NSG 137 EXAM 2 COMPREHENSIVE
QUESTIONS WITH VERIFIED PRACTICE
SOLUTIONS
●● bronchitis (COPD) pathway to airflow limitation
Answer: - continuous irritation from smoke/pollution > inflammation >
bronchial edema/hyper secretion of mucus > airway obstruction
●● emphysema (COPD) pathway to airflow limitation
Answer: - continuous irritation from smoke/pollution > inflammation >
increased protease activity > destruction of alveolar walls > airway
obstruction
●● considerations for metered dose inhalers (MDIs)
Answer: - 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)
Answer: - activated by inhalation (no coordination/spacer necessary)
- improved medication delivery to lungs
,●● considerations for nebulizers
Answer: - fine mist droplets
- no coordination necessary
- powered equipment (not portable, needs battery or plug)
●● considerations for respimats
Answer: - 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
Answer: asthma and COPD
●● routes for pulmonary glucocorticoids
Answer: - oral
- parenteral
- inhalation
●● mechanism of pulmonary glucocorticoids
Answer: - anti-inflammatory
,- immunosuppressant
●● pulmonary glucocorticoid prototypes (and their routes)
Answer: - fluticasone/budesonide (inhalation)
- prednisone/prednisolone (oral)
- methylprednisolone (IV)
●● indications for pulmonary glucocorticoids
Answer: *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
Answer: - 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)?
Answer: 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
Answer: - albuterol
- oral or inhaled
●● long acting beta agonists (LABA) prototype
Answer: Salmeterol
●● "-terol" mechanism of action
Answer: - beta 2 agonist
QUESTIONS WITH VERIFIED PRACTICE
SOLUTIONS
●● bronchitis (COPD) pathway to airflow limitation
Answer: - continuous irritation from smoke/pollution > inflammation >
bronchial edema/hyper secretion of mucus > airway obstruction
●● emphysema (COPD) pathway to airflow limitation
Answer: - continuous irritation from smoke/pollution > inflammation >
increased protease activity > destruction of alveolar walls > airway
obstruction
●● considerations for metered dose inhalers (MDIs)
Answer: - 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)
Answer: - activated by inhalation (no coordination/spacer necessary)
- improved medication delivery to lungs
,●● considerations for nebulizers
Answer: - fine mist droplets
- no coordination necessary
- powered equipment (not portable, needs battery or plug)
●● considerations for respimats
Answer: - 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
Answer: asthma and COPD
●● routes for pulmonary glucocorticoids
Answer: - oral
- parenteral
- inhalation
●● mechanism of pulmonary glucocorticoids
Answer: - anti-inflammatory
,- immunosuppressant
●● pulmonary glucocorticoid prototypes (and their routes)
Answer: - fluticasone/budesonide (inhalation)
- prednisone/prednisolone (oral)
- methylprednisolone (IV)
●● indications for pulmonary glucocorticoids
Answer: *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
Answer: - 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)?
Answer: 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
Answer: - albuterol
- oral or inhaled
●● long acting beta agonists (LABA) prototype
Answer: Salmeterol
●● "-terol" mechanism of action
Answer: - beta 2 agonist
