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Pharm Final > Ch 37 Bronchodilators and Other Respiratory Drugs > Flashcards

Ch 37 Bronchodilators and Other Respiratory Drugs Flashcards

1
Q

What are Bronchodilators used for?

A

Bronchodilators are used w/ COPD patients because of their ability to relax bronchial smooth muscle bands to dilate the bronchi and bronchioles.

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3
Q

What is the primary use of the beta agonists?

A
  • For acute phase of asthmatic attack to quickly reduce airway constriction and restore airflow to normal.
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4
Q

What is another name for beta-adrenergic agonists?

A

Sympathomimetic bronchodilators

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5
Q

What are some examples of beta-adrenergic agonists?

A
  • Albuterol
  • Bitolterol
  • Ephedrine
  • Epinephrine
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6
Q

What are the main indications for the use of beta-adrenergic agonists?

A
  • Relief of bronchospasm related to asthma, bronchitis and other COPD
  • Treatment of ACUTE asthma attack as well as prevention
  • Hypotension and shock
  • Produce uterine relaxation to prevent premature labor
  • Hyperkalemia = stimulates K + to shift into cells
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7
Q

What are the main adverse effects of beta-adrenergic agonists?

A

Ex: Epinephrine

  • Insomnia
  • Restlessness
  • Anorexia
  • Vascular headache
  • Hyperglycemia
  • Tremor
  • ❤ stimulation

Ex: Albuterol

  • Hypotension or Hypertension
  • Vascular headache
  • Tremor
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8
Q

What is a contraindication w/ beta-adrenergic agonists?

A

Risk of stroke (because of vasoconstrictive drug actions)

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9
Q

What are the nursing implications in concerns to beta-adrenergic agonists?

A
  • Excess of Albuterol use will results in nausea, ⬆ anxiety, palpitations, tremors and ⬆ HR
  • Patients should take medications EXACTLY as prescribed w/ no omission or double dose
  • Instruct patient to REPORT insomnia, jitteriness, restlessness, palpitation and chest pain
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10
Q

What is an interaction the nurse needs to be concerned about w/ beta-adrenergic agonists?

A

Interaction w/ MAOIs –> ⬆ risk of hypertension

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11
Q

What are some patient teaching tips the nurse can share in regards to Beta-adrenergic agonists?

A
  • Educate about healthy habits
  • Instruct about potential drug interactions (or OD can be lethal)
  • Pts w/ asthma, chronic bronchitis and emphysema should avoid allergens, smoke, stress and pollutants
  • MDIs use: wait 1 or 2 min between puffs
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12
Q

What is the mechanism of action of Anticholinergics?

A

Anticholinergic drugs block ACh receptors to prevent bronchoconstriction and indirectly cause airway dilation.

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13
Q

What are is the main indication for Anticholinergic?

A

To prevent bronchospasm associated w/ Chronic Bronchitis or Emphysema

  • Not used for the management of acute symptoms.
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14
Q

What are the 2 known Anticholinergic drugs?

A
  • Ipratropium bromide = Atrovent

- Tiotropium = Spiriva

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15
Q

What are the adverse effects of Anticholinergics?

A
  • Dry mouth or throat
  • Nasal congestion
  • ❤ palpitations
  • GI distress
  • Headache
  • Coughing
  • Anxiety
  • Dizziness
  • Fatigue
  • Nervousness
  • Urinary retention
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16
Q

What are the nursing implications in concerns to Anticholinergics?

A
  • Provide lozenges for dry mouth
  • Review use of inhaler w/ patient (1 to 2 min btw doses)
  • Ensure patient knows to wait 2 to 5 min before use of additional inhaled medication
  • Ensure adequate hydration (helps w/ secretions)
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17
Q

What are some contraindications with Anticholinergics?

A
  • Allergy to Atropine or to soy lecithin

- Allergy related to food products such as peanut oil, peanuts, soybeans, and other legumes (beans)

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18
Q

What are some patient teaching tips the nurse can share in regards to Anticholinergics?

A
  • Educate patient that Ipratropium is used prophylactically to ⬇ the frequency and severity of asthma and is taken YEAR round for effectiveness.
  • ⬆ fluids to decrease viscosity of secretions and increase expectoration of sputum
  • Teach patient to wait 2 to 5 min if taking another inhaled medication
19
Q

What is the mechanism of action of Xanthines?

A

Xanthines cause bronchodilation by increasing the levels of the energy-producing substance cAMP.

20
Q

What are the actions of Xanthines?

A
  • Stimulate the CNS (less than caffeine)
  • Act directly on medullary respiratory center to enhance respiratory drive
  • In high dosage = ⬆ ❤contraction
    ⬆ HR
    –> Result = ⬆ CO and GFR –> Diuretic effect
21
Q

What are the indications for Xanthines?

A

Dilate the airways in patients w/:

  • Asthma
  • Chronic Bronchitis
  • Emphysema
  • Slow onset so used more for prevention than for acute asthma attacks
22
Q

What are the contraindications of Xanthines?

A
  • Uncontrolled ❤ dysrhythmias
  • Seizure disorders
  • Hyperthyroidism
  • Peptic ulcers
23
Q

What are the adverse effects of Xanthines?

A
  • Nausea, vomiting, anorexia
  • GI reflux
  • Sinus tachy❤, extrasystole, palpitations + ventricular dysrhythmias
  • Transient ⬆ urination + hyperglycemia
  • In case of overdose = Activated Charcoal
24
Q

What drug and food interactions are known w/ Xanthines?

A
  • Sympathomimetics (or even caffeine) can produce an additive cardiac and CNS stimulation
  • Charcoal-broiled, high protein and low carb foods can reduce serum levels of Xanthines
25
Q

What are some patient teaching tips the nurse can share in regards to Xanthines?

A
  • Educate about interactions such as smoking ⬇ blood concentration of drug as well as charcoal-broiled foods
  • Avoid caffeine-containing beverages or foods
  • Encourage patient to be accurate w/ time of administration (DO NOT CRUSH or chew extended-release forms)
27
Q

What is the mechanism of action of Leukotriene Receptor Antagonists (LTRAs)?

A

The LTRAs prevent leukotrienes from attaching to lymphocytes and therefore do not allow inflammation, bronchoconstriction and mucus production to happen.

28
Q

What are the main indications for LTRAs?

A
  • Prophylaxis + long-term treatment of asthma

- Allergic rhinitis

29
Q

What are the contraindications for the use of LTRAs?

A

Allergies to:

  • Povidone
  • Lactose
  • Titanium dioxide
  • Cellulose
  • —> inactive ingredients of LTRAs *
30
Q

What are the adverse effects of LTRAs?

A
  • Headache
  • Dyspepsia
  • Nausea, diarrhea
  • Dizziness
  • Insomnia
  • Potential liver dysfunction
31
Q

What are some patient teaching tips the nurse can share in regards to LTRAs?

A
  • Emphasize that LTRAs are used for prevention NOT for treatment of acute asthma attack
32
Q

What are some important properties of Corticosteroids (glucocorticoids)?

A

Can be given:

  • Orally
  • Inhalation
  • IV in severe cases of asthma
33
Q

What is the mechanism of action of Corticosteroids?

A

Dual effects of:

  • Reducing inflammation
  • Enhancing activity of beta agonists
  • Prevent release of harmful bronchoconstricting substances
34
Q

What are the indications for the use of Corticosteroids?

A

Primary treatment:

  • Bronchospastic disorders = to control inflammatory responses
  • Acute exacerbation of respiratory illnesses and severe asthma
  • Often used w/ bronchodilator beta agonists
35
Q

What contraindications are known for the use of Corticosteroids?

A
  • Hypersensitivity
  • Candida organisms
  • Systemic fungal infections
36
Q

What are the main adverse effects w/ Corticosteroids?

A
  • Pharyngeal irritation
  • Coughing
  • Dry mouth
  • Oral fungal infections
  • Some system is effects can:
  • ⬆ risk for infection
  • fluid and electrolyte disturbances
  • CNS effects (insomnia, nervousness, seizures)
  • brittle skin
  • bone loss
  • osteoporosis
37
Q

What is a VERY important point to remember w/ patients on Corticosteroid therapy?

A

When switching from systemic corticosteroids to inhaled corticosteroid, the process HAS to be done GRADUALLY –> Adrenal failure = DEATH of patients

  • Up to 1 year of adaptation after discontinuation
38
Q

What interactions are known w/ the use of Corticosteroids?

A
  • May ⬆ serum glucose level
  • Greater risk of hypokalemia w/ concurrent use of potassium-depleting diuretics
  • Caution w/ children = growth suppression
39
Q

What are some patient teaching tips the nurse can share in regards to Corticosteroids?

A
  • Oral hygiene = rinse mouth to prevent fungal infection
  • Instruct patient to keep track of doses left to avoid running out. 1 container = 200 puffs
  • Keep track of progress and REPORT adverse effects
  • Instruct the patient to discard MDI after 3 months
  • DO NOT over medicate –> Follow prescriber’s order
  • Overdose = Cushing’s syndrome
  • Addisonian crisis if stopped abruptly
  • Patient will REPORT a gain of 2 lbs in 24h or 5 lbs in 1 week
39
Q

What are the 3 subclasses of Bronchodilators?

A

1) Beta-adrenergic Agonists
2) Anticholinergics
3) Xanthines

40
Q

What are the 2 subclasses of Nonbronchodilating Respiratory drugs?

A

1) Leukotriene Receptor Antagonists (LTRAs)

2) Corticosteroids

41
Q

What are some patient teaching tips the nurse can share in regards to Monoclonal Antibody Antiasthmatic drugs?

A
  • Educate patient these drugs are used for treatment of moderate to severe asthma not ACUTE asthma attacks
  • Instruct and have patient demonstrate proper subcutaneous injections (route of monoclonal antibody antiasthmatic drugs
41
Q

What is the only drug in the Monoclonal Antibody Antiasthmatic class?

A

Omalizumab (Xolair)

Pharm Final (5 decks)

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