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Respiratory Agents > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are two Obstructive lung disease?

A

Asthma and COPD

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2
Q

The definition of Asthma

A

Inflammation and bronchospasm and Immune mediated and hypersensitivity response to chemical mediators such as,-Histamine
-leukotrienes
-prostaglandins
-eosinophils

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3
Q

what are two patho processes that make up to get COPD?

A

chronic bronchitis and emphysema

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4
Q

Asthma sx

A

SOA, cough, decreased exercise intolerance

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5
Q

COPD sx

A

dyspnea, cough, hypoxemia, hypercapnia and activity intolerance

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6
Q

_________ leads to bronchospasms and _________ leads to airway obstruction and air trapping

A

Asthma and COPD

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7
Q

Difference between Asthma and COPD?

A

Asthma leads to bronchospasms and COPD leads to airway obstruction and air trapping

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8
Q

what stands out with Chronic bronchitis?

A

chronic cough and excessive sputum

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9
Q

What leads to bronchospasm in asthma?

3 symptoms

A

-cough
-SOA
-decreased exercise tolerance

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10
Q

what immune-related airway inflammations does asthma have?

4 items

A

-Histamine
-leukotrienes
-prostaglandins
-eosinophils

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11
Q

what leads to airway obstruction and air trapping in COPD?

5 items

A

-dyspnea
-cough
-hypoxemia and hypercapnia
-activity intolerance

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12
Q

what inflammatory mechanism is COPD?

A

-exaggerated inflammatory response to cig smoking
-chronic bronchitis
-emphysema

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13
Q

what class are these?
SABA
LABA
Methylxanthines
Anticholinergics

A

Bronchodilators

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14
Q

what class are these?
-Inhaled glucocorticoids
-Oral glucocorticoids
-Leukotriene receptor antagonists
-Mast cell stabilizers
-Immunoglobulin E antagonists
-Phosphodietsterase-4 inhibitors

A

Anti-inflammatories

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15
Q

MDI

A

metered dose inhaler

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16
Q

what does an MDI require?

A

-hand/breath coordination
- with or without an aero chamber

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17
Q

who would have difficulty with an MDI?

A

elderly or child d/t how to use the mdi

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18
Q

DPI

A

dry powder inhaler that delivers more drugs to lungs because there is no space

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19
Q

what does a nebulizer deliver?

A

What inhaler delivers a mist

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20
Q

how does a metered dose inhaler MDI work?

A

-preset amt of drugs to puff.
-depress inhalation during inhalation

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21
Q

how does DPI work?

A

it is breath activated

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22
Q

what are short acting beta agonists?
what are the
beta 2-adrenergic agonists?
What are the bronchodilators in saba?

2 items

A

-Albuterol (Ventolin)
-Levalbuterol (Xopenex)

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23
Q

what does SABA stand for?

A

short acting beta agonists

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24
Q

what is the MOA of SABA?

A

The MOA that:

-activate BETA 2 adrenergic receptors
- cause bronchodilation
-oral and inhaled (MDI and nebulized)

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25
Q

what does SABA cause?

A

bronchodilation

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26
Q

how is SABA used? How is albuterol used for PRN?

A

-PRN puffs for flare ups
2 puffs every 4-6 hrs
- Preventative for exercise induced asthma (EIA)
2 puffs 30 minutes before activity

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27
Q

what would a person use before activity if they have asthma?

A

2 puffs 30 minutes before activity (albuterol)

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28
Q

what are the AE of SABA’s?
Albuterol and levalbuterol

A

tachycardia (increased HR) , tremors, nervousness and jitters
these are temp and may last 15 minutes

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29
Q

does Xopenex have less AE’s?

A

yes. Xopenex has less AEs

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30
Q

how to educate a pt on using a MDI?

A

wait one minute between puffs, inhale before activating the device, and a spacer is needed.

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31
Q

how are chronic asthma and stable COPD how are glucocosteroids or needed PRN managed on a schedule?

What type of schedule?

A

fixed schedule

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32
Q

how is a nebulizer administered?
2 ways

A

face mask or mouth piece and can take several minutes

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33
Q

what are LABA’s?

A

Long acting BETA agonists

-Salmeterol (Serevent)
-Formoterol (Foradil)
-Arformoterol (Brovana)

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34
Q

what are some examples of LABA’s?

A

-Salmeterol (Serevent)
-Formoterol (Foradil)
-Arformoterol (Brovana)

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35
Q

What is the MOA of LABA’s?

A

activate BETA 2 adrenergic receptors
- cause bronchodilation
-oral and inhaled (MDI and nebulized)

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36
Q

what is the main goal of using LABA?

A

Uses:
-maintenance therapy
-NOT for acute relief
- BID dosing

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37
Q

what is the Black Box warning for using the long acting beta agonists?

A

DO NOT use alone.

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38
Q

what are the direct bronchodilators?
B- adrenergic agonists?

A

-albuterol (inhaled, short acting), levalbuterol (Xopexex)

-salmeterol (inhaled, long acting), formoterol (foradil), arformoterol (brovana.

Methylxanthines (Theophylline )theo-24), aminophylline

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39
Q

what do patients add with a bronchodilator for COPD?

A

inhaled glucocorticoids for long term suppression of inflammation

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40
Q

what prominent action is Methylxanthines?

A

What med is the prominent action of
central nervous system
-excitation
- bronchodilation

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41
Q

what is the MOA of Methylxanthines?

A

MOA:

bronchodilation via blocking adenosine receptors

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42
Q

what examples are Methylxanthines?

A

Bronchodilator meds in what class:

-Theophylline (Theo)
-Aminophylline

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43
Q

how are Methylxanthines administered?

A

Different administration of med. capsule, tablet, oral solution, IV

44
Q

what is Methylxanthines and LABAs used for, indications?

A

Which bronchodilators are used for maintenance therapy

45
Q

what are some AE of Methylxanthines?

A

tremors, palpitations , tachycardia

46
Q

what are some drug interactions of Methylxanthines?

A

caffeine, tobacco, marijuana, and others
these will exacerbate sx

47
Q

what do you monitor when taking Methylxanthines?

A

-NTI drug
-5-15 mcg/ml
-3 days to steady state
-sx/PFTs (pulmonary function test)
-Toxicity

48
Q

what is the AE toxicity of Methylxanthines?

A

-n/v/d
-DYSRYTHMIAS
-SEIZURES
-DEATH

49
Q

what to educate a patient who smokes and takes Methylxanthines?

A

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

50
Q

What med and why does the dose change when smoking on Methylxanthines?

A

because metabolism impacts smokers. Smoking breaks down theophylline from the body.

51
Q

what is the therapeutic goal of Methylxanthines

A

Med is the therapeutic goal to decrease the intensity and frequency of mod to severe asthma attacks and control COPD exacerbations.

52
Q

how do you monitor a patient on Methylxanthines

A

What medics to monitor on patients—HR and rhythm and therapeutic range of meds

53
Q

what therapeutic index if theophylline?

A

Narrow therapeutic index

54
Q

what is an anticholinergic?

A

a parasympathetic- rest and digest

55
Q

what MOA is anticholinergic?

A

-block cholinergic response
-blocks muscarinic receptor activity
( muscarinic antagonists)

56
Q

what indications are needed to take an anticholinergic?

LAma
Sama

A

COPD and off label Asthma

57
Q

what are anticholinergics?

A

LAMAS AND SAMAS

58
Q

what patient is contraindicated with Methylxanthines?

A

untreated seizures and peptic ulcer disease., heart disease

59
Q

what drugs reduce theophylline levels (Methylxanthines)?

A

phenobarbital, phenytoin, rifampin,

60
Q

what drugs increase theophylline levels (Methylxanthines)?

A

cimetidine, fluoroquinolone, antibiotics

61
Q

how to manage toxicity levels of theophylline levels (Methylxanthines)?

A

stop drug, give charcoal, and give cathartic.

62
Q

what is the patient misses a theophylline (Methylxanthines) dose?

A

do not double up and swallow and don’t chew tab

63
Q

what is the AE of theophylline (Methylxanthines) toxic levels?

A

n/v, abdominal discomfort, diarrhea, insomnia, restlessness, palpitations

64
Q

what are SAMA’s?
short acting muscarinic antagonists

A

Ipratropium (atrovent)
-MDI & Nebulizer
* 2 puffs or single neb QID

65
Q

what are the AE for Ipratropium (atrovent)?

A

Adverse Effects for all:
* Dry mouth
* Oral irritation
*minimal systemic AE

66
Q

what are LAMAs?
Long acting muscarinic antagonists

these are Maintenace therapy.

A

Aclidinium (Tudorza): DPI
* One inhalation BID
Tiotropium (Spiriva): DPI
* Once inhalation once daily
Umeclidinium (Incruse Ellipta): DPI
* Once inhalation once daily

67
Q

What AE are with Aclidinium (Tudorza),
Tiotropium (Spiriva), and
Umeclidinium (Incruse Ellipta): DPI?

A

Adverse Effects for all:
* Dry mouth
* Oral irritation
*minimal systemic AE

68
Q

what is the patient education after administering SAMA’s and LAMA’s?

A

rinse out mouth to prevent irritation

69
Q

How does a patient take Aclidinium (Tudorza): DPI ?

A

One inhalation BID

70
Q

how does a patient take Tiotropium (Spiriva) and Umeclidinium (Incruse Ellipta): DPI ?

A

Once inhalation once daily and don’t forget to pierce the capsule in
Tiotropium (Spiriva)

71
Q

Histamine
-leukotrienes
-prostaglandins
-eosinophils

A

What are immune medicated airway inflammation in asthma

72
Q

-hand/breath coordination
- with or without an aero chamber

what is this?

A

MDI –metered dose inhaler

73
Q

How does a patient take Ipratropium (Atrovent)?

A

2 puffs or single dose QID

74
Q

-Decreased
synthesis and
release of:
Histamine
Leukotrienes
Prostaglandins

-Decreased
activity of:
Eosinophils
Leukocytes

-Decreased
airway edema

-Reduced
bronchial
hyperreactivity

A

What is MOA of Glucocorticoids

75
Q

-Decreased
synthesis and
release of:
Histamine
Leukotrienes
Prostaglandins

-Decreased
activity of:
Eosinophils
Leukocytes

-Decreased
airway edema

-Reduced
bronchial
hyperreactivity

A

What is MOA of Glucocorticoids

76
Q

Why would a patient need oral Glucocorticoids?

A

-acute exacerbations of asthma and COPD

-chronic mgmt of COPD

77
Q

How is prednisone administered?

A

Burst therapy 40-60 mg/day x 3-10 day

78
Q

How is prednisolone
(Pediapred) administered?

A

Burst therapy by weight 1-2 mg/kg/day

79
Q

what are the AE of Oral Glucocorticoids in short terms use?

A

short term is less than 10 days and patient would have minimal AE’s

80
Q

what are the AE of Oral Glucocorticoids in long terms use?

A
  1. PUD- peptic ulcer disease
  2. Osteoporosis
  3. Hyperglycemia
  4. HTN
  5. Weight gin
  6. Immunosuppression- increased r/f infections
  7. Adrenal suppression

bad for gut and if patient already had HTN, it would be worse

81
Q

Aclidinium (Tudorza): DPI
* One inhalation BID

Is this LAMA or SAMA?

A

LAMA
Long acting

82
Q

Tiotropium (Spiriva): DPI
* Once inhalation once daily
Umeclidinium (Incruse Ellipta): DPI
* Once inhalation once daily

are these LAMA or SAMA?

A

LAMA
Long acting

83
Q

What are the AE of Inhaled Corticosteroids?

A

-Oral candidiasis
– Hoarseness
– Cough
– Headache

84
Q

what is the patient education after taking Inhaled Corticosteroids?

A

rinse out mouth after every dose to minimize oral candidiasis

85
Q

What is Inhaled Corticosteroids used for?

A

Asthma and COPD as maintenance therapy

86
Q

How is the Inhaled Corticosteroids budesonide (Pulmicort) administered?

age and which inhaler

A

-Respules via Nebulizer-down to
one year of age
* MDI-ages 6 and up

87
Q

How is the Inhaled Corticosteroids beclomethasone (QVAR) administered?

age and which inhaler

A
  • MDI-ages 5 and up
88
Q

How is the Inhaled Corticosteroids fluticasone (Flovent) administered?

age and which inhaler

A
  • HFA & DPI: ages 4 and up
89
Q

How is the Inhaled Corticosteroids mometasone (Asmanex) administered?

age and which inhaler

A
  • DPI-ages 4 and up
90
Q

Are all the Inhaled Corticosteroids used for pediatrics?

yes/no

A

Yes, Inhaled Corticosteroids

91
Q

which Inhaled Corticosteroids can be used for a 1 year old?

A

budesonide (Pulmicort) as a nebulizer

92
Q

what are the combination agents for maintenance therapy for COPD and Asthma?

A

Inhaled Corticosteroids (ICS) and LABA’s

93
Q

what are the medications of the Combination Therapy needed for maintenance therapy for COPD and Asthma?

4 meds

A

-fluticasone/salmeterol (Advair Diskus/HFA)

-fluticasone/vilanterol (Breo Ellipta)

mometasone/formoterol (Dulera)

budesonide/formoterol (Symbicort)

94
Q

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

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

95
Q

Beta-adrenergic agonists such as albuterol are given to a child with asthma. Such drugs are administered primarily to do which of the following?

A

dilate the bronchioles

96
Q

Which med is Leukotriene Receptor Antagonists (LTRA) ?

A

montelukast (Singulair) – PO once daily (tablet, chewable, granule packet)

97
Q

what class is montelukast (Singulair) ?

– PO once daily (tablet, chewable, granule packet)

A

Leukotriene Receptor Antagonists (LTRA)

98
Q

what is the MOA of Leukotriene Receptor Antagonists (LTRA) ?

A

To block leukotriene receptors in the airway (pro-inflammatory cells)

99
Q

what are the AE of Leukotriene Receptor Antagonists (LTRA) ?

A

all MOOD related- depression, aggression, suicide ideation.

all these meds affect neruropsych

100
Q

why would Leukotriene Receptor Antagonists (LTRA) be prescribed?

A

-Maintenance of asthma (ages 1 and older)

– Prevention of exercise-induced asthma (ages 15 and older)

– Maintenance of allergic rhinitis

101
Q

Asthma leads to bronchospasms and COPD leads to airway obstruction and air trapping

A

_____leads to bronchospasms and ______leads to airway obstruction and air trapping

102
Q

what does the Anticholinergic Ipratropium (atrovent) do?

A

this medication dries out respiratory secretions and causes bronchodilation.

103
Q

what is the short acting Anticholinergic Ipratropium (atrovent)?

A

Ipratropium (atrovent) MDI & Nebulizer

104
Q

what are the long acting Anticholinergics?

3 items

A

-Tiotropium (Spiriva) DPI

-Umeclidinium (Incruse Ellipta) DPI

-Aclidinium (Turdoza) DPI

105
Q
A

Respiratory Agents (2 decks)

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