Respiratory Medications

Question 1

What are two types of bronchodilators?

Answer 1

• Beta 2 adrenergic agonist
• Anticholinergic

Question 2

What type of drugs can Beta 2 adrenergic agonist be and the onset these work plus the duration?

Answer 2

• Short Acting (SABA) - fast relief
  (Immediate action, lasts 4-6 hours)
• Long Acting (LABA)
  (Delayed onset, lasts 8-12 hours)

Question 3

What are examples of SABA and LABA?

Answer 3

Salbutamol (SABA)

Salmeterol (LABA)

Question 4

What is the indication for use of SABA?

Answer 4

Short acting beta agonists are used for relief of symptomatic asthma, asthma induced by exercise, bronchospasm in COPD and for allergic reactions caused by smoke inhalation.

Question 5

What is the MOA for Beta 2 Adrenergic Agonist?

Answer 5

Stimulates beta 2 receptors in the smooth muscles causing bronchodilation, this allows increased airflow to the lungs. Inhibit mediator release from mast cells

Question 6

What are the pharmacokinetics for SABA?

Answer 6

rapid onset between 1-3 minutes, peak effect 1-2 hours and duration action of between 4-6 hours. Metabolised by the liver and excreted in the kidneys

Question 7

What are some adverse drug reactions associated with SABA?

Answer 7

tremor, palpitations, anxiety, restlessness, tachycardia, headaches, hyperglycaemia

Question 8

What are some patient education related to SABA?

Answer 8

SABA have rapid onset; administration occurs via inhalation utilising a spacer or pump (50% more medicine enters the lungs via use of a spacer and less medicine is left in the throat or mouth), relief short term symptoms. Only use when needed

Question 9

What are some monitoring requirements associated with SABA?

Answer 9

spirometry testing, monitoring RR, HR and BP (baseline vitals), positioning to maximise air entry.

Question 10

What is a caution for use of SABA?

Answer 10

Frequent use can result in decreased β2 agonism due to down regulation of beta receptors, results in decreased bronchodilation. β1 stimulation results in increased HR; increased anxiety; tremors

Question 11

What is the indication for use for LABA?

Answer 11

control of asthma and COPD

Question 12

What are the pharmacokinetics for LABA?

Answer 12

prolonged actions and half lives in the range of 6-12 hours.

Question 13

What is a caution of use associated with LABA

Answer 13

LABA are used in combination with inhaled corticosteroids

Not to be used in the treatment of acute asthma symptoms

Question 14

Where are Beta 1 receptors located?

Answer 14

Receptors located on the smooth muscle of the heart

Question 15

Where are Beta 2 receptors located?

Answer 15

• Smooth muscle of bronchioles
• Blood vessels supplying brain, heart, kidneys and skeletal muscles
• Uterus
• Liver

Question 16

Why are Beta-2 Agonists ideally administered through the inhaled route?

Answer 16

beta-2 agonists are best given by the inhaled route, which provides immediate access to the airways. The single layer of epithelial cells, the large surface area of the alveoli and the rich blood supply within the airways promote fast absorption of the drug & a rapid onset of action. Using the inhaled route rather than the oral route also means a smaller dose is required. This helps to minimise systemic side effects

Question 17

What are the two forms of Anticholinergics and give an example for each?

Answer 17

Short Acting Muscarine Antagonist (SAMA) - Ipratropium
Long Acting Muscarine Antagonist (LAMA) - Tiotropium

Question 18

What is the indication for use of Anticholinergics?

Answer 18

Used in long-term maintenance of COPD

Question 19

What is the MOA of anticholinergics?

Answer 19

Blocks parasympathetic stimulation of Vagus nerves resulting in smooth muscle relaxation & bronchodilation, reduced mucus secretion

Question 20

What are some adverse drug reactions associated with anticholinergics?

Answer 20

Dry mouth, Metallic taste, Nausea, Constipation, Headache, Tachycardia, Glaucoma- with nebs and face mask

Question 21

What are some patient education associated with anticholinergics?

Answer 21

Avoid spray in the eyes as it might cause blurred vision or acute narrow angle glaucoma.

• Sugarless gum or candy might help with dry mouth
• Maintaining good oral hygiene is necessary

Question 22

What is an example of inhaled corticosteroids? (preventers)

Answer 22

Fluticasone,

Question 23

What is the indicator for use of inhaled corticosteriods?

Answer 23

• Used by both the inhaled and systemic routes in chronic asthma and moderate severe COPD to decrease airway inflammation and obstruction
• Used for asthma either alone or with beta 2 adrenergic agonist. Decreases inflammation locally.

Question 24

What should someone use first before the inhaled corticosteroid and why?

Answer 24

Use beta 2 adrenergic agonist first then oral corticosteroids. This opens airways then reduces inflammation.

Question 25

What is the MOA for inhaled corticosteroids?

Answer 25

mimic the action of the natural glucocorticosteroids, the stress hormone secreted from the adrenal gland. Their action in the lungs decreases early + late stages of inflammatory response, decreases mucosal inflammation, decreases bronchial hyper – reactivity and increases responsiveness to beta agonists.

Question 26

What happens in the lungs with inhaled corticosteroids?

Answer 26

decreased early + late stages of inflammatory response

decreased bronchial mucosal inflammation

decreased bronchial hyper-reactivity

increased responsiveness to β-agonists

Question 27

What are some adverse drug reactions associated with inhaled corticosteroids?

Answer 27

has less side effects, mainly is dysphonia (changed voice), oral thrush and allergic reaction

Question 28

What are some adverse drug reactions associated with oral corticosteriods?

Answer 28

Increased BGL, Muscle wasting/weakness, Osteoporosis, Adrenal suppression, Weight gain, Diabetes Mellitus, Skin atrophy, Growth suppression in children.

Question 29

What are some monitoring requirements associated with corticosteroids?

Answer 29

BGL (known to increase BGL), baseline vitals

Question 30

What is the patient education associated with corticosteroids?

Answer 30

after use, use mouth rinse to prevent candidiasis (oral thrush). Best administered in the morning

Question 31

Why would a patient with diabetes require closer monitoring of blood glucose while taking a corticosteroid?

Answer 31

Corticosteroid can elevate blood glucose by gluconeogenesis in the liver

Question 32

What measures can be taken to reduce the risk of adverse effects for inhaled corticosteroids?

Answer 32

Use spacer and rinse mouth afterwards to reduce the side effects

Question 33

Oral corticosteroids are best administered in the morning. Why is this?

Answer 33

Mimic the body’s own production of cortisone, has less suppression of the HPA (hypothalamic-pituitary-adrenal) axis. Take in the evening might cause difficulty in sleeping.

Question 34

Discuss the nursing role in supporting the patient/client taking both bronchodilator and corticosteroids medications for asthma and COPD.

Answer 34

Ensure the patient takes bronchodilators first and then corticosteroid 5 mins later. This is because the bronchodilator will open the airway for the corticosteroid to be effective.