Respiratory study guide Flashcards
Pathophysiology of asthma
- Chronic inflammation, resulting in an increase in airway edema and mucous secretions
- Bronchospasm; hyper responsiveness to stimuli
Pathophysiology of COPD
-Consists of either chronic bronchitis and/or emphysema
Chronic bronchitis
Excess mucus production in the lower respiratory tract
Emphysema
Loss of bronchiolar elasticity and destruction of alveoli
Common causes of COPD
Smoking and air pollutants
Definition of respiration
Process by which oxygen brought into body, carbon dioxide is removed
Definition of perfusion
Blood flow through the lung
Ventilation
Process of moving air in/out of lungs
Step 1 treatment approach
Preferred: SABA PRN
Step 2 treatment approach
Preferred: Low dose ICS
Alternative: Cromolyn, LTRA, nedocromil, or theophylline
Step 3 treatment approach
Preferred: Low dose ICS + LABA or Medium dose ICS
Alternative: Low dose ICS + either LTRA, theophylline, or zileuton
Step 4 treatment approach
Preferred: Medium dose ICS + LABA
Alternative: Medium dose ICS + either LTRA, theophylline, or zileuton
Step 5 treatment approach
Preferred: High dose ICS + LABA and consider omalizumab for patients who have allergies
Step 6 treatment approach
Preferred: High dose ICS + LABA + oral corticosteroids AND consider omalizumab for patients who have allergies
What are the differences between treatment of acute symptoms vs prevention?
Acute symptoms: SABA
Prevention: Corticosteroids, Inhaled anticholinergic, leukotriene modifiers
Mechanism of Albuterol
- Beta 2 agonist (SABA)
- Selectively binds to beta 2 adrenergic receptors in bronchial smooth muscle to cause bronchidilation
- fast onset
Mechanism of Salmeterol
- Beta 2 agonist (LABA)
- Selectively binds to beta 2 adrenergic receptors in bronchial smooth muscle to cause bronchodilation
- Slow onset
Mechanism of Ipratropium
- Inhaled anticholinergic
- Blocks cholinergic receptors in bronchial smooth muscle
Mechanism of Beclomethasone
- Inhaled corticosteroid
- Reduces inflammation and immune response, thus decreasing frequency of asthma attacks
Mechanism of Cromolyn
- Mast cell stabilizer
- Stabilizes mast cells, thus preventing inflammatory response
- Prevents release of histamine and other inflammatory mediators in airways
Mechanism of Theophylline
- Methylxantine
- Relaxes bronchial smooth muscle
- Suppresses airway responsiveness to stimuli that promote bronchospasm
- Modest bronchodilator
Mechanism of Omalizumab
- Monoclonal antibodies
- Prevents inflammation and dampens response to allergens
SE of albuterol and salmeterol:
- Headache
- Throat irritation, dry mouth
- Restlessness, insomnia
- Nervousness, tremor
- Cardiac tachycardia, chest pain
- Paradoxical bronchospasm
- Allergic reaction
Precautions of slameterol and albuterol:
- History of tachycardia
- Prolonged QT interval
- Coronary artery disease
- Hypertension
SE of Ipratropium:
- Dry mouth, bitter taste
- Nausea, GI distress
- Upper respiratory tract irritation
- Paradoxical brochospasm
Precautions of Ipratropium:
- Closed angle glaucoma
- Urinary tract obstruction
SE of Beclomethasone
- Hoarseness, dry mouth, disgusia
- Development of cataracts (long term therapy)
- Corticosteroid toxicity
- Growth Inhibition in children
- Oral thrush
SE of Cromolyn
- Cough
- Pharyngeal irritation
- Local burning and stinging
- Discontinue if eosinophilia develops*
Contraindications of Theophylline:
- Seizure disorders
- Heart failure, dysrhythmias
- Active peptic ulcer
- Liver disease
SE of Theophylline:
- Nausea/vomiting
- Headache, irritability, insomnia
- Dysrhythmias
- Seizures
SE of Omalizumab:
- Anaphylaxis
- Bleeding
- Severe dysmenorrhea
