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ATI: PHARM > Ch 17 airflow disorders > Flashcards

Ch 17 airflow disorders Flashcards

1
Q

What is the pharmacological action of beta 2 adrenergic agonists

A

It acts by selectively activating the beta2 receptors in the bronchial smooth muscle, resulting in bronchodilaton, as a result bronchospasm is relieved. Histamine is inhibited. Ciliary motility is increased.

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2
Q

Albuterol

A

Inhaled* short acting
Oral* long acting

Prevention of asthma episode,
Inhaled short acting for prevention of Asthma
Treatment for bronchospasm
Long term control of asthma

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3
Q

Formoterol ( foradil, Aerolizer)

Salmeterol ( serevent)

A

Inhaled, long acting

Used for long term treatment of asthma

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4
Q

Terbutaline ( Brethine)

A

Oral* long acting

Long term control of asthma

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5
Q

What are adverse effects of beta 2 adrenergic agonists

A

Oral agents can cause tachycardia and angina because the activation of alpha 1 receptors in the heart.
Advise clients to avoid caffeine
Instruct client to check pulse and report HR above 20-30 more BPM.

Tremors caused by activation of beta 2 receptors in skeletal muscle.

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6
Q

What are contraindications and precautions of beta 2 adrenergic agonists

A

Pregnancy category C
contraindicated in clients with tachydysrrhythmia
Use cautiously in client who have diabetes, hyperthyroidism, heart disease, hypertension and angina.

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7
Q

What drug interactions exist for beta2 adrenergic agonists

A

MAOI and TCA can increase the risk of tachycardia and angina

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8
Q

What should the pt do when prescribed a beta 2 agonist and a inhaled glucocorticoid

A

Inhale the beta 2 agonist before inhaling the glucocorticoid. The beta2 agonist promotes bronchodilation and enhances absorption of the glucocorticoid

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9
Q

What are short acting beta2 agonists used to treat

A

Acute episodes

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10
Q

Methylxanthines

A

Theophylline ( the oldie, theo 24)

Causes relaxation of bronchial smooth muscle resulting in broncho dilation

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11
Q

What is oral theophylline used for

A

Long term control of chronic asthma or COPD

route of administration: oral or IV( emergency use only)

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12
Q

What are therapeutic ranges of theophylline

A

5-15

Therapeutic effects are unlikely to occur at levels less than 20.

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13
Q

What are signs of toxicity when taking theophylline

A

Nausea, diarrhea, restlessness

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14
Q

What severe reactions can occur with higher therapeutic levels of theophylline

A

Dysrhythmias

Seizures

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15
Q

Theophylline should be used cautiously in clients who

A

Have heart disease, HTN, liver and kidney dysfunction and diabetes

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16
Q

What are medication food interactions of theophylline

A

Caffeine increases CNS and cardiac adverse effects of theophylline
Caffeine can increase theophylline levels
Phenobarbitol and phenytoin decrease theophylline levels
Cimetidine ( Tagamet) ciproflaxacin ( cipro) and other fluoroquinolone antibiotics increase theophylline levels.

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17
Q

What is the pharmacological action of Inhaled anticholinergics

A

Blocks muscarinic receptors of the bronchi, resulting in bronchodilation

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18
Q

What is the prototype drug of inhaled anticholinergics

A

Ipratropium ( Atrovent)

Other meds: tiotropium (Spiriva)

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19
Q

What are the therapeutic uses of inhaled anticholinergics

A

Relieves bronchospasm assoc with COPD
allergen induced and exercise induced Asthma
Route of administration: inhalation

20
Q

What are adverse effects of inhaled anticholinergics

A

Local anticholinergic effects such as dry mouth, hoarseness

21
Q

What are contraindications and precautions of inhaled anticholinergics

A

Pregnancy category B
Contraindicated in clients who have an allergy to peanuts because the medication preparations may contain soy lecithin
Use cautiously in clients who have closed angle glaucoma and benign prostatic hyperplasia ( due to anticholinergic effects)

22
Q

Glucocorticoids

A

Short term IV agents are used to treat status asthmaticus
Inhaled agents are used for long term prophylaxis of asthma
Short term oral therapy is used to treat manifestations following acute asthma episode.
Long term oral therapy is used to treat chronic asthma
Promote lung maturity and decrease respiratory distress in fetuses at risk for preterm birth.

23
Q

What are the prototype meds of glucocorticoids

A

Inhalation: beclomethasone
Oral: prednisone

24
Q

What are inhalation glucocorticoid meds

A 
Budesonide  ( Pulmicort Flexhaler)
budesonide  and formoterol ( Symbicort)
Fluticasone and salmeterol ( Advair)
fluticasone ( Flovent)
mometasone  furoate and formoterol fummarate dihydrate (Dulera)
25
Q

What are oral medications of glucocorticoids

A

Prednisone

Prednisolone ( Prelone)

26
Q

What are IV Medications of glucocorticoids

A

Hydrocortisone sodium succinate ( Solu- Cortef)

Mehtylprednisolone sodium succinate ( Solu- medrol)

27
Q

What is the expected pharmalogical action of glucocorticoids

A

Theses meds prevent inflammation, suppress airway mucus production, and promote responsiveness of beta2 receptors in the bronchial tree.
The use of glucocorticoids does not provide immediate effects, but rather promotes decreased frequency and severity of exacerbations and acute attacks.

28
Q

Prednisone when used for 10 days or more can result in what

A

Supression of adrenal gland function, such as a decrease in the ability of the adrenal cortex to produce glucocorticoids, can occur with inhaled agents and oral agents. ( administer oral glucocorticoids on a alternate day dosing schedule, monitor blood glucose levels, taper the dose do not stop abruptly)
Bone loss ( advise pt to perform at bearing exercises, consume a diet with sufficient calcium and vit D, use lowest dose possible)
Hyperglycemia and glycosuria ( pt with diabetes should have blood glucose monitored)
Myopathy AEB muscle weakness
Peptic ulcer disease ( advise pt to,avoid NSAIDS, administer with food, report black tarry stools check for blood)
Disturbances of fluid and electrolytes

29
Q

What are contraindications and precautions of glucocorticoids

A

Pregnancy category C
Contraindicated in clients who have received a live virus vaccine and those with systemic fungal infections
Use cautiously in children and in clients who have diabetes, HTN, peptic ulcer disease and or kidney dysfunction
Use cautiously in pt taking NSAIDS

30
Q

How long are oral glucocorticoids used for

A

Short term 3-10 days following an acute asthma exacerbation

31
Q

What are leukotriene modifiers

A

Leukotriene modifiers prevent the effect of leukotrienes, thereby suppressing inflammation, bronchoconstriction, airway edema, and mucus production
They are used for long term therapy of asthma and to prevent exercise induced bronchospasm

Administered orally

32
Q

What is the prototype drug of leukotriene modifiers

A

montelukast ( singulair)

Other meds: zileuton ( zyflo) zafirlukast (accolate)

33
Q

Singular is used for what age group

A

In kids as young as 12 months of age

34
Q

accolate can be used for what age group

A

In children 5 years and up

35
Q

What is the age group for Zyflo administration

A

Adolescents and adults

36
Q

What are adverse effects of leukotrienes

A

Liver injury with use of zileuton ( Zyflo) and zafirlukast ( Accolate)

Obtain baseline liver function tests and monitor periodically
Advise clients to monitor for signs of liver damage ( nausea, anorexia, abdominal pain)

37
Q

What 2 leukotrienes limit the metabolism of warfarin

A

zileuton and zafirlukast inhibit the metabolism of warfarin leading to increased levels

Monitor PT and INR levels

38
Q

What 2 leukotrienes inhibit the metabolism of theophylline

A

Zileuton and Zafirlukast

Monitor theophylline levels
Advise clients to watch for theophylline toxicity such as nausea, vomiting, seizures.

39
Q

How should zileuton be administered

A

Take as prescribed can be given with or without food

40
Q

How should zafirlukast be administered

A

Take with food and take 1 hour before or 2 hours after meals

41
Q

When should montelukast be administered

A

Once daily at bedtime

42
Q

A nurse is providing teaching to a young cult female client who has anew prescription for beclomethasone ( QVAR) what should she include in the teaching?

A

Rinse your mouth after each use to decrease the risk of oral fungal infections

43
Q

A nurse is providing instructions to the parent of an adolescent client who has a new prescription for albuterol. What instruction should the Nurse include

A

Tremors are an adverse effect of this med

Tremors may be due to excessive stimulation of beta2 receptors of skeletal muscle.

44
Q

A client is prescribed long term use of oral prednisone for treatment of chronic asthma, the nurse should instruct the client to watch for what?

A

Wt gain and fluid retention due to the effect of sodium and water retention.

45
Q

Beta 2 adrenergic agonists

A

Albuterol ( Proventil, Ventolin)

formoterol ( foradil aerolizer)
salmeterol ( serevent)
terbutaline ( Brethine)

ATI: PHARM (39 decks)

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