Respiratory Drugs Flashcards
What is bronchial asthma
Recurrent and reversible SOB.
Occurs when the airways of the lungs become narrow/obstructed
What are the diseases of the Lower respiratory tract
COPD, Asthma
With bronchial asthma, the alveolar ducts and alveoli are ________, but airflow to them is ________.
Open; obstructed
What are 2 symptoms of bronchial asthma
Wheezing
Difficulty breathing
List the 4 ways the airways of the lungs can narrow
Bronchospasms
Inflammation of the bronchial mucosa
Edema of the bronchial mucosa
Production of viscous mucus
What is the difference between and asthma attack and status asthmaticus
An asthma attack is a sudden onset of SOB
Status asthmaticus is a prolonged (several minutes to hours) asthma attack that does not respond to typical drug therapy
T/F: Status asthmaticus is not a medical emergency
False; it is a medical emergency
What is COPD and what is it characterized by?
It’s a progressive respiratory disorder
It is characterized by chronic airflow limitation, systematic manifestations and significant comorbidities
What is chronic bronchitis
Presence of cough and sputum for at least 3 months within a span of 2 years
What are the 3 classes of bronchodilators?
B-adrenergic agonists
anticholinergics
Xanthine derivatives
Name a short and long acting B-adrenergic agonist
SABA: Salbutamol
LABA: Salmeterol
Name a long acting B-agonist and glucocorticoid steroid combo inhaler and when is it used
Budesonide and formoterol fumarate dihydrate (Symbicort)
Used as a reliever or rescue treatment for moderate to severe asthma when symptoms worsen
when are b-adrenergic agonists indicated and what are they also referred to as
During acute asthma attacks because they quickly reduce airway constriction
Relief of bronchospasm resulting from COPD or asthma
Also used for hypotension and shock
AKA sympathomimetics
What are the 3 subtypes of B-adrenergics
Non-selective adrenergics
Non-selective B-adrenergics
Selective B2 drugs
What do non-selective adrenergics target and name one
Stimulate B, B1 (cardiac) and B2 (resp) receptors
Epinephrine
What do non-selective B-adrenergics target
Stimulate B1 and B2 receptors
What do selective B2 drugs target and name one
Only stimulate B2 receptors
Salbutamol
What is the MOA of B-adrenergic agonists
They begin at the specific receptor that is stimulated, smooth muscle is relaxed in the airway which results in bronchodilation
What are the contraindications of B-adrenergic agonists
Uncontrolled cardiac dysrhythmias
High risk of strokes (because of vasoconstrictive drug action)
What are the adverse effects of b-adrenergic agonists
Insomnia
Restlessness
Anorexia
Vascular headache
Hyperglycemia
Tremor
Cardiac stimulation
Anginal pain
What are the interactions with B-adrenergic agonists
Less bronchodilation when used with B-blockers
MAOIs
Diabetic therapy (increases BG)
What is the most commonly used B-adrenergic agonists
Salbutamol
T/F: Salmeterol (LABA) should always be used alone
False; It should never be used alone but in combo with an inhaled glucocorticoid steroid
What is the maximum daily dose of salmeterol
One puff BID
What is the MOA of anticholinergics
Ach causes bronchial constriction and narrowing of airways
Anticholinergics bind to the ACh receptors, preventing ACh from binding
Name 2 anticholinergics
Ipratropium, tiotropium bromide monohydrate
What are the indications for anticholinergics
Prevention of the bronchospasm associated with COPD; not used to manage acute symptoms
What are the adverse effects of anticholinergics
Dry mouth/throat
Nasal congestion
Heart palpitations
GI distress
Urinary retention
Increased intraocular pressure
Headache
Coughing
Anxiety
What is the most commonly used anticholinergic
Ipratropium
Name 2 xanthine derivates and the general name for them
Caffeine and theophylline
Plant alkaloids
What is the MOA of xanthine derivatives
Increase levels of cyclic adenosine monophosphate (cAMP) by inhibiting the enzyme that breaks it down (phosphodiesterase)
Increased cAMP levels cause smooth muscle relaxation, bronchodilation and increased airflow
How do xanthine derivatives cause cardiovascular stimulation
Increases force of contraction and HR, resulting in increased Cardiac output and increased blood flow to kidneys (diuretic effect)
What are the indications for xanthine derivatives
Mild to moderate asthma
Adjunctively to treat COPD
T/F: Xanthine derivatives are not used for management of acute asthma
True
What are the contraindications for xanthine derivatives
Uncontrolled cardiac dysrhythmias
Seizure disorders
Hyperthyroidism
Peptic ulcers
Oral contraceptives
What are the adverse effects of xanthine derivatives
Gastro reflux during sleep
Sinus tachycardia
Extrasystole
Palpitations
Ventricular dysrhythmias
Increased urination
Hyperglycemia
What are other uses for caffeine
CNS stimulant or analeptic
Cardiac stimulant in infants with bradycardia
Increase respiratory drive in infants in the NICU
What is the most common xanthine derivative
Theophylline
When is injectable/IV theophylline used
Patients with status asthmaticus who have not responded to B-adrenergics such as epinephrine
What are 2 types of nonbronchodilating respiratory drugs
Leukotriene receptor antagonists (montelukast)
Corticosteroids
What is the MOA for leukotriene antagonists
Leukotrienes cause inflammation, bronchoconstriction and mucus production when triggered
Leukotrienes antagonists prevent leukotrienes from attaching to receptors in the lungs
What are the indications of Leukotriene receptor antagonists
Prophylaxis and long term treatment of asthma
Treatment of allergic rhinitis
When should improvements be seen when using montelukast
Symptoms should improve in about a week
What are the contraindications of leukotriene receptor antagonists
Previous adverse drug reaction
Allergy to povidone, lactose, titanium dioxide or cellulose derivatives (all inactive ingredients in these drugs)
What are the adverse effects of leukotriene receptor antagonists
Liver dysfunction
Nausea
Diarrhea
Headache
What is the MOA of corticosteroids
Stabilization of membranes of cells that release broncho constricting substances (leukocytes)
Increase responsiveness of bronchi smooth muscle to b-adrenergic agonists
Reduces inflammation and enhances the activity of b-adrenergics
Name 3 inhaled corticosteroids
Beclomethasone dipropionate
Budesonide
Fluticasone propionate
What are the indications for inhaled corticosteroids
Persistent asthma
Concurrently with B-adrenergic agonists
What are the contraindications of inhaled corticosteroids
Patients with sputum positive for candida bacteria
Patients with systemic fungal infection
What are the adverse effects of inhaled corticosteroids
Pharyngeal irritation
Coughing
Dry mouth
Oral fungal infections
Systemic effects (rare)
What are some interactions with inhaled corticosteroids
Antidiabetics (increases BG)
Raises blood levels of immunosuppressants
Risk of hypokalemia with diuretics
What happens when salbutamol is used too frequently
Loses its B2 specific actions and causes B1 receptor stimulation resulting in nausea, anxiety, palpitations, tremors and increased HR
What are some foods that interact with xanthine derivatives
Charcoal-broiled, high-protein and low-carb food
They reduce serum levels of xanthines
T/F: Smoking does not affect xanthine derivatives
F: It enhances xanthine metabolism
What does the patient need to do after using an inhaled corticosteroid and what does it prevent
Patients must gargle and rinse mouth after using to prevent oral fungal infections
What is a nursing consideration when administering a corticosteroid and a B-agonist bronchodilator
Use the bronchodilator several minutes before the corticosteroid so it has time to dilate the bronchi to receive the steroid
