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189 Cards in this Set

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Two main categories of lower respiratory tract diseases?
COPD and restrictive pulmonary disease
The cause of COPD
airway obstruction w/ increased airway resistance of airflow to lung tissues
Four disorders that can cause COPD
chronic bronchitis
bronchiectasis
emphysema
asthma
Are chronic bronchitis, brochiectasis, and emphysema are irreversible or reversible lung damage
irreversible
Is the lung tissue damage from acute asthmatic attack reversible or irreversible
reversible but may be irreversible
The lung test in COPD
decreased force expiratory volume 1 second
What is restrictive lung disease?
cant get air out due to fluid accumulation or loss of elascity
What causes restrictive lung disease? (6)
pulmonary edema
pulmonary fibrosis
pneumonitis
lung tumors
scoliosis
disorders of thoracic wall
What is asthma
inflammatory disorders that involve hyperresponsiveness of the airways with varying obstruction
Wheezing related to chronic bronchitis, emphysema, and bronchiectasis
there is no wheezing
Chronic bronchitis is caused by:
smoking or chronic lung infections
S/S of chronic bronchitis: (2)
bronchial inflammation
excessive mucous secretion in airways
Auscultation of chronic bronchitis:
Can hear inspiratory and expiratory rhonchi
What leads to respiratory acidosis?
hypercapnia and hypoxemia
What is bronchiectasis?
abnormal dialation of the bronchi and bronchioles
mucus becomes stuck and obstructs
What patients are commonly seen with tissue fibrosis?
HIV pts
What is paroxysmal?
whooping cough
What is emphysema?
progressive lung disease caused by cigarettes, atmosphere, or alpha1-antitrypsin deficiency
What is alpha1-antitrypsin?
inhibit proteolytic enzymes that destroy alveoli
With emphysema what happens to the proteolytic enzymes?
They are released in the lung by bacteria or phagocytic cells
With emphysema what happens to the bronchioles?
become plugged with mucus, causing loss in the fiber & elastin network in the alveoli (enlarge and destroyed)
With emphysema what happens to the air?
air becomes trapped in the overexpanded alveoli, leading to inadequate gas exchange
Is there a cure for COPD
no, but it is preventable
How to bronchodilators help COPD
assist in opening airways
How do glucocortocoids help COPD
decrease inflammation
How do Leukotriene help COPD
reduce inflammation in the lung tissue
How do cromolyn and nedocromil help with COPD
antiinflammatory
How do expectorants help with COPD
assist in loosening the mucous
How do antibiotics help with COPD
prevent serious complications from bacterial infections
Characteristics of bronchial asthma
periods of bronchospasm resulting in wheezing and difficulty in breathing
Bronchospasm or bronchoconstriction result from:
lung tissue exposed to extrinsic & intrinsic factors that stimulate a bronchoconstrictive response
What drugs can trigger asthma? (3)
aspirin
indomethacin (arthritis)
ibuprofen
How are mast cells related to asthma attacks
They are found in CT bc allergens attatch themselves to mast cells resulting in an antigen antibody response in the lungs
Mast cells stimulate the release of?
chemical mediators
Eosinophil are elevated when?
During an allergic rx, and indicate an inflammatory process
What do chemical mediators stimulate (3)
bronchial constrictions
mucous secretions/congestions
inflammation
What are histamine and ECF-A?
strong bronchoconstrictors
What is cyclic adenosine monophosphate
cylic amp or cAMP
cellular signaling molecule
maintains bronchodilation
What increase the amount of cAMP
sympathomimetic (adrenergic) bronchodilators and methylxanthines
During an asthma attack what is the first line of defense?
short acting sympathomimetics (beta2-adrenergic agonists)
How do the short-acting sympathomimetics help defend an asthma attack?
promote cAMP production and enhance bronchodilation
What are long-acting sympathomimetics used for?
maintenance
Why is epinephrine (adrenalin) administered during an emergency? (2)
restore circulation
increase airway patency
High dose or overuse of beta2-adrenergic agents may cause?
beta1 responses such as nervousness, tremor, and increased pulse rate
What does the ideal beta2 agonist do? (3)
rapid onset
longer duration
few SE
Drug class for abuterol?
beta2 adrenergic agonist
Pregnancy category for abulterol
C
Contraindications for abuterol? (4)
severe cardiac disease
hyperthyroidism
diabetes mellitus
pregnancy
What drugs increase the effect of albuterol (3)
sympathomimetics
MAO inhibitors
tricyclic antidepressants
Lab effects because of albuterol?
increase glucose
decrease serum potassium
Where is albuterol absorbed
GI tract
Albuterol is used for: (4)
bronchospasm
asthma
bronchitis
COPD
Mode of action for albuterol:
stimulates beta2-adrenergic receptors in the lungs, which relaxes the SM
SE of albuterol: (4)
tremor
dizziness
nervousness
restlessness
Adverse Rx of albuterol: (3)
palpitations
reflex tachycardia
hallucinations
Life threatening rx to albuterol
cardia dysrhythmias
What is the drug class for metaproterenol:
bronchodialator: adrengic beta2 and some beta1
Pregnancy category for metaproterenol
C
Contraindications of metaproterenol: (2)
hypersensitivity
cardiac dysrhythmias
When giving metaproterenol use caution with these patients: (2)
narrow-angle glaucoma
cardiac disease
Drug interactions with metaproterenol: (2)
Increase action with sympathomimetics

Decrease with beta blockers
Lab interactions with metaproterenol: (1)
decrease serum potassium
Therapeautic effects of metaproterenol: (3)
bronchospasm
asthma
promote bronchodialation
SE of metaproterenol: (5)
nervousness
tremors
restlessness
hyperglycemia
muscle cramping
Adverse rx of metaproterenol:
cardiac
Life threatening reactions of metaproterenol: (2)
cardiac
paradoxical-bronchoconstriction
What was the first beta-adrenergic agent used to treat bronchospasm:
isoproterenol
What does isoproterenol stimulate:
beta1 and beta2 receptors
How is isoproterenol administered:
inhalation or IV for severe asthma attacks
Why is isoproterenol rarely prescribed:
severe SE
Why is a spacer device used?
to improve delivery to the lungs with less deposition in the mouth
What happens if the medication is not inhaled properly?
it will remain in the upper airways
What are some SE of using an inhalter: (2)
dry mouth
throat irritation
Excessive use of an inhaler can result in: (3)
tolerance
loss of drug effectiveness
severe:paradoxical airway resistence
Frequent dosing of an inhaler results in: (3)
tremors
nervousness
increased heart rate
SE of epinephrine:
tremors
dizziness
cardiac
SE of beta2 drugs:
tremors
nervousness
Why do diabetes pts need to monitor glucose level with beta2
it increases blood glucose
What class is adrenalin under:
alpha-beta adrenergic
What class is formoterol fumarate under:
beta adrenergic
Serevent is under what classification:
beta adrenergic
Brethine is under what classification:
beta andrenergic
What classification is Bricanyl under:
beta adrenergic
What classification is atrovent under:
anticholinergics
What classification is combivent under:
anticholinergics
ipratropium works by:
dilating the bronchioles
Clients using beta-agonist inhalant should use it _ mins before ipratropium
5mins
How long should iprotropium be used before a steroid or cromolyn:
5mins-so that the bronchioles dialate and the steroid can enter
Ipratropium is combined with what to treat bronchitis:
albuterol sulfate
How do ipratropium bromide and albuterol sulftate work together:
increase FEV1 which is how asthmatics and lung disease are evaluated
Xanthines stimulate: (4)
CNS
Respiration
dilate coronary &pulmonary
cause diuresis
Xanthines are used in the treatment of:
asthma
How does theophylline work:
relaxes SM of bronchi, bronchioles, pulmonary blood vessels by inhibiting phosphodiesterase
What happens when phosphiesterase in inhibited
increase in cAMP which promotes bronchodilation
The therapeutic index and range of theophylline
index:low
range:narrow 10-20mcg/ml
Why is theophylline prescribed:
maintenance therapy for pts w/ chronic stable asthma or COPDS
How will food and antacids affect theophylline:
decrease the rate of absorption
How will large amts of fluid and high protein meals affect theophylline:
increase rate of absorption
How does tobacco smoking effect theophylline:
decreases half life
SE of theophylline: (4)
anorexia
gastric pain
nervousness
dizziness
adverse effects of theophylline is: (4)
intestinal bleeding
cardiac
hyperreflexia
seizures
To avoid SE what medication should not be taken with theophylline:
xanthines
Toxicity of theophylline can result in: (3)
hyperglycemia
reduced clotting time
increased WBC
Patients should avoid what products when taking theophylline:
caffeinated products
What drugs increase the affect theophylline? (3)
betablockers
cimetidine
propandol & erythromycin
What drugs decrease the effect of theophylline:
barbiturate and carbamazepine
How does theophylline affect digitalis
increases risk of toxicity
How does theophylline affect lithium:
decreases its effects
What happens if theophylline and beta-adrenergic agonist were given together:
synergistic affect can occur along with cardiac dysrhythmias
What is leukotriene:
chemical mediator that can cause inflammatory changes in the lungs
What does leukotriene promote: (3)
increase eosinophil migration
mucous production
airway wall edema (bronchoconstriction)
What are LT receptor antagonists & LT synthesis (leukotriene modifiers) affect:
reduce inflammatory symptoms of asthma triggered by allergic & environmental stimuli---not for acute asthma
What classification is zafirlukast:
leukotriene modifiers
How does zafirlukast work:
acts as an LT receptor antagonist reducing inflmmatory & decreasing bronchoconstriction
How is zafirlukast administered:
oral
What is the half life of zafirlukast:
moderately long life
How many times is zafirlukast given a day:
twice
What is Zileuton:
LT synthesis inhibitor
How does zileuton work:
it decreases the inflammatory process and bronchoconstriction
How many times is zileuton administered a day:
4
What ages can take zafirlukast and zileuton:
adults and children older than 12
What are glucocoricoids used for:
treat respiratory disorders particularly asthma
When are glucocorticoids used:
if asthma is unresponsive to bronchodilator therapy or if client has an asthma attack while taking theophylline or adrenergic drugs
Why are inhaled glucocortocoids not helpful treating severe asthma attacks:
may take 1-4wks for full effect
Who are given IV glucocorticoids:
COPD
What classification is accolate under:
leukotriene modifiers not for acute asthmatic attack
What classification is zyflo under:
leukotriene modifiers not for acute asthmatic attack
What classification is flonase under:
glucocorticoids
glucocorticoids & beta2 agonist combination
What classification is flovent under:
glucocorticoids
What classification is Intal under:
Cromolyn and Nedocromil
Not use for actue asthma attacks
What classification is Tilade under:
Cromolyn and Nedocromil
Not used for acute asthma attacks
What doesn't work on acute asthma attacks?
glucocorticoids
What drug class is montelukast under?
bronochdialator: leukotriene receptor antagonist
Trade name for monelukast:
singulair
Pregnancy category for monelukast?
B
Contraindications for monelukast:
hypersensitivity
severe asthma attack
status asthmaticus
Use caution w/ montelukast when:
pt has severe liver disease
Montelukast lab interactions:
abnormal liver function test (ALT, AST)
Excretion of montelukast:
feces
Side effects of montelukast: (11)
fever
dizziness
fatigue
nasal congestion
cough
sore throat
dental pain
influenza
dyspepsia
abdominal pain
rash
Glucocorticoids can irritate:
gastric mucosa, take w/ food
What is Advair diskus:
glucocorticoid fluticasone propionate 100mcg & salmeterol 50mcg, effective in keep asthma in check
How is advair used:
q day inhalation in am & pm
Advair should not substitute:
fast acting inhalers
Purpose of Advair:
alleviate airway constriction & inflammation
SE of orally inhaled glucocorticoids:
local, with fungal infections
Candida albicans can be prevented with:
use of spacer, rinsing mouth w/ h2o after each use, & washing apparatus daily with water
When are adverse SE seen with glucocorticoids:
2wks
Oral and IV steroids are used for:
prolonged use
SE of oral & IV steroids:
fluid retention
thinning of the skin
purpura
abnormal fat distribution
increased blood sugar
impaired immune
hyperglycemia (oral)
Cromolyn(Intal)is used for:
prophylactic tx of bronchial asthma and must be taken daily
Cromolyn should not be used for:
acute asthmatic attacks
How does cromolyn sodium acts by:
inhibiting the release of histamine
SE of cromolyn :
cough & bad taste- can be eliminated by drinking water before and after inhalation
Cromolyn can be used with:
beta adrenergics and xanthine derivatives
What is a serious SE of cromolyn:
bronchospasm
How does nedocromil work:
antiinflammatory effect & supresses the release of histamine, leukotrienes, & mediators from mast cells
When to use nedocromil:
not during an asthma attack but to prevent bronchospasm & acute asthmatic attack
Which is more effective cromolyn or nedocromil:
nedocromil
Medications used to treat inflammatory effects in children:
cromolyn & nedocromil
Medications used to treat asthma attacks in children:
oral glucocorticoids
Medications to treat severe athma attacks in children:
oral beta2-adrenergic agonist
Frequent use of glucocorticoids can cause _ in old ppl:
increase risk of:
cataracts
osteoporosis
diabetes mellitus
If a theophylline drug is ordered for an older person what should happen:
glucocorticoids are decreased
Mucolytics work by:
detergents by liquefying & loosening thick mucous secretions & work like an expectorant
How is mucomyst administered:
nebulization
Mucomyst can be administered w/ ___ for what purpose:
bronchodilator for asthma or hyperactive airway disease bc increased secretions may obstruct bronchial airway
If giving mucolytic when should the bronchodialator be used:
bronchodialator should be given 5mins before
SE of mucolytics: (2)
stomatitis (oral ulcers)
runny nose
Mucomyst can be used as an antidote for:
acetaminophen if given w/in 12-24h-diluted in juice or soft drinks
What is pulmozyme:
enzyme that digests the DNA in thick sputum secretions of clients with cystic fibrosis
What does pulmozyme do:
reduce respiratory infections & improves pulmonary function
When does pulmozyme work:
w/ 3-7 days
SE of pulmozyme:
chest pain
sore throat
laryngitis
hoarsenss
PEF or FEV/PEF variability of severe persistent asthma attack:
<60%/>30%
Treatment for severe persistent asthma attack:
high-dose inhaled corticosteroids, long acting inhaled beta2 agonists, possibly corticosteroids tab/syrup 2mg/day
Symptoms of moderate persistent:
daily/>1night/wk
PEF or FEV/ PEF variability of moderate persistent:
>60%to<80%/ >30%
Tx for moderate persistent:
low-med inhaled corticosteroids & long acting inhaled beta2 agonists
Alternative tx for moderate persistent:
increase inhaled corticosteroids w/ low dose w/ leukotriene modifier or theophylline
Symptoms with mild persistent:
>2/wk but <1day/>2nights/mo
PEF or FEV/PEF varibility for mild persistent:
>80%/20-30%
Tx of mild persistent:
low-dose inhaled corticosteroids
Alternative tx for mild persistent:
cromolyn, leukotriene modifier, nedocromil or sustained release theophylline to serum concentration of 5-15mcg/ml
Symptoms for mild intermittent:
<2days/wk/ <2nights/mo
PEF or FEV/ PEF variability:
>80%/<20%
Tx for mild intermittent:
no daily meds
course of systemic corticosteroids
Quick relief of asthma attacks:
short acting bronchodialators: 2-4 puffs short acting inhaled beta2 agonists PRN, up to 3Tx at 20min intervals or single nebulizer Tx PRN, maybe course of systemic corticosteroids
What indicates the need for long term therapy for asthma:
use of short acting beta2 agonists > 2times/wk in intermittent asthma (daily or increasing use)