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restrictive pulmonary disease leads to a:

DECREASE in total lung capacity
this is due to fluid accumulation/loss of lung elasticity

what are examples of restrictive pulmonary disease?

pulmonary edema, lung tumors, scoliosis (thoracic deformities), myasthenia gravis, pulmonary fibrosis

what is the effect stimulated alpha 1 receptors?

1. increased contractility of the heart
2. vasoconstriction, which increases venous return, and increases BP
3. mydriasis (pupil dilation)

what is the effect of stimulated alpha 2 receptors?

1. reduced norepinephrine
2. decreased BP
3. dilates blood vessels
4. decreases gatric motility

what is the effect of stimulated beta 1 receptors?

1. increased heart rate and constriction
2. increases renin secretion

what is the effect of stimulated beta 2 receptors?

1. bronchodilation
2. increased blood sugar

in an acute asthma attack, what is the first line of defense?

beta 2 adrenergic agonists (short acting sympathomimetics)

what do beta 2 adrenergic agonists promote?

cAMP production and enhance bronchodilation

sympathomimetics are also knowns as

adrenergics

what are four adrenergic bronchodilators?

epinephrine (adrenalin)
isopoterenol (isuprel)
metaproterenol (alupent)
albuterol (proventil, ventolin)

what is the prototype selective beta 2 adrenergic drug?

albuterol (proventil, ventolin)

high doses or overuse of beta 2 adrenergic agent may cause some degree of _____ response

beta 1

what is beta 1 response?

nervousness, tremor, increased HR, dysrhythmias, palpitations, angina, dizziness

what is the therapeutic use of albuterol?

treats, and controls: bronchospasm, asthma, bronchitis, and oher COPD

side effects of albuterol

tremor, dizziness, nervousness, restlessness

adverse effects of albuterol

palpitations, reflex tachycardia, hallucinations, cardiac dysrhythmias

how long do you wait after using MDI with adrenergic (like albuterol) if using steroid inhaler?

5 minutes

metaproterenol (alupent) effects what recepts?

mostly beta 2, but some beta 1 effects

excessive use of aerosol sympathomimetic oral inhalation can lead to

tolerance and paradoxic bronchoconstriction

isoproterenol (isuprel) is a ______ beta agonist

nonselective
it stimulates both beta 1 and bota 2 receptors

epinephrine is a ______ agonist

nonselective alpha, beta 1, and beta 2 agonist

what is epinephrine used for?

relief for acute bronchoconstriction, and anaphylactic reaction

when is epinephrine given SQ?

promote bronchodilation and increase BP

when is epinephrine given IV?

emergency restoration of circulation, and increase in airway patency

what drugs are included in the methylxanthine derivatives?

theophylline
aminophylline
caffeine

how do methylxanthines operate?

1. stimulate CNS and respiration
2. dilate coronary and pulmonary vessels
3. cause diuresis by increasing blood flow to kidney

what is the prototype xanthine derivative?

theophylline (theo-dur, slo-bid)

what was the first theophylline preparation?

aminophylline

theophylline has a _____therapeutic index and range

low
10-20 micrograms/ml

what precaution must one take with theophylline

serum/plasma levels should be frequently monitored

what is theophylline mainly prescribed for now a day?

maintenance therapy in clients with chronic stable asthma and other COPD

contraindications for theophylline

1. uncontrolled seizure disorder
2. severe cardiac dysrhythmias/disease
3. renal disease
4. liver disease

it requires VERY close monitoring!

how should IV theophylline preparations be administered?

slowly via an infusion pump

rapid administration of aminophylline leads to what?

dizziness, flushing, hypotension, severe bradycardia, and palpitations

theophylline toxicity most likely occurs when serum concentrations exceed:

20 mcg/ml

what are life-threatening adverse reactions of theophylline:

seizures, cardiac dysrhythmias, convulsions

what are theophylline adverse reactions?

irritability
tremors
tachycardia
palpitations
urticaria

what age range of individuals is most susceptible to adverse CNS reactions to theophylline?

children

what are leukotrienes?

chemical mediators that cause inflammatory changes

leukotrienes promote an increase in what?

eosinophil migration, mucus production, airway wall edema, which result in bronchoconstriction

LT modifiers do what?

suppress leukotriene synthesis or block their receptrs

which drugs are not recommended for the treatment of acute asthma attack?

leukotrient modifiers

leukotriene modifiers are used for what kind of asthma?

exercise induced

prevention and maintenance

what is an example of a leukotriene modifier?

montelukast sodium (singulair)

_______ are used to treat respiratory disorders, especially asthma

glucorticoids

when are glucocorticoids indicated?

if asthma is unresponsive to bronchodilator therapy
OR
if client has asthma attack while on maximum doses of theophylline or adrenergic drug

glucocorticoids may have synergistic effects if given with?

beta 2 agonist

Glucocorticoids can be given by MDI inhaler, which si used for what?

maintenance

how long does it take for an inhaled steroid to reach its full effect?

1-4 weeks

inhaled glucocorticoids are perferred over what kind of preperation?

oral

inhaled glucocorticoids are more useful at controling bronchial hyperresponsiveness than?

beta 2 agonists

injection/IV glucocorticoids are given when?

during an acute attack

tablet glucocorticoids are given when?

after an acute attack

which form of glucocorticoids have fewer systemic effects?

inhaler

with a single dose, or short term use, glucorticoids may be discontinued when?

abruptly after symtpoms are controlled

with prolonged glucocorticoid therapy, what can happen if therapy is abruptly disccontinued?

exacerbation of asthma symptoms and suppression of adrenal fx

glucocorticoids can irritate what tissue?

gastic mucosa, so should be taken with food to avoid ulceration

inhaled glucocorticoids run the risk of what infection?

oropharygeal and laryngeal fungal infections?

what can be done to avoid fungal infections with glucocorticoids?

use of spacer
rinsing mouth and throat with water after each dose
washing apparatus daily with warm water

side effects with inhaled glucorticoids are generally:

local

what are the side effects of inhaled glucocoticoids?

throat irritation, hoarseness, dry mouth, coughing

when used long term, oral and injectible glucocorticoids have what kind of side effets?

numerous side effects

most adverse reactions are seen within ___ weeks of glucocorticoid therapy

2

they are reversible

long term po/injectible glucocorticoid therapy can lead to what eefects?

fluid retention (puffy eyelids, edema in lower extremities, moon face, weight gain)
electrolyte imbalance
hypertension
thinning of skin
purpura
hyperglycemia
abnormal fat distribution
impaired immune response

what does an advair diskus consist of?

steroid (fluticasone)
long acting beta 2 agonist (salmeterol)

advair diskus is not used for what kind of asthma?

acute attacks

allow for how many hours in between doses of advair diskus?

12

advair diskus is ____ acting

long

cromolyn is administered how?

inhalation

how often should cromolyn be used?

daily

cromolyn is used for ______ treatment of _______ asthma

prophylactic
bronchial

how does cromolyn act?

it released by inhibiting the release of histamine

what are common side effects of cromolyn?

bad taste and cough

how does one counter the bad effects of cromolyn?

drink water before, and after administration

why should cromolyn not be used for an acute asthma attack?

it is not a bronchodilator

what is believed to be more effective than cromolyn?

nedocromil sodium

nedocromil sodium has an ______ effect

anti-inflammatory

_____ act like detergents to liquefy and loosen thick secretions so they can be expectorated

mucolytics

_______ is a mucolytic administered by neulization

acetylcysteine (mucomyst)

what is one thing one should never do with acetylcysteine (mucomyst)

mixed with other drugs

when clients produce increased secretions, what can be done with mucomyst?

mucomyst can be given with a bronchodilator

how does one administer a bronchodilator and mucomyst?

give bronchodilator 5 minutes before mucolytic

how should cromolyn be discontinued?

NOT abrubtly because rebound asthma can occur

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