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Pharmacology > respiratory, fluid/electrolyte, anemia > Flashcards

respiratory, fluid/electrolyte, anemia Flashcards

1
Q

two most common types of respiratory disorders

A

COPD (Chronic Obstructive Pulmonary disease)

and Asthma

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2
Q

general terms used to describe the type of COPD

A

Emphysema and chronic bronchitis

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3
Q

what is COPD

A

respiratory disorder that is progressive, partially reversible airway obstruction and increases frequency and severity of exacerbations

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4
Q

describe emphysema

A

tiny air sacs (alveoli) become enlarged and the wall are damaged so they lose their elasticity and air become trapped in the lungs making them less efficient

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5
Q

describe chronic bronchitis

A

A persistent chronic cough and sputum production, usually for at least three months each year for at least two consecutive years. The cause is unknown

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6
Q

COPD can be caused by

A

cigarette smoking
workplace exposure (mining, asbestos)
repeated respiratory infections
chronic airflow limitation that progresses slowly over a period of years and is IRREVERSIBLE

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7
Q

list the characteristics of asthma

A

paroxysmal (sudden attack)
dyspnea, chest tightness, wheeze and cough
variable airflow limitation
airway hyper-responsiveness to a variety of stimuli

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8
Q

describe physiological changes with respect to asthma

A

inflammation - irritation and swelling produces a sticky mucuc or phlegm in the air ducts

broncho-constriction - tightens the mucsles and constricts the airway

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9
Q

Causes of development of asthma

A

Pollen, dust mites, mold, pet dander.
chroninc condition that can develop at any age
most common in children, about 10%
varies in degree from very mild to severe.

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10
Q

asthma and COPD compared

A

ASTHMA - non-smokers, before age 40, intermittent attacks, night-time symptoms common, asymptomatic between attacks, exercise may affect symptoms
COPD - smokers, after age 40, persistent and progressive difficulty, night-time symptoms uncommon, symptoms are always there, symptoms worsen with exercise.

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11
Q

COPD pharmacotherapy ( slowly increase interventions)

A
  1. at risk = avoid risk factos
  2. Mild = FEV >80% - plus short-acting bronchdilator
  3. moderate = FEV 50-79% - regular treatment plus long acting bronchodilators: Add rehabilitation
  4. Severe = FEV 30-49% - Add inhaled corticosteriods if repeated exacerbation
  5. Very Severe = FEV <30% add long term oxygen and consider surgical treatment
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12
Q

asthma pharmacotherapy (hit early, hit hard!)

A 
step 1 = beta 2 agonist PRN (bronchdilators)
step 2 = add inhaled corticosteriods (200-500 units
step 3 = add long acting beta agonist or SR theophylline OR inhaled corticosteroids 500-1000 units. 
step 4 = inhaled 500-1000 and LA beta agonists AND/OR SR theophylline. PLUS refer to pulmonologist.
step 5 (severe) = inhaled 1000 units/day, oral corticosteroids, long acting beta agonist, SR theophylline, pulmonologist. plus orginal bronchodilator from step 1 − 4-6 times/day
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13
Q

Beta2 Agonists

A 
Fast/Short acting:
Salbutamol
Fenoterol
Formoterol
Terbutaline

Slow/Long acting:
Salmeterol

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14
Q

Beta agonist mechanism of action

A

bind to the beta receptors in the body
Lungs - bronchdilate (good)
Heart - tachycardia (bad adverse effect)

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15
Q

COPD and asthma symptoms

A

shortness of breath, wheezing, coughing

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16
Q

Beta2 agonists adverse effects

A

tachycardia

tremors

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17
Q

beta2 agonists administration and nursing implications

A

inhalation via inhaler or nebulization (oral/parental not used often - too many A/E)
nursing: use appropriate technique, monitor effectiveness. remember: Salmeterol = long acting AND you need Salbutamol for fast relief

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18
Q

Anticholinergics - relievers/bronchodilators

A

Ipratropium (fast/short acting)

Tiotropium (slow/long acting)

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19
Q

anticholinergics mechanism of action

A

acetylcholine causes bronchconstriction, so the anti-cholinergic agents cause bronchdilation as it blocks the muscarinic (M3) receptors thus producing decreased mucus
NOTE: may be more effective for COPD than asthma

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20
Q

anticholinergics adverse effects

A

dry mouth

urinary retention

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21
Q

anticholinergics administration and nursing implications

A

inhalation via inhaler or nebulization

nursing: use appropriate technique

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22
Q

corticosteroids (aka. glucocorticosteroids or steroids)
last choice for COPD
drug of choice for asthma

A 
Oral: prednisone
Parenteral: methylprednisone and hydrocortisone
Inhaled: Fluticasone and Budesonide
Combined inhaled: 
-Fluticasone + Salmeterol
-Budesonide + Formoterol
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23
Q

cortocosteroids adverse affects

A

inhaled: oral thrush (rinse and spit or may get yeast infection), potential for growth abnormalities, voice hoarseness
Systemic: ulcers, fluid retention (hypertension), osteoporosis

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24
Q

Theophylline mechanism of action and A/E’s

A

stimulates bronchdilation by: inhibiting phosphodiesterase and adenosine, and improves diaphragmatic fatigue

A/E: (Caffeine) - tachycardia, headache, nausea, loss of appetite, tremors, restlessness and seizures.

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25
Q

Theophylline disong and nursing implications

A

oral or parental (aminophylline)

monitor for A/E’s and blood levels require monitoring

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26
Q

Leukotriene antagonists

A

Monteleukast

Zafirleukast

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27
Q

Leukotriene antagonists mechanism of action and A/E

A

inhibits Leukotriene production
Leukotriene is a substance correlated with the pathophysiology of asthma. Mucus secretion, airway edema, bronchoconstriction.

A/E: upper respiratory infections, sedation, and headaches

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28
Q

Cromolyn and Nedocromil use, M/A’s and A/E’s

A

Mast-cell stabilizers that prevent the release of histamines from sensitized mast cells. histamine instigate inflammation, therefore the inflammation does not occur that blocks the airways. used primarily for asthma
A/E - hoarseness, dry throat

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29
Q

types of inhalers

A

aerochambers - spacers
diskhaler - circular disc that punctures medication
turbuhaler - cylinder, twist to medicate and then inhale
nebulizer - compressor, mouthpiece and nebulizer cup

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30
Q

COPD and asthma diagnosing and monitoring

A

Spirometry - measures the amount and rate of air a person breathes

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31
Q

what is hay fever

A

its a type 1, IgE mediated allergy

immune system reaction to airborne allergens

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32
Q

symptoms of hay fever

A

repetitive sneezing, runny, itchy and/or congested nose
decreased sense of smell and taste
eyes become itchy, red, watery, or swollen with crusty eyelids
inflamed sinuses
headaches, irritability, and fatigue

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33
Q

first generation antihistamines

A 
diphenhydromine
chlorpheniramine
hydroxyzine
brompheniramine
clemastine
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34
Q

second generation antihistamines

A

Cetirizine
Loratidine
Desloratidine
Fexofenidine

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35
Q

first generation versus second generation

A

drowsiness and dry mouth
multiply daily doses
less expensive

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36
Q

intranasal corticosteroids for hayfever

A

Fluticasone and Beclomethasone

37
Q

why are intranasal corticosteroids used

A

helps prevent inflammation of nasal passage

may be more effective than oral antihistamines

38
Q

decongestants - nasal and oral

A

nasal: Xylometazoline (Otrivin)
oral: Pseudoephedrine (Sudafed)

39
Q

what is rebound congestion

A

abnormal swelling and enlargement of the nasal mucosa, which blocks the nasal airway completely and causes extreme discomfort.
- this cycle repeats as the releif from dose wears off and then the swollen mucosa blocks the airway again and another dose is required

40
Q

Dextromethorphan

A

DM cough syrup

41
Q

symptoms of cough and cold

A 
cough: dry (hacky) or wet (loose)
nasal congestion
watery eyes
sneezing
headaches
inability to sleep
42
Q

I cause insomnia (non-drowsy), hypertension, and clear nasalcongestion and fluids in ear

A

Decongestants

43
Q

I cause sneezing and watery eyes

Can be drowsy or nondrowsy

A

Antihistamines

44
Q

What are intracellular electrolytes

A

Liquid within the cell membrane
2/3 of body fluids
intracellular electrolytes: K+, Mg2+, Ca2+

45
Q

What are extracellular electrolytes

A

Liquids outside the cell membranes
1/3 of body fluids
Extracellular electrolytes: Na+, Cl-

46
Q

what do electrolytes do

A

Conduct energy
Regulate fluid balance and transport nutrients
Support proper muscle function and mental function
Help convert calories into energy
Regulate pH
and much, much, much more

47
Q

Gain and loss of electrolytes and water. regulation by…

A

dehydration, diarrhea, vomiting, sweating, fluid retention

regulated by: Kidneys (primary), skin, and respiratory system

48
Q

types of IV fluids that replace electrolytes

A 
Crystalloids - fluids that maintain a balance between the extravascular and intravascular compartments
Most commonly used:
-normal saline 0.9%
-hypertonic saline 3%
-D5W (Dextrose 5% in water)
-Lactated Ringers Solution
49
Q

what are Colloids

A 
IV fluids that move fluid from the interstitial space to the plasma space by pulling the fluid into the blood vessels
Colloids are:
-Dextran
-Hetastarch
-Albumin
50
Q

what is dehydration, some common causes, and signs and symptoms

A

A condition caused by the loss of too much water from the body
Common causes: diuretic therapy, vomiting, diarrhea, hemorrhage, decreased fluid intake, excess urination
signs/symptoms: hypotension, weak and rapid pulse, decreased skin turgor, dry mucus membrane, low urine output

51
Q

Management and prevention of dehydration

A 
Replace fluids
 Replace electrolytes
 Treat underlying causes if possible
 Patient education
 Prevent recurrences
52
Q

normal electrolyte blood concentrations for Sodium

A

135 − 145 mmol/L

53
Q

normal electrolyte blood concentrations for Chloride

A

100 − 106 mmol/L

54
Q

normal electrolyte blood concentrations for Potassium

A

3.5 − 5.0 mmol/L

55
Q

normal electrolyte blood concentrations for Magnesium

A

0.7 − 1.5 mmol/L

56
Q

normal electrolyte blood concentrations for Phosphate

A

0.8 − 1.5 mmol/L

57
Q

normal electrolyte blood concentrations for Calcium

A

2.2 − 2.6 mmol/L

58
Q

causes of elevated sodium

A

Hypernatremia

Excessive loss of water through G.I. system, lungs, or skin.

59
Q

Causes of decline in sodium

A

Hyponatremia
Congestive heart failure, cirrhosis, nephrosis, excess fluid intake. Loss of body fluids without replacement, diuretic therapy and laxatives

60
Q

Causes of elevated potassium

A

Hyperkalemia

Aldosterone deficiency, sodium depletion. hemolysis of RBC’s

61
Q

causes of decline in potassium

A

Hypokalemia
Lack of dietary intake of potassium
Vomiting, nasogastric suctioning, kidney disease, major G.I. surgery.

62
Q

Causes of elevated Calcium

A

hypercalcemia

excessive vitamin D, immobility, poptassium sparring diuretics, ACE inhibitors

63
Q

causes od declined calcium

A

hypocalcemia

inactive or excessively low vitamin D, diuretic therapy, gastric surgery

64
Q

signs and symptoms of hyponatremia

A

anorexia, nausea, lethargy, disorientation, agitation, depressed reflexes, seizures, coma (sodium <120)

Cerebral edema - osmotic gradient causes water to flow into the brain

Mortality rates from 5-50% depending on how rapidly the sodium levels decrease

65
Q

management of hyponatremia

A
  • replace sodium and water as required
  • replace underlying causes or remove precipitating agent if possible
  • sodium must be replaced at a certain rate or else central pontine myelinolysis. a severe damage to myelin sheath that causes paralysis, dysarthria, dysphagia. some patients may experience locked in syndrome, cognotive function intact, but all muscles are paralyzed with the exception of eye blinking
66
Q

Fluids for hyponatremia

A

Oral: Pedialyte. Gatorade, sodium chloride
IV Fluids: normal saline 0.9%, 3% saline in extreme cases,
1 mL/kg/hr

67
Q

signs and symptoms of hypernatremia

A

lethargy, weakness, irritability, hyperreflexia, seizures, coma and potentially death

68
Q

management of hypernatremia

A

-lower the serum sodium concentration by about 0.5 mmol/L per hour
-rapid correction should be avoided to avoid cerebral edema
remove excess source of salt, use diuretics to increase salt excretion and increase water consumption

69
Q

signs and symptoms of hypokalemia

A

heart arrhythmias, muscle weakness, confusion, thirst, low blood pressure and vomiting

70
Q

management of hypokalemia if no cardiac symptoms (K+ = 2.5 − 3.5 mEq)

A 
potassium supplementation
IF NO CARDIAC SYMPTOMS:
-potassium chloride Micro K capsules or tablet 600mg (8mEq)
-monitor potassium frequently
-food supplementation
71
Q

management of hypokalemia if any cardiac symptoms or if K+ <2.5 mEq

A

IF ANY CARDIAC SYMPTOMS - <2.0 mEq
-potassium chloride (avail in 20 or 40 mEq IV bags)
-MAX IV rate of 40 mEq/hr (any rate faster requires continuous cardiac monitoring
MAX. 40mEq/L in peripheral arm
MAX. 80mEq/L in central line (by neck)

72
Q

Signs and symptoms of hyperkalemia

A

Frequently patients are asymptomatic

Nausea, irregular heartbeat, slow/weak pulse

73
Q

Management of hyperkalemia

A

Reverse the underlying cause
If K+ >6 or any ECG changes:
-insulin and D5W. insulin will push the K+ back into the cell
-Salbutamol “pushes potassium back into the cells”
-diuretics
-sodium polystyrene. Binds to K+ to increase excretion via GI tract.

74
Q

what are common anemias and how are they defined

A

microcytic (iron-deficiency)
macrocytic (megaloblastic)
defined as a hemoglobin vakue that is two standard deviations below the mean average, according to gender, age and sometimes race

75
Q

therapeutic goals for enemia

A

alleviate sign and symptoms
determine and address the underlying issue
restore normal or adequate Hgb levels
avoid transfusions

76
Q

what is ferritin

A

intracellular protein that stores iron and releases it in a controlled fashion. the amount of ferritin stored reflects the amount of iron stored.

77
Q

what are the 3 main classifications of enemia

A
  1. Blood loss
  2. Impaired production (hypoproliferative)
  3. increase destruction (Hemolytic)
78
Q

causes of anemia

A 
medications
diet
GI loss/malabsorption
alcohol use
cancer 
renal disease
menorrhagia
79
Q

symptoms of anemia

A

fatigue, dizziness, yellowing of eyes/skin, dyspnea, muscle weakness, low BP, rapid HR., enlargement of spleen (kills RBC’s)
SEVERE: fainting, chest pain, angina, heart attack

80
Q

What is MCV and the ranges for anemia

A

Mean cell volume
MCV 100 = macrocytic - decreased B12 and folic acid.
MCV 80-100 = normocytic

81
Q

dietary intake for iron deficiency anemia

A

foods rich in iron. fruits, veggies, greens, fish

82
Q

oral supplements for iron deficiency anemia

A

“elemental iron” in a variety of forms ‘salts’
1. Ferrous Gluconate
2. Ferrous Sulfate
3. Ferrous Fumarate
Target dose: 100-200 mg/day in divided doses

83
Q

A/E for iron deficiency

A

constipation and black tarry/sticky stool

84
Q

Parenteral therapy for iron deficiency anemia

A

-Iron Dextran
-Sodium Ferric Gluconate
-Iron Sucrose
parenteral reserved for Pt’s with malabsorption or true intolerance t oral therapy. Anaphylaxis is a risk
Adding parenteral to oral therapy does not lead to more rapid resolution.

85
Q

mechanism of action for macrocytic anemia

A

impaired DNA synthesis from deficiences in cobalamin (vitamin B12) or folic acid.
note: cobalamin deficiency can also lead to degenration of spinal cord (spinabifida)

86
Q

dietary therapy for macrocytic anemia (vitamin B12 deficiency)

A

meat and dairy products are the only dietary sources of cobalamin.

  • Cobalamin stored in body is usually sufficient to last several years
  • strict vegans are at risk unless they take supplements
87
Q

most common causes and treatments of macrocytic vitamin B12 deficient anemia

A

CAUSES: -Pernicious anemia (defect with production of ‘intrinsic factor’)
-gastrectomy
-inflammatory bowel disease
TREATMENTS: oral supplementation or IM (most common 1xmonth) or subcutaneous

88
Q

causes and treatments for marcocytic folic acid deficiency anemia

A

CAUSES: dietary deficiency and alcoholism (alcohol inhibits folate absorption.
TREATMENTS: Folate in food is destroyed by cooking. Generally take 1mg PO daily
NOTE: increase Folic acid in pregnancy to prevent neural tube defects and when certain other medications are taken (methotrexate and phenytoin)

Pharmacology (7 decks)

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