Beta-Adrenergic Agonists in Respiratory Therapy

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Questions and Answers

What is a critical guideline for using a DISKUS for medication delivery?

Patient should inhale deeply into the DISKUS

DISKUS should not be washed or taken apart (correct)

Patient should gently blow into the DISKUS

DISKUS can be disassembled for cleaning purposes

Why might nebulizers be more challenging for younger children?

Nebulizers are less effective for younger patients

Younger children often have better lung function

Coordination difficulties can hinder usage (correct)

The nebulizer device is often too large for them

In the context of asthma treatment, what does SABA stand for?

Secondary anti-inflammatory bronchial agents

Standard aerosolized bronchodilator agents

Sustained automatic beta anti-inflammatories

Short-acting beta agonists (correct)

What is one key difference between acute and chronic asthma treatment?

Acute asthma treatment often involves SABA Signup and view all the answers

Which of the following statements is true regarding the delivery of medication through nebulizers?

It can lead to medication being deposited at the back of the throat Signup and view all the answers

What is the primary effect of albuterol in treating respiratory conditions?

Stimulating beta-2 receptors Signup and view all the answers

What should be monitored closely in patients taking albuterol and digoxin?

Heart rhythm Signup and view all the answers

What is the recommended interval for inhalation puffs using a bronchodilator?

1 minute apart Signup and view all the answers

Which side effect is NOT typically associated with albuterol use?

Hypoglycemia Signup and view all the answers

What should be avoided when using NSAIDs in patients with certain respiratory conditions?

Use before controller treatment Signup and view all the answers

Which population group has no specific monitoring requirements when using bronchodilators?

All age groups Signup and view all the answers

What is a potential effect of albuterol that requires monitoring in some patients?

Muscle cramps Signup and view all the answers

What is a known consequence of using beta-2 agonists like albuterol?

Increased heart rate Signup and view all the answers

Which symptom indicates a need to evaluate the effectiveness of a bronchodilator treatment?

Decreased peak flow measures Signup and view all the answers

Which of the following is a common side effect of albuterol that patients should be aware of?

Dizziness Signup and view all the answers

What are the primary metabolic pathways for first-generation antihistamines?

Hepatic metabolism Signup and view all the answers

Which of the following is a common side effect associated with first-generation antihistamines?

Blurred vision Signup and view all the answers

What is a distinguishing feature of second-generation antihistamines compared to first-generation?

They have less incidence of dry mouth. Signup and view all the answers

What condition is contraindicated for the use of first-generation antihistamines?

Narrow-angle glaucoma Signup and view all the answers

Which of these side effects is specifically noted for Brompheniramine?

Dry mouth Signup and view all the answers

What is the potential effect of combining second-generation antihistamines with other H1 blockers?

Increased drowsiness Signup and view all the answers

Which of the following is true regarding the use of cetirizine?

It selectively blocks peripheral H1 receptors. Signup and view all the answers

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

Binding to beta-2 receptors to activate adenylate cyclase Signup and view all the answers

What is a specific contraindication for the use of first-generation antihistamines in infants?

Breastfeeding Signup and view all the answers

Which adverse effect is most commonly associated with the use of beta-adrenergic agonists?

Hypokalemia Signup and view all the answers

What is the most significant effect of severe diastolic hypertension on pregnancy?

Reduces utero placental blood flow Signup and view all the answers

Which antihistamine is least likely to cause sedation at recommended doses?

Cetirizine Signup and view all the answers

Which of the following statements about the hepatic metabolism of Levalbuterol is correct?

It has no active metabolites. Signup and view all the answers

What special consideration should be made when prescribing beta-adrenergic agonists to elderly patients?

Caution with dosing is needed due to renal excretion Signup and view all the answers

Which of the following is an indication for using beta-adrenergic agonists?

Acute bronchospasm in any age group Signup and view all the answers

What adverse effect results from the anticholinergic properties of first-generation antihistamines?

Blurred vision Signup and view all the answers

What is a primary contraindication for the usage of certain antihistamines?

Use in patients with CAD Signup and view all the answers

Which of the following conditions should raise caution if first-generation antihistamines are used?

Psychiatric disorders Signup and view all the answers

In what condition is the use of Tiotropium contraindicated?

Patients with severe renal impairment Signup and view all the answers

What effect does a positive response to beta-adrenergic agonists indicate in asthma patients?

An FEV1 increase of at least 12% from baseline Signup and view all the answers

What type of receptors do brompheniramine and similar first-generation antihistamines primarily bind to?

Non-selectively to central H1 receptors Signup and view all the answers

What is the mechanism of action for anticholinergics such as Ipratropium?

Blocking the action of acetylcholine at muscarinic receptors Signup and view all the answers

What adverse effect is more commonly associated with first-generation antihistamines?

Sedation Signup and view all the answers

Which receptors are NOT blocked by antihistamines?

H2 receptors Signup and view all the answers

Which of the following features is characteristic of second-generation antihistamines regarding their sedation profile?

Lower incidence of sedation compared to first-generation Signup and view all the answers

Which adverse effect is most likely to occur with anticholinergic medications like Ipratropium?

Dry mouth Signup and view all the answers

What role do inhaled corticosteroids play in respiratory treatment?

Reduction of inflammation in the airways Signup and view all the answers

Which side effect is considered a central nervous system effect of antihistamines?

Tremors Signup and view all the answers

How does levalbuterol achieve its effects?

By stimulating B2 adrenergic receptors Signup and view all the answers

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

Oral thrush Signup and view all the answers

What potential interaction should be monitored when using antihistamines?

Interactions with CNS depressants Signup and view all the answers

What should patients be counseled to do after using inhaled corticosteroids to minimize side effects?

Rinse their mouth thoroughly Signup and view all the answers

Which of the following conditions may be aggravated by the use of first-generation antihistamines?

Glaucoma Signup and view all the answers

What is the primary action of leukotriene modifiers such as Montelukast?

Block leukotriene receptors Signup and view all the answers

What is a prominent clinical indication for using levalbuterol?

Prevention of exercise-induced bronchoconstriction Signup and view all the answers

What is a common side effect of antihistamines such as Cetirizine?

Drowsiness Signup and view all the answers

What could be a side effect of high doses of first-generation antihistamines?

Somnolence Signup and view all the answers

Why are first-generation antihistamines advised against in newborns?

They are too sedating Signup and view all the answers

Which of the following decongestants is classified as a systemic agent?

Pseudoephedrine Signup and view all the answers

What effect does Dextromethorphan have?

Acts as a cough suppressant Signup and view all the answers

What is true regarding the absorption characteristics of second-generation antihistamines?

Food intake may delay absorption Signup and view all the answers

Which drug interaction is most commonly associated with Levalbuterol?

With MAOIs Signup and view all the answers

Which medication class is primarily aimed at treating inflammation in the lungs?

Corticosteroids Signup and view all the answers

Study Notes

Beta-Adrenergic Agonists

Beta-adrenergic agonists bind to the beta 2 receptor, activating adenylate cyclase.
This increases cyclic AMP, which decreases cytosolic calcium levels.
This leads to bronchodilation or bronchial smooth muscle relaxation.
Beta-adrenergic agonists are indicated for reversible bronchospasm in Asthma, COPD, RAD, and bronchitis.
Beta-adrenergic agonists are not considered RAD after age 2 years.
Adverse effects include tremors, heart palpitations, hypokalemia, reduction in O2 saturation, anxiety, headache, throat irritation/cough, dizziness, muscle cramps, insomnia, and nausea.
Hypokalemia is clinically significant with long term or continuous use of beta-adrenergic agonists.
Beta-adrenergic agonists can increase the risk of arrhythmias in patients on digoxin and should be monitored closely.
Patients with pheochromocytoma should avoid B2 agonists as they can cause a hypertensive crisis.
A positive response in asthma is an increase of 200 ml or 12% in FEV1 compared to baseline.
Beta-adrenergic agonists are metabolized in the liver and excreted in the urine (renal).
Elderly patients should receive a lower dose.
Avoid NSAIDs.
One minute should be between puffs.
Use beta-adrenergic agonist before controller medications, not after.

Albuterol (SABA)

Albuterol is a short-acting beta-2 adrenergic agonist.
Albuterol's mechanism of action is by stimulating B2 receptors in the smooth muscles of the airways.
This leads to muscle relaxation and bronchodilation.
Albuterol is the drug of choice as first-line therapy for bronchospasm in Asthma, COPD, RAD, and bronchitis.
Patients on digoxin require close monitoring due to the increased risk of heart rhythm abnormalities.
This is due to the fact that albuterol increases volume of distribution and decreases digoxin levels in the blood.
Albuterol is the preferred treatment for patients with pheochromocytoma due to its short duration.

Ipratropium and Tiotropium (Anticholinergics)

Anticholinergics block the action of acetylcholine at the muscarinic receptors in the airways.
This leads to bronchodilation.
Ipratropium is a short-acting anticholinergic that is indicated for reversible bronchospasm in Asthma and COPD.
Tiotropium is a long-acting anticholinergic indicated for maintenance therapy of COPD.
Anticholinergics can cause dry mouth, constipation, blurred vision, and urinary retention.

Inhaled Corticosteroids (Beclomethasone, Budesonide, and Fluticasone)

Inhaled Corticosteroids (ICS) reduce airway inflammation by reducing inflammation in the airways.
This involves suppressing the production of pro-inflammatory mediators, such as leukotrienes and cytokines.
ICS are indicated for maintenance therapy of Asthma and COPD.
Common side effects include thrush (oral candidiasis), dysphonia (hoarseness of voice), and suppression of the hypothalamic-pituitary-adrenal (HPA) axis, especially with high doses.

Leukotriene Modifiers (Montelukast)

Leukotriene modifiers block the action of leukotrienes.
Leukotrienes are inflammatory mediators that contribute to airway inflammation.
Leukotriene modifiers are indicated for the prophylaxis and treatment of asthma.
Common side effects include headache, nausea, and diarrhea.

Antihistamines (Diphenhydramine, Brompheniramine, Cetirizine, Fexofenadine, and Azelastine)

Antihistamines block the action of histamine at the H1 receptor.
Histamine is a chemical that is released by the body during an allergic reaction.
Antihistamines are indicated for the treatment of allergic rhinitis, allergic conjunctivitis, and urticaria.
Common side effects include drowsiness, sedation, dry mouth, urinary retention, and constipation.

Decongestants (Phenylephrine, Pseudoephedrine, and Oxymetazoline)

Decongestants work by constricting blood vessels in the nasal passages.
This reduces swelling and congestion.
Decongestants are indicated for the treatment of nasal congestion.
Common side effects include insomnia, anxiety, and hypertension.

Cough Preparations (Dextromethorphan and Guaifenesin)

Dextromethorphan is an antitussive that suppresses the cough reflex.
Guaifenesin is an expectorant that helps to thin mucus.
Cough preparations are indicated for the treatment of cough.
Common side effects include drowsiness, dizziness, and nausea.

Antihistamines

Antihistamines block the action of histamine at H1 receptors.
They do not block H2 receptors.
Some bind to muscarinic receptors.
Antihistamines strongly block the physiological effects of histamines.
Antihistamines decrease the flare and itch response.
Antihistamines can cause CNS depression in therapeutic doses.
Drug overdose includes CNS stimulation, convulsions, and sensitivity in children.
Drug interactions include interactions with CNS depressants.
There is a large margin of safety for antihistamines.
Use with caution in the 3rd trimester, nursing/newborn infants, the elderly, young children, and patients whose conditions may be aggravated by blocking muscarinic receptors.
Indications for antihistamines include allergic rhinitis and conjunctivitis (seasonal).
There is no lab monitoring required for antihistamines.

First-Generation Antihistamines

First-generation antihistamines are lipid-soluble amines.
First-generation antihistamines are well-absorbed from the GI tract.
First-generation antihistamines are metabolized in the liver.
First generation antihistamines are contraindicated in breastfeeding and in giving to newborns/premature infants (convulsions).
First-generation antihistamines should be used with caution in children due to the possible paradoxical CNS stimulation.

Second-Generation Antihistamines

Second-generation antihistamines are rapidly absorbed from the GI tract.
Second-generation antihistamines should be taken with food to decrease and delay absorption.
Second-generation antihistamines have more generic forms and are inexpensive.
Second-generation antihistamines do not impair daytime functioning.
Second-generation antihistamines have a longer-acting effect, requiring less frequent dosing (1-2x/day).
Second-generation antihistamines are well-tolerated and are preferred.

Diphenhydramine (Oral Antihistamine)

Diphenhydramine is a first-generation H1 receptor agonist.
Diphenhydramine competes with histamine for H1 receptor sites on effector cells.
Diphenhydramine is highly sedating.
Diphenhydramine can cause fatigue and lassitude, dizziness, headache, and tinnitus.
Diphenhydramine is contraindicated in newborns and infants.
Diphenhydramine can be used in pregnancy, categorized as B.

Levalbuterol

Levalbuterol is a short-acting B2 agonist.
Levalbuterol is half the dose of albuterol.
Levalbuterol stimulates the enzyme.
Side effects of levalbuterol include headache, tremors, and nervousness.
Levalbuterol is FDA approved for children.
Inactive metabolites of levalbuterol account for 50% of the drug excreted unchanged in urine.

Tiotropium

Tiotropium is a long-acting anticholinergic that can be used for COPD
Tiotropium causes bronchospasm.
Tiotropium has a creatinine clearance of 99% protein bound.
There are no human studies regarding the use of tiotropium in relation to BBB & breast milk.
In rats, Tiotropium crossed the BBB and into breast milk.

Severe Diastolic Blood Pressure (Hypertension)

Severe diastolic blood pressure can interfere with uterine contractility.
Severe diastolic blood pressure is safe for infants and children.
Severe diastolic blood pressure is metabolized by the liver and eliminated by the kidneys.
Thyroid hormones enhance the cardiac effects of both drugs.
Severe diastolic blood pressure is contraindicated in CAD.
There are drug interactions with digoxin, MAOIs, TCAs, BB, cocaine, thyroid hormones, and ritodrine.

First Generation Antihistamines

First generation antihistamines are primarily metabolized by the liver
They do not prevent histamine release or bind with histamine that has already been released
First generation antihistamines are associated with adverse effects including:
- Disturbed coordination in those who are drowsy or have reduced mental alertness
- Nausea or vomiting
- Irritability or nervousness
- Blurred vision
- Diplopia
- Tremors
- Increased or decreased appetite
- Epigastric distress
- Constipation
- Diarrhea
- Dry mouth
- Urinary retention
- Dysuria
- Tachycardia
Contraindications include narrow-angle glaucoma, lower respiratory infections, stenosing peptic ulcer, symptomatic BPH, bladder neck obstruction, pyloroduodenal obstruction, and MAOI use
First generation antihistamines cannot be used in newborns and premature infants
First generation antihistamines cannot be taken while breastfeeding

Brompheniramine (1st Generation Antihistamine)

Binds non-selectively to central H1 receptors
Indicated for allergic and vasomotor rhinitis
Side effects include:
- CNS stimulation and depression
- Pruritus
- Conjunctivitis
Brompheniramine is metabolized hepatically and eliminated renally
Brompheniramine crosses the blood-brain barrier and is found in breast milk

Second Generation Antihistamines

Second generation antihistamines are less sedating than first generation antihistamines
Second generation antihistamines have a lower incidence of dry mouth
Second generation antihistamines are associated with fewer CNS side effects
Using a second generation antihistamine with another H1 blocker may cause sedation

Cetirizine (2nd Generation Antihistamine)

Cetirizine selectively blocks peripheral H1 receptors
Indicated for allergic rhinitis, chronic urticaria, and pruritus
Cetirizine does not cross the blood-brain barrier in appreciable amounts
Cetirizine is generally safe to use in children aged 6 months and older
Cetirizine can be given to children at higher than recommended doses
Contraindications include hypersensitivity to levocetirizine and hydroxyzine
Cetirizine has fewer contraindications than first generation antihistamines
Cetirizine cannot be taken during the third trimester of pregnancy
Cetirizine can be used during pregnancy (category B and C)
Cetirizine can be used with other H1 blockers

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Explore the role of beta-adrenergic agonists in treating respiratory conditions such as asthma and COPD. This quiz covers mechanisms, indications, adverse effects, and monitoring requirements associated with these medications. Test your understanding and knowledge of this essential topic in pharmacology and respiratory care.