40 Questions
What is Chronic Obstructive Pulmonary Disease?
A disease that affects the airways of the lungs
What causes the airways of the lungs to become narrow in COPD?
All of the above
What type of inhaler is used as a rescue inhaler for acute episodes of COPD?
Short-acting beta inhaler
What is the most commonly used short-acting beta-2 specific bronchodilating beta agonist?
Albuterol
Why should SABAs not be used too frequently?
They increase systemic effects
What is the purpose of LABAs in COPD treatment?
To provide maintenance therapy for COPD
Which of the following LABAs should never be given more than twice daily or exceeded the maximum daily dose?
Salmeterol
What is the main difference between SABAs and LABAs?
SABAs are used for acute episodes, while LABAs are used for maintenance
Why are SABAs used in patient education for rapid/onset of respiratory episode?
All of the above
Which of the following is NOT a characteristic of COPD?
Reversible airflow limitation
What is the combination of vilanterol and fluticasone known as?
Breo Ellipta
What type of receptors do non-selective adrenergics stimulate?
Alpha, beta-1, and beta-2 receptors
What is the indication for using beta-2 agonists?
Relief of bronchospasm in asthma and COPD patients
What is a contraindication for using beta-2 agonists?
Uncontrolled hypertension
What is a common adverse effect of albuterol?
All of the above
How often should salmeterol be taken?
Twice daily
What is the mechanism of action of anticholinergics?
Inhibition of ACh receptors
What is the indication for using ipratropium?
Prevention of bronchospasms associated with chronic bronchitis or emphysema
What is a common adverse effect of ipratropium?
Dry mouth or throat
What is the only xanthine derivative used as a bronchodilator?
Theophylline
What is the therapeutic blood level range for the medication Aminophylline?
10-20mcg/ml
Which of the following is a contraindication for Leukotriene Receptor Antagonist (LRTAs)?
Allergy to povidone
What is the primary effect of Aminophylline on the cardiovascular system?
Cardiac stimulation and increased heart rate
Which of the following is an indication for Aminophylline?
Mild or Moderate cases of acute asthma
What is the primary mechanism of action of Leukotriene Receptor Antagonist (LRTAs)?
Non-bronchodilating
Which of the following is a side effect of Aminophylline?
Nausea and vomiting
Why is it recommended to avoid caffeine when taking Aminophylline?
Because caffeine increases the metabolism of Aminophylline
Which of the following is an approved indication for Montelukast?
Allergic rhinitis
What is the effect of Aminophylline on the kidneys?
Diuretic effect
When can improvement be seen with the use of Leukotriene Receptor Antagonist (LRTAs)?
Within 1 week
What is the primary use of inhaled corticosteroids in the treatment of asthma?
To control the inflammatory responses that are believed to be the cause of bronchospastic disorders
What is a common side effect of inhaled corticosteroids?
Pharyngeal irritation
Why are systemic corticosteroids generally used to treat acute exacerbations or severe asthma?
Because they are more effective in treating acute exacerbations or severe asthma
What is a nursing implication for patients taking beta-adrenergic agonist therapy?
All of the above
What is a contraindication for the use of inhaled corticosteroids?
Patients whose sputum test positive for Candida organisms
What is a nursing implication for patients taking xanthine derivatives?
All of the above
What is the mechanism of action of inhaled corticosteroids?
Stabilizing membranes of cells that release harmful bronchoconstricting substances
What is a nursing implication for patients taking LRTAs?
Ensure that the drug is being used for chronic management of asthma, not acute asthma
What is a common combination therapy for asthma treatment?
Inhaled corticosteroids and beta-adrenergic agonist bronchodilators
What is a nursing implication for patients taking inhaled corticosteroids?
Teach patients to gargle and rinse the mouth with lukewarm water after use to prevent oral fungal infections
Study Notes
Chronic Obstructive Pulmonary Disease (COPD)
- COPD occurs when the airways of the lungs become narrow, leading to recurrent and reversible shortness of breath
- Narrowing of airways is caused by bronchospasms, inflammation of the bronchial mucosa, edema of the bronchial mucosa, and production of viscous mucus
Beta-Adrenergic Agonists
- Used to treat bronchospasm related to asthma, bronchitis, and other pulmonary diseases
- Three types: nonselective adrenergics, nonselective beta-adrenergics, and selective beta-2 drugs
- Examples: epinephrine, metproterenol, and albuterol
- Indications: relief of bronchospasm, treatment and prevention of acute attacks
- Contraindications: known drug allergy, uncontrolled hypertension, cardiac dysrhythmias, and high risk of stroke
- Adverse effects: insomnia, restlessness, anorexia, vascular headache, hyperglycemia, tremor, and cardiac stimulation
Short-Acting Beta-2 Agonists (SABAs)
- Used as rescue inhalers for acute episodes
- Examples: albuterol (Ventolin, ProAir), levalbuterol (Xopenex), and terbutaline (Brethine)
- Patient education: used for rapid onset of respiratory episode, must not be used too frequently
Long-Acting Beta-2 Agonists (LABAs)
- Used as maintenance medications
- Examples: arformoterol (Brovana), formoterol (Foradil, Perforomist), and salmeterol (Serevent)
- Patient education: used for chronic management of asthma, not for acute asthma treatment
Anticholinergics
- MOA: bind to ACh receptors, preventing ACh binding, resulting in prevention of bronchoconstriction and airway dilation
- Examples: ipratropium (Atrovent), tiotropium (Spiriva), and aclidinium (Tudorza)
- Indications: prevention of bronchospasms associated with chronic bronchitis or emphysema
- Adverse effects: dry mouth or throat, nasal congestion, heart palpitations, gastrointestinal distress, headache, coughing, and anxiety
Xanthine Derivatives
- Only theophylline is used as a bronchodilator
- Decreases cAMP levels, causes smooth muscle relaxation, bronchodilation, and increased airflow
- Also known as Aminophylline, given IV for treatment of patients with status asthmaticus
- Therapeutic blood level range: 10-20mcg/ml, now most clinicians advise levels between 5 and 15 mcg/ml
- Drug effects: cardiac stimulation, increased force of contraction, and increased heart rate
- Patient education: avoid caffeine, teach patients to take medications exactly as prescribed, and report adverse effects
Leukotriene Receptor Antagonists (LRTAs)
- Nonbronchodilating
- Newer class of asthma medications
- Examples: montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo)
- Indications: prophylaxis and long-term treatment and prevention of asthma in adults and children 12 years of age and older
- Contraindications: known drug allergy, previous adverse drug reaction, and allergy to inactive ingredients
- Patient education: approved for treatment of allergic rhinitis, improvement seen in about 1 week, and report adverse effects
Corticosteroids
- Naturally occurring or synthetic drugs used for their anti-inflammatory effects
- MOA: stabilize membranes of cells that release harmful bronchoconstricting substances, increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation
- Indications: primarily used to treat bronchospastic disorders, persistent asthma, and often used concurrently with beta-adrenergic agonist
- Adverse effects: pharyngeal irritation, coughing, dry mouth, oral fungal infections, and systemic effects
- Patient education: teach patients to take medications exactly as prescribed, report adverse effects, and monitor for therapeutic effects
Nursing Implications
- Encourage patients to take measures to prevent, relieve, or decrease symptoms of COPD
- Perform a thorough assessment before beginning therapy, including skin color, baseline vitals, respirations, respiratory assessment, and pulse oximetry
- Teach patients to take bronchodilators exactly as prescribed, report adverse effects, and monitor for therapeutic effects
- Ensure patients know how to use inhalers and MDIs, and provide a demonstration to ensure successful administration
This quiz covers the definition, symptoms, and treatment of Chronic Obstructive Pulmonary Disease (COPD), a lung condition characterized by recurring and reversible shortness of breath. Learn about the causes, such as bronchospasms, inflammation, and mucus production, and the role of rescue inhalers like albuterol.
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