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Pharm > Lower Resp > Flashcards

Lower Resp Flashcards

1
Q

COPD

A

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

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2
Q

COPD

S/S

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

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

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3
Q

Asthma

A

chronic, intermittent, & reversible airway inflammatory disease

triggered by stress & allergens

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

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4
Q

Asthma

A

Signs/symptoms:
cough
dyspnea
wheezing

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5
Q

Aerosol

A

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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6
Q

DPI

A

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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7
Q

MDI

A

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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8
Q

Spacer

A

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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9
Q

Nebulizer

A

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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10
Q

Respiratory Medication Administration Terminology

A

Rescue medications:

Maintenance medications:

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11
Q

Rescue medications:

A

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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12
Q

Maintenance medications:

A

Must take at regular times regardless of symptoms (scheduled)

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13
Q

Bronchodilators
β2 Adrenergic Agonist (inh)
MOA

A

bronchodilation,
↓ histamine,
↑ ciliary motility

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14
Q

Bronchodilators
β2 Adrenergic Agonist (inh)
SIDE EFFECTS

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

avoid stimulants:
caffeine,
nicotine

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15
Q

Bronchodilators
β2 Adrenergic Agonist (inh)
TOLERANCE

A

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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16
Q

Bronchodilators
β2 Adrenergic Agonist (inh)
CONTRAINDICATIONS

A

Contraindications:
pregnancy,
tachycardia,
hyperthyroidism

Use before inhaled corticosteroids

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17
Q

Short acting, rescue inhaler

Adrenergic Agonist

A

albuterol
MDI/Neb

levalbuterol
MDI/Neb

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18
Q

Long acting, maintenance Adrenergic Agonist

A

albuterol
PO

salmeterol
diskus DPI

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19
Q

BronchodilatorsAnticholinergic
MDI
NEB

MOA:

A

anticholinergic (PNS) →
bronchodilation

Maintenance treatment

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20
Q

ipratropium

tiotropium

A

BronchodilatorsAnticholinergic

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21
Q

albuterol + ipratropium

A

synergistic effect when combined with:

β-agonists

22
Q

ipratropium
tiotropium
albuterol + ipratropium

A

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

23
Q

ipratropium
tiotropium
albuterol + ipratropium

A

peanut allergy,
glaucoma,
BPH

24
Q

Corticosteroids = Glucocorticoids

A

Often called: “steroids”

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

Similarity of glucocorticoids to mineralocorticoids (aldosterone)

25
Q

Corticosteroids = Glucocorticoids

MOA

A

anti-inflammatory

similar to body’s cortisol, negative feedback

26
Q

Corticosteroids = Glucocorticoids

ROUTES

A

IV
PO
Inh: DPI/MDI/Nebulized
Nasal Spray

27
Q

Corticosteroids = glucocorticoids
SIDE EFFECTS
THERES A LOT!

A

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!
28
Q

Combination TherapyDPI

A

Long acting Beta 2 agonist and corticosteroid

Maintenance therapy only
SCHEDULED ONLY

29
Q

budesonide = formoterol

fluticasone = salmeterol

A

Combination TherapyDPI

SCHEDULED ONLY

30
Q

Bronchodilators Methylxanthines PO/IV

A

theophylline

31
Q

theophylline

MOA

A

PO is maintenance,
IV is for emergencies

Bronchodilator

Anti-inflammatory effects
(=> reverses corticosteroid resistance)

CNS & respiratory stimulant
dilates coronary &
pulmonary circulation

diuretic

32
Q

theophylline

INDICATIONS

A

Asthma or COPD
not well controlled by inhaled corticosteroids/ long-acting β2-
agonists

Apnea in preterm infants

33
Q

theophylline

SIDE EFFECTS

A

N/V, HA, dysrhythmia =>

hypotension; 
seizure, 
cardiopulmonary collapse; 
GIB; 
hyperglycemia
34
Q

GIB: GI bleed

A

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

35
Q

Leukotriene ModifiersPO

A

montelukast

36
Q

Leukotriene IS AN

A

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

37
Q

Leukotriene

MOA

A

suppress the effect of LT =>
↓ inflammation,

edema, mucus =>
bronchodilation

38
Q

Leukotriene

INDICATION

A

Indication:
maintenance therapy
(not for acute SOB)

39
Q

montelukast

A

for 1-year & up

40
Q

montelukast

SIDE EFFECTS

A

depression,
suicidal ideation,
liver failure,
drug interactions

Consider age limits!

41
Q

Mucolytic

MOA

A

Breakdown protein structure of bronchial secretions

Different from expectorant

42
Q

Mucolytic

Indication:

A

cystic fibrosis,
COPD,
bronchitis

43
Q

acetylcysteine

ROUTES

A

inh, PO/IV

44
Q

acetylcysteine

NURSING

A

Encourage hydration throughout the day

45
Q

acetylcysteine

SIDE EFFECTS

A 
dizziness, 
drowsiness, 
orthostatic hypotension, 
tachycardia, 
hepatotoxicity
46
Q

acetylcysteine

CONTRAINDICATION

A

children < 7 years of age

Strong rotten egg smell (liquid po form)

powder to mix with drinks to manage the smell

47
Q

MUCOLYTIC

acetylcysteine

SECONDARY USES

A

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

48
Q

Supplemental Oxygen

USES

A

continuous (long-term)

PRN for DOE and QHS
dyspenea on excretion
at bedtime

acute SOB
shortness of breath

49
Q

Supplemental Oxygen

AVAILABLE IN

A

tank - portable

condenser - at home

piped- in medical facilities

50
Q

Supplemental Oxygen

SIDE EFFECT

A

vasoconstriction

loss of (hypoxia) 
- which is the respiratory drive for CO2 retainers

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

51
Q

Supplemental Oxygen

CONSIDERATION

A

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

Pharm (7 decks)

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