Lower Resp Flashcards by Abby Hurst

COPD

chronic, progressive, airflow limitation, not reversible
combination of two diseases:
Chronic bronchitis
Emphysema

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COPD

S/S

Signs/symptoms: 
productive cough
dyspnea
rhonchi
sectional diminished/absent breath sounds

3rd leading cause of death (increasing from 4th)

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Asthma

chronic, intermittent, & reversible airway inflammatory disease

triggered by stress & allergens

inflammation, smooth muscle contraction, and mucus production => airway obstruction

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Asthma

Signs/symptoms:
cough
dyspnea
wheezing

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Aerosol

exhale completely

inhale the dose slow & deep
hold breath for 5-10 seconds
exhaled through pursed lips slowly

Rinse mouth and spit (to avoid oral thrush)

After rinsing, drink water (to avoid pharyngitis)

DPI (dry powder Inhaler)

MDI (Meter Dose Inhaler)

Spacer

Nebulizer

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DPI

by the force of inhalation dry powder is inhaled

many shape of devices

No need for shaking, no need for spacer

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MDI

uses a propellant to deliver a liquid drug

Shake before using

If two puffs is prescribed wait one minute between two puffs

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Spacer

allows only the smallest droplets to be inhaled

If inhaled too quickly the spacer would make a whistling sound

if no spacer, hold MDI 1”-2” away from the mouth

rinse spacer daily,
never wipe inside

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Nebulizer

pressurized air vaporizes liquid medication into a fine mist

A treatment (a dose) takes 15 minutes, every breath is part of the dose

Mask versus hand-held device

Administer nebulizers with pressurized air (medical air) not with O2

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Respiratory Medication Administration Terminology

Rescue medications:

Maintenance medications:

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Rescue medications:

taken when symptoms indicate
(as needed) (PRN)

Do not use more than recommended

“q2 hrs PRN for dyspnea” means must not be used any sooner than 2 hours from the previous dose

Do not take it every two hours if asymptomatic (it is not a maintenance drug)

If dyspnea persists do not ↑the frequency,
-instead call the provider to add a new drug or call 911

Always use before other inhaled drugs

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Maintenance medications:

Must take at regular times regardless of symptoms (scheduled)

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Bronchodilators
β2 Adrenergic Agonist (inh)
MOA

bronchodilation,
↓ histamine,
↑ ciliary motility

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Bronchodilators
β2 Adrenergic Agonist (inh)
SIDE EFFECTS

can cause Beta1 activation => 
tachycardia, 
dysrhythmia, 
angina, 
HTN, 
palpitation
nervousness, 
tremors, 
HA, 
↑ BG

avoid stimulants:
caffeine,
nicotine

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Bronchodilators
β2 Adrenergic Agonist (inh)
TOLERANCE

Tolerance:

Do not ↑the frequency, instead call the provider to add a new drug or call 911

Do not use more than prescribed:

OD => paradoxical airway resistance

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Bronchodilators
β2 Adrenergic Agonist (inh)
CONTRAINDICATIONS

Contraindications:
pregnancy,
tachycardia,
hyperthyroidism

Use before inhaled corticosteroids

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Short acting, rescue inhaler

Adrenergic Agonist

albuterol
MDI/Neb

levalbuterol
MDI/Neb

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Long acting, maintenance Adrenergic Agonist

albuterol
PO

salmeterol
diskus DPI

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BronchodilatorsAnticholinergic
MDI
NEB

MOA:

anticholinergic (PNS) →
bronchodilation

Maintenance treatment

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ipratropium

tiotropium

BronchodilatorsAnticholinergic

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albuterol + ipratropium

synergistic effect when combined with:

β-agonists

ipratropium
tiotropium
albuterol + ipratropium

no cardiac adverse effects because of local effect as an inhaler

large doses may cause systemic anticholinergic effects (see code phrases)

Rinse mouth (taste), allow at least 5 min between various inhalers

ipratropium
tiotropium
albuterol + ipratropium

peanut allergy,
glaucoma,
BPH

Corticosteroids = Glucocorticoids

Often called: “steroids”

Must always wean off (never stop abruptly can cause adrenal crisis)

Similarity of glucocorticoids to mineralocorticoids (aldosterone)

Corticosteroids = Glucocorticoids | MOA

anti-inflammatory | similar to body’s cortisol, negative feedback

Corticosteroids = Glucocorticoids | ROUTES

IV PO Inh: DPI/MDI/Nebulized Nasal Spray

Corticosteroids = glucocorticoids SIDE EFFECTS THERES A LOT!

hyperglycemia - in diabetic patients leukocytosis - yet immunosuppressant!!! immunosuppressant - anti-inflammatory mechanism - higher risk of infection ``` water/NA retention = worsening of: HF edema HF HTN --> Hypoglkalema - dysrhythmia ``` water/Na retention=> increased IOP worsening of glaucoma Sub Q tissue loss with chronic use => paper skin or steroid skin adrenal suppression - never stop abruptly to avoid: adrenal crisis requires weaning osteoporosis - take vitamin D - Ca++ and exercise!

Combination TherapyDPI

Long acting Beta 2 agonist and corticosteroid Maintenance therapy only SCHEDULED ONLY

budesonide = formoterol fluticasone = salmeterol

Combination TherapyDPI SCHEDULED ONLY

Bronchodilators Methylxanthines PO/IV

theophylline

theophylline | MOA

PO is maintenance, IV is for emergencies Bronchodilator Anti-inflammatory effects (=> reverses corticosteroid resistance) CNS & respiratory stimulant dilates coronary & pulmonary circulation diuretic

theophylline | INDICATIONS

Asthma or COPD not well controlled by inhaled corticosteroids/ long-acting β2- agonists Apnea in preterm infants

theophylline | SIDE EFFECTS

N/V, HA, dysrhythmia => ``` hypotension; seizure, cardiopulmonary collapse; GIB; hyperglycemia ```

GIB: GI bleed

Theophylline (dimethylxanthine) occurs naturally in tea and cocoa beans in trace amounts first extracted from tea and synthesized chemically in 1895 and initially used as a diuretic introduced as a clinical treatment for asthma in 1922 Nursing: Pregnancy (C), caution in HTN, heart/liver/kidney disease, DM, peds/geriatrics Avoid caffeine, nicotine Many drug interactions

Leukotriene ModifiersPO

montelukast

Leukotriene IS AN

Leukotriene is an inflammatory mediator MOA: suppress the effect of LT => ↓ inflammation, edema, mucus => bronchodilation Indication: maintenance therapy (not for acute SOB)

Leukotriene | MOA

suppress the effect of LT => ↓ inflammation, edema, mucus => bronchodilation

Leukotriene | INDICATION

Indication: maintenance therapy (not for acute SOB)

montelukast

for 1-year & up

montelukast | SIDE EFFECTS

depression, suicidal ideation, liver failure, drug interactions Consider age limits!

Mucolytic | MOA

Breakdown protein structure of bronchial secretions Different from expectorant

Mucolytic | Indication:

cystic fibrosis, COPD, bronchitis

acetylcysteine | ROUTES

inh, PO/IV

acetylcysteine | NURSING

Encourage hydration throughout the day

acetylcysteine | SIDE EFFECTS

``` dizziness, drowsiness, orthostatic hypotension, tachycardia, hepatotoxicity ```

acetylcysteine | CONTRAINDICATION

children < 7 years of age Strong rotten egg smell (liquid po form) powder to mix with drinks to manage the smell

MUCOLYTIC acetylcysteine SECONDARY USES

(IV, PO) acetaminophen OD and liver failure (PO) prevent nephrotoxicity prior and after IV contrast agent

Supplemental Oxygen | USES

continuous (long-term) PRN for DOE and QHS dyspenea on excretion at bedtime acute SOB shortness of breath

Supplemental Oxygen | AVAILABLE IN

tank - portable condenser - at home piped- in medical facilities

Supplemental Oxygen | SIDE EFFECT

vasoconstriction ``` loss of (hypoxia) - which is the respiratory drive for CO2 retainers ``` Administer nebulizers with pressurized air (medical air) not with O2

Supplemental Oxygen | CONSIDERATION

Safety of Oxygen use at home (fire hazard, projectile hazard)