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Flashcards in Respiratory Medications Deck (30):
1

Goals of Resp Meds

-Minimize symptoms of airway disease
-Increase capacity to exercise
-improve overall health
-reduce number and severity of exacerbations
-reduce lung remodeling
-minimize SE of meds
-treat co-existing medical problems

2

Methods of delivery

Metered-dose inhaler (MDI)
Dry powder inhaler (DPI)
Nebulizer
Orally
Intravenously
Subcutaneously

3

Corticosteroids

(anti-inflammatory) (IV, PO, inhaled)
-one of the most effective asthma therapy drugs
-ICS performed route for asthma
-Reduces bronchial hyper-responsiveness
-blocks late phase reaction
-inhibits migration of inflammatory cells
-1-2 weeks for complete therapeutic effect

4

Corticosteroid IV meds

-Hydrocortisone (solu-cortef) -iv
-Methylprednisolone (solu-medrol) -Iv

5

Corticosteroid Systemic Meds

short term basis for mod asthma
daily low dose for severe asthma

6

Corticosteroid Inhaled meds

-long term prophylactic use
-little systemic absorption
-given on a fixed schedule
-highest dosage levels -> bruising and accelerated bone loss

7

Side effects of Inhaled corticosteroids

ORAL THRUSH, hoarseness, irritated thorat, dry mouth, cough, few systemic effects
-teach: gargle or rinse mouth after use. spacer may be helpful to both decrease SEs and increase amount of med reaching the lungs.

8

Names of Inhaled corticosteroids

-Fluticasone (flovent)- MDI w/ spacer, DPI (diskus)
-Budesonide (pulmicort)- DPI
-Mometasone (Asmanex) - DPI
-Beclomethasone (beclovent, vanceril) MDI w/ spacer)

9

Corticosteroids: IV & PO

-Given po for prompt control
-take on fixed schedule in morning (w/ meals)
-Women take calcium and vit d supplement -participate in weight bearing exercises (due to accelerated bone loss)

10

Oral Corticosteroids: Prednisone
Long & short term SEs

long term: immunosuppression, skin changes, osteoporosis, increased blood glucose (not for diabetics), wt gain, cushing's (moon face)

short term: insomnia, increased appetite

11

Oral corticosteroid teaching

DON'T STOP ABRUPTLY. taper doses until prescription completed.
prednisone mimics the action of cortisol. Causes adrenal cortex to decrease or stop production or cortisol.
results in adrenal insufficiency or crisis which is life threatening.
S/S: HA, confusion, restlessness, vomiting, shock, death.

12

Leukotriene Modifiers

Leukotrienes are: inflammatory mediators, potent bronchoconstrictors, produce airway inflammation and edema.
-interferes with synthesis of or blocks the action of leukotrienes--->anti-inflammatory, bronchodialator
-not for acute episode-prophylactic and maintenance therapy.
-administered orally.

13

Leukotriene Modifier Names

-Zafirlukast (Accolate)-po
---SE: HA, dizzy, n/v/d, fatigue, abd pain
-Montelukast (Singulair)-po
----SE: well tolerated
Leukotriene synthesis inhibitor
---Zileuton (Zyflo) -po
---increases LFTs, dyspepsia, HA

14

Immunodialators: Anti-IgE

-Not first line Tx
-For moderate to severe asthma not controlled with inhaled steroids.
-Improves asthma control
-small risk anaphylaxis
-decreases circulating IgE levels.-prevents IgE from attaching to mast cells. -prevents release of inflammatory mediators from mast cells
-Not for acute attacks

15

Immunodilators: name

Omalizumab (xolair)
Sub-Q injection. Dose based on IgE and body weight
-SEs: injection site rxn (bruising, redness, warmth, pain. risk of anaphylaxis. C
Cost $18,000 per year, most insurance companies cover.

16

Bronchodilators

-Short acting Beta 2 Adrenergic Agonists (SABA)
-Long Acting Beta 2 Adrenergic Agonists (LABA)
-Anti-Cholinergics

17

SABA

-Decreases bronchospasms
-produces bronchodilation (stimulate beta-2 adrenergic receptors in bronchioles and prevents release of inflammatory mediators from mast cells)
-overuse results in rebound bronchospasms
-used as rescue, not long tern control

18

SABA Side effects

-tremors, anxiety, tachycardia, palpitations, nausea

19

Common SABA drugs

-Albuterol (Proventil, ventolin)--MDI, Neb
-Levalbuterol (Xopenex)--MDI, Neb
-Pirbuterol (Maxair)--MDI
-inhaled form directly to site-minimal SEs, caution in patients with cardiac disorders. Rarely given in oral form due to CV side effects.
-teach: always carry rescue inhaler, goal is to never to use. freq use= poor asthma control.

20

LABA

Long term control -used to prevent acute attacks
-dilates bronchioles to increase airflow
-not for acute symptoms
-not monotherapy for asthma
-often combined with other meds

21

What to teach about LABAs

-use daily even when feeling well, only use q 12hrs, do not work quickly, not for acute symptoms

22

Common LABA drugs

-Salmeterol (Serevent)- DPI --not exceed 2 puffs q 12hrs. not to be used acutely. SE: HA dry throat, tremor, dizziness, pharyngitis
-Formoterol (Foradil)- DPI, Neb
SE: angina, tachycardia, nervousness, HA, tremor, dizziness

23

Anti-Cholinergic Drugs

-blocks bronchoconstricting effects of parasympathetic nervous system. (Inhibits vagal nerve stimulation)
-less effective than beta-2 adrenergic agonists
-used for quick relief when can not tolerate SABA (slower initial onset than SABAs)
-Used in combination with other bronchodilators
-systemic SEs uncommon due to poorly absorbed
-most common SE is dry mouth

24

Anti-Cholinergic -short acting

-Ipratropium (Atrovent) -Neb, MDI
--alternate with beta agonist (SABA) may be helpful or can be mixed (Duonebs).
--Temp blurry vision if eye contact
--caution with narrow angle glaucoma or enlarged prostate
--SEs: dry oral mucosa, cough, skin flushing, bad taste

25

Anti-Cholinergic -long acting

-Tiotropium (Spiriva: DPI
-Cannot take with Ipratropium -use SABAs for quick relief of symptoms
-Indication: once daily maintenance tx for COPD
-blurred vision with eye contact
SE: dry mouth, upper respiratory infection

26

Bronchodilators: Methylxanthines

-Not first line controller medication
-bronchodilator with mild inflammatory effects
-sustained release for maintenance
-exact mechanism of action unknown
-high interaction with other medications
-Lots of SEs

27

Methylxanthine Drugs

-Theophylline (Theo-Dur)--PO
-Aminophylline--IV
-require blood levels to prevent toxicity- narrow therapeutic range
-SEs: tachycardia, BP changes, dysrhythmias, anorexia, n/v, nervousness
Teach: take daily even if feeling well, smoking decreasing effectiveness

28

Combination medications

Benefits: convenient, improve compliance
Negatives: double the side effects

29

Combination Agents

-Ipratropium/Albuterol
AKA: combivent, DuoNeb - MDI, Neb
take as prescribed, do not overuse. SEs: CP, pharyngitis, diarrhea, nausea
-Fluticasone/Salmeterol
AKA: Advair- DPI (diskus), MDI (HFA)-- SEs: HA, pharyngitis, oral candidiasis
-Budesonide/Formoterol-
AKA: Symbicort-- MDI SEs: Dysrhythmias, HTN, paradoxic bronchospasm

30

Mucolytics

-enzyme breaks bonds in mucous
-decrease viscosity and enhances mobilization of secretions
Meds:
Acetylcysteine (Mucomyst) -nebulizer
Guaifenesin (Humibid_ - oral tablets
-easier to expectorate mucous and clear airway.