NURS 6015 LATEST QUESTIONS AND ANSWERS.
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Asthma
Chronic inflammatory disease of the airways where allergens bind to IgE antibodies on
mast cells and activate mediators and inflammatory cells
Major effects of asthma on the airways
Bronchoconstriction of airways, chronic inflammation also permanently changes the
airways and increases swelling and mucous
COPD (Chronic Obstructive Pulmonary Disease)
Chronic, progressive, largely irreversible disorder caused by inflammation, airway
obstruction and air trapping
Emphysema
Enlargement of air space within bronchioles and alveoli
Chronic Bronchitis
Hypertrophy of mucus secreting glands that cause cough and excessive sputum,
obstruction of airways
Advantages of inhalation drug therapy
"1) therapeutic effects are enhanced 2) systemic effects are minimized 3) Relief of acute
attacks is rapid"
Spacer
Increases aount of medication that actually gets into the lungs
MDI
Metered-dose inhaler
Inhaled glucocorticoids
"Foundation for asthma and COPD therapy
Action: decreases synthesis and release of inflammatory mediators, decreases
infiltrtation and activity of inflammatory cells, decreases edema of airway mucosa, can
increase number and responsiveness of beta 2 receptors on bronchioles
Adverse effects: inhalers - no serious toxicity, thrush, dysphonia (hoarseness), rare risk
of growth suppression, systemic - infection, hyperglycemia, fluid retention, weight gain,
peptic ulcer, bone loss"
Inhaled cromolyn
"Anti-inflammatory effects - stabilizes mast cells, prevents reliease of mediators
Does not cause bronchodilation
Prevents asthma attacks - no quick relief
No significant adverse effects"
Beta2 Adrenergic Agonists
"Bronchodilator - stimulates Beta2 receptors in lungs
Use: prophylaxis and symptomatic relief of asthma and EIB"
Short-Acting Inhaled Beta 2 Adrenergic Agonist (SABA)
"Usage: Bronchial asthma, reversible bronchospasm, prevent EIB
Take PRN to relieve symptoms and treat acute attacks
Side effects: Tachycardia, angina, tremor, hyperactivity, headache, rhinitis"
, Albuterol
SABA example
Long-Acting inhaled Beta2 Adrenergic agonist (LABA)
"Usage: long-term control of asthma, prevent EIB, prevent bronchospasm in COPD
Side effects: headache, hypersensitivity, throat irritation, myalgia, nausea/vomiting
MUST be combined with a glucocorticoid or could cause deadly asthma attack"
Salmeterol
LABA example
Ipratropium
"Anticholinergic drug
Approved only for COPD
can be combined with a beta 2 agonist
not for acute attacks
Adverse effect: dry mouth, irritation of pharynx, dry respiratory secretions
Encourage extra fluid consumption"
Theophylline
"Methylxanthine
Action: relaxes smooth muscle of bronchioles
Oral agent used for long term asthma control
Narrow therapeutic range
Adverse effects: nausea, vomiting, headache, seizure, tachycardia, dysrhythmias
Tx for toxiccity: stop drug, admit activated charcoal with a cathartic
Cannot use with caffeine because of potentiation"
Aminophylline
Another example of a methylxantine
Action of leukotrienes
Promote smooth muscle constriction, blood vessel permeability, inflammatory
responses
Montelukast
"Leukotriene blocker
Action: decreases bronchoconstriction, decreases inflammatory response
Use: prevent asthma symptoms, prevent exercise-induced bronchospasm, treat allergic
rhinitis, not for acute attack
Adverse effects: neuropsych effects (mood changes, suicidality, hallucinations)"
Signs of poorly controlled asthma
"Symptoms are frequent
Awaken during night-time
Need to use SABA frequently
Unable to tolerate activity
Low lung function test
Urgent care visits"
Allergic rhinitis
inflammation of upper airway, lower airway and eyes, caused by allergic reaction
involving IgE antibodies, mast cells and mediators
Diphenhydramine
Buy Quality Materials!
Asthma
Chronic inflammatory disease of the airways where allergens bind to IgE antibodies on
mast cells and activate mediators and inflammatory cells
Major effects of asthma on the airways
Bronchoconstriction of airways, chronic inflammation also permanently changes the
airways and increases swelling and mucous
COPD (Chronic Obstructive Pulmonary Disease)
Chronic, progressive, largely irreversible disorder caused by inflammation, airway
obstruction and air trapping
Emphysema
Enlargement of air space within bronchioles and alveoli
Chronic Bronchitis
Hypertrophy of mucus secreting glands that cause cough and excessive sputum,
obstruction of airways
Advantages of inhalation drug therapy
"1) therapeutic effects are enhanced 2) systemic effects are minimized 3) Relief of acute
attacks is rapid"
Spacer
Increases aount of medication that actually gets into the lungs
MDI
Metered-dose inhaler
Inhaled glucocorticoids
"Foundation for asthma and COPD therapy
Action: decreases synthesis and release of inflammatory mediators, decreases
infiltrtation and activity of inflammatory cells, decreases edema of airway mucosa, can
increase number and responsiveness of beta 2 receptors on bronchioles
Adverse effects: inhalers - no serious toxicity, thrush, dysphonia (hoarseness), rare risk
of growth suppression, systemic - infection, hyperglycemia, fluid retention, weight gain,
peptic ulcer, bone loss"
Inhaled cromolyn
"Anti-inflammatory effects - stabilizes mast cells, prevents reliease of mediators
Does not cause bronchodilation
Prevents asthma attacks - no quick relief
No significant adverse effects"
Beta2 Adrenergic Agonists
"Bronchodilator - stimulates Beta2 receptors in lungs
Use: prophylaxis and symptomatic relief of asthma and EIB"
Short-Acting Inhaled Beta 2 Adrenergic Agonist (SABA)
"Usage: Bronchial asthma, reversible bronchospasm, prevent EIB
Take PRN to relieve symptoms and treat acute attacks
Side effects: Tachycardia, angina, tremor, hyperactivity, headache, rhinitis"
, Albuterol
SABA example
Long-Acting inhaled Beta2 Adrenergic agonist (LABA)
"Usage: long-term control of asthma, prevent EIB, prevent bronchospasm in COPD
Side effects: headache, hypersensitivity, throat irritation, myalgia, nausea/vomiting
MUST be combined with a glucocorticoid or could cause deadly asthma attack"
Salmeterol
LABA example
Ipratropium
"Anticholinergic drug
Approved only for COPD
can be combined with a beta 2 agonist
not for acute attacks
Adverse effect: dry mouth, irritation of pharynx, dry respiratory secretions
Encourage extra fluid consumption"
Theophylline
"Methylxanthine
Action: relaxes smooth muscle of bronchioles
Oral agent used for long term asthma control
Narrow therapeutic range
Adverse effects: nausea, vomiting, headache, seizure, tachycardia, dysrhythmias
Tx for toxiccity: stop drug, admit activated charcoal with a cathartic
Cannot use with caffeine because of potentiation"
Aminophylline
Another example of a methylxantine
Action of leukotrienes
Promote smooth muscle constriction, blood vessel permeability, inflammatory
responses
Montelukast
"Leukotriene blocker
Action: decreases bronchoconstriction, decreases inflammatory response
Use: prevent asthma symptoms, prevent exercise-induced bronchospasm, treat allergic
rhinitis, not for acute attack
Adverse effects: neuropsych effects (mood changes, suicidality, hallucinations)"
Signs of poorly controlled asthma
"Symptoms are frequent
Awaken during night-time
Need to use SABA frequently
Unable to tolerate activity
Low lung function test
Urgent care visits"
Allergic rhinitis
inflammation of upper airway, lower airway and eyes, caused by allergic reaction
involving IgE antibodies, mast cells and mediators
Diphenhydramine
