NURS 615
Exam 4 Study Guide
Week 12
o Bronchodilators
Indications: key concept: these medications are used to relieve acute
bronchospasm or to treat COPD
It is very important to know what they are used for and equally important to
know what they are not used for, i.e, they do not help with airway
inflammation
- Beta 2 agonists
MOA: Bind to B2 smooth muscle cells in the airway
o Stimulates smooth muscle cell relaxation, causing bronchodilation
via cyclic AMP pathway
o Inhibits release of hypersensitivity mediators – especially from mast
cells
Know the adverse effects and precautions of each of these types (Rescue vs.
Maintenance)
How do adverse effects and precautions affect patient teaching?
Adverse effects: tachycardia, tremors (comes from the beta-1 receptor
activity)
Precautions: monitor when used in patients with arrhythmias,
cardiovascular disease, and hyperthyroidism
What are SABAs, SAMAs, LABAs and LAMAs?
In what patient/clinical diagnosis would it be most appropriate to use
each one?
o For example, SAMAs and LAMAs are most often used in patients
with COPD – know why – because it is useful in treating
o SABA’s and LABA’s are mostly used in asthma patients
Know the names of the following inhalers for the exam (You will see these
on the exam and MUST be able to recognize which type of inhaler they
are)
SABAs (short-acting beta agonists)
o Albuterol – Proair, Ventolin, Proventil
o Levalbuterol – Xopenex
LABAs (long-acting beta agonists)
o Salmeterol - Serevent
o Fomoterol - Foradil
o Arfomoterol – Brovana
o Use of LABAs as monotherapy
- Treatment of acute asthma attacks
Do not use LABAs in monotherapy
o SABAs are used to treat acute asthma attacks
o Initial episodes of asthma exacerbations are treated by
increasing frequency of SABAs
What if the patient is taking a beta blocker for HTN?
o Add a SAMA to help with bronchodilation
, Know why LABAs have a black box warning for use as monotherapy
Must be used with an ICS
LABA’s and ULABA’s have an increased death rate in asthma with the use
of LABA’s alone. Thought to be caused by the beta 2 receptors being
saturated. SABAs, since they’re short-acting, are usually taken in
conjunction with an ICS, whereas LABAs are not.
Down-regulation of beta receptors
o If they do have an acute attack, they don’t respond as well to SABA’s
to help with acute bronchospasm
They do nothing for the underlying inflammatory process that is the basis
for asthma
- Inhaled anticholinergics
LAMA’s (long-acting muscarinic antagonists)
o Tiotropium bromide – Spiriva
In addition to bronchodilation – also reduce sputum volume
reduced Ach stimulation of goblet cells in the airway (goblet
cells produce mucus)
COPD usually, unless patient comes in for an asthma attack then we’ll
use these
What side effects/adverse effects are possible with these inhalers?
o Potential for anticholinergic side effects
o COPD pts are typically elderly
o BPH
o Glaucoma
o They tend to overuse these a lot
o Inhaled Corticosteroids
MOA: Inhibit airway inflammation
Block muscarinic cholinergic receptors by antagonizing acetylcholine
Decreases formation of cyclic GMP → decreased contractility of smooth
muscle of the lungs
Adverse Effects: xerostomia, hoarseness, mouth irritation, dysgeusia,
oral candidiasis
o Can be significantly reduced if we educate
Administration
o Must be taken routinely
o Patient education is key in preventing adverse effects – need to rinse
mouth with water and spit after each use
o Use of a spacing device also decreases adverse effects
Much more will be inhaled and delivered to the lungs than
deposited on the tongue and buccal mucosa
o Leukotriene Antagonists:
Montelukast (Singulair)
MOA: Inhibits the cysteinyl leukotriene receptor blocks action of LTD4
– a component of SRS-A
o This is a late reaction pathway
Rapidly absorbed from the GI tract and highly protein-bound
(significant drug interactions)
Adverse effects: headache, sore throat, dyspepsia is a possible
adverse effect/side effect (dyspepsia)
Exam 4 Study Guide
Week 12
o Bronchodilators
Indications: key concept: these medications are used to relieve acute
bronchospasm or to treat COPD
It is very important to know what they are used for and equally important to
know what they are not used for, i.e, they do not help with airway
inflammation
- Beta 2 agonists
MOA: Bind to B2 smooth muscle cells in the airway
o Stimulates smooth muscle cell relaxation, causing bronchodilation
via cyclic AMP pathway
o Inhibits release of hypersensitivity mediators – especially from mast
cells
Know the adverse effects and precautions of each of these types (Rescue vs.
Maintenance)
How do adverse effects and precautions affect patient teaching?
Adverse effects: tachycardia, tremors (comes from the beta-1 receptor
activity)
Precautions: monitor when used in patients with arrhythmias,
cardiovascular disease, and hyperthyroidism
What are SABAs, SAMAs, LABAs and LAMAs?
In what patient/clinical diagnosis would it be most appropriate to use
each one?
o For example, SAMAs and LAMAs are most often used in patients
with COPD – know why – because it is useful in treating
o SABA’s and LABA’s are mostly used in asthma patients
Know the names of the following inhalers for the exam (You will see these
on the exam and MUST be able to recognize which type of inhaler they
are)
SABAs (short-acting beta agonists)
o Albuterol – Proair, Ventolin, Proventil
o Levalbuterol – Xopenex
LABAs (long-acting beta agonists)
o Salmeterol - Serevent
o Fomoterol - Foradil
o Arfomoterol – Brovana
o Use of LABAs as monotherapy
- Treatment of acute asthma attacks
Do not use LABAs in monotherapy
o SABAs are used to treat acute asthma attacks
o Initial episodes of asthma exacerbations are treated by
increasing frequency of SABAs
What if the patient is taking a beta blocker for HTN?
o Add a SAMA to help with bronchodilation
, Know why LABAs have a black box warning for use as monotherapy
Must be used with an ICS
LABA’s and ULABA’s have an increased death rate in asthma with the use
of LABA’s alone. Thought to be caused by the beta 2 receptors being
saturated. SABAs, since they’re short-acting, are usually taken in
conjunction with an ICS, whereas LABAs are not.
Down-regulation of beta receptors
o If they do have an acute attack, they don’t respond as well to SABA’s
to help with acute bronchospasm
They do nothing for the underlying inflammatory process that is the basis
for asthma
- Inhaled anticholinergics
LAMA’s (long-acting muscarinic antagonists)
o Tiotropium bromide – Spiriva
In addition to bronchodilation – also reduce sputum volume
reduced Ach stimulation of goblet cells in the airway (goblet
cells produce mucus)
COPD usually, unless patient comes in for an asthma attack then we’ll
use these
What side effects/adverse effects are possible with these inhalers?
o Potential for anticholinergic side effects
o COPD pts are typically elderly
o BPH
o Glaucoma
o They tend to overuse these a lot
o Inhaled Corticosteroids
MOA: Inhibit airway inflammation
Block muscarinic cholinergic receptors by antagonizing acetylcholine
Decreases formation of cyclic GMP → decreased contractility of smooth
muscle of the lungs
Adverse Effects: xerostomia, hoarseness, mouth irritation, dysgeusia,
oral candidiasis
o Can be significantly reduced if we educate
Administration
o Must be taken routinely
o Patient education is key in preventing adverse effects – need to rinse
mouth with water and spit after each use
o Use of a spacing device also decreases adverse effects
Much more will be inhaled and delivered to the lungs than
deposited on the tongue and buccal mucosa
o Leukotriene Antagonists:
Montelukast (Singulair)
MOA: Inhibits the cysteinyl leukotriene receptor blocks action of LTD4
– a component of SRS-A
o This is a late reaction pathway
Rapidly absorbed from the GI tract and highly protein-bound
(significant drug interactions)
Adverse effects: headache, sore throat, dyspepsia is a possible
adverse effect/side effect (dyspepsia)
