NSG 511 exam 2
pathways to airflow limitation in asthma - answer*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 - 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 - answerasthma 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)? - answerThese
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 - answerSalmeterol
"-terol" mechanism of action - answer- beta 2 agonist
- epinephrine and "-terols"
Short acting beta agonist (SABA) indications - answerquick relief during asthma (or
similar) exacerbation
, long acting beta agonist (LABA) indications - answer- long term control of asthma
- must be combined with glucocorticoids
side effects of -terols - answer- tachycardia is most common
- activation of the sympathetic nervous system (cross over of beta 2 agonists to beta 1
receptors)
types of bronchodilators - answer- beta agonists (-terols)
- muscarinic antagonists
pulmonary muscarinic antagonist prototypes and route - answer- ipratropium
- tiotropium
- both inhaled
pulmonary muscarinic antagonist mechanism of action - answerantagonize muscarinic
receptors in the lungs causing:
- drying of respiratory secretions (a significant component of bronchitis)
- permits the sympathetic nervous system (β2) to dominate resulting in bronchodilation
(especially useful in COPD)
leukotriene modifiers for asthma prototype drug - answer- montelukast (singulair)
Montelukast mechanism of action - answer- inhibits leukotrienes, a single mediator of
inflammation
- leukotrienes trigger bronchospasm and inflammation
indications and route for montelukast - answer- oral
- second line therapy as an adjunct for glucocorticoids
- NOT for acute attacks
montelukast side effects - answerneuropsychiatric problems:
- anxiety
- agitation
- aggression
- suicidal thoughts
cromolyn mechanism of action - answer- blocks mast cells, thus
- inhibits the release of inflammatory mediators
cromolyn indications and route - answer- inhaled
- regular use can reduce the frequency of chronic asthma attacks
- *used prophylactically for exercise-induced asthma*
phosphodiesterase inhibitor prototypes - answer- theophylline (methylxanthines)
- roflumilast
pathways to airflow limitation in asthma - answer*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 - 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 - answerasthma 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)? - answerThese
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 - answerSalmeterol
"-terol" mechanism of action - answer- beta 2 agonist
- epinephrine and "-terols"
Short acting beta agonist (SABA) indications - answerquick relief during asthma (or
similar) exacerbation
, long acting beta agonist (LABA) indications - answer- long term control of asthma
- must be combined with glucocorticoids
side effects of -terols - answer- tachycardia is most common
- activation of the sympathetic nervous system (cross over of beta 2 agonists to beta 1
receptors)
types of bronchodilators - answer- beta agonists (-terols)
- muscarinic antagonists
pulmonary muscarinic antagonist prototypes and route - answer- ipratropium
- tiotropium
- both inhaled
pulmonary muscarinic antagonist mechanism of action - answerantagonize muscarinic
receptors in the lungs causing:
- drying of respiratory secretions (a significant component of bronchitis)
- permits the sympathetic nervous system (β2) to dominate resulting in bronchodilation
(especially useful in COPD)
leukotriene modifiers for asthma prototype drug - answer- montelukast (singulair)
Montelukast mechanism of action - answer- inhibits leukotrienes, a single mediator of
inflammation
- leukotrienes trigger bronchospasm and inflammation
indications and route for montelukast - answer- oral
- second line therapy as an adjunct for glucocorticoids
- NOT for acute attacks
montelukast side effects - answerneuropsychiatric problems:
- anxiety
- agitation
- aggression
- suicidal thoughts
cromolyn mechanism of action - answer- blocks mast cells, thus
- inhibits the release of inflammatory mediators
cromolyn indications and route - answer- inhaled
- regular use can reduce the frequency of chronic asthma attacks
- *used prophylactically for exercise-induced asthma*
phosphodiesterase inhibitor prototypes - answer- theophylline (methylxanthines)
- roflumilast
