Lower Resp Flashcards
COPD
chronic, progressive, airflow limitation, not reversible
combination of two diseases:
Chronic bronchitis
Emphysema
COPD
S/S
Signs/symptoms: productive cough dyspnea rhonchi sectional diminished/absent breath sounds
3rd leading cause of death (increasing from 4th)
Asthma
chronic, intermittent, & reversible airway inflammatory disease
triggered by stress & allergens
inflammation, smooth muscle contraction, and mucus production => airway obstruction
Asthma
Signs/symptoms:
cough
dyspnea
wheezing
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
DPI
by the force of inhalation dry powder is inhaled
many shape of devices
No need for shaking, no need for spacer
MDI
uses a propellant to deliver a liquid drug
Shake before using
If two puffs is prescribed wait one minute between two puffs
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
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
Respiratory Medication Administration Terminology
Rescue medications:
Maintenance medications:
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
Maintenance medications:
Must take at regular times regardless of symptoms (scheduled)
Bronchodilators
β2 Adrenergic Agonist (inh)
MOA
bronchodilation,
↓ histamine,
↑ ciliary motility
Bronchodilators
β2 Adrenergic Agonist (inh)
SIDE EFFECTS
can cause Beta1 activation => tachycardia, dysrhythmia, angina, HTN, palpitation nervousness, tremors, HA, ↑ BG
avoid stimulants:
caffeine,
nicotine
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
Bronchodilators
β2 Adrenergic Agonist (inh)
CONTRAINDICATIONS
Contraindications:
pregnancy,
tachycardia,
hyperthyroidism
Use before inhaled corticosteroids
Short acting, rescue inhaler
Adrenergic Agonist
albuterol
MDI/Neb
levalbuterol
MDI/Neb
Long acting, maintenance Adrenergic Agonist
albuterol
PO
salmeterol
diskus DPI
BronchodilatorsAnticholinergic
MDI
NEB
MOA:
anticholinergic (PNS) →
bronchodilation
Maintenance treatment
ipratropium
tiotropium
BronchodilatorsAnticholinergic
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)
