Respiratory Pharmacology Quiz

Oxygen is a commonly used medication in prehospital settings, but its use is becoming more controversial. There are pros and cons to consider. For instance, it's essential for neonatal resuscitation, but for conditions like COPD exacerbations and acute coronary syndrome, oxygen is being carefully regulated to prescribed saturation levels rather than indiscriminately administered.

Transtracheal catheters are surgically inserted devices that deliver continuous oxygen to patients with chronic lung disease. These catheters are favoured by some patients for their long-term use in place of nasal cannulas.

Bronchodilators are medications that help to open up the airways, relieving respiratory distress. They are critical for treating conditions like asthma and COPD, where the airways become narrowed.

Asthma is a respiratory condition characterized by airway inflammation, leading to reversible airway obstruction. This narrowing of the airways causes difficulty breathing.

Chronic obstructive pulmonary disease (COPD) is a lung condition marked by airflow obstruction and difficulty breathing. It's often caused by smoking, and leads to chronic respiratory distress.

Respiratory distress is a common medical emergency that affects people of all ages, genders, and backgrounds. This difficulty with breathing can be caused by various underlying conditions, and prehospital professionals play a vital role in their management.

Bronchospasm refers to the narrowing of airways, significantly restricting airflow during breathing. This is a hallmark of conditions like asthma and COPD.

Advanced Life Support (ALS) is a level of emergency medical care delivered by trained paramedics who can administer medications, perform advanced procedures, and provide critical care to patients in serious medical situations.

The narrowing of the airways due to the contraction of the smooth muscle in the bronchi.

Swelling of the mucous membrane lining the respiratory tract, making the airways narrower.

Medications that widen the airways by relaxing the smooth muscle in the bronchi.

Bronchodilators that preferentially target the beta2 receptors in the airways, leading to bronchodilation with minimal side effects.

A class of selective bronchodilators that stimulate the beta2 receptors, resulting in relaxation of bronchial smooth muscle.

Bronchodilators that act on both alpha, beta1, and beta2 adrenergic receptors.

The stimulation of alpha receptors, leading to constriction of peripheral blood vessels and increased blood pressure.

The stimulation of beta1 receptors, primarily located in the heart, resulting in increased heart rate and contractility.

Asthma attacks can be triggered by factors inside (intrinsic) or outside (extrinsic) the body.

Exercise, stress and anxiety are examples of intrinsic triggers, meaning they come from within the body.

Animal dander, dust, pollen and cleaning chemicals are examples of extrinsic triggers, meaning they come from outside the body.

The primary aim of asthma management is to avoid triggers and minimize their impact.

When asthma attacks cannot be prevented, emergency medical services (EMS) are called to reverse the acute airway narrowing (bronchospasm).

Inhaled beta2-specific drugs are the first-line treatment for asthma, but intravenous (IV) medications are used if inhaled treatment fails.

Albuterol (Proventil, Ventolin) is a commonly used inhaled bronchodilator that specifically targets beta2 receptors.

Newer generations of bronchodilators have become more specific to the beta2 receptors, minimizing unwanted side effects.

Ipratropium bromide, commonly known as Atrovent, is used for more severe cases of asthma and COPD. It's particularly helpful when the patient has a limited response to albuterol.

In cases of severe bronchospasm, ipratropium bromide works better than albuterol alone. This is because ipratropium bromide primarily affects the peripheral airways, while albuterol focuses more on the central airways.

Combivent combines the effects of albuterol and ipratropium bromide to effectively relax both central and peripheral airways.

Second-line therapy involves using corticosteroids to treat inflammation. These medications are used in combination with bronchodilators to provide comprehensive relief during an asthma exacerbation or COPD flare-up.

Methylprednisolone and dexamethasone are the commonly used corticosteroids for managing both asthma and COPD exacerbations. Both drugs are effective for moderate to severe symptoms.

In the case of a patient's nonadherence to long-term corticosteroid therapy, a single dose of dexamethasone may be given instead of a prolonged oral course.

PEFR (Peak Expiratory Flow Rate) is a simple and valuable tool for assessing the severity of an exacerbation, response to treatment, and the need for additional therapies like corticosteroids.

When a patient's initial PEFR is below 50% of the predicted value, corticosteroids should be administered after ipratropium bromide. This approach ensures effective management of severe exacerbations.

Corticosteroids are used when initial bronchodilators fail to improve PEFR by at least 10% after one hour, or when the PEFR is less than 70%.

Methylxanthines like aminophylline were once used as second-line treatments but are now rarely used in acute asthma due to limited benefit and potential side effects.

Magnesium sulfate can be helpful in acute asthma when beta2 agonists are ineffective. Its use is limited to those who don't respond to other treatments.

Epinephrine's beta2 effects help treat bronchospasm, but its alpha and beta1 effects can cause unwanted side effects like tachycardia and hypertension, limiting its use in adult asthma.

Epinephrine's short-lived effects and potential for rebound bronchospasm limit its routine use for adults with asthma.

Epinephrine can still be helpful for treating anaphylactic reactions, despite its limitations for asthma.

Repeated use of beta2 agonists can lead to desensitization, requiring higher doses for the same effect, and potentially causing unwanted side effects.

Short-acting beta2 agonists (SABAs) like albuterol are effective for immediate relief of bronchospasm but should not be solely relied upon for long-term asthma management.

Emphysema and chronic bronchitis are two of the most common diseases that contribute to COPD. They both cause an increase in sputum production and bronchospasm, which further worsens the condition.

In severe COPD exacerbations, treatment is first aimed at oxygenation and ventilation. However, excessive oxygen administration can be harmful for patients with long-standing COPD, as they rely on mild hypoxia to stimulate breathing. Therefore, a lower oxygen saturation level in the low 90s as measured by pulse oximetry is considered adequate.

Bronchodilators and steroids are used to treat COPD exacerbations, similar to their use in asthma. They help to open up the airways and reduce inflammation.

Initial treatment for mild to moderate COPD exacerbations focuses on reducing bronchospasm and clearing sputum from the airways. This can be achieved using bronchodilators and medications to thin the mucus.