Week 6 - Final Review Flashcards
Who is at risk for toxicity when using methylxanthines and why?
- Older adults are at higher risk as medication is metabolized by the liver
- People with liver dysfunction
- Heart disease (require lower doses)
- Smoking causes increased clearance so if stop smoking levels will rise to toxic levels
INITIAL doses are based on age and weight.
What is the first line of treatment for asthma and COPD?
Manage with an inhaled ______________ as needed.
Glucocorticoid
What are the day/night symptoms associated with intermittent asthma?
Daytime
- Symptoms two days a week or less
Nighttime
- Symptoms two times per month or less
What are the day/night symptoms associated with mild persistent asthma?
Day
- Symptoms more than 2x per week but less than daily
Night
- 3-4 times a month
What are the day/night symptoms associated with moderate persistent asthma?
Day
- Symptoms daily
Night
- More than once per week but less than nightly
What are the day/night symptoms associated with severe persistent asthma?
Day
- Several times per day
Night
- Often nightly
Examples of SABAs
- Albuterol
- levalbuterol
Benefits of using SABAs
- Taken to relieve an ongoing attack.
- Quick acting
- Can be taken prior to exercise to prevent an attack from occurring
Patient education for SABAs
- Proper inhaler technique
- Daily assessment of peak expiratory flow
- Keep a record of symptoms, attacks, intensity, affect on normal activity and SABA useage
- 1 minute between inhalations for metered dose or dry powder
- Do not exceed prescribed doseage
Why is it important to know the frequency a patient is using their SABA?
So you can determine whether the dose is effective or whether you need to adjust their treatment.
Examples of LABAs
- Aclidinium
- Arformoterol
- Formoterol
- Indacaterol
- Oladaterol
- salmeterol
LABA
Long acting beta agonists
SABA
Short acting beta agonist
Benefits of using a LABA
- Provide long term control of symptoms.
- Dosing is on a fixed schedule (not PRN)
(Must be used with a glucocorticoid in asthma)
LABA use in COPD
Can be used without a glucocorticoid because it does not pose the same risk of death in COPD as it does in asthma.
Inhaled corticosteroid examples
- budesonide
- fluticasone
Benefits of using inhaled corticosteroids
- Suppress inflammation
—- reduce bronchial hyperreactivity and mucous production - Especially effective for asthma prophylaxis and management of COPD exacerbations
- Significant long-term control of symptoms
At what point would an oral steroid be prescribed?
When symptoms cannot be controlled with a safer medication (inhaled glucocorticoid or beta2 agonist) due to potential for toxicity.
Generally prescribed for moderate to severe persistent asthma or COPD.
When would roflumilast be indicated for a COPD patient?
- exacerbation prophylaxis
- patients with severe COPD with a primary chronic bronchitis component
- history of frequent exacerbations
Second line drug
How does nicotine replacement work?
Smoker receives a pharmaceutical source of nicotine to replace the nicotine in cigarettes and then gradually withdraw the replacement nicotine.
Patient education for nicotine patches.
Should be applied once a day to clean, dry, nonhairy skin of the upper body or upper arm. The site should be changed daily and not used again for 1 week.
Patient education for nicotine gum
- Chew the gum slowly and intermittently for approximately 30 minutes
- Patients should not eat or drink for 15 minutes before chewing and while chewing
- Gum should only be used for a maximum of 6 months
Patient education for nicotine nasal spray
- Do not use other tobacco products.
- Spray technique
- 1 spray in each nostril
Contraindications for Wellbutrin
Caution in patient with history of:
- anorexia
- alcohol withdrawal
- cocaine use
- psychiatric disease
- seizure
