Asthma - EXAM 3 Flashcards
1
Q
albuterol (Proventil)
A
Classification:
- Beta-adrenergic agonist, bronchodilator, abbreviated SABA (short acting beta-adrenergic agonist)
Mechanism of Action:
- Bronchodilates by activating beta 2 receptors in the SNS on bronchial smooth muscle. This causes the smooth muscles to relax and the broncial tree to open.
Side/Adverse Effects:
- Tachycardia
- Palpitations
- Nervousness
- N/V
- Muscle tremors
- Dry mouth
- HA
- Hypokalemia
- Paradoxic bronchospasm
Nursing Implications:
- Considered a rescue medication
- Stop drug immediately if paradoxic bronchospasm occurs
- Limit caffeine products
- Use of a spacer is recommended
Speed of Action:
- Very rapid onset 1-3 minutes
- Effective for 4-8 hours
2
Q
ipratropium (Atrovent)
A
Classification:
- Anticholinergic-bronchodilator
Mechanism of Action:
- Inhibits the effect of acetycholine at receptor sites of bronchial smooth muscle, resulting in bronchodilation
Use:
- A secondary rescue agent
- Additive effect when used with Albuterol
- Promotes bronchodilation during bronchospasm in those with COPD and asthma
- Decreases bronchial secretions
Side/Adverse Effects:
- Overuse may cause bronchospasm
- Palpitations
- N/V
- Dry mouth
- Cough
- Anxiety
- Dizziness
- HA
- Nervousness
Nursing Implications:
- Teach patient/family correct method of inhalation
- Evaluate therapeutic response. If symptoms worsen, notify MD.
- Is used in the MDI or nebulization, alone and/or in combination
Speed of Action:
- Onset of action peaks at 30 minutes-1 hour
- Effective up to 4-6 hours
3
Q
fluticasone (Flovent)
A
Classification:
- Inhaled corticosteriod, anti-inflammatory
- Abbreviated ICS (inhaled corticosteroid)
Mechansim of Action:
- Decreases swlling and irritation in the bronchial airways. Effective in late phase reaction of asthma
Use:
- Not effective for an acute asthma attack
- Used in preventative management of persistent asthma symptoms (mild-severe)
Side/Adverse Effects:
- Acts locally in R. tract with relatively rare systemic side effects.
- HA
- Nasal congestion
- Diarrhea
- Difficulty speaking
- Back/joint pain
Nursing Implications:
- May take 2 weeks or longer to feel full benefit
- Reinforce need to rinse mouth after medication administration to prevent opportunistic oral fungal infections (thrush)
- Use of a spacer may lower incidence of thrush
- Applicator and spacer must be cleaned regularly
Speed of Action:
- Onset is 12 hours with speak in several days
4
Q
montelukast (Singulair)
A
Classification:
- Leukotriene receptor antagonist
- Abbreviated LTRA
Mechanism of Action:
- Inhibits bronchoconstriction by selectively antagnoizing leukotriene receptors
Use:
- Leukotrienes induce bronchoconstriction and mucus production and are important inflammatory agents
- Montelukast is used to control the bronchoconstriction and mucus production associated with asthma
Side/Adverse Effects:
- Anorexia
- Nausea
- Diarrhea
- Dizziness
- HA
- Cough
- Influenza
- Laryngitis
- Pharyngitis
- Drowsiness
Nursing Implications:
- Give in the evening for max effectiveness, as leukotriene levels are higher at night
- Better to take when breathing is more controlled
- Not a rescue drug - do not use for an acute asthma attack
- Periodic LFTs
Speed of Action:
- Rapidly absorbed. Peak effect in 3-4 hours.
5
Q
salmeterol/fluticasone (Advair)
A
Classficiation:
- Long acting beta adrenergic agonist in combination with an inhaled corticosteroid.
- Abbreviated LABA
Mechanism of Action:
- Binds to the beta 2 receptors in the lungs, causing bronchodilation along with potent anti-inflammatory activity resulting in reduced swelling and irritation.
Use:
- Prevention and maintence thearpy for bronchospasms in patients with asthma, COPD, and exercise induced asthma
Side/adverse Effects:
- HA
- Tremors
- Tachycardia
- Palpitations
- Bronchospasm
- Pharyngitis
- Upper R. tract infections
Nursing Implications:
- Instruct patient on proper use of a dry powder multiclose inhaler.
- Do not use to stop an asthma attack.
- Teach patient to carry an inhaled, short-acting beta2 antagonist for acute symptoms.
- Rinse mouth after use to decrease incidence of thursh
- Use no more than BID dosing
6
Q
Green Zone
A
Doing Well
- Signals all clear
- No cough, wheeze, chest tightness, or shortness or breath during the day or night
- Can do usual actitivites
- PEFR greater than 80% of personal best
- Patient should use daily control medications
7
Q
Yellow Zone
A
Asthma is getting worse
- Signals caution
- Cough, wheeze, chest tightness, or shortness of breath
- Waking at night due to asthma
- Can do some but not all usual activities
- PEFR 50%-80% of personal best
- Patient should add rescue medications
8
Q
Red Zone
A
Medical Alert!
- Signals a medical alert
- Very SOB
- Rescue medications have not helped
- Cannot do usual activities
- PEFR less than 50% of personal best
- Patient should increase rescue medications and call physician immediately
9
Q
Asthma
A
- Chronic inflammatory disorder of the airways, associated with widespread but variable airflow obstruction that is usually reverisble
- Affects 18.8 million Americans
- Morbidity impacts school, jobs, physical activities
- Public health concern: over 14.2 million lost workdays in adults
- Women are 62% more likely to have asthma than men
- Over 3,300 deaths per year from asthma, but decreasing over the past 10 years
10
Q
Asthma Triggers
A
- Allergens
- Respiratory infections/sinus problems
- Certain drugs
- ASA/NSAIDs
- Beta blockers
- Food additives
- Occupational exposures/air pollutants
- Hormones
- GI reflux
- Can also be exercise induced or triggered by emotional stress
11
Q
Pathophysiology of Asthma
A
- Involved inflammation and nonspecific hyper-irritability and hyper-responsiveness of tracheal bronchial tree
- Specifically, triggers activate mast cells, causing the release of inflammatory mediators (ex. histamine, leukotrienes)
- This leads to intense inflammation, bronchial smooth muscle contraction, vasodilation, increased capillary permeability, and increased mucus production
- These acute changes lead to epithelial damage which causes a chronic change called remodeling or progressive, irreversible lung damage
12
Q
What occurs in the airways (asthma)?
A
- Bronchospasm
- Constriction of bronchial smooth muscle
- Increased mucus production
- Edema and mucosal inflammation
13
Q
Clinical symptoms of Asthma
A
- Chest tightness
- Dyspnea
- Cough
- Wheezing
- Symptoms are variable
- All are related to reduced airway diameter and increased airway resistance
14
Q
Remodeling
A
Over time, chronic changes occur within the airways
- Bronchial smooth muscle hypertrophy
- Basement membrane thickening
- Mucus gland hypertrophy
- Thick, tenacious sputum
- Hyperinflation and air trapping in lungs
15
Q
Treatment of Asthma
A
- Patient education re: self-monitoring of symptoms and daily PEFR measurements
- Avoidance of exposure to triggers
- Daily medication plan, including controllers and rescuers
- Individualized asthma action plan for managing exacerbations
- Treatment of underlying conditions (ex. GERD)
