Lower Respiratory Agents Flashcards
(68 cards)
1
Q
Where do Lower Respiratory Agents work?
A
Where gas exchange occers
* Bronchial tree
* Alveoli
2
Q
Which diseases are treated with lower respiratory drugs?
A
- Asthma
- COPD (Emphysema, Chronic Bronchitis)
- Pneumonia
- Respiratory Distress Syndrome (neonates)
- Adult Respiratory Distress Syndrome
3
Q
What forms do lower respiratory drugs come in?
A
Oral, nebulizer, injection
4
Q
Considerations for Lower Respiratory Tract agents
In Children
A
Prevention is KEY
* Avoid allergens, smoke, crowds, dusty areas
Used frequently:
* Long-Acting inhaled steroid
* Short-Acting Beta2 agonist (SABA)
* Leukotriene receptor agonist (best for prevention)
Theophylline ONLY if nothing else works
5
Q
Considerations for Lower Respiratory Tract agents
In Adults
A
- Avoidance of aggravating factors/triggers
- Periodic review of treatment regimen
- Periodic spirometry to measure lung capacity
- Safety in pregnancy has not been established: benefit vs. risk
6
Q
Considerations for Lower Respiratory Tract agents
In Older Adults
A
- Used frequently in this population
- More likely to experience adverse effects
- Renal and hepatic impairment can alter metabolism and excretion
- START LOW, GO SLOW
- Close monitoring
7
Q
Considerations for Lower Respiratory Tract agents - Adjuvant Therapy
In Older Adults
A
- Pulmonary hygiene (toileting) - positioning, coughing, deep breathing, head of bed up
- Positioning
- Fluids
- Nutrition
- Humidification
- Rest
- Activity Plans
- Support for complicated drug regimen
8
Q
Xanthines
Mechanism of Action
A
- Direct effect on the smooth muscles of the resp. tract, both in the bronchi and in the blood vessels (vasodilation)
- Exact MOA unknown
9
Q
Xanthines
Indications
A
- Symptomatic relief or prevention of asthma and COPD
- Reversal of bronchospasm
10
Q
Xanthines
Drug Names
A
- Caffeine
- Theophylline (most common)
11
Q
Other name for Xanthines
A
Methylxanthines
12
Q
Xanthines
Safety Considerations
A
- Narrow margin of safety
- Interact with MANY drugs
- Numerous adverse effects
- Reserved for when other drugs don’t work or critical situation in ICU
13
Q
Xanthines
Contraindications
A
Absolute:
* Allergy
Cautions: (worsened with xanthines)
* GI problems
* Heart disease
* Renal or hepatic disease
* Alcoholism
* Hyperthyroidism
14
Q
Xanthines
Drug Interactions
A
- ANY drug metabolized in the liver has the potential to interact with xanthines
- Substances in CIGARETTES => need for higher dose to be therapeutic (if pt. decreases or stops smoking, risk for toxicity with the higher dose)
15
Q
Xanthines
Adverse Effects
A
Related to theophylline levels in blood
* GI issues: Nausea & Vomiting
* Cardiac: Tachycardia
* CNS: Tremors, Irritability, Insomnia
SEVERE TOXICITY:
* Seizures
* Life-threatening arrhythmias
* Hypotension
* Coma
16
Q
Xanthines
Assessment
A
History:
* Allergy
* Pregnancy/lactation
* Cautions
* Smoking history
Physical:
* Respiratory
* Cardiac
* Abdomen
* ECG
Labs:
* Liver and Renal funtion tests
* Theophylline levels
17
Q
Xanthines
Nursing Conclusions
A
- Impaired comfort (r/t adverse effects)
- Altered sensory perception (r/t adverse CNS effects)
- Knowledge deficit
18
Q
Xanthines
Implementation/Patient Teaching
A
- Administer WITH food or milk to relieve GI upset
- Swith from IV to oral ASAP to avoid systemic effects
- Comfort measures (rest periods)
- Patient Teaching (sig. adv. effects - how to manage, report)
- Lab tests regularly
19
Q
Sympathomimetics
Mechanism of Action
A
Bronchodilators
* Beta2 selective adrenergic agonists
* Dilates bronchi
* Increases respiratory rate
* Increases depth of respirations
* SABA (short-acting) and LABA (long-acting)
* Mimics sympathetic nervous system stimulation
20
Q
Sympathomimetics
Indications
A
- ACUTE Asthma Attack SABA
- Bronchospasm SABA
- Prevention of exercise-induced asthma SABA
- Maintenance medication for chronic respiratory distress - LABA
21
Q
Sympathomimetics
Drug Names
A
Epiniphrine (Drug of choice in bronchospasm)
“-terol”
* Levalbuterol
* Salmeterol
* Albuterol (rescue inhaler)
* Formoterol
“-proterenol”
* Isoproterenol
* Metaproterenol
22
Q
Sympathomimetics
Contraindications
A
Absolute:
* Allergy
Cautions:
* Conditions that would worsen with SNS stimulation: (cardiac pts), heart disease, vasular disease, hypothyroidism
23
Q
Sympathomimetics
Drug Interactions
A
- Beta Blockers - can block symp. drugs (if administered systemically)
- Other drugs that increase BP or HR
- Substances in cigarettes
24
Q
Sympathomimetics
Adverse Effects
A
- Occasionally CAUSES bronchospasm
- Sympathetic Stimulation: CNS stimulation (anxiety, dizziness, headache)’; GI Upset; Cardiac (arrhythmias, hypertension, sweating, pallor, flushing)
25
**Sympathomimetics**
Assessment
**History:**
* Allergy
* Pregnancy/lactation
* cigarette use *(affects metabolism of drug)*
* conditions that require cautions
**Physical:**
* Respiratory
* Cardiac
* Neuro
* Vital Signs
26
**Sympathomimetics**
Nursing Conclusions
* **Altered tissue perfusion**
* Impaired comfort
* **Anxiety or restlessness**
* Knowledge deficit
27
**Sympathomimetics**
Implementation
* Proper administration
* Safety measures
* Take 30-60 minutes before exercise for exercise-induced asthma
* Comfort measures: small, frequent meals and nutritional consult
* Patient Education
28
**Anticholinergics**
MOA
**Bronchodilation**
* Blocks the vagal effect leading to relaxation of smooth muscle in bronchi
29
**Anticholinergics**
Indications
Maintenance treatment for COPD
*For patients that cannot tolerate sympathomimetics - not as effective*
30
**Anticholinergics**
Drug Names
**"-tropium"**
* Ipatropium
* Tiotropium
**"-clidinium"**
* Aclidinium
* Umeclidinium
31
**Anticholinergics**
Contraindications
**Absolute**
* Allergy
* Acute bronchospasm requiring imm. intervention
**Cautions:**
* Any condition aggravated by anticholinergic effects: *Glaucoma, urinary retention*
32
**Anticholinergics**
Adverse Effects
* Dry Mouth, hoarseness, sore throat
* Dizziness, headache, fatigue, nervousness, palpitations, urinary retention *(from small systemic effects)*
* Paradoxical bronchospasm
33
**Anticholinergics**
Drug Interactions
Other anticholinergics
34
**Anticholinergics**
Assessment
**History:**
* Allergy to drug, acute bronchospasm
* Pregnancy/lactation
* Conditions exacerbated by anticholinergics
**Physical:**
* Respiratory
* Cardiac
* Skin/mucus membranes (color, dryness, lesions)
* CNS: Orientation, affect, and reflexes
* Urinary output
* Vital Signs
35
**Anticholinergics**
Nursing Conclusions
* Impaired comfort
* Knowledge Deficit
36
**Anticholinergics**
Interventions/Patient Teaching
* Void prior to med. administration
* Safety measures for CNS effects
* Comfort measures: small, frequent meals; sugarless lozenges; humidification; adequate hydration
* Patient Teaching
37
**Inhaled Steroids**
Mechanism of Action
* Decreases the inflammatory response in the airways
* Takes **2-3 weeks** to be effective
38
**Inhaled Steroids**
Indications
* Prevention and treatment of **asthma**
* Maintenance treatment of **COPD**
39
**Inhaled Steroids**
Drug Names
**"-one"**
* Beclomethasone *(Qvar)*
* Fluticasone
* Triamcinolone
**"-esonide"**
* Budesonide
* Ciclesonide
40
**Inhaled Steroids**
Implementation/Patient Teaching
* Comfort measures
* Safety measures
* Patient Teaching: NOT for emergencies
* Rinse mouth after using inhaler *(to prevent fungal infections)*
* Clean mouthpiece after every use
* Monitor for signs of respiratory infection
41
**Inhaled Steroids**
Contraindications
**Absolute:**
* Allergy
NOT a drug for acute asthma attack!
**Caution:**
* Active respiratory infection *(because of suppressed immune function by steroids)*
42
**Inhaled Steroids**
Adverse Effects
* Sore throat/hoarseness
* Coughing
* Dry Mouth
* Pharyngeal and laryngeal fungal infections
43
**Inhaled Steroids**
Drug Interactions
NONE/UNKNOWN
44
**Inhaled Steroids**
Assessment
**History:**
* Allergy
* Pregnancy/lactation
* Systemic infections
**Physical:**
* Respiratory
* Vital Signs (temperature) - Baselines
* CV: BP, pulse, cardiac auscultation
* Look for fungal infections
45
**Inhaled Steroids**
Nursing Conclusions
* Impaired Comfort
* **Infection Risk**
* Knowledge Deficit
46
**Leukotriene Receptor Antagonists**
MOA
* Block (antagonize) receptors for the production of leukotrienes
* They DO NOT have an immediate effect: 1-2 weeks for therapeutic effect
47
**Leukotriene Receptor Antagonists**
Indications
*Long term* treatment of **Asthma**
48
**Leukotriene Receptor Antagonists**
Drug Names
**"-lukast"**
* zafirlukast *(Accolate)*
* Montelukast *(Singulair)*
49
**Leukotriene Receptor Antagonists**
Contraindications
**Absolute:**
* Allergy
* Acute Asthma Attack
**Caution:**
* Hepatic Impairment
50
**Leukotriene Receptor Antagonists**
Adverse Effects
* Flu-like symptoms: pharyngitis, cough, generalized pain, fever, myalgia
* CNS: Headache, dizziness
* GI: nausea, diarrhea, vomiting, abdominal pain, elevated liver enzymes
**Black Box Warning**
* Aggressive behavior, depression & suicide, hallucinations => **in children**
51
**Leukotriene Receptor Antagonists**
Drug Interactions
* metabolized by p450 system along with **MANY** others => check drug guide before administration
52
**Leukotriene Receptor Antagonists**
Assessment
**History:**
* Allergy, hepatic impairment, pregnancy/lactation
**Physical:**
* Respiratory: rule out acute asthma attack
* Temp, resp, lung sounds
* CNS: orientation and affect
* Abdomen
**Labs:**
* Liver function tests (LFTs)
53
**Leukotriene Receptor Antagonists**
Nursing Conclusions
* **Injury Risk (Black box warning)**
* Impaired comfort
* Knowledge deficit
54
**Leukotriene Receptor Antagonists**
Implementation/Patient Teaching
* Not for use in acute asthma attack
* Monitor for infection
* Safety measures r/t adverse effects
* Patient Teaching
55
**Lung Surfactants**
MOA
* Replace the surfactant that is missing in the lungs of neonates with RDS
* Begins to work IMMEDIATELY
56
**Lung Surfactants**
Indications
Rescue treatment for infants who have developed RDS (missing surfactant)
57
**Lung Surfactants**
Contraindications
NONE
58
**Lung Surfactants**
Adverse Effects
NONE
59
**Lung Surfactants**
Drug Names
**"-actant"**
* Beractant *(most common)*
* Calfactant
* Lucinactant
* Poractant
60
**Lung Surfactants**
Assessment
**History:**
* Time of birth and exact weight for dosing
**Physical:**
*for effectiveness of drug*
* Respiratory assessment
* Vital Signs
* Blood gases and O2 saturation
61
**Lung Surfactants**
Nursing Conclusions
* Decreased Cardiac Output
* Injury Risk (medication through trachea)
* Knowledge deficit
62
**Lung Surfactants**
Implementation/Patient Teaching
* Monitor continuously
* Ensure tube placement before administration
* Suction before administration but wait TWO hours after administration
* Teaching and support for parents
63
**BAM**
Bronchodilators
* **B**eta2 Agonists (sympathomimetics)
* **A**nticholinergics
* **M**ethylxanthines (xanthines)
64
**SLM**
Soothes Inflammation
* **S**teroids
* **L**eukotriene Receptor Antagonists
* **M**ast Cell Stabilizers ***(Not used anymore)***
65
Treatment for
**Acute Asthma Attack**
**A**: Albuterol *(sympathomimetic/Beta2 agonist)*
**I**: Ipratropium *(anticholinergic)*
**M**: Methylprednisolone *(steroid)*
66
Way to remember
**Anticholinergic**
Side effects
Can't see
Can't pee
Can't spit
Can't shit
*Block secretions, dry out*
67
68
**Inhaler**
Patient Teaching
Multiple puffs of the same inhaler: Wait 1 minute between puffs
Sympathomimetic & Steroid Inhalers:
Sympathomimetic 1st, wait 5 minutes, then steroid
Container Inhalers: Shake it before you take it
Steroid Inhalers: Swish and spit
Clean the mouthpiece after EVERY use
