Respiratory System (part 2) Flashcards
1
Q
What is asthma?
A
A reversible airway obstruction & bronchial hyperresponsiveness w an underlying inflammatory component
2
Q
List etiology of asthma Hint: 4
A
1) Environmental
2) Genetic
3) Allergies
4) Others: Exercise, Certain drugs, GERD, Stress, ↑ emotions
3
Q
List 6 environmental etiologies of asthma
A
1) Pollen
2) Molds
3) Dust mites
4) Animal dander
5) Smoking
6) Weather changes
4
Q
What type of response does asthma have?
A
An immunoglobulin E (IgE) mediated response (Atopic sensitization)
5
Q
What age group is asthma most commonly seen in?
A
Can occur at any age; most common in children & older adults
6
Q
List the 3 major components of asthma
A
1) bronchoconstriction
2) airway inflammation
3) bronchial hyperresponsiveness
7
Q
How does bronchoconstriction occur?
A
In response to a trigger
8
Q
How does airway inflammation occur?
A
Due to T-helper cells and IgE mediated pathways
9
Q
How does bronchial hyperresponsiveness occur?
A
Due to activated mast cells which lead to release of inflammatory mediators (histamine, prostaglandins, & leukotrienes)
10
Q
What could happen overtime in relation to asthma?
A
Airway thickening & hyperplasia of the smooth muscle may lead to remodeling of lung tissue
11
Q
List 5 things leukotrienes cause
A
1) Inflammation
2) Bronchoconstriction
3) Mucus production
4) Infiltration of inflammatory cells into airway wall
5) ↑ vascular permeability
12
Q
What two things cause airway hyperresponsiveness?
A
Inflammation & asthma
13
Q
What does inflammation and asthma limit?
A
Airflow
14
Q
What type of Sx do we see associated with inflammation & asthma?
A
Respiratory Sx
15
Q
What causes airway narrowing of the smooth muscle?
A
Bronchoconstriction
16
Q
Inflammation & asthma causes airway ____
A
edema
17
Q
Inflammation & asthma causes inflamed…
A
Mucus hypersecretion with plugging
18
Q
Inflammation & asthma:
What does hypertrophy of airways and smooth muscles lead to?
A
Remodeling where changes are only partially reversible
19
Q
List 6 clinical manifestations of asthma
A
1) Dyspnea
2) Wheezing
3) Cough
4) Prolonged expiration
5) Chest tightness
6) Use of accessory muscles
20
Q
Severity of asthma is dependent on….
A
The degree of bronchial constriction
21
Q
How does exercise-induced asthma occur? Hint: 2
A
1) Occurs when airways narrow during physical activity
2) Caused by: air, air pollution, chlorine in pools, etc
22
Q
List 3 Sx of exercise-induced asthma
A
1) SOB
2) Wheezing
3) Coughing
& other Sx
23
Q
Who can we see exercise-induced asthma in?
A
Those without asthma & elite athletes
24
Q
What is the Tx for exercise-induced asthma?
A
Short-acting beta-agonists (SABAs) → take before exercising
25
List 2 short-acting beta-agonists (SABAs)
1) Albuterol (ProAir HFA; Proventil-HFA; Ventolin HFA)
2) Levalbuterol (Xopenex HFA)
26
How do SABAs work?
Inhaled medicines that help open airways
**Should NOT be used every day as it can make them less effective**
27
List another Tx option used for exercise-induced asthma that relaxes the airways
Ipratropium (Atrovent HFA)
28
What is nocturnal asthma?
When asthma Sx are often worse at night & may disrupt sleep
29
List 6 causes of nocturnal asthma
1) Reclining position
2) ↑ mucus production/ drainage
3) Hormone level changes
4) Allergens
5) Stress
6) Obesity
30
List 3 Sx of nocturnal asthma
1) Wheezing
2) Chest tightness
3) Difficulty breathing at night
31
List 4 Tx options for nocturnal asthma
1) Montelukast (singulair)
2) Albuterol
3) Long-acting Beta-Agonists
4) Leukotrienes
32
What is status asthmaticus?
Acute, severe asthma that is refractory to Tx
**Can be life-threatening**
33
List the sequence of events that occurs in status asthmaticus **Hint: 5**
Pathologic changes in airway → airflow obstruction → premature closure on expiration → dynamic hyperinflation → hypercarbia
34
What 2 things may or may not be seen in patient w status asthmaticus?
1) Wheezing
2) Cough
35
List 6 non-pharmacological management options for asthma
1) Identify triggers/ risk factors
2) Breathing exercises
3) Diet
4) Acupuncture, yoga
5) Avoid smoking
6) Patient education
36
List 8 pharmacological management options for asthma
1) Adrenergic (SABAs/ LABAs)
2) Anti-cholinergic
3) Methylxanthines
4) Inhaled corticosteroids
5) Leukotriene modifiers
6) Mast cell stabilizer
7) Immunosuppressant monoclonal Ab
8) Adjuvant medications
37
List 4 types of bronchodilators
1) Beta 2 adrenergic agonists
2) Muscarinic antagonists
3) Leukotriene receptor antagonists
4) Methylxanthines
38
List 2 examples of beta-2 adrenergic agonists
**AKA: sympathomimetic**
1) Short-acting (SABA)
2) Long-acting (LABA)
39
How do beta-2 adrenergic agonists work? **Hint: 3**
1) Cause smooth muscle relaxation in the lungs, muscles, & liver
2) Vasodilation of the bronchial passage
3) Release of insulin
40
List 7 side effects of beta-2 adrenergic agonists
1) Tachycardia
2) Tremors/ shakiness
3) Palpitations
4) Anxiety
5) Sweating
6) Arrhythmias
7) Insomnia
41
A pt taking beta-2 adrenergic agonists should avoid use of what two med classes?
1) Beta blockers
2) NSAIDs
42
Short-acting beta agonists (SABAs) **Hint: 2**
1) Known as "Rescue drug"
2) Always used first to Tx an acute attack
43
Explain administration of SABAs **Hint: 3**
1) Shake inhaler before use
2) 2-4 puffs every 20 min, up to 3 doses
3) No relief, call physician
44
List 5 medications considered to be SABAs
1) Albuterol (ProAir, Ventolin, Proventil)
2) Levalbuterol (Xopenex)
3) Metaproterenol (Alupent)
4) Terbutaline (Brethine, Brethaire)
5) Pirbuterol (MaxAir)
45
Which SABA is considered a beta2 agonists with minor beta1 activity?
Albuterol
46
Explain administration of albuterol for exercise-induced asthma
2-5 puffs 15-30 min before exercising
47
Explain administration of albuterol for bronchospasm/ constriction
1) Inhaler solution: 3-4 x a day
2) Inhaled powder: 3-4 x a day
48
What pregnancy category is albuterol?
Category C
49
List 3 routes of administration for albuterol
1) Oral
2) Multi-dose inhaler
3) Nebulizer
50
List 8 side effects of albuterol
1) Muscle tremors
2) Cardiac: angina; tachycardia; palpitations
3) CNS: agitation; anxiety; insomnia; seizures
51
List 5 contraindications of using albuterol
1) Hypersensitivity
2) CAD
3) HTN
4) Diabetes
5) Seizure disorders
52
How do we know if the drug (Albuterol) is effective?
1) Decreased effort of breathing
2) Increase in SpO2
53
List 4 things to note about long-acting beta-agonists (LABAs)
1) Known as "maintenance drug"
2) Often used in combo with a steroid
3) Comes in inhaler- metered-dose or dry powder
4) Allows airway to stay open
54
List 4 examples of medications considered LABAs
1) **Salmeterol (serevent)**
2) Formoterol (Foradil)
3) Indacaterol (Arcapta neohaler)
4) Vilanterol
55
Black box warning of LABAs
Salmeterol & Formoterol should NOT be used w/o a steroid in asthma for ALL ages
**Need to weight risk vs. benefit**
56
What is typical half-life of LABAs
12 hours
57
What should LABAs never be used as?
A rescue inhaler
58
LABAs should not be used in what age group?
Children < 4 yrs & never w/o a steroid
59
Why are LABAs used for patients with COPD?
To reduce exacerbation
60
Muscarinic antagonists are also known as _____
Anticholinergics
61
How do muscarinic antagonists work?
Blocks muscarinic cholinergic receptors by antagonizing the neurotransmitter acetylcholine in smooth muscle
62
List 3 routes of admin for muscarinic antagonists
1) Nebulizer
2) Meter-dose inhaler
3) Oral
63
When are muscarinic antagonists used?
After a SABA
64
List 2 local side effects of muscarinic antagonists
1) Dry mouth
2) Hoarseness
65
List 5 systemic side effects of muscarinic antagonists
1) Dizziness
2) H/A
3) Fatigue
4) Palpitations
5) Urinary retention
66
List an example of a short-acting muscarinic antagonist (SAMA)
Ipratropium bromide (Atrovent)
67
List 3 things to note about Ipratropium bromide (SAMA)
1) Can cause anticholinergic side effects
2) NOT used for acute bronchospasms
3) Can NOT use if allergic to peanuts or soy products
68
List an example of a long-acting muscarinic antagonist (LAMA)
Tiotropium Bromide (Spiriva)
69
List 3 things to note about Tiotropium bromide (LAMA)
1) Inhibits the muscarinic M3 receptors in the lungs
2) Can cause cough/ dry mouth
3) NOT for acute bronchospasm
70
Pathophysiology of muscarinic receptors
They control smooth muscle tone, mucus secretion, vasodilation & inflammation
71
Pathophysiology of muscarinic receptors in COPD & asthma
Cholinergic (parasympathetic) mechnaisms contribute to ↑ bronchoconstriction & mucus secretion that limit airflow
72
Muscarinic receptors:
List sympathetic & parasympathetic responses for eyes
S: Dilates pupils
P: Constricts pupils
73
Muscarinic receptors:
List sympathetic & parasympathetic responses for lungs
S: Dilates bronchioles
P: Constricts bronchioles & increase secretions
74
Muscarinic receptors:
List sympathetic & parasympathetic responses for heart
S: Increases HR
P: Decreases HR
75
Muscarinic receptors:
List sympathetic & parasympathetic responses for blood vessels
S: Constricts
P: Dilates
76
Muscarinic receptors:
List sympathetic & parasympathetic responses for GI
S: Relaxes smooth muscles of GIT
P: increases peristalsis
77
Muscarinic receptors:
List sympathetic & parasympathetic responses for bladder
S: Relaxes bladder muscle
P: Constricts bladder
78
Muscarinic receptors:
List sympathetic responses for uterus
S: Relaxes uterine muscles
79
Muscarinic receptors:
List parasympathetic responses for salivary gland
P: Increases salivation
80
What do combination medications contain?
A SAMA and SABA
**Never a rescue inhaler**
81
What are methylxanthines?
A group of alkaloids used for their effects as a bronchodilator
82
When are methylxanthines used?
**Currently not supported for asthma guidelines**
1) Maybe as 2nd line
2) Used for COPD
83
List 2 contraindications of Methylxanthines
1) Pregnancy
2) Lactation
84
Which type of respiratory medication has several drug interactions?
Methylxanthine
85
List an example of a methylxanthine
Elixophyllin (Theophylline)
86
Routes of admin for elixophyllin (Theophylline)
1) Oral
2) IV
87
What does Elixophyllin (Theophylline) require?
drug monitoring due to narrow therapeutic range (10-2 mcg/ mL)
88
List 5 side effects of Elixophylline (Theophylline)
1) N/V
2) Irritability
3) Tremors
4) Insomnia
5) Tachyarrhythmias
89
List 2 things to avoid if a patient is on Elixophyllin (Theophylline)
1) Caffeine
2) Smoking
90
Pathophysiology of corticosteroids **Hint: 4**
1) Suppress airway inflammation
2) Decrease mucus secretions
3) Suppress release of histamines by mast cells
4) Increase sensitivity of Beta2 adrenergic receptors
91
What are corticosteroids used to Tx?
Mainstay of asthma Tx and advanced COPD
92
Approx what % of inhaled steroids make it into the lungs?
10-30%
93
List 7 medications considered corticosteroids
1) Prednisone (Oral)
2) Beclomethasone (Qvar)
3) Budesonide (Pulmnicort)
4) MOmetasone (Asmanex)
5) Fluticasone (Flovent)
6) Ciclesonide (Alvesco)
7) Methylprednisolone (Solu-medrol)
94
List 4 routes of administration for corticosteroids
1) Oral
2) Nasal/ oral inhalers
3) IV
4) IM
95
How can Fluticasone (Flovent) be used?
May be used alone or in combo with other bronchodilators
96
Fluticasone should be used with caution in what patients?
Patients with hepatic impairment
97
List 7 side effects of fluticasone
1) H/A
2) Dry mouth
3) Cough
4) Hoarseness
5) Candida infection
6) Adrenal insufficiency
7) Hyperglycemia
98
What should be taught to patients after admin of Fluticasone?
Rinse mouth after use
99
Fluticasone / inhaled steroids are NOT for _______ use
Emergency!!
100
List 2 generic forms of LABA/ ICS combo inhalers available
1) Budesonide/ Formoterol (Symbicort)
2) Fluticasone/ Salmeterol (Advair; AirDuo Respiclick)
101
List 2 tips for HFA devices
1) Priming needed
2) May use with spacer
102
List 1 tip for DPI devices
1) Breath-activated (Take deep/ fast breath)
103
How do leukotriene modifiers work?
**AKA: Leukotriene receptor antagonists**
Decrease action of leukotrienes which are strong mediators of bronchoconstriction & inflammation
104
What are leukotrienes used for?
As maintenance therapy ONLY
105
What route are leukotriene modifiers given & when should they be given?
Oral route; taken at night
106
Leukotriene modifiers should be used with caution in what patients?
Those with hepatic impairment
107
List 3 medications considered leukotriene modifiers
1) **Montelukast (Singulair)**
2) Zafirlukast (Accolate)
3) Zileuton (Zyflo)
108
What is the black box warning for leukotriene modifiers? **Hint: 6**
Psychiatric side effects: aggression, depression, agitation, sleep disturbances, suicidal thoughts, & suicide
109
How does Montelukast (Singulair) work? **Hint: 2**
1) Inhibits the leukotrienes receptor & stops actions of the leukotriene
2) Stops allergic response which decreases asthma & inflammatory response
110
List 3 indications for giving Montelukast (Singulair)
1) Asthma (rarely used)
2) Exercise-induced bronchoconstriction
3) Allergic rhinitis
111
List 3 age limitations for Montelukast (Singulair) use
1) Exercise-induced: 1 tab at least 2 hrs prior for pts 6 yrs & >
2) Seasonal allergic rhinitis: daily, 2 yrs & >
3) Asthma: 12 mos & >
112
List 3 adverse reactions of Montelukast (Singulair)
1) H/A
2) GI Sx
3) Liver dysfunction
**Generally well tolerated**
113
List 5 neuropsychiatric adverse reactions of Montelukast
1) Agitation
2) Aggression
3) Depression
4) Sleep disturbances
5) Suicidal thoughts & behaviors
114
What should patient education include when taking Montelukast
There is a reduced effect if taken with Phenytoin
115
How do immunosuppressant monoclonal Ab work? **Hint: 2**
1) Inhibits IgE binding to IgE receptors on mast cells & basophils (Omalizumab)
2) Other drugs in class target production of eosinophils
116
What type of therapy are immunosuppressant monoclonal Ab used for?
Adjunctive therapy for moderate to severe asthma
117
What age ranges are immunosuppressant monoclonal Ab used for?
6 yrs & older
118
List 4 medications considered immunosuppressant monoclonal Ab
1) Omalizumab (Xolair)
2) Mepolizumab (Nucala)
3) Reslizumab (Cinqair)
4) Benralizumab (Fasenra)
119
Suffix for immunosuppressant monoclonal Ab
"mab"
120
Route of administration for immunosuppressant monoclonal Ab
SubQ
121
List 4 side effects of immunosuppressant monoclonal Ab
1) Pain at injection site
2) H/A
3) Nausea
4) Fatigue
122
Black box warning of immunosuppressant monoclonal Ab
Anaphylaxis (< 0.1%)
123
Medication regimens:
Inhaled **Hint: 3**
1) Short acting
2) Long acting (maintenance)
3) Categories
→ SABA & LABA
→ SAMA & LAMA
→ ICS
124
Medication regimens:
Oral **Hint: 4**
1) Methylxanthines
2) Corticosteroids
3) Leukotriene receptor antagonists (inhibitor)
4) Combos
→ SABA + SAMA
→ LABA + LAMA
→ LABA + ICS
→ LABA + LAMA + ICS
125
How do mast cell stabilizers work?
Prevent bronchoconstriction by preventing the release of chemical mediators from mast cells
126
Mast cell stabilizers should NOT be used for Tx of ____ ____
Asthma attacks
127
What type of therapy are mast cell stabilizers?
Effective long-term therapy
128
List 1 medication considered a mast cell stabilizer
Cromolyn (Nasalcrom)
129
List 2 routes of administration of mast cell stabilizers
1) Metered-dose inhaler
2) Nebulizer
130
List 8 side effects of Mast cell stabilizers
1) Hypotension
2) Sore throat
3) Taste changes
4) Bronchospasms
5) Chest pain
6) Restlessness
7) Nausea
8) Dizziness
131
List 4 patient education teaching points
1) Rinse mouth after inhalation, esp inhaled steroids
2) Do NOT swallow Tiotropium capsules
3) Proper use of inhaler
4) When to contact provider
132
List 8 steps for proper inhaler use
1) Shake canister before each use
2)
