): DPI?
Adverse Effects for all:
* Dry mouth
* Oral irritation
*minimal systemic AE
what is the patient education after administering SAMA’s and LAMA’s?
rinse out mouth to prevent irritation
How does a patient take Aclidinium (Tudorza): DPI ?
One inhalation BID
how does a patient take Tiotropium (Spiriva) and Umeclidinium (Incruse Ellipta): DPI ?
Once inhalation once daily and don’t forget to pierce the capsule in
Tiotropium (Spiriva)
Histamine
-leukotrienes
-prostaglandins
-eosinophils
What are immune medicated airway inflammation in asthma
-hand/breath coordination
- with or without an aero chamber
what is this?
MDI –metered dose inhaler
How does a patient take Ipratropium (Atrovent)?
2 puffs or single dose QID
-Decreased
synthesis and
release of:
Histamine
Leukotrienes
Prostaglandins
-Decreased
activity of:
Eosinophils
Leukocytes
-Decreased
airway edema
-Reduced
bronchial
hyperreactivity
What is MOA of Glucocorticoids
-Decreased
synthesis and
release of:
Histamine
Leukotrienes
Prostaglandins
-Decreased
activity of:
Eosinophils
Leukocytes
-Decreased
airway edema
-Reduced
bronchial
hyperreactivity
What is MOA of Glucocorticoids
Why would a patient need oral Glucocorticoids?
-acute exacerbations of asthma and COPD
-chronic mgmt of COPD
How is prednisone administered?
Burst therapy 40-60 mg/day x 3-10 day
How is prednisolone
(Pediapred) administered?
Burst therapy by weight 1-2 mg/kg/day
what are the AE of Oral Glucocorticoids in short terms use?
short term is less than 10 days and patient would have minimal AE’s
what are the AE of Oral Glucocorticoids in long terms use?
- PUD- peptic ulcer disease
- Osteoporosis
- Hyperglycemia
- HTN
- Weight gin
- Immunosuppression- increased r/f infections
- Adrenal suppression
bad for gut and if patient already had HTN, it would be worse
Aclidinium (Tudorza): DPI
* One inhalation BID
Is this LAMA or SAMA?
LAMA
Long acting
Tiotropium (Spiriva): DPI
* Once inhalation once daily
Umeclidinium (Incruse Ellipta): DPI
* Once inhalation once daily
are these LAMA or SAMA?
LAMA
Long acting
What are the AE of Inhaled Corticosteroids?
-Oral candidiasis
– Hoarseness
– Cough
– Headache
what is the patient education after taking Inhaled Corticosteroids?
rinse out mouth after every dose to minimize oral candidiasis
What is Inhaled Corticosteroids used for?
Asthma and COPD as maintenance therapy
How is the Inhaled Corticosteroids budesonide (Pulmicort) administered?
age and which inhaler
-Respules via Nebulizer-down to
one year of age
* MDI-ages 6 and up
How is the Inhaled Corticosteroids beclomethasone (QVAR) administered?
age and which inhaler
- MDI-ages 5 and up
How is the Inhaled Corticosteroids fluticasone (Flovent) administered?
age and which inhaler
- HFA & DPI: ages 4 and up
How is the Inhaled Corticosteroids mometasone (Asmanex) administered?
age and which inhaler
- DPI-ages 4 and up
Are all the Inhaled Corticosteroids used for pediatrics?
yes/no
Yes, Inhaled Corticosteroids
which Inhaled Corticosteroids can be used for a 1 year old?
budesonide (Pulmicort) as a nebulizer
what are the combination agents for maintenance therapy for COPD and Asthma?
Inhaled Corticosteroids (ICS) and LABA’s
what are the medications of the Combination Therapy needed for maintenance therapy for COPD and Asthma?
4 meds
-fluticasone/salmeterol (Advair Diskus/HFA)
-fluticasone/vilanterol (Breo Ellipta)
mometasone/formoterol (Dulera)
budesonide/formoterol (Symbicort)
An adult patient presents for follow-up for moderate persistent
asthma. Current regimen includes albuterol (Ventolin) q 4h prn
and fluticasone (Flovent) 2 puffs BID. Which subjective or
objective finding is consistent with AE of Flovent?
A. Heart rate of 110 bpm
* B. Complaint of palpitations after use
* C. White plaque on tongue and hard palate
* D. Ten-pound weight gain
Beta-adrenergic agonists such as albuterol are given to a child with asthma. Such drugs are administered primarily to do which of the following?
dilate the bronchioles
Which med is Leukotriene Receptor Antagonists (LTRA) ?
montelukast (Singulair) – PO once daily (tablet, chewable, granule packet)
what class is montelukast (Singulair) ?
– PO once daily (tablet, chewable, granule packet)
Leukotriene Receptor Antagonists (LTRA)
what is the MOA of Leukotriene Receptor Antagonists (LTRA) ?
To block leukotriene receptors in the airway (pro-inflammatory cells)
what are the AE of Leukotriene Receptor Antagonists (LTRA) ?
all MOOD related- depression, aggression, suicide ideation.
all these meds affect neruropsych
why would Leukotriene Receptor Antagonists (LTRA) be prescribed?
-Maintenance of asthma (ages 1 and older)
– Prevention of exercise-induced asthma (ages 15 and older)
– Maintenance of allergic rhinitis
Asthma leads to bronchospasms and COPD leads to airway obstruction and air trapping
_____leads to bronchospasms and ______leads to airway obstruction and air trapping
what does the Anticholinergic Ipratropium (atrovent) do?
this medication dries out respiratory secretions and causes bronchodilation.
what is the short acting Anticholinergic Ipratropium (atrovent)?
Ipratropium (atrovent) MDI & Nebulizer
what are the long acting Anticholinergics?
3 items
-Tiotropium (Spiriva) DPI
-Umeclidinium (Incruse Ellipta) DPI
-Aclidinium (Turdoza) DPI
