Respiratory Ch.76-77 Week 2 Ppt Flashcards
(113 cards)
1
Q
What is beta 2 agonist MOA?
A
activate beta 2 receptors Of smooth muscle in the lung to promote bronchodilation, relieving bronchospasm
2
Q
Beta 2 agonist has a limited role in suppressing_____ release in the lung and increasing___
A
Histamine, ciliary motility
3
Q
What is beta 2 agonist indication?
A
Bronchospasm, bronchoconstriction, EIB
4
Q
What is beta 2 agonist CI and DD interaction?
A
Tachycardia and tachydysrrhythmia from digitalis
5
Q
What should be the caution with beta 2 agonist ?
A
Those with DM, Angina pectoris, HBP, hyperthyroidism, heart disease
6
Q
What is short acting beta 2 agonist prototype?
A
Albutetol(proair, proventil, ventolin)
7
Q
What is short acting b2 indication?
A
PRN to abort ongoing asthma attack, prevent EIB before exercise and severe acute attack of asthma and COPD
8
Q
What’s the route for short acting beta 2 agonist?
A
Inhaled(MDI, nebulizer) and PO
9
Q
What are the AE for inhaled B2 agonists
A
tachycardia, angina, Tremor
10
Q
What is long acting beta 2 agonist prototype?
A
Salmetetol (serevent diskus)
11
Q
What is LABA indication?
A
Long term control frequent(chronic) asthma attacks and treatment of stable COPD
12
Q
What is nursing implication for LABA
A
Must be combined with a glucocorticoid and dosing is on a fixed schedule not PRN
13
Q
What is contraindicated for LABA?
A
it’s use alone due to increased risk for asthma attacks and asthma related deaths
14
Q
What is the route for LABA?
A
inhaled and oral
15
Q
What are the adverse effects of LABA for oral and inhaled preparations?
A
Oral: tremor, angina and tachydysrhythmias
Inhaled: severe asthma and asthma related deaths
16
Q
What suffix does anticholinergics end in?
A
Suffix-ium
17
Q
What are the prototypes for anticholinergics?
A
Ipratropium, Tiotropium, Aclidinium, Umeclidinium
18
Q
What is the indication for anticholinergics?
A
Blocks muscarinic receptors in the airways thereby reducing bronchospams/bronchoconstriction
19
Q
What is Indication for anticholinergics?
A
Management of COPD bronchospams
20
Q
What is the route for anticholinergics?
A
Inhaled
21
Q
What are the therapeutic effects for the anticholinergic prototypes?
A
Ipratropium: begins within 30s, reach 50% maximum in 3 minutes and persists for about 6 hrs
Tiotropium: begins within 30 minutes, peak in 3hrs and persists for 24hrs
Aclidinium: peak levels within 10 minutes of delivery
22
Q
Which medication reaches a plateau after 8 consecutive doses and has a longer duration of action causing it to be dosed less?
A
Tiotropium
23
Q
What is anticholinergic adverse effects?
A
Dry mouth, cardiovascular effects( Ipratropium, Tiotropium), glaucoma(Ipratropium Aclidinium), irritation of pharynx(ipratropium), nasopharyngitis, headache and cough(Aclidinium)
24
Q
What is nursing implication for Anticholinergics?
A
Suck on sugar free candy to relieve dry mouth
25
What’s the prototype for methylxanthine?
Theophylline
26
What is MOA for methylxanthine?
Relax smooth muscle of bronchi and probable blockage of adenosine receptors
27
What is indication for methylxanthine? Oral and IV
Oral: maintenance therapy for chronic stable asthma and nocturnal attacks
IV is for emergencies
No longer recommended for COPD
28
What is route for methylxanthine?
Oral and IV
29
What are DD interactions for methylxanthine?
caffeine and intensify Adverse effects
Reduce theophylline: marijuana, tobacco, phenobarbital, phenytoin, rifampin
Increase theophylline: cimetidine, fluoroquinolone antibiotics
30
What is contraindicated for methylxanthines?
Untreated seizure disorders, peptic ulcer disease
31
What are the cautions for methylxanthines?
Heart disease, liver or kidney dysfunction and severe HBP
32
What is the majority’s adverse effect for theophylline
TOXICITY
33
Describe the plasma levels of theophylline
It has a Narrow Therapeutic index of 10-20mcg/ml
Below 20mcg the adverse effects are uncommon
In levels between 20-25 there can be: nausea, vomiting, diarrhea, insomnia and restlessness
In levels above 30mcg there can be severe dysrhythmias, convulsions and death from cardio respiratory collapse
34
What is the toxicity treatment for theophylline?
Stop theophylline
Activated charcoal with a cathartic
Lidocaine for dysrhythmias
IV diazepam may help control seizures
35
What is MOA of glucocorticoids?
Decrease synthesis of inflammatory mediators
Decrease infiltration of inflammatory cells
Decrease bronchial hyper reactivity and airway mucus production
Decrease edema of the airway mucosa due to beta 2 agonists
Increase number of bronchial beta 2 receptors and their responsiveness to beta 2 agonists
36
What is prototypes for inhaled and oral glucocorticoids?
Inhaled: Beclomethasone(beclovent)
Oral: Prednisone
37
What is indication for inhaled glucocorticoids?
First line therapy management of inflammatory component of asthma
Those with persisten asthma should use daily
Very effective and much safer than systemic glucocorticoids
38
What is the contraindication for inhaled glucocorticoids?
Positive sputum for Cándida albicans
39
What are the adverse effects of inhaled glucocorticoids?
Oropharyngeal candidiasis, dysphonia, slow growth in children and adolescents, cataracs, glaucoma, bone loss, adrenal supression
40
What are the nursing implications for inhaled glucocorticoids?
Advise patient to rinse mouth, gargle or use spacer to minimize dysphonia/oropharyngeal candidiasis
Ensure adequate intake of Vitamin D, Calcium and weight bearing exercise to minimize bone loss
Warn patients that switch from oral glucocorticoids to inhaled glucocorticoids to administer glucocorticoids at times of stress to prevent adrenal suppression
41
What is prototype for oral glucocorticoids?
Prednisone
42
What is indication for oral glucocorticoids?
Moderate to severe persistent(chronic) asthma or management of acute exacerbations of asthma or COPD
Most with persistent(chronic) asthma use these drugs daily
43
What should be caution with oral glucocorticoids?
Should only be used when S/s can’t be controlled with safer drugs due to toxicity potential
44
Nursing implication for glucocorticoids?
Treatment should be brief as possible
45
What are adverse effects of oral glucocorticoids?
Adrenal suppression, peptic ulcer disease, osteoporosis, growth suppression, hyperglycemia
46
What is CI for oral glucocorticoids?
Those with systemic fungal infections and those receiving live virus vaccines
47
What are the DD interactions for oral glucocorticoids?
```
NSAIDs
Oral hypoglycemics
Insulin
Digitalis glycosides
Potassium soaring diuretics
```
48
What must the nurse know about prolonged glucocorticoid use?
It can decrease the ability of the adrenal cortex to produce its own endogenous glucocorticoids
49
What can result from prolonged glucocorticoid use?
It can be life threatening during times of severe physiologic stress
50
What needs to happen to avoid adrenal suppression during times of stress?
High levels of glucocorticoids need to be administered
51
What must the nurse know/do when it comes to discontinuing tx in order to prevent adrenal suppression?
Must be done gradually
Recovery of adrenocortical function takes several months
Patients must be given PO or IV glucocorticoids at times of severe stress
52
What is the function of Leukotriene receptors?
Promote smooth muscle construction, blood vessel permeability and inflammatory responses thru direct action and recruitment of eosinophils and other inflammatory cells
53
What are leukotriene adverse effects?
Adverse neuropsychiatric effects
54
What is leukotriene modifiers MOA?
Suppress the effects of leukotrienes and reduce bronchoconstriction and inflammatory responses like edema and mucus secretion
55
What are the prototypes for leukotriene modifiers?
Zafirlukast, Montelukast and zileuton
56
What is the indication of zafirlukast
Maintenance therapy of chronic asthma
57
What is the MOA for zafirlukast
Reduces infiltration of inflammatory cells resulting in reduced bronchoconstriction
58
What is the route for zafirlukast?
Route is PO
59
What is the AE for zafirlukast
Headache, GI disturbances, churg Strauss syndrome, neuropsychiatric effects(depression, suicidal thoughts/behavior) liver injury
60
What’s the drug drug interactions for zafirlukast?
CYP1A2 inhibitor therefore it increases levels of theophylline and warfarin
61
What’s the nursing implications for zafirlukast?
Food reduced its absorption so give 1hr before meal or 2hrs after
Monitor theophylline levels
Liver function tests at first sign of liver injury
62
What is churg Strauss syndrome
Causes weight loss, flu like symptoms, pulmonary vasculitis can be potentially fatal
63
What is indication of montelukast?
Prophylaxis and maintenance therapy of chronic asthma
EIB
Allergic rhinitis relief
64
What is MOA of montelukast?
Blocks leukotriene receptors in the airway and pro inflammatory cells
65
What is the route for montelukast?
PO
66
What is adverse effects of montelukast
Neuropsychiatric effects but generally well tolerated
67
What is DD interaction for montelukast
Phenytoin decreases its level
68
What is the indication for Zileuton?
Asthma prophylaxis and maintenance therapy
69
What is zileuton MOA?
Inhibits 5-lipoxygenase
70
What is the route for zileuton
PO
71
What is zileuton adverse effects
Liver injury as evidenced by increased ALT
neuropsychiatric effects(depression, anxiety, irritability, suicidal thoughts)
72
What are DD interactions for zileuton
Increases theophylline, warfarin and propranolol
73
What is nursing implication for zileuton
Monitor ALT levels
74
What class does cromolyn belong to?
Mast cell stabilizer
75
What is MOA for cromolyn?
Stabilizes the cytoplasmic membranes of mast cells thus preventing the release of histamine and other inflammatory cells
Inhibits various inflammatory cells
Suppresses inflammation but doesn’t cause bronchodilation
76
What is the indication for cromolyn?
Prophylaxis of chronic asthma
EIB
allergic rhinitis
Immediately before allergen exposure
Seasonal allergic attacks
77
What’s the route for cromolyn?
Inhaled(nebulizer)
78
What’s the adverse effects for cromolyn?
Cough and bronchospasm
79
Which drug is the safest of all anti asthma medications?
Cromolyn
80
What’s the prototype for monoclonal antibody?
Omalizumab
81
What’s the MOA for omalizumab?
IgE antagonist
82
What’s the indication for omalizumab
Moderate to severe asthma that’s:
Allergy related
Can’t be controlled with an inhaled glucocorticoid
83
What’s the route for omalizumab?
SQ
84
What’s the Adverse effect for omalizumab?
```
Anaphylaxis
CV events
Headache
Injection site reactions
Malignancy
Pharyngitis
Sinusitis
Uri
Viral infection
```
85
What’s the nursing implications for omalizumab?
Skin test/blood test proving allergen reactivity is required
86
What are the glucocorticoid/LABA combos?
Fluticasone and salmeterol/volanterol
| Mometasone/budesonide and formoterol
87
What must the nurse know about the glucocorticoid/LABA combos?
Not recommended for initial therapy
For long term maintenance in adults and children
88
What are the drugs used for allergic rhinitis?
Glucocorticoids
Antihistamines
Cromolyn
Sympathomimetics(decongestants)
89
What’s the indication for intranasal glucocorticoids?
First choice and most effective for treatment and prevention of seasonal and perennial rhinitis
90
What’s the prototype for intranasal glucocorticoids?
Beclomethasone
91
What’s the A.E for intranasal glucocorticoids?
Mild: drying of nasal mucosa, sore throat, burning/itching, epistaxis, headache
Rarely: systemic effects like adrenal suppression and slow growth of peds
92
What is the indication for roflumilast?
- treatment of severe COPD with a chronic bronchitis component
- not approved for asthma
93
What is roflumilast MOA?
Inhibits PDE, an enzyme that inactivates cAMP
Raising cAMP in lungs reduces inflammation, cough and excessive sputum
94
Roflumilast A.E
Psychiatric effects(most concerning): anxiety, depression, suicidal behavior,insomnia
- nausea
- diarrhea
- weight loss
- reduced appetite
- headache
- back pain
95
What are the intranasal antihistamines prototypes?
Azelastine,olopatadine
96
What are the indications for intranasal antihistamines?
Allergic rhinitis in people over 12
97
What’s the AE for intranasal antihistamines?
Systemic absorption can be sufficient to cause somnolence
Epistaxis
Anticholinergic effects
Unpleasant taste
98
What’s the MOA for intranasal cromolyn?
It’s suppresses release of histamine and other inflammatory mediators from mast cells
99
Indication for intranasal cromolyn sodium
Prophylaxis before signs and symptoms start for allergic rhinitis
100
What’s the therapeutic effect of intranasal cromolyn?
Response develops in 1 to 2 weeks
101
What are the AE of intranasal cromolyn?
Minimal AE less than with any other drug for allergic rhinitis
102
What’s the prototype for sympathomimetics?
Phenylephrine,oxymetazoline
103
What’s the indication for sympathomimetics
Reduces nasal congestion in patients with allergic rhinitis, sinusitis and colds but no rhinorrhea, sneezing or itching
104
What’s the MOA for sympathomimetics?
Activates alpha 1 receptors on nasal blood vessels
105
CI for sympathomimetics
Should Not use longer than 5 days
106
What’s the route for sympathomimetics?
Intranasal: act quicker and more effective than oral
Oral: last longer than intranasal
107
Adverse effects of sympathomimetics
```
Rebound congestion(rare with oral)
CNS stimulation(oral)
CV effects
Stroke
Abuse
Systemic AE occur primarily with oral
```
108
What are the antihistamine sympathomimetic combinations?
Pseudoephedrine with:
- fexofenadine
- loratadine
- desloratadine
109
What are the drugs for cough?
Antitussives
Expectorants
Mucolytics
110
```
Antitussive:
Indication
MOA
Caution
Types/prototypes
```
Indication:For dry cough
MOA:Suppress cough reflex
Caution: do not use longer than 1 week
Types: opioid antitussives (codeine and hydrocodone), non opioid antitussives(dextromethorphan, diphenhydramine, benzonatate)
111
What important things should be known about codeine
Most effective cough suppressant
Route:PO
AE: suppress respiration
Schedule V: low risk for physical dependance
112
What important things should be known about hydrocodone
More potent and greater liability for abuse than codeine
113
What is the caution for opioid antitussives?
History of opioid addiction
| Do not drive or use heavy equipment
