Asthma: Causes, Symptoms, and Categories
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Questions and Answers

What is the primary effect of proteolytic enzymes on alveolar walls in emphysema?

  • Strengthen the alveolar walls
  • Increase the production of mucus
  • Increase the surface area for gas exchange
  • Decrease the surface area for gas exchange (correct)

    • Which of the following is a characteristic of intrinsic asthma?

  • History of allergies
  • Exercise-induced
  • No history of allergies (correct)
  • Exposure to a known allergen

    • What is the main goal of treatment for COPD?

  • To promote the production of mucus
  • To decrease inflammation and prevent hospitalization (correct)
  • To fully reverse the obstruction of lung airflow
  • To enlarge the air spaces in the lungs

    • What is the effect of bronchodilators on bronchial smooth muscle?

    <p>Relaxation</p> Signup and view all the answers

    What is status asthmaticus?

    <p>A prolonged asthma attack that does not respond to typical drug therapy</p> Signup and view all the answers

    What is the primary mechanism of action of beta-adrenergic agonists in bronchodilation?

    <p>Activation of beta2 receptors, leading to increased cyclic adenosine monophosphate (cAMP)</p> Signup and view all the answers

    Which of the following is a characteristic of short-acting beta agonist (SABA) inhalers?

    <p>Used as rescue inhalers for acute episodes</p> Signup and view all the answers

    What is the term that refers to a new delivery system for LABA inhalers?

    <p>Ellipta</p> Signup and view all the answers

    Which of the following is NOT a side effect of beta-adrenergic agonists?

    <p>Bradycardia</p> Signup and view all the answers

    Which class of bronchodilators works by stimulating the sympathetic nervous system?

    <p>Beta-adrenergic agonists</p> Signup and view all the answers

    Which type of adrenergic agonist stimulates alpha, beta1, and beta2 receptors?

    <p>Nonselective adrenergics</p> Signup and view all the answers

    What is the primary mechanism of action of anticholinergic agents?

    <p>Inhibition of muscarinic receptors</p> Signup and view all the answers

    Which of the following is a contraindication for the use of beta-adrenergic agonists?

    <p>Tachydysrhythmia</p> Signup and view all the answers

    What is the primary difference between Salmeterol and Albuterol?

    <p>Duration of action</p> Signup and view all the answers

    What is the primary mechanism of action of anticholinergic bronchodilators like ipratropium?

    <p>Inhibiting the release of acetylcholine</p> Signup and view all the answers

    What is the potential interaction between beta-adrenergic agonists and MAOIs or tricyclic antidepressants?

    <p>Increased risk of tachycardia and angina</p> Signup and view all the answers

    What is the therapeutic use of theophylline in asthma and COPD?

    <p>Long-term control of chronic asthma or COPD</p> Signup and view all the answers

    What is a common adverse effect of anticholinergic bronchodilators like ipratropium?

    <p>Dry mouth or throat</p> Signup and view all the answers

    What is the purpose of rinsing the mouth after inhalation of anticholinergic bronchodilators?

    <p>To decrease the unpleasant taste</p> Signup and view all the answers

    What is the expected pharmacological action of xanthine derivatives like theophylline?

    <p>Relaxation of bronchial smooth muscle resulting in bronchodilation</p> Signup and view all the answers

    What is the primary effect of xanthine derivatives on the cardiovascular system?

    <p>Increased force of contraction and increased heart rate</p> Signup and view all the answers

    What is the primary mechanism of action of leukotriene receptor antagonists in asthma management?

    <p>Preventing leukotrienes from attaching to receptors on cells in the lungs and in circulation</p> Signup and view all the answers

    What is the therapeutic range for theophylline blood level?

    <p>10 to 20 mcg/mL</p> Signup and view all the answers

    What is the indication for xanthine derivatives in the management of asthma?

    <p>Relief of bronchospasm and greater airflow into and out of the lungs</p> Signup and view all the answers

    What is a contraindication for the use of leukotriene receptor antagonists?

    <p>Known drug allergy</p> Signup and view all the answers

    What is the primary indication for the use of inhaled corticosteroids?

    <p>Persistent asthma</p> Signup and view all the answers

    Which of the following is a common adverse effect of inhaled corticosteroids?

    <p>Pharyngeal irritation</p> Signup and view all the answers

    What is a contraindication for the use of inhaled corticosteroids?

    <p>Candida infections</p> Signup and view all the answers

    Which of the following medications may interact with systemic corticosteroids?

    <p>Phenytoin</p> Signup and view all the answers

    What is an important nursing implication for patients using inhaled corticosteroids?

    <p>Teach patients to take bronchodilators exactly as prescribed</p> Signup and view all the answers

    What should a patient experiencing insomnia report to after taking xanthine derivatives?

    <p>The prescriber</p> Signup and view all the answers

    What should a patient do to prevent oral fungal infections when using inhaled corticosteroids?

    <p>Gargle and rinse the mouth with lukewarm water</p> Signup and view all the answers

    What is a precaution to take when using timed-release preparations of xanthine derivatives?

    <p>Do not crush or chew the medication</p> Signup and view all the answers

    What should a patient do when taking a beta agonist bronchodilator and a corticosteroid inhaler?

    <p>Use the beta agonist bronchodilator before the corticosteroid inhaler</p> Signup and view all the answers

    Why should a patient be cautious when taking xanthine derivatives with certain foods?

    <p>The foods may interact with the medication's metabolism</p> Signup and view all the answers

    What should a patient report to a prescriber when taking LTRAs?

    <p>Any changes in symptoms or side effects</p> Signup and view all the answers

    What is a consequence of using albuterol too frequently?

    <p>All of the above</p> Signup and view all the answers

    What should a patient do to ensure proper use of an inhaler?

    <p>Return demonstrate the inhaler to the healthcare provider</p> Signup and view all the answers

    What is a contraindication for the use of xanthine derivatives?

    <p>History of PUD or GI disorders</p> Signup and view all the answers

    What should a patient do when taking LTRAs for chronic management of asthma?

    <p>Take the medication every night on a continuous schedule</p> Signup and view all the answers

    Study Notes

    Asthma

    • Persistent and present most of the time despite treatment
    • Recurrent and reversible shortness of breath
    • Occurs when the airways of the lungs become narrow due to:
      • Bronchospasms
      • Inflammation of the bronchial mucosa
      • Edema of the bronchial mucosa
      • Production of viscous mucus
    • Symptoms:
      • Wheezing
      • Difficulty breathing
      • Coughing at night
    • Four categories:
      • Intrinsic (occurring in patients with no history of allergies)
      • Extrinsic (occurring in patients exposed to a known allergen)
      • Exercise-induced
      • Drug-induced (beta blockers, NSAIDS, aspirin, and Motrin)
    • Status asthmaticus: prolonged asthma attack that does not respond to typical drug therapy, may last several minutes to hours, and is a medical emergency

    Chronic Obstructive Pulmonary Disease (COPD)

    • Chronic obstruction of lung airflow that interferes with normal breathing
    • Not fully reversible
    • Chronic bronchitis and emphysema
    • Key areas to watch for:
      • Long-term prevention of hospitalization
      • Decreasing inflammation
      • Opening airways

    Emphysema

    • Air spaces enlarge as a result of the destruction of alveolar walls
    • Caused by the effect of proteolytic enzymes released from leukocytes in response to alveolar inflammation
    • The surface area where gas exchange takes place is reduced, impairing effective respiration

    Chronic Bronchitis

    • Continuous inflammation and low-grade infection of the bronchi
    • Excessive secretion of mucus and certain pathologic changes in the bronchial structure
    • Often occurs as a result of prolonged exposure to bronchial irritants (smoking, cleaning supplies, pollutants, perfumes)

    Bronchodilators

    • Relax bronchial smooth muscle, causing dilation of the bronchi and bronchioles that are narrowed as a result of the disease process
    • Three classes: beta-adrenergic agonists, anticholinergics, and xanthine derivatives

    Beta-Adrenergic Agonists

    • Short-acting beta agonist (SABA) inhalers:
      • Albuterol (Ventolin, ProAir)
      • Levalbuterol (Xopenex)
      • Terbutaline (Brethine)
      • Metaproterenol (Alupent)
    • Long-acting beta agonist (LABA) inhalers:
      • Arformoterol (Brovana)
      • Formoterol (Foradil, Perforomist)
      • Salmeterol (Serevent)
    • Used during acute phase of asthmatic attacks
    • Quickly reduce airway constriction and restore normal airflow
    • Agonists, or stimulators, of the adrenergic receptors in the sympathetic nervous system

    Mechanism of Action and Uses

    • Begins at the specific receptor stimulated
    • Ends with dilation of the airways
    • Activation of beta2 receptors activates cyclic adenosine monophosphate (cAMP), which relaxes smooth muscle in the airway and results in bronchial dilation and increased airflow
    • Three types:
      • Nonselective adrenergics (e.g., epinephrine)
      • Nonselective beta-adrenergics (e.g., metaproterenol)
      • Selective beta2 drugs (e.g., albuterol)

    Indications and Contraindications

    • Albuterol, levavalbuterol:
      • Inhaled short-acting prevention of asthma episode
      • Exercise-induced
      • Inhaled short-acting treatment of bronchospasm and asthma
      • Oral long-acting long-term control of asthma
    • Formoterol, salmeterol:
      • Long-term control of asthma
    • Terbutaline:
      • Long-term control of asthma
    • Contraindications:
      • Tachycardia
      • Angina
      • Nursing actions: dosage might need to be reduced

    Adverse Effects

    • Insomnia
    • Restlessness
    • Anorexia
    • Vascular headache
    • Hyperglycemia
    • Tremor
    • Cardiac stimulation
    • Alpha and beta effects (e.g., epinephrine)
      • Cardiac stimulation
      • Tremor
      • Anginal pain
      • Vascular headache
    • Beta1 and beta2 effects (e.g., metaproterenol)
      • Cardiac stimulation
      • Tremor
      • Anginal pain
      • Vascular headache
    • Beta2 effects (e.g., albuterol)
      • Hypotension or hypertension
      • Vascular headache
      • Tremor

    Interactions

    • Use of better adrenergic blockers can negate effects of both medications
    • MAOIs and tricyclic antidepressants can increase the risk of tachycardia and angina
    • Sympathomimetics:
      • Monitor patients with diabetes; an increase in blood glucose levels can occur

    Anticholinergics

    • Select prototype medication: ipratropium
    • Inhaled short-acting: tiotropium
    • Inhaled long-acting: aclidinium
    • Pharmacological action:
      • Block muscarinic receptors of the bronchi, resulting in bronchodilation
    • Mechanism of action:
      • Acetylcholine (ACh) causes bronchial constriction and narrowing of the airways
      • Anticholinergics bind to the ACh receptors, preventing ACh from binding
      • Result: bronchoconstriction is prevented, airways dilate
    • Indications:
      • Prevention of the bronchospasm associated with chronic bronchitis or emphysema
      • Not for the management of acute symptoms
    • Adverse effects:
      • Dry mouth or throat
      • Nasal congestion
      • Heart palpitations
      • Gastrointestinal (GI) distress
      • Headache
      • Coughing
      • Anxiety

    Xanthine Derivatives

    • Plant alkaloids: caffeine, theobromine, and theophylline
    • Synthetic xanthine: aminophylline and dyphylline
    • Expected pharmacological action:
      • Relaxation of bronchial smooth muscle, resulting in bronchodilation
    • Therapeutic uses:
      • Oral theophylline is used for long-term control of chronic asthma or COPD
    • Mechanism of action:
      • Increase levels of energy-producing cAMP
      • This is done by competitively inhibiting phosphodiesterase, the enzyme that breaks down cAMP
      • Result: decreased cAMP levels, smooth muscle relaxation, bronchodilation, and increased airflow
      • Cardiovascular stimulation
    • Drug effects:
      • Bronchodilation by relaxing smooth muscle in the airways
      • Relief of bronchospasm and greater airflow into and out of the lungs
      • Cardiovascular stimulation: increased force of contraction and increased heart rate, resulting in increased cardiac output and increased blood flow to the kidneys (diuretic effect)
    • Indications:
      • Dilation of airways in asthma, chronic bronchitis, and emphysema
      • Mild to moderate cases of acute asthma
      • Not for management of acute asthma attack
      • Adjunct drug in the management of COPD
    • Adverse effects:
      • Nausea
      • Vomiting
      • Anorexia
      • Gastroesophageal reflux during sleep
      • Sinus tachycardia
      • Extrasystole
      • Palpitations
      • Ventricular dysrhythmias
      • Transient increased urination
      • Hyperglycemia

    Leukotriene Receptor Antagonists (LTRAs)

    • Nonbronchodilating
    • Newer class of asthma medications
    • Currently available drugs:
      • Montelukast
      • Zafirlukast
      • Zileuton
    • Mechanism of action:
      • Prevent leukotrienes from attaching to receptors on cells in the lungs and in circulation
      • Inflammation in the lungs is blocked, and asthma symptoms are relieved
    • Drug effects:
      • By blocking leukotrienes:
        • Prevent smooth muscle contraction of the bronchial airways
        • Decrease mucus secretion
        • Prevent vascular permeability
        • Decrease neutrophil and leukocyte infiltration to the lungs, preventing inflammation
    • Indications:
      • Long-term therapy of asthma in adults and children
      • Prevention of exercise-induced bronchospasm
      • Not meant for management of acute asthma attacks
    • Contraindications:
      • Known drug allergy
      • Previous adverse drug reaction
      • Allergy to povidone, lactose, titanium dioxide, or cellulose derivatives is also important to note because these are inactive ingredients in these drugs
      • Use cautiously with clients who have liver dysfunction
    • Adverse effects:
      • Headache
      • Nausea
      • Dizziness
      • Insomnia

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    Description

    This quiz covers the definition, symptoms, and categories of asthma, including bronchospasms, inflammation, and airway obstruction. Test your knowledge of this respiratory condition.

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