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HLSC 220 Pharmacotherapeutics for Health Professionals πŸ’Š > Respiratory Tract Drugs: Asthma and COPD - Ch. 79 > Flashcards

Respiratory Tract Drugs: Asthma and COPD - Ch. 79 Flashcards

1
Q

What is bronchial asthma?

A

Recurrent and reversible shortness of breath tyhat occurs when airways narrow

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2
Q

What causes the airways to narrow during bronchial asthma?

A

Bronchospams
Inflammation of the bronchial mucosa
-edema

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3
Q

What is the name for a prolonged asthma attack?

A

Status asthmaticus

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4
Q

What is COPD?

A

Chronic obstructive pulmonary disease
-Chronic bronchitis and emphysema

Obstruction always there but can vary in severity

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5
Q

What occurs during COPD?

A

Continuous inflammation of the bronchi and bronchioles

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6
Q

What are some respiratory tract drugs?

A

Bronchodilators
Anti-inflammatory drugs

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7
Q

What are the kinds of Bronchodilators?

A

Ξ²2-adrenergic agonists
Anticholinergics
Xanthine derivatives

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8
Q

Example of a Ξ²2-adrenergic agonist?

A

Salbutamol (Ventalin or Albuteral)

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9
Q

Example of an Anticholinergic?

A

Ipratropium bromide (Atrovent)

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10
Q

Example of a Xanthine derivative?

A

Theophylline/Aminophylline

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11
Q

What are the kinds of respiratory tract anti-inflammatory drugs?

A

Glucocorticoids
Leukotriene modifiers

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12
Q

Examples of glucocorticoids?

A

Budesonide (Pulmicort)
Fluticasone (Flovent)
combination therapy (Advair diskus)

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13
Q

Example of a Leukotriene modifier?

A

Montelukast (singulair)

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14
Q

What are Ξ²-adrenergic agonist bronchodilators?

A

Sympathomimetic bronchodilators
-Stimulate bronchial smooth muscle Ξ²2-adrenergic receptors

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15
Q

What are the kinds of Ξ²-adrenergic agonist bronchodilators?

A

Short-acting B agonists (SABA)
Long-acting B agonists (LABA)

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16
Q

Selective Ξ²2 drugs do what?

A

Activate airway smooth muscle Ξ²2 adrenergic receptors

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17
Q

Example of a SABA bronchodilator?

A

Salbutamol

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18
Q

Examples of LABA bronchodilator?

A

Salmeterol
Formoterol

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19
Q

Ξ²-agonist bronchodilator mechanism of action?

A

Dilate airways by activating smooth muscle Ξ²2-receptors

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20
Q

What happens when Ξ²-agonists activate smooth muscle Ξ²2-receptors?

A

Smooth muscle relaxes in airways and causes bronchial dilation which increases airflow

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21
Q

What are Ξ²-agonists used for?

A

Relief of bronchospasm related to asthma, COPD, and other pulmonary diseases

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22
Q

Why is Ξ²-agonist treatment used?

A

Acute attacks
-Quickly reduces airway constriction
Prevents attacks -chronic management

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23
Q

What adverse effects are common to all Ξ²-agonists?

A

Cardiac stimulation - tachycardia
Tremors
Restlessness, insomnia (CNS stimulation)

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24
Q

Salbutamol Ξ²-agonists adverse effects?

A

Ξ²2 receptor effects e.g, muscle tremor, CNS (anxiety, nausea)
Decrease receptor selectivity - stimulates Ξ²1-adrenergic receptors in heart
-increased HR, palpitations, chest pains, angina

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25
Q

Salbutamol adverse effects are caused by what?

A

If inhaled form is used too frequently
More likely with oral preparations

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26
Q

What should the nurse encourage when a client is using Ξ²-agonist bronchodilators?

A

Measures that promote good state of health
e.g, Quit smoking, avoid exposure to allergens, stress, pollutants
Adequate fluid intake

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27
Q

What therapeutic effects should the nurse monitor for when Ξ²-agonist bronchodilators are being used?

A

Decreased dyspnea
Decreased wheezing, restlessness and anxiety
Improved respiratory patterns with return to normal rate and quality
Improved activity tolerance

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28
Q

What is the mechanism of action of anticholinergic bronchodilators?

A

Block the action of ACh. Muscle relaxes, airways open

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29
Q

What do anticholergics prevent?

A

Bronchoconstriction if fixed, scheduled use
-Helps with COPD

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30
Q

Anticholinergics are not used alone for what?

A

Acute exacerbations
-Used with SABA

31
Q

Adverse effects associated with anticholiergics?

A

Dry mouth or throat (cough)
Minimal systemic effects

32
Q

What is the oral form of methylxanthines?

A

Theophylline

33
Q

What is the IV form of methylxanthines?

A

Aminophylline
-More water-soluble form of Theophylline

34
Q

What is the mechanism of action of methylxanthines?

A

Cause an intracellular increase in levels of cAMP and bind to adenosine receptors and cause antagonist effects
Have anti-inflammatory properties

35
Q

Methylxanthines provide quick relief for what?

A

Bronchospasm
-Bronchodilation effects, greater airflow

36
Q

What are Methylxanthines (Xanthine derivatives) used for?

A

Mild to moderate cases of acute asthma
ASjunct agent in the management of COPD

37
Q

What adverse effects are associated with Methylxanthines?

A

CNS stimulation (anxiety, insomnia, seizures)
CV stimulation
GI distress (nausea, vomiting)

38
Q

What CV adverse effects are cause by Methylxanthines?

A

Palpitations (increased force of contraction/fast HR)
Sinus tachycardia (Increased HR)
ventricular dysrhythmias
Diureses (increased blood flow to kidneys)

39
Q

What drugs interact with methylxanthine (Theophylline) to increase its effects?

A

Ciprofloxacin (fluoroquinolone antibiotic) -inhibits CYP
Many others

40
Q

Large amounts of what can intensify Methylxanthines’ adverse effects?

A

Caffeine

41
Q

What drugs interact with methylxanthine (Theophylline) to decrease its effects?

A

Liver enzyme inducers e.g, phenytoin, phenobarbital (antiseizure)
-Increases metabolism of theophylline

42
Q

When caring for clients who use Methylxanthines what should be encouraged?

A

Reporting palpiations, nausea, vomiting, weakness, dizziness, chest pain, convulsions

43
Q

Glucocorticoid drugs have similar action to what?

A

Cortisol (adrenal steroid hormone)

44
Q

Glucocorticoid structure is based on what?

A

Cholesterol
-Steroid drug

45
Q

What is the high dosing of glucocorticoids used for?

A

Immunosuppressant effect

46
Q

Inhaled glucocorticoids are used for what?

A

Chronic asthma and COPD

47
Q

Oral/IV Glucocorticoids are used for what?

A

Severe/short-term treatment of asthma/COPD

48
Q

Glucocorticoids do not provide what for asthmatic attacks?

A

Symptomatic relief

49
Q

Inhaled forms of Glucocorticoids reduce what?

A

Systemic effects

50
Q

How long does it take to see the full therapeutic effects of Glucocorticoids?

A

Several weeks

51
Q

What is the mechanism of action of Glucocorticoids?

A

Many mechanisms

reduces inflammatory mediators (PGs, LTs, etc)
decrease the production of cytokines
reduces infiltration and activity of inflammatory cells (e.g. eosinophils, other leukocytes)
reduces edema (capillary permeability)

52
Q

Examples of inhaled Glucocorticoids?

A

Budesonide (Pulmicort)
beclomethasone
mometasone
fluticasone

53
Q

What are Glucocorticoids combined with?

A

LABAs

54
Q

Examples of Glucocorticoids combination preparations?

A

Budesonide + formoterol
Fluticasone + salmeterol
Mometasone + formoterol

55
Q

What is Fluticasone?

A

When used alone called Flovent
When used in combination called Advair diskus (+ salmeterol)

56
Q

Inhaled Glucocorticoids is used in the prophylaxis treatment of what?

A

Asthma
COPD (with LABA)

57
Q

Adverse effects associated with Inhaled Glucocorticoids?

A

Oral fungal infections
Pharyngeal irritation
Coughing
Dry mouth

-Systemic effects are rare bc low doses

58
Q

When should Inhaled Glucocorticoids be avoided?

A

If candida is present in sputum

59
Q

Inhaled Glucocorticoids may slow what in children?

A

Slow growth
-Doesn’t reduce adult height

60
Q

Inhaled Glucocorticoids may cause possible what?

A

Bone loss

61
Q

How should you administer the doses if a beta-agonist bronchodilator and corticosteroid inhaler are both to be used?

A

Bronchodilator used several minutes before glucocorticoid to provide bronchodilator before glucocorticoid

62
Q

What should the nurse teach clients to do to prevent oral fungal infections associated with Inhaled Glucocorticoids?

A

Gargle and rinse the mouth with water afterwards

63
Q

What are Leukotrienes?

A

Released in immune responses from mast cells, eosinophils, in asthma

64
Q

What do leukotrienes cause?

A

Inflammation
Bronchoconstriction
Mucous production
Leucocyte recruitment

65
Q

What asthma symtoms do leukotrienes cause?

A

Coughing, wheezing, shortness of breath

66
Q

What do leukotriene modulators do?

A

Suppress leukotriene effects
-Prevent smooth muscle contraction of bronchiala irways
-Decrease mucous secreteion
-Prevent vascular permeability
-Decrease neutrophil and other leukocyte infiltration to the lungs, preventing inflammation

67
Q

When leukotriene modulators reduce lung inflammation, what happens?

A

Asthma symptoms relieved

68
Q

What are the kinds of leukotriene modulators?

A

Leukotriene receptor antagonists
Leukotriene synthesis inhibitor

69
Q

Examples of Leukotriene receptor antagonists?

A

Montelukast (generally well tolerated)
Zafirlukast (CYP inhibition, liver injury)

70
Q

Example of Leukotriene synthesis inhibitor?

A

Zileuton (CYP inhibition, liver injury)

71
Q

What are Leukotriene modulators used for?

A

Prophylaxis and chronic treatment of asthma in adults and children
-Continuous schedule

72
Q

What age children can use montelukast in Canada?

A

ages 2 and older

73
Q

Leukotriene modulators are not used for what?

A

Acute asthmatic attacks

74
Q

When using Leukotriene modulators, what improvement should be seen within what time period?

A

1 day - 1 week

HLSC 220 Pharmacotherapeutics for Health Professionals πŸ’Š (31 decks)

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