LR Drugs Flashcards
(97 cards)
1
Q
Mimic action of epinephrine and norepinephrine
Selectively activates alpha 1
Used as
Common alpha 1 adrenergic agonist effects:
A
Alpha 1-adrenergic agonists (sympathomimetic) - UR
2
Q
Causes smooth muscle and vessel constriction
A
Selectively activates alpha 1
3
Q
Decongestant – shrinks mucous membranes, decreases mucous production in upper respiratory tract
Example: pseudoephedrine
A
Used as
4
Q
CNS stimulation (insomnia, nervousness, dizziness), urinary retention, hypertension, tachycardia
A
Common alpha 1 adrenergic agonist effects:
5
Q
Goal is to achieve bronchodilation; cannot do perfectly when act as agonist of SNS - see AE
Mimic effects of sympathetic nervous system – specifically trying to target the beta2 receptors of sympathetic NS
Act on beta receptors
Beta agonists that activate both B receptors are nonselective bronchodilators
Beta agonist that activate only B2 are selective bronchodilators
Common beta agonist effects:
A
Beta2-adrenergic agonists (sympathomimetic)
6
Q
Dilation of bronchi with increased rate and depth of respiration
A
Mimic effects of sympathetic nervous system – specifically trying to target the beta2 receptors of sympathetic NS
7
Q
Example: epinephrine activates all a and b
A
Beta agonists that activate both B receptors are nonselective bronchodilators
8
Q
Example: albuterol
A
Beta agonist that activate only B2 are selective bronchodilators
9
Q
Relax bronchi, hypertension, tachycardia, tremors, anxiety, headaches
A
Common beta agonist effects:
10
Q
Blocks parasym NS in terms resp is get bronchodilation; norm action of PSNS is bronchoconstriction - use resp anticholinergics for bronchodilation
Substance that blocks neurotransmitter acetylcholine (Ach) (cholinergic) in CNS and PNS
Used as alternative to beta-agonists in asthma therapy (inhaled form)
Common anticholinergic effects:
A
Anticholinergics
11
Q
Affect vagus nerve to relax bronchial smooth muscle and promote bronchodilation
A
Substance that blocks neurotransmitter acetylcholine (Ach) (cholinergic) in CNS and PNS
12
Q
Example: Ipratropium (Atrovent)
A
Used as alternative to beta-agonists in asthma therapy (inhaled form)
13
Q
Relax bronchi, drowsiness, confusion, tachycardia, hypertension, dry mouth, pupil dilation, flushing, urinary retention, constipation
A
Common anticholinergic effects:
14
Q
Drugs that are acting to mimic SNS/drugs that blocking parasympathetic NS - end up in the same spot; get bronchodilation and see some same effects
Use these drugs have have specific conditions that contraindicated in because drug effects
Sympathetic activity: - diseases/disorders which meds act as sympathomimetics use drugs with caution - be very careful in pats that have these disorders that mimic SNS:
Anticholinergic effects:
A
Med caution: conditions exacerbated by:
15
Q
Glaucoma
Hypertension
Coronary artery disease
Peripheral artery disease
Diabetes
Hyperthyroidism
Prostate hypertrophy
A
Sympathetic activity: - diseases/disorders which meds act as sympathomimetics use drugs with caution - be very careful in pats that have these disorders that mimic SNS:
16
Q
Increase BP more; not want to happen: not want issue worse
A
Hypertension
17
Q
Potential to increase BG and diabetics don’t need that
A
Diabetes
18
Q
Increased sweating, increased HR - potential arythmias
A
Hyperthyroidism
19
Q
Exacerbating prob
A
Prostate hypertrophy
20
Q
Blocking parasymp NS
Constipation
Prostate hypertrophy
Hypertension
Tachycardias
Dementia
A
Anticholinergic effects:
21
Q
slower digestion - not get activated
Exacerbating prob
A
Constipation
22
Q
Exacerbating prob
A
Prostate hypertrophy
23
Q
Common disorders:
Clinical manifestations:
A
LR disorders and CM
24
Q
Asthma (trigger)
COPD
Infections/diseases (pneumonia)
A
Common disorders:
25
Inflammatory disorder - trigger: pet dander, exercise, allergens
Results in Bronchoconstriction and Inflammation
Mucous production
Asthma (trigger)
26
Chronic cough, mucous production
Emphysema: have Expiratory airway collapse w/air trapping
Chronic bronchitis: with chronic inflammation
COPD
27
Shortness of breath/dyspnea
Increased work of breathing and use of accessory muscles
Sputum production
Hypoxia
Clinical manifestations:
28
Prior to admin:
After administration:
Nursing assessment
29
Baseline assessment of all systems - first step of nursing process always assessment; always want do baseline head to toe
Focus assessments:
Prior to admin:
30
Be priority assessment and bare minimum in assessing pats before give meds; key in on and prioritize if going give med that treats LR prob; 2 big assessments do; do together if can
Respiratory: lung sounds, sputum production, RR, O2 saturation
Cardiac: HR&R, peripheral perfusion, presence of cyanosis - impacts CV with LR drugs
Assessments do for baseline
Focus assessments:
31
meds in rescue capacity - always reassess to eval if med effective/still not - suffering AE that are problematic and what extent
Therapeutic effects: absence of acute respiratory distress, decreased symptoms, relief of respiratory distress, increased O2 sat
Adverse effects: see meds
After administration:
32
Divided into short- and long-acting classifications
Short-acting beta agonist (SABA) “rescue inhaler” - rescue drug
Inhalers targeting beta2 receptors of adrenergic sys - SNS - giving meds trying target receptors to achieve bronchodilation
2 subclasses of beta2-adrenergic agonists: short and long-acting (sig difference)
Long-acting beta2 agonist (LABA) “maintenance inhaler”
Sympathomimetics: beta2-adrenergic agonists
33
Albuterol (ProAir)
2 subclasses of beta2-adrenergic agonists: short and long-acting (sig difference)
34
Short-acting
Indications: Acute tx of bronchospasm
PRN; sometimes scheduled if have pneumonia
Only one can use for rescue
Onset quick
Shorter duration - not for maintenance; scheduling is shorter
Albuterol (ProAir)
35
Salmeterol
Long-acting beta2 agonist (LABA) “maintenance inhaler”
36
Indications: prevention of bronchospasm
Everyday bid to help maintain bronchodilation and prevent asthma attacks and try to keep airways open and prevent exacerbations of COPD
Salmeterol
37
Sympathomimetic
MOA:
Indications:
Route:
Contraindications:
Drug-drug:
Adverse Effects:
Nursing:
Beta2-adrenergic agonists (SABA) prototype: albuterol
38
Beta2 selective adrenergic agonist - acts to selectively target beta2 receptors to achieve bronchodilation in someone having resp prob
MOA: (Beta2-adrenergic agonists (SABA) prototype: albuterol)
39
Acute bronchospasm (asthma attack, COPD exacerbation, pneumonia); prevention of exercise-induced asthma
Indications: (Beta2-adrenergic agonists (SABA) prototype: albuterol)
40
inhaler, nebulizer (not do mechanics of inhaler); onset: 5-15 minutes - quick acting which is what need for rescue inhaler and need open airways quickly - cannot wait hours for it to happen
Route: (Beta2-adrenergic agonists (SABA) prototype: albuterol)
41
Conditions exacerbated by sympathomimetic effects
Contraindications: (Beta2-adrenergic agonists (SABA) prototype: albuterol)
42
beta-adrenergic antagonists - opp of each other and producing opp effects
Drug-drug: (Beta2-adrenergic agonists (SABA) prototype: albuterol)
43
comes from Sympathomimetic stimulation - trying to target specific receptors not perfect; some systemic action to meds: cardiac arrhythmias, hypertension, sweating, tremors from its activation (pretty common), HR up - tachycardia; in some cases can have opp effect want to: worsened bronchospasm - prob worse trying to fix
Adverse Effects: (Beta2-adrenergic agonists (SABA) prototype: albuterol)
44
admin for symptoms or scheduled; overuse increases likelihood of AE (systemic effects); use 30-60 min prior to exercise; give as prescribed
Nursing: (Beta2-adrenergic agonists (SABA) prototype: albuterol)
45
Not rescue; scheduled; maintenance of inhaler; duration of action longer and onset slower
MOA:
Indications:
Route:
Contraindications:
Black box warning:
Drug-drug:
AE:
Nursing:
Beta2-adrenergic agonists (LABA) prototype: salmeterol (servent diskus) - long-acting
46
Beta2 selective adrenergic agonist; bronchodilation
MOA: (Beta2-adrenergic agonists (LABA) prototype: salmeterol (servent diskus) - long-acting)
47
prevent exercise induced bronchospasm, COPD, asthma (maintenance)
Indications: (Beta2-adrenergic agonists (LABA) prototype: salmeterol (servent diskus) - long-acting)
48
Inhaler
Route: (Beta2-adrenergic agonists (LABA) prototype: salmeterol (servent diskus) - long-acting)
49
Conditions exacerbated by sympathomimetic effects
Contraindications: (Beta2-adrenergic agonists (LABA) prototype: salmeterol (servent diskus) - long-acting)
50
increased risk of asthma-related deaths; use inhaled corticosteroid to decrease risk
Black box warning: (Beta2-adrenergic agonists (LABA) prototype: salmeterol (servent diskus) - long-acting)
51
beta-adrenergic antagonists
Drug-drug: (Beta2-adrenergic agonists (LABA) prototype: salmeterol (servent diskus) - long-acting)
52
comes from Sympathomimetic stimulation - trying to target specific receptors not perfect; some systemic action to meds: cardiac arrhythmias, hypertension, sweating, tremors from its activation (pretty common), HR up - tachycardia; in some cases can have opp effect want to: worsened bronchospasm - prob worse trying to fix
AE: (Beta2-adrenergic agonists (LABA) prototype: salmeterol (servent diskus) - long-acting)
53
NOT a rescue inhaler; admin on schedule
Nursing: (Beta2-adrenergic agonists (LABA) prototype: salmeterol (servent diskus) - long-acting)
54
Achieve bronchodilation through diff pathway: blocking parasym NS from bronchoconstriction - bronchioles relaxed - blocking Ach to achieve airway dilation; also used as maintenance - prevention ashtma attacks/COPD
MoA:
Indication:
Route:
Adverse Effects:
Nursing:
Resp anticholingeric: prototype: ipratropium (atrovent)
55
blocks acetylcholine; airway dilation
MoA: (Resp anticholingeric: prototype: ipratropium (atrovent))
56
Indication:
Prevention of bronchospasm (maintenance) (Resp anticholingeric: prototype: ipratropium (atrovent))
57
Route:
inhaler (Resp anticholingeric: prototype: ipratropium (atrovent))
58
dry mouth, nasal congestion, heart palpitations; other systemic anticholinergic effects rare - able to more selectively target with some drugs because more limit systemic effects better off are; more local effects
Adverse Effects: (Resp anticholingeric: prototype: ipratropium (atrovent))
59
NOT a rescue inhaler
Nursing: (Resp anticholingeric: prototype: ipratropium (atrovent))
60
Actions:
Indications:
Route:
Adverse Effects:
Nursing:
Inhaled corticosteroid: prototype: fluticasone (flovent)
61
Decrease inflammatory response in airways; decrease/targets inflammation; prevent acute bronchospasm from occurring
Actions: (Inhaled corticosteroid: prototype: fluticasone (flovent)
62
Prevention and treatment of asthma (as a maintenance); sometimes COPD if chronic bronchitis - lot of inflammation
Indications: (Inhaled corticosteroid: prototype: fluticasone (flovent)
63
Inhaler
Route: (Inhaled corticosteroid: prototype: fluticasone (flovent)
64
Sore throat, hoarseness, coughing, dry mouth, pharyngeal and laryngeal fungal infections - imp for med - try to suppress inflammatory and immune response - (anti-IR drug) does locally is disrupts ability of body keep fungal infections at bay in mouth if med sits in mouth and throat overtime - local immunosupressive response - imp rinse mouth out after use to limit amount sitting in mouth and throat to reduce risk of opportunistic infections; systemic rare; limit to local effects
Adverse Effects: (Inhaled corticosteroid: prototype: fluticasone (flovent)
65
assess mucous membranes-fungal infection; Educate pt.:rinse mouth after inhalation; NOT a rescue inhaler - dosed on schedule for pat to control asthma, COPD, etc and take every single day
Nursing: (Inhaled corticosteroid: prototype: fluticasone (flovent)
66
Combination inhalers
Consider both adverse effect profiles for both drugs and how they act
Examples
Combo resp drugs
67
Greater control over symptoms by approaching disorder from two different pathways
Put two drugs in one inhaler; see how many drugs in inhaler when looking at med list; nice if two in one and attack prob by diff pathways at same time and eases pat
Combination inhalers
68
Ipratropium & albuterol (Combivent, DuoNeb): anticholinergic/SABA
Fluticasone/salmeterol (Advair Diskus): steroid/LABA - monitor for fungal infections, cough, tremors, sweating, arythmias
Fluticasone/vilanterol (Breo Ellipta): steroid/LABA
Examples
69
Correct administration procedure and return demonstration
Clean delivery devices weekly
Rinse mouth after inhaler use (esp. with inhaled corticosteroid) - edu
Timing of administration - scheduled, rescue, before exercise, etc
Inhaler edu
70
Remove cap and ensure free of foreign objects
Shake for 10 sec and remove cap
Place inhaler onto spacer
Hold between index and thumb
Stand up, take deep breath, breath out as much as an
Put end spacer in mouth above tongue and close lips around spacer
Press down to release spray and breathe in through bouth deeply and slowly for 5 sec
Hold breath for 5-10 sec keeping mouth closed or as long can
Breath out slowly
1 min before 2nd puff
Rinse mouth with water and spit
Correct administration procedure and return demonstration
71
Wash hands thoroughly; remove metal canister - do not get it wet; remove cap; hold one end of inhaler under warm water and let run through it for 30 sec and then flip and let warm water run through it for another 30 sec; remove hardened med with toothpick; shake excess water off inhaler cover; place clean inhaler and cap on paper towel and air dry
Spacer: wash hands thoroughly; pull off flexible back of spacer; twist off front of spacer; soak all parts in slightly soapy water for 15 min; risk parts with clean water; shake excess water; let air dry on clean dry paper towel; keep spacer standing up; can use dishwasher on top rack - not use fabric towel because parts get into spacer
Clean delivery devices weekly
72
Prior to exercise; acute attack; daily etc. - when take it
Timing of administration - scheduled, rescue, before exercise, etc
73
Multiple independently certain sequence want take them
Bronchodilating meds first help some action of inhaled corticosteroids if lungs more dilated - enhance action of corticosteroids - why sequence is imp
Bronchodilators
Corticosteroids
Admin: sequencing of multiple inhalers
74
Beta agonist agents
Anticholinergic agents
Bronchodilators
75
First
Wait 1 minute between puffs for multiple inhalations of same medications
Wait 2-5 minutes before administering next medication when giving multiples
Beta agonist agents
76
After beta agonist
Scheduled administration only (not a rescue inhaler)
Anticholinergic agents
77
Last
Help with action of inhaled corticosteroid if lungs more dilated because enhance corticosteroids
Administer after bronchodilators
Wait 1 minute between puffs for multiple inhalations of the same medication
Rinse mouth following use (do not swallow the water) to prevent oropharyngeal fungal infection
Corticosteroids
78
Actions:
Indications:
Gen well tolerated
Route:
Adverse Effects:
Nursing implications:
Leukotriene receptor antagonist: prototype: montelukast (singulair)
79
Selectively block receptors for production of leukotrienes (inflammatory mediator - part inflammatory process - block production so end up with less inflammation); reduces inflammation
Actions: (Leukotriene receptor antagonist: prototype: montelukast (singulair)
80
Prophylaxis for asthma in adults & children - targets more specifically way inflammation provoked in body with asthma relative to other LR disorders
Indications: (Leukotriene receptor antagonist: prototype: montelukast (singulair)
81
oral
Route: (Leukotriene receptor antagonist: prototype: montelukast (singulair)
82
headache, nausea, diarrhea; not many
Adverse Effects: (Leukotriene receptor antagonist: prototype: montelukast (singulair)
83
NOT a rescue medication; approved for use in children 1+; maintenance for asthma
Nursing implications: (Leukotriene receptor antagonist: prototype: montelukast (singulair)
84
MoA:
Indications:
Route:
Contraindications:
Adverse Effects:
Nursing Implications:
Xanthine derivatives: prototype: theophylline/aminophylline
85
Direct effect on smooth muscles of the respiratory tract, both in bronchi & blood vessels (once in body metabolized to caffeine); relaxing smooth muscle of resp tract to achieve bronchodilation
MoA: (Xanthine derivatives: prototype: theophylline/aminophylline)
86
prevention (theophylline) or reversal of bronchospasm (aminophylline)
Indications: (Xanthine derivatives: prototype: theophylline/aminophylline)
87
oral (theophylline) or IV (aminophylline)
Route: (Xanthine derivatives: prototype: theophylline/aminophylline)
88
cardiovascular disease
Contraindications: (Xanthine derivatives: prototype: theophylline/aminophylline)
89
all AE Related to amount drug in blood levels: GI upset, nausea, irritability, and tachycardia to seizure, brain damage, and even death; lead to toxic effects quickly and process is unpredictable in pats - not very safe and more dangerous because not know how affect all pats; monitor blood levels of drug
Adverse Effects: (Xanthine derivatives: prototype: theophylline/aminophylline)
90
narrow therapeutic window/index - low margin of safety so monitor closely and monitor levels closely; smoking increases metabolism of the drug (lowers levels) - increase metabolism drug levels go down and med not as effective
Nursing Implications: (Xanthine derivatives: prototype: theophylline/aminophylline)
91
Auscultation, how breathing, accessory muscles to breathe - resp assessments
Cardiac
Lung sounds, RR, heart sounds, HR, oxygen saturation, work of breathing, skin color (cyanosis)
A medical-surgical nurse is caring for a client with a history of asthma. The client turns on the call light and states to the nurse "I'm feeling short of breath, and I need my inhaler!"
Prescribed inhalers: salmeterol, albuterol, fluticasone
What assessments should the nurse perform?
92
Monitor them for further decline
Asthma attack, respiratory compromise, potential for respiratory distress and declining oxygen saturation
What is the problem?
93
Albuterol
What medication should the nurse administer?
94
Increase oxygen saturation to > 92%, decrease RR to normal limits, decrease work of breathing
The nurses asks the unlicensed assistant personnel (UAP) to obtain a set of vitals while obtaining the medication.
VS: HR 102; RR 26; BP 128/70; O2 sat 87%
What is the expected outcome / short term goal for this client?
95
Second dose of albuterol; apply O2 - typ have standing order in-pat to keep >92% and if do not, call provider to get order
Administer albuterol, apply oxygen, place client in upright position, keep calm and not exacerbate what going on
What interventions should the nurse perform?
96
eval piece
Evaluate the client: assess vital signs; heart and lung assessment; client statements
Reassess pat - looking at VS making sure went way wanted to go; monitor HR so not go up too much after admin of albuterol - might have impact on HR and not - why get VS and listen to heart and lung sounds if note any probs or abnormalities; elevated - already distressed
How will the nurse know the desired outcome has been achieved?
97
Remember to
document interventions and evaluation did! - Doc gave med, on O2 - make sure doc reassessment and what found
