Egan’s Chapter 32 Practice Questions:


1. What are adverse effects of Inhaled Corticosteroids?: Systemic: Adrenal Insufficiency, Extrapulmonary Allergy, Acute Asthma, HPA Suppression, Growth Retardation, Osteoporosis. Local: Oropharyngeal Fungal Infections, Dysphonia, Cough, Bronchoconstriction

2. What are common Inhaled Corticosteroids brand names?: Azmacort, Flovent, Pulmicort, Advair (Flovent and Serevent), Symbicort

3. What are side effects of the types of Non-Steroidal Antiasthma drugs?: Cromolyn-like: None. Antileukotrienes: Headache, Dyspepsia, Liver Enzyme elevation. Monoclonal Antibodies: Injection site reaction, Viral infections.

4. What are some adverse effects of using adrenergic bronchodilators?: CFC induced broncospasm, Dizziness, Hypokalemia (Hypopotassemia), Loss of bronchoprotection, Nausea, Tolerance (Tachyphylaxis), Worsening vent/perf ratio (decrease in PaO2), Inhalation gives fewer and less sever effects than oral administration.

5. What are some common side effects of using adrenergic bronchodilators?: Tremor, Headache, Insomnia, Nervousness.

6. What are the adverse effects of Spiriva and Atrovent?: Almost none as they are fully ionized.

7. What are the currently available Inhaled Anti-infective agents?: Pentamidine Isethionate (Nebupent): Used for treatment of P. carinii pneumonia [no longer recommended for use]. Ribavirin (Virazole): Used for treatment of severe lower respiratory tract infections caused by Respiratory Syncytial Virus (RSV) requires a Small Particle Aerosol Generator (SPAG) for administration. Side effects: Skin rash, eyelid erythema, conjunctivitis. Warnings: Pregnate women should not be exposed to this drug. Tobramycin (TOBI): Used to treat chronic P. aeruginosa infection in patients with CF. Side effects: Vocal changes and tinnitus (ringing in the ears)
Zanamivir (Relenza): Used to treat Influenza. Side effects: Can cause bronchospasms and allergic reactions.

8. What are the four advantages of using inhaled aerosols?: Aerosol doses are smaller than systemic doses. Onset of drug action is rapid. Delivery is targeted to the organ requiring treatment. Systemic effects are often fewer and less severe.

9. What are the indications for Dornase Alfa?: Use in cases of Cystic Fibrosis to reduce the frequency of infections and to improve pulminary function of these patients.

10. What are the indications for Inhaled Corticosteroids?: Used for anti-inflammatory maintenance of asthma and severe COPD. Intranasal use is for control of of seasonal rhinitis. Patients need to be informed that the drugs will not provide immediate relief and could take days for full effect.

11. What are the indications for Long-Acting (maintenance) agents?: For maintenance of bronchodilation, control of bronchospasm, and nocturnal symptoms in asthma or other obstructive diseases, such as COPD. Examples are: Salmeterol (Serevent)

12. What are the indications for Non-Steroidal Antiasthma drugs?: Used to manage mild to severe persistent asthma and as an alternative to steroidal treatments. No benefit for acute airway obstruction with asthma.

13. What are the indications for Racemic Epinephrine, its proper doses?: For strong α-adrenergic vasoconstriction effects, used after extubation, during epiglottitis, croup, or bronchiolitis; or to control airway bleeding during endoscopy. SVN: 2.25% solution, 0.25-0.5 ml (5.63 – 11.25 mg) q.i.d.

14. What are the indications for Short-Acting (rescue) agents, examples and their proper doses?: For immediate relief of acute reversible airflow obstruction caused by asthma or other obstructive airway diseases. Examples are: Albuterol (Proventil), SVN: 0.5% solution, 0.5 ml (2.5 mg), Levalbuterol (Xopenex), SVN: 0.63 mg / 3 ml t.i.d. or 1.25 mg / 3 ml t.i.d.

15. What are the indications for using anticholinergic drugs?: For effective maintenance of COPD but less in asthma, a nasal formulation for relief rhinitis is available.

16. What are the indications for using combined anticholinergic and β-agonist bronchodilator drugs?: For COPD patients require more bronchodilation for relief of airflow obstruction. Also in severe asthma that does not respond well to β-agonist therapy.

17. What are the most common devices used to administer respiratory drugs?: MDI (Metered Dose Inhaler), SVN (Small Volume Nebulizer), DPI (Dry Powder Inhaler)

18. What are the three phases of drug action?: Drug Administration, Pharmacokinetic, Pharmadynamic

19. What are the three types of Non-Steroidal Antiasthma drugs?: Cromolyn-like agents (Cromolyn Sodium, Nedocromil Sodium), AntiLeukotrienes (Zarfirlukast, Zileuton), Monoclonal Antibodies or Anti-IgE agents (Omalizumab).

20. What are the two inhaled vasodilators?: Nitric Oxide (INOmax): Used in treatment of neonates with hypoxic respiratory failure can cause hypotension. Iloprost (Ventavis): Used in the treatment of pulmonary hypertension by dilating the pulmonary vasculature. Administered with I-neb or Prodose nebulizers. Side effects: Increased cough and headache

21. What does an α-receptor stimulate?: Causes vasoconstriction and a vasopressor effect (increased blood pressure).

22. What does a β1-receptor stimulate?: Increased heart rate and myocardial contractility.

23. What does a β2-receptor stimulate?: Relaxes bronchial smooth muscle, stimulates mucociliary activity, and has some inhibitory action on inflammatory mediator release.

24. What is a fully ionized drug and an example of one in the respiratory setting?: A fully ionized drug is not absorbed across a lipid membrane (not fat-soluble). Ipratropamine (Atrovent) is a fully ionized drug.

25. What is a Muscarinic drug?: A drug that stimulates that ACh receptors specifically at the parasympathetic nerve-ending sites.

26. What is an Agonist and an Antagonist? What are some examples of each?: Agonists are the stimulating agents. Antagonists are the blocking agents.

27.What is an isomer?: Isomers are compounds with the same molecular formula but different structural formulas compare the structures of albuterol and levalbuterol.

28. What is another term for the sympathetic receptors and parasympathetic receptors and why are they named so?: Sympathetic = Adrenergic (Adrenalin), Parasympathetic = Cholinergic (Acetylcholine)

29. What is a prodrug?: It is a drug that is not active till it is metabolized.

30. What is Combivent?: Ipratropium Bromide and Albuterol

31. What is DuoNeb and its proper dose?: Ipratropium Bromide 0.5 mg and Albuterol 2.5 mg administered with a SVN

32. What is Exubera?: The only inhaled human insulin currently available. Patients should not use if they are smokers or stopped smoking within the past 6 months and if they have uncontrolled lung problems. If the disease is controlled they should take all other inhaled medications before using the inhaled insulin.

33. What is the brand name for Acetylcysteine (NAC)?: Mucomyst

34. What is the brand name for Dornase Alfa?: Pulmozyme

35. What is the brand name for Ipratropium Bromide?: Atrovent

36. What is the brand name for Tiotropium Bromide: Spiriva

37. What is the drug administration phase?: Describes the method by which a drug dose is made available to the body.

38. What is the mode of action for Cromolyn Sodium?: Inhibits degranulation of mast cells which prevents the release of histamine and other mediators of inflammation.

39. What is the Mode of Action for Inhaled Corticosteroids?: Lipid soluble drugs that act on intracellular receptors, full effect requires hours to days, will not provide instant relief.

40. What is the pharmacodynamic phase?: Describes the mechanism by which a drug molecule causes its effects. Drug effects are caused by

41. What is the pharmacokinetic phase?: Describes the Time, Course, and Disposition of a drug in the body. Based on ADME (Absorption, Distribution, Metabolism, and Elimination)

42. What should the patient know about Inhaled Corticosteroids?: Not for use as a rescue drug, the importance of consistent use.

43. Why do you always need to add Albuterol to Mucomyst?: Mucomyst can cause bronchospasms.

Question Answer
What are the three phases of drug action? drug administration phase, pharmacokinetic phase, pharmacodynamic phase
drug administration phase method by which a drug dose is made available to the body; (How are we going to deliver it?)
What is the most common route of drug administration to a pulmonary patient? aerosol therapy
What are the three most common devices used to administer inhaled aerosols? MDI (metered-dose inhaler), SVN (small volume nebulizer), DPI (dry-powder inhaler)
What are the ADVANTAGES of inhaled aerosols? can use smaller doses (as compared to the systemic route), onset of drug is rapid, delivery is targeted to specific organ needing treatment, less systemic side effects
What are the DISADVANTAGES of inhaled aerosols? the number of variables affecting the delivered dose AND lack of knowledge of device performance by patients & caregivers
pharmacokinetic phase time course & disposition of drug in body based on its absorption, distribution, metabolism & elimination
Inhaled bronchoactive aerosols are intended for local effects in the airway; UNDESIRED systemic effects result from what? absorption and distribution throughout the body
What is the difference between a fully ionized aerosol drug and a non-ionized aerosol drug? A fully ionized drug has little or NO systemic side effects (it is not absorbed across lipid membranes) whereas a non-ionized drug produces systemic side effects (it is lipid soluble & diffuses across cell membranes and into bloodstream)
What is an example of a fully ionized aerosol drug? Ipratropium
What is an example a non-ionized aerosol drug? Atropine (side effects: mydriasis: dilation of pupils AND blurred vision)
What is the L/T ratio? Lung availability/total systemic availability; quantifies efficiency of aerosol drug to lung; L/T ratio=Lung availability/(Lung + GI Availability)
Using the L/T ratio, which aerosol delivery method is more efficient? MDI (46%) works a little better than DPI (23%)
Pharmacodynamic phase describes the MECHANISM OF ACTION by which a drug molecule causes its effects in the body
What are drug effects caused by? the combination of a drug with a matching receptor
The nervous system is divided into what two paths? Central & Peripheral
Central Nervous System brain & spinal cord
Peripheral Nervous System sensory (receives impulses), somatic (sends voluntary impulses: ex: putting hand in fire and pulling it out), autonomic (sends involuntary impulses ex: breathing)
What three things make up the autonomic (involuntary) system? parasympathetic, muscarinic (M3), Sympathetic
Parasympathetic receptors CHOLINERGIC: acetylcholine> cGMP> bronchoconstriction
Sympathetic receptors ADRENERGIC: norepinephrine (epinephrine)> cAMP> bronchodilation
What is cAMP constantly being degraded by? phosphodiesterase
Muscarinic (M3) acts like parasympathetic; stimulates acetylcholine receptors specifically at parasympathetic nerve-ending sites
What is the usual neurotransmitter in the sympathetic system? norepinephrine (epinephrine), aka adrenaline
What is the usual neurotransmitter in the parasympathetic system? acetylcholine
Adrenergic directly dilates what? the bronchial tree; antiadrenergic blocks receptor for epinephrine
Cholinergic causes what? bronchoconstriction; Don’t want that, so you need and anti-cholinergic drug that BLOCKS the constriction (Atrovent-would never give by itself)
indications for Adrenergic short-acting agents rescue drugs good for about 4 hours; for relief of acute obstructive airflow obstruction; albuterol and levalbuterol
Albuterol 2.5 mg qid (4 times a day); Beta-2
Indications for Adrenergic long-acting agents drugs that will last 12 hours (bid), in MDIs and DPI; salmeterol, formoterol, arformoterol; for maintenance of bronchodilation with obstructive lung disease
What is the most common use of adrenergic bronchodilators? improve the flow rates in asthma & exercise induced asthma, acute and chronic bronchitis, emphysema, bronchiectasis, cystic fibrosis and other obstructive airway states
Racemic epinephrine adrenergic bronchodilator; reduces airway swelling after extubation or with acute upper airway inflammation from croup, epiglottitis or bronchiolitis or to control airway bleeding during endoscopy
alpa-receptor stimulation causes vasoconstriction and a vasopressor effect (increased blood pressure)
beta-1-receptor stimulation causes increased heart rate and myocardial contractility
beta-2-receptor stimulation relaxes bronchial smooth muscle, stimulates mucociliary activity, and has some inhibitory action on inflammatory mediator release
Why would you choose Xopenex over Albuterol? When patient comes in with a high heart rate
Levalbuterol 1.25 (.63) mg TID/QID; beta-2
What is the main side effect of beta-2 selective agents? tremor
What are the potential adverse effects with use of adrenergic bronchodilators? dizziness, hypokalemia, worsening ventilation/perfusion ratio (decrease in PaO2/SpO2)
What are the specific actions suggested to evaluate patient response to bronchodilator therapy? pre & post bronchodilator studies, ABG or pulse oximetry, blood glucose & potassium (if available), and blood pressure
What are the two inhaled anticholinergic bronchodilators? Ipratropium and tiotropium (both used for COPD)
What is combined anticholinergic and beta-agonist indicated for? Ipratropium bromide & albuterol (Duoneb) is indicated for patients with COPD or asthma
What is the mode of action of anticholinergic bronchodilators? act as competitive antagonists for acetylcholine on airway smooth muscle
What are the adverse effects of anticholinergic bronchodilators? atrovent produces side effects and eyes can accidentally be sprayed by MDI or nebulizer mask
What are the side effects seen with anticholinergic aerosol agents? cough & dry mouth
What are the two mucus-controlling agents? N-acetyl-cysteine (called Muco Mist) and Dornase alfa
N-acetyl cysteine (NAC) comes in what two concentrations? 10% and 20%
How is NAC given to patient? either by nebulization or by direct tracheal installation
How does NAC work? breaks down disulfide bonds of the mucus, thinning it, so patient can cough it out themselves
What can NAC cause? bronchospasm due to irritating side effects (reason why you never give it without bronchodilator- Albuterol)
What patients get treated with Dornase alfa? Patients with Cystic Fibrosis
What is the mode of action of Dornase alfa? It breaks down protein bonds (DNA) and thins it
What is the other name for Dornase alfa? Pulmozyme
Inhaled corticosteroids will help reduce swelling if it is ________, it wont help if it’s _________ Inflammatory; bronchoconstriction
What is the mode of action of inhaled corticosteroids? they act on intracellular receptors
What are the three types of drugs that prevent asthma from happening? (1) Cromolyn sodium (2) Antileukotrienes (3) Monoclonal antibodies or anti-IgE agents REMEMBER THESE 3 ARE NOT RESCUE DRUGS
What are the indications for use of nonsteroidal antiasthma drugs? Prophylatic management of asthma; offers NO BENEFIT for acute airway obstruction in asthma
Pentamindine isethionate treats pneumonia caused by pneumocystis jiroveci which is seen in patients with AIDS
Ribavirin treats respiratory syncytial virus using SPAG generator
Inhaled tobramycin used to fight pseudomonas aeruginosa in patients with cystic fibrosis
Inhaled zanamivir treats influenza A; Tamiflu
Nitric oxide treatment of pulmonary hypertension most common side effect: hypotension


1. Acting length on bronchodilators refers to? How long the drug lasts…. Bronchodilators typically start working instantaneously.
2. Do we still use Pentamindine? Nope not so much. due to limited efficacy and side effects of cough, wheezing, dyspnea and a grip of other bad stuffs.
3. For whom would you use a combined anticholinergic and beta-agonist for? For patients with COPD
4. For whom would you use an anticholinergic bronchodilator? as a maintenance bronchodilator therapy for COPD patients
5. How is Mucomyst administered? Given by aerosol or direct tracheal instillation to reduce accumulation of airway mucus via breaking the disulfide bonds of mucus DNA (unzips the DNA)
6. How is Ribavirin administered? Via aerosol requiring use of small particle aerosol generator (SPAG)
7. If you are going to administer a bronchodilator what would you do? Test the patient with a peak flow meter before and after administration of breathing treatments to ensure/document that the treatment was effective.
8. In general what are common side effects to Adrenergic Bronchodilators? Dizziness, hypokalemia, nausea and tolerance to the drug.
9. In regards to aerosol inhalers what is a solution to the problem propellant dangers? dry-powder inhalers
10. Is Ribavirin cost effective? *Shrug* I dunno….
11. N-Acetyl-L-cysteine’s brand name is…. Mucomyst
12. Other than the patients subjective response what is used for the assessment of bronchodilator therapy? Vital signs, breath sounds, and breathing pattern evaluation (Pre and Post therapy treatment)
13. Precautions with anticholinergic bronchodilators (Atropine)? There is a sh*t ton of side effects (ie Dry mouth, increased HR and increased ocular pressure) when atropine is inhaled due to its easy absorption into the bloodstream. DO NOT BE A DUMBASS AND SPRAY IT INTO THE EYES!
14. Side affects of Acetyl Cysteine (Mucomyst)? May cause bronchospasm and airway obstruction due to irritating side effects… plus a sh*t ton more like hydrogen sulfide stank.
15. What action is triggered by anticholinergic bronchodilators? Acts as a competitive antagonist for acetylcholine on airway smooth muscle.
16. What are 3 common devices used to administer inhaled aerosols. 1. Metered-dose inhaler (MDI)
2. small-volume nebulizer (SVN)
3. dry-powder inhaler (DPI)
17. What are 3 subgroups of Adrenergic Bronchodilators? 1. Ultra-short catecholamine agents
2. Short-acting non-catecholamine agents
3. Long-acting adrenergic bronchodilators
18. What are adverse effects of newer beta 2 selective agents? Generally safe with primary side effect being tremors
19. What are adverse effects of older adrenergic bronchodilators? Older drugs can cause tachycardia, palpitations & nervousness
20. What are adverse effects of Ribavirin? Skin rash, Eyelid erythema and conjunctivitis.
21. What are COMMON side effects of SVN, MDI and DPI administration of anticholinergic aerosol agents? Cough, Dry Mouth
22. What are drug effects caused by? A combination of drugs with matching receptors
23. What are examples of Long-acting adrenergic bronchodilators? Salmeterol, formoterol, and arformoterol (12 hour action)
24. What are examples of Ultra-short catecholamine agents? Epinephrine and isoproterenol (immediate reaction rapidly metabolized) old school drugs
25. What are inhaled corticosteroids? Lipid-soluble drug that is orally inhaled preparations used for anti-inflammatory maintenance therapy of persistent asthma and severe COPD
26. What are mast cells Cells that contain histamine, causes inflammation.
27. What are non-ionized aerosol drugs? drug that is lipid soluble and will diffuse across cell membranes and into the bloodstream, producing systemic side effects.
28. What are nonsteroidal antiasthma drugs used for? Prophylactic management (control) of persistent (chronic) asthma. May be used as an alternative to steroids in patients with persistent asthma symptoms.
29. What are OCCASIONAL side effects of MDI administration of anticholinergic aerosol agents? Nervousness, irritation, dizziness, headache, palpitation and rash
30. What are Short-acting non-catecholamine agent examples? Metaproterenol, pirbuterol, albuterol, and levalbuterol (4-6 hour action)
31. What are side effects of Zanamivir? Bronchospasm and allergic reactions!
32. What are some special considerations for inhaling a corticosteroid? Rinse mouth after taking medicine and document it that way they can avoid THRUSH (candida albicans)
33. What are the three airway receptors and neurotransmitters of the lung? 1. Sympathetic (adrenergic) and parasympathetic (cholinergic) receptors are in the lungs.
2. Norepinephrine (epinephrine) is the neurotransmitter in the sympathetic system
3. Acetylcholine is the neurotransmitter in the parasympathetic system
34. What are the UNCOMMON side effects of SVN & DPI administration of anticholinergic aerosol agents? Pharyngitis, dyspnea, flu-like symptoms, bronchitis, upper respiratory infections, nausea, occasional bronchoconstriction, eye pain, urinary retention
35. What are two drug signaling mechanisms? Item Deleted due to Lalim Principle of Irrelevance (LPI)
36. What brand names of drugs do we need to know? Singulair, Albuterol, Xopenex, Recemic epinephrine, Atropine, Atrovent, and all steroids
37. What does a beta1-receptor stimulation cause? increased heart rate and increased heart contractility (yeah…not really used….really…)
38. What does alpha-receptor stimulation cause? vasoconstriction and increases blood pressure (used for airway bleeding and croup/stridor)
39. What does beta 2-receptor stimulation cause? Relaxation of bronchial smooth muscle, stimulates mucociliary activity, and has some inhibitory action on inflammatory mediator release. (THIS IS THE IDEAL SETTING FOR BRONCHODILATORS for the purposes of dilating without adverse/contradictory side effects)
40. What does Lalim think about persnickety patients? “They are Lame”
41. What is a Cholinergic drug? Drugs that stimulate receptors for acetylcholine
42. What is a combination of Ipratropium and albuterol? Duoneb
43. What is an Adrenergic drug? Drugs that stimulate receptors responding to norepinephrine or epinephrine
44. What is an advantage inhaled aerosols has over systemic administration? Can use smaller doses.
45. What is an Agonist? Stimulating agents (The sexy person)
46. What is an Antagonist Blocking agent (The ugly sidekick)
47. What is an Antiadrenergic drug? Drugs that block receptors for norepinephrine or epinephrine
48. What is an Anticholinergic drug? Drugs that block receptors for acetylcholine
49. What is an assessment of drug therapy for inhaled corticosteroids? Inform patient about the drug, encourage peak flowmeter use, assess patient for side effects.
50. What is an example of Inhaled Pulmonary Vasodilators? Nitric oxide (Brand Name: INOmax)
51. What is a side effect of inhaled tobramycin? Voice alteration and tinnitus
52. What is Cromolyn sodium? (Brand Name: Intal) mast cell stabilizer
53. What is Dornase Alfa? (brand name: Pulmozyme) A Proteolytic enzyme for management of cystic fibrosis by breaking down DNA material from neutrophils found in purulent secretions.
54. What is inhaled tobramycin intended for? intended to manage chronic infection with P. Aeruginosa in patients with cystic fibrosis.
55. What is inhaled Zanamivir? DPI indicated for treatment of uncomplicated acute illness due to the flu virus in adults and children. (Off-label H1N1 treatment)
56. What is INOmax used for? treatment of neonates with persistent pulmonary hypertension by relaxing the smooth muscle in pulmonary vasculature by producing pulmonary vasodilation and reducing artery pressure/ improving V/Q
57. What is intranasal steroids used for? Control of allergic and non-allergic rhinitis
58. What is Motelukast Sodium? (Brand Name: Singulair) an antileukotriene, aka a leukotriene (the bad guy) receptor antagonist.
59. What is Mucomyst for? An agent for mucus control
60. What is paradoxical breathing When inhalation causes the abdomen deflate and chest to inflate… (not normal unless you are a chick)
61. What is Pentamindine (Brand Name: NebuPent) Was usd for treatment of opportunistic pheumonia caused by the fungus Pneumocystis Jiroveci which is the causative agent of Pneumocystis pneumonia (PCP)
62. What is Ribavirin? An antiviral agent used in the treatment of severe lower respiratory tract infections caused by respiratory syncytial virus (RSV)
63. What is the brand name for Albuterol? Proventil (2.5 mg/Q4 hours) Pg 710
64. What is the brand name for Ipratropium bromide? Atrovent
65. What is the brand name for Levalbuterol? Xopenex (0.63 mg/Q6 hours) Pg 710
66. What is the brand name for Tiotropium bromide? Spiriva
67. What is the delivery route for inhaled aerosols? Delivery to specific organ needing treatment
68. What is the difference in side effects between inhaled aerosols and systemic administered drugs? Aerosols have less systemic side effects
69. What is the drug administration phase? The method by which a drug is made available to the patient
70. what is the formula to quantify efficiency of aerosol delivery to lungs? item deleted via Lalim Principle of Irrelevance (LPI)
71. What is the mode of action for Inhaled corticosteroids? Acts on intracellular receptors with full anti-inflammatory effects that require hours to days to take full effect (No immediate relief from dyspnea NOT A RESCUE INHALER)
72. What is the mode of action for nonsteroidal antiasthma drugs? **Intal Stabilizes mast cells in response to allergic and nonallergic stimuli
**Singulair inhibits reactions induced by exercise, cold air and allergens by reducing bronchoconstriction and mucus secretion.
73. What is the most common route for a drug administered to a pulmonary patient? Aerosol (MDI: meter-dose inhaler)
74. What is the outcome of pregnant patients and practitioners being exposed to Ribavirin? No bueno
75. What is the pharmacodynamics phase of pharmacology? describes mechanisms of drug action by which drug molecule causes its effects in body
76. What is the pharmacokinetic phase of pharmacology? Describes the time course, and disposition of drug in body based on its absorption, distribution, metabolism, and elimination.
77. What is the primary side effect of INOMax? Hypotension
78. What is the risk of administering a bronchodilator? increased heart rate (20 point increase HR stop treatment and call doctor)
79. What is the speed of onset for inhaled aerosols? rapid. peak onset is 15 minutes
80. What side effects do fully ionized aerosol drug have? Little or no systemic side effects (ie ipratropium bromide)
81. Why would you use a long acting Adrenergic Bronchodilator? For maintenance bronchodilator in patients with obstructive lung disease
82. Why would you use a short acting (rescue) Adrenergic Bronchodilators? For relief of acute reversible airway obstruction
83. Why would you use racemic epinephrine? 1. to reduce airway swelling after extubation or with acute upper airway inflammation from croup, epiglottis, or bronchiolitis.
2. to control airway bleeding during endoscopy

1. Actions Suggested to evaluate patient response to long-acting beta agonists:: Assess ongoing lung function, including predose FEV1 over time and variability in peak expiratory flows. Assess amount of rescue beta agonist use and nocturnal symptoms. Assess number of exacerbations, unscheduled clinic visits, and hospitalizations. Assess days of absence from school or work because of symptoms. Assess ability to reduce the dose of concomitant inhaled corticosteroids.

2. Actions suggested to evaluate patients response to Bronchodilator Therapy: (1): Monitor flow rates using bedside peak flowmeters, portable spirometry, or laboratory reports of pulmonary function before and after bronchodilator studies to assess reversibility of airflow obstruction. Assess arterial blood gases or pulse oximetry saturation, as needed, for acute states with asthma or COPD to monitor changes in ventilation and gas exchange (oxygenation). Note the effect of beta-agonists on blood glucose (increase) and K+ (decrease) laboratory values, if using high doses, such as with continuous nebulization or emergency department treatments.

3. Actions suggested to evaluate patients response to Bronchodilator Therapy: (2): In the long-term, monitor pulmonary function studies of lung volumes, capacities, and flows. Instruct asthmatic patients in the use and interpretation of disposable peak flowmeters to assess the severity of asthmatic episodes and provide an action plan for treatment modification. Emphasize in patient education that beta agonists do not treat underlying inflammation and do not prevent progression of asthma, and additional anti-inflammatory treatment or more aggressive medical therapy may be needed if there is a poor response to the rescue beta-agonist.

4. Actions suggested to evaluate patients response to Bronchodilator Therapy: (3): Instruct and then verify correct use of aerosol delivery device (SVN, MDI, reservoir, DPI). Instruct patients in use, assembly, and especially cleaning of aerosol inhalation devices.

5. Adrenergic: Drug that stimulated a receptor responding to a norepinephrine or epinephrine

6. Adrenergic: of or pertaining to the sympathetic nerve fibers of the autonomic nervous system that use epinephrine or epinephrine-like substances as neurotransmitters; any chemical or drug that mimics the effect of these neurotransmitters. Also called a sympathomimetic drug; catecholamine

7. Adrenergic Bronchodilator agents:: differences in these agents determine the optimal clinical application of individual agents. Form 3 subgroups: 1. Ultra-Short-Acting Catecholamines. 2. Short-Acting Noncatechloamine Agents. 3. Long- Acting Adrenergic Bronchodilators

8. Adrenergic Bronchodilators: The largest group of drugs among the aerosolized agent. Used for Oral inhalation.

9. Adrenergic Bronchodilators can Stimulate one or more of the following receptors.: Aplha-Receptor Stimulation. Beta-1-Receptor Stimulation. Beta-2-receptor stimulation

10. Advantages of Treatment of The Respiratory Tract with Inhaled Aerosols:: 1. Aerosol doses are usually smaller than doses for systemic administration. 2. Onset of drug action is rapid. 3. Delivery is targeted to the organ requiring treatment. 4. Systemic side effects are often fewer and less severe.

11. adverse affects of inhaled aztreonam: Inhaled aztreonam can cause bronchospasm and decrease FEV1. All patients should be screened for baseline pulmonary function results and be treated with a bronchodilator before administering inhaled aztreonam. Patients have been reported to experience severe allergic reactions with injectable aztreonam. Careful observation is warranted when first using inhaled aztreonam because it could cause an allergic reaction. If any signs occur during the delivery of inhaled aztreonam, the treatment should be stopped immediately, and the health care team should be informed. The use of antibiotics in the absence of infection may lead to the development of drug-resistant bacteria. Inhaled aztreonam should not be used in patients with CF not infected with P. aeruginosa.

12. Adverse Effects (al 725): Possible side effects with aerosolized pentamidine include cough, bronchial irritation, bronchospasm and wheezing, shortness of breath, fatigue, bad or metallic taste, pharyngitis, conjunctivitis, rash, and chest pain. Systemic effects have also been noted with inhaled pentamidine, including decreased appetite, dizziness, rash, nausea, night sweats, chills, spontaneous pneumothoraces, neutropenia, pancreatitis, renal insufficiency, and hypoglycemia. It is difficult to distinguish systemic effects caused by the drug versus the disease. Extrapulmonary infection with P. jiroveci can occur with prophylactic inhaled pentamidine.

13. adverse effects colistimethate sodium: Side effects seen with parenteral administration include neurotoxic events and nephrotoxicity. Because colistimethate sodium is mainly eliminated by the renal system, renal insufficiency should be considered. Neurotoxic events associated with colistimethate sodium include dizziness, confusion, muscle weakness, and possible neuromuscular blockade, leading to respiratory arrest. When using aerosolized colistimethate sodium, the most common complication seen is bronchospasm. Pretreatment with a beta agonist can decrease the potential for this complication.

14. adverse effects of inhaled tobramycin: Side effects with parenteral aminoglycosides include possible auditory and vestibular damage with potential for deafness and nephrotoxicity. Other possible effects are listed in Box 32-5. Side effects observed since the introduction of inhaled tobramycin have been minimal and include voice alteration and tinnitus in a small percentage of patients. Risk for more serious side effects with tobramycin, whether by inhaled or parenteral routes, increases with the use of other aminoglycosides, in the presence of poor renal function and dehydration, with preexisting neuromuscular impairment, or with use of other ototoxic drugs.

15. Adverse Effects to ribavirin: Skin rash, eyelid erythema, and conjunctivitis have been noted with aerosol administration. Important equipment-related effects during mechanical ventilation include endotracheal tube occlusion and occlusion of ventilator expiratory valves or sensors. Deterioration of pulmonary function can occur. Patients or practitioners who are pregnant should not have exposure to ribavirin.

16. Agonists: of or pertaining to a chemical substance or drug that has affinity for a receptor and exerts a desired or expected effect (as opposed to an antagonist).

17. Agonists & Antagonists that act on receptors are given classificaitons:: Adrenergic, Antiadrenergic, Cholinergic, Anticholinergic, Muscarinic

18. Airway Receptors & Their Effects in the Cardiopulmonary System:

19. Alpha-Receptor Stimulation: Causes vasoconstriction & a Vasopressor effect (increased blood pressure).

20. Antagonists: in pharmacology, a drug that has affinity but produces no effect; an antagonist can be competitive (forms reversible bond with receptor) or noncompetitive (forms irreversible bond).

21. Antiadrenergic: Drug that blocks a receptor for norepinephrine or epinephrine.

22. Anticholinergic: Drug that blocks a receptor for acertylcholine.

23. Anticholinergic Bronchodilators: 2nd method of producing airway relaxation. Effective only if bronchoconstriction exists secondary to cholinergic activity.

24. Antileukotrienes: are administered orally, and the monoclonal antibody agent omalizumab is given parenterally, but these are included as bronchoactive drugs

25. As of June 2, 20120 the FDA suggests the following on how long-acting beta-2 agonists are used for treating asthma:: are not to be used without a controller medication (i.e., corticosteroid). not be used by patients who are controlled on low-dose or medium-dose inhaled corticosteroids. should be used only if patients are not controlled with agents such as inhaled corticosteroids. should be for short-term use only. should be discontinued when asthma is controlled. Children should use only in conjunction with a corticosteroid. The use of a combination product is needed to increase adherence.

26. Assesment of long term drug therapy: Assess severity of symptoms (coughing, wheezing, nocturnal awakenings, symptoms during exertion; use of rescue bronchodilator; number of exacerbations; missed work or school days; and pulmonary function), and modify level or dosage as recommended by NAEPP and GOLD guidelines. Assess for the presence of side effects with inhaled steroid therapy (oral thrush, hoarseness or voice changes, cough or wheezing with MDI use); use a reservoir (preferably a holding chamber) with MDI use, and verify correct technique

27. assesment of ribavirin: Monitor signs of improvement in RSV infection severity, including vital signs, respiratory pattern and work of breathing (clinically), level of fractional inspired oxygen (FiO2) needed, level of ventilatory support, arterial blood gases, body temperature, and other indicators of pulmonary gas exchange. Monitor the patient for evidence of side effects, such as deterioration in lung function, bronchospasm, occlusion of endotracheal tube (if present), cardiovascular instability, skin irritation from the aerosol drug, and equipment malfunction related to drug residue.

28. The assessment of bronchodilator therapy with an anticholinergic agent: is the same as assessment for adrenergic agent

29. Assessment of Drug Therapy: -Verify that the patient understands that a corticosteroid is a controller agent and is different from a rescue bronchodilator (relieving agent); assess the patient’s understanding of the need for consistent use of an inhaled corticosteroid (compliance with therapy). Instruct the patient in the use of a peak flowmeter to monitor baseline peak expiratory flow (PEF) and changes. Verify that there is a specific action plan, based on symptoms and PEF results. The patient should understand when to contact a physician with deterioration in PEF or exacerbation of symptoms

30. Assessment of inhaled tobramycin: Verify that the patient understands that nebulized tobramycin should be given after other CF therapies, including other inhaled drugs. Check whether the patient has renal, auditory, vestibular, or neuromuscular problems or is taking other aminoglycosides or ototoxic drugs. Consider whether tobramycin should be used for the patient based on the severity of preexisting or concomitant risk factors. Monitor lung function to note improvement in FEV1. Assess rate of hospitalization before and after institution of inhaled tobramycin. Assess need for IV antipseudomonal therapy. Assess improvement in weight. Monitor for occurrence of side effects, such as tinnitus or voice alteration; have the patient rinse and expectorate after aerosol treatments. Evaluate for changes in hearing or renal function during use of inhaled tobramycin.

31. Assessment of therapy with adrenergic bronchodilators should be based on:: the indication for the aerosol agent.

32. Atropine: Poorly ionized & diffuses well. Produces systematic side effects such as mydriasis and blurring of vision.

33. atropine sulfate: is a tertiary ammonium compound that is easily absorbed into the bloodstream. Atropine produces many systemic side effects when inhaled.

34. atropine sulfate side effects: include the local topical effect of dry mouth, pupillary dilation, lens paralysis, increased intraocular pressure, increased heart rate, urinary retention, and altered mental state

35. The basic actions to evaluate an aerosol drug treatment should be followed: Verify that the patient understands that nonsteroidal antiasthma agents are controller drugs and their difference from rescue bronchodilators (relieving agents); assess the patient’s understanding of the need for consistent use of these agents (compliance with therapy).Instruct the patient in use of a peak flowmeter to monitor baseline PEF and changes. Verify that there is a specific action plan, based on symptoms and PEF results. The patient should be clear on when to contact a physician with deterioration in PEF or exacerbation of symptoms.

36. before treatment: Assess the patient’s adequacy of cough and level of consciousness to determine need for treatment with mechanical suctioning or adjunct bronchial hygiene (postural drainage or percussion, positive expiratory pressure therapy) to clear the airway or if treatment is contraindicated

37. Beta-1-receptor stimulation: Causes increased heart rate & myocardial contractility.

38. Beta-2-Receptor Stimulation: -Relaxes bronchial smooth muscle. Stimulates mucociliary activity; has some inhibitory action on inflammatory mediator release.

39. Bland aerosols: have been found to increase secretion clearance and sputum production and cause productive coughing

40. Box 32-5 Side Effects With Aminoglycosides and Tobramycin: Parenteral Administration, Ototoxicity (auditory and vestibular), Nephrotoxicity, Neuromuscular blockade, Hypomagnesemia, Cross-allergenicity, Fetal harm (deafness), Inhaled Nebulized Tobramycin, Voice alteration, Tinnitus, Nonsignificant increase in bacterial resistance

41. Bronchoactive Agents Distinguished as Controllers or Relievers in Treating Asthma, Long-Term Control: Inhaled corticosteroids, Cromolyn sodium, Long-acting beta-2 agonists, Inhaled: salmeterol, formoterol. Oral: sustained-release albuterol, Leukotriene modifiers, Systemic corticosteroids, Methylxanthines (theophylline).

42. Bronchoactive Agents Distinguished as Controllers or Relievers in Treating Asthma, quick relief: Short-acting inhaled beta-2 agonists: albuterol, levalbuterol. Anticholinergic (antimuscarinic): ipratropium. Systemic corticosteroids (oral burst therapy, IV).

43. Catecholamines: any one of a group of sympathomimetic compounds composed of a catechol molecule and the aliphatic portion of an amine.

44. Cholinergic: Drug that stimulates a receptor for acetylcholine

45. Cholinergic: of or pertaining to nerve fibers that elaborate acetylcholine at the myoneural junctions.

46. Choosing an Aerosol Agent: An aerosol agent to treat the respiratory tract is chosen based on the indication for the agent or class of drugs and a corresponding presence of the indication in the patient.

47. Ciclesonide: a prodrug, is given as an inactive compound and is converted to an active metabolite, desisobutyryl-ciclesonide, by intracellular enzymes; is available as an intranasal formulation (Omnaris) and a pressurized MDI (Alvesco

48. Colistimethate Sodium: Colistimethate sodium (colistin) is an antibiotic used to treat sensitive strains of gram-negative bacilli, particularly P. aeruginosa. Colistimethate sodium is available as an inhaled formulation in Europe as Promixin; this agent is not approved for inhalation by the FDA. However, nebulization of the parenteral formulation is commonly used in patients with CF. Falagas and colleagues51 published a review of IV and aerosolized colistimethate sodium

49. Combination of anticholinergic & beta agonist: is indicated for use in patients with COPD receiving regular treatment who require additional bronchodilation for the relief of airflow obstruction.

50.Common Side Effects With inhaled agents:: headache, insomnia, nervousness.

51. Comparison of Efficiency of aerosol delivery with MDI and DPI using the L/T availability Ratio:

52. The Courses of Drug Action from does to effect has 3 phases:: 1. Drug Administration. 2. Pharmacokinetic. 3. Pharmacydynamic

53. Disadvantages of the delivery of inhaled aerosols in treating Respiratory Disease: 1. The # of variables affecting dose. 2. Lack of adequate knowledge of device performance & use among patients and Caregivers

54. Does Forms:: 1. Aerosol of Liquid Solution. 2. Suspensions. 3. Dry Powders

55. Dornase alfa: is a proteolytic enzyme that can break down the DNA material from neutrophils found in purulent secretions. This agent has been shown to be more effective than acetylcysteine in reducing the viscosity of infected sputum.

56. dornase alfa: has not been shown to produce antibodies that might cause allergic reactions, including bronchospasm

57. Dornase alfa (Pulmozyme): is a genetically engineered clone of the natural human pancreatic

58. dornase alfa side effects: pharyngitis and voice alteration, laryngitis, rash, chest pain, and conjunctivitis

59. The Drug Administration Phase: Describe the method by which a drug is made available to the body.

60. Drug Signaling: Mechanisms by which a drug exerts its effect on receptors.

61. Drug Signaling Mechanisms Include::

62. During Treatment and Short-Term: Teach and then verify correct use of aerosol nebulization system, including cleaning. Assess therapy based on indication for drug: mucolysis and improved clearance of secretions. Monitor airflow changes or adverse effects such as a decrease in FEV1. Assess the patient’s breathing pattern and rate. Assess the patient’s subjective reaction to treatment (changes in breathing effort or pattern). Discontinue therapy if the patient experiences adverse reactions

63. The effect of acetycholine on muscarinic (M3) receptors on airway smooth muscle is:: bronchoconstriction

64. Effects & Characteristics of (s)-isomer of Albuterol: Increases intracellular calcium concentration in vitro. Activity is blocked by the anticholinergic atropine. Does not produce pulmonary or extrapulmonary beta-2-mediated effects. Enhances experimental airway responsiveness in vitro. Increases contractile response of bronchial tissue to histamine or leukotriene C4 in vitro. Enhances eosinophil superoxide production with interleukin-5 stimulation. Slower metabolism than (R)-albuterol in vivo. Preferential retention in the lung when inhaled by MDI (in vivo).

65. Expectorants: are mucoactive but stimulate the production and clearance of airway secretions rather than cause mucolysis. Examples are-guaifenesin (also known as glyceryl guaiacolate), iodinated glycerol, and saturated solution of potassium iodide (SSKI)

66. The eyes should be..: protected from drug exposure with aerosol use owing to accidental spraying from an MDI or with nebulizer-mask delivery. There is less chance of eye exposure with the MDI formulation than the SVN solution; a holding chamber is recommended with MDI use

67. The following precautions are suggested with use of inhaled tobramycin: Inhaled tobramycin should be used with caution in patients with preexisting renal, auditory, vestibular, or neuromuscular dysfunction. Tobramycin solution should not be mixed with beta-lactam antibiotics (penicillins, cephalosporins) because of admixture incompatibility, and mixing with other drugs in general is discouraged. Nebulization of antibiotics during hospitalization should be performed under conditions of containment, as previously described for pentamidine and ribavirin, to prevent environmental saturation and development of resistant organisms in the hospital. Aminoglycosides can cause fetal harm if administered to pregnant women; exposure to ambient aerosol drug should be avoided by women who are pregnant or trying to become pregnant. Local airway irritation resulting in cough and bronchospasm with decreased ventilatory flow rates is possible with inhaled antibiotics and seems to be related to the osmolality of the solution.46,47 Peak flow rates and chest auscultation should be used before and after treatments to evaluate airway changes. Pretreatment with a beta agonist may be needed. Allergic reactions in the patient, staff, or family should be considered if exposure to the aerosolized drug is not controlled. The use of a nebulizing system with a scavenging filter, one-way valves, and thumb control could reduce ambient contamination with the drug, as previously described

68. A fully ionized drug: is not absorbed across Lipid membranes

69. How a Beta agonist stimulated the G protein-linked beta receptor to cause smooth muscle relaxation.:

70. The ideal aerosol would distribute:: only to the airway with none reaching the stomach.

71. If NAC is administered by?: direct tracheal instillation, tracheobronchial suction should be immediately available to maintain the airway

72. Iloprost: Indications for Use. Iloprost (Ventavis) inhalation is indicated for the treatment of pulmonary hypertension.59 Iloprost inhalation is administered with the I-neb nebulizer. Mode of Action: Iloprost is a synthetic analogue of prostacyclin (PGI2). This agent dilates pulmonary arterial vascular beds and affects platelet aggregation. It is unknown whether platelet aggregation plays a role in the treatment of pulmonary hypertension. Adverse Effects: Syncope and pulmonary edema may occur secondary to the vasodilatory properties of iloprost. During the 12-week clinical trial, headache and increased cough were the most noted adverse reactions.

73. Inahled Anticholinergic Bronchodilator Agents: Atrovent

74. In asthma, A long-acting bronchodilator is usually combined with:: antiinflammatory medication for control of airway inflammation and bronchospasm.

75. Indication for Long-Acting Agents: (ex: salmeterol, formoterol, & arformoterol): -indicated for maintenance bronchodilation & control of bronchospasm & nocturnal symptoms in obstructive pulmonary disease.

76. Indication for Racemic Epinephrine: used by: Inhaled aerosols, Direct Lung instillation, Used to reduce airway swelling after extubation or during epiglottis, croup, or bronchoiolitis or to control airway bleeding during endoscopy.

77. Indication for Short-Acting Agents: (ex: albuterol & levalbuterol): -Short-Acting beta-2 agonists are indicated for relief of acute reversible airflow obstruction in obstructive airway diseases. These are termed rescue agents.

78. indications for use of inhaled zanamivir: Inhaled zanamivir is indicated for the treatment of uncomplicated acute illness caused by influenza virus in adults and children 5 years or older who have been symptomatic for no longer than 2 days. The agents have an off-label use for treatment and prophylaxis of H1N1 influenza

79. Indications of use for Adrenergic Bronchodilators: -The presence of reversible airflow obstruction. The most common use of this is to improve flow rates in asthma, acute bronchitis, emphysema, bronchiectasis, cystic fibrosis, and other obstructive airway states.

80. Indications of use for use for Anticholinergic Bronchodilators:: Ipatropium & tiotropium bromide are the only inhaled anticholinergic bronchodilators available in the US. These are indicated as bronchodilators for maintenance treatment in COPD.

81. Inhalation Route: Administering Drugs Directly yo the Respiratory tract

82. An inhaled aerosol distributes:: -To the Lung: by inhalation. The Stomach: through swallowing os the drug that deposits in the oropharynx

83. Inhaled Aztreonam: Aztreonam was approved in December 1986 by the FDA as a monobactam, a synthetic bactericidal antibiotic; it is given as an IV solution. Inhaled aztreonam (Cayston) was approved in 2010 to improve pulmonary symptoms in patients with CF colonized with P. aeruginosa.50 Inhaled aztreonam is not indicated for patients younger than 7 years old or patients with Burkholderia cepacia infection. This agent has been studied only in patients with FEV1 greater than 25% or less than 75% of predicted. The agent is delivered by itself using the Altera Nebulizer System.

84. Inhaled bronchoactive aerosols are intended for:: Local effects in the airway.

85. Inhaled Corticosteroids: Corticosteroids are endogenous hormones produced in the adrenal cortex, which regulate basic metabolic functions in the body and exert an anti-inflammatory effect. All corticosteroids used to treat asthma and COPD are glucocorticoid

86. Inhaled Tobramycin: Patients with CF have chronic respiratory infection with Pseudomonas aeruginosa and other microorganisms. Such chronic infection causes recurrent acute respiratory infections and deterioration of lung function. With the exception of the quinoline derivatives such as ciprofloxacin, antibiotics such as the aminoglycosides (e.g., tobramycin), which are effective against Pseudomonas organisms, have poor lung bioavailability when taken orally. Consequently, these antibiotics must be given either intravenously or by inhalation. The aminoglycoside tobramycin has been approved for inhaled administration (TOBI) and is intended to manage chronic infection with P. aeruginosa in patients with CF. Goals of therapy are to treat or prevent early colonization with P. aeruginosa and maintain present lung function or reduce the rate of deterioration. The emergence of bacterial resistance was not seen in clinical trials with inhaled tobramycin.

87. Inhaled Zanamivir: Zanamivir is an inhaled powder aerosol (DPI). Despite the availability of zanamivir and the oral antiinfluenza agent oseltamivir (Tamiflu), prophylactic vaccination against influenza is still recommended, especially in high-risk individuals with cardiovascular or pulmonary disease. Zanamivir and oseltamivir represent a new class of antiviral agents termed neuraminidase inhibitors.

88. Ipratropium: fully ionized quarternary ammonium compound, diffuses poorly across lipid membranes.

89. ipratropium: is not contraindicated in subjects with prostatic hypertrophy, urinary retention, or glaucoma. the drug should be used with precaution and adequate evaluation for possible systemic side effects in these subjects

90. Ipratropium bromide and tiotropium bromide: -are fully ionized compounds that are not well absorbed and distributed throughout the body

91.Levalbuterol is available as nebulixation solution in 3 strengths:: 0.31 mg/ 3 ml. 0.63 mg/ 3 ml. 1.25 mg/3ml

92.Long-Acting Adrenergic Bronchodialtor Agents: Salmeterol, Formoterol, Arformoterol.

93. Long-Term: Assess severity of symptoms (coughing, wheezing, nocturnal awakenings, symptoms during exertion); use of rescue medication; number of exacerbations; missed work or school days; pulmonary function), and modify level of asthma therapy (up or down, as described in the 2007 NAEPP EPR III guidelines for step therapy). Assess for the presence of side effects with nonsteroidal antiasthma agents; refer to the particular agent and its side effects

94. long term: -Discontinue therapy if the patient experiences adverse reactions. Monitor number and severity of respiratory tract infections and need for antibiotic therapy, emergency visits, and hospitalizations. Monitor pulmonary function for improvement or slowing in the rate of deterioration

95. Lung Availability- to- total systematic availability ratio.: (L/T ratio) quantifies the efficiency of aerosol delivery to the lung: L/T ratio=Lung availability/(Lung+GI availability)

96. “Mode of action of anticholinergic agents in blocking muscarinic receptors in the airway to inhibit cholinergic-induced bronchoconstriction. ACH, Acetylcholine:

97. most commonly used devices to administer orally or nasally inhaled aerosols.: 1. MDI- Metered Dose Inhaler. 2. SVN- Small Volume Nebulizer. 3. DPI- Dry Poweder Inhaler

98. Mucoactive therapy: should be used with caution in patients with severely compromised vital capacity and expiratory flow, such as in the presence of end-stage pulmonary disease or neuromuscular disorders

99. The mucus macromolecule consists of?: -a polypeptide (protein) chain of amino acids, to which carbohydrate side chains are attached
-There is internal cross-linking between strands with disulfide (-S-S-) bonds and hydrogen bonds

100. Muscarinic: Drug that stimulates acetylcholine receptors specifically at parasympathetic nerve-ending sites.

101. Muscarinic: stimulating the postganglionic parasympathetic receptor; pertaining to the poisonous activity of muscarin

102. Muscarinic & antimuscarinic distinguishes: cholinergic agents whose action is limited to parasympathetic sites.

103. Mydriasis: Dialation of the pupils

104. NAC is indicated to?: reduce accumulation of airway secretions, with concomitant improvement in pulmonary function and gas exchange and prevention of recurrent respiratory infection and airway damage. NAC also is used to treat or prevent liver damage that can occur when a patient takes an overdose of acetaminophen

105. NAC is the N-acetyl derivative of the amino acid L-cysteine and is given either by nebulization or by?: direct tracheal instillation

106. Nitric Oxide: Indications for Use: As described in more detail in Chapter 38, nitric oxide (INOmax) is indicated in the treatment of neonates (>34 weeks’ gestational age) with hypoxic respiratory failure.56 The patient should have evidence of pulmonary hypertension in which nitric oxide would improve oxygenation and decrease the need for extracorporeal membrane oxygenation. Off-label uses include reducing pulmonary artery pressure in the neonate.cMode of Action: Nitric oxide is produced by cells in the body. It relaxes vascular smooth muscle by binding to the heme group of cytosolic guanylate cyclase, activating guanylate cyclase, and increasing cyclic guanosine monophosphate. When inhaled, nitric oxide produces pulmonary vasodilation, reducing pulmonary artery pressure and improving mismatching. Adverse Effects: Nitric oxide is contraindicated in neonates with dependent right-to-left shunts. Precautions include methemoglobinemia and nitric dioxide formation. The most common adverse events are hypotension and withdrawal.

107. A Nonionized drug: is a lipid-soluble and diffuses across cell membranes and into the bloodstream

108. Nonsteroidal antiinflammatory drugs: constitute a growing class of drugs in the treatment of asthma. These include mast cell stabilizers

109. Other side effects that can occur include the following: -Airway obstruction secondary to rapid liquefaction of secretions. Disagreeable odor secondary to hydrogen sulfide. Incompatibility with certain antibiotics (sodium ampicillin, amphotericin B, erythromycin, tetracyclines, and aminoglycosides) if mixed in solution. Increased concentration and toxicity of nebulizer solution toward end of treatment. Nausea and rhinorrhea. Stomatitis. Reactivity of acetylcysteine with rubber, copper, iron, and cork”

110. The patient should be monitored for onset of any of the previously described adverse reactions. In addition, the following actions are recommended: Monitor for occurrence rate of PCP and rate of long-term hospitalizations. Monitor for presence of side effects (shortness of breath, possible pneumothorax, conjunctivitis, rash, neutropenia, dysglycemia) or appearance of extrapulmonary P. jiroveci infection. Evaluate need for prior use of a bronchodilator if symptoms of bronchospasm or coughing occur after inhalation of pentamidine.

111. Pentamidine isethionate (NebuPent) (al 724): is an antiprotozoal agent that has been used in the treatment of opportunistic pneumonia caused by Pneumocystis jiroveci, which is the causative agent of pneumocystis pneumonia (PCP). PCP is seen in immunocompromised patients, especially patients with AIDS.

112. Pharmacodynamic Phase: Describes the mechanisms of drug action by which a drug molecule causes it’s effects in the body.

113. Pharmacokinetic Phase: -Describes the time course & disposition of a drug in the body based on it’s: Absorption, Distribution, Metabolism, Elimination.

114. Potential Adverse Effects with the use of Adrenergic Bronchodilators include:: Dizziness, Hypokalemia, Loss of Bronchoprotection, Nausea, Tolerance (tachyphylaxis), Worsening ventilation/perfusion ratio

115. Potential Hazards and Side Effects of Aerosolized Corticosteroids are?: Adrenal insufficiency, Extrapulmonary allergy, Acute asthma, HPA suppression (minimal, dose-dependent), Growth retardation, Osteoporosis

116. The Primary focus of respiratory care pharmacology: The delivery of bronchoactive inhaled aerosols to the respiratory tract for the diagnosis & Treatment of Pulmonary Disease.

117. Ribavirin: Ribavirin (Virazole) is an antiviral agent used in the treatment of severe lower respiratory tract infections caused by respiratory syncytial virus (RSV). RSV is a common seasonal respiratory infection in infants and young children, which is usually self-limiting. The cost-effectiveness of ribavirin continues to be debated. Recommendations for use of the drug were published in a statement by the American Academy of Pediatrics.44 Administration of the aerosol requires use of a special large-reservoir nebulizer called a small particle aerosol generator (SPAG). The mode of action of ribavirin is ascribed to the similarity of the drug to guanosine, a natural nucleoside. Substitution of ribavirin for the natural nucleoside interrupts the viral replication process in the host cell.

118. Short-Acting Adrenergic Bronchodilator Agents: Metaproterenol, Albuterol, Pirbuterol, Levalbuterol

119. Short-Acting Nooncatecholamine Agents: -Short Duration (4-6 hours)- results in loss of beonchodilating effect overnight. Lack beta-2 specificity. replace with longer acting beta-2 specific agents. more suited for maintenance therapy. Can be taken 4 times daily

120. Side Effects Seen With Anticholinergic Aerosol Agent: SVN, MDI, and DPI (Common). Cough, dry mouth. MDI (Occasional). Nervousness, irritation, dizziness, headache, palpitation, rash
SVN DPI. Pharyngitis, dyspnea, flulike symptoms, bronchitis, upper respiratory infections, nausea, occasional bronchoconstriction, eye pain, urinary retention. Side effects were reported in a small percentage (1% to 5%) of patients. Precautions: Use with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, bladder neck obstruction, constipation, bowel obstruction, or tachycardia

121. systemic effects of inhaled aerosols: are due to absorption of the drug from the airway & gastrointestinal (GI) tract.

122. To prevent concentration of solution in the nebulizer during treatment you should?: it is suggested that the last fourth of the solution in the nebulizer be diluted with an equal volume of sterile water to prevent concentrated residue, possibly leading to airway irritatio

123.Treprostinil: Indication for Use: Treprostinil (Tyvaso) is indicated for the treatment of pulmonary arterial hypertension to increase walking distance in patients with New York Heart Association class III symptoms.60 It is administered using the Tyvaso Inhalation System, which is an ultrasonic, pulsed-delivery device. Mode of Action: Treprostinil is a prostacyclin analogue that causes vasodilation of the pulmonary and systemic arterial vascular beds and inhibits platelet aggregation. Treprostinil is available in a 2.9-mL ampule, which contains 1.74 mg of treprostinil (0.6 mg/mL). It is provided as a nebulization in the Tyvaso Inhalation System. The ampule is dumped into the medication cup of the nebulizer and is used for the entire day. The patient receives the prescribed amount of drug as a nebulization in four separate, equally spaced treatment sessions per day during waking hours. Each breath delivers 6 mcg of treprostinil. The initial dose is 3 breaths (18 mcg) per treatment session. If not tolerated, the dose may be reduced to 1 to 2 breaths per session and then increased to 3 breaths. Treprostinil should be increased by 3 breaths every 1 to 2 weeks until a dose of 9 breaths (54 mcg) per treatment session is reached. Adverse Effects: Treprostinil has not been studied in patients with underlying lung disease (e.g., asthma, COPD). Treprostinil may cause bronchospasm. This agent should not be mixed with any other agents.

124. The two agents approved in the United States for oral inhalation with an effect on mucus are?: N-acetyl-cysteine (NAC), dornase alfa. *Both agents are mucolytic, although their modes of action differ.

125. The two general formulations of aerosolized glucocorticoids are?: orally inhaled and intranasal aerosol preparations

126. Type of Receptors in the lung: Sympathetic (adrenergic), Parasympathetic (cholinergic)

127. Ultra-Short-Acting Adrenergic Bronchodilator Agents: Epinephrine, Racemic Epinephrine

128. The unusual neurotransmitter in the sympathetic system:: norepinephrine. this is similar to epinephrine AKA adrenaline.

129. Unusual Neurotransmitter is the Parasympathetic System:: Acetylcholine

130. The use of intranasal steroids is used for?: control of seasonal allergic or nonallergic rhinitis

131. various respiratory symptoms include: cough, dyspnea, pneumothorax, hemoptysis, rhinitis, sinusitis), flu syndrome, GI obstruction, hypoxia, malaise, and weight loss

132. With all aerosol drug therapy:: -basic vital signs should be assessed before and after treatment. Patient’s subjective reaction should be monitored. Patient’s should be instructed on the correct use of aerosol devices and correct use should be verified.

133. Zafirlukast and montelukast: leukotriene receptor antagonists and are selective competitive antagonists of leukotriene receptors LTD4 and LTE4

134. Zileuton: inhibits the 5-lipoxygenase enzyme that catalyzes the formation of leukotrienes from arachidonic acid