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Class 3 Respiratory system: Asthma Flashcards

1
Q

Long-term drugs used to treat asthma

A

-Leukotriene receptor antagonists, theophylline, mast cell stabilizers, anticholinergics
-Inhaled/PO glucocorticosteroids, long-acting β2-agonists (LABAs)
-Combination of glucocorticoid OR corticosteroid AND LABA

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2
Q

Rapid relief asthma drugs

A

-SAβA
-Corticosteroid and LABA; budesonide and formoterol combination (>=12 years old)
-Ipratropium (rarely used)

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3
Q

Asthma management step 1 (mild, intermittent)

A

-SABA PRN and low dosage glucocorticoids

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4
Q

Asthma management step 2 (moderate; persistent)

A

-SABA PRN and medium-dosage of corticosteroid
-LABA & corticosteroid combination (>=12 years old)
-Leukotriene receptor antagonist

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5
Q

Asthma management step 3-4 (severe; uncontrolled)

A

-Step 1&2 + PO prednisone if FEV<60%
-Anti-IgE antagonist if >=12 years old

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6
Q

Antiasthmatics

A

-Leukotriene receptor antagonist, anticholinergics, corticosteroids
-B-agonist & xanthine derivatives
-Mast cell stabilizers (Na+ cromoglycate & nedocromil)

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7
Q

Anticholinergic MOA

A

Block cholinergic receptors, thus preventing the binding of cholinergic substances that cause constriction and increase secretions

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8
Q

Leukotriene receptor antagonist MOA

A

Disrupt leukotrienes, which decreases arachidonic acid-induced inflammation and allergen-induced bronchoconstriction

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9
Q

B-agonists & xanthine derivatives MOA

A

Raise intracellular levels of cyclic adenosine monophosphate, which promotes smooth muscle relaxation and dilates bronchi & bronchioles

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10
Q

Corticosteroids MOA

A

Prevent the inflammation commonly provoked by the substances released from mast cells

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11
Q

Mast cell stabilizers (Na+ cromoglycate & nedocromil) MOA

A

Stabilize mast cells membranes in which the antigen–antibody reactions take place, thereby preventing the release of substances such as histamine

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12
Q

Bronchodilators

A

-Beta-adrenergic agonists
-Anticholinergics
-Xanthine derivatives

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13
Q

Non-bronchodilating respiratory drugs

A

-Leukotriene Receptor Antagonists
-Corticosteroids

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14
Q

Bronchodilators: B-agonists

A

-AKA sympathomimetic bronchodilators
-Stimulate β2-adrenergic receptors, used in acute asthma attacks

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15
Q

Types of bronchodilators

A

-Nonselective adrenergics
-Nonselective β-adrenergics
-Selective β2 drugs

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16
Q

-Nonselective adrenergic bronchodilators

A

-Stimulate α, β1 (cardiac), and β2 (respiratory) receptors
-Include epinephrine (Adrenalin)

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17
Q

Nonselective β-adrenergics bronchodilators

A

-Stimulate both β1 and β2 receptors
-Include isoproterenol

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18
Q

Selective β2 drugs: Bronchodilators

A

-Stimulate only β2 receptors
-Include salbutamol (Airomir, Ventolin)

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19
Q

B-agonist MOA

A

-Begins at the specific receptor stimulated & ends with the dilation of the airways
-Activation of β2 receptors activates cyclic adenosine monophosphate (cAMP)

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20
Q

B-agonist indications

A

-Relief of bronchospasm related to asthma, bronchitis, and other pulmonary diseases
-Treatment and prevention of acute attacks, hypotension & shock
-To produce uterine relaxation to prevent premature labor
-Treatment of hyperkalemia (stimulates potassium to shift into the cell)

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21
Q

Adrenergic receptor responses to stimulation: A1

A

-Vasoconstriction

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22
Q

Adrenergic receptor responses to stimulation: B2

A

-Vasodilation

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23
Q

Adrenergic receptor responses to stimulation: Heart muscle B1

A

-Increased contractility

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24
Q

Adrenergic receptor responses to stimulation: AV&SA node B1

A

Increased HR

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25
Adrenergic receptor responses to stimulation: Pupillary muscles of iris a1
-Mydriasis (dilated pupils)
26
Adrenergic receptor responses to stimulation: Kidney B1
-Increased renin secretion
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Adrenergic receptor responses to stimulation: Liver B2
Glycogenolysis
28
Adrenergic receptor responses to stimulation: Muscle a2&B2
Decreased motility
29
Adrenergic receptor responses to stimulation: Bladder sphincter a1
Constriction
30
Adrenergic receptor responses to stimulation: Penis a2
Ejaculation
31
Adrenergic receptor responses to stimulation: Uterus a2
Contraction
32
Adrenergic receptor responses to stimulation: Uterus B2
Relaxation
33
Adrenergic receptor responses to stimulation: Bronchial muscles B2
Dilation
34
B-agonist contraindications
-Uncontrolled cardiac dysrhythmias -High risk of stroke (because of the vasoconstrictive drug actions)
35
B-agonist adverse effects a-B
-Epinephrine: anorexia, insomnia, vascular headache, cardiac stimulation, tremor, restlessness, hyperglycemia
36
B-agonist adverse effects B1&B2
-Isoproterenol: Cardiac stimulation, anginal pain, vascular headache, hypotension & tremor
37
B-agonist adverse effects B2
-Salbutamol: aBP, vascular headache, tremor
38
B-agonist interactions
-Require an adjustment to antihyperglycemic drugs -Increase risk for HTN & cardiac toxicity
39
B-agonist derivatives: Nursing implications
-Avoid excessive fatigue, extremes in temperature, caffeine, take in adequate fluids -Salbutamol can lose its β2-specific actions at larger doses... As a result, β1 receptors are stimulated, causing nausea, anxiety, palpitations, tremors, and increased HR
40
B-agonist derivatives: Nursing implications (things to report)
-Insomnia, restlessness, palpitations, chest pain, or any change in symptoms
41
Inhalers: Pt education
-Teach time-intervals for inhalers -Provide spacer if coordination of breathing is impaired -Teach patient how to keep track of the number of doses in the inhaler
42
Anticholinergic mechanism of action
-Anticholinergics bind to the ACh receptors, preventing ACh from binding -Prevents bronchoconstriction and airways dilate
43
About anticholinergics
-Include ipratropium bromide (Atrovent) and tiotropium (Spiriva) -Slow and prolonged action
44
Anticholinergic adverse effects
-Dry mouth/throat, congestion, coughing, headache -Heart palpitations, anxiety, GI distress
45
Bronchodilators: Xanthine derivatives
-The natural xanthines are the plant alkaloids caffeine, theobromine, and theophylline (Theolair, Uniphyl) -Only theophylline is used as a bronchodilator
46
Synthetic xanthines
-Aminophylline (Phyllocontin) -Oxtriphylline
47
Xanthine derivatives: Mechanism of action
-Increase levels of cAMP by inhibiting phosphodiesterase, the enzyme that breaks down cAMP -The result is increased smooth muscle relaxation & bronchodilation
48
Xanthine derivatives: Drug effects (other effects)
-Increased contraction & HR resulting in increased CO and blood flow to the kidneys (diuretic effect) -Stimulate CNS
49
Xanthine derivatives: Indications
-Dilation of airways in asthma, chronic bronchitis, and emphysema -Mild to moderate acute asthma -Combination drug in COPD management
50
Xanthine derivatives: Contraindications
-Uncontrolled cardiac dysrhythmias, seizure disorders -Hyperthyroidism, peptic ulcers
51
Xanthine derivatives: Adverse effects
-N/V, nocturnal GERD, anorexia -Sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias -Transient increased urination
52
Xanthine derivatives: Interactions
-Several drugs increase serum levels of xanthine derivatives -When used with sympathomimetics (e.g., caffeine) additive heart and CNS stimulation -St. John’s wort (Hypericum perforatum) and cigarette smoking enhance the rate of metabolism -Charcoal broiling and high-protein and low-carbohydrate foods may reduce serum levels of xanthines
53
Xanthine derivatives: Implications
-Report N/V, weakness, dizziness, palpitations, chest pain, & convulsions
54
Antileukotrienes
-AKA leukotriene receptor antagonists (LRTAs) -"lukasts"; montelukast (Singulair) & zafirlukast (Accolate)
55
Antileukotrienes mechanism of action
-Leukotrienes cause inflammation, bronchoconstriction, and mucus production -The result is coughing, wheezing, and SOB -Antileukotriene drugs prevent leukotrienes from attaching to receptors on circulating immune cells and immune cells within the lungs
56
Antileukotrienes drug effects
-Prevent smooth muscle contraction of the bronchial airways, decrease mucus secretion -Prevent vascular permeability, decrease inflammatory response in the lungs
57
Antileukotrienes indications
-Used for asthma if >=12 -NOT for acute asthmatic attacks -Montelukast: Approved for use in children ages 2 and older and for treatment of allergic rhinitis
58
Antileukotrienes contraindications
Allergy to cellulose derivatives, titanium dioxide, povidone, or lactose
59
Antileukotrienes adverse effects: Zafirlukast
-Headache, nausea, diarrhea -Liver dysfunction
60
Antileukotrienes: Nursing implications
-For chronic asthma, not acute -Taken every night even if symptoms improve -Therapeutic effect ~ 1 week -High interaction rate -Assess liver function before beginning therapy
61
Corticosteroids
-For chronic asthma, not acute asthmatic attacks -PO or inhaled forms -Inhaled forms reduce systemic effects -May take several weeks before full effects are seen
62
Corticosteroids mechanism of action
-Stabilize membranes of leukocytes or WBCs that release broncho-constricting substances -Increase responsiveness of bronchial smooth muscle to β-adrenergic stimulation
63
Inhaled corticosteroids
-Budesonide, triamcinolone acetonide "ides" -Fluticasone furoate & propionate -Mometasone furoate monohydrate "ates"
64
Inhaled corticosteroids indications
-Bronchospastic disorders that cannot be controlled by conventional bronchodilators
65
Inhaled corticosteroids contraindications
-Hypersensitive to glucocorticoids -Positive for Candida organisms -Systemic fungal infection
66
Inhaled corticosteroids adverse effects
-Pharyngeal irritation, oral fungal infection -Coughing, dry mouth -Systemic effects are rare because of the low doses used for inhalation therapy
67
Inhaled corticosteroids nursing implications
-Rinse mouth after to prevent fungal infections -Bronchodilator used before the corticosteroid -Encourage use of a spacer device to ensure successful inhalations -Teach patients how to keep inhalers and nebulizer equipment clean after use
68
Care of the respiratory client: Diagnostics
-Pulmonary Function Tests, SpO2 -ABG’s, D-Dimer, sputum Cultures -Chest X-Ray, CT Scan, MRI
69
Care of the respiratory client: Diagnostics cont'd
-D-Dimer is a by-product of blood clotting. D-dimer is released when a blood clot begins to break down. -Fluoroscopy; continuous x ray image -Bronchoscopy; scope to see interior of airway -Thoracoscopy; look at the space inside the chest -Pulmonary Angiogram; shows blood flow through lung -Thoracentesis; remove fluid or air from around the lungs -Biopsy; bronch, thoracentesis
70
Common upper airway complications
Rhinitis, sinusitis, pharyngitis, tonsillitis, laryngitis
71
Nursing care for common upper airway complications
-Fluid & Electrolyte balance -Promote communication -Medication management
72
Obstruction & trauma to upper airway
Obstructive Sleep Apnea, epistaxis, nasal Obstruction, laryngeal Obstruction
73
Nursing care of obstruction & trauma to upper airway
-Fear & Anxiety, sleep, communication -Nutrition, body Image
74
Lower respiratory tract disorders
Atelectasis, pneumonia, tuberculosis, abscess
75
Lower respiratory tract disorders: Nursing care
-Rest -Fluid balance, nutrition -Knowledge -Medication management
76
Lower respiratory tract disorders in pediatrics
-Respiratory Syncytial Virus (RSV)
77
-Respiratory Syncytial Virus (RSV)
-Acute viral infection causing bronchiolitis -Most frequent cause of pediatric hospitalization for lower respiratory tract infection
78
RSV presentation
SOB, wheezing, tachypnea, nasal secretions, poor feeding, +/- fever
79
RSV nursing care
Symptom management, NP suction, I&O, IV fluids
80
Severe RSV may require...
PICU admission and intubation
81
Prevention of RSV
Monoclonal antibody (palivizumab)
82
Asthma diagnostic tests
-Pulmonary function tests (PFTs) -Peak expiratory flow rate (PEFR) -Lab tests (CBC + diff) and CXR
83
Status asthmaticus goals of therapy
Correct dehydration and acidosis + the obvious goals
84
Status asthmaticus treatment
-Humidified O2, SABA, +/- corticosteroids & anticholinergics -IV Mg+ sulfate -Admit to PICU
85
Pleural conditions
-Pleurisy -Pleural Effusions -Empyema
86
Pleural conditions: Nursing care
-Effective breathing pattern, gas exchange -Tube & medication management
87
Respiratory failure
-Pulmonary Edema, Pulmonary Embolism; D-dimer -Acute Respiratory Failure, ARDS -Pulmonary HTN, Cor Pulmonale
88
Respiratory failure: Nursing care
-Medications, weight & fluid balance, nutrition -Patient teaching, family centered care -Fear & Anxiety
89
Chest trauma
-Blunt Trauma -Sternal/Rib Fractures -Penetrating Trauma -Pneumothorax -Cardiac Tamponade -Hemothorax
90
Chest trauma: Nursing care
-Emergency…ABC -Oxygen -Lines & tubes -Pain -Fluid & electrolyte balance -Medication management -Family centered care -Pt education
91
Chest tubes, drains and catheters
-1) Drainage of air: -Pneumothorax -Primary or secondary -Spontaneous or traumatic -2) Drainage of fluid: -Malignant pleural effusion -Parapneumonic effusions / Empyema -Hemothorax -3) Post operative for recovery
92
Insertion technique: Factors to consider
-Percutaneous: -Simple -Less painful & traumatic -Quick -No inspection of pleural space -Required if located pleural space -Surgical: -More complex & painful -Allows examination of pleural space -Allows placement of large bore tubes
93
Large bore chest tubes
-Stiff -Thick fluid (blood, pus) -Large air leaks -Pain -Wound infections
94
Small bore tubes
-Pigtails -Strait “pneumothorax” -Tubes -With or w/o image -Guidance -More comfortable -Less traumatic -Plugs easily, need for flushing -Good for “lighter” fluids
95
Tunneled pleural catheters (Pleurx)
-Malignant effusions -Long term use, intermittent home -Low complication rates, soft/comfortable

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