Chapter 36 worksheet- Medications Flashcards
what is the most common route of administration that used by RT’s
inhalation
name four advantages of inhalation
- smaller doses can be used
- rapid onset of action
- delivered directly to the target organ
- less systemic side effects
name two disadvantages of inhalation
- # of variables can affect delivered dose
2. lack of knowledge about devices (caregivers and patients)
what is the catch phase for the sympathetic division
fight or flight
what is the other name for the sympathetic division
adrenergic
what is the neurotransmitter what the sympathetic division
norepinephrine
what is the airway muscle effect of the sympathetic division
bronchial muscle relaxed
what is the catch phrase for parasympathetic division
rest and digest
what is the other name for parasympathetic division
cholinergic
what is the neurotransmitter for the parasympathetic
acetylcholine
what is the airway muscle effect for the parasympathetic
bronchial muscle contracted
what is the primary effect alpha
vasoconstriction and vasopressor (increased BP)
what is the primary effect of B1
increased heart rate and heart contractility
what is the primary effect of B2
smooth muscle relaxation, stimulates mucociliary activity
what is the brand name for Albuterol
Proventil Ventolin ProAir Accuneb VoSpire
what is the dose for Albuterol
0.5 ml (2.5 mg) BID
(0.5%) QID
2 puffs 90 ug/puff TID
what is the brand name for levalbuterol
xopenex
what is the dose for xopenex
0.63 to 1.25 mg
(0.25%)
2 puffs 45 ug/puff
every 4 to 6 hours
what is the brand name for Ipratropium bromide
atrovent
what is the dose for atrovent
17 ug/puff
2 puffs
QID
what is the agent for mucomyst
A. Acetylcysteine 10%
B. Acetylcysteine 20%
what is the dose for mucomyst
3 to 5 ml
what is the agent for pulmozyme
C. Dornase alfa
what is the dose for pulmozyme
2.5 ml
what is mucomyst medication with no brand name
D. Hypertonic Osmotic Solutions 3% or 7%
what is the dosage of D. Hypertonic Osmotic Solutions 3% or 7%
3 to 5 ml
- What would you recommend if a patient experienced bronchospasm from a CFC inhaler?
Switch to an HFA inhaler or DPI if it is appropriate.
what is the onset and duration for xopenex
onsent: 15 mins.
duration: 5 to 8 hours
what is the onset and duration for asthmanefrin
onset: 3 to 5 minutes
duration 0.5 to 2 hours
what is the onsent and duration for proventil
onsent: 15 mins.
duration 5 to 12 hours
what is onset and duration for servent
onset: 20 minutes
duration: 12 hours
what is the onset and duration for formoterol
onsent: 15 minutes
duration: duration 12 hours
what is the arformoteral onsent and duration
onset: 15 mins
duration: 12 hours
List the adverse effects of bronchodilator drugs.
Tremor Headache Insomnia Nervousness Dizziness Tolerance Tachycardia Hypokalemia Palpitations
What should you monitor when administering drugs via the aerosol route?
A. Heart rate B. Peak Flow C. Breath sounds D. Respiratory rate E. Pulse oximetry
Generally, Ipratropium is indicated for use in what types of patients?
Patients with chronic obstructive pulmonary disease
what is the onset and duration and peak effect for Ipratropium
onset: 15 minutes
peak effect: 1 to 2 hours
duration: 6 hours
what is the onset, peak effect, duration for Tiotropium
onset: 30 mins
peak effect: 3 hours
duration: 24 hours
What medication is available by SMI and SVN with both ipratropium and albuterol? What is the possible advantage of this medication?
Combivent Respimat is available by SMI. Duoneb is the SVN version The advantage for practitioners and patients is the simplified delivery of both drugs.
Describe the most common side effects to watch for when administering this class of drugs.
A. Cough
B. Dry mouth
Bronchospasm is a common side effect of the administration of mucolytic agents. How would you recommend modifying the therapy to prevent or treat this problem?
Give a bronchodilator prior to the mucolytic or with the mucolytic
How long will it take inhaled steroids to have a noticeable effect on the symptoms of asthma?
Hours to days
What significance does this have in terms of patient education?
Patients must be taught to use their inhaled steroid as prescribed and not expect immediate relief. They also need to know that these drugs are not bronchodilators and do not replace them. They will have to follow the treatment regimen every day to get the desired results.
The most common side effects of inhaled steroids are:
A. Oropharynx fungal infections
B. Cushing’s syndrom
What is the brand name of Omalizumab? Based on the time between shots, how long might this take to start working?
Xolair. It takes 2 months or longer to see real benefits in many cases, but the effects can be dramatic.
What agent may be nebulized to treat P. jiroveci (formerly PCP) seen in severely immunocompromised patients? Why isn’t the drug used much anymore?
Pentamidine isethionate (Nebupent), limited efficacy
What is the inhaled drug that shortens the course and alleviates the symptoms of the flu?
Zanamivir given via DPI
Specifically, when is nitric oxide used for newborns? When is it contraindicated?
Infants with persistent pulmonary hypertension and hypoxemia. It is contraindicated for any other use.
What is the brand name of Iloprost? The delivery system used?
Ventavis, I neb
What is the brand name of Epoprostenol? The delivery system used?
Flolan SVN
A patient who has asthma is admitted to the hospital for the second time in 2 months. She has not been able to get relief and is using her albuterol inhaler frequently.
A. In addition to inhaled beta agonists, steroids are commonly administered to reduce inflammation associated with asthma. Name one inhaled steroid and recommend a dose
. Flovent is available in 44, 110, and 220 g doses in the HFA MDI. MDI 2 puffs BID. Could also be Pulmicort, QVAR, Alvesco, Aerospan and so on. Any of the inhaled corticosteroids
A patient who has asthma is admitted to the hospital for the second time in 2 months. She has not been able to get relief and is using her albuterol inhaler frequently.
B. What device is important to use along with MDI’s to prevent deposition of these drugs in the mouth?
Spacer or holding chamber
A patient who has asthma is admitted to the hospital for the second time in 2 months. She has not been able to get relief and is using her albuterol inhaler frequently.
C. Why should this patient rinse her mouth after use of her inhaled steroid?
Rinsing reduces systemic absorption from the mouth and throat and the risk of thrush
A patient who has asthma is admitted to the hospital for the second time in 2 months. She has not been able to get relief and is using her albuterol inhaler frequently.
What long acting bronchodilator may help this patient sleep through the night without being awakened by dyspnea and wheezing?
Serevent or foradil, Arcapta, Stiverdi Respimat. If Advair is used, you don’t need the flovent, for example.
Cystic Fibrosis is diagnosed in a 7 year old. This patient has extremely thick mucus (like glue). Auscultation reveals scattered wheezing and rhonchi.
A. What drug would you recommend aerosolizing for treatment of the thick mucus?
Dornase alfa (Pulmozyme)
Cystic Fibrosis is diagnosed in a 7 year old. This patient has extremely thick mucus (like glue). Auscultation reveals scattered wheezing and rhonchi.
What other drug should be given to treat the wheezing?
A bronchodilator such as albuterol or Xopenex
Cystic Fibrosis is diagnosed in a 7 year old. This patient has extremely thick mucus (like glue). Auscultation reveals scattered wheezing and rhonchi.
C. He has Pseudomonas in his sputum. What could you nebulize to treat gram negative bad boys in CF?
Tobramycin
67 year old man with long standing COPD characterized by chronic bronchitis is coughing up copious amounts of very thick white sputum. He complains that his chest feels tight, and he cannot catch his breath. His albuterol inhaler is not providing relief.
A. What bronchodilator is appropriate to add to the therapeutic regimen?
Ipratropium (Atrovent)
A 67 year old man with long standing COPD characterized by chronic bronchitis is coughing up copious amounts of very thick white sputum. He complains that his chest feels tight, and he cannot catch his breath. His albuterol inhaler is not providing relief.
B. What alternative delivery methods might be useful?
He may need a nebulizer if his inhaler is not effective.
A 67 year old man with long standing COPD characterized by chronic bronchitis is coughing up copious amounts of very thick white sputum. He complains that his chest feels tight, and he cannot catch his breath. His albuterol inhaler is not providing relief.
C. What mucolytic may be considered if other means of sputum clearance are ineffective? Why might this drug be counterproductive?
Mucomyst. It may worsen bronchospasm.
A respiratory care student is administering a standard dose of Albuterol via SVN to a 65 year old male admitted for pneumonia and COPD. Five minutes into the treatment the patient’s HR increases from 92-156 on the monitor. The instructor walks in at this moment.
A. What action should the student do first? What other actions might be taken right away at the bedside?
Stop administering the drug. Give the patient oxygen. Assess the patient and reassure.
A respiratory care student is administering a standard dose of Albuterol via SVN to a 65 year old male admitted for pneumonia and COPD. Five minutes into the treatment the patient’s HR increases from 92-156 on the monitor. The instructor walks in at this moment.
B. What change in medication could provide bronchodilation with fewer side effects?
Lower the dose, change to levalbuterol or even consider ipratropium
