Chapter 37 Bronchodilators and Respiratory Drugs

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Chapter 37 Bronchodilators and Respiratory Drugs

A. Diseases of the Lower Respiratory Tract
* COPD
* Asthma
* Emphysema
* Chronic bronchitis

B. Bronchial Asthma
* Recurrent and reversible shortness of breath
* Occurs when the airways of the lungs become narrow as a result of: * Bronchospasms
* Inflammation of the bronchial mucosa
* Edema of the bronchial mucosa
* Production of viscid mucus
* Alveolar ducts/alveoli remain open, but airflow to them is obstructed * Symptoms
* Wheezing
* Difficulty breathing

C. Asthma
* Three categories
* Allergic
* Idiopathic
* Mixed allergic-idiopathic
* Status asthmaticus
* Prolonged asthma attack that does not respond to typical drug therapy * May last several minutes to hours
* Medical emergency

D. Chronic Bronchitis
* Continuous inflammation of the bronchi and bronchioles
* Often occurs as a result of prolonged exposure to bronchial irritants

E. Emphysema
* Air spaces enlarge as a result of the destruction of alveolar walls * The surface area where gas exchange takes place is reduced * Effective respiration is impaired

F. Drugs Used to Treat Asthma
* Long-term control
* Leukotriene receptor antagonists
* Inhaled steroids
* Long-acting beta2-agonists
* Quick relief
* Intravenous systemic corticosteroids
* Short-acting inhaled beta2-agonists

G. Bronchodilators and Respiratory Drugs
* Bronchodilators
* Beta-adrenergic agonists
* Xanthine derivatives
* Anticholinergics
* Leukotriene receptor antagonists
* Corticosteroids

H. Bronchodilators: Beta-Agonists
* Large group, sympathomimetics
* Used during acute phase of asthmatic attacks
* Quickly reduce airway constriction and restore normal airflow * Stimulate beta2-adrenergic receptors throughout the lungs

Three types
* Nonselective adrenergics
* Stimulate alpha, beta1 (cardiac), and beta2 (respiratory) receptors * Example: epinephrine
* Nonselective beta-adrenergics
* Stimulate both beta1 and beta2 receptors
* Example: metaproterenol (Alupent)
* Selective beta2 drugs
* Stimulate only beta2 receptors
* Example: albuterol (Proventil, others)

Beta-Agonists: Mechanism of Action
* Begins at the specific receptor stimulated
* Ends with dilation of the airways
* Activation of beta2 receptors activates cyclic adenosine monophosphate (cAMP), which relaxes smooth muscle in the airway and results in bronchial dilation and increased airflow
Beta-Agonists: Indications
* Relief of bronchospasm related to asthma, bronchitis, and other pulmonary diseases * Used in treatment and prevention of acute attacks
* Used in hypotension and shock
* Used to produce uterine relaxation to prevent premature labor

Beta-Agonists: Adverse Effects
* Alpha and beta (epinephrine)
* Insomnia
* Restlessness
* Anorexia
* Vascular headache
* Hyperglycemia
* Tremor
* Cardiac stimulation

* Beta1 and beta2 (metaproterenol)
* Cardiac stimulation
* Tremor
* Anginal pain
* Vascular headache
* Hypotension

* Beta2 (albuterol)
* Hypotension OR hypertension
* Vascular headache
* Tremor

Beta-Agonists: Nursing Implications
* Encourage patients to take measures that promote a generally good state of health so as to prevent, relieve, or decrease symptoms of COPD * Avoid exposure to conditions that precipitate bronchospasm (allergens, smoking, stress, air pollutants) * Adequate fluid intake

* Compliance with medical treatment
* Avoid excessive fatigue, heat, extremes in temperature, caffeine * Encourage patients to get prompt treatment for flu or other illnesses, and to get vaccinated against pneumonia or flu * Encourage patients to always check with their physician before taking any other...
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