respiratory 2 Flashcards
1
Q
What is asthma?
A
a reversible airway obstruction and bronchial hyperresponsiveness with an underlying inflammatory component
2
Q
What are possible etiologies of asthma?
A
- environmental: pollen, molds, dust mites, animal danger, smoking, weather changes
- genetic
- allergies
- other: exercise, certain drugs, GERD, stress, increased emotions
3
Q
What immunoglobulin mediates the response resulting in asthma?
A
immunoglobulin E mediate response (atopic sensitization)
4
Q
When is the onset of asthma?
A
can occur at any age; most common in children & older adults
5
Q
What are the three major components of the pathophysiology of asthma?
A
- bronchoconstriction
- airway inflammation
- bronchial hyperresponsiveness
6
Q
why does bronchoconstriction happen in asthma?
A
in response to a trigger
7
Q
why does airway inflammation happen in asthma?
A
due to T-helper cells & IgE mediated pathways
8
Q
Why does bronchial hyperresponsiveness happen in asthma?
A
due to activated mast cells which lead to the release of inflammatory mediators (histamine, prostaglandins & leukotrienes)
9
Q
What may happen overtime with asthma?
A
overtimes, airway thickening & hyperplasia of the smooth muscle may lead to remodeling of lung tissue
10
Q
What can leukotrienes cause?
A
- inflammation
- bronchoconstriction
- mucus production
11
Q
What does the inflammatory reaction during asthma cause?
A
- infiltration of inflammatory cells into the airway wall
- increased vascular permeability
- airway hyperresponsiveness
- airflow limitation
- respiratory sx
- bronchoconstriction
- airway edema
- inflamed mucus hypersecretion with plugging
- hypertrophy of the airways & smooth muscle leads to remodeling where changes are only partially reversible
12
Q
What are the clinical manifestations of asthma?
A
- dyspnea
- wheezing
- cough
- prolonged expiration
- chest tightness
- use of accessory muscles
- severity depends on the degree of bronchial constriction
13
Q
When does exercise-induced asthma occur?
A
occurs when the airways narrow during physical activity
14
Q
What can cause exercise-induced asthma?
A
- dry air
- pollution
- chlorine in swimming pools
15
Q
What are sx of exercise- induced asthma?
A
- SOB
- wheezing
- coughing
16
Q
Who may exercise induced asthma affect?
A
those w/o asthma & elite athletes
17
Q
What can exercise induced asthma be tx with?
A
- short-acting beta agonists (SABAs) before exercise
- albuterol, levalbuterol, & ipratropium as inhaled medication
18
Q
What are albuterol & levalbuterol?
A
inhaled medicines that help open the airways; should not be used daily as it can make them less effective
19
Q
What is nocturnal asthma?
A
asthma sx that worsen at night & may disrupt sleep
20
Q
What are the possible causes of nocturnal asthma?
A
- reclining position
- increased mucus production/drainage
- hormone level changes
- allergens
- stress
- obesity
21
Q
What are sx of nocturnal asthma?
A
- wheezing
- chest tightness
- difficulty breathing
22
Q
What are treatments for nocturnal asthma?
A
- montelukast (singulair)
- albuterol
- long-acting beta agonists
- leukotrienes
23
Q
What is status asthmaticus?
A
acute, severe asthma that is refractory to tx; can be life-threatening
24
Q
how does status asthmaticus happen?
A
pathologic changes in airway → airflow obstruction → premature closure on expiration → dynamic hyperinflation → hypercarbia
25
What may be absent in staus asthmaticus?
wheezing or cough
26
What are some non-pharmacological ways to manage asthma?
- identify/ avoid triggers
- breathing exercises
- diet
- acupuncture/yoga
- avoid smoking
- patient education
27
What are pharmacological tx of asthma?
- adrenergic (short or long acting beta agonists)
- anti-cholinergic
- methylxanthines
- inhaled corticosteroids
- leukotriene modifiers
- mast cell stabilizer
- immunosuppressant monoclonal antibodies
- adjuvant medications
28
What medications are bronchodilators?
- beta 2 adrenergic agonists
- muscarinic antagonists
- leukotriene receptor antagonists
- methylxanthines
29
What are beta 2 adrenergic agonists also known as?
sympathomimetic
30
What are the two forms of beta adrenergic agonsists?
- short acting (SABA)
- long acting (LABA)
31
What do beta 2 adrenergic agonists do?
- cause smooth muscle relaxation in the lungs, muscles, and liver
- vasodilation of the bronchial passage
- release of insulin
32
What are the side effects of beta 2 adrenergic agonists?
- tachycardia
- tremors/shakiness
- palpitations
- anxiety
- sweating
- arrhythmias
- insomnia
33
What medications should you not take with beta 2 adrenergic agonists?
- beta-blockers
- NSAIDS
34
What are short-acting beta agonists known as?
rescue drugs
35
What kind of drugs should be used first to treat an acute asthma attack?
always used first to treat an acute attack
36
How should short acting beta agonist inhalers be used?
- shake the inhaler before use
- 2-4 puffs every 20 minutes up to 3 doses
- if no relief, call the doctor
37
What medications are short acting beta agonists?
- albuterol (proair, ventolin, proventil) **
- levalbuterol (xopenex)
- metaproternol (alupent)
- terbutaline (brethine, brethaire)
- pirbuterol (maxair)
38
What kind of medication is albuterol?
selective beta 2 agonist with minor beta 1 activity
39
How should albuterol be administered for exercise induced asthma?
2 puffs; 15 to 30 minutes before exercising
40
How should albuterol be administered for bronchospasm/ bronchoconstriction?
inhaler solution or inhaler powder; 3-4 times a day
41
What pregnancy category is albuterol?
pregnancy category C
42
What are the routes of administration for albutetrol?
- oral
- multi-dose inhaler
- nebulizer
43
What are the side effects of albuterol?
- muscle tremors
- cardiac: angina, tachycardia, palpitations
- CNS: agitation, anxiety, insomnia, seizures
44
What are contraindications for albuterol?
- hypersensitivity
- CAD
- HTN
- diabetes
- seizure disorders
45
What are long-acting beta agonists known as?
maintenance drug
46
What are long-acting beta agonists often used with?
often used in combination with a steroid
47
What do long-acting beta agonists come as?
come as inhalers; metered-dose or dry powder
48
What do long-acting beta agonists allow for?
allows airway to stay open
49
What medications are long-acting beta agonists?
- salmeterol (serevent)**
- fomoterol (foradil)
- indacaterol (arcapta noehaler)
- vilanterol
50
What is the black box warning for long-acting beta agonists?
- salmeterol (serevent) and formoterol (foradil) should not be used w/o a steroid in asthma for all ages
- need to weigh risk vs. benefit
51
What is the half life of a long-acting beta agonist?
typically, 12-hour half-life
52
what should long acting beta agonists never be used as?
never use as a rescue inhaler
53
What does the FDA recommend long acting beta agonists be used with?
FDA recommends using in combination with an inhaled steroid
54
When should long acting beta agonists not be used?
should not be used in children less than 4 and never w/o a steroid
55
What other disease state are long-acting beta agonists used in?
used in COPD to reduce exacerbation
56
What are muscarinic antagonists also known as?
anticholinergics
57
how do muscarinic antagonists work?
block muscarinic cholinergic receptors by antagonizing the neurotransmitter acetylcholine in smooth muscle
58
What are the routes of administration for muscarinic antagonists?
- nebulizer
- meter-dose inhaler
- oral
59
What are the side effects of muscarinic antagonists?
local: dry mouth, hoarseness
systemic: dizziness, headache, fatigue, palpitations, urinary retention
60
What are the two muscarinic antagonists?
ipratropium bromide (atrovent)
tiotropium bromide (spiriva)
61
is ipratropium bromide short or long acting?
short acting (SAMA)
62
What kind of side effects can ipratropium bromide cause?
can cause anticholinergic side effects
63
When should ipratropium not be used?
- not for acute bronchospasm
- can not use if allergic to peanuts or soy products
64
is tiotropium bromide short or long acting?
long acting (LAMA)
65
How does tiotropium bromide work?
inhibits the muscarinic M3 receptors in the lungs
66
What can tiotropium bromide cause?
can cause a cough/dry mouth
67
When should tiotropium not be used?
not for acute bronchospasm
68
What do muscarinic receptors control?
muscarinic receptors control smooth muscle tone, mucus secretion, vasodilation, & inflammation
69
What does the parasympathetic response contribute to in COPD & asthma?
in COPD & asthma, cholinergic (parasympathetic) mechanism contribute to increased bronchoconstriction and mucus secretion that limit airflow
70
What should always be given first?
always give SABA fist if not combined
71
combinations meds that have SAMA & SABA should never be used as what?
a rescue inhaler
72
What are methylxanthines?
a group of alkaloids used for their effects as bronchodilators
73
Should methylxanthines be used for asthma?
current asthma guidelines do not support its use
- maybe used as a second- line tx
- also used in COPD
74
Are methylxanthines safe for pregnancy or breastfeeding?
no; do not use if pregnant or breastfeeding
75
do methylxanthines have drug interactions?
yes; several
76
What drug is in the methylxanthines class?
elixophyllin (theophylline)
77
What are the routes of administration for elixophyllin?
oral or IV
78
What does elixophyllin require?
requires drug monitoring due to its narrow therapeutic range (10-20mcg/ml)
79
What are the side effects of elixophyllin?
- N/V
- irritability
- tremors
- insomnia
- tachyarrhythmias
80
What should you avoid when taking elixophyllin?
- avoid caffeine
- avoid smoking
81
how do corticosteroids work?
- suppress airway inflammation
- decrease mucus secretions
- suppress the release of histamines by mast cells
- increase sensitivity of beta 2 adrenergic receptors
82
What drug class is the mainstay of asthma & advanced COPD tx?
corticosteroids
83
How much of inhaled steroids make it to the lungs?
10-30%
84
What drugs are in the corticosteroid class?
- beclomethasone (qvar)**
- fluticasone (flovent)&**
- prednisone (oral drug)
- budesonide (Pulmicort)
- methylpredisolone (solu-medrol)
- mometasone (asmanex)
- ciclesonide (alvesco)
85
What are the routes of administration for corticosteroids?
- oral
- nasal/oral inhalers
- IV
- IM
86
Can fluticasone (flovent) inhaler be used with other bronchodilators?
yes; may be used alone or in combination with other bronchodilators
87
When should fluticasone (flovent) be used cautiously?
in patients w/ hepatic impairment
88
What are the side effects of a flovent inhaler?
- headache
- dry mouth
- cough
- hoarseness
- candida infection
- adrenal insufficiency
- hyperglycemia
89
What should you teach pts about a fluticasone (Flovent) inhaler?
- teach pt to rinse mouth after use
- inhaled steroids are not for emergency use
90
What are leukotriene modifiers also known as?
leukotriene receptor antagonists
91
How do leukotriene modifiers work?
decrease the action of leukotrienes which are strong mediators of bronchoconstriction and inflammation
92
What kind of therapy are leukotriene modifiers used as?
used as maintenance therapy only
93
What is the route of administration for leukotriene modifiers?
oral
94
When should leukotriene modifiers be used with caution?
caution in those with hepatic impairment
95
What drugs are in the leukotriene modifier class?
- montelukast (singular)**
- zafirlukast (Accolate)
- zileuton (zyflo)
96
When should leukotriene modifiers be taken?
taken at night
97
What is the black box warning with leukotriene modifiers?
psychiatric side effects such as aggression, depression, agitation, sleep disturbances, suicidal thoughts & suicide
98
How does singulair work?
- inhibit the leukotriene receptors and stop the action of leukotrienes
- stop the allergic response which decreases the asthma and inflammatory response
99
What are indications for singulair?
- asthma (rarely used)
- exercise- induced bronchoconstriction
- allergic rhinitis
100
What are the age limitations for singulair?
- exercise induced: 1 tablet at least 2 hours before exercise for pts 6 years or older
- seasonal allergic rhinitis: daily, age 2 & older
- asthma: age 12 months or older
101
What are the side effects of singulair?
- headache
- GI side effects
- liver dysfunction
- neuropsychiatric: agitation, aggression, depression, sleep disturbances, suicidal thoughts & behavior
102
Is singulair tolerated?
yes; generally, well tolerated
103
What medication reduces the effect of singulair?
phenytoin
104
How do immunosuppressant monoclonal antibodies work?
- inhibit IgE binding to IgE receptors on mast cells and basophils (omalizumab)
- other drugs in class target production of eosinophils
105
What are immunosuppressant monoclonal antibodies adjuvant therapy for?
adjuvant therapy for moderate to severe asthma
106
in what ages are immunosuppressant monoclonal antibodies used?
used in children 6 and older
107
What drugs are in the immunosuppressant monoclonal antibody class?
- omalizumab (xolair)**
- mepolizumab (nucala)
- reslizumab (cinqair)
- benralizumab (fasebra)
108
What is the route of administration for immunosuppressant monoclonal antibodies?
SubQ
109
What are the side effects of immunosuppressant monoclonal antibodies?
- pain at injection site
- headache
- nausea
- fatigue
110
What is the black box warning for immunosuppressant monoclonal antibodies?
anaphylaxis (<0.1%)
111
What medications are inhaled?
- SABA
- LABA
-SAMA
- LAMA
- ICS
112
What medications are oral?
- methylxanthines
- corticosteroids
- leukotriene receptor antagonists
113
What are the combinations of medications used?
- SABA + SAMA
- LABA + LAMA
- LABA + ICS
- LABA + LAMA + ICS
114
How do mast cell stabilizers work?
prevent bronchoconstriction by preventing the release of chemical mediators from mast cells
115
What should mast cell stabilizers not be used for?
not for the tx of asthma attacks
116
are mast cell stabilizers effective?
yes; effective long-term therapy
117
What drug is in the mast cell stabilizer class?
cromolyn (nasalcrom)
118
what is the route of administration for mast cell stabilizers?
- metered-dose inhaler
- nebulizer
119
What are the side effects of mast cell stabilizers?
- hypotension
- sore throat
- taste changes
- bronchospasm
- chest pain
- restlessness
- nausea
- dizziness
120
What patient education should be given for those taking respiratory medications?
- rinse mouth after inhalation, especially after an inhaled steroid
- do not swallow tiotropium capsules
- proper use of inhaler
- when to contact their provider
121
How do you properly use an inhaler?
- shake canister before each use
- breath out steadily
- place mouthpiece between lips
- depress the inhaler when taking a slow, deep breath in
- hold breathe for about 10 seconds then exhale slowly
- repeat after 5 minutes, if needed
- clean mouthpiece
