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Pharm Final > Corticosteroids, Bronchodilators Respiratory Agents > Flashcards

Corticosteroids, Bronchodilators Respiratory Agents Flashcards

1
Q

asthma

A

○ Chronic airway inflammation, causes bronchial constriction
○ Wheezing and difficulty breathing
○ Tightness of chest
- inspiratory wheeze

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2
Q

chronic bronchitis

A

○ Continous inflammation of bronchi
○ Excessive secretion of mucus
Blue bloater – pts appear cyanotic and often have edema

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3
Q

Emphysema

A

○ Alveolar wall destruction and enlarged air spaces
○ Impaired gas exchange
○ Smoking is the primary causation

Permanent inflation of the air sacks – decreases perfusion, impaired gas exchange.

Pink puffer – body compensates by hyperventilating, pts look pinkish & thin (use a lot of extra energy)

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4
Q

Bronchodilators include

A

○ B-Adrenergic Agonists
○ Anticholinergic Drugs
○ Xanthine Derivatives

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5
Q

Non-Bronchodilators include

A

○ Corticosteroids
○ Leukotriene Receptor Antagonists (LTRAs)

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6
Q

Bronchodilators:

B-Adrenergic Agonists

Indication for Use

A

○ Used to treat severe bronchospasm
○ For quick relief of symptoms** fastest acting bronchodilators

  • immediate onset of action for acute attacks
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7
Q

Bronchodilators:

B-Adrenergic Agonists

Mechanism of Action

A

○ Stimulates B2-Adrenergic receptors in the lungs
○ Relaxes bronchial smooth muscles which causes dilation of the bronchi and bronchioles

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8
Q

Bronchodilators:

B-Adrenergic Agonists

medications

A

○ Salbutamol (Ventolin), short acting (BLUE COLOR = used first) Onset of action (inhaled) is IMMEDIATE

○ Salmeterol xinafoate (Serevent), long acting
○ Combination: Steroid and B-Adrenergic (Symbicort or Advair)

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9
Q

Salbutamol (Ventolin)

A

■ Onset of action (inhaled) is IMMEDIATE
- It is sympathomimetic*** (Imitates norepinephrine on the b-cells and causes vasodilation and increases ventilation)
o Comes in IV & inhalation (puffer/aero chamber: metered dose inhaler; or nebuliser)
- Can be given on a regular basis but mostly in combination (with a long acting), used mostly for quick relief of bronchospasms.

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10
Q

Adverse Effects of B-Adrenergic Agonists

A

○ Tachycardia
○ Palpitations
○ Tremor
○ Nervousness/anxiety
○ Hypertension/hypotension
○ Headache

  • If used too frequently, dose-related adverse effects may be seen because B-Adrenergic loses it’s B2 specific action, especially at larger doses
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11
Q

Bronchodilators:

Anticholinergics

Indication for Use

A

Maintenance and prevention of bronchospasm

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12
Q

Bronchodilators:

Anticholinergics

action

A

Prevents bronchial constriction by blocking acetylcholine receptors

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13
Q

Bronchodilators:

Anticholinergics

medication

A

○ Ipratropium bromide (Atrovent) GREEN COLOR - used second
○ Tiotropium bromide monohydrate (Spiriva - it is a pill !!)
○ Salbutamol and ipratropium combination (Combivent)

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14
Q

Bronchodilators:

Xanthine Derivatives

indications for use

A

○ Prevention of symptoms/maintenance
○ Used with mild/moderate asthma
○ Used with chronic bronchitis and emphysema

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14
Q

Adverse Effects of Anticholinergics

A

○ Dry mouth/throat
○ Nasal congestion
○ Heart palpitations
○ Urinary retention
○ GI problems
○ Increased intraocular pressure
○ Headache
○ Coughing
○ Anxiety

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15
Q

Bronchodilators:

Xanthine Derivatives

Action

A

Causes bronchodilation by inhibiting phosphodiesterase enzyme results in smooth muscle dilation

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16
Q

Bronchodilators:

Xanthine Derivatives

medications

A

○ Theophylline (oral): narrow therapeutic window (chronic COPD)
○ Aminophylline (IV only - metabolized as theophylline): used for status asthmaticus** (when asthma attack does not stop no matter what interventions**)

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17
Q

Adverse Effects of Xanthine Derivatives

A

○ Cardiac irregularities
■ Tachycardia
■ Palpitations
■ Ventricular dysrhythmias
○ GERD
■ Nausea
■ Vomiting
■ Anorexia
○ Increased urination
○ Hyperglycemia*

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18
Q

Non-Bronchodilators:

Corticosteroids

indications for use

A

○ Anti-inflammatory
○ For management of difficult to treat asthma/respiratory illnesses
○ Allergic rhinitis
○ Mainly inhalation, sometimes PO (more localized tx & less SE)

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19
Q

Non-Bronchodilators:

Corticosteroids

Action

A

○ Prevent non-specific inflammatory processes by acting on the 5 types of WBC
○ Controls inflammatory responses
○ Increases the effects of B-Agonists (bronchodilation)

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20
Q

Non-Bronchodilators:

Corticosteroids

medications

A

○ Budesonide (Pulmicort)
○ Fluticasone propionate (Flovent) ORANGE COLOR (used third)
○ Prednisone
○ Combination with B-Agonist (Advair)

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21
Q

Adverse Effects of Corticosteroids (bronchodilators)

A

○ Pharyngeal irritation
○ Cough and dry mouth
○ Oral fungal infections (yeast on the tongue, roof of mouth, buccal cavity)
■ PO provides more systemic effects, therefore adverse effects are more systemic
■ Susceptibility to infection
■ Fluid and electrolyte imbalance
■ Endocrine effects (hyperglycemia)
■ Osteoporosis

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22
Q

Non-Bronchodilators:

Leukotriene Receptor Antagonist

indications for use

A

○ Used for the prophylaxis and long-term treatment and prevention of asthma
○ Seasonal allergies/asthma

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23
Q

Non-Bronchodilators:

Leukotriene Receptor Antagonist

medications

A

○ Montelukast (Singulair) PO
○ Zafirlukast (Accolate) PO
■ Both are dosed once daily

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24
Q

Nursing Assessment respiratory

A
  • Respiratory assessment
  • Environmental exposures and allergens
  • Smoking habits
  • Emotional status (anxiety/fear/stress)
  • Allergies
  • Caffeine intake
25
Q

Adverse Effects of Leukotriene Receptor Antagonist

A

○ Nausea
○ Diarrhea
○ Headache
○ Nightmares
○ Liver dysfunction

26
Q

Nursing Interventions respiratory

A
  • Discuss adherence to medication regimen
  • Demonstrate proper administration of inhaled drugs
  • Reassess respiratory system and breath sounds
  • Instruct patient to rinse mouth with water after use of inhaler or nebulized drug
  • Especially with use of steroids and anticholinergic to prevent dryness and muscosal irritation
  • Wash inhaler, spacer, and nebulizer every week with warm soapy water
27
Q

How to Use:
- A metered dose inhaler (MDI)

A

2 puffs of same, requires 1-2 minute break in between doses
- puffs of different medications, requires 2-5 minute break in between doses

28
Q

How to Use:
- A metered dose inhaler (MDI) with apcer/aerochamber

A

Place the 2 puffs of one medication, until patient inhales all medication, then add second medication puffs to aerochamber

29
Q

Corticosteroid levels regulated by the ?

A

the hypothalamic-pituitary-adrenal (HPA) axis

30
Q

the hypothalamic-pituitary-adrenal (HPA) axis

A

There is a negative feedback between the hormones
■ Hypothalamus produces corticotropin releasing hormone (CRH) then
■ Anterior pituitary produces adrenocorticotropic hormone (ACTH) then
■ Adrenal cortex produces glucocorticoids (CORT) then the negative
feedback continues

31
Q

Adrenal Gland

A

Adrenal Cortex (80-90%)
- Corticosteroids
- Glucocorticoids
- Mineralocorticoids
Adrenal Medulla (10-20%)
- Epinephrine
- Norepinephrine

32
Q

Corticosteroids

A
  • Glucocorticoids
  • Mineralocorticoids
33
Q

Glucocorticoids

A
  • Major anti-inflammatory actions
  • Regulates carbohydrate, protein, and lipid metabolism
  • Maintenance of normal BP
  • Stress effects
  • Immune response
34
Q

Mineralocorticoids

A
  • BP control
  • Maintenance of pH levels in the blood
  • Maintenance of serum K levels
  • Sodium and water reabsorption
35
Q

Cushing’s syndrome

A

an oversecretion of adrenal hormones

  • Glucocorticoid hypersecretion: redistribution of body fat from arms and legs to
    face, shoulder, trunk, and abdomen, characteristic ‘moon face’
  • Aldosterone hypersecretion: increased water and sodium retention, and muscle
    weakness from potassium loss
  • Causes: tumor, excessive administration of steroids (medications)
36
Q

Addison’s disease

A

an under secretion of adrenal hormones
- - Decreased blood sodium and glucose levels, increased potassium levels

37
Q

Addison’s disease S&S

A
  • hyperpigmentation, weakness, headache, fatigue, nausea, vomiting, anorexia, dehydration, weight loss, confusion, fever, abdominal pain, increased HR, diaphoresis, decreased BP
  • Often vague, chronic, and non-specific complaints
38
Q

Mineralocorticoids

indications for use

A

○ Used for Addison’s disease
○ Promotes hydrogen and potassium excretion
○ Helps regulate blood pH

39
Q

Mineralocorticoids

Action

A

Acts on distal kidney tubule, leading to sodium reabsorption into blood, which pulls water and fluids, helping to regulate edema and BP (hypertension)

40
Q

Mineralocorticoids medication

A

Fludrocortisone 21-acetate (drug replacement)

41
Q

Glucocorticoids

indictions of use

A

○ Bronchospasms (inhalation using fluticasone-flovent)
○ Allergic rhinitis (nasal route using fluticasone-flonase)
○ Inflammation of ear, eye, and skin (topical route using betamethasone)
○ Exacerbations of chronic respiratory illnesses (asthma and COPD) (inhalation using methylprednisolone (SOLU-MEDROL [4mg]) or hydrocortisone (SOLU-COTEF [20mg]). Not interchangeable !!!

○ Bacterial meningitis
○ Cerebral edema
○ Collagen diseases; systemic lupus erythematosus
○ Dermatological diseases
○ Endocrine diseases; thyroiditis
○ GI diseases; ulcerative colitis
○ Ocular disorders
○ Leukemia and lymphoma

42
Q

Glucocorticoids

Action

A

○ Promotes breakdown of protein, production of glycogen in liver, and redistribution of fat from peripheral areas to central areas of body
○ It inhibits inflammatory and immune responses
○ Inhibits or controls inflammatory response by
(1) stabilizing cell membranes of inflammatory cells,
(2) decreasing permeability of capillaries to inflammatory cells,
and (3) decreasing migration of WBCs into inflamed areas
○ Some mineralocorticoid-like activity such as fluid and water retention

43
Q

Glucocorticoids medications

A

○ Adrenocorticotropic hormone (ACTH)
○ Betamethasone
○ Cortisone
○ Dexamethasone
○ Hydrocortisone
○ Methylprednisone
○ Prednisolone
○ Triamcinolone

44
Q

Dexamethasone (PO, IV, IM)

A

class: Synthetic, long acting glucocorticoid

indications:
○ Variety of endocrine, rheumatic, collagen, dermatological allergic, ocular,
respiratory, hematological, neoplastic, GI, nervous system disorders
○ Inflammation

45
Q

Fludrocortisone 21-acetate (PO)

A

class: Synthetic mineralocorticoid

indications:
○ Addison’s disease
○ Salt losing adrenogential syndrome

46
Q

Hydrocortisone (PO, IV, IM)

A

class: Natural short-acting glucocorticoid

indications:
○ Adrenocortical insufficiency
○ Many inflammatory conditions

47
Q

Prednisone (PO)

A

class: Synthetic, immediate acting glucocorticoid

indications:
○ Variety of endocrine, rheumatic, collagen, dermatological allergic, ocular,
respiratory, hematological, neoplastic, GI, nervous system disorders
○ Inflammation

48
Q

Adverse Effects of Corticosteroids

A
  • Worse effects are seen in glucocorticoids !!!
  • Increased risk of infections
  • Hyperglycemia
  • Mania/psychosis
  • Insomnia
  • Akathisia
  • Depression
  • Euphoria
  • Osteoporosis
  • Gastritis
  • Fluid retention
  • Hypertension
  • Arrhythmias
  • Acne
  • Weight gain
  • Skin thinning
49
Q

Adrenal Drugs: Corticosteroids Nursing Process

A
  • Assess nutritional and hydration status, baseline weight, intake and output, VS, skin condition, and immune status
  • Assess muscle strength and stature
  • Baseline laboratory values
  • Growth suppression in children and adrenal suppression in older adults
  • Benefits outweight risks of drug’s adverse effects
  • Best time to give glucocorticoids is early morning between 0600 and 0900, which
    minimizes adrenal suppression
  • Avoid alcohol, caffeine, aspirin, and NSAIDs
  • Healing may be decreased with long term therapy (immunocompromised)
  • Assess therapeutic response and adverse effects to monitor effectiveness
  • Observe for Addisonian crisis***
50
Q

Adrenal Drugs: Corticosteroids Nursing Process Routes

A
  • Oral
  • Give with milk, food, or antacids
  • IM
  • Administered into large muscle with rotation of sites
  • Topical
  • Skin should be clean and dry, gloves are worn for application
  • Nasally
  • Clear nasal passage first, patient breathes in through the nose with administration
  • Inhaled
  • Fungal infections common, rinse mouth with lukewarm water
51
Q

Adrenal Drugs: Corticosteroids Nursing Process Patient Education

A
  • NEVER stop taking medications abruptly or alter dose
  • Long term effects of glucocorticoid therapy
  • Bone health and prevention of falls
  • S&S of acute adrenal insufficiency
  • Document response to treatment, BP, daily weight, adverse effects
  • Maintian low-sodium and high-potassium diet
52
Q

What is the rationale for using inhaled budesonide (Pulmicort®)?

A

It provides an anti-inflammatory response.

53
Q

Combivent

A

Combination Anticholinergic and B-Adrenergic

54
Q

Symbicort

A

Combination B-Adrenergic and Corticosteriod

55
Q

budesonide (Pulmicort)

A

Inflammatory response and synergistic response of B-agonist

56
Q

true or false: Peak flows are used during times of acute illness

A

false

57
Q

true or false: Peak flow is used to assess patients ability to breath out

A

true

58
Q

true or false: Peak flow reading reflects the patients degree of obstruction

A

true

59
Q

true or false: Peak flows are used prior to the inhaler

A

true

60
Q

When teaching a patient who has been prescribed a daily dose of prednisone, the nurse knows that the patient will be told to take the medication at which time of the day to help reduce adrenal suppression?

A

In the morning

Pharm Final (7 decks)

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