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NANJU #2/3 > Ch 35 Drugs Affecting Lower Respiratory System > Flashcards

Ch 35 Drugs Affecting Lower Respiratory System Flashcards

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0
Q

Where does lung tissue receive its blood supply from?

A

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.

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1
Q

What is the physiology of the LOWER RESPIRATORY SYSTEM

A

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.

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2
Q

What is emphysema

A

Air trapping
Expiratory problems

In the end stages; the alveoli is less elastic

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3
Q

Acute bronchitis

A

Is caused most frequently by viruses

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4
Q

Asthma

A

Is a disorder characterized by recurrent episodes of bronchospasm, bronchial muscle spasm that leads to narrowed or obstructed airways

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5
Q

Chronic airway limitation

A

Is an umbrella term that describes gradually progressive, degenerative diseases, such as chronic bronchitis, emphysema or repeated severe asthma attacks

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6
Q

Chronic bronchitis

A

Is a long standing largely irreversible inflammation of the bronchial tree

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7
Q

Emphysema

A

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.

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8
Q

Pneumonia

A

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

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9
Q

Cystic fibrosis

A

Is a hereditary disease that affects the functioning of the body’s exocrine glands: the mucus- secreting and sweat glands.

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10
Q

Mucolytic drugs

A

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

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11
Q

What is the prototype drug of mucolytics

A

Acetylcysteine (Mucomyst)

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12
Q

What is core drug knowledge of acetylcysteine (mucolytic drug)

A

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

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13
Q

What contraindications exist regarding acetylcysteine

A

Hypersensitivity

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14
Q

What are the adverse effects regarding acetylcysteine

A 
Bronchospasm
Bronchoconstriction
Chest tightness
A burning feeling in the upper airway 
Rhinorrhea
* caution is asthmatic patients
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15
Q

How can a nurse maximize the therapeutic effects of acetylcysteine

A

Administer an inhaled beta agonist before administering acetylcysteine

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16
Q

How can a nurse minimize the adverse effects of acetylcysteine

A

Inform the pt that nebulization may produce an initially disagreeable odor but that this odor is transient; drink OJ to cover the odor

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17
Q

Acetylcysteine is administered by…..

A

Inhalation or direct instillation

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18
Q

Bronchodilators

A

Most important group of rescue drugs
Used to facilitate respiration by dilating the airways
May be administered orally, parenterally, or by inhalation

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19
Q

What is the most frequent method of administering bronchodilators

A

Inhalation is the most frequent method using metered dose inhalers or dry powder inhalers

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20
Q

What are bronchodilators classified as

A

Beta agonists ( sympathomimetics)

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21
Q

What is the action of beta agonists

A

One of the actions of beta stimulation in the sympathetic nervous system is dilation of the bronchi and increased rate and depth of respiration.

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22
Q

What is the prototype drug of bronchodilators

A

albuterol ( Proventil, Ventolin)

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23
Q

What is the core drug knowledge of albuterol (Proventil, Ventolin)

A

It is a bronchodilator in managing CAL and asthma
Administered: inhalation
Excreted: urine and feces
Onset: 5-15 min

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24
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.
25
What are contraindications and precautions of albuterol
Hypersensitivity
26
What are the adverse effects of albuterol
Tachycardia, palpitations, anxiety, tremors, headache, insomnia, muscle cramping and GI symptoms
27
What are drug interactions of albuterol
Other sympathomimetic agents, beta- adrenergic blocking agents, digoxin, antidepressants and potassium losing diuretics
28
How can one maximize the therapeutic effects of albuterol
To obtain the correct dose, prime the device
29
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.
30
What is important to limit when taking albuterol
Limit caffeine intake
31
What is albuterol given for?
Acute exacerbation of CAL or asthma
32
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
33
What is the prototype drug of respiratory anticholinergic agents
ipratropium ( Atrovent)
34
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.
35
What are contraindications and precautions of ipratropium bromide
Sensitivity to ipratropium and atropine | Adverse effects- paradoxic acute bronchospasms, cough, hoarseness, throat irritation, or dysgeusia
36
Ipratropium is used for what purpose
It is used prophylactically | Assess the clients needs for beta agonist drugs in addition to ipratropium
37
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.
38
What is the prototype drug of xanthine derivatives
Theophylline ( Slo- phyllin)
39
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 ```
40
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.
41
In a hospital setting, what rate should theophylline be administered
20mg/min
42
What are anti inflammatory agents used for
In addition to bronchodilators, anti inflammatory drugs are used to manage respiratory disorders especially asthma.
43
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
44
What is the prototype drug of inhaled glucocorticoid steroids
flunisolide ( AeroBid)
45
What is the glucocorticoid steroid flunisolide used for
It is used to prevent bronchospasm. | Administered PO, parenterally or by inhalation
46
What are the contraindications and precautions of flunisolide
Active systemic fungal infection
47
What are the adverse effects of flunisolide
Sore throat, hoarseness, coughing, dry mouth, and pharyngeal and laryngeal fungal infections
48
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
49
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
50
What is the prototype drug of mast cell stabilizers
Cromolyn sodium
51
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.
52
What are the contraindications and precautions of chromolyn sodium
Hypersensitivity
53
What are the adverse effects of cromolyn sodium
Bronchospasm, throat irritation, and cough
54
Before giving cromolyn sodium what is appropriate to assess for
Monitor for lactose intolerance | Pregnancy category B
55
What is cromolyn sodium used for
It is used for long time management of respiratory disorders
56
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
57
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
58
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.
59
What is the prototype drug of leukotriene receptor antagonists
zafirlukast
60
What is the core drug knowledge of zafirlukast
Hypersensitivity
61
What are adverse effects of zafirlukast
Headache, gastritis, pharyngitis and rhinitis
62
What are drug interactions of zafirlukast
Theophylline, warfarin aspirin erythromycin and drugs metabolized though the P-450 CYP2C9
63
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
64
How can one maximize therapeutic effects of zafirlukast
Ensure that pt takes twice daily despite the absence of symptoms
65
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

NANJU #2/3 (3 decks)

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