NSG 511: Exam Questions and Correct Answers
pathways to airflow limitation in asthma
airflow limitation in asthma is caused by bronchospasm and/or inflammation
- allergen > mast cell reaction > inflammatory mediators > bronchospasm
- allergen > mast cell reaction> infiltration of inflammatory mediators and inflammatory cells
> inflammation
- bronchial hyperreactivity > triggers > bronchospasm
bronchitis (COPD) pathway to airflow limitation
- continuous irritation from smoke/pollution > inflammation > bronchial edema/hyper
secretion of mucus > airway obstruction
emphysema (COPD) pathway to airflow limitation
- continuous irritation from smoke/pollution > inflammation > increased protease activity >
destruction of alveolar walls > airway obstruction
considerations for metered dose inhalers (MDIs)
- most commonly prescribed
- must coordinate between activation and inhalation
- notorious for incorrect use: patient education necessary
- more drug reaches lungs with use of spacer (21% vs 9%)
considerations for dry powder inhaler (DPIs)
- activated by inhalation (no coordination/spacer necessary)
- improved medication delivery to lungs
,considerations for nebulizers
- fine mist droplets
- no coordination necessary
- powered equipment (not portable, needs battery or plug)
considerations for respimats
- better than other drug inhalation delivery devices
- activated by inhalation (no coordination)
- fine mist droplets (better delivery to lower respiratory tract)
- portable
Uses for pulmonary glucocorticoids
asthma and COPD
routes for pulmonary glucocorticoids
- oral
- parenteral
- inhalation
mechanism of pulmonary glucocorticoids
- anti-inflammatory
- immunosuppressant
pulmonary glucocorticoid prototypes (and their routes)
- fluticasone/budesonide (inhalation)
- prednisone/prednisolone (oral)
- methylprednisolone (IV)
,indications for pulmonary glucocorticoids
prophylaxis for obstructive airway diseases
- inhaled
- on a fixed schedule
- controller medication
temporary use for severe obstructive disease when unable to deliver drug via inhalation
- oral or parenteral
- ex: no airway movement during status asthmaticus finch
side effects for pulmonary glucocorticoids
- thrush (oral candidiasis): rinse mouth after usage of inhaled agents to prevent this
- hyperglycemia
- peptic ulcer disease
theoretical side effects
- immunosuppression
- skeletal muscle growth suppression in children
- bone loss
- adrenal suppression
why are side effects of inhaled glucocorticoids rare (other than thrush)?
These side effects are predictable for glucocorticoid use. However, the inhaled dose for
asthma patients is typically too low to elicit any of these effects. They may be seen during
long term oral use, which is also uncommon for asthma patients.
short acting beta agonists (SABA) prototype and route
, - albuterol
- oral or inhaled
long acting beta agonists (LABA) prototype
Salmeterol
"-terol" mechanism of action
- beta 2 agonist
- epinephrine and "-terols"
Short acting beta agonist (SABA) indications
quick relief during asthma (or similar) exacerbation
long acting beta agonist (LABA) indications
- long term control of asthma
- must be combined with glucocorticoids
side effects of -terols
- tachycardia is most common
- activation of the sympathetic nervous system (cross over of beta 2 agonists to beta 1
receptors)
types of bronchodilators
- beta agonists (-terols)
- muscarinic antagonists
pulmonary muscarinic antagonist prototypes and route
pathways to airflow limitation in asthma
airflow limitation in asthma is caused by bronchospasm and/or inflammation
- allergen > mast cell reaction > inflammatory mediators > bronchospasm
- allergen > mast cell reaction> infiltration of inflammatory mediators and inflammatory cells
> inflammation
- bronchial hyperreactivity > triggers > bronchospasm
bronchitis (COPD) pathway to airflow limitation
- continuous irritation from smoke/pollution > inflammation > bronchial edema/hyper
secretion of mucus > airway obstruction
emphysema (COPD) pathway to airflow limitation
- continuous irritation from smoke/pollution > inflammation > increased protease activity >
destruction of alveolar walls > airway obstruction
considerations for metered dose inhalers (MDIs)
- most commonly prescribed
- must coordinate between activation and inhalation
- notorious for incorrect use: patient education necessary
- more drug reaches lungs with use of spacer (21% vs 9%)
considerations for dry powder inhaler (DPIs)
- activated by inhalation (no coordination/spacer necessary)
- improved medication delivery to lungs
,considerations for nebulizers
- fine mist droplets
- no coordination necessary
- powered equipment (not portable, needs battery or plug)
considerations for respimats
- better than other drug inhalation delivery devices
- activated by inhalation (no coordination)
- fine mist droplets (better delivery to lower respiratory tract)
- portable
Uses for pulmonary glucocorticoids
asthma and COPD
routes for pulmonary glucocorticoids
- oral
- parenteral
- inhalation
mechanism of pulmonary glucocorticoids
- anti-inflammatory
- immunosuppressant
pulmonary glucocorticoid prototypes (and their routes)
- fluticasone/budesonide (inhalation)
- prednisone/prednisolone (oral)
- methylprednisolone (IV)
,indications for pulmonary glucocorticoids
prophylaxis for obstructive airway diseases
- inhaled
- on a fixed schedule
- controller medication
temporary use for severe obstructive disease when unable to deliver drug via inhalation
- oral or parenteral
- ex: no airway movement during status asthmaticus finch
side effects for pulmonary glucocorticoids
- thrush (oral candidiasis): rinse mouth after usage of inhaled agents to prevent this
- hyperglycemia
- peptic ulcer disease
theoretical side effects
- immunosuppression
- skeletal muscle growth suppression in children
- bone loss
- adrenal suppression
why are side effects of inhaled glucocorticoids rare (other than thrush)?
These side effects are predictable for glucocorticoid use. However, the inhaled dose for
asthma patients is typically too low to elicit any of these effects. They may be seen during
long term oral use, which is also uncommon for asthma patients.
short acting beta agonists (SABA) prototype and route
, - albuterol
- oral or inhaled
long acting beta agonists (LABA) prototype
Salmeterol
"-terol" mechanism of action
- beta 2 agonist
- epinephrine and "-terols"
Short acting beta agonist (SABA) indications
quick relief during asthma (or similar) exacerbation
long acting beta agonist (LABA) indications
- long term control of asthma
- must be combined with glucocorticoids
side effects of -terols
- tachycardia is most common
- activation of the sympathetic nervous system (cross over of beta 2 agonists to beta 1
receptors)
types of bronchodilators
- beta agonists (-terols)
- muscarinic antagonists
pulmonary muscarinic antagonist prototypes and route
