Week 4 - Respiratory

Question 1

What are MDIs and how should they be used?

Answer 1

Small, hand-held, pressurized devices. Begin slow inhalation before activation, hold medicine in lungs for 10 seconds, and wait 1 minute between activations.

Question 2

What are two advantages of inhalers using the HFA propellant?

Answer 2

Don’t affect ozone layer; smaller droplets do not require spacer.

Question 3

What is the advantage of DPIs?

Disadvantage? How fast should the patient inhale?

Answer 3

No hand-lung coordination needed, breath-activated. Must have adequate inspiratory flow to inhale powder. Inhale rapidly.

Question 4

What are SVNs and how are they used? What are the advantages?

Answer 4

Small volume nebulizers. Converts a solution into a mist. Does not require timing of dose with inhalation, rapid deep inspiration, or hand strength.

Question 5

List three ways glucocorticoids treat asthma.

Answer 5

Suppress inflammation and bronchial reactivity, decrease mucus production, increase number and responsiveness of beta-adrenergic receptors.

Question 6

What is the first-line treatment for moderate to severe persistent asthma?

Answer 6

Inhaled glucocorticoids

Question 7

Discuss the proper way to administer inhaled glucocorticoids. Why?

Answer 7

Gargle &spit after use. Use the beta-adrenergic inhaler first if one is used. The beta-adrenergic inhaler opens the airways so that the glucocorticoid can penetrate deeper into the lungs. Gargling and spitting decreases the chance of an oropharyngeal infection.

Question 8

Why might oral glucocorticoids be necessary during stress even if asthma symptoms are controlled?

Answer 8

May need to supplement because stressful events require bursts of steroids. The patient may develop adrenal crisis without supplementation.

Question 9

How does montelukast (Singular), a leukotriene modifier, work?

Answer 9

Blocks leukotriene receptors.

Question 10

What are four mechanisms of action for leukotriene modifiers?

Answer 10

Bronchodilation, decreased mucus, decreased edema, and decreased eosinophil infiltration

Question 11

How does Cromolyn, a mast cell stabilizer, work?

Answer 11

Prevents mast cells from lysing and releasing histamine and other mediators.

Question 12

How long must mast cell stabilizers be used to obtain a therapeutic effect?

Answer 12

May take 4 weeks.

Question 13

How does omalizumab (Xolair) work? Why are patients asked to stay in the clinic after injections?

Answer 13

Myoclonal antibody binds free IgE so that it cannot bind to mast cells and cause their lysis. Risk for anaphylaxis.

Question 14

Why are beta2-adrenergic agonists used?

Answer 14

Relieve bronchospasm and prevent exercise-induced bronchospasm.

Question 15

What are the three mechanisms of action for beta2-adrenergic agonists?

Answer 15

Bronchodilation, suppression of histamine release, increased ciliary motility.

Question 16

What is the difference between short-acting and long-acting beta2-adrenergic agonists?

Answer 16

Short-acting: lasts 3-5 hrs, immediate effect, used for relief of bronchospasm and before exercise.
Long-acting: given every 12 hrs, used to prevent bronchospasm.

Question 17

Discuss the adverse effects of beta2-adrenergic agonists.

Answer 17

Tachycardia, angina, tremor, hypokalemia, nervousness, insomnia, paradoxical bronchospasm.

Question 18

Discuss three drug-drug interactions of beta2-adrenergic agonists.

Answer 18

Decreased potassium levels with diuretics, glucocorticoids, and methylxanthines. Beta-blockers block their therapeutic effects. Use of long-acting inhaled glucocorticoids may protect against increase in asthma-related deaths with inhaled long-acting beta2-adrenergic agonists.

Question 19

List 5 actions of methylxanthines.

Answer 19

Bronchodilation, CNS stimulation, cardiac stimulation, vasodilation, diuresis

Question 20

What is the therapeutic blood level for theophylline?

Answer 20

5-15 mcg/mL

Question 21

Discuss the adverse effects of theophylline.

Answer 21

Nausea, vomiting, diarrhea
Insomnia, restlessness, hallucinations, 
     tremors
Tachycardia, palpitations
Dysrhythmias
Seizures
Death
Hypokalemia
Increased blood sugars.

Question 22

Explain how anticholinergic inhalers work. List two anticholinergic inhalers.

Answer 22

Interrupt parasympathetic response causing bronchodilation and decreased mucus.
Atrovent (ipratropium)
Spiriva (tiotropium)

Question 23

What two inhalers should a patient allergic to soy or peanuts avoid?

Answer 23

Atrovent and Combivent

Question 24

How many minutes should elapse between 2 inhalations of a beta-adrenergic agonist? How long should the patient hold his breath? In what order should you have the patient take two inhalations of an inhaled steroid and 2 inhalations of a beta-adrenergic agonist inhaler?

Answer 24

1 minute
Hold breath for 10 seconds
2 inhalations of beta-agonist, then 2 inhalations of inhaled steroid.

Question 25

How many times per week can a patient have symptoms and still be classified as mild intermittent asthma? How many night-time symptoms in a month?

Answer 25

< 2 /week

< 2/month

Question 26

A patient with daily asthma symptoms is classified as having what type of asthma?

Answer 26

Moderate persistent

Question 27

Explain the PEF zone system. If a patient’s personal best is 1000 and the PEF drops to 600, what zone is he in? What drug should he use?

Answer 27

Yellow 50-80%.

Use short-acting beta agonist.

Question 28

In conscious persons with severe asthmas exacerbations, which drugs should be administered first?

Answer 28

Beta-agonist and ipratropium (Atrovent) inhalations