Exam 2 Blueprint
Drugs for Gas Exchange
➔ Asthma
◆ General Drug Knowledge
● Bronchodilators:
○ Beta-adrenergic agonists
○ Anticholinergics
○ Methylxanthines
● Anti-Inflammatory
○ Glucocorticoids
○ Mast Cell Stabilizers:
◆ Prevents cells involved in the inflammatory process from
degranulating so they can’t cause inflammation.
◆ Not as strong as steroids but a good choice if steroids are
contraindicated
○ Leukotriene Modifiers
◆ Block leukotrienes (inflammation participants)
◆ FDA Alert: psych problems like hallucinations and suicidal
thoughts
● Peak Flow Meter
○ This is how we measure how well the medication regimen is
working. It may tell the patient about a deterioration in their
condition before they realize it.
○ Contact HCP if they are blowing in the yellow when their baseline
is in the green.
◆ Anticholinergics
● Muscarinic receptors are cholinergic receptors that work on the PNS
(remember “rest and digest”) so muscarinic antagonists will produce
anticholinergic effects.
● Therapeutic Effect: Cholinergic (or muscarinic) receptor activation
causes constriction in the bronchial airways. This means that
anticholinergics (or muscarinic antagonists) will cause
bronchodilation by blocking the activation of cholinergic (or muscarinic)
receptors.
● Adverse Effects: Can’t see, can’t pee, can’t sh*t, can’t spit…and
tachycardia
○ Can cause urinary retention and constipation. This can be even
more problematic for older populations who are already
experiencing a decrease in GI motility.
○ Sexual dysfunction
○ Sweating is how we regulate our thermodynamics. If we can’t
sweat, we can overheat (especially older/younger populations).`
◆ Adrenergic Agonists (Beta Agonists)
, ●
Beta agonists stimulate the SNS. This will activate the body’s “fight or
flight” response.
● Therapeutic Effect: bronchodilation. Remember, we need nice and open
airways to allow maximum oxygen intake while running from the lion.
● Adverse Effects: Without a selective beta-2 agonist, we will also see the
response of the heart and kidneys to this activation. That will cause
tachycardia and increased blood pressure due to renin release.
○ Keep this in mind for clients who may already have a history of
hypertension. You may choose a selective beta-2 agonist for
them.
◆ Inhaled Drug Delivery Devices
● Nebulizer: turns the medication into mist to be inhaled through a face
mask or mouthpiece. Takes longer to administer, but is more effective.
● Spacer: 3-4 inch plastic piece that will hold the aerosolized cloud so that
people don’t have to coordinate breathing with the administration of the
medication.
○ Allows the large particles to fall out and deposits less medication
in the mouth and throat.
○ Results in more than double the amount of medication reaching
the lungs. (9%-21%)
◆ Glucocorticoids
● MOA: decreases inflammation in the airways
● Patient Education
○ Always rinse the mouth out after use. If the patient isn’t rinsing
their mouth out, they can develop a fungal infection called
candidiasis (thrush). This is a yeast infection in the mouth.
○ Glucocorticoids need to be used prophylactically. This is not a
medication that can be used only when they feel an attack coming
on.
◆ Adrenergic agonists & Glucocorticoids
○ If using a glucocorticoid inhaler during a respiratory emergency,
use the bronchodilator first and then the glucocorticoid or
anti-inflammatory inhaler.
○ MO8: Identify the purposes of various delivery methods and
devices for inhaled drugs.
◆ I think this may be going back to spacers/nebulizers.
◆ Remember to teach the patient to rinse their mouth out
after glucocorticoid inhaler use, even if they are using a
spacer.
➔ COPD
◆ Xanthine derivatives
● Methylxanthines (Theophylline)
● Lots of drug-drug interactions
● Narrow therapeutic index
Drugs for Gas Exchange
➔ Asthma
◆ General Drug Knowledge
● Bronchodilators:
○ Beta-adrenergic agonists
○ Anticholinergics
○ Methylxanthines
● Anti-Inflammatory
○ Glucocorticoids
○ Mast Cell Stabilizers:
◆ Prevents cells involved in the inflammatory process from
degranulating so they can’t cause inflammation.
◆ Not as strong as steroids but a good choice if steroids are
contraindicated
○ Leukotriene Modifiers
◆ Block leukotrienes (inflammation participants)
◆ FDA Alert: psych problems like hallucinations and suicidal
thoughts
● Peak Flow Meter
○ This is how we measure how well the medication regimen is
working. It may tell the patient about a deterioration in their
condition before they realize it.
○ Contact HCP if they are blowing in the yellow when their baseline
is in the green.
◆ Anticholinergics
● Muscarinic receptors are cholinergic receptors that work on the PNS
(remember “rest and digest”) so muscarinic antagonists will produce
anticholinergic effects.
● Therapeutic Effect: Cholinergic (or muscarinic) receptor activation
causes constriction in the bronchial airways. This means that
anticholinergics (or muscarinic antagonists) will cause
bronchodilation by blocking the activation of cholinergic (or muscarinic)
receptors.
● Adverse Effects: Can’t see, can’t pee, can’t sh*t, can’t spit…and
tachycardia
○ Can cause urinary retention and constipation. This can be even
more problematic for older populations who are already
experiencing a decrease in GI motility.
○ Sexual dysfunction
○ Sweating is how we regulate our thermodynamics. If we can’t
sweat, we can overheat (especially older/younger populations).`
◆ Adrenergic Agonists (Beta Agonists)
, ●
Beta agonists stimulate the SNS. This will activate the body’s “fight or
flight” response.
● Therapeutic Effect: bronchodilation. Remember, we need nice and open
airways to allow maximum oxygen intake while running from the lion.
● Adverse Effects: Without a selective beta-2 agonist, we will also see the
response of the heart and kidneys to this activation. That will cause
tachycardia and increased blood pressure due to renin release.
○ Keep this in mind for clients who may already have a history of
hypertension. You may choose a selective beta-2 agonist for
them.
◆ Inhaled Drug Delivery Devices
● Nebulizer: turns the medication into mist to be inhaled through a face
mask or mouthpiece. Takes longer to administer, but is more effective.
● Spacer: 3-4 inch plastic piece that will hold the aerosolized cloud so that
people don’t have to coordinate breathing with the administration of the
medication.
○ Allows the large particles to fall out and deposits less medication
in the mouth and throat.
○ Results in more than double the amount of medication reaching
the lungs. (9%-21%)
◆ Glucocorticoids
● MOA: decreases inflammation in the airways
● Patient Education
○ Always rinse the mouth out after use. If the patient isn’t rinsing
their mouth out, they can develop a fungal infection called
candidiasis (thrush). This is a yeast infection in the mouth.
○ Glucocorticoids need to be used prophylactically. This is not a
medication that can be used only when they feel an attack coming
on.
◆ Adrenergic agonists & Glucocorticoids
○ If using a glucocorticoid inhaler during a respiratory emergency,
use the bronchodilator first and then the glucocorticoid or
anti-inflammatory inhaler.
○ MO8: Identify the purposes of various delivery methods and
devices for inhaled drugs.
◆ I think this may be going back to spacers/nebulizers.
◆ Remember to teach the patient to rinse their mouth out
after glucocorticoid inhaler use, even if they are using a
spacer.
➔ COPD
◆ Xanthine derivatives
● Methylxanthines (Theophylline)
● Lots of drug-drug interactions
● Narrow therapeutic index
