Week 4 - Respiratory Flashcards
What are MDIs and how should they be used?
Small, hand-held, pressurized devices. Begin slow inhalation before activation, hold medicine in lungs for 10 seconds, and wait 1 minute between activations.
What are two advantages of inhalers using the HFA propellant?
Don’t affect ozone layer; smaller droplets do not require spacer.
What is the advantage of DPIs?
Disadvantage? How fast should the patient inhale?
No hand-lung coordination needed, breath-activated. Must have adequate inspiratory flow to inhale powder. Inhale rapidly.
What are SVNs and how are they used? What are the advantages?
Small volume nebulizers. Converts a solution into a mist. Does not require timing of dose with inhalation, rapid deep inspiration, or hand strength.
List three ways glucocorticoids treat asthma.
Suppress inflammation and bronchial reactivity, decrease mucus production, increase number and responsiveness of beta-adrenergic receptors.
What is the first-line treatment for moderate to severe persistent asthma?
Inhaled glucocorticoids
Discuss the proper way to administer inhaled glucocorticoids. Why?
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.
Why might oral glucocorticoids be necessary during stress even if asthma symptoms are controlled?
May need to supplement because stressful events require bursts of steroids. The patient may develop adrenal crisis without supplementation.
How does montelukast (Singular), a leukotriene modifier, work?
Blocks leukotriene receptors.
What are four mechanisms of action for leukotriene modifiers?
Bronchodilation, decreased mucus, decreased edema, and decreased eosinophil infiltration
How does Cromolyn, a mast cell stabilizer, work?
Prevents mast cells from lysing and releasing histamine and other mediators.
How long must mast cell stabilizers be used to obtain a therapeutic effect?
May take 4 weeks.
How does omalizumab (Xolair) work? Why are patients asked to stay in the clinic after injections?
Myoclonal antibody binds free IgE so that it cannot bind to mast cells and cause their lysis. Risk for anaphylaxis.
Why are beta2-adrenergic agonists used?
Relieve bronchospasm and prevent exercise-induced bronchospasm.
What are the three mechanisms of action for beta2-adrenergic agonists?
Bronchodilation, suppression of histamine release, increased ciliary motility.
What is the difference between short-acting and long-acting beta2-adrenergic agonists?
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.
Discuss the adverse effects of beta2-adrenergic agonists.
Tachycardia, angina, tremor, hypokalemia, nervousness, insomnia, paradoxical bronchospasm.
Discuss three drug-drug interactions of beta2-adrenergic agonists.
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.
List 5 actions of methylxanthines.
Bronchodilation, CNS stimulation, cardiac stimulation, vasodilation, diuresis
What is the therapeutic blood level for theophylline?
5-15 mcg/mL
Discuss the adverse effects of theophylline.
Nausea, vomiting, diarrhea
Insomnia, restlessness, hallucinations,
tremors
Tachycardia, palpitations
Dysrhythmias
Seizures
Death
Hypokalemia
Increased blood sugars.Explain how anticholinergic inhalers work. List two anticholinergic inhalers.
Interrupt parasympathetic response causing bronchodilation and decreased mucus.
Atrovent (ipratropium)
Spiriva (tiotropium)
What two inhalers should a patient allergic to soy or peanuts avoid?
Atrovent and Combivent
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?
1 minute
Hold breath for 10 seconds
2 inhalations of beta-agonist, then 2 inhalations of inhaled steroid.
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?
< 2 /week
< 2/month
A patient with daily asthma symptoms is classified as having what type of asthma?
Moderate persistent
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?
Yellow 50-80%.
Use short-acting beta agonist.
In conscious persons with severe asthmas exacerbations, which drugs should be administered first?
Beta-agonist and ipratropium (Atrovent) inhalations
