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nurs 366: pathopharm ii > RESPIRATORY - obstructive lung disorders: asthma & COPD drugs > Flashcards

RESPIRATORY - obstructive lung disorders: asthma & COPD drugs Flashcards

EXAM 2 content

1
Q

what do we use to aid in reducing asthma (NOT TYPES OF DRUG CLASSES)?

A
  • ventilation support: O2 & mech vent
  • medications to open airways
  • medications to reduce allergic reaction
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2
Q

what are the medications we use to open the airways for asthma?

A
  • bronchodilators
  • anticholinergics
  • glucocorticoids
  • methylxanthines
  • leukotriene modifiers
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3
Q

what are the medications we use to reduce allergic reactions?

A
  • mast cell stabilizers
  • monoclonal antibodies for IgE
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4
Q

what does monoclonal antibodies for IgE do?

A
  • IgE are antibodies that degranulate mast cells –> releases histamines
  • monoclonal antibodies binds to IgE so they can not bind/degranulate to mast cells
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5
Q

what are the example drugs for bronchodilators?

A
  • ALBUTEROL (SABA)
  • SALMETEROL (LABA)
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6
Q

what are the routes of ALBUTEROL & SALMETEROL?

A
  • inhaled is more common
  • PO is more for SALMETEROL (LABA)
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7
Q

what are the pharmacologic action of ALBUTEROL & SALMETEROL?

A

stimulates beta 2 receptors (that control bronchodilation) –> bronchodilation

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8
Q

what are the major adverse reactions of ALBUTEROL & SALMETEROL?

A
  • both: tachycardia (due to beta 1 effects of albuterol because it is non-selectie) , tremors, angina, & hyperglycemia
  • SALMETEROL (LABA): exacerbation of asthma
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9
Q

what are the nursing interventions for ALBUTEROL & SALMETEROL?

A

monitor for CN side effects

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10
Q

what is the client education for ALBUTEROL & SALMETEROL?

A
  • ALBUTEROL (SABA): used for an acute exacerbation
  • SALMETEROL (LABA): is not used for primary control. needs to be on a schedule & ONLY in conjunction with other drugs to manage asthma
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11
Q

what are the contraindications for ALBUTEROL & SALMETEROL?

A

hypersensitivity

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12
Q

what are the interactions of ALBUTEROL & SALMETEROL?

A
  • MAOIs: increase CN manifestations
  • antidiabetic agents: monitor blood glucose
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13
Q

which one is short term and which is long term for bronchodialators?

A

SABA = short, acute exacerbations
LABA = long term management

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14
Q

what is the example drugs for anticholinergics?

A

IPRATROPIUM

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15
Q

what is the route of IPATROPIUM?

A

inhaled

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16
Q

what is the pharmacological action of IPRATROPIUM?

A

blocks cholinergic receptors in smooth muscle –> reduces bronchoconstriction

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17
Q

what happens if you mix IPRATROPIUM w a SABA?

A

makes LAMA (long acting muscarinic antagonist): increased effect on reducing bronchoconstriction because they work on different mechanisms

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18
Q

what are the adverse reactions of IPRATROPIUM?

A
  • dry mouth
  • increased intraocular pressure
  • urinary retention
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19
Q

what are the nursing interventions for IPRATROPIUM?

A

monitor UOP (urinary output)

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20
Q

what should educate about IPRATROPIUM?

A
  • report urinary changes
  • seek regular eye exams
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21
Q

what are contraindications of IPRATROPIUM?

A
  • glaucoma
  • hypersensitivity
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22
Q

what is the example drug for glucocorticoids?

A

BECLOMETHASONE DIPROPIONATE

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23
Q

what are the routes of BECLOMETHASONE?

A

inhaled & PO

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24
Q

what is the pharmacological action of BETHCLOMETHASONE?

A

suppresses inflammatory response –> helps keep airways open

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25
Q

what are the major adverse reactions of BETHCLOMETHASONE?

A
  • immunosuppression!
  • hyperglycemia!
  • bone loss
  • adrenal suppression
  • fluid and electrolyte imbalance
  • GI bleed
  • candidiasis
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26
Q

what is candidiasis?

A

a fungal infection with BECLOMETHASONE due to inhalation

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27
Q

what are the nursing interventions for BETHCLOMETHASONE?

A
  • monitor lab values: for immune problems
  • monitor infection: candidiasis
28
Q

what should we educate about BETHCLOMETHASONE?

A
  • rinse mouth after inhaler to prevention infection
  • taper dose before discontinuing
  • perform weight bearing exercises
  • consume calcium & vit D
29
Q

what are the contraindications of BETHCLOMETHASONE?

A

infection - especially fungal

30
Q

what are the interactions of BETHCLOMETHASONE?

A
  • potassium wasting diuretics
  • NSAIDs
  • antidiabetic medications
31
Q

what is the example drug for methylxanthines?

A

THEOPHYLLINE

32
Q

what is the route for THEOPHYLLINE?

A

PO & IV

33
Q

what is the pharmacological action of THEOPHYLLINE? what is it similar to?

A

relaxes bronchial smooth muscle –> better flow of air
- similar to caffeine analog: works on SNS –> bronchodilation

34
Q

what are the major adverse reactions for THEOPHYLLINE?

A
  • CNS: restlessness & insomnia
  • dysrhythmias
  • seizures
35
Q

what are the nursing interventions for THEOPHYLLINE?

A
  • monitor drug levels carefully: USUALLY GIVEN IN COMBO and not usually given because of CN & CNS effects
  • seizure precautions
  • cardiac monitoring
36
Q

what should we educate about THEOPHYLLINE?

A
  • reduce caffeine intake
  • ongoing level testing
  • notify provider of adverse effects
37
Q

what are the contraindications of THEOPHYLLINE?

A
  • high levels of caffeine use
  • tobacco or marijuana use
38
Q

what are the interactions of THEOPHYLLINE?

A
  • anti seizure meds w/nicotine –> decrease metabolism of THEOPHYLLINE
  • caffeine & CIMETIDINE increase risk of toxicity
39
Q

what is the example drug for leukotrine modifiers?

A

MONTELUKAST

40
Q

what is the route for MONTELUKAST?

A

PO

41
Q

what is the pharmacological action of MONTELUKAST?

A

blocks leukotriene receptors –> decreases inflammation, bronchoconstriction & vascular permeability –> long term preventative measure (esp if asthma for exercise reasons)

42
Q

what are the major adverse reactions of MONTELUKAST?

A

possible suicide ideation & hepatotoxic

43
Q

what are the nursing interventions for MONTELUKAST?

A
  • liver function testing
  • observe behavioral changes bc of SI
44
Q

what should we educate about MONTELUKAST?

A
  • report manifestations of liver dysfunction
  • report behavioral changes
  • take at least 2 hours before exercise
  • take with a full glass of water
45
Q

what are the contraindications for MONTELUKAST?

A
  • liver dysfunction
  • status asthmaticus
  • NOT for acute exacerbation
46
Q

what are the interactions with MONTELUKAST?

A
  • phenobarbital
  • phenytoin
  • rifampin

all decrease efficacy of MONTELUKAST

47
Q

what is the example drug of mast cell stabilizers?

A

CROMOLYN

48
Q

what is the route of CROMOLYN?

A

inhaled & PO

49
Q

what is the pharmacological action of CROMOLYN?

A

stabilizes membrane of mast cells –> reduces release of histamine –> for long term PREVENTION, NOT acute exacerbation

50
Q

what are the major adverse reactions to CROMOLYN?

A

allergic reactions - more for allergy induced asthma

51
Q

what should we educate about for CROMOLYN?

A

monitor for manifestations of allergic reaction

52
Q

what are the contraindications of CROMOLYN?

A

hypersensitivity

53
Q

are there any interactions for CROMOLYN?

A

none known

54
Q

what is the difference between DIPHENHYDRAMINE & CROMOLYN?

A
  • DIPHENHYDRAMINE only BINDS to histamine receptors
  • CROMOLYN prevents the RELEASE of histamine –> better for allergic induced asthma
55
Q

what is generally used for long term asthma treatment?

A
  • glucocorticoids
  • leukotriene receptor antagonists
  • mast cell stabilizers
  • LABAs
  • methylxanthines
  • SABA for acute exacerbation
56
Q

what is generally used for acute, severe exacerbations, esp if they dont respond to their SABA?

A
  • oxygen
  • systemic glucocorticoid
  • SABA!
  • anticholinergic to enhance bronchodilation
  • sympathomimetic agents if nothing else works: epinephrine!
57
Q

for COPD, what level should the oxygen level be and why?

A

no higher than ~92% (88-92) if higher it can make things worse

58
Q

what do we use to reduce inflammation for COPD?

A
  • LABA bronchodilators
  • LAMA anticholinergics
  • phosphodiesterase-4 inhibitor
59
Q

what do we not use now to reduce inflammation in COPD?

A

glucocorticoids

60
Q

what do we use to clear mucus for COPD?

A
  • expectorants: GUAIFENESIN
  • mucolytics: ACETYLCYSTEINE
61
Q

what do we use for infection for COPD?

A

antibiotics

62
Q

what is the example drug for phosphodiesterase-4 inhibitors?

A

ROFLUMILAST

63
Q

what is the route of ROFLUMILAST?

A

PO

64
Q

what is the pharmacological action of ROFLUMILAST?

A

inhibits PED4 –> increase cAMP levels in lungs –> cAMP suppresses cytokine active + decrease immune cell penetration into lungs –> overall anti-inflammatory effect

65
Q

what are the major adverse reactions to ROFLUMILAST?

A
  • diarrhea
  • nausea
  • headache
  • psychiatric effects

nurs 366: pathopharm ii (30 decks)

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