Bronchodilators

Question 1

Asthma

Answer 1

• Narrowing of the airways due to rapid swelling

Question 2

COPD

Answer 2

• Narrowing of the airways due to smoking, scarring, tissue damage

Question 3

Beta-Adrenergic Agonists

Answer 3

• Short acting to relieve acute symptoms
• Used first to open airways so that other medications can then be delivered more effectively
• Frequent use can lead to beta receptor desensitization, reducing effectiveness over time. This medication should be used in combination with other therapies

Question 4

Agonist vs. Antagonist

Answer 4

• Agonists bind to receptors to create a therapeutic response
• Antagonists bind to receptors to block their response

Question 5

Beta 1 Receptor

Answer 5

• Increase HR and contractility when stimulated

Question 6

Beta 2 Receptor

Answer 6

• Dilates both blood vessels and bronchi
• Mostly found in airways
• Non-selective beta blockers can be a risk for asthma and COPD patients because it will prevent this bronchodilation

Question 7

Beta-Adrenergic Agonist Mechanism of Action

Answer 7

• Med is delivered to specific beta 2 receptors, activating them
• Receptors stimulate adenylyl cyclase, causing an increase of cAMP
• cAMP causes relaxation of airway smooth muscle, producing bronchodilation

Question 8

Long Acting Beta Agonists

Answer 8

• Some beta agonists last longer than others
• Slower onset of action
• Longer effect
• Used preventatively

Question 9

Beta-Adrenergic Agonist Adverse Effects

Answer 9

• Loss of receptor selectivity at high doses, meaning beta 1 receptors are also stimulated and sympathetic activity is increased
• Cardiovascular: Hypertension (beta 1 stimulation) or hypotension (beta 2 stimulation dilates bronchioles, blood vessels dilate in response), tachycardia, palpitations, vascular headache
• Neuromuscular: tremor, nervousness
• Metabolic: Temporary decrease in K, Ph, Mg, increased glucose levels. Rarely clinically significant
• Side effects are increased by oral deposition so using a chamber can help decrease them

Question 10

Beta 1 Activation With Beta-Adrenergic Agonist Use

Answer 10

• Can be normal
• Can cause a nervous, jittery feeling and mild tachycardia during administration
• This is not an indication to hold the med, just continue monitoring

Question 11

Bronchodilator Contraindications

Answer 11

• Uncontrolled cardiac dysrhythmias because the heartrate is being increased
• High stroke risk because the med is vasoactive

Question 12

Salbutamol Cautions

Answer 12

• Arrhythmias
• Coronary insufficiency (not enough blood flow to heart)
• Hypertension
• Diabetes: may stimulate liver to create more glucose
• Glaucoma: may increase intraocular pressure
• Thyroid: may stimulate thyroid
• Hypokalemia: may decrease serum potassium
• Seizure disorders: stimulates CNS, may have to increase seizure med dose
• Renal impairment: can cause vasoconstriction to renal vessels

Question 13

Beta-Adrenergic Agonist Evaluations

Answer 13

• Ease of breathing
• Peak flow/spirometry
• Respiratory assessment trends

Question 14

Parasympathetic Response in Lungs

Answer 14

• Bronchoconstriction
• Increased secretions

Question 15

Anticholinergics (Long Acting Muscarinic Antagonist)

Answer 15

• Antagonist to parasympathetic responses
• Block cholinergic receptors
• Prevent acetylcholine from causing bronchoconstriction and increased secretions
• Slow and prolonged action
• Preventative, long-term

Question 16

Anticholinergic Suffix

Answer 16

ium

Question 17

LAMA Adverse Effects

Answer 17

• Some systemic effects
• Dry mouth/throat
• Nasal congestion - dryness can stimulate congestion
• Heart palpitation
• GI distress
• Urinary retention
• Increased intraocular pressure
• Headache
• Coughing
• Anxiety

Question 18

LAMA Interactions

Answer 18

• Possible additive toxicity when used with other anticholinergic drugs