Respiratory Pharmacology Quiz

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Questions and Answers

What is bronchospasm primarily responsible for in patients with respiratory distress?

Decrease in mucosal thickness

Increase in airway diameter

Decrease in airway diameter (correct)

Increase in alveolar surface area

Which of the following is a primary characteristic of selective bronchodilators?

They act on all adrenergic receptors

They act preferentially on bronchial smooth muscle (correct)

They always cause tachycardia

They primarily target beta1 receptors

What is the potential risk of using excessive doses of beta2 agonists?

Tachycardia and hypertension (correct)

Hypotension and bradycardia

Increased secretion of mucus

Decreased airway resistance

Which medication is an example of a nonselective bronchodilator?

Racemic epinephrine Signup and view all the answers

Why is bronchodilation important for patients experiencing respiratory distress?

It relaxes bronchial smooth muscle Signup and view all the answers

Which receptor stimulation can lead to increased heart rate and cardiac contractility?

Beta1 receptors Signup and view all the answers

Acute asthma attacks can affect individuals of which age group?

All ages Signup and view all the answers

Mucosal edema in the respiratory tract leads to which of the following?

Thickening of mucosal linings 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 initial treatment goal for mild to moderate COPD exacerbation?

Reduce bronchospasm and clear sputum Signup and view all the answers

What happens if a patient with COPD receives too much oxygen?

It removes their hypoxic respiratory drive Signup and view all the answers

What is considered an adequate SaO2 level for monitoring patients with COPD?

In the low 90s Signup and view all the answers

How are bronchodilators and steroids used in the management of COPD?

Similar to the treatment of asthma Signup and view all the answers

What is the primary aim of prehospital care for respiratory distress?

Treating reversible bronchial constriction Signup and view all the answers

Which medication is most commonly used in the prehospital setting for respiratory issues?

Oxygen Signup and view all the answers

What is a concern about the indiscriminate application of oxygen in certain medical situations?

Oxygen can lead to unnecessary lung damage Signup and view all the answers

What is a key consideration for oxygen delivery in patients with COPD?

Providing oxygen according to prescribed saturation ranges Signup and view all the answers

What might patients with chronic lung disease receive if nasal cannulas are irritating?

Transtracheal catheters Signup and view all the answers

In which situation has the approach to oxygen use become controversial?

Neonatal resuscitation Signup and view all the answers

What condition is characterized by typically reversible airway obstruction?

Asthma Signup and view all the answers

What is a common feature of bronchodilators used for respiratory distress?

They help open narrowed airways Signup and view all the answers

What are intrinsic triggers for asthma?

Exercise Signup and view all the answers

Which medication is considered the first line for asthma management?

Inhaled beta2-specific drugs Signup and view all the answers

What is a primary focus in the management of asthma?

Avoiding triggers Signup and view all the answers

What class of medications is Albuterol categorized under?

Inhaled bronchodilators Signup and view all the answers

Which of the following statements is true regarding first-generation beta2 agonists?

They have varying effects on alpha and beta1 receptors. Signup and view all the answers

What is the key advantage of third-generation beta2 agonists compared to earlier generations?

They predominantly target beta2 receptors with minimal systemic effects. Signup and view all the answers

How does Levalbuterol differ from Albuterol?

Levalbuterol is a purified version believed to cause fewer adverse effects. Signup and view all the answers

What should be the management goal when emergency medical services are called for asthma?

To reverse acute bronchospasm Signup and view all the answers

When should corticosteroids be considered for asthma treatment?

If PEFR is less than 70% after 1 hour of therapy Signup and view all the answers

What is the current role of aminophylline in asthma exacerbations?

It is no longer recommended as a routine therapy Signup and view all the answers

In which patients is magnesium sulfate particularly beneficial?

Patients who do not improve after beta agonist therapy Signup and view all the answers

What are potential complications of using epinephrine for asthma?

Rebound bronchospasm and cardiac complications Signup and view all the answers

Why should epinephrine be used with caution in adults with asthma?

It may cause undesirable beta1 and alpha effects Signup and view all the answers

What is a common side effect of epinephrine that may impact its use in asthma treatment?

Tachycardia Signup and view all the answers

Under what condition might epinephrine still be indicated in asthma treatment?

If an anaphylactic reaction is suspected Signup and view all the answers

What adverse effect might occur with the administration of epinephrine due to its short-lived effects?

Rebound bronchospasm Signup and view all the answers

What is the primary role of ipratropium bromide in treating asthma exacerbations?

To provide additional symptomatic relief in severe cases. Signup and view all the answers

How does ipratropium bromide differ from adrenergic agents like albuterol?

It acts only on peripheral airways. Signup and view all the answers

In what situation should corticosteroids be considered during treatment?

In cases of prolonged transport time. Signup and view all the answers

What combination product utilizes both albuterol and ipratropium?

Combivent. Signup and view all the answers

What is a common characteristic of patients experiencing an asthma attack?

Gasping for breath and wheezing. Signup and view all the answers

Which corticosteroid might be administered if patient compliance is a concern?

Dexamethasone. Signup and view all the answers

What is the importance of measuring PEFR in asthma or COPD exacerbations?

It helps in assessing the severity of the exacerbation. Signup and view all the answers

What effect do bronchodilators have in asthma and COPD?

They provide symptomatic relief but do not treat the underlying causes. Signup and view all the answers

Study Notes

Respiratory Emergencies

Respiratory distress is a common presentation in pre-hospital settings, affecting all ages and ethnicities.
Acute respiratory distress, excluding pulmonary edema, often involves reversible bronchial constriction (bronchospasm).
Advanced life support (ALS) interventions, including respiratory medications, significantly reduce mortality in respiratory distress patients.

Oxygen

Oxygen is the most frequently used medication in pre-hospital settings.
As with any drug, oxygen has associated benefits and risks.
Oxygen use is increasingly approached with careful titration to prescribed oxygen saturation levels, rather than indiscriminate application. This is particularly crucial during neonatal resuscitation, COPD exacerbations, and acute coronary syndromes.
EMS providers must anticipate guideline updates related to oxygen delivery.
Continuous oxygen use by some patients with COPD may require transtracheal catheters (inserted surgically), supplementing traditional methods like nasal cannulas.
Nasal cannula use can sometimes be irritating at night, so patients may prefer transtracheal catheters, held in place by a necklace.

Bronchodilators

Asthma and COPD can lead to respiratory distress from airway narrowing.
Bronchospasm (smooth muscle spasm) and mucosal edema contribute to this narrowing.
Increased secretions further exacerbate respiratory distress.
Bronchodilators are medications to ease this.
They can be divided into selective (targeting beta2 receptors specifically to minimize side effects) and nonselective agents.
Beta2 agonists (like albuterol, terbutaline, formoterol, and pirbuterol) are sympathomimetic medications relaxing bronchial smooth muscle without causing tachycardia or hypertension. Be cautious in patients with heart disease. Monitor ECG during and after treatment.
Nonselective agents (like racemic epinephrine) target alpha, beta1, and beta2 receptors. Alpha receptor stimulation leads to vasoconstriction and blood pressure elevation, while beta1 receptor stimulation raises heart rate and cardiac contractility.

Asthma Management

Acute asthma attacks are often triggered by intrinsic (internal) or extrinsic (external) factors.
Intrinsic triggers include exertion and anxiety.
Extrinsic triggers include allergies to animal dander, dust, insect droppings, pollen, and cleaning chemicals.
Management focuses on avoiding triggers and mitigating their effects.
In the pre-hospital setting, reversing acute bronchospasm is a main concern.
First-line medications are inhaled beta2-specific drugs such as albuterol.
Levalbuterol (a newer, "purified" albuterol) is believed to cause fewer adverse effects.
If inhaled bronchodilators don't work, intravenous medications are used.
Ipratropium bromide (e.g., Atrovent) is a non-adrenergic anticholinergic agent helpful in more severe exacerbations, where patients might have less response to albuterol. It's particularly useful for patients with limited response or COPD. Combination medications like albuterol/ipratropium are also helpful.

COPD Management

COPD exacerbations present with symptoms like breathlessness, accessory muscle use, and wheezing.
Initial treatment targets reducing bronchospasm and mobilizing sputum.
In severe COPD exacerbations, oxygen is carefully administered, to avoid suppression of the patient's hypoxic respiratory drive.
SaO2 levels in the low 90's are acceptable, measured by pulse oximetry, depending on previous patient history.
Similar to asthma, bronchodilators and steroids can also be used for COPD management.

Second-Line Therapies

Consider corticosteroids (like methylprednisolone and dexamethasone) when the patient does not respond sufficiently to bronchodilators. Consider them if transport time is prolonged.
Consider magnesium sulfate for cases where beta2 agonists show inadequate response. This can help decrease bronchospasm.
Historically, epinephrine was a frequent treatment for young patients with asthma; however, it should be used cautiously in adults due to possible undesirable alpha/beta1 effects. Rebound bronchospasm is a potential concern with epinephrine.

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Description

Test your knowledge on the pharmacological management of respiratory distress and conditions like COPD. This quiz covers bronchodilators, medication risks, and treatment goals. Ideal for students in respiratory therapy or related health fields.