Exam 1 Flashcards
Short Acting Beta Agonists (SABA)
Albuterol:
-short acting beta 2 agonist that relaxes bronchial smooth muscle
- Used for treatment of bronchospasm
- Onset: within 10 mins
- Duration: 4-6 hrs
- Adverse effects: excitement, nervousness, tremor, bronchospasm, tachycardia
Long Acting Beta Agonist (LABA)
Formoterol:
-long acting beta 2 agonist that relaxes bronchial smooth muscle
- Used for long term prevention of bronchospasm
- Onset: within 3 mins, but peaks within 1-3 hrs
- Duration: 12 hrs
- Adverse effects: excitement, nervousness, tremor, bronchospasm, tachycardia
- SHOULD NOT BE USED FOR TREATMENT OF ACUTE ASTHMA EXACERBATIONS*
Short Acting Anticholinergics (SAMA)
Ipratropium:
-blocks the action of acetylcholine on bronchial smooth muscle which causes bronchodilation
- Used for COPD maintenance, off-label asthma exacerbations
- Onset: within 15 mins
- Duration: Neb 4-5hrs, MDI 2-4 hrs
- Adverse effects: bronchitis, headache, dizziness, anticholinergic effects
Long Acting Anticholinergics (LAMA)
Tiotropium:
-blocks the action of acetylcholine on bronchial smooth muscle which causes bronchodilation
- Used for COPD/asthma maintenance
- Half-life: 25-44 hrs
- Adverse effects: bronchitis, headache, dizziness, anticholinergic effects
Inhaled Corticosteroids (ICS)
Budesonide:
-Used for COPD/asthma maintenance
- Onset: Neb 2-8 days, Inhaler 24 hrs
- Adverse effects: otitis media, respiratory infections, thrush, immunosuppression
- NOT USED IN ACUTE RESPIRATORY DISTRESS*
Systemic IV steroid
Solumedrol:
-Used for COPD/asthma exacerbations
- Onset: 1 hr
- Adverse effects: immunosuppression, hyperglycemia
- Monitor response and glucose
Oral Systemic Glucocorticoid
Prednisone:
-Used for long term management of severe COPD/asthma, acute asthma/COPD exacerbations
-Adverse effects: (dry mouth, throat irritation, hoarseness)
(headache, euphoria, confusion, depression) (hyperglycemia, GI distress, hypertension) (electrolyte imbalance, fluid retention) (osteoporosis, psychosis, superinfections)
Magnesium sulfate
- Classification: Electrolyte supplement
- Uses: off labeled treatment of severe asthma exacerbations
- Onset: IV immediate
- Adverse effects: flushing, hypotension
Epinephrine
- Classification: alpha/beta agonist
- Uses: severe bronchospasm in asthma exacerbations
- Onset: SQ 5-10 mins
- Adverse effects: cardiovascular effects
- Monitor cardiopulmonary response
Xolair
- Classification: IgG monoclonal antibody
- inhibits IgE binding to IgE receptors on mast cells and basophils
- for pts whose asthma is triggered by allergens
- Onset: 12-16 weeks
- Half-life: 26 days
- Adverse effects: headaches, local injection site reactions
- Monitor for anaphylactic/hypersensitivity reactions, monitor baseline IgE, monitor for signs of infection (bc it has immunosuppressant affects)
Leukotriene Receptor Antagonist
Singulair
-leukotriene receptor plays a role in promoting the associated airway edema, smooth muscle contraction and altered cellular activity associated with inflammatory process of asthma
- Uses: asthma maintenance
- Duration: 24 hrs
- Adverse effects: headache, dizziness, fatigue, nausea, and neuropyschiatric events
- Monitor mood or behavior changes including suicidal thoughts/actions
Mucolytics
Acetylcysteine
-Uses: adjunct therapy in pts with abnormal viscous secretions like COPD/bronchial asthma
- Onset: 5 -10 mins
- Adverse effects: chest tightness, hypotension, rash, GI symptoms, bronchospasm
- Likely will increase bronchial secretions*
First generation antihistamines
Cause drowsiness
Ex: diphenhydramine (Benadryl)
Avoid use with MAOIs, CNS depression with use of alcohol, barbituates, hypnotics and opioids
Second generation antihistamines
Less drowsiness
Ex: cetirizine, loratadine, desloratadine, fexofenadine
Half life: 3-30 hrs
Decongestants
Stimulate alpha adrenergic receptors causing vasoconstriction of capillaries in mucosa allowing less fluid secretion
Long term use can cause rebound nasal congestion
Glucocorticoids
Prednisone, beclomethasone
Stabilization of mast cells
Anti-inflammatory action
Antitussives
Act on cough control center in medulla to stop cough reflex
1) non-opioid (Benzonatate)
2) opioid (codeine, guaifenesin)
3) combination
Ex: dextromethorphan - expectorant and antitussive (non-opioid)
Expectorants
Loosen bronchial secretions so they can be excreted by coughing
Ex: guaifenesin (most common), dextromethorphan can be used as expectorant
Maintain good hydration to help thin secretions (hydration is natural expectorant)
Rapid acting insulin
Ex: insulin lispro, insulin aspart, glulisine
Onset: 15-30mins
Administer 10-15 mins before meal time
Short acting insulin
Regular insulin
Onset: 30 mins
Peak: 90 mins-3.5 hrs
Duration: 4-12 hrs
Intermediate acting insulin
NPH, Humulin N, Novolin N
Onset: 1-2 hrs
Peak: 4-12 hrs
Duration: 14-24 hrs
Long acting insulin
Lantus (glargine), Levemir (detemir)
Onset: 2 hrs
Peak: NONE
Duration: 24 hrs
Somoygi effect
Hypoglycemia in pre-dawn hours (2am-4am)
Indicates decrease insulin dose at bedtime
Dawn phenomenon
Hyperglycemia upon awakening
Indicates need for increased insulin dose at bedtime
