Chapters 73 & 74 Flashcards by Ky Arnold

Perfusion

Ventilation

Blood flow through the lungs

Air moving through the lungs

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Sympathetic branch of ANS

Relaxes smooth muscle of bronchioles
Increases diameter of airway
Bronchodialates, relaxing smooth muscle

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Parasympathetic branch of ANS

Contracts smooth muscle of bronchioles
Narrows diameter of airway, decrease lumen
Bronchoconstricts

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Asthma

Bronchospasm

Inflammation

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COPD (chronic obstructive pulmonary disease)

Emphysema

Chronic Bronchitis

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Beta Adrenergics (primary treatment for asthma)

Beta 1

Beta 2

Beta 1 receptors found in heart

Beta 2 receptors found in lungs and other organs

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Non selective Bronchodialators

Selective agents

Non act on both beta 1&2

Selective act on only 1 or 2. (prescribed more often, minimal effect on heart)

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Beta 2 Adrenergic agonist (used most)

Relaxes bronchial smooth muscle resulting in Bronchodialation
Meds either long or short acting
Short-terminates attack
Long-prevention, used routinely

Used by inhalation of Meds by inhalers or nebulizer

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Prototype Beta 2 Adrenergic agonist-

Adverse effects-

Albuterol:
Short acting (rescue inhaler)

Adverse effects- tachycardia, headache, throat irritation, nervousness, restless, insomnia

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Albuterol contraindications

Tachydysrhythmia
Coronary artery disease
HTN

Drug interaction:
Use with beta blockers, MAOI, thyroid replacement therapy

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Albuterol nursing interventions

Rinse mouth
Asses VS before and after use
Asses lungs
Limit caffeine and nicotine

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Anticholinergics

Prevention of bronchospasm, not rescue
Atrovent
Blocks parasympathetic nervous system to stimulate sympathetic
Bronchodialates by blocking cholinergic receptors in bronchial smooth muscle.

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Prototype Anticholinergic-

Adverse effect-

Atrovent

Adverse effects: 
Can worsen glaucoma
Dry mouth, nausea 
Life threatening paradoxical acute bronchospasm 
Bitter taste in mouth (common)

*contraindication: do not use with other Anticholinergics

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Nursing interventions when using Atrovent

Treat to report lack of improvement or increasing severity of bronchospasm
Asses for history of glaucoma
Use for prevention not attack
Not for children under 12

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Inhaled corticosteroid

Most effective
Decreases inflammation
Inhibits synthesis and release of inflammatory mediators:
Histamine, leukotrienes, cytokines, prostaglandins (these cause edema & mucus in airway

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Prototype Corticosteroid-

Adverse effect-

Beconase

Adverse effects (all rare):
Dry mouth, hoarse voice
Cataract development
Growth inhibition in children
Masking infection (no fever, WBC count normal)
Yeast infection in mouth

*no contraindications for corticosteroids

Nursing interventions for Beconase

Vaccinate children for chicken pox
Monitor diabetes and chronic illnesses
Height of children
Density in older patients
Cataract development 
Teach steroids will not terminate attack
Steroids increase blood glucose

Mast cell stabilizers

Mast cells- large cells containing inflammatory granules (histamine) which mediates inflammatory and allergic reactions

Prevent degranulation of mast cells

Prototype Mast cell stabilizer-

Adverse effects-

Interventions-

Intal

Bronchospasm
Cough
Throat irritation

Use Bronchodialator, wait 5 min, then use Intal
Not for attacks
Takes several weeks

Leukotriene Modifiers

Mediators of immune inflammatory responses
When in airways they promote: edema, inflammation, bronchoconstriction
Reduces spasms by blocking synthesis or receptors
Prevention

Leukotriene Modifier Prototype-

Adverse effects-

Contraindications-

Interventions-

Accolate

Headache
Rhinitis
NVD(rare)

Contraindications- liver failure. Interactions with aspirin

Take on an empty stomach
No alcohol
Take routinely

Methylxanthines

Used when other Meds don’t work
Mild bronchodilator effect
Narrow therapeutic index
Stimulants, related to caffeine

Methylxanthine Prototype-

Adverse effects-

Theolair

Toxicity, NV, headache, insomnia, dysrhytmia, hypotension, seizures

Methylxanthine Contraindications-

Interventions-

Seizure disorder
Heart failure
Dysrhytmia
Liver disease

Monitor respiratory status
Limit caffeine
No smoking
Report S/S: no appetite, NV, dizziness, insomnia, hypotension, seizures

Biologic Therapy Monoclonal Antibodies Prototype Adverse effects

Xolair Used when other Meds don't work Given SC every 2-4 weeks Attached to receptor on IgE that reacts to antigen causing release of chemical mediators from mast cells -ages 12 and up ``` Anaphylaxis Bleeding Rash Headache Viral infections ```

Antihistamines (H1 receptor antagonist)

First generation- Benadryl They block histamine from reaching its h1 receptor Do not prevent release of histamine from mast cells

2nd generation Antihistamine Prototype Adverse effects

Allegra Binds with histamine sites, long half life, made in combination with a decongestant (sudafed) Headache Nausea Viral infections Dry mouth *contraindications- renal disease Aluminum and magnesium decrease absorption Fruit juice decrease bio availability

Allegra interventions

Dizziness precautions Call if symptoms last longer than 3 weeks Stop 4 days prior to skin allergy tests

Intranasal corticosteroid Adverse effect

Flonase- works by vasoconstriction and anti inflammatory actions, stops secretions of mast cells. 1-3 weeks to work Stinging Headache Nose bleeds *contraindications- not for under age 4

Decongestants

Sudafed Used for: allergic rhinitis, congestion, cold, opening eustachian tubes, prevents barotrauma Activates alpha 1(nose) Adrenergic receptors causing vasodilation Stimulates beta 2 Adrenergic receptors in respiratory tract for slight Bronchodialation.

Adverse effects of Sudafed Contraindications

Insomnia, dizziness, anxiety Dysrhythmia, HTN, palpations, dry mouth Contraindicated in: HTN, CAD, children under 2, caution with all children

Drug interactions with Sudafed Interventions

``` Not with MAOI CNS and cardiovascular stimulation Extreme hypertension and bradycardia with beta blockers Avoid nitrates With digoxin= cardiac Dysrhythmias ``` Monitor VS frequent Use 3-5 days Asses for CV disease Not before bed or higher doses

Treatment for common cold

``` Antihistamines Decongestants Antitussives Expectorants Analgesics ```

Antitussives

Suppress cough- Robitussin, not for pneumonia Opioids= most effect- codeine and hydocodone Contraindications- CNS toxic at high doses (grapefruit raises serum), liver damage, 2 and older, caution with COPD

Expectorants

Mucinex Increase secretions of mucus Reduces thickness of secretions Adverse: NV, ab pain at high doses, toxic for children under 2

Mucolytics

Mucomyst Thins and loosens thick secretions Adverse: bronchospasm, NV, fever