[Exam 1] ATI: Module 4: Lower Respiratory Disorders Flashcards
1
Q
What are the two classifications of drugs to help treat asthma and chronic obstructive pulmonary diseases
A
Bronchodilators and Anti-inflammatory
2
Q
Sub specific groups of drugs include
A
Beta2-Adrenergic Agonists
Anticholinergics
Methylxanthines
Glucocorticoids
Mast Cell Stabilizers
Leukotrine Modifiers
3
Q
Remember that Beta-2 Adrenergic agonists stimulate
A
BEta2 cells of the adrenergic or sympathetic nervous sytem
4
Q
Beta2-Adrenergic Agonists: Therapeutic use are
A
in the relief of acute bronchospasm and prevention of exercise induced bronchospasm (EIB)
5
Q
Beta2-Adrenergic Agonists: Drug selection depends on intended effect such as
A
Fast relief ( used as rescue inhalers) or long term management
6
Q
Beta2-Adrenergic Agonists - Prototype and Other Drugs: Short acting Beta2 Adrenergic Agonist is
A
Albuterol (Proventil HFA and Ventolin HFA)
7
Q
Beta2-Adrenergic Agonists - Prototype and Other Drugs: Long Acting beta2 - adrenergic agonists include
A
Formoterol (Foradil Aerolizer)
Salmeterol (Serevent)
Terebutaline only in generic form
8
Q
Beta2-Adrenergic Agonists - Expectd Pharmacologic
Action: Therapeutic Effect
A
Stimulate Beta2- Adrenergic receptors of sympathetic resulting in bronchdilation.
9
Q
Beta2-Adrenergic Agonists - Expected Pharmacologic Action, the primary one
A
Relieve bronchospasm of the bronchi and bronchioles of the lungs.
Play minor role in increasing ciliary motility.
Airways stay open and used on those with COPD
10
Q
Beta2-Adrenergic Agonists - Adverse Drug Reactions : Side Effects?
A
Tachycardia, Heart Palpitations and Tremors. Angina as well.
11
Q
Beta2-Adrenergic Agonists - Adverse Drug Reactions : Be cautioned against overusing
A
short-acting rescue inhalers more than twice a week
12
Q
Beta2-Adrenergic Agonists - Interventions : Monitor for
A
Tachycardia, heart palpitations and any chest pain
13
Q
Beta2-Adrenergic Agonists - Administration: You can give this
A
Orally or by Inhalation
14
Q
Beta2-Adrenergic Agonists - Administration: Give Shor and Long Acting Preps for what?
A
Short-acting preparations for acute exacerbations
Long-acting preparations for long-term control
15
Q
Beta2-Adrenergic Agonists - Administration: IF taking glucocorticoid, what must you do?
A
Take Beta2 drug before glucocorticoid. Allows airway to dilate first.
16
Q
Beta2-Adrenergic Agonists - Client Instructions: Tell client to avoid
A
Caffeine
17
Q
Beta2-Adrenergic Agonists - Client Instructions: Let provider know if
A
they experience tremors that interefere with ADL. Watch for impending exacerbations of asthma.
18
Q
Beta2-Adrenergic Agonists - Contraindications and Precautions: Dont give what to clients
A
Albuterol or Levabuterol to those who are allergic.
For allergy to Beta2, give caution when giving albuterol with history of side effects
19
Q
Beta2-Adrenergic Agonists - Contraindications and Precautions: For those with diabetes, hyperthyroidism, CVD, or hypertension they make take…. but …
A
Albuterol, but make sure you monitor them incase of increase in sympathetic stimulation
20
Q
Beta2-Adrenergic Agonists - Interations: Beta-Adrenergic Blockers do what?
A
Reduce effectiveness
21
Q
Beta2-Adrenergic Agonists - Interations: MAOIs and Tricyclic Antidepressants do what?
A
Increase risk of hypertension, tachycardia, and Angina.
22
Q
Beta2-Adrenergic Agonists - Interations: HYpoglyemic or Antidiabetics do what?
A
REquire increased dosing because of hyperglycemic effect of drug
23
Q
Beta2-Adrenergic Agonists - Interations: What drugs to watch out for
A
BEta-Adrenergic Blocker
MAOIs
Tricyclic Antidepressants
Hypoglycemia ./ Antidiabetic Drugs
24
Q
Anticholinergics: Why are these used?
A
Provide relief of bronchoconstriction and reduction of secretions in clients who have COPD
25
Anticholinergics - Prototype and Other Drugs: Drugs included are
Ipatropium (Atrovent , Atrovent HFA)
26
Anticholinergics - Expected Pharmacologic Action: Inhaled anticholinergics work by
inhibiting the action of acetylcholine.
27
Anticholinergics - Expected Pharmacologic Action: What does Acetylcholine causes
vasoconstriction of the bronchi and bronchioles, blocking stimulation of fparasympathetic receptors.
28
Anticholinergics - Adverse Drug Reactions: Confined to local reactions like
dry mouth and pharyngeal iritation.
29
Anticholinergics - Adverse Drug Reactions: For someone who has history of narrow-angle glaucoma, what can occur
Increased intraocular pressure
30
Anticholinergics - Adverse Drug Reactions: Other adverse reactions include
headache, dizziness, blurred vision, epistaxis, bronchospasms and hypotension
31
Anticholinergics - Interventions: WIth dry mouth, provide
Also monitor for
Water to sip on and hard candy to ease discomfort.
Get routine eye exams
Monitor urinary eleimation patterns for unirary retention.
32
Anticholinergics - Administration: Can admister via
inhaler or nebulizer
33
Anticholinergics - Administration: If you have to admiister otoher inhalants at same time, how long should you wait?
Five minutes .
34
Anticholinergics - Administration: Drugs and the aftertase
Drugs have unpleasant aftertase, so make sure to have water to rinse mouth
35
Anticholinergics - Administration (Safety Alert): Make sure client knows what?
Ensure clients know that inhaled anticholinergics are not meant for acute asthma exacerbation.
Labeled bronchodilators for COPD
36
Anticholinergics - Client Insttructions: Instruct client to
suck on hard candy and sip water frequently for dry mouth
Regular eye exams
Report any changes in urinary
37
Anticholinergics - Contraindications and Precautions: Take caution in giving what to clients who have glaucoma, prostatic hyperplasia, bladder neck obstruction, or urinary retention?
Ipratropium
38
Anticholinergics - Contraindications and Precautions (Safety Alert): Clients sensitive to what need to avoid Combivent (Ipratropium/Albuterol Combination) MDI due to allergic reaction risk
Those sensitive to soy or peanuts
39
Anticholinergics - Interactions: What should you do if taking Beta2-Adrenergic Agonists?
They enhance bronchodilation, so make sure dosage adjusted if taking both
40
Methylxanthines: What is this used for?
Drug used in long-term management of chronic stable asthma, though not idely used. No longer recommended for COPD
41
Methylxanthines - Prototype and Other Drugs: Prototype is
Theophylline (Theolair, Theochron, and Theo-24)
Aminophylline (generic only) us preferred for IV Administration
42
Methylxanthines - Prototype and Other Drugs: Theo-24 is what?
Extended-release form that provides 24-hour coverage in clients who metabolize theophylline at expected rate. Those who smoke would not be apporpriate candiates. Check blood levels
43
Methylxanthines - Expected Pharmacologic ACtion:
Relax smooth muscles of bronchi
44
Methylxanthines - Adverse Drug Reactions: When blood level exceeds the therapeutic level, wha thappens?
Restlessness and Insomnia.
Might also experience N/V, Diarrhea.
45
Methylxanthines - Adverse Drug Reactions: When blood at toxic levels signs are
Seizures and Dysrhythmias
46
Methylxanthines - Interventions: You should do what?
Monitor blood level, making sure it doesnt rise from delayed metabolism
Give activated charcoal to decrease additional absorption
47
Methylxanthines - Interventions (Safety Alert): What is administered if life-threatening cardiac dysrhythmias occur?
Antidysrhythmics to restore heart rate and rhythm
48
Methylxanthines - Interventions (Safety Alert): If client experiences a seizure ..
initiate anticonvulsant therapy
49
Methylxanthines - Administration: How is this administered?
Orally. Base dose based on childs age, weight, and other factors.
50
Methylxanthines - Administration: insructions to follow?
Give at prescribed intervals, to maintain therapeutic blood level.
Do not double dose if missed.
If chewable, chew throughouly.
51
Methylxanthines - Administration: IV Administration is set aside for
emergencies and care must be taken to infuse drug slowly
52
Methylxanthines - Client Instructions: What shhoudl they do?
Reduce caffeine intake.
Periodic lab testing of drug levels.
List side effects of if blood level too high to notify provider
Stop taking of toxic effects occur
53
Methylxanthines - Contraindications and Precuations: Use cautiosly in those who
smoke tobacco or marijuana.
54
Methylxanthines - Contraindications and Precuations: Need to be aware of what disease and their medications drug-to-drug interaction?
Seizure, TB Peptic Ulcer, or Bacteria
55
Methylxanthines - Interactions: What can increase clients risk of toxicity?
Cimetidine (Tagamet) as well with some FLuroquinolones
56
Methylxanthines - Interactions: Caffeine should be minimized because?
Caffeine is a Methyxanthines, and would increase dosage.
57
Methylxanthines - Interactions: What causes increases in metabolism of theophylline causing a decrease in blood level?
Nicotine, Phenobarbitl, and Phenytoin
58
Methylxanthines - Interactions (Safety Alert), Taking what for indigestion of GERD increases risk for methyxanthine toxicity?
Cimetidine
59
Glucocorticoids: Why are they important?
Because of their significant ability to suppress the immune system and decrease inflamtion.
60
Glucocorticoids: Inhaled Glucococorticoids are for what?
Long-term management of chronic asthma
61
Glucocorticoids: What are oral glucocorticoids are for
short-term management of post-exacerbation symptoms
62
Glucocorticoids - Prototype and Other Drugs: What are theey
Beclomethasone Dipropionate (QVAR) - Inhalant
Prednisone (Orally)
Gluticasone (Flonase) Intranasally or orally known as FLovent
63
Glucocorticoids - Expected Pharmacologic Action: These prevent the release of
leukotrienes, prostaglandins and histamine. PRevents action of WBC too.
Decreases actions of these cells decrease inflammation and subsequently, decreases edema of airways.
64
Glucocorticoids - Adverse Drug Reactions: Inhaled glucocorticoids can cause
oral candidiasis, which is a yeast infection.
Includes hoarseness and difficulty speaking.
Muscle wasting and bone demineralization
65
Glucocorticoids - Adverse Drug Reactions: Oral glucocorticoids can cause suppression of
Adrenal function
66
Glucocorticoids - Adverse Drug Reactions: Additional side-effects of short- and long term oral glucocorticoid are
hyperglycemia (elevated blood sugaR)
Peptic ulcer Disease
Increased susceptibility and fluid and electrolyte imbalance
67
Glucocorticoids - Adverse Drug Reactions: Nasal glucoccorticoids can cause
dry mucous membranes , epistaxis (bleedfing from the nose) , sore throat, and headache
68
Glucocorticoids - Interventions - Inhaled: Side effects can be minimized by
attaching a spacer to the inhaler. Decreases amount of drug that comes in contact with the tissues of the mouth and oropharynx
69
Glucocorticoids - Interventions - Inhaled: What to do if oral candidiasis occurs?
Timely initiation of antifungal therapy
70
Glucocorticoids - Interventions - Oral: Monitor what?
Plasma drug levels to deteramint amount of adrenal function.
Recommend lowest possible effective dose
71
Glucocorticoids - Interventions - Oral: Take with what?
FOod or meals and recommending an analgesic substitiue such as acetaminophen if NSAID needed
72
Glucocorticoids - Interventions - Oral: Closely monitor
blood glucose levels for hyperglycemia.
Look for infections.
Monitor sodium retention or hypernatremia or potassium losss so initiate approrpriate replacement therapy
73
Glucocorticoids - Interventions - Nasal: What to do if taken nasaly?
Because of dry mucous membranes or sore throat, provide comfort measures such as fluids.
Adminiter non-NSAID analgeic like acetaminophen for headaches
74
Glucocorticoids - Administration - Inhaled: How to give it?
Give on schedule.
75
Glucocorticoids - Administration - Inhaled: Useful in asthma attack?
Not as useful as a rescue drug.
76
Glucocorticoids - Administration - Inhaled: What happened if given when Beta2 Adrenergic Agonist?
Use Beta2 first to dilate airways.
77
Glucocorticoids - Administration - Oral: Short-term oral glucocorticoid therapy gigven for
5-10 days.
78
Glucocorticoids - Administration - Oral: Long term use is used for how long
10 or more days
79
Glucocorticoids - Administration - Oral: Administering orally cna decrease
incidence of Adverse Drug REactions.
80
Glucocorticoids - Administration - Oral: What can occur if dose is withdrawaled too quickly?
Adrenal crisis
81
Glucocorticoids - Administration - Oral: What may be needed in time of stress such as illness or surgery because adrenal gland may not be functioning at optimum.
Supplemental Doses
82
Glucocorticoids - Administration - Nasal: Use giving a
nasal-metered dose spray device
83
Glucocorticoids - Administration - Nasal: Initial dose is when
a client takes is usually higher than the maintenance dose you give on long term basis.
84
Glucocorticoids - Administration - Nasal: If nares are blocked, use
a nasal decongestant first to open the nasal passages
85
Glucocorticoids - Client Instructions - Inhaled: Encourge them to use
spacer during administration.
Also rinse their mouth and gargle after using inhaler to prevent candidiasis
86
Glucocorticoids - Client Instructions - Oral: Because glucocorticoids suppresses adrenal function, ensure client understands that
drugs can never be stopped abruptly. Dose must be tapered off to prevent adrenal crisis
87
Glucocorticoids - Client Instructions - Oral: To prevent osteoporosis, instruct clients to
increase intake of calcium and vitamin D and perform weight bearing exercises.
88
Glucocorticoids - Client Instructions - Oral: Bc glucocorticoids affect blood sugar, instruct clients to report
the incidience of polyphagia.
89
Glucocorticoids - Client Instructions - Oral (Safety Alert): How to prevent ulcers?
Take gastric-protective measures.
Avoid taking NSAIDS and use acetaminophen instead.
90
Glucocorticoids - Client Instructions - Oral (Safety Alert): Take Glucocorticoid with
And report if
a snack or meal.
Report immediately if they vomit blood or produce black tarry stools
91
Glucocorticoids - Client Instructions - Oral (Safety Alert): Because glucocorticoids suppress the immune system, clients should
notify their provider at first sign of infection.
92
Glucocorticoids - Client Instructions - Nasal: Bc clients experience dry mucous membranes, epistaxis and sore throat, instruct them to
use a humidifier when sleeping, increase their fluid intake, or suck on hard candies .
93
Glucocorticoids - Client Instructions - Nasal: If headaches accompany use of an intranasal glucocorticoid, client can take
non-NSAID analgesics such as acetaminophen
94
Glucocorticoids - Contraindications and Precautions: Be cautious on giving this to someone with
peptic ulcer disease, diabetes, hypertension, renal dysfunction or taking NSAIDs
95
Glucocorticoids - Contraindications and Precautions: If client has systemic fungal infecition or recently received a live virus immunization, what should you do
avoid giving oral glucocorticoids . Reduces body ability to produe antibodies.
96
Glucocorticoids - Interactions: Don't give with
potassium-depleting diurects (furosemide, Lasix), because will increase risk of hypokalemia .
97
Glucocorticoids - Interactions: Use of NSAIDS increases risk of
GI Bleeding
98
Glucocorticoids - Interactions: What effect is decreased when clients are on glucococorticoid therapy?
Insulin and Oral Hypoglycemics
99
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers: What are these?
Type of anti-inflammatory inhalant-type of drug used to reduce bronchial inflammation prophylactically in mild to moderate asthma.
100
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers: They treat
long-term allergy-related asthma.
101
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers: They are used to prevent
exercise-induced bronchospasm and seasonal allergy symptoms and management of allergic rhinitis
102
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers: In case of allergic rhinitis, what is required?
Intranasal Instillation of Cromolyn (NasalCrom)
103
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Prototype and OTher Drugs:
Cromolyn (NasalCrom)
104
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Expected Pharmacologic Action: Mast cell stabilizers suppress
inflammation in manner similar to corticosteroids
105
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Expected Pharmacologic Action: Prevent the release of
leukotrienes and histamine , which mediate inflammation.
106
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Expected Pharmacologic Action: This keeps WBC like leukocytes and eosinophils form stimulating
inflammatory response by attacking foreign cells
107
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Expected Pharmacologic Action: Minimizing the actions of these cells decrease
inflammation and edema of the airways. They do not have bronchodilation effects
108
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Adverse Drug Reactions: Why is this drug useful?
Safest drugs. Cough and bronchospasm may occur in fewer than 1 out of 10000
109
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Interventions : Contraindicated in clients who have demonstrated
a previous allergic response to the drug
110
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Administration: Mast Cell Stabilizers given with
a power-driven nebulizer
111
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Administration: Initial dosage of
20mg four times daily, clients should be maintained on lowest dosage
112
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Administration: To prevent EIB, administer
10-15 minutes prior to activity and no sooner than 1 hour prior
113
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Administration: When using prophylactically to avoid seasonal allergies, take
cromolyn prior to exposure.
114
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Client Instructions: Not effective against
an acute asthma attack
115
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Client Instructions: How long to achieve therapeutic effects?
Several weeks
116
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Contraindications and Precautions: Use of mast cell stabilizers is contraindicated in clients who are
allergic to cromolyn
117
Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Interactions:
No known drug or food interactions
118
Anti-Inflammatory Drugs / Leukotriene Modifiers: What are these?
Oral drugs that are normally prescribed as adjunctive therapy to assist in decreasing bronchoconstriction and inflammation
119
Anti-Inflammatory Drugs / Leukotriene Modifiers: Used in treatment of
allergic rhinitis, asthma, and exercise induced bronchospasm
120
Anti-Inflammatory Drugs / Leukotriene Modifiers - Prototype and Other Drugs: Drug is
Montelukast (Singulair)
121
Anti-Inflammatory Drugs / Leukotriene Modifiers - Expected Pharmacologic Action: Modifiers work to supress
effect of leukotrines
122
Anti-Inflammatory Drugs / Leukotriene Modifiers - Expected Pharmacologic Action: What does Montelukast do?
Leukotriene antagonists that decrease inflammation by preventing the activation of leukotrienes
123
Anti-Inflammatory Drugs / Leukotriene Modifiers - Adverse Drug Reactions: What may cause liver damage?
Zileuton (Zyflo) and Zafirlukas (Accolate)
Montelukast does not cause any untoward side effect
124
Anti-Inflammatory Drugs / Leukotriene Modifiers - Adverse Drug Reactions: All leukotriene modifiers do not carry
the slight risk of adverse neuropsychiartic symptoms such as suicidal thoughts or behaviors
125
Anti-Inflammatory Drugs / Leukotriene Modifiers - Interventions: If taking Zileuton and Zafirlukast, you must m onitor for
Liver damage and provide liver function tests.
126
Anti-Inflammatory Drugs / Leukotriene Modifiers - Administration: When is this given?
Once daily in the evening.
127
Anti-Inflammatory Drugs / Leukotriene Modifiers - Administration: Available as what?
Oral or chewable tablets and oral granules
128
Anti-Inflammatory Drugs / Leukotriene Modifiers - Administration: ADvice for when using oral granules?
Clients can mix them with applesauce, carrots, rice, or ice cream or place directly on tingue
129
Anti-Inflammatory Drugs / Leukotriene Modifiers - Administration: If using drug to prevent EIB...
make sure its at least 2 hours before exercising . And don't take again for 24 hours
130
Anti-Inflammatory Drugs / Leukotriene Modifiers - Client Instructions: For clients reporting headaches after administration, encourage them to use
OTC analgesics as needed.
131
Anti-Inflammatory Drugs / Leukotriene Modifiers - Client Instructions: Educate clients and family to be aware of
any behavioral changes such as anxiety, agitiation, insomnia or irritability
132
Anti-Inflammatory Drugs / Leukotriene Modifiers - Contraindications and Precautions: Don't give leukotrieve modifiers for
acute asthma exacerbations or status asthmaticus because of the time it takes for the drug to take effect
133
Anti-Inflammatory Drugs / Leukotriene Modifiers - Contraindications and Precautions: Use leukotriene modifiers with cautions in clients who have
severe asthma because of the higher level of efficacy of other drug options
134
Anti-Inflammatory Drugs / Leukotriene Modifiers - Interactions: Clients may need higher doses of Montelukast for
Clients taking Phenobarbital, Rifampin, or Phenytoin
