Airflow Disorder Drugs Flashcards
1
Q
bronchodilator drugs
A
- b2 adrenergic agonists
- methylxanthines
- anticholinergics
2
Q
anti-inflammatory drugs
A
- corticosteroids
- leukotriene antagonists
- mast cell stabilizers
3
Q
b2 adrenergic agonists moa
A
stimulates beta 2 receptors in the bronchial smooth muscle, resulting in bronchodilation
4
Q
b2 adrenergic agonists indications
A
- control asthma
- treat bronchospasm
- prevent exercise-induced asthma
5
Q
b2 adrenergic agonists caution/contraindications
A
-contraindicated in tachydysrhythmia
6
Q
b2 adrenergic agonists adverse effects
A
- tremors
- cardiac stimulation
- cns stimulation (increase bp & hr)
- oral agents: tachycardia & angina
- SABA: rebound bronchospasm with overuse
7
Q
SABA drugs
A
- rescue drugs, most effective for relief of acute bronchospasm
- can also relax other smooth muscles
- albuterol & levalbuterol
8
Q
albuterol route
A
- inh mdi or aerosol (s.aa)
- po (long acting)
9
Q
LABA
A
- long term maintenance/prevention of bronchospasm (not for acute sx)
- prescribed with INH corticosteroid
- given AM & PM 12 hours apart
- salmeterol & formoterol
10
Q
salmeterol
A
- can be given alone or combined with a fluticasone as Advair
- bbw: can worsen severe asthma attacks
11
Q
formoterol
A
given in combo with corticosteroid budesonide as Symbicort
12
Q
b2 adrenergic agonists interactions
A
- MAOIs increase risk for hypertensive crisis
- use with b-adrenergic blockers negate effects of both medication
- thyroid hormone, caffeine, some cold products will enhance CNS stimulation
13
Q
b2 adrenergic agonists implications
A
- use b2 agonists before corticosteroids
- follow manufacturer instructions and dose schedule
- don’t exceed prescribed dose
- observe indications of impending asthma episode
- notify hcp of increase in frequency & intensity of asthma exacerbation
- monitor breath sounds before and after admin to note effectiveness
14
Q
anticholinergics moa
A
block muscarinic receptors of the bronchi, resulting in bronchodilation
15
Q
anticholinergics indications
A
- relieve bronchospasm associated with COPD
- treat allergen and exercised induced bronchospasm
16
Q
anticholinergics adverse effects
A
- dry mouth/throat
- hoarseness
- constipation
- coughing
- nasal congestion
- palpitations
- blurred vision
- urinary retention
- decreased mucus
- anxiety
17
Q
anticholinergics drugs
A
- ipratropium
- tiotropium
18
Q
ipratropium
A
- often given in combo with albuterol as combvient (MDI) or duoneb (nebulizer)
- dose: bid, tid, qid
- route: inhalation
- can be a rescue drug or a maintenance drug
19
Q
tiotropium
A
- similar to ipratropium but longer duration
- once daily as a DPI
20
Q
anticholinergic interactions
A
increase anticholinergic effects if used with other antimuscarininc agents (atropine, benztropine)
21
Q
anticholinergic implications
A
- wait length of time between pumps
- rince mouth after inh to rid unpleasant taste
- wait 2 minutes between inh drugs
- never swallow tiotropium caps, use inh device
22
Q
methylxanthines moa
A
relaxation of bronchial smooth muscle resulting in bronchodilation with mild-inflammatory effects
23
Q
methylxanthines indications
A
2nd line treatment for bronchitis and COPD
24
Q
methylxanthines caution
A
heart disease, htn, liver & renal dysfunction (decrease CO slows clearance of xanthine, can become cardiotoxic)
25
methylxanthines adverse effects
- mild: n/v, anorexia, restlessness
| - severe: ventricular dysrhythmias, seizures (can be first sign of toxicity)
26
methylxanthines drugs
- theophylline
| - aminophylline
27
theophylline
oral dose based on weight
28
aminiophylline
- po or iv, based on weight
| - iv use for emergency only (status asthmaticus or severe COPD exacerbations)
29
aminophylline iv dose instructions
- give loading dose first (usually given piggyback over 30 minutes
- order is given mg/hr based on weight
- don't admin too fast, can cause severe or even fatal acute circulatory shock
30
methylxanthines therapeutic levels
- 5-15 mcg/mL, obtain trough regularly and must be timed with dose for accuracy
- serious effects usually appear with levels > or = 20
31
methylxanthines drug interactions
- increase level: cimetidine, fluroquinolone abx, macrolide abx
- decrease level: antiepileptic drugs (phenytoin, phenobarbital)
- caffeince increase CNS and cardiac ae
- smoking
32
methylxanthine implications
- monitor xanthine blood level
- report s/s of toxicity
- no otc meds containing sympathomimetic agents
- limit other xanthine- coffee, tea, chocolate, soda
- notify if new prescribe drugs
- never double dose
33
corticosteroids moa
- promotes responsiveness of b2 receptors in the bronchial tree
- inhibits synthesis of leukotrienes, reducing broncho-constriction and mucus production (decrease hyper-responsiveness to inflammation)
34
corticosteroids indication
- iv: status asthmaticus, severe COPD exacerbation
- PO: treat sx after acute asthma attack (short-term), mgmt of chronic asthma
- inh: longterm prophylaxis asthma, COPD
35
corticosteroids adverse effects
- inh: hoarseness, cough w/out infection, dry mouth, unpleasant taste, candidiasis
- high dose/long term: adrenal suppression, cns stimulation, increased risk of infection, bone loss, osteoporosis, cushing syndrome
36
corticosteroid drugs
- IV: hydrocortisone, methylprednisone
- PO: prednisone, methylprednisone
- INH: beclomethasone, fluticasone, budesonide
37
corticosteroids teaching
- bronchodilator 5 min before ICS
- examine mouth daily. rinse mouth after every treatment to prevent candiasis and get ride of aftertaste
- fastidious cleaning of MDI, nebulizer
- using spacer
- take on schedule
- given qd or bid by inh, iv, & po
- may take 4 weeks to see improvement
38
leukotriene modifiers moa
- suppress effects of leukotrienes, thus decreasing inflammation, bronchoconstriction, airway edema, and mucus production
- interferes with formation of substances that cause mucous plugs and constricts airways
39
leukotriene modifiers indications
- treats chronic asthma
- manages seasonal allergic rhinitis
- prevents EIA
- COPD
40
leukotriene modifiers caution/contraindications
- caution with liver dysfunction
| - bbw: neuropsychiatric events in adult and children
41
leukotriene modifiers adverse effect
- fatigue
- h/a
- weakness
- cough
- n/v
42
leukotriene modifiers drugs
- po
- montelukast
- zafirlukast
- zileuton
43
leukotriene modifiers teaching
- with asthma, take qd (bedtime), or bid, even if no sx
- for eia, take 2 hours before exercise, but not within 24 hours of another dose of that drug
- watch for changes in behavior
44
mast cell stabilizers moa
- inhibits release of histamine, leukotriene, etc. from mast cells (prevents mucus and swelling)
- suppress inflammatory cells
- no bronchodilators effect, no effect on mediators already released
45
mast cell stabilizers indications
- chronic asthma (maintenance drug)
| - takes several weeks to reach therapeutic effects
46
mast cell stabilizers contraindications
- cad
| - dysrhythmias
47
mast cell stabilizers administration
- inh only
| - rinse mouth and gargle to relieve taste and dryness of mouth/throat
48
mast cell stabilizers drugs
- cromolyn
| - nedocromil
49
monoclonal antibody moa
binds to IgE immunoglobin and limits release of chemical mediators of allergic response
50
monoclonal antibody indications
- treat severe persistent asthma
| - for overactive immune responses
51
monoclonal antibody caution
- BBW: risk of anaphylaxis (must be given in HCP office)
| - risk for infection
52
monoclonal antibody adminstration
-subq every 2-4 weeks
53
monoclonal antibody drug
omalizumab
