KARCH: CH. 55 - Drugs Acting on the Lower Respiratory Tract Flashcards
_____: drugs that help w/ breathing by dilating the airways; helpful in symptomatic relief or prevention of bronchial asthma & bronchospasm R/T COPD.
Bronchodilator
_____: an abnormal pattern of breathing characterized by apneic periods followed by periods of tachypnea; May reflect delayed blood flow through the brain.
Cheyne-Stokes respiration
_____: drugs that selectively & competitively block or antagonize receptors to produce leukotrienes D4 and E4 (components of slow-reacting substance of anaphylaxis [SRSA]).
Leukotriene receptor antagonists
_____: drugs that work at the cellular level to inhibit the release of histamine (released from mast cells in response to inflammation or irritation) and the release is a slow-reacting substance of anaphylaxis [SRSA].
Mast cell stabilizer
_____: drugs that mimic the effects of the SNS.
Sympathomimetics
_____: naturally occurring substances; including caffeine and theophylline - that have a direct effect on the resp. tract smooth muscle, both in the bronchi & blood vessels.
Xanthenes
COPD Manifestations of COPD: (3) Prevention and Treatment for COPD:
MANIFESTATION OF COPD: Air is trapped in the lower respiratory tract The alveoli degenerate and fuse together The exchange of gases is greatly impaired PREVENTION & TREATMENT: ↓ Environmental exposure to irritants Stop smoking Filter allergens from the air Avoid exposure to known irritants & allergens Open conducting airways thru muscular bronchodilation ↓ Effects of inflammation on the airway lining
Adult Respiratory Distress Syndrome (ARDS) Characteristics: Caused by: Treatment:
CHARACTERISTICS: The progressive loss of lung compliance & ↑ hypoxia CAUSED BY: CV collapse; major burns; severe trauma; rapid depressurization TREATMENT: Treat/reverse underlying cause combined w/ ventilation support.
Bronchodilators/Antiasthmatics
General use:
Sub-classifications: (3)
Drugs for each sub-class:
MOA:
GENERAL USE:
- To facilitate respiration by dilating the airways
SUB-CLASSIFICATIONS:
- Xanthines
- Sympathomimetics
-
Anticholinergics
-
MOA:
- Blocks vagus nerve activity & dilates bronchi.
-
DRUGS:
- Aclidinium (Tudorza Pressair)
- Ipratropium (Atrovent)
- Tiotropium (Spiriva)
- Umeclidinium (Incruse Ellipta)
-
MOA:
Bronchodilators/Antiasthmatics
Sub-class: Xanthines
Bronchodilators/Antiasthmatics
Sub-class: Xanthines
DRUGS:
- Aminophylline
- Caffeine (Caffedrine)
- Dyphylline
- Theophylline
MOA:
- Relaxes smooth muscle
- Directly relaxes bronchial smooth muscle & blood vessels, causing bronchodilation, ↑ vital capacity & ↑ force of the diaphragmic muscle.
INDICATIONS:
- To prevent or treat bronchial asthma
- To reversal bronchospasm R/T COPD, chronic bronchitis, or emphysema.
PHARMACOKINETICS:
- Narrow therapeutic margin
- Rapidly absorbed for the GI tract
- Metabolized in the liver and excreted in the urine
CONTRAINDICATIONS:
- GI problems
- CAD
- Respiratory dysfunction
- Renal & Hepatic disease; Alcoholism
- Hyperthyroidism
DRUG-DRUG INTERACTIONS:
- Many drugs!
- Substances in cigarettes
ADVERSE EFFECTS:
- NOTE: SE are R/T Theophylline serum level
- Anorexia, N/V, Proteinuria
- Irritable, Restless, Dizzy, Fever, Flushing
- Tachycardia, Palpations, Deadly arrhythmias, Respiratory arrest, Seizure, Brain damage, Death
ASSESS:
- Peptic ulcer, Gastritis, CAD
- Monitor BP, HR/pulse, Heart sounds, Peripheral perfusion, Baseline ECG
- Skin
- LABS:
- Renal & Hepatic function
- Theophylline serum level
- Urinalysis (RF Proteinuria)
- BS
Bronchodilators/Antiasthmatics
Sub-class: Sympathomimetics
Bronchodilators/Antiasthmatics
Sub-class: Sympathomimetics
DRUGS:
- Albuterol (Proventil HFA)
- Arformoterol (Brovana)
- Ephedrine
- Epinephrine (EpiPen)
- Formoterol (Foradil)
- Indacaterol (Arcapta)
- Isoproterenol (Isuprel)
- Levalbuterol (Xopenex HFA)
- Metaproterenol
- Olodaterol (Striverdi Respimat)
- Salmeterol (Serevent)
- Terbutaline
MOA:
- Mimics the SNS - dilates bronchi & & ↑ rate & depth of respirations.
- Beta2 selective adrenergic agonists
INDICATIONS:
- Acute asthma attack
- Bronchospasm in acute or chronic asthma
- Prevention of exercise-induced asthma
PHARMACOKINETICS:
- Rapidly distributed after injection, transformed in the liver to metabolites that are excreted in the urine.
CONTRAINDICATIONS:
- Depends on the underlying condition severity
DRUG-DRUG INTERACTIONS:
- General anesthetics
ADVERSE EFFECTS:
- Sympathomimetic stimulation
- CNS stimulation
- N/V, cardiac arrhythmias, HTN, bronchospasm, sweating, pallor, and flushing
ASSESS:
- Cigarette use
- Pregnancy & Lactation
- Cardiac disease, CVD, Arrhythmias
- DM, Hyperthyroidism
- Reflexes and orientation
Bronchodilators/Antiasthmatics
Sub-class: Anticholinergics
Bronchodilators/Antiasthmatics
Sub-class: Anticholinergics
DRUGS:
- Aclidinium (Tudorza Pressair)
- Ipratropium (Atrovent)
- Tiotropium (Spiriva)
- Umeclidinium (Incruse Ellipta)
MOA:
- Blocks vagus nerve activity & dilates bronchi.
- Blocks vagal mediated reflexes by antagonizing the action of acetylcholine.
INDICATIONS:
- Maintenance & treatment of bronchospasm R/T COPD.
- Tx seasonal allergic rhinitis (as nasal spray)
- Preferred for PTs that CAN’T tolerate Sympathomimetics SNS effects.
PHARMACOKINETICS:
- Onset: 15-min. (if inhaled)
- Peak: 1-2 hr.
- Duration: 3-4 hr.
CAUTION:
- Any condition that would be aggravated by the anticholinergic effects of the drug
DRUG-DRUG INTERACTIONS:
- Other anticholinergics
ADVERSE EFFECTS:
- Anticholinergic effects: Dizzy, HA, fatigue, nervous, dry mouth, sore throat, urinary retention
- Cough
- Palpations
ASSESS:
- Acute bronchospasm, Bladder neck obstruction, BPH
- LOC, orientation, affect, reflexes
- B/P, HR/pulse, RR & LS, Urinary O/P
True or False:
The adverse effects of the Xanthines are related to theophylline levels in the blood and include brain damage.
True
Rationale: Adverse Effects: Related to theophylline levels in the blood; GI upset, nausea, irritability, and tachycardia to seizure, brain damage, and even death
Inhaled Steroids
Inhaled Steroids
DRUGS:
- Beclomethasone (Beconase AQ)
- Budesonide (Pulmicort Respules, Pulmicort Flexhaler)
- Ciclesonide (Alvesco)
- Fluticasone (Flovent Diskus, Flovent HFA)
- Triamcinolone (generic)
INDICATIONS:
- Very effective tx for bronchospasm
- Prevent & tx asthma
- Chronic steroid-dependent bronchial asthma
PHARMACOKINETICS:
- Well absorbed from the respiratory tract
- Metabolized by natural systems, mostly w/in the liver, excreted in urine.
CONTRAINDICATIONS:
-
NOT for emergencies!
- NO acute attack
- NO status asthmaticus
- NO Pregnancy or Lactation
ADVERSE EFFECTS:
- Sore throat
- Hoarseness
- Coughing
- Dry mouth
- Pharyngeal & laryngeal fungal infections
ASSESS:
- Systemic infections
- Pregnancy & Lactation
- VS, RR & LS, nares
Leukotriene Receptor Antagonists
Leukotriene Receptor Antagonists
DRUGS:
- Zafirlukast (Accolate)
- Montelukast (Singulair)
- Zileuton (Zyflo)
MOA:
- Acts more specifically at the site of the problem associated with asthma.
- Selectively and competitively blocks/antagonize receptors to produce leukotrienes
INDICATIONS:
- Prophylaxis & chronic tx of bronchial asthma in adults and kids <12 yr.
PHARMACOKINETICS:
- Rapidly absorbed from GI tract, extensively metabolized in the liver and primarily excreted in feces
ADVERSE EFFECTS:
- HA, Dizzy, Myalgia, N/VD, Abdominal pain
- ↑Liver enzymes
- Generalized pain
DRUG-DRUG INTERACTIONS:
- Propranolol, Theophylline, Terfenadine, or Warfarin
- Calcium channel blockers, Cyclosporine, or Aspirin
CAUTION:
- Hepatic or renal impairment
- Pregnancy and lactation
ASSESS:
- Acute bronchospasm or asthmatic attack
- LABS: Renal & hepatic function
- Temperature, orientation, affect
Mast Cell Stabilizers
Mast Cell Stabilizers
DRUG:
- Cromolyn (NasalCrom)
MOA:
- Works at the cellular level to inhibit the release of histamine and inhibits the release of SRSA
INDICATIONS:
- TX chronic bronchial asthma
- Exercise-induced asthma
- Allergic rhinitis
- NO longer considered TX standards b/c of the availability of more specific & safe
Lung Surfactants
Lung Surfactants
DRUGS:
- Beractant (Survanta)
- Calfactant (Infasurf)
- Lucinactant (Surfaxin)
- Poractant (Curosurf)
MOA:
- Naturally occurring compounds or lipoproteins containing lipids and apoproteins that reduce the surface tension within the alveoli, allowing expansion of the alveoli for gas exchange.
- Replaces missing surfactant in the lungs of neonates with RDS.
INDICATIONS:
- Rescue tx for infants who developed RDS
PHARMACOKINETICS:
- Acts immediately upon instillation into trachea
- Metabolized in the lungs
CONTRAINDICATIONS: NONE! (emergency drug)
ADVERSE EFFECTS:
- Patent ductus arteriosus
- Hypotension
- Intraventricular hemorrhage
- Pneumothorax
- Pulmonary air leak
- Hyperbilirubinemia
- Sepsis
ASSESS:
- Time of birth and Exact weight
- Temp, RR & LS
- Endotracheal tube placement & patency
- Chest movements
- BP, HR/pulse, and arterial pressure
- Blood gases & O2 saturation
Which of the following is a contraindication to using lung surfactants?
A. Prematurity
B. Older adult
C. No contraindications
D. COPD
C. No contraindications
Rationale: Because lung surfactants are used as emergency drugs in the newborn, there are no contraindications
The nurse is caring for a patient taking Budesonide. What would be an appropriate nursing diagnosis for this patient?
A. Risk for injury related to immunosuppression
B. Risk for injury related to CNS effects
C. Risk for injury related to CVS effects
D. Risk for injury related to age and risk of infection
A. Risk for injury R/T immunosuppression
Rationale: Nursing diagnoses related to drug therapy might include: RF injury R/T immunosuppression; acute pain related to local effects of the drug; deficient knowledge regarding drug therapy.
