PHARM: Chapter 37 Respiratory Medications

When teaching a patient who will be receiving antihistamines, the nurse will include which instructions? (SELECT ALL THAT APPLY.) A. "Drink extra fluids if possible." B. "Take the medication on an empty stomach to maximize absorption of the drug." C. "Avoid activities that require alertness until you know how adverse effects are tolerated." D. "Antihistamines may cause restlessness and disturbed sleep." E. "Take the medication with food to minimize gastrointestinal distress." F. "Antihistamines are generally safe to take with over-the-counter medications."

A. "Drink extra fluids if possible." C. "Avoid activities that require alertness until you know how adverse effects are tolerated." E. "Take the medication with food to minimize gastrointestinal distress."

A patient asks the nurse about the uses of echinacea. Which use will the nurse include in the response? A. Boosting the immune system B. Promoting relaxation C. Memory enhancement D. Improving mood

A. Boosting the immune system

What system assessment will the nurse monitor in a patient due to a known common side effect of traditional antihistamines? A. Neurologic status B. Cardiac status C. Gastrointestinal status D. Respiratory status

A. Neurologic status

When evaluating a patient's use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the activation of the inhaler with her breathing. What intervention is most appropriate at this time? A. Obtain an order for a spacer device. B. Notify the doctor that the patient is unable to use the MDI. C. Obtain an order for a peak flow meter. D. Ask the prescriber if the medication can be given orally.

A. Obtain an order for a spacer device.

A patient has a new order for an ipratropium (Atrovent) inhaler, an anticholinergic drug. The nurse knows to assess for an allergy to which food before giving this drug? A. Peanuts B. Shellfish C. Eggs D. Soy products

A. Peanuts

A patient tells the nurse that she wants to start taking the herbal product goldenseal to improve her health. The nurse will assess for which potential cautions or contraindications to goldenseal? (SELECT ALL THAT APPLY.) A. Pregnancy B. Taking a proton-pump inhibitor C. Hypothyroidism D. Hypertension E. Nasal congestion F. Sinus infections

A. Pregnancy B. Taking a proton-pump inhibitor D. Hypertension

The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? (SELECT ALL THAT APPLY.) A. epinephrine B. fluticasone (Flovent) Rotadisk inhaler C. salmeterol (Serevent) inhaler D. montelukast (Singulair) E. aminophylline IV infusion F. albuterol (Proventil) nebulizer solution

A. epinephrine E. aminophylline IV infusion F. albuterol (Proventil) nebulizer solution

A patient has a metered-dose inhaler that contains 200 actuations ('puffs'), and it does not have a dose counter. He is to take two puffs two times a day. If he does not take any extra doses, identify how many days will this inhaler last at the prescribed dose. _______

ANS: 50 days Note the number of doses in the canister, and then calculate the number of days that the canister will last. For this question, assuming that two puffs are taken two times a day, and the inhaler has a capacity of 200 inhalations. Two puffs two times a day equal four inhalations per day. Four divided into 200 yields 50; that is, the inhaler will last approximately 50 days.

A patient will be receiving oral theophylline (Theo-Dur), 600 mg/day, in three divided doses. Identify how many milligrams will the patient receive per dose. _______

ANS: 200 mg

After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response? a. "This is an expected adverse effect. Let me take your pulse." b. "The next scheduled nebulizer treatment will be skipped." c. "I will notify the physician about this adverse effect." d. "We will hold the treatment for 24 hours."

ANS: A Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta agonists. The other options are incorrect responses.

A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient? a. "Take the corticosteroid inhaler first." b. "Take the bronchodilator inhaler first." c. "Take these two drugs at least 2 hours apart." d. "It does not matter which inhaler you use first."

ANS: B An inhaled bronchodilator is used before the inhaled corticosteroid to provide bronchodilation before administration of the anti-inflammatory drug.

A patient is taking a xanthine derivative as part of treatment for chronic obstructive pulmonary disease. The nurse will monitor for which adverse effects associated with the use of xanthine derivatives? a. Diarrhea b. Palpitations c. Bradycardia d. Drowsiness

ANS: B The common adverse effects of the xanthine derivatives include nausea, vomiting, and anorexia. In addition, gastroesophageal reflux has been observed to occur during sleep in patients taking these drugs. Cardiac adverse effects include sinus tachycardia, extrasystole, palpitations, and ventricular dysrhythmias. Transient increased urination and hyperglycemia are other possible adverse effects.

A patient is in an urgent care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment? a. An anticholinergic such as ipratropium (Atrovent) b. A short-acting beta2 agonist such as albuterol (Proventil) c. A long-acting beta2 agonist such as salmeterol (Serevent) d. A corticosteroid such as fluticasone (Flovent)

ANS: B The short-acting beta2 agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta2 agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation.

The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? (Select all that apply.) a. Salmeterol (Serevent) inhaler b. Albuterol (Proventil) nebulizer solution c. Epinephrine d. Montelukast (Singulair) e. Fluticasone (Flovent) Rotadisk inhaler

ANS: B, C Albuterol (a short-acting beta2 agonist) and epinephrine (a beta1 and beta2 agonist) are used for acute bronchospasms. Salmeterol is a long-acting beta2 agonist that is indicated for maintenance treatment, not acute episodes. Fluticasone is an inhaled corticosteroid; montelukast is a leukotriene receptor antagonist (LTRA). These types of medications are used for asthma prophylaxis.

The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed? (Select all that apply.) a. "I will rinse my mouth with water after using the inhaler and then spit out the water." b. "I will gargle after using the inhaler and then swallow." c. "I will clean the plastic inhaler casing weekly by removing the canister and then washing the casing in warm soapy water. I will then let it dry before reassembling." d. "I will use this inhaler for asthma attacks." e. "I will continue to use this inhaler, even if I am feeling better." f. "I will use a peak flow meter to measure my response to therapy."

ANS: B, D The inhaled corticosteroid is a maintenance drug used to prevent asthma attacks; it is not indicated for acute asthma attacks. Rinsing the mouth with water is appropriate and necessary to prevent oral fungal infections; the water is not to be swallowed after rinsing. The patient needs to be given instructions about keeping the inhaler clean, including removing the canister from the plastic casing weekly and washing the casing in warm soapy water. Once the casing is dry, the canister and mouthpiece may be put back together and the cap applied. The glucocorticoid may predispose the patient to oral fungal overgrowth, thus the need for implicit instructions about cleaning inhaling devices. Use of a peak flow meter assists in monitoring the patient's response to therapy. The medication needs to be taken as ordered every day, regardless of whether the patient is feeling better.

The nurse is monitoring drug levels for a patient who is receiving theophylline. The most recent theophylline level was 22 mcg/mL, and the nurse evaluates this level to be: a. below the therapeutic level. b. at a therapeutic level. c. above the therapeutic level. d. at a toxic level.

ANS: C Although the optimal level may vary from patient to patient, most standard references have suggested that the therapeutic range for theophylline blood level is 10 to 20 mcg/mL. However, most clinicians now advise levels between 5 and 15 mcg/mL.

When evaluating a patient's use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the activation of the inhaler with her breathing. What intervention is most appropriate at this time? a. Notify the doctor that the patient is unable to use the MDI. b. Obtain an order for a peak flow meter. c. Obtain an order for a spacer device. d. Ask the prescriber if the medication can be given orally.

ANS: C The use of a spacer may be indicated with metered-dose inhalers, especially if success with inhalation is limited. The other options are not appropriate interventions.

The prescriber has changed the patient's medication regimen to include the leukotriene receptor antagonist (LTRA) montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication? a. The proper technique for inhalation must be followed. b. The patient needs to keep it close by at all times to treat acute asthma attacks. c. It needs to be taken every day on a continuous schedule, even if symptoms improve. d. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued.

ANS: C These drugs are indicated for chronic, not acute, asthma and are to be taken every day on a continuous schedule, even if symptoms improve. These drugs are taken orally.

When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects? a. Fatigue and depression b. Anxiety and palpitations c. Headache and rapid heart rate d. Oral candidiasis and dry mouth

ANS: D Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The other responses are incorrect.

The nurse is providing instructions about the Advair inhaler (fluticasone propionate and salmeterol). Which statement about this inhaler is accurate? a. It is indicated for the treatment of acute bronchospasms. b. It needs to be used with a spacer for best results. c. Patients need to avoid drinking water for 1 hour after taking this drug. d. It is used for the prevention of bronchospasms.

ANS: D Salmeterol is a long-acting beta2 agonist bronchodilator, while fluticasone is a corticosteroid. In combination, they are used for the maintenance treatment of asthma and COPD. As a long-acting inhaler, Advair is not appropriate for treatment of acute bronchospasms. The other statements are incorrect.

A patient is taking intravenous aminophylline for a severe exacerbation of chronic obstructive pulmonary disease. The nurse will assess for which therapeutic response? a. Increased sputum production b. Increased heart rate c. Increased respiratory rate d. Increased ease of breathing

ANS: D The therapeutic effects of bronchodilating drugs such as xanthine derivatives include increased ease of breathing. The other responses are incorrect.

The nurse is discussing management of symptoms of an upper respiratory tract infection. Which classes of medications are often used in treating the symptoms of upper respiratory tract infections? (SELECT ALL THAT APPLY.) A. Antibiotics B. Antitussives C. Nasal decongestants D. Antihistamines E. Expectorants

B. Antitussives C. Nasal decongestants D. Antihistamines E. Expectorants

A patient is taking intravenous aminophylline for a severe exacerbation of chronic obstructive pulmonary disease. The nurse will assess for which therapeutic response? A. Increased respiratory rate B. Increased ease of breathing C. Increased sputum production D. Increased heart rate

B. Increased ease of breathing

The nurse will instruct patients about a possible systemic effect that may occur if excessive amounts of topically applied adrenergic nasal decongestants are used. Which systemic effect may occur? A. Heartburn B. Palpitations C. Drowsiness D. Bradycardia

B. Palpitations

A patient is taking a xanthine derivative as part of treatment for chronic obstructive pulmonary disease. The nurse will monitor for adverse effects associated with the use of xanthine derivatives, such as A. diarrhea. B. palpitations. C. bradycardia. D. drowsiness.

B. palpitations.

Antiasthmatics MOA: Anticholinergics

Block cholinergic (ACh) receptors on bronchial tree, preventing binding of cholinergic substances that cause bronchoconstriction and increased secretions; cause airway dilation and decreased secretions

Anticholinergics used for COPD treatment

Bronchodilators ipratropium (Atrovent) and titropium (Spiriva) NOT indicated for acute treatment as actions are slow/prolonged

A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. The nurse will include which instruction? A. "You won't see effects for at least 1 week." B. "Avoid use of this spray if a fever develops." C. "Limit use of this spray to 3 to 5 days." D. "Continue the spray until nasal stuffiness has resolved."

C. "Limit use of this spray to 3 to 5 days."

What statement by the patient, who is using the anticholinergic inhaler ipratropium bromide (Atrovent), indicates to the nurse that teaching has been successful? A. "I may gain weight as a result of taking this medication." B. "I will increase my intake of caffeine." C. "This inhaler is not to be used alone to treat an acute asthma attack." D. "Nausea and vomiting are common adverse effects of this medication, so I will always take it with meals."

C. "This inhaler is not to be used alone to treat an acute asthma attack."

The nurse is reviewing the use of antitussive durgs. Antitussive drugs would be most appropriate for which patient? A. A patient who has had a productive cough for 2 weeks B. A patient who has a tracheostomy and thick mucus secretions C. A patient who has developed bronchitis 2 days after abdominal surgery D. A patient who has pneumonia with a productive cough

C. A patient who has developed bronchitis 2 days after abdominal surgery

A patient is in an urgent-care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatement? A. An anticholinergic such as ipratropium (Atrovent) B. A long-acting beta2 agonist such as salmeterol (Serevent) C. A short-acting beta2 agonist such as albuterol (Proventil) D. A corticosteroid such as fluticasone (Flovent)

C. A short-acting beta2 agonist such as albuterol (Proventil)

When giving dextromethorphan, the nurse understands that this drug suppresses the cough reflex by which mechanism of action? A. Anesthetizing the stretch receptors B. Decreasing the viscosity of the bronchial secretions C. Having direct action on the cough center D. Causing depression of the central nervous system

C. Having direct action on the cough center

The prescriber has changed the patient's medication regimen to include the leukotriene receptor antagonist montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication? A. The patient needs to keep it close by at all times to treat acute asthma attacks. B. The proper technique for inhalation must be followed. C. It needs to be taken every day on a continuous schedule, even if symptoms improve. D. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued.

C. It needs to be taken every day on a continuous schedule, even if symptoms improve.

When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects? A. Anxiety and palpitations B. Fatigue and depression C. Oral candidiasis and dry mouth D. Headache and rapid heart rate

C. Oral candidiasis and dry mouth

Discharge teaching to a patient receiving a beta-agonist bronchodilator should emphasize reporting which side effect? A. Nonproductive cough B. Hypoglycemia C. Tachycardia D. Sedation

C. Tachycardia

The nurse is monitoring drug levels for a patient who is receiving theophylline. The most recent theophylline level was 13 mcg/mL, and the nurse evaluates this level to be A. at a toxic level. B. above the therapeutic level. C. at a therapeutic level. D. below the therapeutic level.

C. at a therapeutic level.

Loratadine (Claritin) has an advantage over traditional antihistamines such diphenhydramine (Benadryle) in that loratadine has A. less gastrointestinal upset. B. less risk of cardiac arrhythmias. C. less sedative effect. D. increased bronchodilating effects.

C. less sedative effect.

Xanthine Derivatives: MOA, drug effects

Cause bronchodilation by increasing the levels of energy-producing substance cAMP (by inhibiting enzyme phosphodiesterase which breaks down cAMP). cAMP plays a large role in maintenance of opening the airways for pts with COPD. Rationale: Higher intracellular levels of cAMP are correlated with smooth bronchial muscle relaxation and inhibit IgE-induced release of inflammatory chemicals histamine, SRS-A, and leukotrienes. Examples; theophylline, aminophylline

Emphysema definition

Condition in which there is a loss of lung elasticity and hyperinflation of alveoli. Inhaled pollutants break down elastin, which causes alveoli to lose their elasticity and recoil. This results in CO2 retention and persistent respiratory acidosis. May also be caused by aplha-1-antitrypsin enzyme.

Chronic Bronchitis definition

Continuous inflammation and low-grade infection of the bronchi/bronchioles; causing airflow obstruction. Excessive mucous secretion, usually precipitated by prolonged exposure to irritants (smoking).

A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient A. "Take these two drugs at least 2 hours apart." B. "Take the corticosteroid inhaler first." C. "It does not matter which inhaler you use first." D. "Take the bronchodilator inhaler first."

D. "Take the bronchodilator inhaler first."

After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response? A. "We will hold the treatment for 24 hours." B. "The next scheduled nebulizer treatment will be skipped." C. "I will notify the physician about this adverse effect." D. "This is an expected adverse effect. Let me take your pulse."

D. "This is an expected adverse effect. Let me take your pulse."

During a routine checkup, a patient states that she is unable to take the prescribed antihistamine because of one of its most common adverse effects. The nurse suspects that which adverse effect has been bothering this patient? A. Constipation B. Decreased libido C. Abdominal cramps D. Drowsiness

D. Drowsiness

A patient is taking guaifenesin (Humibid) as part of treatment for a sinus infection. Which instruction will the nurse include during patient teaching? A. Avoid driving a car or operating heavy machinery because of the sedating effects. B. Report symptoms that last longer then 2 days. C. Report clear-colored sputum to the prescriber. D. Force fluids to help loosen and liquify secretions.

D. Force fluids to help loosen and liquify secretions

The nurse is providing education to a patient with a history of chronic nasal congestion secondary to allergic rhinitis. Which class of medications would the nurse anticipate the provider would recommend for the patient to use on a long-term basis? A. Antitussives B. Expectorants C. Antihistamines D. Intranasal steroids

D. Intranasal steroids

The nurse is providing instructions about the Advair inhaler (fluticasone propionate and salmeterol). Which statement about this inhaler is accurate? A. It is indicated for the treatment of acute bronchospasms. B. Patients need to avoid drinking water for 1 hour after taking this drug. C. It needs to be used with a spacer for best results. D. It is used for prevention of bronchospasms.

D. It is used for prevention of bronchospasms.

Which laboratory value would the nurse assess before administering zafirlukast (Accolate) to a patient? A. Complete blood count B. Cardiac enzymes C. Renal function tests D. Liver enzymes

D. Liver enzymes

The nurse receives lab values for a patient with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level? A. Subtherapeutic B. Toxic C. Life-threatening D. Therapeutic

D. Therapeutic

A patient with a tracheostomy has difficulty removing excessive, thick mucus from the respiratory tract. The nurse expects that which drug will be ordered to aid in the removal of mucus? A. benzonatate (Tessalon Perles) B. dextromethorphan (Robitussin DM) C. diphenhydramine (Benadryl) D. guaifenesin (Humibid)

D. guaifenesin (Humibid)

A gradener needs a decongestant because of seasonal allergy problems and asks the nurse whether he should take an oral form or a nasal spray. The nurse's answer considers that one benefit of orally administered decongestants is A. shorter duration. B. a more potent effect. C. immediate onset. D. lack of rebound congestion.

D. lack of rebound congestion.

Xanthine derivatives: Indications

Dilate airways in pts with asthma, chronic bronchitis, and emphysema. Used in mild-moderate cases of acute asthma and an adjunct med for COPD pts. Deemphasized in Rx for mild asthma due to potential for drug interactions and greater variability for therapeutic drug levels. Slow onset; used for prevention rather than relief.

Leukotriene Receptor Anatagonists (LTRAs): MOA

Drug effects limited to lungs (inhibit enzymes necessary for leukotriene synthesis or bind to leukotriene receptors), alleviating asthma symptoms by reducing inflammation. Prevent smooth muscle contraction, decrease mucous secretion, reduce vascular permeability (reducing edema) Examples: zileutron (Zyflo), montelukast (Singulair), zafirlukast (Accolate).

Anticholinergics: Adverse Effects

Dry mouth (xerostomia), nasal congestion, heart palpitations, GI distress, urinary retention, h/a, coughing, anxiety, increased intraocular pressure ***Ipratropium classified as Pregnancy category B; tiotropium Pregnancy category C.

The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed? (SELECT ALL THAT APPLY.) A. "I will continue to use this inhaler, even if I am feeling better." B. "I will use a peak flow meter to measure my response to therapy." C."I will clean the plastic inhaler casing weekly by removing the canister and then washing the casing in warm soapy water. I will then let it dry before reassembling." D. "I will rinse my mouth with water after using the inhaler and then spit out the water." E. "I will gargle after using the inhaler and then swallow." F. "I will use this inhaler for asthma attacks."

E. "I will gargle after using the inhaler and then swallow." F. "I will use this inhaler for asthma attacks."

Selective Beta-2 Adrenergic drugs: Adverse Effects

Either hypo/hypertension, vascular h/e, tremor. OD management w/ beta blockers.

Corticosteroids (glucocorticoids) MOA

Exact MOA undetermined, reduce inflammtory effects and have synergistic effects with beta agonists. Prevent vascular permeability (which causes edema) and reduce systemic inflammation.

Beta Adrenergic Agonists (sympathomimetic drugs): Nonselective adrenergic drug effects

Example: epinephrine, stimulate Alpha-adrenergic receptors as well as Beta-1 (cardiac) and Beta-2 (respiratory) receptors, causing bronchodilation, vasoconstriction, secretion reduction, reduced swelling/edema of mucous membranes, increase HR, BP, cardiac contraction, and CNS effects (tremor, nervousness). Used for anaphylactic emergencies

LTRAs: Indications

For prophylaxis/long-term treatment and prevention of asthma. Not indicated for management of acute asthma attacks. ***Contraindications: lactose, povidone, titanium dioxide, or cellulos derivatives are main ingredients; allergies to these must be noted.

Asthma: Pathophysiology (Extrinsic/Allergic asthma)

IgE antibodies (Specialized immune system proteins, aka immunoglobulins) respond to allergens/irritants (smoke, dust, dander, pollen) and stimulate immune response. IgE antibodies bind to mast cell receptors causing degranulation and release of inflammatory mediators such a histamine and leukotrienes (these cause vasodilation, edema, bronchoconstriction

Nonselective Beta Adrenergic Agonist drugs: Adverse Effects

Increase HR, BP, cardiac stimulation, tremor, vascular h/e, anginal pain.

Classifications of Drugs to Treat Asthma: Long-Term control

Leukotriene receptors antagonists, Mast cell stablizers, inhaled corticosteroids, Anticholinergic agents, Long-acting Beta2 Receptor Agonists (salmeterol, formoterol, arformoterol), theophylline, LABA w/ ICS

Corticosteroids: Adverse Effects

Main undesirable local effects of ICS: pharyngel irritation, coughing, dry mouth, oral fungal infections. Systemic effects of CS (higher doses) can affect any organ; adrenocortical insufficiency, F&E disturbances, endocrine effects (hyperglycemia), CNS effects (insomnia, nervousness, seizures), dermatologic/connective tissue effects (brittle skin, bone loss, osteoporosis, Cushing's syndrome). Adrenal gland failure Addisonian crisis may occur if corticosteroids are not slowly tapered; adrenal suppression.

Corticosteroids: Interactions

May increase serum glucose levels, which may indicate adjustment dosages of antidiabetic drugs. Phenytoin, phenobarbital, and rifampin may reduce clearance of steroids. Greater risk of hypokalemia when taken with K-depleting diuretics such as hydrochlorothiazide and furosemide.

Status asthmaticus

Medical emergency; a prolonged asthma attack episode that does not respond to typical drug therapy.

Antiasthmatics MOA: Leaukotriene Receptor Antagonists (LTRA)

Modify or inhibit activity of leukotrienes, which decreases arachidonic acid-induced inflammation and allergen-induced bronchoconstriction

Corticosteroids: MOA

Prevent inflammation commonly provoked by the substances released by mast cells.

Beta-Agonists & Xanthine derivitives MOA

Raise intracellular levels of cyclic adenosine monophosphate, which in turn produces smooth muscle relaxation and dilates the constricted airways.

Asthma

Recurrent and reversible shortness of breath that occurs when the airways become narrow as a result of bronchospasm, inflammation and edema of bronchial mucosa, and formation of thick/sticky mucous (due to inflammatory mechanisms).

Adrenergic drugs: Indications

Rx for bronchoconstriction, relief of bronchospasm r/t asthma/bronchitis. Drugs that stimulate both alpha-1/beta-1 receptors may be used to treat hypotension and shock.

Classifications of Drugs to Treat Asthma: Rescue drugs

Short-Acting Beta2 Receptor Agonists (SABA): Albuterol, metaproterenol, levalbuterol, IV Systemic corticosteroids

Mast cell stablizers: MOA

Stabilize cell membranes of mast cells in which antigen-antibody reactions take place, thereby preventing release of inflammatory chemicals (histamine, leukotrienes) that cause bronchial constriction.

Stepwise Therapy for Asthma Management

Step 1: SABA inhln prn Step 2: low-dose inhln ICS (intranasal corticosteroid); alternative: leukotriene receptor antagonist (LTRA) or xanthine derivitive (theophylline) Step 3: Low-dose ICS and LABA; or medium dose ICS; alternative: Low-dose ICS and either LTRA, theophylline, or zileuton Step 4: Medium dose ICS and LABA; Alternative: Medium-dose ICS and LRTA/theophylline/zileuton Step 5: High-dose ICS and LABA; consider omalizumab for pts w/ allergies Step 6: High-dose ICS and LABA & oral corticosteroid, consider omalizumab for pts w/ allergies

Nonselective beta-adrenergic drug effects

Stimulate both B1 & B2 adrenergic receptors, meaning they will have both cardiac and respiratory effects. Increased HR, BP, contraction force, bronchodilation. Example: metaproterenol

Selective beta-adrenergic drug effects

Stimulate only B2 receptors in lungs, causing local effects of bronchodilation Example: albuterol

Cyclic adenosine monophosphate (cAMP)

Substance (made by enzyme Adenylate cyclase) that helps cause bronchial smooth muscles to relax, increasing airflow in/out of lungs.

Adrenergic drugs: Contraindications

Uncontrolled htn, dysrhythmias, known drug allergy, high risk of stroke (due to vasoconstrictive effects)

Nonselective Aplha/Beta Adrenergic drugs: Adverse Effects

insomnia, restlessness, hyperglycemia, vascular headache, anorexia, cardiac stimulation.

Acetylcholine (ACh)

neurotransmitter for the parasympathetic nervous system (PSNS); receptors located on surfaces of bronchial tree. When PSNS releases ACh, it binds with these receptors and results in bronchoconstriction/narrowing of airways.

Common symptoms of asthma

shortness of breath, wheezing, inability to speak full sentences, coughing Asthma attack: an abrupt/sudden onset