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)
What are oral medications of glucocorticoids
Prednisone
Prednisolone ( Prelone)
What are IV Medications of glucocorticoids
Hydrocortisone sodium succinate ( Solu- Cortef)
Mehtylprednisolone sodium succinate ( Solu- medrol)
What is the expected pharmalogical action of glucocorticoids
Theses meds prevent inflammation, suppress airway mucus production, and promote responsiveness of beta2 receptors in the bronchial tree.
The use of glucocorticoids does not provide immediate effects, but rather promotes decreased frequency and severity of exacerbations and acute attacks.
Prednisone when used for 10 days or more can result in what
Supression of adrenal gland function, such as a decrease in the ability of the adrenal cortex to produce glucocorticoids, can occur with inhaled agents and oral agents. ( administer oral glucocorticoids on a alternate day dosing schedule, monitor blood glucose levels, taper the dose do not stop abruptly)
Bone loss ( advise pt to perform at bearing exercises, consume a diet with sufficient calcium and vit D, use lowest dose possible)
Hyperglycemia and glycosuria ( pt with diabetes should have blood glucose monitored)
Myopathy AEB muscle weakness
Peptic ulcer disease ( advise pt to,avoid NSAIDS, administer with food, report black tarry stools check for blood)
Disturbances of fluid and electrolytes
What are contraindications and precautions of glucocorticoids
Pregnancy category C
Contraindicated in clients who have received a live virus vaccine and those with systemic fungal infections
Use cautiously in children and in clients who have diabetes, HTN, peptic ulcer disease and or kidney dysfunction
Use cautiously in pt taking NSAIDS
How long are oral glucocorticoids used for
Short term 3-10 days following an acute asthma exacerbation
What are leukotriene modifiers
Leukotriene modifiers prevent the effect of leukotrienes, thereby suppressing inflammation, bronchoconstriction, airway edema, and mucus production
They are used for long term therapy of asthma and to prevent exercise induced bronchospasm
Administered orally
What is the prototype drug of leukotriene modifiers
montelukast ( singulair)
Other meds: zileuton ( zyflo) zafirlukast (accolate)
Singular is used for what age group
In kids as young as 12 months of age
accolate can be used for what age group
In children 5 years and up
What is the age group for Zyflo administration
Adolescents and adults
What are adverse effects of leukotrienes
Liver injury with use of zileuton ( Zyflo) and zafirlukast ( Accolate)
Obtain baseline liver function tests and monitor periodically
Advise clients to monitor for signs of liver damage ( nausea, anorexia, abdominal pain)
What 2 leukotrienes limit the metabolism of warfarin
zileuton and zafirlukast inhibit the metabolism of warfarin leading to increased levels
Monitor PT and INR levels
What 2 leukotrienes inhibit the metabolism of theophylline
Zileuton and Zafirlukast
Monitor theophylline levels
Advise clients to watch for theophylline toxicity such as nausea, vomiting, seizures.
How should zileuton be administered
Take as prescribed can be given with or without food
How should zafirlukast be administered
Take with food and take 1 hour before or 2 hours after meals
When should montelukast be administered
Once daily at bedtime
A nurse is providing teaching to a young cult female client who has anew prescription for beclomethasone ( QVAR) what should she include in the teaching?
Rinse your mouth after each use to decrease the risk of oral fungal infections
A nurse is providing instructions to the parent of an adolescent client who has a new prescription for albuterol. What instruction should the Nurse include
Tremors are an adverse effect of this med
Tremors may be due to excessive stimulation of beta2 receptors of skeletal muscle.
A client is prescribed long term use of oral prednisone for treatment of chronic asthma, the nurse should instruct the client to watch for what?
Wt gain and fluid retention due to the effect of sodium and water retention.
Beta 2 adrenergic agonists
Albuterol ( Proventil, Ventolin)
formoterol ( foradil aerolizer)
salmeterol ( serevent)
terbutaline ( Brethine)
