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NURS 306 > Chapter 37: Respiratory Drugs > Flashcards

Chapter 37: Respiratory Drugs Flashcards

1
Q

Asthma

A

Recurrent and reversible SOB (reversible in early stage)

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2
Q

Asthma occurs when

A

Air of lungs become too narrow as a result of bronchospasm, inflammation and edema of bronchial mucosa

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3
Q

Intrinsic asthma

A

(No he of allergies)

Unknown cause, but can be associated with respiratory infections, stress and cold weather

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4
Q

Extrinsic Asthma

A

(Exposed to known allergen)

Caused by hypersensitivity to allergen(s) in environment.

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5
Q

Exercise induced Asthma

A

Bronchospasm at beginning of exercise

Symptoms stop once exercise is stopped

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6
Q

Drug induced asthma

A

Can be from NSAIDs, beta-blockers, sulfite a or certain foods

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7
Q

S&S of Asthma

A 
Expiratory Wheezing
SOB
Tachycardia, tachypnea
Maybe cough and chest tightness
"Silent" Chest
Watch how pt talks in full sentences, do they have to catch their breath?
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8
Q

Complications of Asthma

A

Atelectasis, Respiratory Failure, Respiratory Arrest

Status Asthmaticus

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9
Q

Status Asthmaticus

A

Prolonged asthma attack and doesn’t respond to typical drug therapy
Requires hospitalization

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10
Q

Chronic Bronchitis

A

Continuous infection of bronchi
Inflammation in associated bronchioles responsible for airflow obstruction
Chronic productive cough

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11
Q

S&S of Chronic Bronchitis

A

Productive cough
Heavy set or normal weight
SOB
Hypercapnia and hypoxemia

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12
Q

Complications of Bronchitis

A 
Respiratory infections
Hypoxia
Respiratory failure and arrest
Atelectasis
Cor pulmonale (right sided CHF)
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13
Q

Chronic Bronchitis can arise as a result of

A

Repeated episodes of acute bronchitis or in context of chronic generalized diseases.

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14
Q

Most common bronchial irritants are

A

Cigarette smoking

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15
Q

Emphysema

A

Air spaces enlarge as a result of destruction of alveolar walls.
Loss of lung elasticity.
Decreased surface area available for oxygen and CO2

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16
Q

Primary irritant for Emphysema

A

Cigarette smoke.

Also recurrent infection, heredity and aging.

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17
Q

S&S of Emphysema

A 
SOB
Use of intercostal and accessory muscles
Underweight 
Barrel chest
Cough is minimal
Hypoxemia
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18
Q

Pulmonary Embolism

A

Undissolved embolus that occluded blood vessels of lungs

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19
Q

Risk Factors for Pulmonary Embolism

A

Virchow’s Triad:

Venous stasis, hypercoagulability and damage to venous wall.

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20
Q

Factors contributing to venous stasis

A

Prolonged be rest or immobility

Prolonged sitting

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21
Q

Types and Causes of Pulmonary Embolism

A
  1. Thrombotic (blood clots develop in venous system - legs)
  2. Fat (fat emboli - bone fractures)
  3. Amniotic Fluid (pregnancy)
  4. Air (from venous access -IV)
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22
Q

S&S of Pulmonary Embolism

A 
SOB
Chest pain
Anxiety
Tachycardia
Tachypnea
Dizziness
Hemoptysis
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23
Q

Treatment of Pulmonary Embolism

A

Prevention
Compression stockings, early mobilizations
Anticoagulants (heparin, enoxaparin, warfarin)
Thrombolytic
Umbrella filter

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24
Q

Umbrella filter

A

Filter in inferior vena cava

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25
Q

Complications of Pulmonary Embolism

A

Shock
Respiratory failure
Cardiac/Respiratory

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26
Q

Pneumonia

A

Upper respiratory infections, tracheal intubation, aging and incompetent immune system.
Impaired mucociliary mechanism, decrease cough and epiglottis reflexes, inhalation of microbes

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27
Q

Classification of Pneumonia

A

Community Acquired
Hospital Acquired
Bacterial, viral, atypical

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28
Q

Community acquired pneumonia

A

Infection lower lung onset in community

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29
Q

Hospital acquired pneumonia

A

Highest mortality rate of nosocomial infection

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30
Q

S&S of Pneumonia

A 
Fever, cough, chills, purulent sputum
Back pain, pleuritic chest pain, headaches
Myalgia, fatigue, maybe sore throat
Tachypnea, tachycardia
SOB, Hypoxemia
Crackles, abnormal CXR
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31
Q

Diagnostics for Pneumonia

A

H&P (history and physical)
CXR
Sputum Culture
Elevated WBC

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32
Q

Treatment for Pneumonia

A

O2, antibiotics, analgesics, antipyretics, fluids (IV/oral), caloric intake, rest
Depends on type of pathogen
Pneumococcal vaccine

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33
Q

Pulmonary Tuberculosis is usually seen in

A

Immunocompromised patients, malnourished, elderly

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34
Q

Pulmonary Tuberculosis

A

Always considered a population risk
Usually spread via airborne
Organisms can be dormant

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35
Q

S&S of Pulmonary Tuberculosis

A 
Low grade fever
Cough
Night sweats
Fatigue
Weight loss, Anorexia
Malaise
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36
Q

Treatment for Pulmonary Tuberculosis

A

Multiple drug therapy to prevent resistance

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37
Q

Bronchodilators can be categorized based on the duration of action such as

A

Short acting and long acting

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38
Q

Short acting bronchodilators include

A

Albuterol and levalbuterol

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39
Q

Long acting bronchodilators include

A

Salmeterol

40
Q

Bronchodilators

A

Relax bronchial smooth muscle resulting in bronchodilatation

41
Q

Bronchodilators are used during

A

An acute asthma attack, immediately reduces airway constriction and restores normal airflow.

42
Q

Types of Bronchodilators

A

Nonselective and selective beta2 drugs

43
Q

Nonselective Bronchodilators

A

Stimulate alpha and beta receptors: epinephrine

44
Q

Selective beta2 bronchodilators

A

Stimulates only beta2 receptors: albuterol

45
Q

Mechanism of action: Bronchodilators

A

Begins at specific receptor stimulated

Ends with dilation of airways

46
Q

Mechanism of Action: Selective beta2 drugs (bronchodilator)

A

Activates beta2 receptors that stimulates cAMP, which relaxes smooth muscle in airway and results in bronchial dilation and increased airflow

47
Q

Mechanism of Action: Nonselective Bronchodilators

A

Vasoconstriction reduces amount of edema or swelling in mucous membranes and limits quantity of secretions

48
Q

Indications for Bronchodilators

A

Relief of bronchospasm r/t asthma, bronchitis and other pulmonary diseases
Treatment and prevention of acute attacks

49
Q

Contraindications of Bronchodilators

A

Those with high risk of strokes, uncontrolled HTN and cardiac dysrhythmias, CAD

50
Q

Adverse Effects of Alpha and Beta Bronchodilators

A

Insomnia, restlessness, headache, tremor, palpitations, and anorexia

51
Q

Adverse Effects of Beta1 and Beta2 Bronchodilators

A

Cardiac stimulation
Tremor (usually lasts 30-40 minutes and then usually goes away)
Angina
Headache

52
Q

Adverse Effects of Beta2 - albuterol (Bronchodilator)

A

Headache and tremor

53
Q

Anticholinergic drugs include

A

Ipratropium
Bromide
Tiotropium

54
Q

Anticholinergic drugs

A

Slow and prolonged action
Prevents bronchoconstriction
NOT for ACUTE asthma exacerbation a

55
Q

Mechanism of Action: Anticholinergic Drugs

A

Acetylcholine causes bronchial constriction and narrowing of airways.
Bind to Ach receptors preventing binding.
Result- bronchoconstriction is prevented, airways dilate
Help reduce secretions in COPD pts

56
Q

Indications for Anticholinergic drugs

A

Prevention of bronchospasm r/t chronic bronchitis or emphysema

57
Q

Contraindications of Anticholinergic drugs

A

Allergy to atropine or to soy lecithin or to related food products (peanut oils, peanuts, soybeans, other legumes)

58
Q

Adverse Effects of Anticholinergic Drugs

A 
Dry mouth or throat
Nasal congestion
Palpitations, tachycardia
GI discomfort
Headache, cough, anxiety, restlessness
59
Q

Xanthine Derivatives: Two types

A

Plant alkaloids and synthetic

60
Q

Xanthine Derivatives: Plant Alkaloids include

A

Theophylline
Caffeine
Theobromine

61
Q

Xanthine Derivatives: Synthetic includes

A

Aminophylline

Dyphilline

62
Q

Mechanism of Action: Xanthine Derivatives

A
  • Increased levels of cAMP by competitively initiating PDE (enzyme that breaks down cAMP) -> Results in smooth muscle relaxation, bronchodilation and increased airflow
  • Cause bronchodilation by relaxing smooth muscle in airways
  • Cause CNS and cardiac stimulation (+ into trophy, chronotropy)
63
Q

Indications for Xanthine Derivatives

A

Dilation of airways in pt with asthma, chronic bronchitis, emphysema
Mild to moderate cases of acute asthma
Adjunct drug in management of COPD

64
Q

Adverse Effects of Xanthine Derivatives

A 
N/V and loss of appetite (anorexia)
Gastroesophageal reflux during sleep
Palpitations, tachycardia, ventricular dysrhythmias
Increased urinary frequency
Hyperglycemia
65
Q

Interactions of Xanthine Derivatives

A

Charcoal-boiled food, high protein and low carb

St. John’s wort decreases serum drug

66
Q

Leukotriene Receptor Antagonists include

A

Montelukast
Zafirlukast
Zileuton

67
Q

Leukotriene Receptor Antagonists

A

Onset may be 24 hours

Nonbronchodilating

68
Q

Mechanism of Action: Leukotriene Receptor Antagonist

A

Block receptors to prevent inflammation, bronchoconstriction, mucus production -> causes coughing, wheezing, SOB from triggers (cat hair, dust, etc)
Prevent smooth muscle contraction of bronchial airways
Decreased mucus secretion
Prevent vascular permeability
Decreased neutrophil and leukocyte filtration to lungs -> prevents inflammation

69
Q

Indications for Leukotriene Receptor Antagonist

A

Prophylaxis and long-term treatment and prevention of asthma in adults and children > 12 years
NOT meant for ACUTE asthma attacks

70
Q

Montelukast is indicated for treatment of

A

Allergic rhinitis

71
Q

Adverse Effects of Zileuton (Leukotriene Receptor Antagonist)

A

Headache, nausea, dizziness, insomnia and liver function problems

72
Q

Adverse Effects of Zafirlukast (Leukotriene Receptor Antagonist)

A

Headache, nausea, diarrhea, and liver function problems

73
Q

Nursing Implications of Leukotriene Receptor Antagonists

A

Monitor liver enzymes

Allergies to providone, lactose, titanium dioxide and cellulose derivatives

74
Q

Corticosteroids include

A 
Budesonide
Flunisolide
Fluticasone
Ciclesonide
Prednisone
75
Q

Mechanism of Action: Corticosteroids

A

Suppress inflammation -> reduces edema, bronchospasm, increased beta2 agonist and responsiveness to beta2 agonist
Suppress inflammation -> decreases inflammation

76
Q

Indications for Corticosteroids

A

Prophylaxis of asthma (inhalers)

NOT used for ACUTE asthma attacks

77
Q

Adverse effects of Corticosteroids

A

Increased concentration - adrenal suppression (associated with long-term therapy)
Most common: oropharyngeal candidiasis and dysphonia
Bone loss
Can slow growth in children and adolescents
Hyperglycemia
GI discomfort - peptic ulcers
Infection
F&E disturbances
Cataracts and glaucoma
Mood changes
Crushing’s Syndrome

78
Q

Withdrawal and stopping of corticosteroid treatment must

A

Be done slowly, dosage must be tapered (taper oral agents gradually)
Must be administered on a regular schedule.

79
Q

Abrupt stopping of corticosteroids can cause

A

Hypotension, hypoglycemia, myalgia

80
Q

Oral corticosteroids

A

Used for long term treatment, relieve asthma episode

81
Q

Teaching for Corticosteroid use

A

Gargle after each administration to prevent candidiasis with lukewarm water
Use a space device to reduce deposition of drug in oropharynx
To prevent bone loss, have adequate intake of calcium and vitamin D
Participate in weight bearing exercises

82
Q

Combination drugs include

A

Advair Diskus

83
Q

Advair Diskus

A

Combination of corticosteroids, fluticasone and long-term acting beta2 agonist Salmeterol
Bronchodilator and anti-inflammatory

84
Q

Advair Diskus is used for

A

Asthma and COPD

85
Q

Encourage pt to take measures that promote a generally good state of health to

A

Prevent, relieve and decrease symptoms of COPD

86
Q

To prevent, relieve or decrease symptoms of COPD, pt should

A

Avoid exposure to conditions that precipitate bronchospasm
Have adequate fluid intake
Compliance
Avoid excessive fatigue, heat, extremes in temperature and caffeine

87
Q

Encourage pt to get

A

Prompt treatment for flu or other illness and to get vaccinated

88
Q

The nurse must first do what before beginning therapy?

A

Do a thorough assessment of pt

89
Q

Nurse must ensure that patient know how to use by

A

Having pt do a return demonstration

90
Q

Nurse should monitor patient for

A

Adverse and therapeutic effects

91
Q

Albuterol if used too frequently can

A

Lose its beta2 specific actions at larger doses

92
Q

Caution use of Xanthine in patients with

A

Cardiac disease

93
Q

Nursing Implications for Leukotriene Receptor Antagonists

A

Ensure being used from chronic management of asthma and NOT acute
Teach purpose of therapy
Improvements should be seen in about a week
Assess liver function before beginning and throughout

94
Q

Bronchodilators should be used

A

Several minutes before inhaled corticosteroids.

95
Q

The nurse should keep track of

A

The number of doses in the inhaler devices

96
Q

Nursing Implications for Inhaled drugs

A

Keep track of the number of doses in the inhaler devices

Wait 1-2 minutes between puffs for same drug and 2-5 minutes between different medications

97
Q

Order to Administer Medications

A
  1. Bronchodilators
  2. Anticholinergics
  3. Corticosteroids

NURS 306 (26 decks)

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