Drug Classes – Asthma Management Quick-Relief Short-acting beta 2 -adrenergic agonists (SABA) Bronchodilators Choice drug for acute sx Anticholinergics Bronchodilators Alternate drug for those who CANNOT tolerate SABAs Corticosteroids: systemic Anti-Inflammatory Not rapid acting The physiology of the respiratory system involves two main processes: perfusion and ventilation. Perfusion is the blood flow through the lungs, which allows for gas exchange across the capillaries. Ventilation is the process of moving air into and out of the lungs. The airway diameter is regulated by the autonomic nervous system, which can cause the airway to dilate or constrict. Asthma is a chronic disease that has both inflammatory and bronchospasm components. The inflammatory component of asthma involves an increase in airway edema coupled with increased mucus secretions that contribute to airway obstruction. Bronchospasm may be induced by various triggers. Acute dyspnea and wheezing are common signs of asthma. Drugs are used to prevent asthmatic attacks and to terminate an attack in progress. Inhalation is a common route of administration for pulmonary drugs because it delivers drugs directly to the sites of action. The inhalation route is used to deliver medications directly and safely to the respiratory system. Aerosol medications are those delivered as very small liquid droplets or fine, dry particles. Nebulizers, MDIs, and DPIs are types of devices used for aerosol therapies. The goals of asthma pharmacotherapy are to terminate acute bronchospasms and to reduce the frequency of asthma attacks. National Asthma Education and Prevention (NAEPP) guidelines are used in asthma management. These guidelines initiate therapy in a stepwise approach based
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Anticholinergics Bronchodilators Alternate drug for those who CANNOT tolerate SABAs
Corticosteroids: systemic Anti-Inflammatory Not rapid acting
The physiology of the respiratory system involves two main processes: perfusion and ventilation.
Perfusion is the blood flow through the lungs, which allows for gas exchange across the capillaries. Ventilation is the process of moving air into and out of the lungs. The airway diameter is regulated by the autonomic nervous system, which can cause the airway to dilate or constrict.
Asthma is a chronic disease that has both inflammatory and bronchospasm components.
The inflammatory component of asthma involves an increase in airway edema coupled with increased mucus secretions that contribute to airway obstruction. Bronchospasm may be induced by various triggers. Acute dyspnea and wheezing are common signs of asthma. Drugs are used to prevent asthmatic attacks and to terminate an attack in progress.
Inhalation is a common route of administration for pulmonary drugs because it delivers drugs directly to the sites of action.
The inhalation route is used to deliver medications directly and safely to the respiratory system. Aerosol medications are those delivered as very small liquid droplets or fine, dry particles. Nebulizers, MDIs, and DPIs are types of devices used for aerosol therapies.
The goals of asthma pharmacotherapy are to terminate acute bronchospasms and to reduce the frequency of asthma attacks.
National Asthma Education and Prevention (NAEPP) guidelines are used in asthma management. These guidelines initiate therapy in a stepwise approach based on the severity of asthma symptoms. The goals of asthma therapy are to terminate acute bronchospasms and to prevent asthma attacks. Medications used in asthma management are classified as quick-relief agents or long-term control agents.
Beta2-adrenergic agonists are the most effective drugs for relieving acute bronchospasm.
Beta agonists activate beta2 receptors in bronchial smooth muscle to cause bronchodilation. The short-acting beta agonists have a rapid onset of action and are used to terminate acute
bronchospasm. The long-acting beta agonists are prescribed for asthma prophylaxis, usually when corticosteroids fail to achieve symptom control.
The inhaled anticholinergics are used for preventing bronchospasm.
Ipratropium and tiotropium act by blocking cholinergic receptors in bronchial smooth muscle. Ipratropium is used as an alternative drug for asthma prophylaxis and intranasally as a decongestant. Tiotropium is used to prevent bronchospasm in patients with chronic bronchitis or emphysema.
Inhaled corticosteroids are the most effective drugs for the long-term control of asthma.
Corticosteroids are the most potent natural anti-inflammatory substances known. Inhaled corticosteroids are the drugs of choice for the prevention of asthmatic attacks and the management of chronic asthma. Oral corticosteroids may be used for the short-term management of acute asthma exacerbations.
Mast cell stabilizers are used for the prophylaxis of asthma and act by preventing the release of histamine.
Mast cells contain inflammatory granules, such as histamine, that mediate inflammatory and allergic reactions. When these cells are sensitized, they release the inflammatory substances into the body where they initiate an inflammatory response. Mast cell stabilizers are considered alternate drugs for the prophylaxis of mild to moderate asthma symptoms.
The leukotriene modifiers, which are primarily used for asthma prophylaxis, act by reducing the inflammatory component of asthma.
Leukotriene modifiers are medications that reduce inflammation and are considered alternate drugs in the prophylaxis of persistent asthma. Zileuton acts by blocking lipoxygenase, the enzyme that controls leukotriene synthesis. Montelukast and zafirlukast block leukotriene receptors. They are not considered bronchodilators, although they do reduce bronchoconstriction indirectly.
Methylxanthines were once the mainstay of asthma pharmacotherapy but are now rarely prescribed for that disorder.
Methylxanthines such as theophylline are less effective, have a narrow therapeutic index, and produce more adverse effects than the beta agonists. They are primarily reserved for the long-term management of persistent asthma that is unresponsive to beta agonists or inhaled corticosteroids.
Monoclonal antibodies are a newer form of therapy for the prevention of asthma symptoms.
Omalizumab is the only biologic therapy for asthma management. The drug binds to IgE, preventing the release of chemical mediators of inflammation. It is used for treating moderate to severe, persistent asthma that cannot be controlled with inhaled corticosteroids.
Chronic obstructive pulmonary disease (COPD) may be treated with bronchodilators, anti-inflammatory agents, and mucolytics.
COPD is a progressive disorder characterized by chronic and recurrent obstruction of airflow. The two most common conditions that cause chronic pulmonary obstruction are chronic bronchitis and emphysema. The goals of the pharmacotherapy of COPD are to relieve symptoms and avoid complications of the condition. Multiple pulmonary drugs such as bronchodilators, anti-inflammatory agents, expectorants, mucolytics, antibiotics, and oxygen may offer symptomatic relief.
Causes of bronchial asthma-Bronchospmasma, Inflammation, Edema, Viscid mucus
Bronchial asthma -Alveolar ducts/alveoli are open but airflow to them is obstructed
Status asthmaticus -^^^^^^^^DOES NOT respond to typical drug therapy
Emphysema -^^^^^^^^Air spaces enlarge bc of alveolar wall destruction
Reduced gas exchange area
Long term asthma tx (3) -Leukotriene receptor antagonists, Inhaled steroids, Long-acting beta2-agonists
Allergen -^^^^^^^^a substance capable of producing an allergic reaction.
Angioedema -^^^^^^^^edema and swelling beneath the skin.
Antiallergic -^^^^^^^^drug that prevents mast cells from relaeasing histamine and other vasoactive substances.
Antibody -^^^^^^^^a specialized protein (immunoglobulin) that recognizes the antigen that triggered its production.
Antigen -^^^^^^^^substance, usually protein or carbohydrate, that is capable of stimulating an immune response.
Antihistaminic -^^^^^^^^drug that blocks the action of histamine at the target organ.
Asthma -^^^^^^^^inflammation of the bronchioles associated with constriction of smooth muscle, wheezing, and edema.
Dermatitis -^^^^^^^^inflammatory condition of the skin associated with itching, burning, and edematous vesicular formations.
Eczematoid Dermatitis -^^^^^^^^condition in which lessons on the skin ooze and develop scaly crusts.
Erythema -^^^^^^^^redness of the skin, often a result of capillary dilation
Excoriation -^^^^^^^^an abrasion of the epidermis (skin) usually from a mechanical (not chemical) cause, a scartch.
Histamine -^^^^^^^^substance that interacts with tissues to produce most of the symptoms of allergy.
Hives -^^^^^^^^a skin condition characterized by intensely itching wheals caused by an allergic reaction; also called urticaria
Hyperemia -^^^^^^^^increased blood flow to a body part like the eye; engorgement.
Nonselective -^^^^^^^^interacts with any subtype receptor.
Prophylactic -^^^^^^^^process or drug that prevents the onset of symptoms (or disease) as a result of exposure before the reactive process can take place.
Selective -^^^^^^^^interacts with one subtype of receptor over others.
Sensitize -^^^^^^^^to induce or develop a reaction to naturally occuring substances (allergens) as a result of repeated exposure.
Urticaria -^^^^^^^^intensely itching raised areas of skin caused by an allergic reaction; hives.
Wheal -^^^^^^^^a firm, elevated swelling of the skin often pale red in color and itchy; a sign of allergy.
Xerostomia -^^^^^^^^dryness of the oral cavity resulting from inhibition of the natural moistening action of salivary gland secretions or increased secretion of salivary mucus, rather than serous material.
Bronchodilator -^^^^^^^^drug that relaxes bronchial smooth muscle and dilates the lower respiratory passages.
Chemical Mediator -^^^^^^^^substance released from mast cells and white blood cells during inflammatory and allergic reactions.
Chronic Bronchitis -^^^^^^^^respiratory condition caused by chronic irration that increasessecretion of mucus and causes degeneration of the respiratory lining.
COPD -^^^^^^^^Chronic Obstructive Pulmonary Diesase, usually caused by emphysema and chronic bronchitis.
Emphysema -^^^^^^^^disease process causing destruction of the walls of the alveoli
Expectorant -^^^^^^^^drug that helps clear the lungs of respiratory secretions.
Leukotrienes -^^^^^^^^chemical mediators involved in inflammation and asthma.
Mucolytic -^^^^^^^^drug that liquefies bronchial secretions.
Prostaglandins -^^^^^^^^chemical mediators released from mast and other cells involved in inflammatory and allergic conditions.
Abortifacient -^^^^^^^^substance that induces abortion.
Absorption -^^^^^^^^the uptake of nutrients from the GI tract.
Acid Rebound -^^^^^^^^effect in which a great volume of acid is secreted by the stomach in response to the reduced acid environment caused by antacidneutralization.
Antacid -^^^^^^^^drug that neutralizes hydrochloric acid (HCI) secreted by stomach.
Antisecretory -^^^^^^^^substance that inhibits secretion of digestive enzymes, hormones, or acid.
Chyme -^^^^^^^^partially digested food and gastric secretions that move into the stomach by peristalsis.
Digestion -^^^^^^^^mechanical and chemical breakdown of foods into smaller units.
Dyspepsia -^^^^^^^^indigestion.
Emesis -^^^^^^^^vomiting.
Enterochromaffin-Like Cells (ECL) -^^^^^^^^celsl that synthesize and release histamine.
GERD -^^^^^^^^gastroesphageal refluex disease.
Heartburn (Acid Indigestion) -^^^^^^^^a painful burning feeling behindthe sternum that occurs when stomach and backs up into the esophagus.
Heaptic Microsomal Metabolism -^^^^^^^^specific enzymes in the liver (p450 family) that meabolize somedrugs and can be increased (stimulated) by some medications or decreased (inhibited) by other medications so that therapeutic drug blood levels are altered.
Hyperacidity -^^^^^^^^abnormally highdegree of acidity (for example, pH less than 1) in the stomach.
Hypercalcemia -^^^^^^^^elevated concentration of calcium ions in the circulating blood.
Hyperchlorhydria -^^^^^^^^excess hydrochloricacid in the stomach.
Hypermotility -^^^^^^^^increase in muscle tone or contractions causing faster clearance ofsubstances through the GI tract.
Hypophosphatemia -^^^^^^^^abnormally low concentrations of phosphate in thecirculating blood.
Parietal (Oxyntic) Cell -^^^^^^^^cell that synthesizes and releases hydrocholoric acid (HCI) into thestomach lumen.
Pepsin -^^^^^^^^enzyme that digests protein in the stomach.
Perforation -^^^^^^^^opening in a hollow organ, such as a break in the intestinal wall.
Proteolytic -^^^^^^^^action that causes the decomposition or destruction of proteins.
Ulcer -^^^^^^^^open sore in the mucous membranes or mucosal linings of the body.
Ulcerogenic -^^^^^^^^capable of producing minor irritation or lesions to an integral break in the mucosal lining (Ulcer)
Absordent -^^^^^^^^substance that has the ability to attach other substances to its surface.
Cathartic -^^^^^^^^pharmacological substance that stimulates defecation.
Chloride Channel Activators -^^^^^^^^a novel class of drugs that stimulate pare-forming receptors in the intestine, causing chloride ions to cross membranes.
Constipation -^^^^^^^^a decrese in stool frequency.
Defecation -^^^^^^^^process of discharging the contents of the intestines, as feces.
Diarrhea -^^^^^^^^abnormal looseness of the stool or watery stool, which may be accompanied by a change in stool frequency or volume.
Electrolyte -^^^^^^^^ion in solution, such as sodium, potassium, or chloride, that is capable of mediating conduction (passing impulses in the tissues).
Emollient -^^^^^^^^substance that is soothing to mucous membranes or skin.
Evacuation -^^^^^^^^process of removal of waste material from the bowel.
Hernia -^^^^^^^^protusion of an organ through the tissue usually containing it; for example, intestinal tissue pushing outside the abdominal cavity, or stomach, pushing into the diaphragm (hiatal heria).
Hypokalemia -^^^^^^^^decrease in the normal concentration of potassium in the blood.
Hyponatremia -^^^^^^^^decrease in the normal concentration of sodium in the blood.
IBS (Irritable Bowel Syndrome) -^^^^^^^^a functional disorder of the colon with abdominal pain, cramping, bloating, diarrhea, and/or constipation.
Laxative -^^^^^^^^a substance that promotes bowel movements.
Mu-Opioid Receptor Antagonist -^^^^^^^^drugs that block the mu protein receptor for opioids.
Osmolality -^^^^^^^^the concentration of particles dissolved in a fluid.
Osmosis -^^^^^^^^process in which water moves across membranes following the movementof sodium ions.
Peristalsis -^^^^^^^^movement characteristic of the intestines, in which cirular contraction and relaxation propel the contents toward the rectum.
Transit Time -^^^^^^^^amount of time it takes for food to travel from the mouth to the anus.
Acromegaly -^^^^^^^^condition usually in middle-aged adults from hypersecretion of growth hormone.
Carcinoid Tumor -^^^^^^^^a slow-growing type of cancer that can arise in the gastrointestinal tract, lungs, ovaries, and testes.
Cretinism -^^^^^^^^condition in which the development of the body and brain has been inhibited.
Ductless Glands -^^^^^^^^containing no duct; endocrine glands that secrete hormones directly into the blood or lyumph without goingthrough a duct.
Dwarfism -^^^^^^^^inadequate secretion of growth hormone during childhood, characterized by abnormally short statue and normal body proportions.
Endocrine -^^^^^^^^pertaining to gland that secrete substances directly into the blood.
Gigantism -^^^^^^^^increased secretion of growth hormone in childhood, causing excessive growth and height.
Gonads -^^^^^^^^organs that produce male (testes) or female (ovaries) sex cells, sperm, or ova.
Hormone -^^^^^^^^substance produced within one organ and secreted directly into the circulation to exert its effects at a distant location.
Insulin-Like Growth Factor (IGF) -^^^^^^^^stimulator of cell growth and proliferation.
Somatomedins -^^^^^^^^peptides in the plasma that stimulate cellular growth and have insulin-like activity.
Somatostatin -^^^^^^^^an inhibitory hormone that blocks the release of somatotropin (GH) and thyroid-stimulating hormone (TSH).
Target Organ -^^^^^^^^specific tissue for growth hormone (GH)
Tropic Hormone -^^^^^^^^hormone secreted by the anterior pituitory that binds to a receptor on another endocrine gland.
Addison's Disease -^^^^^^^^inadequate secretion of gluocoriticoids and mineralcorticoids.
ADT -^^^^^^^^Alternate-Day Therapy.
Catabolism -^^^^^^^^process in which complex compounds are broken down into simpler molecules; usually associated with energy release.
Circadian Rhyrhm -^^^^^^^^internal biological clock; a repeatable 24-hour cycle of physiological activity.
Glucocorticoid -^^^^^^^^steriod produced within the adrenal cortex (or a synthetic drug) that directly influences carbohydrate metabolism and inhibits the inflammatory process.
Gluconeogensis -^^^^^^^^the synthesis of glucose from molecules that are not carbohydrates, such as amino and fatty acids.
Intra-Articular (IA) -^^^^^^^^joint space into which drug is injected.
Isotonic -^^^^^^^^Normal salt concentration of most body fluids; a slat concentration of 0.9 percent.
Lymphokine -^^^^^^^^a substance secreted by T-Cells that signals other immune cells like macrophages to aggregate.
Lyysosome -^^^^^^^^part of a cell that contains enzymes capable of digesting or destroying tissue/proteins.
Mineralocorticoid -^^^^^^^^steroid produced within the adrenal cortex that directly influences sodium and potassium metabolism.
Native -^^^^^^^^natural substance in the body.
Proinflammatory -^^^^^^^^tending to cause inflammation.
Replacement Therapy -^^^^^^^^administration of a naturally occuring substance that the body is not able to produce inadequate amounts to maintain normal function.
Repository Preparation -^^^^^^^^preparation of a drug, usually fro intramusclar or subcutaneous injection, that is intends to leach out from the site of injection slowly so that the duration of drug action is prolonged.
Steroid -^^^^^^^^member of a large family of chemical substances (hormones,drugs) containing a structure similar to cortisone (tetracyclic cyclopenta-a-phenanthrene).
Allegra -^^^^^^^^allergies
Benadryl -^^^^^^^^allergies
Claratin -^^^^^^^^allergies
Zyrtec -^^^^^^^^allergies
Delsym -^^^^^^^^antitussive
Tessalon Pexles -^^^^^^^^antitussive
Tussionex -^^^^^^^^antitussive
Sudafed -^^^^^^^^decongestent
Robitussin -^^^^^^^^expectorant
Atrovent -^^^^^^^^asthma
Proventil -^^^^^^^^asthma
Combivent -^^^^^^^^asthma
Flonasc -^^^^^^^^asthma
What is the first line treatment for asthma, a.k.a. quick relief? -^^^^^^^^short acting β agonist (albuterol)
anticholinergics (ipratropium)
Systemic corticosteroids
What is the second line treatment for asthma, a.k.a. controllers? -^^^^^^^^inhaled corticosteroids (aerobid)
long acting β agonist (salmeterol)
leukotriene receptor antagonists (montelukast)
Theophylline or cromolyn may also be considered
First line: How does the short acting β agonist work on the body? -^^^^^^^^-Sympathomimetic that results in smooth airway muscle relaxation
-Bronchodilation reduces airway resistance as shown by increased FEV1, mid-expiratory flow rate, and vital capacity
-Increased cAMP inhibits the release of mediators from mast cells in the airways, producing a mild antiinflammatory effect
Albuterol - Class -^^^^^^^^short acting β agonist
Albuterol - Indication -^^^^^^^^treatment or prevention of bronchospasm in pt's w/ reversible obstructive airway dz; prevention of exercise-induced bronchospasm
Albuterol - MOA -^^^^^^^^relaxes bronchial smooth muscle by action on β₂ receptors w/ little effect on HR
Albuterol - Pregnancy -^^^^^^^^Cat C
albuterol is the preferred short acting β agonist for use in asthma during pregnancy
Overdose symptoms may include nervousness, headache, tremor, dry mouth, chest pain or heavy feeling, rapid or uneven heart rate, pain spreading to the arm or shoulder, nausea, sweating, dizziness, seizure (convulsions), feeling light-headed or fainting.
Albuterol - Precautions -∗use w/ caution in pt's with CV dz as β agonists can ↑ BP, ↑ HR, stimulate the CNS, and ↑ risk of arrhythmias, *use w/ caution in pt's with DM as β agonists can ↑ serum glucose, *use w/ caution in pt's with glaucoma as β agonists can ↑ intraocular pressure ∗use w/ caution in pt's with hyperthyroidism as β agonists can ↑ thyroid activity ∗use w/ caution in pt's with hypokalemia as β agonists can ↓ serum K⁺ ∗use w/ caution in pt's with seizure disorders as β agonists can stimulate the CNS*Albuterol - Metabolism & Excretion -Metabolism: liver extensively; Excretion: urine primarily, feces; Half-life: 2.7-6h
first line: how do anticholinergic bronchodilators work on the body? -block the nerve responses (parasympathetic) that normally cause narrowing of airways. commonly used in combination with a beta 2 bronchodilator such as albuterol* blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation* ipratropium (atrovent)* drug of choice for beta-blocker induced bronchospasms*ok for pregnant women suffering w/ severe asthma exacerbations*hypersensitivity to ipratropium or atropine*adverse effects -uri, bronchitis, sinusitis, cp, palpitations, ha, dizziness, dyspepsia, nausea, uti, back pain, dyspnea, rhinitis, cough, pharyngitis, ↑ sputum, flu-like syndrome*rarely, paradoxical bronchospasm may occur*ipratropium (atrovent) - precautions -not for rescue therapy, this med should only be used in acute exacerbations of asthma in conjunction with a short acting β agonist for acute episodes*use with caution in pt's w/ narrow angle glaucoma, myasthenia gravis, & prostatic hyperplasia/bladder neck obstructions Binds to mast cells and prevents mast cell rupture and degranulation.Binds to receptors on monocytes, eosinophils, epithelial cells and platelets to interfere with the release of inflammatory mediators and cytokines. In managing lower respiratory tract disorders, which main classes of drugs are used*Drugs can be grouped into mucolytic agents, such as acetylcysteine; bronchodilators, such as theophylline; and anti-inflammatory drugs, such as cromolyn sodium. Theophylline acts by stimulating two prostaglandins, which results in smooth-muscle relaxation in both the bronchi and vasculature. Beta-adrenergic agonists are sympathomimetic agents. That means the drugs mimic the action of norepinephrine. In the lungs, norepinephrine stimulates bronchodilation. Anticholinergic agents block the action of acetylcysteine. When acetylcysteine stimulates the lungs, bronchoconstriction occurs; thus, when its action is blocked, the bronchi do not constrict. In a patient with acute respiratory distress, which of the bronchodilators would be most effective? Beta-adrenergic agonists, such as albuterol, have the quickest onset of action. They are referred to as “rescue drugs.” Which of the anti-inflammatory agents is the most effective? Glucocorticosteroids are the most powerful anti-inflammatory agents. What is the difference between glucocorticoid steroids given orally and by inhalation? Both drugs are effective in reducing inflammation. Glucocorticoid steroids given orally have the potential to cause more adverse effects because they are systemic. Steroids given by inhalation have a local action; thus, they cause fewer adverse effects. Cromolyn sodium works by stabilizing the mast cell. When the mast cell ruptures in response to an antigen, bronchoconstrictive substances such as histamine, bradykinin, serotonin, and leukotrienes are released. By stabilizing the mast cell, the drug prevents release of these substances. Glucocorticoid steroids have a multitude of actions. In the lungs, they decrease the effectiveness of inflammatory cells, thus keeping the bronchioles open. Leukotriene antagonists block the ability of leukotrienes to bind to their receptor sites. Because leukotriene binding to these sites is what causes bronchoconstriction, bronchoconstriction is blocked. If a patient is taking inhaled steroids, an anticholinergic inhaler, and a beta-adrenergic agonist inhaler, which inhaler would you tell the patient to use first? The beta-adrenergic agonist inhaler should be used first because it has the fastest onset. It will open the bronchial tree, so that the other drugs can be dispersed farther into the lungs to exert their action.
Ipratropium (Atrovent) - Precautions -^^^^^^^^NOT FOR RESCUE THERAPY. This med should only be used in acute exacerbations of asthma IN CONJUNCTION WITH a short acting β agonist for acute episodes
use with caution in pt's w/ narrow angle glaucoma, myasthenia gravis, & prostatic hyperplasia/bladder neck obstructions
Ipratropium (Atrovent) - PK/PD -^^^^^^^^Absorption: Mean bioavailability is 7% (inhalation). Ipratropium is not readily absorbed.
Ipratropium (Atrovent)* Drug of choice for beta-blocker induced bronchospasms
Ipratropium (Atrovent) - Indication -^^^^^^^^anticholinergic bronchodilator used in bronchospasm associated w/ COPD, bronchitis, & emphysema (& asthma exacerbations but is more effective in COPD than asthma)
Drug of choice for beta-blocker induced bronchospasms
Ipratropium (Atrovent) - MOA -^^^^^^^^blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation
Drug of choice for beta-blocker induced bronchospasms
Ipratropium (Atrovent) - Pregnancy -^^^^^^^^Cat B
ok for pregnant women suffering w/ severe asthma exacerbations
Ipratropium (Atrovent) - Contraindications -^^^^^^^^hypersensitivity to ipratropium or atropine
Ipratropium (Atrovent) - Precautions -^^^^^^^^NOT FOR RESCUE THERAPY. This med should only be used in acute exacerbations of asthma IN CONJUNCTION WITH a short acting β agonist for acute episodes
use with caution in pt's w/ narrow angle glaucoma, myasthenia gravis, & prostatic hyperplasia/bladder neck obstructions
Ipratropium (Atrovent) - PK/PD -^^^^^^^^Absorption: Mean bioavailability is 7% (inhalation). Ipratropium is not readily absorbed.
Distribution: 0 to 9% is protein bound.
Metabolism: Partially metabolized.
Excretion: The t ½ is approximately 2 h (inhalation or IV). Following IV administration, approximately half of the dose is excreted unchanged in the urine.
Ipratropium (Atrovent) - Pt education -^^^^^^^^Avoid contact with eyes; may cause temporary blurring of vision
First line: Systemic corticosteroids *prednisone, prednisolone, methylprednisone*Second line: How do inhaled corticosteroids (ICS) work on the body? *reduce airflow obstruction by reducing airway inflammation in the bronchioles*Why would you use ICS? -^^^^^^^^∗Management of persistent asthma, all severity levels* ∗Most potent /effective controller asthma medication∗Broad action on inflammatory processes∗MDI, DPI, nebulizer solution∗Improves symptoms, pulmonary function∗Reduces exacerbations (urgent visits, emergency care, hospitalizations, quick-relief medications, oral CS)∗Reduces airway hyperresponsiveness: ∗HPA suppression is noted in adults receiving 32 puffs/day of an inhaled steroid over a period of 1 month - monitor for adrenal insufficiency∗Inhaled corticosteroids (ICS) provide local therapeutic action with minimal systemic ICS are in both Asthma/COPD and Upper Respiratory Infections
I will only include Flunisolide (Aerobid) here because it is oral. The other five ICS are nasal and I will group them together under URI as it is done on the professor's slides [Budesonide (Rhinocort), Flunisolide (Nasarel), Fluticasone propionate (Flonase), Mometasone furoate (Nasonex),
& Triamcinolone acetonide (Nasacort)]
TWO Flunisolides - Aerobid & Nasarel.
Flunisolide (Aerobid) - Class -^^^^^^^^inhaled corticosteroids
Flunisolide (Aerobid) - Indication -^^^^^^^^Long-term prevention of bronchospasm in patients with asthma
Aerobid (flunisolide) Inhaler is indicated in the maintenance treatment of asthma as prophylactic therapy. Aerobid is also indicated for asthma patients who require systemic corticosteroid administration, where adding Aerobid may reduce or eliminate the need for the systemic corticosteroids.
Aerobid Inhaler is NOT indicated for the relief of acute bronchospasm.
Flunisolide (Aerobid) - MOA -^^^^^^^^↓ inflammation by suppression of migration of polymorphonuclear leukocytes & reversal of ↑ capillary permeability; does not depress hypothalamus
Flunisolide (Aerobid) - Adverse effects -^^^^^^^^n/v/d dyspepsia, flu like symptoms sore throat, HA, nasal congestion, URI, unpleasant taste, palpitations, abd pain, CP, ↓ appetite, edema, fever, candida infection, dizziness, nervous,
Flunisolide (Aerobid) - Precautions -^^^^^^^^pts treated w/ Aerobid (flunisolide) should be observed for any systemic corticosteroid effect, including suppression of bone growth in children. Particular care should be taken in post-op pt's or during periods of stress for ↓ in adrenal function.
Also safety issues: bone density, bruising
Corticosteroids may mask infection or predispose to infection, especially fungal; subcapsular cataracts; glaucoma; adrenocortical insufficiency; psychic derangements; GI bleeding; diabetes mellitus, reactivation of tuberculosis
Flunisolide (Aerobid) - Pt Education -^^^^^^^^∗ Rinse mouth after use∗ use at regular intervals for effectiveness∗ do not use as emergency therapy for asthma attacks∗ Do not abruptly stop medication administration ∗ Discard canister when doses should have been used; canister cannot be accurately checked
Second line: How do long acting β agonists work on the body? -cause relaxation of bronchial smooth muscle. Slowly cleared from body so effects are long lasting (onset of action is also longer). Not used in acute asthma attack*How do long acting β agonists and corticosteroids complement each other? -^^^^^^^^Corticosteroids increase b2-receptor synthesis and decrease b2 desensitization*LABAs prime glucocorticoid receptors for steroid-dependent activation*Salmeterol (Serevent) - Class -^^^^^^^^long acting β agonist*Salmeterol (Serevent) - Indication -^^^^^^^^maintenance treatment of asthma & prevention of bronchospasm (as concomitant therapy) in pt's with reversible obstructive airway dz, to include pt's w/ sxs of nocturnal asthma, prevention of exercise-induced bronchospasm, & maintenance treatment of bronchospasm associated with COPD*Salmeterol (Serevent) - MOA -
^^^^^^^^relaxes bronchial smooth muscle by selective action on β₂ receptors w/ little effect on HR; salmeterol acts locally in the lung*Salmeterol (Serevent) - Pregnancy -^^^^^^^^Cat C*β-agonists may interfere with uterine contractility if administered during labor - use only if clearly needed.*Salmeterol (Serevent) - Contraindications -^^^^^^^^hypersensitivity*monotherapy! it should never be used alone to treat asthma*Salmeterol (Serevent) - Adverse effects -^^^^^^^^Arrhythmias and/or tachycardia, cardiac arrest, death, headache, hyperglycemia, hypokalemia, muscle cramps, palpitations, prolongation of the QTc interval, tremor rarely, paradoxical bronchospasm may occur*Salmeterol (Serevent) - Precautions -^^^^^^^^When added to usual asthma therapy, there may be an increase in asthma-related deaths. Only use salmeterol as additional therapy for patient not adequately controlled on other asthma-controller medications (eg, low- to medium-dose inhaled corticosteroids) or whose disease severity clearly warrants initiation of treatment with 2 maintenance therapies, including salmeterol - do not use salmeterol as monotherapy.*Salmeterol (Serevent) - Pt education -^^^^^^^^∗ do not use for acute exacerbations of asthma* NEVER use a spacer device ∗ daily use is required to manage sxs∗ do not exceed prescribed does (yes, it DID go into the nose!)*Salmeterol (Serevent) - drug/drug interactions -^^^^^^^^Beta-adrenergic blockers: Pulmonary effects of salmeterol may be blocked and may produce severe bronchospasm in patients with COPD*Diuretics: ECG changes and hypokalemia associated with diuretics may worsen with coadministration*MAOIs, tricyclic antidepressants: May increase CV effects of salmeterol.
Second line: How do leukotriene receptor agonists work on the body? -^^^^^^^^block the production or action of inflammatory mediators called leukotrienes, reducing inflammation and relaxing airway smooth muscle and reducing mucus production*Not used for acute attack*Montelukast sodium (Singulair) - class leukotriene receptor antagonist*Montelukast sodium (Singulair) - indication -^^^^^^^^prophylaxis and chronic treatment of asthma; relief of symptoms of seasonal allergic rhinitis & perennial allergic rhinitis; prevention of exercise-induced bronchospasm*Montelukast sodium (Singulair) - MOA -^^^^^^^^selective leukotriene receptor antagonist that inhibits the cysteinyl leukotriene receptor (these receptors have been correlated with the pathophys of asthma and allergic rhinitis)* pregnancy -^^^^^^^^Cat B*adverse effects -^^^^^^^^dizziness, fatigue, HA, fever, rash, dyspepsia, dental pain, gastroenteritis, ↑ LFTs, weakness, nasal congestion, epistaxis, sinusitis, URI, abd pain, psychomotor hyperactivity, somnolence, thirst, vomiting*Montelukast sodium (Singulair) - precautions -^^^^^^^^will not interrupt the bronchoconstrictor response to ASA or NSAIDs; use caution with those drugs*rarely, can cause systemic eosinophilia and vasculitis or behavorial changes*pt education -^^^^^^^^Advise patient with asthma or asthma and allergic rhinitis to take prescribed dose once daily in the evening - best taken 1 hour before meals or 2 hours after*Caution patient with asthma that medication is not to be used to treat acute asthma attacks. Instruct patient to always have a short-acting beta-agonist available for acute treatment of asthma symptoms*May be used as an alternative to inhaled corticosteroids in patients with mild persistent or aspirin-sensitive asthma*Effect is weaker than that of low-dose inhaled corticosteroids*Usually used as add-on therapy in asthma
Why use theophylline or cromolyn? -^^^^^^^^Theophylline may be used either as an adjunctive therapy in conjunction with ICS or as an alternative agent, but is not recommended as a preferred therapy*Cromolyn sodium is an alternative option*What are methylxanthines used for? -^^^^^^^^Cause relaxation of bronchial smooth muscle by blocking action of
chemicals that cause contraction. Oral slow release theophylline is used to long term control. They are however irritating to the stomach. Available in IV form for used in acute asthma attack* treatment of symptoms and reversible airway obstruction due to chronic asthma or other chronic lung diseases* Promote bronchodilation by competitively inhibiting phosphodiesterase, the enzyme that degrades cAMP, which in turn, increases intracellular cAMP*Act as a direct central nervous system stimulant, resulting in vasoconstriction and stimulation of the vagal center, which causes bradycardia*In large doses, cause a positive inotropic effect on myocardium and a positive chronotropic effect on SA node*a mild to moderate bronchodilator used as alternative, not preferred, therapy for step 2 care (for mild persistent asthma) or as adjunctive therapy with ICS in patients > 5 years of age* PregCat C*Contrain-hypersens or allergy to corn as the premixed injection may contain corn-derived dextrose*Adverse eff^vomiting, insomnia, restlessness, seizures, increased heart rate, or a headache* have mild anti-inflammatory effects. Monitoring of serum theophylline concentration is essential* Therapeutic index is low - think toxicity*Monitoring Parameters serum drug levels, q24h during infusion*Many drugs and physiologic variables affect theophylline metabolism, and dosage adjustment is required*Pt ed^Extended-release capsules should be taken 1 hour before or 2 hours after meals; immediate-release forms can be taken with food if GI upset occurs*Dont change brands theophylline w/0 consulting provider*Notify if nausea, vomiting, insomnia, jitteriness, headache, rash, severe GI pain, restlessness, convulsions, or irregular heartbeat occurs*Avoid caffeine-containing beverages and other stimulants
Why use a nonsteroidal antiallergic? -^^^^^^^^to block the release or action of inflammatory chemicals in the body reducing symptoms of inflammation. Block degranulation of the mast cell. Not for acute attack.
and for Asthma prophylaxis. Prevention of bronchoconstriction before exposure to a known precipitant
Cromolyn (Intal) - Class -^^^^^^^^nonsteroidal antiallergic - mast cell stabilizer
Note - Cromolyn is another double drug on this test, as Intal here (nebulizer) and later on as NasalCrom (nasal spray)
Cromolyn (Intal) - Indication -^^^^^^^^may be used as an adjunct in the prophylaxis of allergic disorders, including asthma; prevention of exercise-induced bronchospasm
Cromolyn (Intal) - MOA -^^^^^^^^prevents the mast cell release of histamine, leukotrienes, and slow-reacting substance of anaphylaxis by inhibiting degranulation after contact with antigens
Cromolyn (Intal) - Precautions -^^^^^^^^use w/ caution in pt's with a h/o arrhythmias, hepatic or renal impairment
need to be tapered off
now only available in Nebulizer form, the inhalers were discontinued
Cromolyn (Intal) - Pt education -^^^^^^^^take 30 min before meals. clear as much mucus as possible before use. Rinse mouth after use to ↓ unpleasant aftertaste.
What drugs are used for mild COPD? -^^^^^^^^short acting β agonist
What drugs are used for moderate COPD? -^^^^^^^^in addition to those used in mild dz, add on:
anticholinergic
long acting β agonist
What drugs are used for severe COPD? -^^^^^^^^in addition to those used in mild & moderate dz, add on:
inhaled corticosteroid
What drugs are used for very severe COPD? -^^^^^^^^in addition to those used in mild, moderate, & severe dz; add on:
O2, consider surgery
What other drug might you consider for COPD? -^^^^^^^^theophylline
Bronchodilators & the older adult -^^^^^^^^Bronchodilators may cause increased adverse reactions; some older adults may not tolerate side effects such as tachycardia
Theophylline & the older adult -^^^^^^^^Theophylline clearance is reduced in the older adult, causing increased risk of drug toxicity and interaction
Corticosteroids & the older adult -^^^^^^^^High-dose inhaled corticosteroids and oral corticosteroids that are often used in COPD may cause or worsen osteoporosis in the older adult
Nebulization & the older adult -^^^^^^^^Nebulization treatment may be useful when older adults are unable to use inhalers correctly
Corticosteroids & pregnancy -^^^^^^^^ICS does not increase the risks of major malformations, preterm delivery, low birth weight, and pregnancy-induced hypertension
Cat B drugs -^^^^^^^^ipratropium, mast cell stabilizers, budesonide, montelukast and zafirlukast, and terbutaline, cromolyn
Theophylline & breastfeeding -^^^^^^^^Breastfeeding may have to be discontinued because the drug can cause serious toxicity in nursing infants
How do you treat mild, intermittent symptoms of allergic rhinitis? -^^^^^^^^Antihistamine, preferably nonsedating, or a decongestant
If the pt is unable to take an oral antihistamine, consider the use of a nasal antihistamine, intranasal cromolyn, or a leukotriene receptor antagonist
How do you treat moderate, frequent symptoms of allergic rhinitis? -^^^^^^^^Regular- to high-dose intranasal corticosteroid
Add an oral or nasal antihistamine and decongestant if necessary
How do you treat moderate, persistant symptoms of allergic rhinitis? -^^^^^^^^Combination regimen consisting of intranasal corticosteroids plus a nonsedating or intranasal antihistamine and decongestant if necessary
How do you treat severe symptoms of allergic rhinitis? -^^^^^^^^Combination regimen consisting of a nonsedating antihistamine with or without a decongestant and intranasal corticosteroid
Consider the use of an oral steroid for 5 days and the use of oxymetazoline as needed for no longer than 3 days
Which antihistamines are sedating? -^^^^^^^^benadryl, Chlor-Trimeton, ethanolamine: diphenhydramine; clemastine fumarate, alkylamine: chlorpheniramine maleate
Which antihistamines are low-sedating? -^^^^^^^^zyrtec
piperadine: cetirizine HCl
Which antihistamines are nonsedating? -^^^^^^^^allegra, claritin
fexofenadine HCl, loratadine HCl, desloratadine
What are two 1st generation antihistamines that are OTC and on our test? -^^^^^^^^Diphenhydramine (Benadryl) & chlorpheniramine maleate (Chlor-Trimeton)
Diphenhydramine (Benadryl) - Class -^^^^^^^^Histamine H1 Antagonist, first gen
ethanolamine derivative
Diphenhydramine (Benadryl) - Indication -^^^^^^^^Symptomatic relief of allergic symptoms caused by histamine release including nasal allergies and allergic dermatosis
Adjunct to epinephrine in the treatment of anaphylaxis
Nighttime sleep aid
Prevention or treatment of motion sickness
Antitussive
Management of Parkinsonian syndrome including drug-induced extrapyramidal symptoms
Topically for relief of pain and itching associated with insect bites, minor cuts and burns, or rashes due to poison ivy, poison oak, and poison sumac
Diphenhydramine (Benadryl) - MOA -^^^^^^^^Competes with histamine for H1-receptor sites on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract; anticholinergic and sedative effects are also seen
Diphenhydramine (Benadryl) - Pregnancy -^^^^^^^^Cat B
some toxicity seen in newborns if mom was taking a lot; not the antihistamine of choice for allergic rhinitis, n, or v in pregnancy
Diphenhydramine (Benadryl) - Contraindications -^^^^^^^^Hypersensitivity; acute asthma; neonates or premature infants; breast-feeding; use as a local anesthetic (injection)
she mentioned breast feeding like 4 times with this one
Diphenhydramine (Benadryl) - Adverse effects -^^^^^^^^sedation, sleepiness, dizzy, n, v, urinary retenion or frequency, thickening of bronchial secretions, stuffiness, anaphylaxis, dry mouth/throat, blurred vision
Diphenhydramine (Benadryl) - Precautions -^^^^^^^^use w/ caution in those that have asthma, CV dz, glaucoma, prostatic hyperplasia/GU obstruction, pyloroduodenal obstruction, or thyroid dysfunction
Diphenhydramine (Benadryl) - PK/PD -^^^^^^^^PK: Onset of action:
Maximum sedative effect: 1-3 hours
Duration: 4-7 hours
Metabolism: Extensively hepatic via CYP2D6; minor CYP1A2, 2C9 and 2C19; smaller degrees in pulmonary and renal systems; significant first-pass effect
Diphenhydramine (Benadryl) - Pt education -^^^^^^^^Avoid use of other depressants, alcohol, or sleep-inducing medications unless approved by prescriber. It may cause drowsiness or dizziness (use caution when driving or need to be alert); or dry mouth, nausea, or vomiting.
Report persistent sedation, confusion, or agitation; changes in urinary pattern; blurred vision; sore throat, respiratory difficulty, or expectorating; or lack of improvement or worsening or condition
Chlorpheniramine maleate (Chlor-Trimeton) - Class -^^^^^^^^Histamine H1 Antagonist, first gen
alkylamine derivative
Chlorpheniramine maleate (Chlor-Trimeton) - Indication -^^^^^^^^Perennial and seasonal allergic rhinitis and other allergic symptoms including urticaria
Chlorpheniramine maleate (Chlor-Trimeton) - MOA -^^^^^^^^competes w/ histamine for H₁ receptor sites on effector cells in the GI tract, blood vessels, & resp tract
Chlorpheniramine maleate (Chlor-Trimeton) - Pregnancy -^^^^^^^^Cat C
Chlorpheniramine maleate (Chlor-Trimeton) - Contraindications -^^^^^^^^Hypersensitivity to any component of the formulation
Narrow-angle glaucoma
bladder neck obstruction or symptomatic prostate hypertrophy
during acute asthmatic attacks
stenosing peptic ulcer or pyloroduodenal obstruction
In elderly pts, the anticholinergic action may cause significant confusional symptoms, constipation, or problems voiding urine.
Chlorpheniramine maleate (Chlor-Trimeton) - Adverse effects -^^^^^^^^drowsiness, thickening of bronchial secretions, HA, dizzy, n, diarrhea, wt gain & appetite increase, urinary retention, diplopia, polyuria, pharyngitis, arthralgia, weakness
Chlorpheniramine maleate (Chlor-Trimeton) - Precautions -^^^^^^^^watch for CNS depression
use w/ caution in those w/ CV dz, ↑ intraocular pressure, prostatic hyperplasia/GU obstruction, asthma or chronic breathing disorders, or thyroid dysfunction
Metabolism: Substrate of CYP2D6 (minor), 3A4 (major); Inhibits CYP2D6 (weak)
On to more classes of drugs for allergic rhinitis...
What are some intranasal steroids that will be on the test? -^^^^^^^^Traimcinolone acetonide (Nasacort)
Fluticasone propionate (Flonase)
Budesonide (Rhinocort)
Flunisolide (Nasarel)
Mometasone furoate (Nasonex)
And what is an intranasal mast cell stabilizer that will be on the test? -^^^^^^^^Cromolyn sodium (NasalCrom)
this drug was covered above in asthma (Intal the nebulizer) so I'm only going to highlight the differences here (NasalCrom is a nasal spray)
And what is a Leukotriene Receptor Antagonist that will be on the test? -^^^^^^^^montelukast sodium (Singulair)
this was covered above in asthma so I'm not going to do another drug card here as it is in the same form and everything - only major difference is dosing
When should NasalCrom be started? -^^^^^^^^Should be started 3 to 4 weeks before a peak allergy season occurs
What is the effect of NasalCrom on the nose? -^^^^^^^^Their effect on the nose is short acting and makes compliance more difficult in that several doses are needed per day
What should you monitor for with NasalCrom? -^^^^^^^^Instruct patients to notify health care provider of any stinging effect after nasal instillation
Now on to the five intranasal steroids... -^^^^^^^^exciting!!!!!
Intranasal Steroids - Indication -^^^^^^^^Vasomotor rhinitis and relief of symptoms of seasonal or perennial rhinitis when effectiveness of antihistamines or tolerance to treatment develops
Intranasal Steroids - MOA -^^^^^^^^Potent glucocorticoid and weak mineralocorticoid activity
Inhibit cells, including mast cells, eosinophils, neutrophils, macrophages, lymphocytes, and mediators such as histamine, leukotrienes, and cytokines
Exert direct local antiinflammatory effects with minimal systemic effects
Effectively control the four major symptoms of allergic rhinitis—rhinorrhea, congestion, sneezing, and nasal itch
Intranasal Steroids - Effectiveness -^^^^^^^^The most effective agents for the management of allergic rhinitis because of their direct reduction of nasal inflammation and their ability to reduce nasal hyperreactivity
Should be used for at least 3-4 weeks before a decision is made as to whether they are effective (1 inhaler)
Can be used with asthmatic patients and with those who have comorbid nasal polyposis. Intranasal steroids may help shrink nasal polyps
Effectiveness depends on regular use and adequate nasal airway for delivery
Most do not alleviate ocular symptoms
Intranasal Steroids - Common concerns -^^^^^^^^Steroid phobia
Aversion of nasal sprays (Discomfort, Addiction)
Local irritation, mucosal changes; nosebleeds
Cataracts, glaucoma (STUDY CONCLUSION:
No increase risk of cataract in patients taking INS)
Intranasal Steroids - Pt education -^^^^^^^^Use patient information provided with product on how to use nebulizer, inhaler
Do not exceed recommended dosage
Clear secretions from nasal passages before using; use decongestants if necessary
Effects are not immediate; results require regular use and may take up to 7 days
Intranasal Steroids - Side effects -^^^^^^^^Pharyngitis, epistaxis, cough, headache, weakness, tired feeling, nausea, loss of appetite, weight loss; fever, chills, body aches, flu symptoms; easy bruising or bleeding, unusual weakness; white patches or sores inside your nose or mouth, or on your lips; or blurred vision, eye pain, or seeing halos around lights
Intranasal Steroids - Precautions -^^^^^^^^avoid in pts w/ adrenal suppression, delayed wound healing, immunosupression, infections, or ocular dz
especially in nasal infection, trauma, or s/p nasal surgery
Intranasal Steroids - Pregnancy -^^^^^^^^Cat B - budesonide
Cat C - flunisolide, fluticasone, triamcinolone, mometasone
Intranasal Steroids - Dosing differences -^^^^^^^^once a day spray - budesonide, fluticasone, triamcinolone, mometasone
twice a day (or more) spray - flunisolide
Intranasal Steroids - differences -^^^^^^^^there aren't a lot of differences. I highly suspect this is one of those "which one is safe for pregnant women?" ones - which would be budesonide (Rhinocort)
Prophylaxes and treatment for chronic asthma in adults and kids 2+years. NOT for acute attacks. Long term control.
Metered-Dose Inhaler -^^^^^^^^Press canister toward mouthpeice to deliver measured dose or puff of medication.
Dry powder inhaler -^^^^^^^^Activated when the patient inhales through the mouthpiece, delivers a fine dry powder. Timing of drug delivery and inhalation doesn't matter
Nebulizer -^^^^^^^^Machine that delivers a fine mist through a face mask or other hand-held device. Takes approx 30 min for treatment.
Rebound Effect -^^^^^^^^Excessive use of nasal decongestants can lead to greater congestion b/c of __________?
Antihistamines -^^^^^^^^block the release or action of histamine
Drugs for COPD -^^^^^^^^includes: Bronchodilators,inhaled steroids, Leukotriene receptor blockers and other anti-asthma drugs
Decongestants -^^^^^^^^utilized to decrease the blood flow to the upper respiratory tract and decrease the excessive production of secretions
Expectorants -^^^^^^^^used to decrease the viscosity of sputum to produce effective cough
Anti-Histamine contraindications -^^^^^^^^CNS-drowsiness, and sedation
Fatigue
Anticholinergic effects
Skin dryness
Rhinitis -^^^^^^^^inflammation of the mucous membrane of the nose
Xanthines Pharmacodynamics/contraindications -^^^^^^^^Stimulate the CNS such that respiration is stimulated.
CNS effects, cardiac arrhythmias, gi upset, local irriation
Aerosol -^^^^^^^^Suspension of minute liquid droplets or fine solid particles in a gas.
Allergen -^^^^^^^^...
Allergic rhinitis -^^^^^^^^...
Asthma -^^^^^^^^Chronic inflammatory disease of the lungs characterized by airway obstruction.
Bronchospasm -^^^^^^^^Rapid constriction of the airways.
Chronic bronchitis -^^^^^^^^Recurrent disease of the lungs characterized by excess mucus production, inflammation, and coughing.
Chronic obstructive pulmonary disease (COPD) -^^^^^^^^Generic term used to describe several pulmonary conditions characterized by cough, mucus production, and impaired gas exchange.
Dry powder inhaler (DPI) -^^^^^^^^Device used to convert a solid drug to a fine powder for the purpose of inhalation.
Emphysema -^^^^^^^^Terminal lung disease characterized by permanent dilation of the alveoli.
H1 receptor -^^^^^^^^Site located on smooth muscle cells in the bronchial tree and blood vessels that is stimulated by histamine to produce bronchodilation and vasodilation.
H2 receptor -^^^^^^^^Site located on cells of the digestive system that is stimulated by histamine to produce gastric acid.
Histamine -^^^^^^^^Chemical released by mast cells in response to an antigen that causes dilation of blood vessels, bronchoconstriction, tissue swelling, and itching.
Leukotrienes -^^^^^^^^Chemical mediator of inflammation stored and released by mast cells; effects are similar to those of histamine.
Mast cells -^^^^^^^^Connective tissue cell located in tissue spaces that releases histamine following injury.
Metered dose inhaler (MDI) -^^^^^^^^Device used to deliver a precise amount of drug to the respiratory system.
Nebulizer -^^^^^^^^Device used to convert liquid drugs into a fine mist for the purpose of inhalation.
Perfusion -^^^^^^^^Blood flow through a tissue or organ.
Rebound congestion -^^^^^^^^...
Respiration -^^^^^^^^Exchange of oxygen and carbon dioxide in the lungs; also, the process of deriving energy from metabolic reactions.
Ventilation -^^^^^^^^Process by which air is moved into and out of the lungs.
Repiratory center is the ... -^^^^^^^^medulla oblongata
Process of gas exchange is called -^^^^^^^^respiration
Process of ventilation is.. -^^^^^^^^mechanical
V/Q ratio is ... -^^^^^^^^the amount of air reaching the alveoli to the amount of blood reaching the alveoli; should be about .95-1
Airway is the size of your ... -^^^^^^^^pinky
Inadequate ventilation/Oxygen means .... -^^^^^^^^increased airway resistance(swelling/mucus/ decreased ciliary action/bronchospasms)
Loss of elastic recoil of lungs(emphysema, cystic fibrosis)
Emphysema causes your alveoli to... -^^^^^^^^puff up, and become destroyed due to air being trapped and lung size increase
Pink puffers is a condition of... -^^^^^^^^emphysema
Asthma is also called... -^^^^^^^^airway reactive disorder
Asthma is either ... -^^^^^^^^intrinsic- non-allergic; infection or exercised induced
How you use inhalers is .... -^^^^^^^^shake, take deep breath while inhaling, wait 30 seconds, then rinse mouth(thrush/bacterial/yeast infection if don't)
Spacer is used if can't... -^^^^^^^^hold breath
What are the disadvantages/advantages of dry powder? -^^^^^^^^Advantages= no propellant, just inhale
Disadvantages= bulky, limited doses, expensive, don't know when you are out
Nebulizer's advantages/disadvantages are? -^^^^^^^^Advantages= for children/elderly/emrgency; drug nebulized into a mist; breath normally
Disadvantages=bulky, inconvenient, expensive, long tx time(10-15min), drug packaging varies, need power source
Antitussive is a .. -^^^^^^^^cough suppressant
Cough center is in the ... -^^^^^^^^medulla
Antitussive medicines.. -^^^^^^^^depress cough center in medulla; cause post nasal drip
Some antitussive drugs are... -^^^^^^^^narcotics: codeine, hydrocodone; in tablets or syrup; cause drowsiness
Benzonatate(Tessalon) is similar to...Side effects are... -^^^^^^^^local anesthetic, anesthetizing stretch receptors in lungs(if receptors aren't stretch, then can't cough; rash, increased secretion, sedation, nausea, paradoxical excitement
Some long acting antitussive medications are... -^^^^^^^^whiskey+lemon+honey and wild cherry
Halls menthalarem cause ... because cause post nasal drip... -^^^^^^^^cough
Expectorant is.... -^^^^^^^^sputum
Antitussive agents ... -^^^^^^^^promote the cough, or smoothing action on mucosa by increasing amount if liquid in repiratory tract (i.e Robutussin-stimulate secretions)
Antihistimines .... -^^^^^^^^dry you up; blocks effects of histamine(runny nose, congestion, allergic reaction, itching, motion sickness; side effects are sedation, dry mouth, urinary hesitency(anticholinergic)
Antihistimines also can cause an ....... attack, increase ..., increase blood pressure, and may trigger ... storm, increase ... pressure and photosensitivity, increase risk for seizures (avoid driving). -^^^^^^^^asthma;HR;Thyroid(too much); intraocular
Mucolytic's do what... -^^^^^^^^lysis tenacious secretion; some side effects are bronchospasms, smells like rotton eggs
Some mucolytic drugs are... -^^^^^^^^acetylcysteine-liquefies
Some nursing considerations of antitussives are... -^^^^^^^^adequate fluid intake(except milk); liquid cough medicine; Head above body when sleep; note color, consistency of sputum, avoid caffeine
Inflammatory cell(mast cell) stabilizer's .... -^^^^^^^^work on mast/macrophage/neutrophils/eosinophils cell's to prevent release of histamines; not antihistamines; give before exercising, running
Some Inflammatory cell stabilizer medicines are... -^^^^^^^^cromolyn sodium(Ital); have short half life
Antiinflammatory leukotriene receptor antagonist drugs are... -^^^^^^^^zafir lukast(accolate) or monte lukast (Singular); promotes bronchorelaxation, improves wheezing, coughing, dyspnea, decrease inflammation; slow acting and po; side effects are headache, nausea/vomiting
Corticosteroids... -^^^^^^^^decrease inflammation and edema; side effects are hoarseness, oral candida infection(suppress normal flora of mouth); must observe mouth for thrush
Some corticosteroid medications are -^^^^^^^^beclomethasone(Beclovert) and fluticasone propionate(Flonase), and prednisone given typically via inhalation and intranasal
Singular with inhaled steroid provides... -^^^^^^^^better control of inflammation becuase inhaled steroid can't formation of cysteinyl leukotrienes
Bronchodilator Xanthine(caffeine) acts directly on .. muscle of bronchus and inhibits release of ... -^^^^^^^^smooth; SRS-A; (i.e. Theophylline by IV and Thoedor(sustained release); has narrow margin of safety of 10-20 ug/ml
Nursing considerations of bronchodilators... -^^^^^^^^initial therapy, stay with patient,quiet environment, upright position; percuss side and back to expel mucus plug then give aerosol; metered dose requires 2 puffs(wait 1min b/w puffs)
1. Rescue from acute Bronchoconstriction
2. Prevent recurrent episodes
3. Treat hyper-responsiveness caused by inflammation (prevent remodeling) -^^^^^^^^3 Approaches to Management of Asthma
B2 Agonist (albuterol, terbutaline, pirbuterol, bitolterol -^^^^^^^^Primary rescue agent; inhaled form most effective with least side effects
--careful when inhibiting expectorant cough; need to cough up mucus plugs
Acute -^^^^^^^^Short term, usually less than six months.
Alveoli -^^^^^^^^Tiny air sacs in the lungs that permit the exchange of oxygen and carbon dioxide through capillary walls.
Antihistamine -^^^^^^^^Drug that counteracts the effects of histamine, relieving allergy symptoms.
Antitussive -^^^^^^^^Drug that decreases coughing.
Apnea -^^^^^^^^Stoppage of breathing; may be temporary or fatal.
Bronchi -^^^^^^^^Air passages leading from the trachea to the bronchioles in the lungs.
Bronchiole -^^^^^^^^Branch of the bronchi leading to alveolar ducts.
Bronchodilator -^^^^^^^^Drug that increases the vital capacity of the lungs by dilating the bronchi and relaxing the smooth muscles.
Bronchopulmonary -^^^^^^^^Pertaining to the lungs and the air passages.
Chronic -^^^^^^^^Long term, usually more than six months.
Decongestant -^^^^^^^^Drug that reduces congestion or swelling, especially in nasal passages, by constricting blood vessels and restricting blood flow to the area.
Dyspnea -^^^^^^^^Labored or difficult breathing.
Emphysema -^^^^^^^^Condition in which the air sacs dilate and are unable to contract to their original size; the alveoli lose their elasticity, causing residual air to be trapped in them.
Epiglottis -^^^^^^^^Leaf-shaped structure on top of the larynx that seals off the air passages to the lungs during swallowing.
Expectorant -^^^^^^^^Drug that breaks down mucus to enable the patient to cough it up more easily.
Fowler's Position -^^^^^^^^Position in which the patient's upper body is raised 45° to 60° by means of pillows or by adjusting the head of the bed.
Hemoptysis -^^^^^^^^Spitting of blood.
Hyperpnea -^^^^^^^^Breathing too rapidly or deeply.
Hypoxia -^^^^^^^^Absence or decrease in oxygen.
Influenza -^^^^^^^^Flu
Inhaler -^^^^^^^^Handheld and pocketsize device used to administer a breathing treatment.
Larynx -^^^^^^^^Voice box; joins the pharynx with the trachea.
Mucolytic -^^^^^^^^Drug that liquefies or breaks down tenacious mucus so it can be coughed up more easily.
Nicotine Dependence -^^^^^^^^A physical vulnerability of the body to the chemical nicotine, which is brought on by tobacco products.
Orthopnea -^^^^^^^^Abnormal condition in which the patient must sit or stand to breathe deeply and comfortably.
Peak Flow Meter -^^^^^^^^A device that measures the air flowing out of the lungs, called the peak expiratory flow rate (PEFR), when a patient with asthma forcefully blows into the device.
Percussion -^^^^^^^^Physical therapy for respiratory patients; tapping of various body organs and structures.
Pharynx -^^^^^^^^Tube like structure that extends from the base of the skull to the esophagus; serves as both respiratory and digestive tracts.
Pleura -^^^^^^^^Membranes lining the lungs and lung cavities.
Pneumococcal Disease -^^^^^^^^Serious disease leading to infections of the lungs, the blood, and the meninges.
Postural Drainage -^^^^^^^^Physical therapy for respiratory patients; use of positioning along with vibration and percussion to drain secretions from specific areas of the lungs, bronchi, and trachea.
Productive cough -^^^^^^^^Cough that brings up large amounts of mucus.
Pulmonary -^^^^^^^^Pertaining to the lungs.
Pulse Oximeter -^^^^^^^^A device that monitors the oxygen saturation by placing a probe on the finger, toe, ear, forehead, or the bridge of the nose.
Rebound Effect -^^^^^^^^Reappearance of symptoms in even stronger form after a drug dose has worn off.
Respiration -^^^^^^^^Breathing.
Semi-Fowler's Position -^^^^^^^^Position in which the patient's upper body is elevated to 30°.
Sputum -^^^^^^^^Abnormally thick fluid formed in the lower respiratory tract that may contain blood, pus, or bacteria.
Stethoscope -^^^^^^^^Instrument for listening to the heartbeat and breathing sounds.
Tachypnea -^^^^^^^^Rapid breathing.
Trachea -^^^^^^^^Windpipe; Connects larynx to bronchi.
Unproductive Cough -^^^^^^^^Cough that brings nothing up from the lungs; a dry cough.
Ventilator -^^^^^^^^Machine that assists breathing.
Vibration -^^^^^^^^Physical therapy for respiratory patients; a fine, shaking pressure applied to the chest wall during exhalation.
Viscosity -^^^^^^^^Thickness.
Coughing -^^^^^^^^Protective reflex to clear the trachea, bronchi, and lungs of secretions and irritants.
Wheezing -^^^^^^^^High-pitched, musical sound that occurs through a narrowed airway.
Pneumonia -^^^^^^^^Infection of the lower respiratory tract.
Sympathomimetic -^^^^^^^^mimics the sympathetic nervous system
Sympathetic Neuro-Receptors -^^^^^^^^Alpha: arteries and arterioles, B1: heart, B2: Lungs
Nor epinephrine -^^^^^^^^Sympathetic Nuero-transmitter
Adrenergic Bronchodilators -^^^^^^^^Drug class that directly stimulates Sympathetic Receptors
Effects of Epinephrine -^^^^^^^^Increased BP, Tachycardia, Skeletal Muscle Tremors, Short duration
Albuterol -^^^^^^^^Most common short acting bronchodilator
Levalbuterol -^^^^^^^^Single Isomer form of Albuterol (R Isomer)
Mucolytics -^^^^^^^^agents that destroy or dissolve mucus, degrade mucin, helpful in opening airways
Mucomyst generic name -^^^^^^^^N. Acetylcysteine trade name
Pulmozyme generic name -^^^^^^^^the trade name or Dornase alfa-used with CF
N. Acetylcysteine -^^^^^^^^mucolytic,(mucomyst) may cause bronchospasm (use w/bronchdilator), limited shelf life (refrig)
Dornase Alfa -^^^^^^^^mucolytic,(Pulmozyme) disrupts DNA polymers, effective in CF
Bronchoalveolar Lavage (BAL) -^^^^^^^^bronchoscope passed through mouth or nose into the lungs, a fluid is squirted into a small part of the lung and then recollected for examination.
Chronotropic Drugs mode of action -^^^^^^^^Drugs that change the HR by affecting signals to the SA node
Ionotropic Drug's mode of action -^^^^^^^^Drugs that affect the myocardial contractility
Side effects to corticosteroid use -^^^^^^^^Osteoporosis, adrenal suppresion, mood changes
Three Classifications of Antiinflammatory Agents -^^^^^^^^Corticosteroids, Leukotriene Antagonists, and Mast Cell Stabilizers
Common ACE inhibitors -^^^^^^^^CaptroPRIL, LisinoPRIL, EnalaPRIL, BenzaPRIL
Angiotensins effect on Blood Pressure -^^^^^^^^Blood vessels constrict and raise blood pressures
Angiotensin Converting Enzyme Inhibitors Mode of Action(ACE Inhibitors) -^^^^^^^^Blocks the conversion of Angiotensin I to Angiotension II
bradykinin defined -^^^^^^^^substance released by damaged tissue that promotes inflammation
Antithrombotics defined -^^^^^^^^Prophylactic Drug to treat Formation of Clots (blood thinners)
Drugs used to treat Thrombosis -^^^^^^^^Coumadin, Heparin, Lovenox
Leukotrienes -^^^^^^^^Initiate and mediate the inflammatory response (singulair is a Leukotriene Antagonist)
Mast Cell Stabilizers -^^^^^^^^inhibit the release of inflammatory chemicals from mast cells and make the airways less likely to narrow.
Chronotropics which increase Heart Rate -^^^^^^^^Atropine and Isoproternol
Chronotropics which decrease Heart Rate -^^^^^^^^Adenosine and Metoprolol (Beta Blockers)
Combined Inhaled Medicines Defined -^^^^^^^^Bronchodilators that combine a controller inhaler and a quick relief inhaler, or combine 2 controller inhalers into one.
Pharmacodynamic Defined -^^^^^^^^The drugs affect on the Body
Pharmacokinetic Defined -^^^^^^^^The Body's affect on the Drug
Tachyphylaxis Defined -^^^^^^^^rapidly decreasing response to a drug following administration of initial doses
20% increase to heart rate over baseline -^^^^^^^^Considerations to stop treatment of SABA (Sign of Side Effect)
Adrenergic Antagonists -^^^^^^^^The most common Sympatholytic Agent (Drugs that inhibit the actions of the sympathetic nervous system by any mechanism)
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Normal ABG Values
pH
PaO2
PaCO2
O2 Sat
HCO3
Base Excess
7.35-7.45
80-100
35-45
95-100
22-26
+_2
What are some causes of Respiratory Hypoventilation
acidosis?
Drug Overdose
Pulmonary Edema
Chest Trauma
Neuromuscular Disease
Airway Obstruction
COPD
What are some causes of Metabolic Acidosis?
Diabetic Ketoacidosis
Salicylate OD
Shock
Sepsis
Severe Diarrhea
Renal Failure
What are some Causes of Respiratory Alkalosis?
Hyperventilation
Initial Stage of Pulmonary Emboli
Anxiety
Hypoxia
Fever
Pregnancy
High Altitude
What are some Causes of Metabolic Alkalosis?
Overuse of Antacids
Loss of Gastric Juices (vomiting, NG tube)
Potassium Wasting Diuretics (Increase loss of H+)
Hypoxia Inadequate amounts of oxygen available for Cellular Metabolism
Signs of Early: restless, tachycardia, tachypnea, dyspnea, increased agitation,
Emphysema Destruction and Enlargment of Air Spaces; Loss of elasticity of alveoli
Chronic Bronchitis
Inflammation and structural changes of airways. Rigidity of airway due to chronic inflammation and scarring.
Asthma airway narrowing due to hyper-responsiveness and bronchoconstriction
COPD--Picture S&S
Easily Fatigued, Frequent Respiratory Infections, Use of Accessory Muscles, Orthopneic, Wheezing, Pursed Lip breathing, Chronic Cough, Barrel Chest, Dyspnea, Prolonged Expiratory Time, Digital Clubbing, Cor Pulmonale (late in disease), Thin in Appearance
Emphysema Pathophysiology and Manifestation
Hyperinflation and loss of elasticity of alveoli.
Significant and progressive reduction in expiratory outflow Hyperinflation of lungs, bullae formation (can rupture and form
a pneumothorax) Small airway collapse Dyspnea on exertion Chronic (minimum) cough and sputum productoin Barrel chest Speak in short jerky sentences Anxious Thin appearance Purse lip Breathing
What will the lungs of a patient with emphysema sound like?
Hollow and Resonant. There will be hyperresonance on chest percussion.
What will the skin color of a patient with emphysema look like?
Pink because they do not retain CO2 well. They will have minimal cyanosis.
Explain the complications of Emphsema Pts and Exercise
Emphysema patients have exertional dyspnea.
What is the Pathology of Chronic Bronchitis & its' manifestations
Results from exposure of airways to irritants. As a result there will be scarring and rigidity of airway
walls.
Thick, copious mucus production Chronic COUGH Hypoxemia and hypercapnea (respiratory
aciosis)
Diagnosis of Chronic Bronchitis
1. Productive cough for 3 months in each of 2 consecutive years AND air flow obstruction
2. FEV==less than 70%
Em FUH syma/BronchitisPink PuFUHer/Blue BLOATER
What will be found on a physical exam of a pt with Chronic Bronchitis?
Skin color: blue bloater, dusky to cyanotic
Clubbing of fingers
Breath sounds: crackles, rhonchi, wheezing
Productive cough
JVD (late sign=cor pulmonale)
Hypoxia
Hypercapnia
Increased Respiratory Rate
Cardiac Enlargment
Use of Accessor Muscles to Breathe
(Makes the right side of the heart work harder to pum blood into the lungs.
What is the Pathology of Bronchial Asthma and its Manifestations?
REVERSIBLE airflow obstruction caused by inflammation and constriction of airway when exposed to irritant.
dyspnea wheezing cough increased mucus production S/S mostly in early morning or night
Bronchial Asthma-- Anxious
Physical Findings
Breath Sounds: Expiratory wheezing, tight
Cough
Asymptomatic between attacks
Increase Mucus Production
Shortness of Breath
Prolonged Expiration
Retractions
ASA and NSAIDs should be given with caution to patients with which respiratory condition?
Asthma
Budesonide (Pulmoicort)--Class, Use
It is an anti-inflammatory and anti-allergy medication used to decrease or prevent the respiratory tissue response to the inflammatory process.
It is used for maintenance prophylaxis and long term managment of asthma.
hydrocortisone (Solu-Cortef)
What is it?
An anti-inflammatory/corticosteroid agent for IV.
methylprednisolone (Medrol, Solu-Medrol)
What is it?
An anti-inflammatory/corticosteroid agent for IV or Oral.
Prednison
What is it?An anti-inflammatory/corticosteroid agent for Oral.
Name four Antiinflammatory/Corticosteroid Inhalers
With COPD, but not asthma. Should be used with inhaled steroids when treating asthma.
Name the LABA
salmeterol (Serevent)
formoterol (Foradil Aerolizer, Perforomist)
arformoterol (Brovana)
Pathophysiology of Pneumonia
1. Exposure to foreign mattter
2. Inflammatory Response
3. Capillary Walls Become Leaky
4. Fluid shifts from capillaries to interstitial space and then to alveoli
5. Alveoli fill with fluid
6. Lungs lse compliance
7. VQ mismatch
How does bad stuff get in the lungs to cause pneumonia?
1. Aspiration
2. Inhalation--mycoplasma and fungal
3. Hematogenous Spread--Staph aureus
What qualifies as a HCAP? 1. New Onset
2. person was hospitalized in a cute care hospital for 2 days or longer withing 90 days of the infection
3. Resided in LTCF
4. Received IV ABO therapy, chemotherapy, or wound care within past 30 days
5. Attended a hospital or hemodalysis clinic
RALES, RHONCHI AND DIMINISHED BREATH SOUNDS, PRODUCTIVE COUGH, PURULENT OR RUST COLORED SPUTUM, FEVER CHILLS, DYSPNEA ON EXERTION, ELEVATED WBCS, DEHYDRATION, ABN CXR, ABN ABGS
Daily ICS—dysphonia and oropharyngeal Candida albicans
What is the important client teaching with Flunisolide (Aerobid)?
Rinse mouth after administration or ICS
Signs of candidiasis (white patches)
Smoking decreases effectiveness
Importance of daily use
Use of beta-2 agonist before dilates the bronchial tree increases dispersion of the drug.
What pathological events leads up to an acute asthma attack?
Vasoactive substances, such as histamine, serotonin, bradykinin, and leukotrienes, are located within the mast cell.
When the mast cell ruptures, these substances cause an inflammatory response, such as bronchial constriction
What is the prototype for mast cell stabilizers?
cromolyn sodium
cromolyn sodium:
Pharmacotherapeutics
Pharmacodynamics
Pharmacotherapeutics
Prophylactic agents for mild to moderate asthma
Acute bronchospasm induced by exercise
Pharmacodynamics
Works at the surface of the mast cell to inhibit mast cell rupture and degranulation after contact with an antigen
Prevents the release of histamine and SRS-A mediators
When is cromolyn sodium contraindicated?
With lactose intolerance
What are the adverse effects of cromolyn sodium?
Throat irritation, bronchospasm, cough
Oral: lactose intolerance
What is important client teaching with cromolyn sodium?
Take daily; not a "rescue drug"
What are leukotrienes?
Leukotrienes are inflammatory mediators released from mast and t-cells.
Leukotrienes are powerful bronchoconstrictors and vasodilators.
Leukotrienes have been identified as important mediators in the pathology and symptomatology of asthma
Result in airway hyperreactivity, bronchoconstriction, and hypersecretion
What is the prototype for Leukotriene Receptor Agonists?
Zafirlukast (Accolate)
Zafirlukast (Accolate):
Pharmacotherapeutics
Pharmacokinetics
Pharmacodynamics
Pharmacotherapeutics
Prophylaxis or treatment of chronic asthma
Pharmacokinetics
Oral/food decrease bioavailability
1 hour before or 2 hours after
Pharmacodynamics
Blocks receptors for leukotrienes bound to amino acid cysteine (very potent vasoconstrictor)
What are contraindications for Zafirlukast (Accolate)?
Povidone, lactose, hepatic insufficiency, pregnancy, & NOT for kids
What are adverse effects of Zafirlukast (Accolate)?
h/a, gastritis, pharyngitis, rhinitis
What are main drug interactions w/ Zafirlukast (Accolate)?
Drugs metabolized through P-450 system, theophylline, warfarin, aspirin, erythromycin
How is Singulair (Montelukast) different from Zafirlukast (Accolate)?
Once a day dosing, approved for kids > 2yrs, doesn't inhibit cytochrome isoenzymes
Why has omalizumab (Xolair) gotten a lot of TV press?
What is important to remember when administering?
How does it work?
First monoclonal antibody directed against immunoglobulin E (IgE) and first biological therapy developed to treat asthma.
SQ. Wait 20 minutes to ensure powder dissolves.
Binds to mast cells and prevents mast cell rupture and degranulation.Binds to receptors on monocytes, eosinophils, epithelial cells and platelets to interfere with the release of inflammatory mediators and cytokines. In managing lower respiratory tract disorders, which main classes of drugs are used*Drugs can be grouped into mucolytic agents, such as acetylcysteine; bronchodilators, such as theophylline; and anti-inflammatory drugs, such as cromolyn sodium. Theophylline acts by stimulating two prostaglandins, which results in smooth-muscle relaxation in both the bronchi and vasculature. Beta-adrenergic agonists are sympathomimetic agents. That means the drugs mimic the action of norepinephrine. In the lungs, norepinephrine stimulates bronchodilation. Anticholinergic agents block the action of acetylcysteine. When acetylcysteine stimulates the lungs, bronchoconstriction occurs; thus, when its action is blocked, the bronchi do not constrict. In a patient with acute respiratory distress, which of the bronchodilators would be most effective? Beta-adrenergic agonists, such as albuterol, have the quickest onset of action. They are referred to as “rescue drugs.” Which of the anti-inflammatory agents is the most effective? Glucocorticosteroids are the most powerful anti-inflammatory agents. What is the difference between glucocorticoid steroids given orally and by inhalation? Both drugs are effective in reducing inflammation. Glucocorticoid steroids given orally have the potential to cause more adverse effects because they are systemic. Steroids given by inhalation have a local action; thus, they cause fewer adverse effects. Cromolyn sodium works by stabilizing the mast cell. When the mast cell ruptures in response to an antigen, bronchoconstrictive substances such as histamine, bradykinin, serotonin, and leukotrienes are released. By stabilizing the mast cell, the drug prevents release of these substances. Glucocorticoid steroids have a multitude of actions. In the lungs, they decrease the effectiveness of inflammatory cells, thus keeping the bronchioles open. Leukotriene antagonists block the ability of leukotrienes to bind to their receptor sites. Because leukotriene binding to these sites is what causes bronchoconstriction, bronchoconstriction is blocked. If a patient is taking inhaled steroids, an anticholinergic inhaler, and a beta-adrenergic agonist inhaler, which inhaler would you tell the patient to use first? The beta-adrenergic agonist inhaler should be used first because it has the fastest onset. It will open the bronchial tree, so that the other drugs can be dispersed farther into the lungs to exert their action.
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Your Results for "NCLEX-RN® Review" Print this page
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Summary of Results for Litta Oglesby
Site Title:MyNursingKit for Pharmacology: Connections to Nursing Practice
Book Title:Pharmacology: Connections to Nursing Practice
Book Author:AdamsLocation on
Site:Unit X > Chapter 73 > Student Home > NCLEX-RN® Review
Submitted:March 31, 2012 at 5:46 PM (UTC/GMT)
72% Correct of 10 questions13 correct: 72%
5 incorrect: 28%
2 questions contain multiple pairs, scored for a total of 10 questions.
More information about scoring
1. A client with asthma asks which of the prescribed medications should be used in the event of an acute episode of bronchospasm. The nurse will instruct the client to use:
Your Answer:
Albuterol, a beta agonist bronchodilator, by inhalation.
Rationale: There are two important items to consider: (1) the medication and (2) the route. A drug to abort bronchospasm should be given by inhalation in order to ensure rapid action directly at the site. An inhaled beta agonist such as albuterol meets both criteria. Option 2 is incorrect because although inhalants are delivered directly, they do not work quickly and are used for prevention of inflammation. Option 3 is incorrect because this anticholinergic is not approved as rescue therapy for treatment of acute bronchospasm. Option 4 is incorrect because leukotriene modifiers are indicated for prevention of respiratory problems, not for treatment of acute bronchospasm. Furthermore, giving a medication PO would not be appropriate when treating acute bronchospasm.
2. A client is prescribed beclomethasone (Beclovent), a glucocorticoid inhaler. Education by the nurse will include:
Your Answer:
“Rinse your mouth out well after each use.”
Rationale: Glucocorticoids can decrease the beneficial oral flora that will allow for an overgrowth of fungal infections such as candida. Rinsing the mouth removes any glucocorticoid drug deposited there, and prevents it from being being swallowed. Thus it decreases the likelihood of toxicity through systemic absorption. Option 1 is incorrect because it is the bronchodilators (e.g., adrenergic agonists, anticholinergics, and xanthines) that are likely to cause tachycardia, not glucocorticoids. Option 2 is incorrect because it is the xanthines (e.g., aminophylline and theophylline) that are chemically related to caffeine, not the glucocorticoids. It would not be restricted with a glucocorticoid. Option 4 is incorrect because it is the bronchodilators (e.g., adrenergic agonists, anticholinergics, and xanthines) that are likely to cause the client to feel shaky and nervous.
3. The nurse should inform the client who is prescribed a nebulizer treatment with a bronchodilator agent that a common adverse effect is:
Your Answer:
An increased heart rate with palpitations.
Rationale: Bronchodilators (e.g., beta agonists, anticholinergics, xanthine derivatives) have an adverse effect on heart rate elevation and palpitations. Option 2 is incorrect because bronchodilators do not decrease the immune response the way certain anti-inflammatory agents do. Option 3 is incorrect because bronchodilator increase alertness. Option 4 is incorrect because bronchodilators relieve dyspnea. While some bronchodilators have been known to cause unexpected problems and paradoxical bronchospasm, this is uncommon and the question asks for a common adverse effect.
4. The nurse should monitor the client who is taking corticosteroids for evidence of: Select all that apply.
Your Answers:
Infection.
Hyperglycemia.
Correct.
Correct.
5. A 4-year-old child with respiratory distress secondary to asthma has an order for a nebulizer treatment. The type of medication most likely to be given for asthma management is a:
Your Answer:
Beta agonist.
Rationale: Beta agonists are agents that are used in the management of asthma that may be given to children younger than 5, and are available in formulations suitable for nebulizer treatments. The agents in options 2, 3, and 4 do not meet one or more of the criteria listed above.
Cognitive Level: Analysis; Client Need: Health Promotion and Maintenance; Nursing Process: Planning
6. Despite repeated demonstrations of proper inhaler use by the nurse, the client is unable to return a proper demonstration on the training inhaler. The client is becoming frustrated.
The best action for the nurse to take is to:
Your Answer:
Provide a spacer for use with the inhaler.
Rationale: Some clients have difficulty mastering the coordination between inhalation and activation of the medication. In these instances, a spacer will hold the medication cloud so that this is not a concern. The spacer has additional advantages because it results in a more effective delivery of the drug to the site of action and less drug deposition in the mouth and oropharynx. Additional practice may help in the long term, but it is not the priority for an immediate solution to the problem (option 1). The health care provider would not need to be contacted because the client has difficulty learning, provided that a solution is readily available (option 2). Substitution of an oral form of drug is not in the nursing scope of practice and, even if it were, an oral formulation would not be a suitable substitute because the onset of action would be delayed (option 4).
Cognitive Level: Analysis; Client Need: Health Promotion and Maintenance; Nursing Process: Planning
7. A 60-year-old man is prescribed ipratropium (Atrovent) for the treatment of asthma. The appropriate nursing intervention includes:
Your Answer:
Assessing for an enlarged liver.
Correct Answer:
Teaching the client to report the inability to urinate.
Rationale: Ipratropium in an anticholinergic agent. Anticholinergics can cause urinary retention. Although urinary retention is uncommon with inhalant medications, clients should be aware of this potential side effect. Caffeine is not contraindicated for clients taking anticholinergic agents (option 1). Anticholinergic agents do not cause problems resulting in liver enlargement (option 2). These agents are more likely to cause constipation, not diarrhea (option 4).
Cognitive Level: Application Client Need: Health Promotion and Maintenance Nursing Process: Implementation
8. Match each prototype on the left to the category of drug it represents.
Option Your Answer
8.1 Beta-adrenergic agonists D. albuterol (Proventil, Ventolin, Volmax)
8.2 Anticholinergic corticosteroids
C. ipratropium (Atrovent)
8.3 Corticosteroids B. beclomethasone (Beclovent, Beconase, Vancenase, Vanceril)
8.4 Leukotriene modifiers A. zafirlukast (Accolate)
9. A client who is prescribed 400 mg/day of theophylline smokes two packs of cigarettes per day. The nurse knows that this will pose what complication?
Your Answer:
The dose may be inadequate to manage symptoms.
Rationale: Smoking increases the clearance of the theophylline; therefore, a larger than usual dose may be required to maintain a therapeutic level of medication. Otherwise, the dosage is one that is adequate and safe. Smoking does not increase the stimulant effect (option 1). Smoking would not contribute to the likelihood of theophylline toxicity (option 3) or systemic side effects (option 4).
Cognitive Level: Knowledge Client Need: Health Promotion and Maintenance Nursing Process: Planning
10.
Match each category of drug with its primary effect as a bronchodilator or anti-inflammatory agent.
Option Your Answer Correct Answer
10.1 Corticosteroids A. Anti-Inflammatory Agent A. Anti-Inflammatory Agent
10.2 Methylxanthines B. Bronchodilator F. Bronchodilator
10.3 Mast cell stabilizers D. Anti-inflammatory agent E. Anti-inflammatory agent
10.4 Anticholinergic corticosteroids
C. Bronchodilator C. Bronchodilator
10.5 Leukotriene modifiers E. Anti-inflammatory agent D. Anti-inflammatory agent
10.6 Beta-adrenergic agonists F. Bronchodilator B. Bronchodilator
Rationale: Each category has a specific effect that plays a role in management of pulmonary disorders.
Cognitive Level: Knowledge Client Need: Health Promotion and Maintenance Nursing