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Nurs8024 Module 8 (Questions With Detailed Answers)
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Nurs8024 Module 8 (Questions With Detailed Answers)
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NURS8024: M6 – Questions & Accurate Answers (A+)Drugs affecting the ANS. Right Ans - Cholinergic: act on receptors that are
activated by ACh
Adrenergic: act on receptors that are stimulated by NE and E
BOTH: act by either stimulating or blocking receptors of the ANS
Sympathomimetics Right Ans - drugs that mimic that actions of E or NE
Adrenergic receptor agonists - relaxes airway, inhibits bronchoconstriction,
inhibits microvasc leakage
Stimulation of B2 receptors - relaxes airway, inhibits mediator release
Optimally delivered by inhalation
Benefits of inhaler spacer. Right Ans - decreases deposition of drug in
mouth
Reduces velocity of large-particle drugs
Improved amount of small-particle drug that gets into airway
Reduced GI absorption of drug
Adrenergic Agonists (Inhaled B2) Right Ans - selective B2 agonists
Drug of choice ONLY for mild intermittent symptoms (monotherapy)
Rescue therapy for all types of asthma
Direct-acting B2 agonists are potent vasodilators that relax airway smooth
muscle
Short-Acting B-Adrenergic Agonists (SABAs) Right Ans - bronchodilators
with DOS 2-4 hrs
,MOA: B2 stimulation, smooth muscle relaxation and bronchodilation
E.g. albuterol (PO/inhaled), levalbuterol, pirbuterol, terbutaline,
metaproterenol
Clinical Uses: asthma, COPD, bronchoconstriction, hyperK (temporarily)
ADEs: tachyC, tremor, N/V, HA, nervousness, hypoK, palpitations, insomnia
Serious ADEs: paradoxical bronchospasm, arrhythmias, angioedema,
increased LFTs (effects minimized with inhaled route)
OD: symptoms of excessive B stimulation - HTN, seizure, angina, tachyC,
arrhythmia, nervousness, dizziness, cardiac arrest, death
Notes: increased effect w/ other sympathomimetics, toxicity with
methylxanthines, decreased effect with BB use, decreased effectiveness of
insulin and PO hypoglycemics
Long-Acting B-Adrenergic Agonists (LABAs) Right Ans - bronchodilators
with DOA 12 hrs
MOA: B2 stimulation, smooth muscle relaxation and bronchodilation
E.g. salmeterol (dry powder), formoterol
ADEs: tremor, nervousness, tachyC, HA, palpitations, nasal congestion,
insomnia
Serious ADEs: bronchospasm, rash, angina, hypersensitivity reaction,
angioedema, arrhythmia, hypoK, metabolic acidosis
BBW: small (but sig) increase in asthma related death
Notes: MUST be combined with ICS in asthma
Ultra-Long-Acting B-Adrenergic Agonists
(U-LABAs) Right Ans - indacaterol, olodaterol, & vilanterol
, taken daily
currently approved only for COPD Tx
Ipratropium (Atrovent) Right Ans - inhaled cholinergic (muscarinic)
antagonist, short-acting (DOA 4-6 hrs)
MOA: blocks muscarinic receptors in ANS, promotes bronchodilation
less effective than B2 agonists
ADEs: HA, dizziness, fatigue, rash, cough, palpitations, URI symptoms, dry
mouth, constipation, urinary retention
Serious ADEs: anaphylaxis, worsening of NA glaucoma, paradoxical
bronchospasm, tachyC, urticaria
Notes: inhaled only, less effective in elderly, limited use in asthma, 1st line for
COPD, OK for preg/lact
Caution: myasthenia gravis, glaucoma, BPH, bladder neck obstruction
Tiotropium (Spiriva) Right Ans - inhaled cholinergic (muscarinic)
antagonist, long-acting (half-life 5-6 days)
MOA: blocks muscarinic receptors in ANS, promotes bronchodilation
Similar side effect/ADEs/contraindications as ipratropium
Corticosteroids Right Ans - modify the immune response to control
inflammation
Suppression of cytokine production, inhibits infiltration of irways by WBCs,
inhibits release of leukotrienes
Decreased mucosal edema & cap perm, decreased airway
hyperresponsiveness (AHR), decreased frequency and severity of
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