Ch 17 airflow disorders Flashcards
What is the pharmacological action of beta 2 adrenergic agonists
It acts by selectively activating the beta2 receptors in the bronchial smooth muscle, resulting in bronchodilaton, as a result bronchospasm is relieved. Histamine is inhibited. Ciliary motility is increased.
Albuterol
Inhaled* short acting
Oral* long acting
Prevention of asthma episode,
Inhaled short acting for prevention of Asthma
Treatment for bronchospasm
Long term control of asthma
Formoterol ( foradil, Aerolizer)
Salmeterol ( serevent)
Inhaled, long acting
Used for long term treatment of asthma
Terbutaline ( Brethine)
Oral* long acting
Long term control of asthma
What are adverse effects of beta 2 adrenergic agonists
Oral agents can cause tachycardia and angina because the activation of alpha 1 receptors in the heart.
Advise clients to avoid caffeine
Instruct client to check pulse and report HR above 20-30 more BPM.
Tremors caused by activation of beta 2 receptors in skeletal muscle.
What are contraindications and precautions of beta 2 adrenergic agonists
Pregnancy category C
contraindicated in clients with tachydysrrhythmia
Use cautiously in client who have diabetes, hyperthyroidism, heart disease, hypertension and angina.
What drug interactions exist for beta2 adrenergic agonists
MAOI and TCA can increase the risk of tachycardia and angina
What should the pt do when prescribed a beta 2 agonist and a inhaled glucocorticoid
Inhale the beta 2 agonist before inhaling the glucocorticoid. The beta2 agonist promotes bronchodilation and enhances absorption of the glucocorticoid
What are short acting beta2 agonists used to treat
Acute episodes
Methylxanthines
Theophylline ( the oldie, theo 24)
Causes relaxation of bronchial smooth muscle resulting in broncho dilation
What is oral theophylline used for
Long term control of chronic asthma or COPD
route of administration: oral or IV( emergency use only)
What are therapeutic ranges of theophylline
5-15
Therapeutic effects are unlikely to occur at levels less than 20.
What are signs of toxicity when taking theophylline
Nausea, diarrhea, restlessness
What severe reactions can occur with higher therapeutic levels of theophylline
Dysrhythmias
Seizures
Theophylline should be used cautiously in clients who
Have heart disease, HTN, liver and kidney dysfunction and diabetes
What are medication food interactions of theophylline
Caffeine increases CNS and cardiac adverse effects of theophylline
Caffeine can increase theophylline levels
Phenobarbitol and phenytoin decrease theophylline levels
Cimetidine ( Tagamet) ciproflaxacin ( cipro) and other fluoroquinolone antibiotics increase theophylline levels.
What is the pharmacological action of Inhaled anticholinergics
Blocks muscarinic receptors of the bronchi, resulting in bronchodilation
What is the prototype drug of inhaled anticholinergics
Ipratropium ( Atrovent)
Other meds: tiotropium (Spiriva)
What are the therapeutic uses of inhaled anticholinergics
Relieves bronchospasm assoc with COPD
allergen induced and exercise induced Asthma
Route of administration: inhalation
What are adverse effects of inhaled anticholinergics
Local anticholinergic effects such as dry mouth, hoarseness
What are contraindications and precautions of inhaled anticholinergics
Pregnancy category B
Contraindicated in clients who have an allergy to peanuts because the medication preparations may contain soy lecithin
Use cautiously in clients who have closed angle glaucoma and benign prostatic hyperplasia ( due to anticholinergic effects)
Glucocorticoids
Short term IV agents are used to treat status asthmaticus
Inhaled agents are used for long term prophylaxis of asthma
Short term oral therapy is used to treat manifestations following acute asthma episode.
Long term oral therapy is used to treat chronic asthma
Promote lung maturity and decrease respiratory distress in fetuses at risk for preterm birth.
What are the prototype meds of glucocorticoids
Inhalation: beclomethasone
Oral: prednisone
What are inhalation glucocorticoid meds
Budesonide ( Pulmicort Flexhaler) budesonide and formoterol ( Symbicort) Fluticasone and salmeterol ( Advair) fluticasone ( Flovent) mometasone furoate and formoterol fummarate dihydrate (Dulera)