Chapter 39 Flashcards
Functions of the Respiratory System
Gas exchange Delivery of oxygen to tissues through Kreb cycle Remove wastes Acid-base balance Protection
Respiratory pH range
7.34-7.45
Respiratory diffusion
O2 & CO2 between alveoli & pulmonary capillaries
Respiratory perfusion
O2 & CO2 between capillaries & body cells
bronchodilators stimulate?
beta2- adrenergic receptors
Sympathetic nervous system stimulation causes?
Bronchodilation
Increased rate & depth of respirations
Parasympathetic nervous stimulation causes?
Bronchconstriction
Decreases rate & depth of respirations
Aerosol Therapy effects
Immediate relief of bronchospasm
Loosens thick mucus
Disadvantages of Aerosol Therapy
Difficult to measure dose (only 10–50% of drug is placed)
side effects occur if client swallows drug
bitter taste
must rinse mouth
Small volume nebulizer (SVN)
Aerosol
Vaporizes liquid drug into fine mist
Uses small machine and face mask
Asthma
inflammation and constriction of airway
Status Asthmaticus
acute attack with severe bronchospasm
does not respond well to bronchodilator therapy
Rescue medication types
Short acting beta2-agonists
Anticholingerics
Controller medication types
Inhaled corticosteroids
Long acting beta2-agonists
Leukotriene modifiers
Mast cell stabilizers
Bronchodilators
Beta agonists
Albuterol (Proventil)
Salmeterol (Serevent)
Salmeterol + Fluticasone (Advair)
Bronchodilator mechanism of action
stimulates sympathetic receptors in bronchial smooth muscle to cause bronchodilation
Beta2-Adrenergic Agonists
Sympathomimetics
Most effective drugs for relieving acute bronchoconstriction
Beta2-Adrenergic Agonists action
activate beta2-receptors in bronchial smooth muscle to cause bronchodilation
Beta2-Adrenergic Agonist route
inhalation
orally
Beta2-Adrenergic Agonist oral therapy
Longer duration of action than oral
can cause systemic effects of tachycardia, dysrhythmias, hyperglycemia(because of steroid component)
Beta2-Adrenergic Agonist long term use
decreased duration of action
leads to increased dose or addition of glucocorticoid
beta 2 receptors may decrease as you age
salmeterol (Serevent) category
Beta2-Adrenergic Agonists
salmeterol (Serevent) mechanism of action
selectively binds to beta2-receptors in bronchial smooth muscle
causes bronchodilation
salmeterol (Serevent) use
prevention of exercise-induced bronchospasm
not for acute rescue, given hours before exercise
salmeterol (Serevent) adverse effects
headaches, throat irritation nervousness, restlessness, tachycardia, dry mouth
Anticholinergics action
block parasympathetic nervous system causing bronchodilator effect
possible alternative to beta agonists
Ipratropium (Atrovent) category
Anticholinergic
Ipratropium (Atrovent)
slower and less effective than beta 2 agonists
most effective when combined with beta 2 agonist or glucocorticoid
Tiotropium (Spiriva) category
Anticholinergic
Tiotropium (Spiriva) adverse effects
dry mouth, GI distress, HA, anxiety, rare systemic
Anticholinergic contraindications
narrow-angle glaucoma, benign prostatic hyperplasia, renal disorders, urinary bladder neck obstruction
do not give under 12 years old
Albuterol (Proventil) length of action
short
Salmeterol (Serevent) length of action
moderate
Salmeterol + Fluticasone (Advair) length of action
moderate plus steroid for long action
Beta2-Adrenergic Agonist contraindications
soy or peanut allergy
Anticholinergics ending
tropium
Ipratropium (Atrovent) mechanism of action
bronchodilation by blocking cholinergic receptors in bronchial smooth muscle
Ipratropium (Atrovent) use
acute bronchospasm
chronic bronchitis
symptomatic relief of nasal congestion
Ipratropium (Atrovent) adverse effects
cough, drying of nasal mucosa, hoarseness, bitter taste
Methylxanthines category
bronchodilators related to caffiene
Methylxanthines ending
lline
theophylline (Theo-dur) category
Methylxanthines
theophylline (Theo-dur) cautions
narrow margin of safety & interacts with many drugs
why don’t we use Methylxanthines
Less effective and produce more side effects than beta 2-agonists
Methylxanthines adverse effects
profound nervousness
nausea, vomiting, CNS stimulation, dysrhythmias, insomnia
Methylxanthines route
intravenous or oral
Methylxanthines use
long-term prophylaxis of asthma that is unresponsive to beta-agonists or glucocorticoids
theophylline (Theo-dur) use
given IV for an acute event
What to assess when giving Methylxanthines
Respiratory and pulse rate, cardiac rhythm, lung sounds
Respiratory effort, skin color, oxygen-saturation level
conditions contraindicated with Methylxanthines
Coronary artery disease, angina pectoris
Severe renal or liver disorders, peptic ulcer
Benign prostatic hyperplasia, diabetes mellitus
Glucocorticoids action
decrease activation of inflammatory cells and increase production of anti-inflammatory mediators
Diminish mucus production
Sensitize bronchial muscle to be more responsive to beta2-agonist
Reduce bronchial hyper responsiveness to allergens
Glucocorticoids route
inhaled or oral
Glucocorticoids inhaled use
preventing an asthma attack
Glucocorticoids oral use
short-term therapy of severe, acute asthma
Oral Glucocorticoids time
Limit therapy to 5-7 days
Oral Glucocorticoids adverse effects
adrenal gland atrophy, peptic ulcers, osteoporosis, hyperglycemia
more dangerous than inhailed
inhaled Glucocorticoids time
take 4-8 weeks for maximal effectiveness
taken daily for therapeutic effect
inhaled Glucocorticoids adverse effects
hoarseness, candidiasis
Glucocorticoids teaching
rinse mouth after use (all steroid inhalers)
Cautions when using Glucocorticoids
PT’s with hypertension, GI disease, congestive heart failure, thromboembolic disease
Closely monitor blood glucose levels
beclomethasone (Beclovent, Beconase, Vancenase, Vanceril)
category
Glucocorticoid
beclomethasone (Beclovent, Beconase, Vancenase, Vanceril) mechanism of action
reducing inflammation
beclomethasone (Beclovent, Beconase, Vancenase, Vanceril) use
decrease # of asthma attacks
allergic rhinitis
not for acute attack
use 1-2 inhalations tid (max 20)
beclomethasone (Beclovent, Beconase, Vancenase, Vanceril) adverse effects
oropharyngeal candidiasis, dry mouth, cough, sore throat
Leukotrienes
occur naturally in the body
mediators of immune response
Promote edema, inflammation & bronchoconstriction
Involved in allergic and asthmatic reactions
Leukotriene Modifiers use
oral medications used for asthma prophylaxis
not for acute tx
Leukotriene Modifiers mechanism of action
Reduce inflammation/edema
Zileuton (Zyflo) category
leukotriene modifier
Zafilukast (Accolate) & Montelukast (Singulair)
block leukotriene receptors
May take up to 1 week for optimum therapeutic benefit
take in AM to avoid insomnia
Zileuton (Zyflo) mechanism of action
blocks lipoxgenase, an enzyme that synthesizes leukotrienes
Zileuton (Zyflo) time
Must be taken QID
More rapid onset of action
What to monitor with Leukotriene Modifiers
Respiratory and pulse rates, respiratory effort, lung sounds
Skin color, oxygen-saturation level
Liver finction
PT & INR when taking coumadin
zafirlukast (Accolate) category
Leukotriene Modifier
zafirlukast (Accolate) mechanism of action
prevents airway edema and inflammation by blocking leukotriene receptors in airways
zafirlukast (Accolate) use
for prophylaxis of persistent, chronic asthma
zafirlukast (Accolate) adverse effects
headache, nausea, diarrhea, rare hepatic failure, depression, insomnia, dark urine, clay colored stools (indicate hepatic involvement)
Mast-Cell Stabilizers action
inhibit mast cells from releasing histamine and other chemical mediators
Reduce inflammation
Mast-Cell Stabilizers teaching
take daily
takes weeks to reach therapeutic level
not for acute attack
less effective than glucocorticicoids
Cromolyn (Intal) category
mast cell stabilizers
Cromolyn (Intal) administration
through MDI of nebulizer
Inhaled 4-6x/day due to short half life
Cromolyn (Intal) adverse effects
stinging or burning of nasal passages, throat irritation, nasal congestion
Uncommon: bronchospasm, anaphylaxis
unplesent taste
Chronic Obstructive Pulmonary Disease (COPD)
characterized by airflow obstruction resulting from chronic bronchitis or emphysema
emphysema characteristics
loss of elastic recoil in the lungs so they are overly distended
destruction of elastic lining trapping air in distal spaces
emphysema breathing pattern
Use of accessory muscles, tachypnea, pursed-lip breathing
Chronic Bronchitis
productive cough for 3 months in each of 2 successive years
Chronic Bronchitis characteristics
Potential cor pulmonale (collapse), atelectasis
Increased airway resistance
COPD Drug Therapy
Bronchodilators (maintenance)
Corticosteroids (exacerbations)
Mucolytics & expectorants
Antibiotics
Parasympathetic
constriction
Sympathetic
dilation
