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

Ch 35 Drugs Affecting Lower Respiratory System Flashcards

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
Q

What are the pharmacodynamics of albuterol

A

It selectively stimulates receptors of smooth muscle in the lungs, the uterus and the vasculature that supplies skeletal muscle.

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25
Q

What are contraindications and precautions of albuterol

A

Hypersensitivity

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26
Q

What are the adverse effects of albuterol

A

Tachycardia, palpitations, anxiety, tremors, headache, insomnia, muscle cramping and GI symptoms

27
Q

What are drug interactions of albuterol

A

Other sympathomimetic agents, beta- adrenergic blocking agents, digoxin, antidepressants and potassium losing diuretics

28
Q

How can one maximize the therapeutic effects of albuterol

A

To obtain the correct dose, prime the device

29
Q

How can one mimimize the adverse effects of albuterol

A

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
Q

What is important to limit when taking albuterol

A

Limit caffeine intake

31
Q

What is albuterol given for?

A

Acute exacerbation of CAL or asthma

32
Q

What are respiratory anticholinergic drugs

A

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
Q

What is the prototype drug of respiratory anticholinergic agents

A

ipratropium ( Atrovent)

34
Q

What is ipratropium used for

A

Used for maintenance of bronchospasm
Inhalation
Onset 15-30 min

-antagonizes the action.of acetylcysteine by blocking muscarinic cholinergic receptors.

35
Q

What are contraindications and precautions of ipratropium bromide

A

Sensitivity to ipratropium and atropine

Adverse effects- paradoxic acute bronchospasms, cough, hoarseness, throat irritation, or dysgeusia

36
Q

Ipratropium is used for what purpose

A

It is used prophylactically

Assess the clients needs for beta agonist drugs in addition to ipratropium

37
Q

What are xanthine derivatives

A

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
Q

What is the prototype drug of xanthine derivatives

A

Theophylline ( Slo- phyllin)

39
Q

What is the core drug knowledge of theophylline

A 
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
Q

What are contraindications and precautions of theophylline

A

Hypersensitivity, status asthmaticus, or peptic ulcer

Any adverse effects of theophylline are due directly to serum levels of the drug.

41
Q

In a hospital setting, what rate should theophylline be administered

A

20mg/min

42
Q

What are anti inflammatory agents used for

A

In addition to bronchodilators, anti inflammatory drugs are used to manage respiratory disorders especially asthma.

43
Q

Name a anti inflammatory drug

A

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
Q

What is the prototype drug of inhaled glucocorticoid steroids

A

flunisolide ( AeroBid)

45
Q

What is the glucocorticoid steroid flunisolide used for

A

It is used to prevent bronchospasm.

Administered PO, parenterally or by inhalation

46
Q

What are the contraindications and precautions of flunisolide

A

Active systemic fungal infection

47
Q

What are the adverse effects of flunisolide

A

Sore throat, hoarseness, coughing, dry mouth, and pharyngeal and laryngeal fungal infections

48
Q

What should be used in addition to the glucocorticoid steroid flunisolide

A

Use a beta 2 agonist before flunisolide dilates the bronchial tree spacers may help alleviate dysphonia by filtering larger aerosol particles

49
Q

What are mast cell stabilizers

A

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
Q

What is the prototype drug of mast cell stabilizers

A

Cromolyn sodium

51
Q

What is the core drug knowledge regarding chromolyn sodium

A

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
Q

What are the contraindications and precautions of chromolyn sodium

A

Hypersensitivity

53
Q

What are the adverse effects of cromolyn sodium

A

Bronchospasm, throat irritation, and cough

54
Q

Before giving cromolyn sodium what is appropriate to assess for

A

Monitor for lactose intolerance

Pregnancy category B

55
Q

What is cromolyn sodium used for

A

It is used for long time management of respiratory disorders

56
Q

What should the nurse educated patient and family about regarding cromolyn sodium

A

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
Q

The patient has been prescribed cromolyn sodium for exercise-induced asthma what would you teach about administration of this medication

A

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
Q

Leukotriene receptor antagonists

A

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
Q

What is the prototype drug of leukotriene receptor antagonists

A

zafirlukast

60
Q

What is the core drug knowledge of zafirlukast

A

Hypersensitivity

61
Q

What are adverse effects of zafirlukast

A

Headache, gastritis, pharyngitis and rhinitis

62
Q

What are drug interactions of zafirlukast

A

Theophylline, warfarin aspirin erythromycin and drugs metabolized though the P-450 CYP2C9

63
Q

What are core patient variables regarding zafirlukast

A

Assess medical status and liver function
Pregnancy category B
Take med on a empty stomach
Generally given at home

64
Q

How can one maximize therapeutic effects of zafirlukast

A

Ensure that pt takes twice daily despite the absence of symptoms

65
Q

What is the ongoing assessment of zafirlukast

A

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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