Ch 35 Drugs Affecting Lower Respiratory System Flashcards
Where does lung tissue receive its blood supply from?
Lung tissue receives its blood supply from the bronchial artery which branches directly off the thoracic aorta.
The act of breathing is controlled by the CNS.
What is the physiology of the LOWER RESPIRATORY SYSTEM
The lower respiratory tract is virtually sterile because of the various defense mechanisms in the upper respiratory system.
Protective mechanisms*
All the tubes in the lower airway contain goblet cells, which secrete mucus to entrap any particles.
Micro organisms and other foreign bodies are removed from the air by tiny hairlike structures called cilia.
What is emphysema
Air trapping
Expiratory problems
In the end stages; the alveoli is less elastic
Acute bronchitis
Is caused most frequently by viruses
Asthma
Is a disorder characterized by recurrent episodes of bronchospasm, bronchial muscle spasm that leads to narrowed or obstructed airways
Chronic airway limitation
Is an umbrella term that describes gradually progressive, degenerative diseases, such as chronic bronchitis, emphysema or repeated severe asthma attacks
Chronic bronchitis
Is a long standing largely irreversible inflammation of the bronchial tree
Emphysema
Is an abnormal distinction of the lungs with air characterized by loss or degeneration of elastic tissue, disappearance of capillary walls and breakdown of the alveolar walls.
Pneumonia
Is an inflammation of the lungs.
It can be caused by bacterial or viral invasion of the tissue or by aspiration of foreign substances into the lower respiratory tract
Cystic fibrosis
Is a hereditary disease that affects the functioning of the body’s exocrine glands: the mucus- secreting and sweat glands.
Mucolytic drugs
Much lyrics break down mucus
These drugs can be administered by a nebulizer or by direct instillation into the trachea
Mucolytics are reserved for patients who have major difficulty mobilizing and coughing up secretions
What is the prototype drug of mucolytics
Acetylcysteine (Mucomyst)
What is core drug knowledge of acetylcysteine (mucolytic drug)
Used to liquefy the thick tenacious secretions
Onset is very fast within one minute
It splits disulfide bonds that are responsible for holding mucous material together
What contraindications exist regarding acetylcysteine
Hypersensitivity
What are the adverse effects regarding acetylcysteine
Bronchospasm Bronchoconstriction Chest tightness A burning feeling in the upper airway Rhinorrhea * caution is asthmatic patients
How can a nurse maximize the therapeutic effects of acetylcysteine
Administer an inhaled beta agonist before administering acetylcysteine
How can a nurse minimize the adverse effects of acetylcysteine
Inform the pt that nebulization may produce an initially disagreeable odor but that this odor is transient; drink OJ to cover the odor
Acetylcysteine is administered by…..
Inhalation or direct instillation
Bronchodilators
Most important group of rescue drugs
Used to facilitate respiration by dilating the airways
May be administered orally, parenterally, or by inhalation
What is the most frequent method of administering bronchodilators
Inhalation is the most frequent method using metered dose inhalers or dry powder inhalers
What are bronchodilators classified as
Beta agonists ( sympathomimetics)
What is the action of beta agonists
One of the actions of beta stimulation in the sympathetic nervous system is dilation of the bronchi and increased rate and depth of respiration.
What is the prototype drug of bronchodilators
albuterol ( Proventil, Ventolin)
What is the core drug knowledge of albuterol (Proventil, Ventolin)
It is a bronchodilator in managing CAL and asthma
Administered: inhalation
Excreted: urine and feces
Onset: 5-15 min
What are the pharmacodynamics of albuterol
It selectively stimulates receptors of smooth muscle in the lungs, the uterus and the vasculature that supplies skeletal muscle.
What are contraindications and precautions of albuterol
Hypersensitivity
What are the adverse effects of albuterol
Tachycardia, palpitations, anxiety, tremors, headache, insomnia, muscle cramping and GI symptoms
What are drug interactions of albuterol
Other sympathomimetic agents, beta- adrenergic blocking agents, digoxin, antidepressants and potassium losing diuretics
How can one maximize the therapeutic effects of albuterol
To obtain the correct dose, prime the device
How can one mimimize the adverse effects of albuterol
The pt. Should be encouraged to contact the provider to obtain adjunct medications if symptoms persist, rather than increase the frequency of albuterol use.
What is important to limit when taking albuterol
Limit caffeine intake
What is albuterol given for?
Acute exacerbation of CAL or asthma
What are respiratory anticholinergic drugs
Inhaled ANTICHOLINERGIC drugs are considered first line treatment for pt with CAL
Anticholinergic agents diminish the effects of acetylcholine
In the respiratory system, use of inhaled anticholinergic drugs stops the bronchoconstriction
What is the prototype drug of respiratory anticholinergic agents
ipratropium ( Atrovent)
What is ipratropium used for
Used for maintenance of bronchospasm
Inhalation
Onset 15-30 min
-antagonizes the action.of acetylcysteine by blocking muscarinic cholinergic receptors.
What are contraindications and precautions of ipratropium bromide
Sensitivity to ipratropium and atropine
Adverse effects- paradoxic acute bronchospasms, cough, hoarseness, throat irritation, or dysgeusia
Ipratropium is used for what purpose
It is used prophylactically
Assess the clients needs for beta agonist drugs in addition to ipratropium
What are xanthine derivatives
The xanthine derivatives, including theophylline, aminophylline, diphylline and caffeine, come from a variety of naturally occurring sources.
They are excellent bronchodilators but do not work as rapidly as beta agonists drugs.
What is the prototype drug of xanthine derivatives
Theophylline ( Slo- phyllin)
What is the core drug knowledge of theophylline
It is indicated for the the symptomatic relief or prevention of bronchial asthma and reversal of bronchospasm. Administered: PO metabolized : liver Excreted: kidneys Peak: 2 hours
What are contraindications and precautions of theophylline
Hypersensitivity, status asthmaticus, or peptic ulcer
Any adverse effects of theophylline are due directly to serum levels of the drug.
In a hospital setting, what rate should theophylline be administered
20mg/min
What are anti inflammatory agents used for
In addition to bronchodilators, anti inflammatory drugs are used to manage respiratory disorders especially asthma.
Name a anti inflammatory drug
Inhaled glucocorticoid steroids
Are the most effective anti inflammatory drugs available for managing respiratory disorders.
They can be given PO, parenterally or by inhalation
What is the prototype drug of inhaled glucocorticoid steroids
flunisolide ( AeroBid)
What is the glucocorticoid steroid flunisolide used for
It is used to prevent bronchospasm.
Administered PO, parenterally or by inhalation
What are the contraindications and precautions of flunisolide
Active systemic fungal infection
What are the adverse effects of flunisolide
Sore throat, hoarseness, coughing, dry mouth, and pharyngeal and laryngeal fungal infections
What should be used in addition to the glucocorticoid steroid flunisolide
Use a beta 2 agonist before flunisolide dilates the bronchial tree spacers may help alleviate dysphonia by filtering larger aerosol particles
What are mast cell stabilizers
Vasoactive substances, such as histamine, serotonin, bradykinin, and leukotrienes are located within the mast cell. When the mast cell ruptures, theses substances cause an inflammatory response, such as bronchial constriction, which accounts for the symptoms of an acute asthma attack
What is the prototype drug of mast cell stabilizers
Cromolyn sodium
What is the core drug knowledge regarding chromolyn sodium
It is a prophylactic agent in treating mild to moderate asthma
It is administered by inhalation or PO, it is distributed to the lungs and excreted in the feces
It works at the surface of the mast cell to inhibit mast cell rupture and degranulation after contact with an antigen.
What are the contraindications and precautions of chromolyn sodium
Hypersensitivity
What are the adverse effects of cromolyn sodium
Bronchospasm, throat irritation, and cough
Before giving cromolyn sodium what is appropriate to assess for
Monitor for lactose intolerance
Pregnancy category B
What is cromolyn sodium used for
It is used for long time management of respiratory disorders
What should the nurse educated patient and family about regarding cromolyn sodium
Emphasize the cromolyn sodium is not useful for managing acute symptoms
Teach patient how to use a peek flowmeter to monitor his or her personal respiratory status
The patient has been prescribed cromolyn sodium for exercise-induced asthma what would you teach about administration of this medication
Take 15 to 20 minutes before exercise advise patients who experience exercise-induced bronchospasm to take cromolyn sodium 15 to 20 minutes before exercise
Leukotriene receptor antagonists
Leukotrienes or inflammatory mediators that are powerful bronchoconstrictors and vasodilators
Leukotrienes have been identified as important mediators in the pathology and symptomatology of asthma.
What is the prototype drug of leukotriene receptor antagonists
zafirlukast
What is the core drug knowledge of zafirlukast
Hypersensitivity
What are adverse effects of zafirlukast
Headache, gastritis, pharyngitis and rhinitis
What are drug interactions of zafirlukast
Theophylline, warfarin aspirin erythromycin and drugs metabolized though the P-450 CYP2C9
What are core patient variables regarding zafirlukast
Assess medical status and liver function
Pregnancy category B
Take med on a empty stomach
Generally given at home
How can one maximize therapeutic effects of zafirlukast
Ensure that pt takes twice daily despite the absence of symptoms
What is the ongoing assessment of zafirlukast
Explain that zafirlukast is used in maintenance therapy
Encourage pt’s to take non narcotic analgesics if headache occurs.
Assess whether pt needs beta agonist drugs in addition to zafirlukast
