PHARM WEEK 2 RESPIRATORY AGENTS Flashcards
(267 cards)
1
Q
In order to go to Bioavailability, meds need to go first pass____.
A
metabolism and absorption
2
Q
Med dose goes through the stomach and intestines for what process?
A
metabolism and absorption
3
Q
after absorption of meds, the remaining meds goes to what organ to metabolize?
A
liver
4
Q
what is half life?
A
Time it takes for ½ drug concentration to be eliminated
5
Q
what two process affect half life?
A
metabolism and elimination
6
Q
what can prolongs half life? hint: this involves two organs
A
liver and kidney dysfunction
7
Q
how many half lives are needed to completely saturates the biologic system?
A
3 to 5
8
Q
what is steady state?
A
biologic system is saturated so that the
intake of the drug equals the amount metabolized
9
Q
steady state is attained after about how many half-times?
A
about 4
10
Q
the time to steady state is dependent or independent of dosage?
A
independent
11
Q
Each “hop” on the same concentration value on the steady state concentration picture is a what?
A
a steady state concentration, specifically from ingestion of med to metabolism of med. note that the concentration values are stable so intake and output is the same, which is what steady state is all about.
12
Q
When the therapeutic index is low, the margin of safety is…
A
narrow
13
Q
when the margin of safety is wide, the therapeutic index is…
A
high
14
Q
what is the “peak” of pharmacodynamics?
A
Time of highest plasma drug concentration & shows rate of absorption
15
Q
when the blood work is drawn at prescribed time, the drug …
A
peaks!
16
Q
Lowest plasma drug concentration & shows rate of excretion is known as
A
trough
17
Q
when is the trough of pharmacodynamics reflected in the blood work
A
When the blood work is drawn just before next dose of drug
18
Q
should the trough be documented?
A
Of course dawg!
19
Q
how do you classify or categorize medications?
A
by using the CHEMICAL NATURE OF THE DRUG (ex: benzodiazepines), SYMPTOMS OR DISEASE (ex: antipsychotic), AFFECTED ORGAN SYSTEM (ex: respiratory meds), and GENERATION (ex 1st generation (typical) and 2nd generation (atypical) antipsychotics)
20
Q
what is the ligand-binding domain?
A
it is the site on the receptor in which drugs bind
21
Q
where are the receptors ?
A
they are found on the cell membranes
22
Q
explain receptor theory
A
the ligand (hormones, drugs, neurotransmitters) binds to the receptor on the ligand binding domain. It then triggers the cell to act accordingly.
23
Q
Does the neurotransmitter give pharmacological response?
A
yes.
24
Q
does the agonist give pharmacological response?
A
yes.
25
does antagonist give pharmacological response?
NO!
26
The CNS includes which two organs
brain and Spinal cord
27
what two nervous systems are under peripheral nervous system?
Autonomic nervous system and somatic nervous system
28
what two nervous systems are under autonomic nervous system?
sympathetic and parasympathetic
29
what is the neurotransmitter for the sympathetics NS?
Norepinephrine
30
what are the stimulants of sympathetics NS?
adrenergics, adrenomimetics, or adrenergic agonists
31
what are the depressants of the sympathetics NS?
Sympatholytics, Adrenergic Blockers, Adrenolytics or Adrenerigc Antagonists
32
What is the neurotransmitter for the parasympathetics NS?
Acethylcholine
33
What are the stimulants of the parasympathetics NS?
Cholinergics, Cholinergic Agonists
34
what are the depressants of the parasympathetics NS?
Parasympatholytics Anticholinergics, Cholinergic Antagonists, or Antispasmodics
35
what is the sympathetic response of the eyes?
dilate pupils
36
what is the sympathetic response of the lungs?
dilates bronchioles
37
what is the sympathetic response of the heart?
increase heart rate
38
what is the sympathetic response of the blood vessels?
constricts blood vessels
39
what is the sympathetic response of the gastrointestinal?
relaxes smooth muscles of the GI tract
40
what is the sympathetic response of the bladder
relaxes bladder muscle
41
what is the sympathetic response of the uterus?
relaxes uterine muscle
42
what is the parasympathetic response of the eyes?
constricts pupils
43
what is the parasympathetic response of the lungs?
constricts bronchioles and increases secretions
44
what is the parasympathetic response of the heart
decreases heart rate
45
what is the parasympathetic response of the blood vessels
dilates blood vessels
46
what is the parasympathetic response of the gastrointestinal?
increase peristalsis
47
what is the parasympathetic response of the bladder
constricts bladder
48
what is the parasympathetic response of the salivary gland?
increase salivation
49
alpha 1 receptor's response on blood vessels
vasoconstriction, increased bp, increased contractibility of the heart
50
alpha 1 receptor's response on the eyes
mydriasis (puil dilation)
51
alpha 1 receptor's response on bladder
relaxation
52
alpha 1 receptor's response on prostate
contraction
53
alpha 2 receptor's response on blood vessels
decreased bp (reduced norepinephrine)
54
alpha 2 receptor's response on smooth muscle (GI tract)
decreased gastrointestinal tone and motility
55
Beta 1 receptor's response on heart
increased heart contraction and increase heart rate
56
beta 1 receptor's response on kidney
increased renin secretion, increased angiotensin and increased bp
57
beta 2 receptor's response on the smooth muscle (GI tract)
decreased GI tone and motility
58
beta 2 receptor's response on on the lungs
bronchodilation
59
beta 2 receptor's response on the uterus
relaxation of uterine smooth muscle
60
beta 2 receptor's response on on the liver
activation of glucogneolysis and increased blood sugar
61
respiratory agents are for... hint: top and bottom
the upper respiratory infection and the acute and chronic lower respiratory disorders
62
what is included in the upper respiratory tract (4)?
nares, nasal cavity, pharynx, larynx
63
what is included in the lower respiratory tract (5)?
trachea, bronchi, bronchioles, alveoli and alveolar-capillary membrane
64
the movement of air from the atmosphere through the upper and lower airways to the alveoli is known as what process?
ventilation
65
the process whereby gas exchange occurs at the alveolar-capillary membrane is known as what process?
respiration
66
what are the 3 phases of respiration in order?
ventilation, perfusion, diffusion
67
what is happening during the ventilation process?
oxygen passes through the airways
68
what is inspiration?
when air moved into lungs
69
what is expiration
air transported out of lungs
70
what is perfusion?
when blood flow at the alveolar-capillary bed
71
what is influenced by the alveolar pressure?
perfusion
72
for gas exchange, what must happen?
perfusion must be matched by adequate ventilation
73
how will mucosal edema, secretions and bronchospasm affect respiration? ( related to resistance and ventilation)
increased resistance to airflow, and decreased ventilation and diffusion of gases
74
what happen during diffusion(3)?
gas move from high to low concentration, O2 passes into capillary bed into circulation, and CO2 leaves capillary bed to alveoli for ventilatory excretion
75
what is lung compliance
ability of the lungs to stretch
76
what are the 2 factors that can influence lung compliance?
connective tissue and surface tension
77
COPD has increased or decreased lung compliance?
increased!
78
restrictive disease has increased or decreased lung compliance?
decreased
79
What does decreased lung compliance mean?
it takes greater than normal pressure to expand lung tissue
80
respiration is influenced by what 3 concentration in the blood?
O2, CO2 and H+
81
how is chemoreceptors stimulated?
by changes in gases and ions
82
where are the central chemoreceptors? they are controlled by what two ions/molecules?
near the respiratory center, controlled by CO2 and H+
83
where are the peripheral chemoreceptors? what are they controlled by?
in the carotid and aortic bodies, controlled by O2 concentration.
84
the muscles in the tracheobronchial tube are composed of what types of muscle?
smooth muscle
85
bronchodilation is stimulated by what two chemical molecules/hormones?
1. epinephrine from the sympathetic NS, 2. cyclic AMP (cyclic adenosine monophosphate)
86
bronchoconstriction is stimulated by what chemical?
acetylcholine from the parasympathetic NS.
87
what are the 4 types of Upper respiratory infections?
common cold, acute rhinitis, sinusitis, acute pharyngitis
88
what is the etiology of common cold? what precaution to use? Where does it affect?
rhinovirus, droplet precautions, and it affects the nasopharyngeal tract
89
what is acute rhinitis?
the inflammation of nasal mucous membranes
90
what is sinusitis
inflammation of mucous membranes of sinuses
91
what is acute pharyngitis?
inflammation of throat
92
what is the contagious period of common cold?
1 to 4 days before onset of symptoms and during the first 3 days of cold
93
how is common cold transmitted?
by touching contaminated surfaces, and then touching nose or mouth or via viral droplets from sneezing
94
what are the symptoms of common cold?
nasal congestion, nasal discharge, cough, and increased mucosal secretions
95
drugs for upper respiratory infections are (2) ...
generally not curative, but aim to lessen or control the symptoms of URI
96
what are some meds for the common cold, acute rhinitis and allergic rhinitis (5)?
```
antihistamines
decongestants (nasal or systemic)
intranasal glucocorticoids
expectorants
antitussives
```
97
what is one type of antihistamines?
H1 blockers (H1 blockers or H1 antagonists)
98
side effects of H1 blockers
drowsiness, dizziness, fatigue, and impaired coordination
99
an example of first generation antihistamines?
diphenhydramine (Benadryl)
100
what are the 2 categories (types) of antihistamines?
first generation antihistamines, and second generation antihistamines (ex: non sedating antihistamine)
101
what are the 4 examples of non sedating antihistamines?
cetirizine (Zyrtec)
Fexofenadine (Allegra)
Loratadine (Claritin)
Azelastine (Astelin)
102
what are the actions of benadryl (diphenhydramine) (2)?
it competes with histamine fore receptor sites preventing a histamine response and it reduces nasopharyngeal secretion, itching, and sneezing
103
what is benadryl used for?
to treat acute and allergic rhinitis, antitussive and as a pre-med prior to blood transfusion in some cases
104
what are the contraindication/ cautions for benadryl?
severe liver disease, narrow-angle glaucoma, and urinary retention.
105
benadryl (diphenhydramine) can be administer via (3)...
oral, IM, IV
106
what are the interactions of benadryl (diphenhydramine)?
it increases CNS depression with alcohol and other CNS depressants and avoid use of MAOIs.
107
what are the side effects of diphenhydramine (benadryl)?
drowsiness, dry mouth, dizziness, blurred vision, wheezing, photosensitivity, urinary retention, constipation, GI distress, blood dycrasias .
108
benadryl
diphenhydramine
109
additional side effects of benadryl (diphenhydramine) for elderly.
elderly are at greater risk for side effects. the usual ones and decreased bp and confusion. so give lower dosage and consider the second generation meds
110
non-sedating antihistamines has...
fewer anticholinergic symptoms
111
nasal congestion are due to what 2 reasons?
1. dilation of nasal blood vessels due to infection, inflammation and allergy
2. transudation of fluid into tissue spaces, leading to swelling nasal cavity
112
nasal decongestants; systemic decongestants stimulate what?
alpha- adrenergic receptors
113
stimulation of alpha- adrenergic receptors causes what effects (4)?
1. produces nasal vascular vasoconstriction
2. shrinks nasal mucous membranes
3. reduces nasal secretion
4. rebound nasal congestion
114
systemic decongestants are used primarily for what?
for allergic rhinitis, including hay fever and acute coryza (inflammation of the membranes of the nasal cavity)
115
what are 3 examples of systemic decongestants?
1. ephedrine (ephedrine)
2. phenyephrine (neo-synephrine)
3. pseudoephedrine (sudafed)
116
what are 6 examples of nasal decongestants?
1. Ephedrine HCl (Primatene)
2. Naphazoline HCl (Privine)
3. Oxymetazoline (Afrin)
4. Phenylephrine HCl (Neo-Synephrine Nasal)
6. Pseudoephedrine (Sudafed)
7. Tetrahydrozoline (Tyzine)
117
what are the different types of nasal decongestants administration methods (5)?
1. nasal spray
2. nasal drops
3. tablet
4. capsule
5. liquid
118
what are the side effects of nasal decongestants?
nervousness, restlessness, "jitters", alpha-adrenergic effect (hypertension, hyperglycemia)
119
frequent use of nasal decongestants may lead to (2)
tolerance and rebound nasal congestion (so it should not be used more than 5 days)
120
Intranasal Glucocorticoid is effective for what?
allergic rhinitis
121
Intranasal Glucocorticoid has what type of effect?
anti-inflammatory
122
Intranasal Glucocorticoid may be used alone or with ____?
H1 antihistamine
123
Dexamethasone should not be used longer than __ days to avoid ___ ____
30 days, systemic effects
124
continuous use of Intranasal Glucocorticoids may cause ...
nasal mucosa dryness
125
an example of Intranasal Glucocorticoids is
fluticasone (Flonase)
126
what are 2 things about Intranasal Glucocorticoids?
1. systemic steroid effects are rare
| 2. rapid deactivation after absorption
127
what is an example of expectorants?
guaifenesin (robitussin)
128
what is the action of guaifenesin?
lossens bronchial secretions by reducing surface tension of secretions
129
what is guaifenesin used for?
dry, nonproductive cough
130
what are the side effects of guaifenesin?
drowsiness, nausea
131
Antitussives act on what?
the cough-control center in the medulla to suppress the cough reflex
132
what are the Three types of antitussives?
nonnarcotic
narcotic
combination preparations
133
what is an example of non-narcotic antitussive?
dextromethorphan (benylin)
134
what is an example of narcotic antitussive?
hydrocodone (hycodan)
135
The evidence for effectiveness for antitussive medications in adults are ___.
Scant; barely sufficient or adequate
136
Serious adverse events for cough and cold medicines are seen in children under the age of __.
6
137
US Food and Drug Administration (FDA) recommendation on _(date)_, to avoid use of cough and cold meds to treat infants and children ___ years of age, “because serious and potentially life-threatening side effects can occur.”
January 17, 2008
| less than 2
138
COPD: Airway obstruction with ____ to airflow to lung tissues
↑ airway resistance
139
COPD is generally...
progressive – extra-pulmonary effects
140
COPD may be accompanied by _____
airway hyper-reactivity
141
COPD is
Not a disease in itself
142
COPD is the ___ leading cause of death worldwide (___ in US)
Fourth, 3rd in US
143
More than one half of COPD patients die within __ years of diagnosis
10
144
Primary cause of COPD in the U.S. is
Exposure to tobacco smoke
145
Two types of COPD:
emphysema and Bronchitis
146
Emphysema is
Abnormal permanent enlargement of the air space distal to the terminal bronchioles
147
Emphysema is
Accompanied by destruction of bronchioles without obvious fibrosis
148
Emphysema lacks
alpha1-antitrypsin protein
149
Bronchitis is
the presence of chronic productive cough for 3 or more months in each of 2 successive years in a patient whom other causes of chronic cough have been excluded
150
Bronchitis has
Peribronchial Fibrosis
151
emphysema is the hyperinflation of ___, destruction of ___ ___, and destruction of ___ ___ ___
alveoli, alveolar walls, alveolar capillary walls
152
Emphysema is characterized by (3)
1. narrowed airways
2. loss of lung elasticity
3. repeated cycles of inflammation and repair, increases collagen and scarring of small airways
153
Bronchitis is characterized by
Chronic inflammation –The primary pathology causes vasodilation, congestion, mucosal edema (mucus production)
154
Bronchitis is characterized by (3)
1. greater airflow resistance
2. Hypoxemia and hypercapnia
3. Tendency to hypoventilate and retain CO2
155
retention of CO2 via bronchitis causes
respiratory acidosis
156
Emphysema is aka
Pink Puffers
157
emphysema is characterized by (8)
```
Increasing dyspnea
Little or no cough
Marked chest overexpansion
No cyanosis
No peripheral edema
Quiet breath sounds
Arterial PO2 only slightly depressed
Arterial PCO2 normal
```
158
Chronic Bronchitis is aka
Blue Bloater
159
Chronic Bronchitis is characterized by (8)
```
Increasing dyspnea
Frequent cough with sputum
Moderate or no increase in chest expansion
Cyanosis
Rales, rhonchi
Peripheral edema
PO2 often low
PCO2 often raised
```
160
What is cor pulmonale/pulmonary hypertension
Right side of the heart must increase to push blood into the lungs
161
What can develop due to for pulmonale/pulmonary hypertension?
Right-sided heart failure
162
Since the right side of the heart has to push harder to pump blood into the lungs, what can this lead to (before and after the heart)?
Subsequent intravascular volume expansion and later systemic venous congestion.
163
Cor pulmonale is
right-sided heart failure
164
Cor pulmonale is an enlargement of ...
enlargement of the right ventricle due to high bp in the lungs usually caused by chronic lung disease.
165
signs and symptoms of Cor Pulmonale (7)
Ventricular diastolic gallop (S3)
Distended neck veins (JVD)
Hepatomegaly with upper quadrant tenderness
Ascites, epigastric distress
Peripheral edema, weight gain
Acute exacerbations of chronic bronchitis
Acute respiratory failure
166
The pathophysiologic changes of restrictive lung disease is
Decrease in total lung capacity from
fluid accumulation
and loss of elasticity of the lung tissues
167
The etiologies of restrictive lung disease include (5)
```
Pulmonary fibrosis
Pneumonitis
Lung tumors
Thoracic deformities (scoliosis)
Myasthenia gravis
```
168
Asthma is ...
Inflammatory disorder of the airway walls associated with a varying amount of airway obstruction
169
Asthma is triggered by (3)
stress, allergens, pollutants
170
what are the manifestations of asthma?
bronchospasm, wheezing, mucus secretions and dyspnea
171
Bronchiectasis is...
abnormal dilation of the bronchi and bronchioles
172
Bronchiectasis is caused by
frequent infection and inflammation
173
During Bronchiectasis, bronchioles become obstructed by what?
by the breakdown of the epithelium of the bronchial mucosa
174
what can result due to bronchiectasis?
tissue fibrosis
175
What is an agonist?
it is a drug which has affinity for the cellular receptors of another drug or natural substance and which produces a physiological effect.
176
effects of alpha 1 adrenergic agonists
vasoconstriction and increased contractility of heart
177
effects of alpha 2 adrenergic agonists
decreased bp, reduced norepinephrine
178
effects of beta 1 adrenergic agonists
increased heart rate
179
effects of beta 2 adrenergic agonists
bronchodilation
180
What is the action of Selective Beta2 Receptor Agonists?
It works specifically with beta 2 receptors in the bronchi causing bronchodilation
181
what is the systemic effects of selective beta 2 receptor agonists?
increased BP/HR, decreased GI/renal blood flow
182
What is an example of selective beta 2 receptor agonists?
Albuterol (Proventil, Ventolin)
| Metaproterenol (Alupent)
183
what are some things about albuterol (proventil, Ventolin)?
Rapid onset of action
Longer duration of action
Few side effects
184
What are Metaproterenol (Alupent) administered?
Administered oral, inhalation, metered-dose inhaler nebulizer
185
albuterol is aka
proventil, ventolin
186
metaproterenol is aka
alupent
187
what is the action of Sympathomimetics?
It mimics the effects sympathetic nervous system causing bronchial dilation and increased rate and depth of respiration
188
what is an example of sympathomimetics
Epinephrine (Adrenalin)
189
what are the actions of epinephrine (adrenalin)(3)?
1. Increases cAMP in lung tissue. Cyclic adenosine monophosphate (cAMP) is a second messenger transferring the effects of hormones like glucagon and adrenaline into the cell, promoting bronchodilation bronchodilation
2. Restores circulation and increases airway patency
3. First line of defense in acute asthma attack or anaphylaxis, given sub Q
190
What are some side effects of sympathomimetics?
Palpitations, dizziness (caution in cardiac patients)
| Nervousness, tremors, tachycardia, dysrhythmia, hypertension
191
What is the action of Nonselective Beta-adrenergic Agonists
It relaxes smooth muscle of bronchi
192
What is an example of nonselective Beta-adrenergic agonists?
Isoproterenol (Isuprel)
193
What is one severe side effect due to nonselective Beta-adrenergic agonists?
Severe side effects from beta1 response; it is seldom prescribed due to cardiac side effects (tachycardia)
194
How is nonselective Beta-adrenergic agonists administered?
IV or inhalation
195
What are some side effects of nonselective Beta-adrenergic agonists?
nervousness, tremors, restlessness, flushing, headache, tachycardia, palpitations, hypertension
196
What is the action of Anticholinergics?
Blocks or antagonizes acetylcholine at the vagal-mediated receptor sites relaxes smooth muscle of bronchi (blocks parasympathetic response)
197
What is an example of Anticholinergics?
Tiotropium (Spiriva)
198
What is Tiotropium (Spiriva) used for?
It is used for maintenance treatment of bronchospasms associated with COPD (once daily)
199
How is Tiotropium (Spiriva) administered?
by inhalation only with the HandiHaler device (dry-powder capsule inhaler)
200
What are some adverse effects of Tiotropium (Spiriva)?
dry mouth, constipation, vomiting, dyspepsia, abdominal pain, depression, insomnia, headache, joint pain, peripheral edema, and chest pain
201
What is another example of anticholinergics?
Ipratropium bromide (Atrovent)
202
What is Ipratropium bromide (Atrovent) used for?
As a maintenance treatment for COPD/bronchospasm
203
Combination of ipratropium bromide with albuterol sulfate (Combivent) can be used to treat what?
used to treat chronic bronchitis
204
What is the action of Combivent?
To dilates bronchioles
205
How is combivent administered?
aerosol inhaler
206
What are some cautions for combivent (2)?
Narrow-angle glaucoma, urinary retention
207
Patients who use a beta-agonist inhalant should administer it _ minutes before using ____.
5, ipratropium
208
When using the ____ agent in conjunction with an inhaled glucocorticoid (steroid) or cromolyn, the ___ ___ should be used 5 minutes before the steroid or cromolyn.
anticholinergic, ipratropium bromide
209
What is the action of Methylxanthine (xanthine) Derivatives?
It relaxes smooth muscle of bronchi, bronchioles increasing cAMP (cyclic adenosine monophosphate). cAMP is a second messenger transferring the effects of hormones like glucagon and adrenaline into the cell, promoting bronchodilation
210
What are some examples of Methylxanthine (xanthine) Derivatives (3)?
1. Aminophylline—theophylline 2. ethylenediamine (Elixophyllin, Theo-24)
3. dyphylline (Lufyllin)
211
What is Methylxanthine (xanthine) Derivatives
| 1. Aminophylline—theophylline 2. ethylenediamine (Elixophyllin, Theo-24
3. dyphylline (Lufyllin)) used for?
As a maintenance therapy for chronic stable asthma
212
What is the therapeutic range of Methylxanthine (xanthine) Derivatives?
10 to 20 mcg/mL (toxicity greater than 20)
213
What are some contraindications for Aminophylline?
seizure, cardiac, renal, or liver disorders
214
How is Aminophylline administered?
oral, IV
215
What are some side effects of Aminophylline?
dysrhythmias, nervousness, irritability, insomnia, flushing, dizziness, hypotension, seizures, GI distress, intestinal bleeding, hyperglycemia, tachycardia, palpitations, cardiorespiratory collapse
216
What is the action of Leukotriene Receptor Antagonists?
It selectively and competitively blocks or antagonizes receptors for the production of leukotrienes D4 and E4 (components of slow-reacting substance of anaphylaxis [SRSA]).
Reduce inflammatory process and decrease bronchoconstriction
217
What are some examples of Leukotriene Receptor Antagonists (3)?
1. Zafirlukast (Accolate)
2. montelukast (Singulair)
3. zileuton (Zyflo CR)
218
What are Leukotriene Receptor Antagonists
| 1. Zafirlukast (Accolate
2. montelukast (Singulair)
3. zileuton (Zyflo CR)) used for?
prophylactic and maintenance for chronic asthma, not for acute attacks
219
What are the side effects of Leukotriene Receptor Antagonists?
dizziness, HA, GI distress, abnormal liver enzymes, nasal congestion, cough, pharyngitis
220
What is the action of glucocorticoids (steroids)?
It decreases swelling and promote (anti-inflammatory effect) beta-adrenergic receptor activity promoting smooth muscle relaxation
221
What are some examples of glucocorticoids (steroids) (2)?
1. Beclomethasone (Beclonase)
| 2. dexamethasone (Decadron)
222
Which glucocorticoid medications can be administered orally as a tablet?
1. triamcinolone (Aristospan)
2. dexamethasone (Decadron)
3. prednisone
4. prednisolone
5. methylprednisolone
223
Which glucocorticoid medications can be administered Intravenously (2)?
1. dexamethasone (Decadron)
| 2. hydrocortisone
224
Which glucocorticoid medication can be administered via a MDI inhaler (1)?
beclomethasone (Beconase)
225
What are two information regarding inhaled glucocorticoids?
1. Not helpful in treating a severe asthma attack
| 2. May take 1 to 4 weeks for an inhaled steroid to reach its full effect
226
Which type of asthma attack is good to use intravenous glucocorticoids?
acute asthma exacerbations
227
Tablet glucocorticoids are best for treating...
asthma that requires prolonged glucocorticoid therapy
228
What is an example of Mast Cell Stabilizer?
Cromolyn (NasalCrom)
229
What is the action of Cromolyn (NasalCrom)?
It inhibits the release of histamine from mast cells and inhibits the release of SRSA (slow-reacting substance of anaphylaxis). NO BRONCHODILITATION
230
What are some examples of Cromolyn (2)?
1. Intal (cromolyn)
| 2. tilade (nedocromil)
231
What are some information of Cromolyn (3)?
1. It is used for prophylactic treatment of bronchial asthma
2. Must be taken daily
3. Not to be used for acute asthmatic attack
232
How is Cromolyn administered?
inhalation
233
what are some side effects of cromolyn?
cough, bad taste, rebound bronchospasm
234
What is Nedocromil used for (2)?
1. Prophylactic treatment of bronchial asthma
| 2. Not to be used for acute asthmatic attack
235
How is Nedocromil administered?
inhalation
236
what is a side effect of Nedocromil?
bad taste
237
What is one fact about Nedocromil?
Nedocromil is believed to be more effective than cromolyn.
238
Drug Therapy for Asthma is prescribed according to ___
age
239
For Young Children with asthma... (2)
1. Cromolyn and nedocromil are drugs used to treat the inflammatory effects of asthma.
2. Oral glucocorticoids may be prescribed for the young child to control a moderate to severe asthmatic state.
240
For Older Adults with asthma... (1)
requires careful consideration due to adverse effects
241
What is the action of Mucolytics?
Splits apart disulfide bonds that are responsible for holding mucus together. Liquefies and loosens thick mucus secretions.
242
What is the two examples of Mucolytics
1. Acetylcysteine (Mucomyst)
| 2. Dornase alfa (Pulmozyme)
243
How is Acetylcysteine (Mucomyst) administered?
Administer 5 minutes after a bronchodilator.
| Should not be mixed with other drugs.
244
Acetylcysteine (Mucomyst) is an antidote for what?
an antidote for acetaminophen overdose if within 12 to 24 hours
--Give orally diluted in juice or soft drink
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What is Dornase alfa (Pulmozyme)?
It is an enzyme that digests deoxyribonucleic acid (DNA) in thick sputum secretions of patients with cystic fibrosis (CF)
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What is the Client Education for the Use of Metered Dose Inhaler (7 step procedure)?
1. Insert canister into holder
2. Shake well before using & remove cap
- --if new inhaler do test spray
3. Breathe out thru mouth, open mouth wide, & hold 1-2” from mouth
- --If spacer used, put in mouth
4. Simultaneously open mouth, take slow deep breath & push top of canister once.
5. Hold breath few seconds & exhale slowly
6. Wait 2 minutes if 2nd dose ordered & repeat.
7. Wait 5 min if giving steroid inhaler
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The nursing process for Bronchodilators is ... (hint: ADPIE)
1. Assessment
2. Nursing diagnoses
3. Planning
4. Nursing interventions
-----Patient teaching
-----Cultural considerations
5. Evaluation
– assess peak flow readings, breath sounds, O2 sat, color, ability to perform ADLS
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What is two nursing diagnoses for bronchodilators?
1. Ineffective airway clearance related to retained secretions in bronchi
2. Activity intolerance related to fatigue and imbalance between oxygen demand and supply
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What are four plannings (goals) appropriate for Bronchodilators?
1. Client will be free of wheezing & lung fields clear
2. O2 saturation will return to baseline
3. Rate of respirations will be between 12 to 20
4. Patient states “I am breathing better”
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Is COPD an individual disease?
No! It can be a combo of different conditions; bronchitis with emphysema/ asthma
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Fibrosis is...
it is the hardening of tissues thus affecting expansion of the lungs
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During emphysema, the alveoli are
the alveoli are distended with air, can't breathe out because structures around the bronchioles are not there anymore, they collapsed, can't open bronchioles so air is trapped.
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During Chronic Bronchitis, the pt does not require high O2 concentration, because...
you can take away the hypoxia drive if the pt is high on O2. Pt is alway high on CO2 so main stimulus for them to breath is the hypoxia drive.
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Blue Bloater's rhonchi breath sound is due to?
due to sputum trapped inside the airway
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Blue Bloater's rales breath sound is due to?
due to CHF, RHF, and fluid in alveoli
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Blue Bloater's peripheral edema is due to?
due to RHF
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Blue Bloater is blue (cyanosis) because?
The O2 can't go into the cells and tissues.
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Asthma can exacerbate COPD and vice versa?
True
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agonists are ...
producing an effect!
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Beta 2 adrenergic agonist's effect of vasodilation is vasodilation of what tissue?
skeletal muscle! not blood vessel!
261
When cAMP is increased...
there are more 2nd messengers transferring the effects of hormones (glucagon and adrenaline) into the cell nucleus, promoting bronchodilation.
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Tiotropium (Spiriva) is used for...
it is for maintenance of COPD, not for acute management of exacerbation.
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When pt is using Combivent, the nurse should...
monitor urine output, because urinary retention can increase prostate enlargement r
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When pt is using Combivent, the nurse should monitor pt's pupil because....
Combivent can cause dilation of pupils, so it can block the opening where the fluid drains. If fluid builds up, it can exacerbate glaucoma.
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Overuse of glucocorticoids can lead to...
Cushing's syndrome
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Acetylcysteine (Mucomyst) can be used to prevent what?
can be used to prevent kidney damage due to contrast media's side effects, prevent nephron toxic.
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When planning goals for pts with COPD, O2 saturation should be...
aimed for 90 to 95%, don't aim for 100% because he has COPD!!
