Respiratory Flashcards
1
Q
What are two Obstructive lung disease?
A
Asthma and COPD
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
3
Q
what are two patho processes that make up to get COPD?
A
chronic bronchitis and emphysema
4
Q
Asthma sx
A
SOA, cough, decreased exercise intolerance
5
Q
COPD sx
A
dyspnea, cough, hypoxemia, hypercapnia and activity intolerance
6
Q
_________ leads to bronchospasms and _________ leads to airway obstruction and air trapping
A
Asthma and COPD
7
Q
Difference between Asthma and COPD?
A
Asthma leads to bronchospasms and COPD leads to airway obstruction and air trapping
8
Q
what stands out with Chronic bronchitis?
A
chronic cough and excessive sputum
9
Q
What leads to bronchospasm in asthma?
3 symptoms
A
-cough
-SOA
-decreased exercise tolerance
10
Q
what immune-related airway inflammations does asthma have?
4 items
A
-Histamine
-leukotrienes
-prostaglandins
-eosinophils
11
Q
what leads to airway obstruction and air trapping in COPD?
5 items
A
-dyspnea
-cough
-hypoxemia and hypercapnia
-activity intolerance
12
Q
what inflammatory mechanism is COPD?
A
-exaggerated inflammatory response to cig smoking
-chronic bronchitis
-emphysema
13
Q
what class are these?
SABA
LABA
Methylxanthines
Anticholinergics
A
Bronchodilators
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
15
Q
MDI
A
metered dose inhaler
16
Q
what does an MDI require?
A
-hand/breath coordination
- with or without an aero chamber
17
Q
who would have difficulty with an MDI?
A
elderly or child d/t how to use the mdi
18
Q
DPI
A
dry powder inhaler that delivers more drugs to lungs because there is no space
19
Q
what does a nebulizer deliver?
A
What inhaler delivers a mist
20
Q
how does a metered dose inhaler MDI work?
A
-preset amt of drugs to puff.
-depress inhalation during inhalation
21
Q
how does DPI work?
A
it is breath activated
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)
23
Q
what does SABA stand for?
A
short acting beta agonists
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)
25
what does SABA cause?
bronchodilation
26
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
27
what would a person use before activity if they have asthma?
2 puffs 30 minutes before activity (albuterol)
28
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
29
does Xopenex have less AE's?
yes. Xopenex has less AEs
30
how to educate a pt on using a MDI?
wait one minute between puffs, inhale before activating the device, and a spacer is needed.
31
how are chronic asthma and stable COPD how are glucocosteroids or needed PRN managed on a schedule?
What type of schedule?
fixed schedule
32
how is a nebulizer administered?
2 ways
face mask or mouth piece and can take several minutes
33
what are LABA's?
Long acting BETA agonists
-Salmeterol (Serevent)
-Formoterol (Foradil)
-Arformoterol (Brovana)
34
what are some examples of LABA's?
-Salmeterol (Serevent)
-Formoterol (Foradil)
-Arformoterol (Brovana)
35
What is the MOA of LABA's?
activate BETA 2 adrenergic receptors
- cause bronchodilation
-oral and inhaled (MDI and nebulized)
36
what is the main goal of using LABA?
Uses:
-maintenance therapy
-NOT for acute relief
- BID dosing
37
what is the Black Box warning for using the long acting beta agonists?
DO NOT use alone.
38
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
39
what do patients add with a bronchodilator for COPD?
inhaled glucocorticoids for long term suppression of inflammation
40
what prominent action is Methylxanthines?
What med is the prominent action of
central nervous system
-excitation
- bronchodilation
41
what is the MOA of Methylxanthines?
MOA:
bronchodilation via blocking adenosine receptors
42
what examples are Methylxanthines?
Bronchodilator meds in what class:
-Theophylline (Theo)
-Aminophylline
43
how are Methylxanthines administered?
Different administration of med. capsule, tablet, oral solution, IV
44
what is Methylxanthines and LABAs used for, indications?
Which bronchodilators are used for maintenance therapy
45
what are some AE of Methylxanthines?
tremors, palpitations , tachycardia
46
what are some drug interactions of Methylxanthines?
caffeine, tobacco, marijuana, and others
these will exacerbate sx
47
what do you monitor when taking Methylxanthines?
-NTI drug
-5-15 mcg/ml
-3 days to steady state
-sx/PFTs (pulmonary function test)
-Toxicity
48
what is the AE toxicity of Methylxanthines?
-n/v/d
-DYSRYTHMIAS
-SEIZURES
-DEATH
49
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
50
What med and why does the dose change when smoking on Methylxanthines?
because metabolism impacts smokers. Smoking breaks down theophylline from the body.
51
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.
52
how do you monitor a patient on Methylxanthines
What medics to monitor on patients—HR and rhythm and therapeutic range of meds
53
what therapeutic index if theophylline?
Narrow therapeutic index
54
what is an anticholinergic?
a parasympathetic- rest and digest
55
what MOA is anticholinergic?
-block cholinergic response
-blocks muscarinic receptor activity
( muscarinic antagonists)
56
what indications are needed to take an anticholinergic?
LAma
Sama
COPD and off label Asthma
57
what are anticholinergics?
LAMAS AND SAMAS
58
what patient is contraindicated with Methylxanthines?
untreated seizures and peptic ulcer disease., heart disease
59
what drugs reduce theophylline levels (Methylxanthines)?
phenobarbital, phenytoin, rifampin,
60
what drugs increase theophylline levels (Methylxanthines)?
cimetidine, fluoroquinolone, antibiotics
61
how to manage toxicity levels of theophylline levels (Methylxanthines)?
stop drug, give charcoal, and give cathartic.
62
what is the patient misses a theophylline (Methylxanthines) dose?
do not double up and swallow and don't chew tab
63
what is the AE of theophylline (Methylxanthines) toxic levels?
n/v, abdominal discomfort, diarrhea, insomnia, restlessness, palpitations
64
what are SAMA's?
short acting muscarinic antagonists
Ipratropium (atrovent)
-MDI & Nebulizer
* 2 puffs or single neb QID
65
what are the AE for Ipratropium (atrovent)?
Adverse Effects for all:
* Dry mouth
* Oral irritation
*minimal systemic AE
66
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
67
What AE are with Aclidinium (Tudorza),
Tiotropium (Spiriva), and
Umeclidinium (Incruse Ellipta): DPI?
Adverse Effects for all:
* Dry mouth
* Oral irritation
*minimal systemic AE
68
what is the patient education after administering SAMA's and LAMA's?
rinse out mouth to prevent irritation
69
How does a patient take Aclidinium (Tudorza): DPI ?
One inhalation BID
70
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)
71
Histamine
-leukotrienes
-prostaglandins
-eosinophils
What are immune medicated airway inflammation in asthma
72
-hand/breath coordination
- with or without an aero chamber
what is this?
MDI --metered dose inhaler
73
How does a patient take Ipratropium (Atrovent)?
2 puffs or single dose QID
74
-Decreased
synthesis and
release of:
Histamine
Leukotrienes
Prostaglandins
-Decreased
activity of:
Eosinophils
Leukocytes
-Decreased
airway edema
-Reduced
bronchial
hyperreactivity
What is MOA of Glucocorticoids
75
-Decreased
synthesis and
release of:
Histamine
Leukotrienes
Prostaglandins
-Decreased
activity of:
Eosinophils
Leukocytes
-Decreased
airway edema
-Reduced
bronchial
hyperreactivity
What is MOA of Glucocorticoids
76
Why would a patient need oral Glucocorticoids?
-acute exacerbations of asthma and COPD
-chronic mgmt of COPD
77
How is prednisone administered?
Burst therapy 40-60 mg/day x 3-10 day
78
How is prednisolone
(Pediapred) administered?
Burst therapy by weight 1-2 mg/kg/day
79
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
80
what are the AE of Oral Glucocorticoids in long terms use?
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
Aclidinium (Tudorza): DPI
* One inhalation BID
Is this LAMA or SAMA?
LAMA
Long acting
82
Tiotropium (Spiriva): DPI
* Once inhalation once daily
Umeclidinium (Incruse Ellipta): DPI
* Once inhalation once daily
are these LAMA or SAMA?
LAMA
Long acting
83
What are the AE of Inhaled Corticosteroids?
-Oral candidiasis
– Hoarseness
– Cough
– Headache
84
what is the patient education after taking Inhaled Corticosteroids?
rinse out mouth after every dose to minimize oral candidiasis
85
What is Inhaled Corticosteroids used for?
Asthma and COPD as maintenance therapy
86
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
87
How is the Inhaled Corticosteroids beclomethasone (QVAR) administered?
age and which inhaler
* MDI-ages 5 and up
88
How is the Inhaled Corticosteroids fluticasone (Flovent) administered?
age and which inhaler
* HFA & DPI: ages 4 and up
89
How is the Inhaled Corticosteroids mometasone (Asmanex) administered?
age and which inhaler
* DPI-ages 4 and up
90
Are all the Inhaled Corticosteroids used for pediatrics?
yes/no
Yes, Inhaled Corticosteroids
91
which Inhaled Corticosteroids can be used for a 1 year old?
budesonide (Pulmicort) as a nebulizer
92
what are the combination agents for maintenance therapy for COPD and Asthma?
Inhaled Corticosteroids (ICS) and LABA's
93
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)
94
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
95
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
96
Which med is Leukotriene Receptor Antagonists (LTRA) ?
montelukast (Singulair) – PO once daily (tablet, chewable, granule packet)
97
what class is montelukast (Singulair) ?
– PO once daily (tablet, chewable, granule packet)
Leukotriene Receptor Antagonists (LTRA)
98
what is the MOA of Leukotriene Receptor Antagonists (LTRA) ?
To block leukotriene receptors in the airway (pro-inflammatory cells)
99
what are the AE of Leukotriene Receptor Antagonists (LTRA) ?
all MOOD related- depression, aggression, suicide ideation.
all these meds affect neruropsych
100
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
101
Asthma leads to bronchospasms and COPD leads to airway obstruction and air trapping
_____leads to bronchospasms and ______leads to airway obstruction and air trapping
102
what does the Anticholinergic Ipratropium (atrovent) do?
this medication dries out respiratory secretions and causes bronchodilation.
103
what is the short acting Anticholinergic Ipratropium (atrovent)?
Ipratropium (atrovent) MDI & Nebulizer
104
what are the long acting Anticholinergics?
3 items
-Tiotropium (Spiriva) DPI
-Umeclidinium (Incruse Ellipta) DPI
-Aclidinium (Turdoza) DPI
105
