Chapter 37: Respiratory Drugs Flashcards
Asthma
Recurrent and reversible SOB (reversible in early stage)
Asthma occurs when
Air of lungs become too narrow as a result of bronchospasm, inflammation and edema of bronchial mucosa
Intrinsic asthma
(No he of allergies)
Unknown cause, but can be associated with respiratory infections, stress and cold weather
Extrinsic Asthma
(Exposed to known allergen)
Caused by hypersensitivity to allergen(s) in environment.
Exercise induced Asthma
Bronchospasm at beginning of exercise
Symptoms stop once exercise is stopped
Drug induced asthma
Can be from NSAIDs, beta-blockers, sulfite a or certain foods
S&S of Asthma
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?
Complications of Asthma
Atelectasis, Respiratory Failure, Respiratory Arrest
Status Asthmaticus
Status Asthmaticus
Prolonged asthma attack and doesn’t respond to typical drug therapy
Requires hospitalization
Chronic Bronchitis
Continuous infection of bronchi
Inflammation in associated bronchioles responsible for airflow obstruction
Chronic productive cough
S&S of Chronic Bronchitis
Productive cough
Heavy set or normal weight
SOB
Hypercapnia and hypoxemia
Complications of Bronchitis
Respiratory infections Hypoxia Respiratory failure and arrest Atelectasis Cor pulmonale (right sided CHF)
Chronic Bronchitis can arise as a result of
Repeated episodes of acute bronchitis or in context of chronic generalized diseases.
Most common bronchial irritants are
Cigarette smoking
Emphysema
Air spaces enlarge as a result of destruction of alveolar walls.
Loss of lung elasticity.
Decreased surface area available for oxygen and CO2
Primary irritant for Emphysema
Cigarette smoke.
Also recurrent infection, heredity and aging.
S&S of Emphysema
SOB Use of intercostal and accessory muscles Underweight Barrel chest Cough is minimal Hypoxemia
Pulmonary Embolism
Undissolved embolus that occluded blood vessels of lungs
Risk Factors for Pulmonary Embolism
Virchow’s Triad:
Venous stasis, hypercoagulability and damage to venous wall.
Factors contributing to venous stasis
Prolonged be rest or immobility
Prolonged sitting
Types and Causes of Pulmonary Embolism
- Thrombotic (blood clots develop in venous system - legs)
- Fat (fat emboli - bone fractures)
- Amniotic Fluid (pregnancy)
- Air (from venous access -IV)
S&S of Pulmonary Embolism
SOB Chest pain Anxiety Tachycardia Tachypnea Dizziness Hemoptysis
Treatment of Pulmonary Embolism
Prevention
Compression stockings, early mobilizations
Anticoagulants (heparin, enoxaparin, warfarin)
Thrombolytic
Umbrella filter
Umbrella filter
Filter in inferior vena cava
Complications of Pulmonary Embolism
Shock
Respiratory failure
Cardiac/Respiratory
Pneumonia
Upper respiratory infections, tracheal intubation, aging and incompetent immune system.
Impaired mucociliary mechanism, decrease cough and epiglottis reflexes, inhalation of microbes
Classification of Pneumonia
Community Acquired
Hospital Acquired
Bacterial, viral, atypical
Community acquired pneumonia
Infection lower lung onset in community
Hospital acquired pneumonia
Highest mortality rate of nosocomial infection
S&S of Pneumonia
Fever, cough, chills, purulent sputum Back pain, pleuritic chest pain, headaches Myalgia, fatigue, maybe sore throat Tachypnea, tachycardia SOB, Hypoxemia Crackles, abnormal CXR
Diagnostics for Pneumonia
H&P (history and physical)
CXR
Sputum Culture
Elevated WBC
Treatment for Pneumonia
O2, antibiotics, analgesics, antipyretics, fluids (IV/oral), caloric intake, rest
Depends on type of pathogen
Pneumococcal vaccine
Pulmonary Tuberculosis is usually seen in
Immunocompromised patients, malnourished, elderly
Pulmonary Tuberculosis
Always considered a population risk
Usually spread via airborne
Organisms can be dormant
S&S of Pulmonary Tuberculosis
Low grade fever Cough Night sweats Fatigue Weight loss, Anorexia Malaise
Treatment for Pulmonary Tuberculosis
Multiple drug therapy to prevent resistance
Bronchodilators can be categorized based on the duration of action such as
Short acting and long acting
Short acting bronchodilators include
Albuterol and levalbuterol
Long acting bronchodilators include
Salmeterol
Bronchodilators
Relax bronchial smooth muscle resulting in bronchodilatation
Bronchodilators are used during
An acute asthma attack, immediately reduces airway constriction and restores normal airflow.
Types of Bronchodilators
Nonselective and selective beta2 drugs
Nonselective Bronchodilators
Stimulate alpha and beta receptors: epinephrine
Selective beta2 bronchodilators
Stimulates only beta2 receptors: albuterol
Mechanism of action: Bronchodilators
Begins at specific receptor stimulated
Ends with dilation of airways
Mechanism of Action: Selective beta2 drugs (bronchodilator)
Activates beta2 receptors that stimulates cAMP, which relaxes smooth muscle in airway and results in bronchial dilation and increased airflow
Mechanism of Action: Nonselective Bronchodilators
Vasoconstriction reduces amount of edema or swelling in mucous membranes and limits quantity of secretions
Indications for Bronchodilators
Relief of bronchospasm r/t asthma, bronchitis and other pulmonary diseases
Treatment and prevention of acute attacks
Contraindications of Bronchodilators
Those with high risk of strokes, uncontrolled HTN and cardiac dysrhythmias, CAD
Adverse Effects of Alpha and Beta Bronchodilators
Insomnia, restlessness, headache, tremor, palpitations, and anorexia
Adverse Effects of Beta1 and Beta2 Bronchodilators
Cardiac stimulation
Tremor (usually lasts 30-40 minutes and then usually goes away)
Angina
Headache
Adverse Effects of Beta2 - albuterol (Bronchodilator)
Headache and tremor
Anticholinergic drugs include
Ipratropium
Bromide
Tiotropium
Anticholinergic drugs
Slow and prolonged action
Prevents bronchoconstriction
NOT for ACUTE asthma exacerbation a
Mechanism of Action: Anticholinergic Drugs
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
Indications for Anticholinergic drugs
Prevention of bronchospasm r/t chronic bronchitis or emphysema
Contraindications of Anticholinergic drugs
Allergy to atropine or to soy lecithin or to related food products (peanut oils, peanuts, soybeans, other legumes)
Adverse Effects of Anticholinergic Drugs
Dry mouth or throat Nasal congestion Palpitations, tachycardia GI discomfort Headache, cough, anxiety, restlessness
Xanthine Derivatives: Two types
Plant alkaloids and synthetic
Xanthine Derivatives: Plant Alkaloids include
Theophylline
Caffeine
Theobromine
Xanthine Derivatives: Synthetic includes
Aminophylline
Dyphilline
Mechanism of Action: Xanthine Derivatives
- 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)
Indications for Xanthine Derivatives
Dilation of airways in pt with asthma, chronic bronchitis, emphysema
Mild to moderate cases of acute asthma
Adjunct drug in management of COPD
Adverse Effects of Xanthine Derivatives
N/V and loss of appetite (anorexia) Gastroesophageal reflux during sleep Palpitations, tachycardia, ventricular dysrhythmias Increased urinary frequency Hyperglycemia
Interactions of Xanthine Derivatives
Charcoal-boiled food, high protein and low carb
St. John’s wort decreases serum drug
Leukotriene Receptor Antagonists include
Montelukast
Zafirlukast
Zileuton
Leukotriene Receptor Antagonists
Onset may be 24 hours
Nonbronchodilating
Mechanism of Action: Leukotriene Receptor Antagonist
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
Indications for Leukotriene Receptor Antagonist
Prophylaxis and long-term treatment and prevention of asthma in adults and children > 12 years
NOT meant for ACUTE asthma attacks
Montelukast is indicated for treatment of
Allergic rhinitis
Adverse Effects of Zileuton (Leukotriene Receptor Antagonist)
Headache, nausea, dizziness, insomnia and liver function problems
Adverse Effects of Zafirlukast (Leukotriene Receptor Antagonist)
Headache, nausea, diarrhea, and liver function problems
Nursing Implications of Leukotriene Receptor Antagonists
Monitor liver enzymes
Allergies to providone, lactose, titanium dioxide and cellulose derivatives
Corticosteroids include
Budesonide Flunisolide Fluticasone Ciclesonide Prednisone
Mechanism of Action: Corticosteroids
Suppress inflammation -> reduces edema, bronchospasm, increased beta2 agonist and responsiveness to beta2 agonist
Suppress inflammation -> decreases inflammation
Indications for Corticosteroids
Prophylaxis of asthma (inhalers)
NOT used for ACUTE asthma attacks
Adverse effects of Corticosteroids
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
Withdrawal and stopping of corticosteroid treatment must
Be done slowly, dosage must be tapered (taper oral agents gradually)
Must be administered on a regular schedule.
Abrupt stopping of corticosteroids can cause
Hypotension, hypoglycemia, myalgia
Oral corticosteroids
Used for long term treatment, relieve asthma episode
Teaching for Corticosteroid use
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
Combination drugs include
Advair Diskus
Advair Diskus
Combination of corticosteroids, fluticasone and long-term acting beta2 agonist Salmeterol
Bronchodilator and anti-inflammatory
Advair Diskus is used for
Asthma and COPD
Encourage pt to take measures that promote a generally good state of health to
Prevent, relieve and decrease symptoms of COPD
To prevent, relieve or decrease symptoms of COPD, pt should
Avoid exposure to conditions that precipitate bronchospasm
Have adequate fluid intake
Compliance
Avoid excessive fatigue, heat, extremes in temperature and caffeine
Encourage pt to get
Prompt treatment for flu or other illness and to get vaccinated
The nurse must first do what before beginning therapy?
Do a thorough assessment of pt
Nurse must ensure that patient know how to use by
Having pt do a return demonstration
Nurse should monitor patient for
Adverse and therapeutic effects
Albuterol if used too frequently can
Lose its beta2 specific actions at larger doses
Caution use of Xanthine in patients with
Cardiac disease
Nursing Implications for Leukotriene Receptor Antagonists
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
Bronchodilators should be used
Several minutes before inhaled corticosteroids.
The nurse should keep track of
The number of doses in the inhaler devices
Nursing Implications for Inhaled drugs
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
Order to Administer Medications
- Bronchodilators
- Anticholinergics
- Corticosteroids
