Lower Respiratory Flashcards
Lower Respiratory Disorders
1 Chronic Bronchitis
2 Emphysema
3 Asthma
Chronic Bronchitis
- doesn’t affect the alveolar membrane
- productive cough 2-3mos. of year for consec yrs
- causes pulmo HTN>Cor pulmonale
- if PaO2 is decr then PT put on home O2
- we want the SpO2 to be bw 88-92% on pulse ox
Emphysema
- decr DLCO, histological patho Dx
- occurs late in life anti-trypsin deficiency
- almost always fr cigarette use
Asthma
-reversible disease
Status Asthmaticus
- irreversible
- emergency
Lower Respiratory Drug Types
BAM SLAM
Beta Adrenergic Agonist
Anticholinergics
Methylxanthines
Steroids
Leukotriene Modifiers
Mast Cell Inhibitors
Adrenergic aka
- alpha, beta agonist
- sympathomimetics
- catecholamines
adrenergic/sympathetic lung effect
dilates bronchioles
cholinergic aka
muscarinic agonist
- parasympathomimetic
- ACH-erase inhibitors
cholinergic/muscarinic effects on lungs
- constricts bronchioles
- increases secretions
Beta-2 Adrenergic Agonist drugs are divided into 2 categories
1 Short-Acting
2 Long-Acting
Beta-2 Adrenergic Agonist
MOA
selective B2 adrenergic agonist in bronchial smooth muscles resulting in bronchodilation, block histamine release
Short-Acting Beta-2 Adrenergic Agonist
Tx
acute asthma attack
-inhaled
Long-Acting Beta-2 Adrenergic Agonist
Tx
control of chronic asthma
-PO
**Beta-2 Adrenergic Agonist
A/E
- tachycardia/angina
- tremors
- insomnia…MI?
- hypo-K
Beta-2 Adrenergic Agonist
CI
- MI
- tachydysrhytmias
- angina
- caution w hyperthyroidism
Beta-2 Adrenergic Agonist
RN/teaching
- monitor chest pain
- AVOID CAFFEINE
- check pulse prior to admin
- report HR>20-30
- avoid using along w beta blocker meds
use Beta-2 Adrenergic Agonist first, wait ____ before using ____
5 mins
steroid inhaler
terbutaline
Tx
- acute asthma attack
- —rescue medication
- to delay labor
- –opposes oxytocin to strop pre-term labor/premature contractions
Anticholinergic
drug names
ipratropium + tiotropium
ipratropium + tiotropium [antichol]
MOA
relieve bronchospasm R2 COPD by blocking ACH
ipratropium + tiotropium [antichol]
Tx
- COPD
- EIB
- off-label asthma
*ipratropium + tiotropium [antichol]
A/E
- DRY MOUTH
- hoarseness
- dizziness
- blurred vision
*ipratropium + tiotropium [antichol]
CI
- soy/peanut algy
- glaucoma
- caution in BPH + NA
ipratropium + tiotropium [antichol]
RN/teaching
how to use the diskus (advair)
- 2 puffs, rinse mouth after to reduce taste
- at same time each day
- 2 inhaled meds are prescribed, wait 5 mins in bw
- DO NOT SWALLOW TIOTROPIUM CAPSULES (must inhale)
ipratropium + tiotropium [antichol] is often used in combination w ______
albuterol
-to incr effectiveness over just using individual med
peanut allergy [anaphylaxis] when there is acute bronchospasms
drugs
Epinephrine
-bc is beta 1 + 2 + alpha agonist
Isoproterenol
- beta 1 + 2 agonists so it will affect the heart
- used to treat bradycardia/brady arrythmias
avoid the use of _____ when taking beta-2 adrenergic agonist
caffeine
Methylxanthines
drug names
theophylline, aminophylline, theobromine
A/E of theophylline, aminophylline, theobromine [methyxanthines] are unlikely below _____
20 mcg/mL
theophylline, aminophylline, theobromine [methyxanthines]
MOA
relaxation of bronchial smooth muscles
-bronchodilation
theophylline, aminophylline, theobromine [methyxanthines]
Tx
- long term control of chronic asthma
- rarely COPD
*theophylline, aminophylline, theobromine [methyxanthines]
A/E
- DYSRHYTHMIAS (treat w LIDOCAINE)
- TACHY
- GI distress
- restlessness
- seizure (treat w DIAZEPAM)
- insomnia
*theophylline, aminophylline, theobromine [methyxanthines]
CI
- caffeine
- caution in liver + kidney dysfunction
**theophylline, aminophylline, theobromine [methyxanthines]
RN/teaching
teach to avoid caffeinated beverages, hidden sources
-smoking increases theophyline metabolism
theophylline, aminophylline, theobromine [methyxanthines]
therapeutic range
5-15 mcg/mL
adverse effects are unlikely when below 20 mcg/mL
_____ increases theophylline metabolisn
smoking
Steroids
beclomethasone, fluticasone, budesonide
beclomethasone, fluticasone, budesonide [steroids]
MOA
- prevent metabolism
- suppress mucous
- reduce airway mucose edema
*beclomethasone, fluticasone, budesonide [steroids]
Tx
*short-term IV is for status asthmaticus
- inhalation is for:
- long term prophylacis of asthma
- chronic severe asthma
- in utero for bbs to improve lung function
*beclomethasone, fluticasone, budesonide [steroids]
A/E
*candidiasis
-hoarseness
suppress adrenal function
-osteoperosis
-hyperglycemia
-infection
-hypokalemia
-PUD
-myopathy
-edema/fluid retentn
-wt gain
-Cushing syndrome
GI ulcers
*beclomethasone, fluticasone, budesonide [steroids]
CI
- no recent live virus vaccines
- caution in DM
beclomethasone, fluticasone, budesonide [steroids]
RN/teaching
- prevent suppression of adrenal gland function by Q OD Dosing
- candidiasis is treated w Nystatin prep
- always taper dose esp long term tx
beclomethasone, fluticasone, budesonide [steroids]
candidiasis Tx + teaching
nyastatin prep aka swish + spit/swallow
- swish for several minutes
- avoid eating 15 min
- report 3 P’s, wt gain, or muscle weakness
Leukotriene Modifiers
drugs
monteLUKast, ziLEUton, zafirLUKast
*all have leuk/luk
montelukast, zileukton, zafirlukast
MOA
- suppress leukotrienes
- reduce inflammation
montelukast, zileukton, zafirlukast
Tx
long term asthma therapy
—adults or children 12 mos +
*montelukast, zileukton, zafirlukast
A/E
- depression
- suicidal ideation
- liver injury
- headache
*montelukast, zileukton, zafirlukast
CI
cirrhosis
*montelukast, zileukton, zafirlukast
RN/teaching
- obtain baseline LFT’s
- monitor for NV
- anorexia
- abd pain
Short-Acting Beta-2 Adrenergic Agonist
drug names
LA is a short road trip
Levabulterol
Albuterol
Long-Acting Beta-2 Adrenergic Agonist
drug names
SF is a long road trip
Salmeterol
Formoterol
the absorption of theophylline, aminophylline, theobromine [methyxanthines] can be lowered with _____
activated charcoal
theophylline, aminophylline, theobromine [methyxanthines] can cause dysrhytmias but may be treated with ______
lidocaine
if patient is a smoker and is prescribed theophylline, their dosing will increase/decrease?
increase
bc smoking increases theophylline metabolism
mast cell stabilizer
drug
cromolyn
mast cell stabilizer - cromolyn
MOA
suppresses histamine in blood vessels
which causes swelling/edema
mast cell stabilizer - cromolyn
Tx
prophylaxis for asthma
- great for kids bc weak replacement for steroids
- EIB adults
mast cell stabilizer - cromolyn
A/E
- metallic taste
- throat burn but very safe
- dry mouth
mast cell stabilizer - cromolyn
CI
contact lenses w eye drops
mast cell stabilizer - cromolyn
RN/teaching
15-30 min before exercise
- drink water
- gargle after inhalations
- give w nebulizer or MDI
in kids, inhaled steroids can have systemic absorption which can ___
stunt their growth
