Lewis 31 - Obstructive Pulmonary Disease Flashcards
MOA/Class
albuterol
Stimulates beta-2 receptors causing bronchodilation.
Short-acting beta-agonist (SABA)
Adrenergic agonist (B2)
Tucker 30, 55
Side Effects
albuterol
Tachycardia, palpitations, anxiety, insomnia, tremors
Paradoxical bronchospasms, hypokalemia
Tucker 30, 55
Nursing Considerations
albuterol
Take beta-agonist inhaler before other inhaled medications for maximum effect
Monitor for paradoxical bronchospasms
Monitor for dysrhythmias, tachycardia
Tucker 30, 55
Indications
albuterol
Acute respiratory distress caused by bronchoconstriction (asthma, COPD, etc.)
Tucker 30, 55
MOA/Class
salmeterol, formoterol
Stimulates beta-2 receptors causing bronchodilation.
Long-acting beta-agonist (LABA)
Adrenergic agonist (B2)
Tucker 30, 55
Side Effects
salmeterol, formoterol
Tachycardia, palpitations, anxiety, insomnia, tremors
Paradoxical bronchospasms, hypokalemia
*Generally has fewer side effects than SABA medications
Tucker 30, 55
Nursing Considerations
salmeterol, formoterol
May be combined with other inhaled medications as a combination inhaler
Prophylactic use
Tucker 30, 55
Indications
salmeterol, formoterol
Prevention of respiratory distress caused by bronchoconstriction (asthma, COPD, etc.)
Tucker 30, 55
MOA/Class
ipratropium, tiotropium
Inhaled
Blocks acetylcholine (ACh) from binding to ACh receptors.
Decreased secretions due to anti-SLUDGE effects and bronchodilation.
Anticholinergic
Tucker 33, 55
Side Effects
ipratropium, tiotropium
Inhaled
Localized dryness; headache, dizziness, palpitations. blurred vision
Tucker 33, 55
Nursing Considerations
ipratropium, tiotropium
Inhaled
Primarily maintenance therapy; Duo-Neb (ipratropium/albuterol) nebulizer may be used for acute symptoms
Tucker 33, 55
Indications
ipratropium, tiotropium
Inhaled
Maintenance therapy for asthma/COPD
Tucker 33, 55
MOA/Class
Prednisone, methylprednisolone
Steroids stabilize leukocytes (WBCs) preventing the release of intracellular chemical/inflammatory mediators
Restore/increase bronchial responsiveness to beta-adrenergic receptor stimulation
Systemic glucocorticoid/corticosteroid
Tucker 36
Side Effects
Prednisone, methylprednisolone
Growth suppression, elevated blood glucose, weight gain
GI upset (tolerated best in AM with food/milk)
Osteoporosis (long-term use)
Tucker 36
Nursing Considerations
Prednisone, methylprednisolone
Taper dose when stopping to prevent adrenal insufficiency
Tucker 36
Indications
Prednisone, methylprednisolone
Used to gain control of severe asthma or COPD exacerbations. Not a rescue medication, but systemically decreases inflammatory response in severe disease.
Tucker 36
MOA/Class
fluticasone, budesonide
Inhaled
Steroids stabilize leukocytes (WBCs) preventing the release of intracellular chemical/inflammatory mediators
Restore/increase bronchial responsiveness to beta-adrenergic receptor stimulation
Inhaled corticosteroid (ICS)
Tucker 36, 55
Side Effects
fluticasone, budesonide
Thrush/candidiasis
Tucker 36, 55
Nursing Considerations
fluticasone, budesonide
Often given as combination inhaler or nebulizer with beta-adrenergic
Rinse mouth after using
Spacer use decreases risk of oral candidiasis
Tucker 36, 55
Indications
fluticasone, budesonide
Maintenance therapy for asthma or COPD
Tucker 36, 55
MOA/Class
omalizumab (Xolair)
Binds to IgE receptors on mast cells and basophils decreasing release of inflammatory mediators
Tucker 55
Side Effects
omalizumab (Xolair)
Myalgia, fatigue, rash, headache, back pain
Tucker 55
Nursing Considerations
omalizumab (Xolair)
Given subcutaneously every 4 weeks; First dose administered with healthcare monitoring. Subsequent doses may be administered at home.
Tucker 55
Indications
omalizumab (Xolair)
Maintenance treatment for moderate to severe persistent asthma or allergic symptoms
Tucker 55
MOA/Class
montelukast
Leukotrienes are produced in leukocytes such as mast cells. Once released from the mast cell during an inflammatory response, leukotrienes mediate additional responses such as bronchial constriction
LTRAs prevent leukotrienes from attaching to receptors on lymphocytes and alveolar macrophages thus reducing the inflammatory response thus preventing smooth muscle contraction (bronchi), decreasing mucus secretion, decreasing vascular permeability
Leukotriene Receptor Antagonist (LTRA)
Tucker 55
Side Effects
montelukast
Headache, nausea, diarrhea, cough, elevated LFTs, myalgia, neuropsychiatric events
Tucker 55
Nursing Considerations
montelukast
Tablets contain lactose (monitor patients for lactose intolerance)
Maintenance therapy
Safe for young children (used in ages 2 years and older)
Tucker 55
Indications
montelukast
Asthma, seasonal allergic rhinitis
Tucker 55
MOA/Class
theophylline, aminophylline
Relaxes the smooth muscles located in the bronchial airways and pulmonary blood vessels. Also reduces the airway responsiveness to histamine, adenosine, methacholine, and allergens.
Methylxanthine
Tucker 55
Side Effects
theophylline, aminophylline
CNS stimulation
Tucker 55
Nursing Considerations
theophylline, aminophylline
Many drug interactions; Narrow therapeutic range
Tucker 55
indications
theophylline, aminophylline
Asthma and COPD maintenance
*May also be used to manage respiratory issues in premature infants.
Tucker 55
