Respiratory Quiz

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Questions and Answers

What is the primary mechanism of action for beta 2 adrenergic agonists?

Activate beta2 adrenergic receptors (correct)

Relax bronchial smooth muscles

Inhibit inflammatory mediators

Block muscarinic receptors

Which of the following is a common adverse effect associated with the use of inhaled short-acting beta 2 agonists?

Hypotension

Tachycardia (correct)

Nausea

Cough

What is a contraindication for the use of beta 2 adrenergic agonists?

Pregnancy

Chronic obstructive pulmonary disease

Asthma

Beta blockers (correct)

What is the therapeutic range for the drug theophylline?

5-15 mcg/mL Signup and view all the answers

Which adverse effect is particularly related to the use of inhaled glucocorticoids?

Candidiasis Signup and view all the answers

For what condition is ipratropium primarily used?

COPD Signup and view all the answers

Which route of administration is NOT commonly associated with epinephrine?

Oral Signup and view all the answers

What is a potential consequence of excessive use of inhaled short-acting beta 2 agonists?

Prolonged bronchospasm Signup and view all the answers

What type of medication is most effective for acute bronchospasm?

Short-acting beta agonists Signup and view all the answers

What should be a special nursing implication when administering theophylline?

Check for caffeine intake Signup and view all the answers

What is the primary mechanism of action of leukotriene modifiers like montelukast?

Decrease bronchoconstriction and mucus secretion Signup and view all the answers

Which of the following adverse effects is associated with the use of beclomethasone?

Dry nasal mucosa Signup and view all the answers

What is the main function of mast cell stabilizers like cromolyn sodium?

Prevent the release of histamine from mast cells Signup and view all the answers

Which statement best describes the main clinical use of omalizumab?

To block IgE binding to receptors on mast cells Signup and view all the answers

What is a potential serious adverse effect of using montelukast?

Neuropsychiatric events Signup and view all the answers

What primary action do sympathomimetics like pseudoephedrine perform in nasal congestion?

Reduce blood flow to nasal mucosa Signup and view all the answers

Which medication is contraindicated for individuals with hypertension and coronary artery disease?

Pseudoephedrine Signup and view all the answers

What is the role of expectorants like guaifenesin in respiratory therapy?

Make cough more productive Signup and view all the answers

What mechanism does acetylcysteine utilize as a mucolytic?

Thins mucus to improve flow Signup and view all the answers

Which of the following is a common adverse effect of first-generation antihistamines like diphenhydramine?

Sedation Signup and view all the answers

Study Notes

Bronchodilators

Beta 2 Adrenergic Agonists (-terol) - sympathomimetics that activate beta 2 adrenergic receptors causing bronchodilation
- Short-acting (albuterol, levalbuterol): used for acute bronchospasm
  - Most effective drugs for acute bronchospasm
  - Oral route: Can be used on a fixed schedule for long-term control
  - Adverse effects: Tachycardia, angina, muscle tremors, insomnia, anxiety
- Long-acting (salmeterol, arformoterol, formoterol): used on a fixed schedule for long-term control
  - Preferred over short-acting for stable COPD
  - Adverse effects: *Increased risk of severe asthma and asthma-related death when used as monotherapy
  - Nursing implications: Avoid beta-blockers and NSAIDs
Epinephrine: Used for acute attacks of bronchoconstriction
- Routes: Inhalation, Subcutaneous
- Therapeutic rescue effects: In less than 5 minutes
Anticholinergic Bronchodilators: Block muscarinic receptors in bronchi to reduce bronchoconstriction and mucus secretion
- Prototype: Ipratropium (Atrovent)
  - Approved for COPD, but used off-label for asthma
- Tiotropium (Spiriva): Long-acting, preferred for COPD
- Adverse effects: Cough, nervousness, nausea, GI upset, dizziness
- Contraindications: Glaucoma
Methylxanthines: Relax bronchial smooth muscles
- Prototype: Theophylline
- Not commonly used anymore, but may be prescribed for severe COPD/bronchitis as a second-line drug
- Therapeutic range: 5-15 mcg/mL
- Toxic levels: Above 20 mcg/mL
  - Adverse effects: Seizures, tachycardia, dysrhythmia
- Nursing implications: Avoid cimetidine, ciprofloxacin, and caffeine

Anti-inflammatory Drugs

Glucocorticoids: Suppress inflammation, decrease synthesis and release of inflammatory mediators (leukotrienes, histamine, prostaglandins)
- Inhaled: First-line therapy for management of inflammatory component of asthma
  - Prototype: Beclomethasone
  - Other inhaled drug examples: Budesonide, Fluticasone propionate, Mometasone furoate
  - Route: Scheduled, not for PRN use
- Oral: Used for maintenance of moderate to severe persistent asthma
  - Examples: Prednisone, Methylprednisolone
- Adverse effects: Oropharyngeal candidiasis, hoarseness, dry mouth
- Nursing implications: Rinse mouth with water after use
Leukotriene Modifiers: Block leukotrienes, which promote smooth muscle constriction, blood vessel permeability, inflammatory responses, and inflammatory cell recruitment
- Prototype: Montelukast (PO leukotriene receptor blocker)
- Use: Second-line therapy when inhaled glucocorticoids are contraindicated or ineffective, and add-on therapy
- Adverse effects: Neuropsychiatric events (black box warning)
- Route: Oral (slow-acting)
Immunosuppressant Monoclonal Antibodies: Inhibit IgE binding to IgE receptors on mast cells and basophils, reducing allergic response
- Prototype: Omalizumab
- Adverse effects: Anaphylaxis with first injection, anaphylaxis occurrence more than one year after initial dose (black box warning)
Mast Cell Stabilizer: Prevent mast cell degranulation and release of inflammatory mediators
- Prototype: Cromolyn sodium
- Uses: Used when glucocorticoids are contraindicated or ineffective, not effective for acute attacks
- Administration: Nebulizer for asthma, taken when anticipating exertion

Drugs for URI Allergic response

Glucocorticoids: Suppress congestion, rhinorrhea, sneezing, nasal itching, and erythema
- Prototype: Beclomethasone
- Route: Intranasal
- Adverse effects: Dry nasal mucosa, burning or itching sensation, sore throat, epistaxis, headache
Antihistamines: Relieve sneezing, rhinorrhea, and nasal itching, but not nasal congestion
- First generation: Diphenhydramine
  - Adverse effects: Sedation
- Second generation: Cetirizine
  - Advantages: Less sedation
- Third generation: Fexofenadine
  - Advantages: Less sedation
- Route: Oral
Sympathomimetics (Decongestants): Reduce nasal congestion by activating alpha 1-adrenergic receptors on nasal blood vessels
- Prototype: Pseudoephedrine (Sudafed)
  - Route: Oral
- Adverse effects: Rebound congestion, CNS stimulation, cardiovascular effects, potential for abuse
- Contraindications: Hypertension, coronary artery disease, cardiac arrhythmias, cerebrovascular disease
- Nursing implications: Only use topical agents for 3-5 days, watch out for stimulants and other decongestants in combination drugs
Phenylephrine (Neo-Synephrine): Drops, spray, oral
- Adverse Effects: Same as pseudophedrine
- Contraindications: Same as pseudophedrine
Oxymetazoline (Afrin): Spray
- Adverse effects: Same as pseudophedrine
- Contraindications: Same as pseudophedrine

Drugs for Cough

Antitussives: Supress cough by numbing stretch receptors in the lung to reduce cough
- Opioids
  - Prototype: Codeine
  - Other examples: Hydrocodone (Hycodan)
  - Adverse effects: Sedation, respiratory depression, death
- Non-opioids
  - Prototype: Dextromethorphan (Delsym, Robitussin)
  - Other examples: Benzonatate (Tessalon, Zonatuss)
  - Adverse effects: Nausea, drowsiness, rash, difficulty breathing
Expectorants: Make cough more productive by stimulating flow of respiratory tract secretions
- Prototype: Guaifenesin (Mucinex, Humibid)
- Nursing implications: Maintain patent airway, monitor oxygenation, encourage adequate fluid intake, elevate HOB, auscultate lung sounds, assess characteristics of sputum, monitor for sedation and other adverse effects
Mucolytics: Make mucus more watery to make cough more productive
- Prototype: Acetylcysteine (Mucomyst): Inhalation
- Nursing considerations: Same as Expectorants

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