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RESPIRATORY QUESTIONS

1. TY is a 12 yo with asthma. He was recently started on albuterol.


a. How does albuterol treat asthmatics? Albuterol is a beta adrenergic agonist & dilates
airways by stimulating the beta2-adrenergic receptors located throughout bronchi.
aborts acute episode, some situations use it prior to episode (TRIGGER)
b. Is it used around the clock or prn? PRN to abort attacks
c. *What side effects are seen with it? Since these are non-selective side effects include
insomnia, restlessness, anorexia, cardiac stimulation (palpitations), hyperglycemia,
tremor, vascular headache, hypotension or hypertension. Hyperadrenergic. Used also to
treat hyperkalemia b/c t lowers potassium levels.
d. What is the preferred route of administration and why? Inhalation because it’ll go
straight to lungs & it has an immediate onset of action, less systemic effects. MDI equal
or better than neb and you have to carry it around.
e. What is the role of a spacer device? Please explain how a spacer works. A spacer is a
plastic cylinder, designed to make a metered dose inhaler (MDI) easier to use & for a
more efficient delivery - it improves on timing and particle size to break down more.
2. SA is a 27 yo female with asthma she asks about the use of salmeterol since her boyfriend
uses it for his asthma.
a. How does it treat asthma? It is a long acting beta adrenergic agonist- dilate airways,
slow onset and for long term prevention. Can also be used prior to exercise, prevent
trigger.
b. Is it used around the clock or prn? Given twice daily for maintenance treatment only.
Also these are to never be used alone; they are to be used in conjunction with other
drugs such as inhaled corticosteroid. Slow onset of action so not effective for PRN
c. What side effects are seen with it? Some adverse effects include immediate
hypersensitivity rxns, headache, hypertension, & neuromuscular & skeletal pain.
d. How does it compare to levalbuterol? They are both beta2 agonist, however
levalbuterol is a short acting one while salmeterol is a LABA
3. PO is a 23 yo with asthma to be started on an inhaled steroid.
a. Are inhaled steroids used to abort an acute asthma episode? If not what is it used for?
Inhaled steroids are used for the primary treatment of bronchospatic disorders to
control inflammatory responses. Not necessarily used to abort an acute asthma episode
because they do not stimulate beta receptors. No longterm control
b. How does it treat asthma? Steroids have the effect of reducing inflammation &
enhancing the beta agonist activity.
c. Is it used around the clock or prn? It is used around the clock, They are indicated for
persistent asthma 6-8 wks max clinical response
d. What side effects are seen with it? The main undesirable local effects of typical doses
of inhaled corticosteroids in the resp system include pharyngeal irritation, coughing, dry
mouth, & oral fungal infections.
e. How does it compare to systemic steroids? Inhaled steroids are used for the primary
treatment of bronchospatic disorders to control inflammatory responses while systemic
steroids are added if a pt asthma progresses. Inhaling is local while systemic steroids has
effects on entire system. Not common, dose dependent.
4. What instructions should PO receive when you teach him how to use the steroid inhaler and
why? Use beta agonist first, then take the steroid inhaler. Rinse mouth after using it to avoid
thrush
5. OP is the parent of an 8 yo female with asthma. What side effects may be seen with inhaled
steroids? Side effects that may be seen with inhaled steroids include pharyngeal irritation,
coughing, dry mouth, & oral fungal infections, rare systemic effects (height stunt)
6. Who is at risk for steroid induced adrenal suppression? What are the signs or symptoms of it?
Patients who have received systemic corticosteroids at high dosages for an extended period are
at risk; if they switch to inhaled steroids abruptly. Some of these pts may need up to a yr to
recover after discontinuing systemic therapy and switching to inhaled meds. Sxs include Chronic,
worsening fatigue and muscle weakness, loss of appetite, and weight loss are characteristic of
the disease. Nausea, vomiting, and diarrhea, shck, hypotension, munchies, moon face, water
retention, buffalo hump. High doses and long time
7. KI is a 12 yo male with severe asthma. To bring him under rapid control prednisone is started.
a. What are the side effects commonly seen when this used for 1-2 weeks? Most
common adverse effects are hyperglycemia, psychosis, mood disorders, fluid retention,
thrush, peptic ulcer, osteoporosis, growth stunt PEPTIC ULCER DISEASE SO TAKE IT WITH
FOOD/MILK
b. Can the medication be abruptly stopped? NO, because the administration of these
drugs causes the endogenous production of hormones to stop (adrenal suppression
therefore may experience hypoadrenal crisis 1-2 WK TAPER
8. LT is a 46 yo with asthma that recently underwent an organ transplant. The patient will be on
prednisone for at least a year. What are the long term side effects that may be seen with it.
These meds can cause systemic side effects (HF, edema, HTN, convulsions, headaches, vertigo,
mood swings, peptic ulcers) but a long term effect of the med is moon face & steroid psychosis.
9. Why are steroid inhalers preferred to systemic steroids? Because systemic steroids adverse
effect can affect any organ in the body while inhalers have a local effect
10. How do the side effects of systemic steroids compare to inhaled steroids? Inhaled steroids
include adverse effects that are limited to the topical site of action in the lungs while systemic
steroids effects can affect any organ in the body.
a. Inhaled: pharyngeal irritation, coughing, dry mouth, & oral fungal infections.
b. Systemic: adrenocortical insufficiency, ↑ susceptibility to infection, fluid & electrolyte
disturbances, endocrine effects, CNS effects, dermatologic & connective tissue defects
(brittle skin, bone loss, osteoporosis, & Cushing’s), cataracts, peptic ulcers, etc
11. Why is theophylline no longer commonly used in the treatment of asthma? Because of their
greater potential for drug interactions & the greater interpatient variability in therapeutic drug
levels in the blood. They also have a slow onset of action. Its beneficial effects can be
maximized by maintaining blood level within a certain target range (8-20 mcg/ml) SERUM LEVEL
AND NOT THAT EFFECTIVE
12. Besides asthma what is montelukast used for? And what side effects may be seen with it? It is
a second line for PREVENTION of acute episodes. It is also used for seasonal allergies to stop
inflammation. There have been reports of depression or mood disorders (rare).
13. BV is a 78 yo with COPD. A decision is made to start theophylline.
a. Why would someone take this med? This med is used to alleviate mild to moderate
acute asthma & is used as an adjunct med for COPD
b. Why do we monitor the serum levels of it? Levels are monitored because of the greater
interpatient variability in therapeutic drug levels in the blood (8-20 mcg/ml)
c. What side effects and drug interactions does one have to be cornered about when
taking it
i. Side effects: ↑ HR, arrhythmias, excitability, insomnia, seixures, dilation of renal
arterioles, N/V
ii. Interactions: erythromycin & caffeine
14. KY is having an acute allergic reaction to “something”. His practitioner tells him to take
diphenhydramine.- 1st generation Antihistamine
a. Why is it used for an acute allergic reaction? Diphenhydramine is an antihistamine
drug. Histamine 1 (PERIPHERY) mediates smooth muscle contraction and dilation of
capillaries & its release in excess can cause anaphylaxis & severe allergic sxs. These
meds are H1 antagonists so they compete w/ Histamine for receptors & prevent this
smooth muscle constriction during allergic rxns
b. Does it block H1 or H2 receptors? H1 receptors on smooth muscle & capillaries. H2 ON
GI TRACT
c. What is the appropriate dose for a 12 yo 145 lb child? PO/IM/IV: 12.5-25mg tid-qid- do
not go above adult doses even if child’s med dose (calculated with wt) is higher. ADULT
MAX DOSE, DO NOT GO ABOVE
d. This medication has been associated with anticholinergic side effects. What are these
side effects? sedation, dry mouth, constipation, CNS depression or stimulation, urinary
retention, GI discomfort
e. If a decision is made to start him on a non-sedating antihistamine, which would you
pick and what is the correct dose? Would get the pt on a 2nd gen antihistamine
i. Cetirizine (Zyrtec)
ii. Desloratadine (Clarinex)
iii. Loratadine (Claritin, Alavert)
iv. Fexofenadine (Allegra).
15. AP is a 21 yo to be started on a nasal decongestant.
a. What is the name of several oral agents and several that taken by inhalation? Nasal
decongestants can be taken orally to produce a systemic effect, can be inhaled, or can
be administered topically to the nose.
i. Oral: pseudoephedrine (sudaphed), BTC BC OF METH, CYLAPHRINE?,
ii. Spray: Phenylephrine, OXYMATAZINE? TETRAHYDRAZINE?
b. How do they work?
i. Adrenergic drugs constrict the small arterioles that supply the structures of the
upper resp tract, primarily the blood vessels surrounding the nasal sinuses.
Once these vessels shrink the nasal secretions in the swollen mucous
membranes are better able to drain.
ii. Nasal steroids are aimed at the inflammatory response elicited by invading
organisms or antigens. They exert their anti-inflammatory effect by causing
these cells to be turned off or rendered unresponsive. Goal is to not complete
immunosuppression of the resp tract but to reduce the inflammatory sxs.
c. What side effects may be seen with them? Possible side effects include nervousness,
insomnia, palpitations, & tremor. Mucosal irritation & dryness for the steroids. The
systemic oral meds can cause CV effects such as headache, nervousness, and dizziness.