Drugs for Respiratory Emergencies

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

When should corticosteroids be considered in the treatment of asthma exacerbation?

When PEFR improves by at least 10% after bronchodilator therapy

When PEFR is less than 70% after 1 hour of therapy (correct)

When the patient shows significant improvement with beta agonists

When the patient exhibits no signs of respiratory distress

What is the primary function of aminophylline and other methylxanthines in asthma treatment?

To improve pulmonary function through fluid retention

To act as a first-line treatment for all asthma patients

To reduce smooth muscle bronchospasm (correct)

To enhance the effects of glucocorticoids

In which scenario would magnesium sulfate be considered for asthma treatment?

Patients with mild, persistent asthma

Patients who do not respond adequately to beta-agonists (correct)

Patients under 12 years of age with asthma

Patients with a history of recurrent asthma attacks

What adverse effects are associated with epinephrine in asthma treatment?

Tachycardia and hypertension Signup and view all the answers

What is a potential complication of using epinephrine for asthma treatment?

Rebound bronchospasm Signup and view all the answers

Why have methylxanthines like aminophylline diminished in routine use for asthma?

They are associated with higher risks of side effects Signup and view all the answers

Which of the following is a desired effect of epinephrine in asthma management?

Strong beta2 effects Signup and view all the answers

What factor is important to consider when administering epinephrine to adults with asthma?

Beta1-mediated cardiac complications Signup and view all the answers

What is the primary effect of bronchospasm on the respiratory system?

Decreased airway diameter Signup and view all the answers

Which type of bronchodilator primarily targets bronchial smooth muscle?

Selective agents Signup and view all the answers

What potential adverse effects should paramedics monitor for when using excessive doses of beta2 agonists?

Tachycardia and hypertension Signup and view all the answers

What is a characteristic of non-selective bronchodilators?

Act on alpha, beta1, and beta2 receptors Signup and view all the answers

Which of the following examples is a beta2 agonist?

Terbutaline Signup and view all the answers

What is the physiological effect of stimulating beta2 receptors in the lungs?

Bronchodilation Signup and view all the answers

During treatment with beta2 agonists, what must paramedics regularly monitor?

Electrocardiogram Signup and view all the answers

What is a common trigger for acute asthma attacks?

Allergens Signup and view all the answers

Which of the following is considered an intrinsic trigger for asthma?

Exercise Signup and view all the answers

What is the primary goal in managing asthma?

Avoid triggers and mitigate their effects Signup and view all the answers

Which medication is primarily used as the first line of treatment for asthma?

Albuterol Signup and view all the answers

What happens when inhaled bronchodilators fail during an asthma attack?

Intravenous medications are given Signup and view all the answers

How did the first-generation beta2 agonists differ from the newer options?

They had significant effects on both beta1 and alpha receptors Signup and view all the answers

What is a significant advantage of third-generation medications for asthma over earlier generations?

Predominantly target beta2 receptors with minimal systemic effects Signup and view all the answers

Which of the following statements regarding Levalbuterol is accurate?

It is believed to have fewer adverse effects than albuterol. Signup and view all the answers

Which factors contribute to the need for more time between administering earlier beta2 agonists?

Adverse beta1 receptor effects increasing heart rate Signup and view all the answers

What are the two most common diseases classified under COPD?

Emphysema and chronic bronchitis Signup and view all the answers

What is the goal of treatment in mild to moderate COPD exacerbations?

To reduce bronchospasm and clear sputum Signup and view all the answers

Why is oxygenation in COPD patients required to be carefully monitored?

Excess oxygen can eliminate their hypoxic respiratory drive. Signup and view all the answers

What range of SaO2 levels is typically considered adequate for monitoring COPD patients?

In the low 90s% Signup and view all the answers

Which treatment options are commonly used to manage COPD exacerbations?

Bronchodilators and steroids Signup and view all the answers

What is the primary focus of prehospital care in respiratory distress situations?

Treatment of reversible bronchial constriction Signup and view all the answers

In which situation is the use of oxygen considered particularly controversial?

Neonatal resuscitation Signup and view all the answers

What is a potentially necessary device for long-term oxygen therapy in COPD patients?

Transtracheal catheter Signup and view all the answers

What significant change in oxygen delivery is anticipated for EMS providers in the future?

Moving towards more individualized oxygen saturation targets Signup and view all the answers

What common respiratory condition is characterized by typically reversible airway obstruction?

Asthma Signup and view all the answers

What is a drawback of long-term nasal cannula use for oxygen therapy?

It can irritate the nose during prolonged use Signup and view all the answers

What condition primarily affects the underlying airway function leading to respiratory distress in COPD patients?

Functional narrowing of the conducting airways Signup and view all the answers

Which of the following can be a consequence of incorrectly administered oxygen therapy?

Hyperoxia or oxygen toxicity Signup and view all the answers

What type of medication is ipratropium bromide classified as?

Anticholinergic agent Signup and view all the answers

In which condition is ipratropium bromide most beneficial compared to albuterol?

Severe asthma exacerbations Signup and view all the answers

Which statement about the mechanism of action of ipratropium bromide and albuterol is true?

Ipratropium has a peripheral action in the airways. Signup and view all the answers

When should corticosteroids be administered in relation to ipratropium bromide in an exacerbation?

After ipratropium bromide Signup and view all the answers

What is the purpose of bronchodilators in asthma and COPD?

To provide symptomatic therapy Signup and view all the answers

What combination product includes both albuterol and ipratropium?

Combivent Signup and view all the answers

Which corticosteroids are mentioned as commonly used for managing asthma symptoms?

Methylprednisolone and dexamethasone Signup and view all the answers

What does peak expiratory flow rate (PEFR) help to assess in asthma treatment?

The severity of the exacerbation and response to therapy Signup and view all the answers

Study Notes

Drugs Used to Treat Respiratory Emergencies

Respiratory distress is a common presentation in prehospital settings, affecting people of all ages, genders, and ethnicities.
While underlying causes vary, reversible bronchial constriction (bronchospasm) is a frequent target of prehospital treatment, excluding acute pulmonary edema.
Advanced life support interventions, including respiratory medications, significantly reduce mortality in respiratory distress cases.
Oxygen is the most frequently used medication in prehospital settings, but its use is increasingly controversial due to associated risks.
Oxygen use is now carefully titrated to target oxygen saturation ranges for specific situations, like neonatal resuscitation, COPD exacerbations, and acute coronary syndrome, rather than blanket application.
Ongoing research emphasizes a shift toward updated guidelines in oxygen delivery protocols.
Some COPD patients require continuous oxygen at home, often necessitating transtracheal catheters for long-term oxygen therapy.
Transtracheal catheters, similar to nasal cannulas, are surgically inserted and may be preferable to nasal cannulas for some patients.

Bronchodilators

Asthma and COPD often cause respiratory distress due to functional narrowing of conducting airways, leading to a sensation of breathing through a straw.
Bronchospasm, a spasm in bronchial smooth muscle, decreases airway diameter.
Mucosal edema within the respiratory tract further contributes to respiratory distress by thickening the lining and reducing airway diameter.
Increased secretions also worsen patient distress.
Bronchodilators are categorized as selective or nonselective, differing in their primary target receptors.
Selective bronchodilators (e.g., albuterol, terbutaline, formoterol, pirbuterol) preferentially target beta2 receptors to relax bronchial smooth muscle with reduced side effects, primarily avoiding tachycardia and hypertension.
Nonselective bronchodilators (e.g., racemic epinephrine) act on alpha, beta1, and beta2 adrenergic receptors, influencing peripheral blood vessels (alpha), heart rate and cardiac contractility (beta1), and bronchial smooth muscle relaxation (beta2).

Management of Asthma

Key management focus in asthma involves avoiding triggers and mitigating their impact whenever possible.
Initial prehospital management, when EMS is called, aims at reversing acute bronchospasm.
The first-line approach uses inhaled beta2-specific drugs.
Intravenous (IV) medications are used if inhaled bronchodilators fail, to reduce bronchospasm and inflammation.
The most common inhaled bronchodilator, albuterol (Proventil, Ventolin), targets beta2 receptors, but prior forms also affected alpha and beta1 receptors, potentially causing unwanted side effects like tachycardia.
Levalbuterol (Xopenex) is a newer, purified form of albuterol with fewer adverse effects, making it often preferred.
First-generation bronchodilators often have significant beta1 effects alongside beta2, while second-generation drugs are more focused on beta2 but may still influence other sites.
Third-generation drugs mainly target beta2 receptors.
Ipratropium bromide (Atrovent) is used for severe exacerbations or when a patient doesn't respond adequately to albuterol. It's considered an anticholinergic, not an adrenergic agent, and effectively targets peripheral airways (as opposed to central airways that are targeted by adrenergic agents).
Albuterol/ipratropium (Combivent) combines these two medications for efficient dual action targeting both central and peripheral airways.

Management of COPD

The first-line treatment approach for COPD exacerbations involves oxygenation and ventilation.
Oxygen administration should be handled carefully to ensure adequate but not excessive oxygenation.
COPD patients often have a hypoxic respiratory drive, requiring a certain degree of hypoxia to breathe normally.
High oxygen levels can suppress this drive. Therefore, the goal in COPD management is an adequate SpO2 (pulse ox) reading, typically in the low 90's range.
Treatment strategies for COPD exacerbations follow similar patterns with bronchodilators and steroids as seen with asthma treatment.

Second Line Therapy for Acute Exacerbations of Asthma

Key aspects of second-line strategies include identifying the cause of the attack, assessing its severity, and providing appropriate care tailored to the patient's individual circumstances.
The severity of exacerbation is often assessed with parameters like peak expiratory flow rate (PEFR).
Consider corticosteroids for persistent exacerbation when the underlying inflammation is evident.
Corticosteroids should be considered for exacerbations where improvement from bronchodilators is minimal, or the PEFR is low (below 70% of predicted).
Another strategy sometimes used is magnesium sulfate. However, it is not appropriate for all acute asthma attacks.
Older second-line agents that employ aminophylline and other methylxanthines, while once common, are now less often used for their role in relieving smooth muscle bronchospasm.
Epinephrine, while once a primary choice, is now used with caution, and primarily when dealing with short-lived bronchospasm responses among young patients.

Chronic Obstructive Pulmonary Disease (COPD)

COPD encompasses a group of lung diseases, including emphysema and bronchitis, characterized by airway obstruction.
Both conditions commonly cause increased sputum production, leading to bronchospasm and irritation.
Managing mild to moderate COPD exacerbations initially focuses on reducing bronchospasm and clearing secretions.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the medications used to manage respiratory emergencies, emphasizing the significance of oxygen therapy and its evolving guidelines. It highlights the role of respiratory medications in reducing mortality rates and addresses the specific needs of different patient populations in prehospital settings.