Test Bank for Pharmacology and the
Nursing Process 10th Edition By Linda
Lilley, Shelly Collins, Julie Snyder Chapter
1-58
bronchodilators overview - ansBronchodilators are an important part of the
pharmacotherapy for all respiratory diseases. These drugs relax bronchial smooth
muscle, which causes dilation of the bronchi and bronchioles that are narrowed as a
result of the disease process. There are three classes of such drugs: beta adrenergic
agonists, anticholinergics, and xanthine derivatives.
beta andregenic drug overview - ansThe beta-adrenergic agonists are a group of drugs
that are commonly used during the acute phase of an asthmatic attack to quickly reduce
airway constriction and restore airflow to normal. They are agonists of the adrenergic
receptors in the sympathetic nervous system. The beta and alpha adrenergic receptors
are discussed in Chapters 18 and 19. The beta agonists imitate the effects of
norepinephrine on beta receptors. For this reason, they are also called
sympathomimetic bronchodilators. The beta agonists are categorized by their onset of
action. Short-acting beta agonist (SABA) inhalers include albuterol (Ventolin),
levalbuterol (Xopenex), pirbuterol (Maxair), terbutaline (Brethine), and metaproterenol
(Alupent). Long-acting beta agonist (LABA) inhalers include arformoterol (Brovana),
formoterol (Foradil, Perforomist), and salmeterol (Serevent). The newest long-acting
beta agonists are indacterol (Arcapta Neohaler); vilanterol in conjunction with
fluticasone (Breo Ellipta); and vilanterol in conjunction with the anticholinergic
umeclidinium (Anoro Ellipta). The term Ellipta refers to a new delivery system. Because
the long-acting beta agonists (LABAs) have a longer onset of action, they must never be
used for acute treatment. Patients must be taught to use the short-acting beta agonist
(SABA) as rescue treatment.
short acting beta agonist - ansalbuterol (Ventolin), levalbuterol (Xopenex), pirbuterol
(Maxair), terbutaline (Brethine), and metaproterenol (Alupent).
Albuterol - ansClass : beta 2 agonist (short acting)
,Indications and mechanisms of action: is a short-acting beta2-specific bronchodilating
beta agonist. Other similar drugs include bitolterol (Tornalate), levalbuterol (Xopenex),
pirbuterol (Maxair), and terbutaline (Brethine). Albuterol is the most commonly used
drug in this class. If albuterol is used too frequently, dose-related adverse effects may
be seen, because albuterol loses its beta2-specific actions, especially at larger dosages
Contraindications :. As a consequence, the beta1 receptors are stimulated, which
causes nausea, increased anxiety, palpitations, tremors, and an increased heart rate.
Route: po and inhalation
Other facts: levorotatory isomeric form of albuterol, levalbuterol, is sometimes
prescribed as an albuterol alternative for patients with certain risk factors (e.g.,
tachycardia, including tachycardia associated with albuterol treatment). (Lilley 583)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th
Edition. Mosby, 022016. VitalBook file.
long acting beta agonist - ansarformoterol (Brovana), formoterol (Foradil, Perforomist),
and salmeterol (Serevent). The newest long-acting beta agonists are indacterol
(Arcapta Neohaler); vilanterol in conjunction with fluticasone (Breo Ellipta); and
vilanterol in conjunction with the anticholinergic umeclidinium (Anoro Ellipta)
beta andregenic mechanism of action and drug effect - ansThe beta agonists relax and
dilate airways by stimulating the beta2-adrenergic receptors located throughout the
lungs.
582
There are three subtypes of these drugs, based on their selectivity for beta2 receptors:
1. Nonselective adrenergic drugs, which stimulate the beta, beta1 (cardiac), and beta2
(respiratory) receptors. Example: epinephrine. (NOTE: Epinephrine inhalers were taken
off the market in 2012 because they did not comply with FDA requirements).
Epinephrine is available as a prefilled syringe for self-administration by patients with
severe allergic reactions and is called EpiPen (Figure 37-2).
2. Nonselective beta-adrenergic drugs, which stimulate both beta1 and beta2 receptors.
Example: metaproterenol.
,3. Selective beta2 drugs, which primarily stimulate the beta2 receptors. Example:
albuterol.
These drugs can also be categorized according to their routes of administration as oral,
injectable, or inhaled. The various beta agonist bronchodilators are listed in Table 37-3.
The bronchioles are surrounded by smooth muscle. When the smooth muscle contracts,
the airways are narrowed and the amount of oxygen and carbon dioxide exchanged is
reduced. The action of beta agonist bronchodilators begins at the specific receptor
stimulated and ends with the relaxation and dilation of the airways. However, many
reactions must take place at the cellular level for bronchodilation to occur. When a
beta2-adrenergic receptor is stimulated by a beta agonist, adenylate cyclase is
activated and produces cyclic adenosine monophosphate (cAMP). Adenylate cyclase is
an enzyme needed to make cAMP. The increased levels of cAMP cause bronchial
smooth muscles to relax, which results in bronchial dilation and increased airflow into
and out of the lungs.
Nonselective adrenergic agonist drugs such as epinephrine also stimulate alpha-ad
indications of beta andregenics - ansThe primary therapeutic effect of the beta agonists
is the prevention or relief of bronchospasm related to bronchial asthma, bronchitis, and
other pulmonary diseases. However, they are also used for effects outside the
respiratory system. Because some of these drugs have the ability to stimulate both
beta1- and alpha-adrenergic receptors, they may be used to treat hypotension and
shock (see Chapter 18).
contraindications for beta andregenics - ansdrug allergy, uncontrolled hypertension or
cardiac dysrhythmias, and high risk for stroke (because of the vasoconstrictive drug
action)
adverse effects of beta andregenics - ansMixed alpha/beta agonists produce the most
adverse effects because they are nonselective. These include insomnia, restlessness,
anorexia, cardiac stimulation, hyperglycemia, tremor, and vascular headache. The
adverse effects of the nonselective beta agonists are limited to beta-adrenergic effects,
including cardiac stimulation, tremor, anginal pain, and vascular headache. The beta2
drugs can cause both hypertension and hypotension, vascular headaches, and tremor.
Overdose management may include careful administration of a beta blocker while the
patient is under close observation due to the risk for bronchospasm. Because the
half-life of most adrenergic agonists is relatively short, the patient may just be observed
while the body eliminates the medication.
, interactions with beta andregenics - ansWhen nonselective beta blockers are used with
the beta agonist bronchodilators, the bronchodilation from the beta agonist is
diminished. The use of beta agonists with monoamine oxidase inhibitors and other
sympathomimetics is best avoided because of the enhanced risk for hypertension.
Patients with diabetes may require an adjustment in the dosage of their hypoglycemic
drugs, especially patients receiving epinephrine, because of the increase in blood
glucose levels that can occur.
Salmeterol (Serevent Diskus) (Lilley 583) - ansClass : long acting beta 2 agonist
is a long-acting beta2 agonist bronchodilator. Other long-acting inhalers include
formoterol (Foradil, Perforomist), arformoterol (Brovana), and indacterol (Arcapta
Neohaler). The long-acting inhalers are never to be used for acute treatment.
Salmeterol is used for the maintenance treatment of asthma and COPD and is used in
conjunction with an inhaled corticosteroid. It is given twice daily for maintenance
treatment only. In 2006, a large randomized clinical trial showed that use of salmeterol
was associated with an increase in asthma-related deaths (when added to usual
asthma therapy). The risk appears to be higher in African-American patients. All LABAs
have a black box warning regarding this risk. Adverse effects include immediate
hypersensitivity reactions, headache, hypertension, and neuromuscular and skeletal
pain. Salmeterol should never be given more than twice daily nor should the maximum
daily dose (one puff twice daily) be exceeded. It is available as a powder for inhalation
either alone (Serevent Diskus) or combined with a corticosteroid (Advair). The
long-acting inhalers, including salmeterol, are not to be used alone, but in combination
with other drugs such as the inhaled corticosteroids. Advair (salmeterol and fluticasone)
is a very popular inhaler for COPD. Symbicort, a newer inhaler consisting of the
corticosteroid budesonide and the bronchodilator formoterol, is similar to Advair as is
Dulera, which is a combination of formoterol and mometasone. (Lilley 583)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th
Edition. Mosby, 022016. VitalBook file.
Anti cholinergics mechanism of action and drug affects - ansOn the surface of the
bronchial tree are receptors for acetylcholine (ACh), the neurotransmitter for the
parasympathetic nervous system (PSNS). When the PSNS releases ACh from its nerve
endings, it binds to the ACh receptors on the surface of the bronchial tree, which results
in bronchial constriction and narrowing of the airways. Anticholinergic drugs block these
ACh receptors to prevent bronchoconstriction. This indirectly causes airway relaxation
Nursing Process 10th Edition By Linda
Lilley, Shelly Collins, Julie Snyder Chapter
1-58
bronchodilators overview - ansBronchodilators are an important part of the
pharmacotherapy for all respiratory diseases. These drugs relax bronchial smooth
muscle, which causes dilation of the bronchi and bronchioles that are narrowed as a
result of the disease process. There are three classes of such drugs: beta adrenergic
agonists, anticholinergics, and xanthine derivatives.
beta andregenic drug overview - ansThe beta-adrenergic agonists are a group of drugs
that are commonly used during the acute phase of an asthmatic attack to quickly reduce
airway constriction and restore airflow to normal. They are agonists of the adrenergic
receptors in the sympathetic nervous system. The beta and alpha adrenergic receptors
are discussed in Chapters 18 and 19. The beta agonists imitate the effects of
norepinephrine on beta receptors. For this reason, they are also called
sympathomimetic bronchodilators. The beta agonists are categorized by their onset of
action. Short-acting beta agonist (SABA) inhalers include albuterol (Ventolin),
levalbuterol (Xopenex), pirbuterol (Maxair), terbutaline (Brethine), and metaproterenol
(Alupent). Long-acting beta agonist (LABA) inhalers include arformoterol (Brovana),
formoterol (Foradil, Perforomist), and salmeterol (Serevent). The newest long-acting
beta agonists are indacterol (Arcapta Neohaler); vilanterol in conjunction with
fluticasone (Breo Ellipta); and vilanterol in conjunction with the anticholinergic
umeclidinium (Anoro Ellipta). The term Ellipta refers to a new delivery system. Because
the long-acting beta agonists (LABAs) have a longer onset of action, they must never be
used for acute treatment. Patients must be taught to use the short-acting beta agonist
(SABA) as rescue treatment.
short acting beta agonist - ansalbuterol (Ventolin), levalbuterol (Xopenex), pirbuterol
(Maxair), terbutaline (Brethine), and metaproterenol (Alupent).
Albuterol - ansClass : beta 2 agonist (short acting)
,Indications and mechanisms of action: is a short-acting beta2-specific bronchodilating
beta agonist. Other similar drugs include bitolterol (Tornalate), levalbuterol (Xopenex),
pirbuterol (Maxair), and terbutaline (Brethine). Albuterol is the most commonly used
drug in this class. If albuterol is used too frequently, dose-related adverse effects may
be seen, because albuterol loses its beta2-specific actions, especially at larger dosages
Contraindications :. As a consequence, the beta1 receptors are stimulated, which
causes nausea, increased anxiety, palpitations, tremors, and an increased heart rate.
Route: po and inhalation
Other facts: levorotatory isomeric form of albuterol, levalbuterol, is sometimes
prescribed as an albuterol alternative for patients with certain risk factors (e.g.,
tachycardia, including tachycardia associated with albuterol treatment). (Lilley 583)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th
Edition. Mosby, 022016. VitalBook file.
long acting beta agonist - ansarformoterol (Brovana), formoterol (Foradil, Perforomist),
and salmeterol (Serevent). The newest long-acting beta agonists are indacterol
(Arcapta Neohaler); vilanterol in conjunction with fluticasone (Breo Ellipta); and
vilanterol in conjunction with the anticholinergic umeclidinium (Anoro Ellipta)
beta andregenic mechanism of action and drug effect - ansThe beta agonists relax and
dilate airways by stimulating the beta2-adrenergic receptors located throughout the
lungs.
582
There are three subtypes of these drugs, based on their selectivity for beta2 receptors:
1. Nonselective adrenergic drugs, which stimulate the beta, beta1 (cardiac), and beta2
(respiratory) receptors. Example: epinephrine. (NOTE: Epinephrine inhalers were taken
off the market in 2012 because they did not comply with FDA requirements).
Epinephrine is available as a prefilled syringe for self-administration by patients with
severe allergic reactions and is called EpiPen (Figure 37-2).
2. Nonselective beta-adrenergic drugs, which stimulate both beta1 and beta2 receptors.
Example: metaproterenol.
,3. Selective beta2 drugs, which primarily stimulate the beta2 receptors. Example:
albuterol.
These drugs can also be categorized according to their routes of administration as oral,
injectable, or inhaled. The various beta agonist bronchodilators are listed in Table 37-3.
The bronchioles are surrounded by smooth muscle. When the smooth muscle contracts,
the airways are narrowed and the amount of oxygen and carbon dioxide exchanged is
reduced. The action of beta agonist bronchodilators begins at the specific receptor
stimulated and ends with the relaxation and dilation of the airways. However, many
reactions must take place at the cellular level for bronchodilation to occur. When a
beta2-adrenergic receptor is stimulated by a beta agonist, adenylate cyclase is
activated and produces cyclic adenosine monophosphate (cAMP). Adenylate cyclase is
an enzyme needed to make cAMP. The increased levels of cAMP cause bronchial
smooth muscles to relax, which results in bronchial dilation and increased airflow into
and out of the lungs.
Nonselective adrenergic agonist drugs such as epinephrine also stimulate alpha-ad
indications of beta andregenics - ansThe primary therapeutic effect of the beta agonists
is the prevention or relief of bronchospasm related to bronchial asthma, bronchitis, and
other pulmonary diseases. However, they are also used for effects outside the
respiratory system. Because some of these drugs have the ability to stimulate both
beta1- and alpha-adrenergic receptors, they may be used to treat hypotension and
shock (see Chapter 18).
contraindications for beta andregenics - ansdrug allergy, uncontrolled hypertension or
cardiac dysrhythmias, and high risk for stroke (because of the vasoconstrictive drug
action)
adverse effects of beta andregenics - ansMixed alpha/beta agonists produce the most
adverse effects because they are nonselective. These include insomnia, restlessness,
anorexia, cardiac stimulation, hyperglycemia, tremor, and vascular headache. The
adverse effects of the nonselective beta agonists are limited to beta-adrenergic effects,
including cardiac stimulation, tremor, anginal pain, and vascular headache. The beta2
drugs can cause both hypertension and hypotension, vascular headaches, and tremor.
Overdose management may include careful administration of a beta blocker while the
patient is under close observation due to the risk for bronchospasm. Because the
half-life of most adrenergic agonists is relatively short, the patient may just be observed
while the body eliminates the medication.
, interactions with beta andregenics - ansWhen nonselective beta blockers are used with
the beta agonist bronchodilators, the bronchodilation from the beta agonist is
diminished. The use of beta agonists with monoamine oxidase inhibitors and other
sympathomimetics is best avoided because of the enhanced risk for hypertension.
Patients with diabetes may require an adjustment in the dosage of their hypoglycemic
drugs, especially patients receiving epinephrine, because of the increase in blood
glucose levels that can occur.
Salmeterol (Serevent Diskus) (Lilley 583) - ansClass : long acting beta 2 agonist
is a long-acting beta2 agonist bronchodilator. Other long-acting inhalers include
formoterol (Foradil, Perforomist), arformoterol (Brovana), and indacterol (Arcapta
Neohaler). The long-acting inhalers are never to be used for acute treatment.
Salmeterol is used for the maintenance treatment of asthma and COPD and is used in
conjunction with an inhaled corticosteroid. It is given twice daily for maintenance
treatment only. In 2006, a large randomized clinical trial showed that use of salmeterol
was associated with an increase in asthma-related deaths (when added to usual
asthma therapy). The risk appears to be higher in African-American patients. All LABAs
have a black box warning regarding this risk. Adverse effects include immediate
hypersensitivity reactions, headache, hypertension, and neuromuscular and skeletal
pain. Salmeterol should never be given more than twice daily nor should the maximum
daily dose (one puff twice daily) be exceeded. It is available as a powder for inhalation
either alone (Serevent Diskus) or combined with a corticosteroid (Advair). The
long-acting inhalers, including salmeterol, are not to be used alone, but in combination
with other drugs such as the inhaled corticosteroids. Advair (salmeterol and fluticasone)
is a very popular inhaler for COPD. Symbicort, a newer inhaler consisting of the
corticosteroid budesonide and the bronchodilator formoterol, is similar to Advair as is
Dulera, which is a combination of formoterol and mometasone. (Lilley 583)
Lilley, Linda, Shelly Collins, Julie Snyder. Pharmacology and the Nursing Process, 8th
Edition. Mosby, 022016. VitalBook file.
Anti cholinergics mechanism of action and drug affects - ansOn the surface of the
bronchial tree are receptors for acetylcholine (ACh), the neurotransmitter for the
parasympathetic nervous system (PSNS). When the PSNS releases ACh from its nerve
endings, it binds to the ACh receptors on the surface of the bronchial tree, which results
in bronchial constriction and narrowing of the airways. Anticholinergic drugs block these
ACh receptors to prevent bronchoconstriction. This indirectly causes airway relaxation
