Describe the pathophysiology of asthma and chronic obstructive pulmonary disease.

Short teaching presentation. Develop a patient teaching brochure for the management of asthma. One of your resources has to pharmacology for the primary care provider. I have included an example of a brochure

Drugs that Affect the Respiratory System:
Beta2 Agonists, Methylxanthines, Anticholinergics,
Mast Cell Stabilizers, Inhaled and Systemic Corticosteroids,
Leukotriene Modifiers, PDE4 Inhibitor, Cough and Cold Medications
Notes to Accompany
The Program
BY
Margaret Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN
President, Fitzgerald Health Education Associates, Inc.
North Andover, MA
Family Nurse Practitioner, Adjunct Faculty, Family Practice Residency
Greater Lawrence (MA) Family Health Center
Editorial Board Member
The Nurse Practitioner Journal, Prescriber’s Letter, American Nurse Today
© Fitzgerald Health Education Associates, Inc.
85 Flagship Drive, North Andover, MA 01845-6154
Phone 978.794.8366 | Fax: 978.794.2455 | Email: ce@fhea.com | www.fhea.com
All rights reserved
Drugs that Affect the Respiratory System Copyright, Fitzgerald Health Education Associates, Inc. All rights reserved. Reproduction is prohibited. 1
STATEMENT OF LIABILITY
The information contained in this work whether written or oral
has been thoroughly researched and checked for accuracy. However,
clinical practice is a dynamic process and new information becomes
available daily. Prudent practice dictates that the clinician consult
further sources prior to applying information, whether in printed or
verbal form, obtained from this program. Fitzgerald Health Education
Associates, Inc. disclaims any liability, loss, injury or damage incurred
as a consequence, directly or indirectly, from the use and application
of any of the contents of this volume or information given in the
presentation.
Copyright Fitzgerald Health Education Associates, Inc. All rights
reserved. No part of this publication or the accompanying Program
may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopy, recording or any
information storage and retrieval system, without permission in writing
from the author.
Requests for permission to make copies of or to incorporate any part
of the work into academic programs should be mailed to:
Permissions Department, FHEA, 85 Flagship Drive
North Andover, MA 01845-6154
ISBN 978-2-18514142-6 (08pconv4)
***
Fitzgerald Health Education Associates, Inc. provides a variety of
timely, continuing education for health care practitioners. To receive
periodic notice of the availability of such opportunities write or call:
Fitzgerald Health Education Associates, Inc.
85 Flagship Drive
North Andover, MA 01845-6154
978.794.8366 Fax 978.794.2455
Drugs that Affect the Respiratory System Copyright, Fitzgerald Health Education Associates, Inc. All rights reserved. Reproduction is prohibited. 2
Instructions
The goals and objectives for this program are listed at the
bottom of this column. Please read the following material
carefully.
A. Academic Users
See your academic course administrator/coordinator for
instructions as to how to use these resources.
B. Individual Users
After “attending” the Program, complete the on-line
evaluation and posttest for processing fee of $20. If not
ordered with the Program, the test can be ordered from:
fhea.com/store Click “On-line Tests” to locate the test that
corresponds to this Program.
On-line access tests at: www.npexpert.com.
Alternatively, you can request a paper posttest and
evaluation and return with the $30 processing fee to:
Fitzgerald Health Education Associates, Inc.
Posttest processing
85 Flagship Drive
North Andover, MA 01845-6154
Fitzgerald Health Education Associates, Inc. is approved as a
provider of nurse practitioner continuing education by the
American Academy of Nurse Practitioners. Provider number:
070201.
1.3 Contact Hours for each section (total of 3.9 for topic) will
be awarded for successfully completing each posttest with a
score of 70% or better (i.e. 7 out of 10 correct). Should you
be unsuccessful, FHEA will provide feedback as to the
remediation needed prior to retesting. Only one retest is
permitted.
Please note that you MUST provide your professional
license number and state of licensure to validate your
contact hours.
For instructions to take this test on-line, go to
www.fhea.com/testinstructions.htm
Questions regarding continuing education at Fitzgerald
Health Education Associates? Call (978) 794-8366. Answers
must be post-marked within one calendar year from date of
purchase.
The goal of this educational program is:
To provide quality continuing education to advanced
practicing nurses to enhance their knowledge of drugs that
affect the respiratory system.
Objectives:
1. Describe the pathophysiology of asthma and
chronic obstructive pulmonary disease.
2. Develop a plan of pharmacologic intervention for
the person with an acute asthma flare or COPD
exacerbation, as well as long-term preventive
therapy using the NAEPP EPR-3 guidelines,
GOLDCOPD and ATS Guidelines based on the
mechanism of disease.
3. Describe the mechanism of action and potential
uses of commonly prescribed cough, cold and
allergic rhinitis therapies.
About the Author
Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP,
CSP, FAAN, is the founder, president and principal
lecturer with Fitzgerald Health Education Associates,
Inc. (FHEA), an international provider of nurse
practitioner certification preparation and continuing
education for healthcare providers. More than 60,000
nurse practitioners have used the Fitzgerald review
course to successfully prepare for certification.
An internationally recognized presenter, Dr.
Fitzgerald has provided thousands of programs for
numerous professional organizations, universities,
national and state healthcare associations on a wide
variety of topics including clinical pharmacology,
assessment, laboratory diagnosis, healthcare and nurse
practitioner practice. For more than 20 years she has
provided graduate-level pharmacology courses for
nurse practitioner students at a number of universities
including Simmons College (Boston, MA), Husson
College (Bangor, ME), University of Massachusetts
Worcester, Pennsylvania State University, La Salle
University (Philadelphia, PA), and Samford University
(Birmingham, AL). In addition, she is a family nurse
practitioner at the Greater Lawrence Family Health
Center, Lawrence, MA, and adjunct faculty for the
Greater Lawrence Family Health Center Family Practice
Residency Program. She holds a Doctor of Nursing
Practice from Case Western Reserve University,
Cleveland, OH, where she received the Alumni
Association Award for Clinical Excellence.
Dr. Fitzgerald is the recipient of the National
Organization of Nurse Practitioner Faculties’ Lifetime
Achievement Award, given in recognition of vision and
accomplishments in successfully developing and
promoting the nurse practitioner role, the American
College of Nurse Practitioner’s Sharp Cutting Edge
Award and the Outstanding Nurse Award for Clinical
Practice by the Merrimack Valley Area Health Education
Council. She is also a Fellow of the American Academy
of Nursing and a charter fellow in the Fellows of the
American Academy of Nurse Practitioners. Dr.
Fitzgerald is a Professional Member of the National
Speakers Association and is the first nurse practitioner
to earn the Certified Speaking Professional (CSP)
designation in recognition of excellence and integrity as
a speaker.
Dr. Fitzgerald is an editorial board member for the
Nurse Practitioner Journal, Medscape Nurses, LexiComp,
Inc., American Nurse Today, and Prescriber’s
Letter. She is widely published with more than 100
articles, book chapters, monographs, and audio and
video programs to her credit. Her book, Nurse
Practitioner Certification Examination and Practice
Preparation (2nd edition) received the American Journal
of Nursing Book of the Year Award for Advanced
Practice Nursing and has been published in English and
Korean. She has provided consultation to nursing
organizations in the United States, Canada, the
Dominican Republic, Japan, South Korea, Hong Kong,
and the United Kingdom. Dr. Fitzgerald is an active
member of numerous professional organizations at
national and local levels.
Drugs that Affect the Respiratory System Copyright, Fitzgerald Health Education Associates, Inc. All rights reserved. Reproduction is prohibited. 3
Drugs that Affect the Respiratory System:
Beta2 Agonists, Methylxanthines, Anticholinergics,
Mast Cell Stabilizers, Inhaled and Systemic
Corticosteroids, Leukotriene Modifiers, PDE4 Inhibitor,
Cough and Cold Medications
Margaret A. Fitzgerald,
DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC
President, Fitzgerald Health Education Associates, Inc., North Andover, MA
Family Nurse Practitioner, Adjunct Faculty, Family Practice Residency
Greater Lawrence (MA) Family Health Center
Editorial Board Member
The Nurse Practitioner Journal, Prescriber’s Letter, American Nurse Today
1
 Fitzgerald Health Education Associates, Inc.
Please note that significant portions
of this product are only available
on-line.
To access this essential material,
use Fitzgerald Health’s Learning
Management System,
NPexpert
Objectives
 Having completed the learning
activities, the participant will be able
to:
– Recognize indications and therapeutic
actions of commonly used herb, mineral
and vitamin therapies.
 Fitzgerald Health Education Associates, Inc.
3
Objectives
 Having completed the learning
activities, the participant will be able
to:
1. Describe the pathophysiology of
asthma and chronic obstructive
pulmonary disease.
 Fitzgerald Health Education Associates, Inc.
4
Objectives
(continued)
●Having completed the learning
activities…(cont.)
2. Develop a plan of pharmacologic
intervention for the person with an
acute asthma flare or COPD
exacerbation, as well as long-term
preventive therapy using the NAEPP
EPR-3 guidelines, GOLDCOPD and
ATS Guidelines based on the
mechanism of disease.  Fitzgerald Health Education Associates, Inc.
5
Objectives
(continued)
●Having completed the learning
activities…(cont.)
3. Describe the mechanism of action
and potential uses of commonly
prescribed cough, cold and allergic
rhinitis therapies.
 Fitzgerald Health Education Associates, Inc.
6
Drugs that Affect the Respiratory System Copyright, Fitzgerald Health Education Associates, Inc. All rights reserved. Reproduction is prohibited. 4
Report of the Expert Panel: Guidelines
for the Diagnosis and Management of
Asthma (EPR-3)
www.nhlbi.nih.gov
 Fitzgerald Health Education Associates, Inc. 7
Asthma Defined
 “A common chronic disorder of the
airways that is complex and
characterized by variable and
recurring symptoms, airflow
obstruction, bronchial
hyperresponsiveness, and
underlying inflammation.”
– Source- NHLBI, 2007
8
 Fitzgerald Health Education Associates, Inc.
The Interplay Between Airway
Inflammation, Clinical Symptoms &
Pathophysiology
(EPR-3)
9
 Fitzgerald Health Education Associates, Inc.
Goal of Asthma Therapy:
Achieve Control
 Reduce impairment
– Prevent chronic and troublesome symptoms
– Require infrequent use of inhaled SABA (≤2
days/week)
– Maintain (near) “normal” pulmonary
function
– Maintain normal activity levels
– Meet patient’s expectations of, and
satisfaction with, asthma care
10
 Fitzgerald Health Education Associates, Inc.
Goal of Asthma Therapy:
Achieve Control
(continued)
 Reduce risk
– Prevent recurrent exacerbations
– Minimize need for emergency
department visits or hospitalizations
– Prevent progressive loss of lung
function
– Provide optimal pharmacotherapy,
with minimal or no adverse effects 11
 Fitzgerald Health Education Associates, Inc.
Classification of Asthma Severity
(Youths≥12 Years of Age and Adults)
Classifying severity for patients who are
not currently taking long-term control medications
Components of Severity Persistent
Impairment
Normal
FEV1/FVC:
8-19 yr 85%
20-39 yr 80%
40-59 yr 75%
60-80 yr 70%
Symptoms
Intermittent Mild Moderate Severe
≤2 days/week >2 days/week
but not daily Daily Throughout the day
Nighttime
awakenings ≤2x/month 3-4x/month >1x/week but
not nightly Often 7x/week
Short-acting beta2-
agonist use for
symptom control
(not prevention of
EIB)
≤2 days/week
>2 days/week
but not
>1x/day
Daily Several times per day
Interference with
normal activity None Minor limitation Some limitation Extremely limited
Lung function
Normal FEV1
between
exacerbations
FEV1>80%
predicted
FEV1>80%
predicted
FEV1>60% but
<80% predicted FEV1 <60% predicted FEV1/FVC normal FEV1/FVC normal FEV1/FVC reduced 5% FEV1/FVC reduced >5%
Risk
Exacerbations
requiring oral
systemic
corticosteroids
0-1/year (see note) ≥2/year (see note)
Consider severity and interval since last exacerbation. Frequency and severity
may fluctuate over time for patients in any severity category.
Relative annual risk of exacerbations may be related to FEV1
 Fitzgerald Health Education Associates, Inc. 12
Drugs that Affect the Respiratory System Copyright, Fitzgerald Health Education Associates, Inc. All rights reserved. Reproduction is prohibited. 5
Classification of Asthma Control
(Youths 12 Years of Age and Adults)
Components of Control
Impairment
Symptoms Well-controlled Not Wellcontrolled
Very Poorly
Controlled
≤2 days/week >2 days/week Throughout the day
Nighttime awakenings ≤2 x/month 1-3x/week ≥4x/week
Interference with normal
activity None Some limitation Extremely limited
Short-acting beta2-agonist
use for symptom control
(not prevention of EIB)
≤2 days/week >2 days/week Several times per day
FEV1 or peak flow >80% predicted/personal
best
60-80%
predicted/personal
best
<60% predicted/personal best Validated Questionnaires ATAQ ACQ ACT 0 ≤0.75* ≥20 1-2 ≥1.5 16-19 3-4 N/A ≤15 Exacerbations 0-1/year ≥2/year (see note) Consider severity and interval since last exacerbation Risk Progressive loss of lung function Evaluation requires long-term follow-up care Treatment-related adverse effects Medication side effects can vary in intensity from none to very troublesome and worrisome. The level of intensity does not correlate to specific levels of control but should be considered in the overall assessment of risk. *ACQ values of 0.76-1.4 are indeterminate regarding well-controlled asthma. Key: EIB, exercise-induced bronchospasm; FEV1, forced expiratory volume in 1 second. See figure 3-8 for full name and source of ATAQ, ACQ, ACT. 13 Monitoring Control in Clinical Practice: Asthma Control Test™ for Patients Aged≥12 Years https://www.asthma.com/resources/asthma-control-test.html, accessed 2.7.12. Level of Control Based on Composite Score ≥20 = Controlled 16-19 = Not Well Controlled ≤15 = Very Poorly Controlled Regardless of patient’s selfassessment of control in Question 5 14  Fitzgerald Health Education Associates, Inc. Your patient is a 17 yo with asthma who uses fluticasone with salmeterol BID and albuterol PRN. He asks for a note to be excused from gym. What is the most appropriate response to this request? 15  Fitzgerald Health Education Associates, Inc. Linda  47 y/o with >20 y-hx of asthma
 Current asthma medications
– Fluticasone 44 µg/puff, 1 puff BID
– Albuterol via MDI 2 puffs QID PRN
– Albuterol 2.5 mg via nebulizer q 4h
PRN during flares
16
 Fitzgerald Health Education Associates, Inc.
Linda
(continued)
 Concomitant health problems
– HTN, dyslipidemia, allergic rhinitis
 Medications for these problems
– Atenolol 100 mg QD
– Lisinopril 40 mg QD
– Simvastatin 20 mg QD
– Loratadine PRN, uses about 2-3 times
per week when “pollen in the air”
17
 Fitzgerald Health Education Associates, Inc.
Linda
(continued)
 Does she have increased risk of
ACEI-induced cough?
 What is the mechanism of ACEIinduced
cough?
 Other issue(s) with HTN therapy?
18
 Fitzgerald Health Education Associates, Inc.
Drugs that Affect the Respiratory System Copyright, Fitzgerald Health Education Associates, Inc. All rights reserved. Reproduction is prohibited. 6
Renin-angiotensin Cascade:
What Works Where?
Angiotensinogen
 Angiotensin I
 Angiotensin II
AT1
AT2 ATn
Bradykinin
Inactive
peptides
Non-renin
(e.g. tPA)
Non-ACE
(e.g. chymase) ACE
Renin
19
©Fitzgerald Health Education Associates, Inc.
ACEI-induced Cough
 The mechanism of ACE inhibitor-induced
cough remains unresolved, but likely involves
the protussive mediators bradykinin and
substance P, agents that are degraded by
ACE and therefore accumulate in the upper
respiratory tract or lung when the enzyme is
inhibited, and prostaglandins, the production
of which may be stimulated by bradykinin.
– https://chestjournal.chestpubs.org/content/129/1_suppl/169S.full,
accessed 2.6.12.
 Fitzgerald Health Education Associates, Inc.
20
Linda
(continued)
 Does not check PEF at home
– “Not sure this makes a difference.”
 No asthma action plan
 No allergic rhinitis control plan
21
 Fitzgerald Health Education Associates, Inc.
Patient Report of
Asthma Pattern
 “I wake up 1-2 times per week
coughing.”
 “I usually have 3-4 times a year
when my asthma acts up. I need to
go to the emergency room.”
 “I usually use about a canister of
albuterol every month and my
nebulizer practically every day.”
22
 Fitzgerald Health Education Associates, Inc.
Classification of Asthma Control
(Youths 12 Years of Age and Adults)
Components of Control
Impairment
Symptoms
Wellcontrolled
Not Wellcontrolled
Very Poorly
Controlled
≤2 days/week >2 days/week Throughout the day
Nighttime awakenings ≤2 x/month 1-3x/week ≥4x/week
Interference with
normal activity None Some limitation Extremely limited
Short-acting beta2-
agonist use for
symptom control (not
prevention of EIB)
≤2 days/week >2 days/week Several times per day
FEV1 or peak flow
>80%
predicted/personal
best
60-80%
predicted/personal
best
<60% predicted/personal best Validated Questionnaires ATAQ ACQ ACT 0 ≤0.75* ≥20 1-2 ≥1.5 16-19 3-4 N/A ≤15 Exacerbations 0-1/year ≥2/year (see note) Consider severity and interval since last exacerbation Risk Progressive loss of lung function Evaluation requires long-term follow-up care Treatment-related adverse effects Medication side effects can vary in intensity from none to very troublesome and worrisome. The level of intensity does not correlate to specific levels of control but should be considered in the overall assessment of risk. *ACQ values of 0.76-1.4 are indeterminate regarding well-controlled asthma. Key: EIB, exercise-induced bronchospasm; FEV1, forced expiratory volume in 1 second. See figure 3-8 for full name and source of ATAQ, ACQ, ACT. 23 Linda (continued)  Presents today for emergency care  72 h history – URI symptoms including clear nasal discharge, sore throat, feeling feverish, green sputum production X 24 h – Worsening asthma symptoms with decreased response to albuterol 24  Fitzgerald Health Education Associates, Inc. Drugs that Affect the Respiratory System Copyright, Fitzgerald Health Education Associates, Inc. All rights reserved. Reproduction is prohibited. 7 Physical Exam  T= 99.5⁰F (37.5⁰C), BP=140/88, HR 110 BPM, RR 26 BPM  Congested cough w/small amount green sputum production  SaO2=92% on room air  PEF=225 ml with fair to good effort  Physical exam – Decreased breath sounds – Expiratory wheezing 25  Fitzgerald Health Education Associates, Inc. Adapted from Bousquet et al. Am J Respir Crit Care Med. 2000;161:1720-1745. Airway inflammation • I • Mucosal edema • Inflammatory cell infiltration, activation • Cellular proliferation • Epithelial damage • Basement membrane thickening • Bronchoconstriction • Bronchial hyperreactivity • Hyperplasia/Hypertrophy • Inflammatory mediator release Symptoms/Exacerbations Smooth muscle dysfunction 26  Fitzgerald Health Education Associates, Inc. Stepwise Approach for Managing Asthma in Patients Aged12 Years: NAEPP EPR-3 Guidelines Step 1 Preferred: SABA PRN Step 2 Preferred: Low-dose inhaled corticosteroid (ICS) Alternative: Mast cell stabilizer (Cromolyn nedocromil), leukotriene receptor antagonist (LTRA), or theophylline Step 3 Preferred: Medium-dose ICS or Low-dose ICS + LABA Alternative: Low-dose ICS and either LTRA, theophylline, or zileuton Step 5 Preferred: High-dose ICS + LABA and omalizumab (Xolair) use can be considered for patients who have allergies. Step 4 Preferred: Medium-dose ICS + LABA Alternative: Medium-dose ICS and either LTRA, theophylline, or zileuton Step 6 Preferred: High-dose ICS + LABA + oral corticosteroid and consider omalizumab for patients who have allergies Severe Persistent Moderate Mild Persistent Persistent Intermittent  Fitzgerald Health Education Associates, Inc. 27 Controller Drugs to Prevent Inflammation Inhaled Corticosteroids (ICS)  Budesonide  Pulmicort®  Fluticasone  Flovent ®  Beclomethasone  Beclovent ®  Mometasone  Asmanex ® 28  Fitzgerald Health Education Associates, Inc. Mechanism of Action Corticosteroids  Normally endogenously by adrenal cortex  Inhibit production of inflammatory agents – Cytokines, an effect which reduces eosinophil infiltration, inhibits macrophage and eosinophil function – Decreases epithelium mediator cells, reduces vascular permeability, reduces the production of leukotrienes 29  Fitzgerald Health Education Associates, Inc. Inhaled Corticosteroids  Introduced in mid-1970s  First to market – Inhaled beclomethasone, at dose of 4 puffs per day, with 42 ug per puff (164 ug per total daily dose) – Low potency, marginal clinical effect, inconvenient dosing regimens limited acceptance of this therapy initially.  Fitzgerald Health Education Associates, Inc. 30 Drugs that Affect the Respiratory System Copyright, Fitzgerald Health Education Associates, Inc. All rights reserved. Reproduction is prohibited. 8 What dose of inhaled corticosteroid is Linda currently using? 31  Fitzgerald Health Education Associates, Inc. Estimated Comparative Daily Dosages for ICS in Patients Aged≥12 Years Soiurce- https://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf., accessed 2.7.12. Low Daily Dose Medium Daily Dose High Daily Dose Beclomethasone HFA 40 or 80 µg/puff Budesonide DPI 200 µg/inhalation Flunisolide 250 µg/puff Flunisolide HFA 80 µg/puff Fluticasone HFA MDI 44, 110, or 220 µg/puff Fluticasone DPI 50, 100, or 250 µg/puff Mometasone DPI 200 µg/puff 80-240 µg 200-600 µg 500-1000 µg 320 µg 88-264 µg 100-300 µg 200 µg >240-480 µg
>600-1200 µg
1000-2000 µg
320-640 µg
264-440 µg
300-500 µg
400 µg
>480 µg
>1200 µg
>2000 µg
>640 µg
>440 µg
>500 µg
>400 µg
32
Inhaled Corticosteroids:
True or false?
 Most PCPs are well versed in the
relatively potency of the inhaled


 

PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING TERM PAPERS TODAY AND GET AN AMAZING DISCOUNT

get-your-custom-paper
Buy Custom Nursing Papers

Buy Nursing Papers

 

For order inquiries     +1 (518) 291 4128

Open chat
1
You can now contact our live agent via Whatsapp! via +1 518 291-4128

Feel free to ask questions, clarifications or discounts available when placing your order.