Chapter 37: Respiratory Drugs Flashcards
(97 cards)
1
Q
Asthma
A
Recurrent and reversible SOB (reversible in early stage)
2
Q
Asthma occurs when
A
Air of lungs become too narrow as a result of bronchospasm, inflammation and edema of bronchial mucosa
3
Q
Intrinsic asthma
A
(No he of allergies)
Unknown cause, but can be associated with respiratory infections, stress and cold weather
4
Q
Extrinsic Asthma
A
(Exposed to known allergen)
Caused by hypersensitivity to allergen(s) in environment.
5
Q
Exercise induced Asthma
A
Bronchospasm at beginning of exercise
Symptoms stop once exercise is stopped
6
Q
Drug induced asthma
A
Can be from NSAIDs, beta-blockers, sulfite a or certain foods
7
Q
S&S of Asthma
A
Expiratory Wheezing SOB Tachycardia, tachypnea Maybe cough and chest tightness "Silent" Chest Watch how pt talks in full sentences, do they have to catch their breath?
8
Q
Complications of Asthma
A
Atelectasis, Respiratory Failure, Respiratory Arrest
Status Asthmaticus
9
Q
Status Asthmaticus
A
Prolonged asthma attack and doesn’t respond to typical drug therapy
Requires hospitalization
10
Q
Chronic Bronchitis
A
Continuous infection of bronchi
Inflammation in associated bronchioles responsible for airflow obstruction
Chronic productive cough
11
Q
S&S of Chronic Bronchitis
A
Productive cough
Heavy set or normal weight
SOB
Hypercapnia and hypoxemia
12
Q
Complications of Bronchitis
A
Respiratory infections Hypoxia Respiratory failure and arrest Atelectasis Cor pulmonale (right sided CHF)
13
Q
Chronic Bronchitis can arise as a result of
A
Repeated episodes of acute bronchitis or in context of chronic generalized diseases.
14
Q
Most common bronchial irritants are
A
Cigarette smoking
15
Q
Emphysema
A
Air spaces enlarge as a result of destruction of alveolar walls.
Loss of lung elasticity.
Decreased surface area available for oxygen and CO2
16
Q
Primary irritant for Emphysema
A
Cigarette smoke.
Also recurrent infection, heredity and aging.
17
Q
S&S of Emphysema
A
SOB Use of intercostal and accessory muscles Underweight Barrel chest Cough is minimal Hypoxemia
18
Q
Pulmonary Embolism
A
Undissolved embolus that occluded blood vessels of lungs
19
Q
Risk Factors for Pulmonary Embolism
A
Virchow’s Triad:
Venous stasis, hypercoagulability and damage to venous wall.
20
Q
Factors contributing to venous stasis
A
Prolonged be rest or immobility
Prolonged sitting
21
Q
Types and Causes of Pulmonary Embolism
A
- Thrombotic (blood clots develop in venous system - legs)
- Fat (fat emboli - bone fractures)
- Amniotic Fluid (pregnancy)
- Air (from venous access -IV)
22
Q
S&S of Pulmonary Embolism
A
SOB Chest pain Anxiety Tachycardia Tachypnea Dizziness Hemoptysis
23
Q
Treatment of Pulmonary Embolism
A
Prevention
Compression stockings, early mobilizations
Anticoagulants (heparin, enoxaparin, warfarin)
Thrombolytic
Umbrella filter
24
Q
Umbrella filter
A
Filter in inferior vena cava
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Complications of Pulmonary Embolism
Shock
Respiratory failure
Cardiac/Respiratory
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Pneumonia
Upper respiratory infections, tracheal intubation, aging and incompetent immune system.
Impaired mucociliary mechanism, decrease cough and epiglottis reflexes, inhalation of microbes
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Classification of Pneumonia
Community Acquired
Hospital Acquired
Bacterial, viral, atypical
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Community acquired pneumonia
Infection lower lung onset in community
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Hospital acquired pneumonia
Highest mortality rate of nosocomial infection
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S&S of Pneumonia
```
Fever, cough, chills, purulent sputum
Back pain, pleuritic chest pain, headaches
Myalgia, fatigue, maybe sore throat
Tachypnea, tachycardia
SOB, Hypoxemia
Crackles, abnormal CXR
```
31
Diagnostics for Pneumonia
H&P (history and physical)
CXR
Sputum Culture
Elevated WBC
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Treatment for Pneumonia
O2, antibiotics, analgesics, antipyretics, fluids (IV/oral), caloric intake, rest
Depends on type of pathogen
Pneumococcal vaccine
33
Pulmonary Tuberculosis is usually seen in
Immunocompromised patients, malnourished, elderly
34
Pulmonary Tuberculosis
Always considered a population risk
Usually spread via airborne
Organisms can be dormant
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S&S of Pulmonary Tuberculosis
```
Low grade fever
Cough
Night sweats
Fatigue
Weight loss, Anorexia
Malaise
```
36
Treatment for Pulmonary Tuberculosis
Multiple drug therapy to prevent resistance
37
Bronchodilators can be categorized based on the duration of action such as
Short acting and long acting
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Short acting bronchodilators include
Albuterol and levalbuterol
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Long acting bronchodilators include
Salmeterol
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Bronchodilators
Relax bronchial smooth muscle resulting in bronchodilatation
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Bronchodilators are used during
An acute asthma attack, immediately reduces airway constriction and restores normal airflow.
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Types of Bronchodilators
Nonselective and selective beta2 drugs
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Nonselective Bronchodilators
Stimulate alpha and beta receptors: epinephrine
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Selective beta2 bronchodilators
Stimulates only beta2 receptors: albuterol
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Mechanism of action: Bronchodilators
Begins at specific receptor stimulated
| Ends with dilation of airways
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Mechanism of Action: Selective beta2 drugs (bronchodilator)
Activates beta2 receptors that stimulates cAMP, which relaxes smooth muscle in airway and results in bronchial dilation and increased airflow
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Mechanism of Action: Nonselective Bronchodilators
Vasoconstriction reduces amount of edema or swelling in mucous membranes and limits quantity of secretions
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Indications for Bronchodilators
Relief of bronchospasm r/t asthma, bronchitis and other pulmonary diseases
Treatment and prevention of acute attacks
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Contraindications of Bronchodilators
Those with high risk of strokes, uncontrolled HTN and cardiac dysrhythmias, CAD
50
Adverse Effects of Alpha and Beta Bronchodilators
Insomnia, restlessness, headache, tremor, palpitations, and anorexia
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Adverse Effects of Beta1 and Beta2 Bronchodilators
Cardiac stimulation
Tremor (usually lasts 30-40 minutes and then usually goes away)
Angina
Headache
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Adverse Effects of Beta2 - albuterol (Bronchodilator)
Headache and tremor
53
Anticholinergic drugs include
Ipratropium
Bromide
Tiotropium
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Anticholinergic drugs
Slow and prolonged action
Prevents bronchoconstriction
NOT for ACUTE asthma exacerbation a
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Mechanism of Action: Anticholinergic Drugs
Acetylcholine causes bronchial constriction and narrowing of airways.
Bind to Ach receptors preventing binding.
Result- bronchoconstriction is prevented, airways dilate
Help reduce secretions in COPD pts
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Indications for Anticholinergic drugs
Prevention of bronchospasm r/t chronic bronchitis or emphysema
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Contraindications of Anticholinergic drugs
Allergy to atropine or to soy lecithin or to related food products (peanut oils, peanuts, soybeans, other legumes)
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Adverse Effects of Anticholinergic Drugs
```
Dry mouth or throat
Nasal congestion
Palpitations, tachycardia
GI discomfort
Headache, cough, anxiety, restlessness
```
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Xanthine Derivatives: Two types
Plant alkaloids and synthetic
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Xanthine Derivatives: Plant Alkaloids include
Theophylline
Caffeine
Theobromine
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Xanthine Derivatives: Synthetic includes
Aminophylline
| Dyphilline
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Mechanism of Action: Xanthine Derivatives
- Increased levels of cAMP by competitively initiating PDE (enzyme that breaks down cAMP) -> Results in smooth muscle relaxation, bronchodilation and increased airflow
- Cause bronchodilation by relaxing smooth muscle in airways
- Cause CNS and cardiac stimulation (+ into trophy, chronotropy)
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Indications for Xanthine Derivatives
Dilation of airways in pt with asthma, chronic bronchitis, emphysema
Mild to moderate cases of acute asthma
Adjunct drug in management of COPD
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Adverse Effects of Xanthine Derivatives
```
N/V and loss of appetite (anorexia)
Gastroesophageal reflux during sleep
Palpitations, tachycardia, ventricular dysrhythmias
Increased urinary frequency
Hyperglycemia
```
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Interactions of Xanthine Derivatives
Charcoal-boiled food, high protein and low carb
| St. John's wort decreases serum drug
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Leukotriene Receptor Antagonists include
Montelukast
Zafirlukast
Zileuton
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Leukotriene Receptor Antagonists
Onset may be 24 hours
| Nonbronchodilating
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Mechanism of Action: Leukotriene Receptor Antagonist
Block receptors to prevent inflammation, bronchoconstriction, mucus production -> causes coughing, wheezing, SOB from triggers (cat hair, dust, etc)
Prevent smooth muscle contraction of bronchial airways
Decreased mucus secretion
Prevent vascular permeability
Decreased neutrophil and leukocyte filtration to lungs -> prevents inflammation
69
Indications for Leukotriene Receptor Antagonist
Prophylaxis and long-term treatment and prevention of asthma in adults and children > 12 years
NOT meant for ACUTE asthma attacks
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Montelukast is indicated for treatment of
Allergic rhinitis
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Adverse Effects of Zileuton (Leukotriene Receptor Antagonist)
Headache, nausea, dizziness, insomnia and liver function problems
72
Adverse Effects of Zafirlukast (Leukotriene Receptor Antagonist)
Headache, nausea, diarrhea, and liver function problems
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Nursing Implications of Leukotriene Receptor Antagonists
Monitor liver enzymes
| Allergies to providone, lactose, titanium dioxide and cellulose derivatives
74
Corticosteroids include
```
Budesonide
Flunisolide
Fluticasone
Ciclesonide
Prednisone
```
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Mechanism of Action: Corticosteroids
Suppress inflammation -> reduces edema, bronchospasm, increased beta2 agonist and responsiveness to beta2 agonist
Suppress inflammation -> decreases inflammation
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Indications for Corticosteroids
Prophylaxis of asthma (inhalers)
| NOT used for ACUTE asthma attacks
77
Adverse effects of Corticosteroids
Increased concentration - adrenal suppression (associated with long-term therapy)
Most common: oropharyngeal candidiasis and dysphonia
Bone loss
Can slow growth in children and adolescents
Hyperglycemia
GI discomfort - peptic ulcers
Infection
F&E disturbances
Cataracts and glaucoma
Mood changes
Crushing's Syndrome
78
Withdrawal and stopping of corticosteroid treatment must
Be done slowly, dosage must be tapered (taper oral agents gradually)
Must be administered on a regular schedule.
79
Abrupt stopping of corticosteroids can cause
Hypotension, hypoglycemia, myalgia
80
Oral corticosteroids
Used for long term treatment, relieve asthma episode
81
Teaching for Corticosteroid use
Gargle after each administration to prevent candidiasis with lukewarm water
Use a space device to reduce deposition of drug in oropharynx
To prevent bone loss, have adequate intake of calcium and vitamin D
Participate in weight bearing exercises
82
Combination drugs include
Advair Diskus
83
Advair Diskus
Combination of corticosteroids, fluticasone and long-term acting beta2 agonist Salmeterol
Bronchodilator and anti-inflammatory
84
Advair Diskus is used for
Asthma and COPD
85
Encourage pt to take measures that promote a generally good state of health to
Prevent, relieve and decrease symptoms of COPD
86
To prevent, relieve or decrease symptoms of COPD, pt should
Avoid exposure to conditions that precipitate bronchospasm
Have adequate fluid intake
Compliance
Avoid excessive fatigue, heat, extremes in temperature and caffeine
87
Encourage pt to get
Prompt treatment for flu or other illness and to get vaccinated
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The nurse must first do what before beginning therapy?
Do a thorough assessment of pt
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Nurse must ensure that patient know how to use by
Having pt do a return demonstration
90
Nurse should monitor patient for
Adverse and therapeutic effects
91
Albuterol if used too frequently can
Lose its beta2 specific actions at larger doses
92
Caution use of Xanthine in patients with
Cardiac disease
93
Nursing Implications for Leukotriene Receptor Antagonists
Ensure being used from chronic management of asthma and NOT acute
Teach purpose of therapy
Improvements should be seen in about a week
Assess liver function before beginning and throughout
94
Bronchodilators should be used
Several minutes before inhaled corticosteroids.
95
The nurse should keep track of
The number of doses in the inhaler devices
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Nursing Implications for Inhaled drugs
Keep track of the number of doses in the inhaler devices
| Wait 1-2 minutes between puffs for same drug and 2-5 minutes between different medications
97
Order to Administer Medications
1. Bronchodilators
2. Anticholinergics
3. Corticosteroids
