Podcast
Questions and Answers
What are the two most common diseases classified under COPD?
What are the two most common diseases classified under COPD?
- Asthma and emphysema
- Chronic bronchitis and pneumonia
- Emphysema and chronic bronchitis (correct)
- Pulmonary fibrosis and asthma
What is the primary goal in the initial treatment of mild to moderate COPD exacerbation?
What is the primary goal in the initial treatment of mild to moderate COPD exacerbation?
- Reducing bronchospasm and clearing sputum (correct)
- Improving lung elasticity
- Treating underlying infections
- Increasing oxygen saturation levels
Why is careful monitoring of oxygen levels critical for patients with COPD?
Why is careful monitoring of oxygen levels critical for patients with COPD?
- Inadequate oxygen can lead to pulmonary hypertension.
- Excessive oxygen can eliminate their hypoxic respiratory drive. (correct)
- These patients need high oxygen levels to breathe effectively.
- They can develop respiratory alkalosis with too much oxygen.
What is considered an adequate SaO2 level for patients with long-standing COPD?
What is considered an adequate SaO2 level for patients with long-standing COPD?
Which medications are commonly used to manage COPD similarly to asthma?
Which medications are commonly used to manage COPD similarly to asthma?
Which type of trigger for asthma is classified as intrinsic?
Which type of trigger for asthma is classified as intrinsic?
What is the primary goal in managing asthma?
What is the primary goal in managing asthma?
Which medication is considered the first line for treating acute bronchospasm in asthma patients?
Which medication is considered the first line for treating acute bronchospasm in asthma patients?
Which receptor do inhaled beta2-specific drugs primarily target?
Which receptor do inhaled beta2-specific drugs primarily target?
What distinguishes Levalbuterol from Albuterol?
What distinguishes Levalbuterol from Albuterol?
Which generation of beta agonists primarily target beta2 receptors with minimal systemic effects?
Which generation of beta agonists primarily target beta2 receptors with minimal systemic effects?
What is a potential side effect of stimulating beta1 receptors with asthma medications?
What is a potential side effect of stimulating beta1 receptors with asthma medications?
When intravenous medications are administered for asthma, what is usually true?
When intravenous medications are administered for asthma, what is usually true?
What is the primary aim of prehospital care in cases of acute respiratory distress?
What is the primary aim of prehospital care in cases of acute respiratory distress?
What is bronchospasm primarily caused by?
What is bronchospasm primarily caused by?
Why has the use of oxygen in certain conditions become controversial?
Why has the use of oxygen in certain conditions become controversial?
Which type of bronchodilator acts primarily on the beta2 receptors to minimize side effects?
Which type of bronchodilator acts primarily on the beta2 receptors to minimize side effects?
What is a potential reason for a patient to require a transtracheal catheter?
What is a potential reason for a patient to require a transtracheal catheter?
What effect can excessive doses of beta2 agonists have on patients?
What effect can excessive doses of beta2 agonists have on patients?
What condition is NOT typically treated by administering bronchodilators?
What condition is NOT typically treated by administering bronchodilators?
What defines nonselective bronchodilators?
What defines nonselective bronchodilators?
Which of the following statements about oxygen is true?
Which of the following statements about oxygen is true?
Which of the following conditions requires cautious use of beta2 agonists?
Which of the following conditions requires cautious use of beta2 agonists?
How is asthma characterized in terms of its effect on the airways?
How is asthma characterized in terms of its effect on the airways?
What role does mucosal edema play in respiratory distress?
What role does mucosal edema play in respiratory distress?
In which demographic is respiratory distress most commonly encountered?
In which demographic is respiratory distress most commonly encountered?
Which of the following is an example of a nonselective bronchodilator?
Which of the following is an example of a nonselective bronchodilator?
What advanced life support intervention has been shown to significantly reduce mortality in patients with respiratory distress?
What advanced life support intervention has been shown to significantly reduce mortality in patients with respiratory distress?
What is a common symptom reported by patients experiencing bronchial constriction?
What is a common symptom reported by patients experiencing bronchial constriction?
What is the primary use of ipratropium bromide in respiratory treatments?
What is the primary use of ipratropium bromide in respiratory treatments?
Which of the following correctly describes the mechanism of action of ipratropium bromide?
Which of the following correctly describes the mechanism of action of ipratropium bromide?
What does the combination product albuterol/ipratropium (Combivent) aim to achieve?
What does the combination product albuterol/ipratropium (Combivent) aim to achieve?
Which symptom is indicative of a patient experiencing an exacerbation of asthma or COPD?
Which symptom is indicative of a patient experiencing an exacerbation of asthma or COPD?
When should corticosteroids be administered after the use of ipratropium bromide?
When should corticosteroids be administered after the use of ipratropium bromide?
What type of agent is considered more effective for asthma treatment compared to ipratropium?
What type of agent is considered more effective for asthma treatment compared to ipratropium?
What should be considered if there are concerns regarding patient compliance with steroid therapy?
What should be considered if there are concerns regarding patient compliance with steroid therapy?
Which of the following is true regarding bronchodilators in the management of asthma and COPD?
Which of the following is true regarding bronchodilators in the management of asthma and COPD?
Under what condition should corticosteroids be considered for an acute asthma exacerbation?
Under what condition should corticosteroids be considered for an acute asthma exacerbation?
What is the primary concern with using aminophylline as a second-line therapy for acute asthma exacerbations?
What is the primary concern with using aminophylline as a second-line therapy for acute asthma exacerbations?
Which medication is indicated for patients who do not show an adequate response to beta2 agonist therapy?
Which medication is indicated for patients who do not show an adequate response to beta2 agonist therapy?
What effect does epinephrine have that may pose a risk in asthma treatment?
What effect does epinephrine have that may pose a risk in asthma treatment?
Which side effect is a concern with the administration of epinephrine in asthma management?
Which side effect is a concern with the administration of epinephrine in asthma management?
In which situation is magnesium sulfate NOT recommended?
In which situation is magnesium sulfate NOT recommended?
What is a potential cardiovascular complication associated with epinephrine use in asthma treatment?
What is a potential cardiovascular complication associated with epinephrine use in asthma treatment?
What is the reason for considering cautious use of epinephrine in treating adult asthma patients?
What is the reason for considering cautious use of epinephrine in treating adult asthma patients?
Flashcards
Oxygen
Oxygen
The most common medication used in prehospital settings for treating respiratory distress. It helps deliver oxygen to the body's tissues.
Bronchospasm
Bronchospasm
A condition where the airways in the lungs become narrowed, making it difficult to breathe. This can be caused by inflammation or muscle spasms.
Bronchodilators
Bronchodilators
A group of medications used to widen the airways in the lungs, relieving the symptoms of bronchospasm.
Acute Pulmonary Edema
Acute Pulmonary Edema
Signup and view all the flashcards
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
Signup and view all the flashcards
Transtracheal Catheter
Transtracheal Catheter
Signup and view all the flashcards
Nasal Cannula
Nasal Cannula
Signup and view all the flashcards
Intubation
Intubation
Signup and view all the flashcards
Asthma Triggers
Asthma Triggers
Signup and view all the flashcards
Intrinsic Asthma Triggers
Intrinsic Asthma Triggers
Signup and view all the flashcards
Extrinsic Asthma Triggers
Extrinsic Asthma Triggers
Signup and view all the flashcards
Beta2-Specific Bronchodilator
Beta2-Specific Bronchodilator
Signup and view all the flashcards
Albuterol
Albuterol
Signup and view all the flashcards
Levalbuterol
Levalbuterol
Signup and view all the flashcards
Third-Generation Bronchodilators
Third-Generation Bronchodilators
Signup and view all the flashcards
Airway Obstruction
Airway Obstruction
Signup and view all the flashcards
Selective Beta2 Agonist
Selective Beta2 Agonist
Signup and view all the flashcards
Non-selective Bronchodilator
Non-selective Bronchodilator
Signup and view all the flashcards
Mucosal Edema
Mucosal Edema
Signup and view all the flashcards
Asthma
Asthma
Signup and view all the flashcards
What is COPD?
What is COPD?
Signup and view all the flashcards
What is chronic bronchitis?
What is chronic bronchitis?
Signup and view all the flashcards
What is emphysema?
What is emphysema?
Signup and view all the flashcards
What is hypoxic respiratory drive?
What is hypoxic respiratory drive?
Signup and view all the flashcards
Why is too much oxygen dangerous for COPD patients?
Why is too much oxygen dangerous for COPD patients?
Signup and view all the flashcards
Ipratropium Bromide (Atrovent) in Asthma
Ipratropium Bromide (Atrovent) in Asthma
Signup and view all the flashcards
Combivent: Albuterol + Ipratropium
Combivent: Albuterol + Ipratropium
Signup and view all the flashcards
Ipratropium vs Albuterol for Bronchospasm
Ipratropium vs Albuterol for Bronchospasm
Signup and view all the flashcards
Albuterol for Asthma, Ipratropium for COPD
Albuterol for Asthma, Ipratropium for COPD
Signup and view all the flashcards
Corticosteroids in Asthma & COPD Exacerbations
Corticosteroids in Asthma & COPD Exacerbations
Signup and view all the flashcards
Peak Expiratory Flow Rate (PEFR) in Exacerbations
Peak Expiratory Flow Rate (PEFR) in Exacerbations
Signup and view all the flashcards
PEFR < 50% & Corticosteroid Use
PEFR < 50% & Corticosteroid Use
Signup and view all the flashcards
Dexamethasone for Compliance Issues
Dexamethasone for Compliance Issues
Signup and view all the flashcards
When to consider corticosteroids for acute asthma exacerbation
When to consider corticosteroids for acute asthma exacerbation
Signup and view all the flashcards
The role of aminophylline and methylxanthines in acute asthma
The role of aminophylline and methylxanthines in acute asthma
Signup and view all the flashcards
Use of magnesium sulfate in asthma treatment
Use of magnesium sulfate in asthma treatment
Signup and view all the flashcards
Epinephrine's use in asthma
Epinephrine's use in asthma
Signup and view all the flashcards
Rebound bronchospasm with epinephrine
Rebound bronchospasm with epinephrine
Signup and view all the flashcards
Cardiovascular complications of epinephrine
Cardiovascular complications of epinephrine
Signup and view all the flashcards
Epinephrine in anaphylaxis and asthma
Epinephrine in anaphylaxis and asthma
Signup and view all the flashcards
Glucocorticoids in asthma treatment
Glucocorticoids in asthma treatment
Signup and view all the flashcards
Study Notes
Respiratory Emergencies - Drugs Used
- Respiratory distress is a common presentation for prehospital professionals.
- It affects all ages, genders, and ethnicities.
- Most prehospital care focuses on reversible bronchial constriction (bronchospasm), excluding acute pulmonary edema.
- Advanced Life Support (ALS) interventions, including respiratory medications, significantly reduce mortality in respiratory distress patients.
Oxygen
- Oxygen is the most frequently used medication in prehospital settings.
- Oxygen, like any drug, has associated benefits and risks.
- Oxygen use is now carefully titrated to specific oxygen saturation ranges (rather than indiscriminately applied) in situations like neonatal resuscitation, COPD exacerbations, and acute coronary syndromes.
- EMS providers should anticipate updates to guidelines as research evolves and paradigm shifts from traditional oxygen delivery approaches.
- Continuous oxygen use while at home can sometimes require surgical insertion of a transtracheal catheter (like nasal cannulas for long-term oxygen therapy in chronic lung disease).
Bronchodilators
- Asthma (an inflammatory lung disease with reversible airway obstruction) and COPD cause respiratory distress due to a narrowing of conducting airways.
- Patients describe feeling as if they are breathing through a straw.
- Bronchospasm (smooth muscle spasm) narrows airways.
- Mucosal edema (inflammation of lining) also thickens airways and reduces diameter.
- Increased secretions contribute to patient distress.
- Bronchodilators are categorized as selective or nonselective agents.
Selective Bronchodilators
- Selective agents primarily affect bronchial smooth muscle, minimizing side effects.
- Beta2 agonists (sympathomimetics) relax bronchial smooth muscle without triggering tachycardia or hypertension.
- Examples include albuterol, terbutaline, formoterol, and pirbuterol.
- Caution should be exercised with beta2 agonists in patients with heart disease.
- Monitor ECG readings before, during, and after administration.
Nonselective Bronchodilators
- Nonselective agents affect alpha, beta1, and beta2 adrenergic receptors.
- Alpha receptor stimulation constricts peripheral blood vessels, increasing blood pressure.
- Beta1 receptor stimulation increases heart rate and cardiac contractility.
- Beta2 receptor stimulation causes bronchodilation (relaxation of bronchial smooth muscle).
- Racemic epinephrine is an example of a nonselective bronchodilator.
Management of Asthma
- The primary focus of asthma management involves avoiding triggers and mitigating their effects.
- Initial prehospital care aims at reversing acute bronchospasm.
- First-line treatment involves inhaled beta2-specific drugs.
- IV medications are administered if inhaled bronchodilators are ineffective.
Albuterol (Proventil, Ventolin)
- Albuterol is a common inhaled bronchodilator selectively targeting beta2 receptors.
- Prior beta2 agonists may affect alpha and beta1 receptors, potentially causing unwanted effects in compromised patients (vasoconstriction, increased heart rate).
Levalbuterol (Xopenex)
- A "purified" version of albuterol; believed to elicit fewer side effects.
- Both albuterol and levalbuterol are effective in treating acute asthma exacerbations.
- Different generations of beta2-specific drugs have varying impacts on beta1 effects (first-gen have broader impact on beta1, second are more beta2-specific but still affect beta1 to some extent; third-gen predominantly target beta2).
Ipratropium (Atrovent)
- An anticholinergic, not an adrenergic agent.
- Effectively used in severe asthma exacerbations, particularly when patients have limited response to albuterol.
- Primarily effective on peripheral airways (as opposed to central bronchial tree effects with albuterol-type agents).
- Combination products (like Combivent) leverage the diverse mechanisms and anatomic sites of action of individual medications (albuterol/ipratropium) for delivery in one product.
Second-Line Therapies for Acute Asthma Exacerbation
- Consider corticosteroids for prolonged transport times, targeting inflammatory processes in asthma and COPD.
- Methylprednisolone and dexamethasone are common corticosteroids.
- Use peak expiratory flow rate (PEFR) to assess severity and monitor response to therapy.
- Start steroids when initial PEFR is below 50% predicted.
- Corticosteroids should be administered after ipratropium bromide when PEFR doesn't improve 10% or drops below 70% after 1 hour.
- Aminophylline (and related methylxanthines) are less commonly used to lessen smooth muscle bronchospasm.
Additional Medications
- Epinephrine is a subcutaneously administered medication that was once common for young asthma patients; it has a short duration and both beneficial and undesirable alpha and beta effects.
- Magnesium sulfate can be administered to some patients having an asthma attack who don't improve with beta2 agonist therapy.
COPD
- COPD encompasses obstructive lung diseases like emphysema and bronchitis, causing airway obstruction.
- Increased sputum production and bronchospasm result.
- Treatment is aimed at reducing bronchospasm and clearing sputum.
- Oxygen use in COPD patients requires careful consideration of hypoxic respiratory drive (patients need a degree of hypoxia to trigger breathing; too much oxygen removes this drive).
- Low 90s SaO2 levels are considered adequate with pulse oximetry in COPD monitoring.
- Bronchodilators and steroids are used for COPD management, similar to asthma treatment.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.