Respiratory medications

Question 1

Sympathetic vs Parasympathetic responses. Explain and state what neurotransmitters they both use, as well as actions on the lungs and heart for both.

Answer 1

SNS - fight or flight
Noradrenaline & adrenaline
Lungs - bronchodilation
Heart - increased HR and contractile force

PNS rest and digest
Acetylcholine
Lungs - bronchoconstriction
Heart - decreased HR and contractile force

Question 2

Bronchodilators also known as

Answer 2

Beta 2 agonists

Question 3

Beta 2 agonist medications act by

and example

Answer 3

stimulating beta 2 receptors in the bronchial smooth muscle causing bronchodilation and inhibit mediator release from mast cells.

E.g salbutamol

Question 4

Beta 1 receptors are located where? and what is the effect when they’re stimulated

Answer 4

Located on smooth muscle of the heart -

increase HR and contractility

Question 5

Beta 2 receptors are located where? and what is the effect when they’re stimulated

Answer 5

located on smooth muscle of bronchioles, blood vessels supplying brain, heart, kidney and skeletal muscles, uterus, liver.

bronchodilation, vasodilation leading to increased blood supply to these areas and fine muscle tremors, uterine relaxation, glucose release

Question 6

Why do you think the beta 2 agonists are ideally administered via the inhaled route?

Answer 6

Inhalation localizes the drug to the lung tissue, concentrating the therapeutic effect on the airway smooth muscles while minimizing the distribution of the drug to the systemic circulation

Question 7

B2 agonists. What are the two types?

Answer 7

Short acting [SABA’s] and Long acting [LABA’s].

Question 8

Describe the actions of SABA’s and LABA’s

Answer 8

SABA'S
Provide relief for 4-6 hours
Rapid onset of action 5-15mins
Can be used in an acute asthma attack [PRN]
E.g Salbutamol

LABA's
Long acting [12hrs]
Slow onset of action
Not to be used to relieve acute symptoms give regularly
E.g.Salmeterol

Question 9

B2 agonists common ADR’s

Answer 9

Tachycardia, palpitations, headaches, restlessness, tremor

Question 10

Cautions for use of SABA

Answer 10

FREQUENT use can result in

decreased B2 agonism = decreased bronchodilation

increased B1 stimulation, resulting in increased HR, anxiety and tremors

Question 11

Cautions for use of LABA

Answer 11

Not to be used to treat acute asthma

Used in moderate to severe asthma and COPD

Question 12

Anticholinergic Bronchodilators actions and classifications

Answer 12

Block the PNS stimulation of vagus nerve resulting in smooth muscle relaxation and bronchodilation.

SAMA and LAMA short acting and long acting muscarinic antagonists

Question 13

Agonist vs antagonist

Answer 13

An agonist is a drug that binds to the receptor, producing a similar response to the intended chemical and receptor. Whereas an antagonist is a drug that binds to the receptor either on the primary site, or on another site, which all together stops the receptor from producing a response

Question 14

Anticholinergic Bronchodilators common ADR’s

Answer 14

Dry mouth, nausea, metalic taste, constipation, headache

Question 15

Preventers - inhaled corticosteroids [ICS]. MOA? mechanism of action

Answer 15

Mimic action of natural glucocorticoids, the stress hormones secreted from the adrenal gland.

Action in lungs
Dec early+late stages of inflammatory response
Dec bronchial mucosal inflammation
Dec bronchial hyper-reactivity
Inc responsiveness to b-agonists

E.g. fluticasone

Question 16

Inhaled corticosteroids cautions - e.g. when recommended and pt education

Answer 16

Must be taken continuously [full effect may take weeks] and not stopped without consultation with prescriber

Given via inhalation with spacer greatly reduces systemic adverse effects

May reduce the rate of exacerbations in severe COPD.

Not recommended for mild to moderate COPD

Question 17

Adverse effects of inhaled corticosteroids

Answer 17

Dysphonia
Oropharyngeal candidasis [oral thrush]
To minimize these effects, the pt should be taught to administer their medication via a spacer and to rinse mouth and throat after each dose to prevent thrush

Question 18

Nursing factors to consider

Answer 18

Education points - inhaler technique, use of space and care of spacer, action plans for managing symptoms online, ADR’s for both inhalers and oral medications

Question 19

Beta agonists action involves

Answer 19

dilation of airways
relief of bronchospasm
uterine relaxation

Question 20

Leukotriene-receptors trigger all of these actions

Answer 20

Inflammation, bronchoconstriction, mucus production

Question 21

Function of leukotriene receptors?

Answer 21

Leukotrienes are involved in asthmatic and allergic reactions and act to sustain inflammatory reactions.

Question 22

Preventer medications used in the treatment of asthma include:

Answer 22

cromoglycate and zafirlukast

Question 23

Side effects of beta agonists

Answer 23

increased HR, decreased BP, and restlessness

Question 24

Which of these respiratory drug groups is used in the immediate relief of asthma?

Answer 24

Bronchodilators

Question 25

Anticholinergic drugs block vagal tone. T/F

Answer 25

True

Question 26

Salbutamol is a beta

Answer 26

agonist

Question 27

Theophylline, a xanthine derivative, has variable pharmacokinetic parameters. T/F

Answer 27

T. Its variable pharmacokinetic parameter is one of the reasons for the decreasing clinical use.

Question 28

Adverse drug reactions related to corticosteroids include

Answer 28

Pharyngeal irritation. Oral fungal infections. Coughing

Question 29

Beta-adrenoceptor agonists cause all of the following

Answer 29

uterine relaxation, tremor, hyperglycaemia

Question 30

corticosteroid examples

Answer 30

Fluticasone, Beclomethasone, Budesonide

Question 31

Leukotriene receptor antagonists are used for

Answer 31

coughing, wheezing and SOB

Question 32

The organ that is most susceptible to any disruption in oxygen supply is the

Answer 32

brain

Question 33

Frequent use of salbutamol may diminish bronchodilation in the short term. T/F

Answer 33

True