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Pharmocology RN212 > Chap 37 Respiratory Drugs > Flashcards

Chap 37 Respiratory Drugs Flashcards

1
Q

Overview

A

Main function of the respiratory system
Deliver oxygen to and remove carbon dioxide from the cells of the body

Upper respiratory tract (URT)**
Nasal Cavity
Pharynx
Larynx
Trachea

Lower respiratory tract (LRT)**
Bronchi

Alveoli: Point of gas exchange

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2
Q

Diseases of the Lower
Respiratory Tract**

A

Chronic obstructive pulmonary disease (COPD)*
Asthma (persistent and present most of the time despite treatment)
Emphysema*
Chronic bronchitis*

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3
Q

Bronchial Asthma*

A

Recurrent and reversible shortness of breath**

Occurs when the airways of the lungs become narrow as a result of:
Bronchospasms*
Inflammation* of the bronchial mucosa
Edema* of the bronchial mucosa
Production of viscous mucus*

Symptoms**
Wheezing*
Difficulty breathing*

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4
Q

Types of Asthma

A

INTRINSIC IDIOPATHIC*
No history of allergy
Normal IgE*
Aspirin
Cold weather
Stress
Infection

EXTRINSIC Allergic Asthma*
History of Allergy*
Elevated IgE*

EXERCISE INDUCED*
Starts with beginning of the Exercise *
Stops when exercise is halted *

DRUG INDUCED*
NSAIDS*
Beta Blockers*

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5
Q

Asthma

A

Status asthmaticus*
Prolonged asthma attack that does not respond to typical drug therapy**
May last several minutes to hours
Medical emergency*

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6
Q

Asthma Disease

A

Chronic Bronchitis*
Continuous inflammation** and low-grade infection of the bronchi
Excessive secretion of mucus** and certain pathologic changes in the bronchial structure
Often occurs as a result of prolonged exposure to bronchial irritants

Emphysema*
No longer* used as a term but is included into COPD
Air spaces enlarge** as a result of the destruction of alveolar walls.
Caused by the effect of proteolytic enzymes* released from leukocytes* in response to alveolar inflammation
The surface area* where gas exchange* takes place is reduced.*
Effective respiration is impaired.

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7
Q

Pharmacologic Overview

A

Bronchodilator*
relax bronchial smooth muscle,
Causes bronchodilation***
Beta-adrenergic agonist

Anticholinergics

MethylXanthine derivatives

Non-Bronchodilator
Suppressing underlining causes of the respiratory illness
Steroids- Cortcosteroids
Leukotriene receptor antagonist
Mast cell stabilizer

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8
Q

Bronchodilators: Beta-Adrenergic Agonists

A

Used during acute phase of asthmatic attacks

Quickly reduce airway constriction and restore normal airflow

Agonists, or stimulators, of the adrenergic receptors in the sympathetic nervous system

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9
Q

Bronchodilators: Beta-Adrenergic Agonists

A

Short-acting beta agonist (SABA) inhalers**
Albuterol (Ventolin, ProAir)**
Levalbuterol (Xopenex)**
Pirbuterol (Maxair)
Terbutaline (Brethine)
Metaproterenol (Alupent)

Long-acting beta agonist (LABA) inhalers**
Arformoterol (Brovana)**
Formoterol (Foradil, Perforomist)
Salmeterol* (Serevent)
Vilanterol in conjunction with fluticasone (Breo Ellipta)
Vilanterol in conjunction with the anticholinergic, umeclidinium (Anoro Ellipta)
The term Ellipta refers to a new delivery system.

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10
Q

Bronchodilators: Beta-Adrenergic Agonists

A

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

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11
Q

Beta-Adrenergic Agonists: 
Mechanism of Action

A

Begins at the specific receptor stimulated

Ends with dilation* of the airways
Activation of beta2 receptors activates cyclic adenosine monophosphate (cAMP), which relaxes smooth muscle in the airway and results in bronchial dilation and increased airflow.

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12
Q

Beta-Adrenergic Agonists: Indications*

A

Relief of bronchospasm* related to *asthma, bronchitis, and other pulmonary diseases**

Used in treatment and prevention of acute** attacks

Used in *hypotension and shock : Nonselective *adrenergic agonist- EpiPen

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13
Q

Beta-Adrenergic Agonists: Contraindications*

A

Known drug allergy
Uncontrolled hypertension*
Cardiac dysrhythmias**
High risk of stroke (because of the vasoconstrictive drug action)

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14
Q

Beta-Adrenergic Agonists: Adverse Effects*

A

Alpha and beta (epinephrine)*
Insomnia
Restlessness
Anorexia
Vascular headache
Hyperglycemia
Tremor*
Cardiac stimulation

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

Beta2 (albuterol)
Hypotension or hypertension
Vascular* headache
Tremor

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15
Q

Beta-Adrenergic Agonists: Interactions*

A

Nonselective betablockers
Monoamine oxidase inhibitors(MAOI)**
Sympathomimetics… Increases risk for hypertension
Hypoglycemics*….Monitor patients with diabetes; an increase in blood glucose levels can occur.

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16
Q

Beta-Adrenergic Agonists: 
Albuterol* (Proventil)

A

Short-acting beta2-specific bronchodilating beta agonist

Most commonly used drug in this class

Must not* be used too frequently*

Oral and inhalational use

Inhalational dosage forms include metered-dose inhalers (MDIs) as well as solutions for inhalation.

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17
Q

Beta-Adrenergic Agonists: 
 Salmeterol* (Serevent)

A

Long-acting beta2 agonist bronchodilator

Never to be used for acute treatment**

Used for the maintenance treatment** of asthma and COPD** and is used in conjunction with an *inhaled corticosteroid**

Salmeterol should never be given more than twice daily, nor should the maximum daily dose (one puff twice daily) be exceeded.

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18
Q

Nursing Implications: 
Beta-Adrenergic Agonists

A

If 2 puffs are ordered wait 1-2 mins in between puffs**

Albuterol, if used too frequently, loses its beta2-specific actions at larger doses.

As a result, beta1 receptors are stimulated, causing nausea, increased anxiety, palpitations, tremors, and increased heart rate.

Ensure that patients take medications exactly as prescribed, with no omissions or double doses.

Inform patients to report insomnia, jitteriness, restlessness, palpitations, chest pain, or any change in symptoms

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19
Q

Anticholinergics: Mechanism of Action*

A

LAMA: Long-acting muscarinic antagonists**

Acetylcholine (ACh) causes bronchial constriction

Anticholinergics bind to the ACh receptors, preventing ACh from binding.

Result:* bronchoconstriction is prevented, indirectly* causing airways to dilate

Help reduce secretions in COPD patients

Slow and Prolonged action…management of COPD

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20
Q

Anticholinergics: Adverse Effects

A

Dry mouth or throat**

Nasal congestion

Heart palpitations**

Gastrointestinal (GI) distress

Headache

Coughing

Anxiety

21
Q

Anticholinergics: 
Ipratropium* (Atrovent)

A

Oldest and most commonly used anticholinergic bronchodilator
Available both as a liquid aerosol* for inhalation and as a multidose inhaler*
Usually dosed twice daily
Others:
Tiotropium* (Spiriva)
Aclidinium* (Tudorza)
Umeclidinium* (Incruse Ellipta)
Duoneb, Combivent: ( Ipratropium + Albuterol)

22
Q

Anticholinergics: Contraindications*

A

Drug Allergy
* Peanut and Soy allergy**
With caution in patients with *narrow angle glaucoma and prostrate enlargement**

Not* for management* of acute* symptoms

23
Q

Xanthine Derivatives

A

Plant alkaloids: caffeine, theobromine, and theophylline

Only theophylline* is used as a bronchodilator*.

Synthetic xanthines: aminophylline* and dyphylline 


24
Q

Xanthine Derivatives: 
Mechanism of Action*

A

Increase levels of energy-producing cAMP**
This is done by competitively inhibiting phosphodiesterase, the enzyme that breaks down cAMP.

Result: increased cAMP levels, smooth muscle relaxation, bronchodilation, and increased airflow

25
Q

Xanthine Derivatives: 
Drug Effects

A

Xanthine Derivatives: 
Drug Effects

central nervous system (CNS) stimulation

cardiovascular stimulation: increased force of contraction and increased heart rate, resulting in increased cardiac output and increased blood flow to the kidneys (diuretic effect)

26
Q

Xanthine Derivatives: 
Indications*

A

Dilation of airways in asthmas, chronic bronchitis, and emphysema

Mild to moderate cases of acute asthma

NOT for management of acute asthma attack

Adjunct drug in the management of COPD

Not used as frequently because of potential for drug interactions and variables related to drug levels in the blood

27
Q

Xanthine Derivatives: 
Adverse Effects

A

Nausea, vomiting, anorexia

Sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias

Transient increased urination

Hyperglycemia

28
Q

Xanthine Derivatives: 
Theophylline*

A

Most commonly used xanthine derivative

Oral, rectal, injectable (as aminophylline), and topical dosage forms

Aminophylline: intravenous (IV) treatment*& of patients with status asthmaticus** who have not responded** to *fast-acting beta agonists** such as epinephrine

Therapeutic range for theophylline blood level is 10 to 20 mcg/mL*

Most clinicians now advise levels between 5 and 15 mcg/mL.

29
Q

Nursing Implications: 
Xanthine Derivatives

A

Be aware of drug interactions** with cimetidine, oral contraceptives, allopurinol, certain antibiotics, influenza vaccine, and others.

Cigarette smoking enhances xanthine metabolism.***

Interacting foods** include charcoal-broiled, high-protein, and low-carbohydrate foods.
These foods may reduce serum levels of xanthines through various metabolic mechanisms.

30
Q

Nonbronchodilating Respiratory Drugs**

A

Leukotriene receptor antagonists**
(montelukast, zafirlukast, and zileuton)

Corticosteroids**
(beclomethasone, budesonide, dexamethasone, flunisolide, fluticasone, ciclesonide, and triamcinolone)

Mast cell stabilizers:**
rarely used cromolyn and nedocromil, which are sometimes used for exercise-induced asthma

31
Q

Leukotriene Receptor Antagonists (LTRAs)

A

Nonbronchodilating**
Newer class of asthma medications
Currently available drugs
Montelukast (Singulair)***
Zafirlukast (Accolate)
Zileuton (Zyflo)

32
Q

LTRAs: Mechanism of Action

A

Leukotrienes are substances released when a trigger, such as cat hair or dust, starts a series of chemical reactions in the body.

Leukotrienes cause inflammation, bronchoconstriction, and mucus production.

Result: coughing, wheezing, shortness
of breath

LTRAs prevent leukotrienes from attaching to receptors on cells in the lungs and in circulation.

Inflammation in the lungs is blocked, and asthma symptoms are relieved.

33
Q

LTRAs: Drug Effects**

A

By blocking leukotrienes:
Prevent smooth muscle contraction of the 
bronchial airways
Decrease mucus secretion
Prevent vascular permeability
Decrease neutrophil and leukocyte infiltration 
to the lungs, preventing inflammation

34
Q

LTRAs: Indications*

A

*Prophylaxis and long-term treatment and prevention of asthma** in adults and children 12 years of age and older

Not* meant for management* of acute* asthmatic attacks

Montelukast is also approved for treatment of allergic rhinitis

Improvement with their use is typically seen in about 1 week.

35
Q

LTRAs: Contraindications

A

Known drug allergy

Previous adverse drug reaction

Allergy to povidone, lactose, titanium dioxide, or cellulose derivatives is also important to note because these are inactive ingredients in these drugs.

36
Q

Nursing Implications: LTRAs**

A

Ensure that the drug is being used for chronic** management of asthma, not acute asthma.**

Teach the patient the purpose of the therapy.

Improvement should be seen in about 1 week.

Advise patients to check with prescriber before taking OTC or prescribed medications to determine drug interactions.

Assess liver function before beginning therapy and throughout.

*Teach patients to take medications every night on a continuous schedule even if symptoms improve.**

37
Q

Corticosteroids* (Glucocorticoids)

A

Antiinflammatory* properties

Used for chronic asthma

Do not* relieve symptoms of acute** asthma attacks

May be administered IV

Oral or inhaled** forms

May take several weeks before full 
effects are seen

38
Q

Corticosteroids: Mechanism of Action*

A

Stabilize membranes of cells that release harmful bronchoconstricting substances
These cells are called leukocytes, or white 
blood cells.
Increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation
Dual effect of both *reducing inflammation** and enhancing the activity of beta agonists.
Restore or increase the responsiveness of bronchial smooth muscle to beta-adrenergic receptor stimulation, which results in more pronounced stimulation of the beta2 receptors by beta agonist drugs such as albuterol.

39
Q

Inhaled Corticosteroids**

A

Beclomethasone dipropionate** (Beclovent)
Budesonide (Pulmicort Turbuhaler)
Ciclesonide (Omnaris)
Flunisolide (AeroBid)
Fluticasone (Flovent)
Mometasone (Asmanex)
Triamcinolone acetonide (Azmacort)

40
Q

Inhaled Corticosteroids: Indications*

A

Primary treatment of bronchospastic disorders to control the inflammatory responses that are believed to be the cause of these disorders

Persistent asthma

Often used concurrently with the beta-adrenergic agonists

Systemic corticosteroids are generally used only to treat acute exacerbations, or severe asthma.

IV corticosteroids: acute exacerbation of asthma or other COPD

41
Q

Inhaled Corticosteroids: Contraindications*

A

Drug allergy
Not intended as sole therapy for acute asthma attacks
Hypersensitivity to glucocorticoids
Patients whose sputum tests positive for Candida organisms
Patients with systemic fungal infection

42
Q

Inhaled Corticosteroids: 
 Adverse Effects**

A

Pharyngeal irritation**
Coughing*
Dry mouth*
Oral fungal infections*
Systemic effects are rare because low doses are used for inhalation therapy.

43
Q

Inhaled Corticosteroids: 
 Drug Interactions *

A

Drug interactions are more likely to occur with systemic (versus inhaled) corticosteroids.
May *increase serum glucose levels**, possibly requiring adjustments in dosages of antidiabetic drugs
Cyclosporine and tacrolimus
Itraconazole
Phenytoin, phenobarbital, and rifampin

44
Q

Nursing Implications**: 
Inhaled Corticosteroids

A

Teach patients to gargle and rinse the mouth** with lukewarm water afterward to prevent the development of oral fungal infections.**
If a beta agonist bronchodilator and corticosteroid inhaler are both ordered, the bronchodilator should be used at least 5 minutes before the corticosteroid to provide bronchodilation before administration of the corticosteroid.
Encourage use of a spacer** device to ensure successful inhalations.
Teach patient how to keep inhalers and nebulizer equipment clean after use**

45
Q

Monoclonal Antibody Antiasthmatic

A

Omalizumab (Xolair), mepolizumab* (Nucala), reslizumab (Cinqair)
Selectively binds to the immunoglobulin E, which in turn limits the release of mediators of the allergic response
Given by injection
Potential for producing anaphylaxis
Monitor closely for hypersensitivity reactions.

46
Q

Nursing Implications*

A

Encourage patients to take measures that promote a generally good state of health to prevent, relieve, or decrease symptoms of COPD.
Avoid exposure** to conditions that precipitate bronchospasm (allergens, smoking, stress, air pollutants).
Adequate fluid intake**
Compliance* with medical treatment
Avoid excessive fatigue, heat, extremes in temperature, and caffeine.

Encourage patients to get prompt treatment for flu or other illnesses and to get vaccinated against pneumonia or flu.

Encourage patients to always check with their physicians before taking any other medication, including over-the-counter (OTC) medications

Perform a thorough assessment before beginning therapy, including:
Skin color*
Baseline vital signs*
Respirations* (should be between 12 and 24 breaths/min)
Respiratory assessment, including pulse oximetry
Sputum production
Allergies
History of respiratory problems
Other medications
Smoking history

Ensure that patients know how to use inhalers and MDIs and have patients demonstrate use of the devices.

47
Q

Nursing Implications

A

Monitor for therapeutic effects:**
Decreased dyspnea*
Decreased wheezing, restlessness, and anxiety**
Improved respiratory** patterns with return to normal rate and quality
Improved activity tolerance**
Decreased symptoms and increased ease of breathing**

48
Q

Inhalers: Patient Education**

A

For any inhaler prescribed, ensure that the patient can self-administer the medication.
Provide demonstration and return demonstration.**
Ensure that the patient knows the correct time intervals for inhalers.
Provide a spacer if the patient has difficulty coordinating breathing with inhaler activation.
Ensure that the patient knows how to keep track of the number of doses in the inhaler device.

Pharmocology RN212 (20 decks)

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