COPD and Asthma Drugs Flashcards
What is Status asthmaticus?
A medical emergency
Broncholaoliater that is a glucocorticoid? What kind of mechanism/ drug is it?
B2-adrenergic agonists
salbutamol (Ventalin or Albutera)
Broncholaolater that is a Anticholinergics
ipratropium bromide (Atrovent)
Xanthine derivatives bronchodilator?
theophylline/aminophylline
Anti-inflammatory glucocorticoid?
budesonide (Pulmicort)
example of a Anti-inflammatory Leukotriene Modifier?
montelukast (Singulair)
What kind of drug salbutamol? How is it used? When is it used? (Ventalin or Albutera)
It is a Selective b2 drug that Activates airway smooth muscle b2 receptors
-It is a short-acting drug relaxes smooth muscles of the airway and results in bronchial dilation
It is used for acute attacks to quickly reduce airway constriction and restore normal airflow , it is not to be used on its own or as a preventative medication! it is often combined with other medication
Theraputic uses of glucocorticoids as respiratory medication?
They are a first line therapy for management of the inflammatory component of asthma, the provide significant long term control and management of symptoms and because of this they play an important role
Care Implications Bronchodilators: β-Agonists ?
-Encourage measures that promote good state of health in order to prevent, relieve, or decrease symptoms of asthma/COPD
-avoid exposure to conditions that precipitate bronchospasms (smoking, allergens, stress, air pollutants)
Adequate fluid intake
What Bronchodilators: Anticholinergics is used to prevent bronchoconstriction ? Compared to salbutamol how fast does it last? What kind of action does it have? What is it not used for?
ipratropium bromide (Atrovent)
Slow(er) and prolonged action
compared to salbutamol
NOT used alone for acute exacerbations!
Example of oral Bronchodilators: Methylxanthines?
Theophylline
Example of IV Bronchodilators: Methylxanthines? How is it different from theophylline?
Aminophylline
It is more water soluable
What do Methylxanthines allow greater of? what do they provide a quick relief from?
-Quick relief of bronchospasm
greater airflow into and out of the lungs
Bronchial smooth muscle relaxation
When do we use/ what are the indications if use for Xanthine Derivatives? What do they adjunctively treat?
-Used for the treatment of mild to moderate cases of acute asthma
-Adjunct agent in the management of COPD
Methylxanthines: Adverse Effects on CV and GI systems?
CNS stimulation:
CV stimulation
Palpitations (increased force of contraction/fast HR)
Sinus tachycardia (increased HR)
Ventricular dysrhythmias
GI Distress:
nausea, vomiting
Care Implications: Methylxanthines? what must our patients report?
Encourage to have them report to physician:
Palpitations
Nausea and/or Vomiting
Weakness or Dizziness
Chest pain
Convulsions
Methylxanthines: Interactions, what happens with increased effects of theophylline? Large amounts of caffeine? What happens with Decreased effects of theophylline?
-Increased effects of theophylline:
Ciprofloxacin (fluroquinilone antibacterial)
inhibits liver CYP metabolism
many others
Large amounts of caffeine can intensify adverse effects
Decreased effects of theophylline:
increases metabolism of xanthines
What do inhaled forms of glucocorticoids reduce? How long does it take to reach a therapeutic effect?
Inhaled forms reduce systemic effects
May take several weeks for full therapeutic effect
Inhaled glucocorticoid? What is it often combined with to form a certain kind of drug>
budesonide
Budesonide + formoterol (Symbicort)
What is fluticasone? used alone what is it called? What other medication is it combined with?
-used alone (Flovent)
-used in combination Advair diskus
combo with long-acting b2- agonist salmeterol
Why should brinchodilators be used several min before glucocorticoid is administered?
bronchodilator should be used several minutes before the glucocorticoid to provide bronchodilation before administration of the glucocorticoid
What do Leukotrienes do? What can they cause?
-released in immune responses from (eg mast cells, eosinophils) in asthma
Leukotrienes cause
Leukotrienes cause:
-inflammation
-bronchoconstriction
-mucus production
-leucocyte recruitment
What are the Suppressing leukotriene effects?
-Prevent smooth muscle contraction of the
bronchial airways
-Decrease mucus secretion
-Prevent vascular permeability
-Decrease neutrophil and other leukocyte infiltration to the lungs, preventing inflammation
Example of a Leukotriene receptor antagonists? How is it tolerated?
-montelukast: it’s generally well tolerated
Example of a Leukotriene synthesis inhibitor?
zileuton
Leukotriene Modulators: Indications/ when do we use them? What are they not used for? When can improvements be seen?
Prophylaxis and chronic treatment of asthma in adults and children
montelukast in children ages 2 and older (Canada)
NOT for acute asthmatic attacks, they are used for chronic management of asthma
on a continuous schedule, Improvement should be seen in 1 day - 1 week
H1 antagonists are? What do some also act as?
Antihistamines
some also act as anticholinergic drugs
What are H2 blockers or H2 antagonists used for? What are they generally not referred to as?
-used to reduce gastric acid in PUD (peptic ulcer disease)
-generally not referred to as ‘antihistamines’
Histamine-mediated disorders?
Allergic rhinitis (hay fever, mould and dust allergies)
Anaphylaxis
Angioedema
Drug fevers- usually young children
Insect bite reactions
Urticaria (redness and itching)
Antihistamines: Mechanism of Action/ how do they work? Antihistamine effect
Block of H1 receptors prevents the adverse consequences of histamine receptor (increase vasodilation and capillary permeability)
Reduce dilation of blood vessels
Reduce increased permeability of blood vessels
Histamine action/ how does it work?
Dilation and increased permeability
What kind of effects do traditional Antihistamines have?
Have anticholinergic effects
Example of traditional histamine? Downside? What can it also be used as?
diphenhydramine (Benadryl); chlorpheniramine
-Sedation/drowsiness
-also used as a sleep aid
What is the Drying effect that traditional antihistamines reduce?
nasal
lacrimal gland secretions (runny nose, tearing, and itching eyes)
salivary
Traditional antihistamine adverse effects?
Dry mouth (reduced salivary secretions)
Difficulty urinating
Constipation
Changes in vision (dilated pupils, blurred vision)
What kind of CNS effects do non-traditional antihistamines have?
Have fewer CNS adverse effects
Example of non-traditional antihistamines?
Loratadine (Claratin)
What do you not consume when taking traditional antihistamines?
Do not consume alcohol or other CNS depressants.
What kind of drugs are Antitussives? What are they used for? What is the most common form of them?
-Drugs used to stop or reduce coughing
antitussives
-most common form is in opioids
What kind of coughs are antitussives used for?
Used only for nonproductive coughs! (dry cough)
What is Dextromethorphan? What kind of drug is it? What kind of effects does it NOT have?
-It is a common OTC antitussive
-it is a Synthetic opioid-like compound
-does NOT produce morphine-like effects
Antitussives: Adverse Effects (codeine)
*Constipation
typical opioid effects
Antitussives: Adverse Effects Dextromethorphan (Benylin)
Dizziness, drowsiness, nausea
much less than CNS effects of codiene
Antitussive Agents: Nursing Implications/ what must we watch for?
cough that lasts more than a week
-persistent headache
fever
-rash
*-Antitussive agents are for nonproductive coughs *
