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Pharmacology > Lower Respiratory Agents > Flashcards

Lower Respiratory Agents Flashcards

1
Q

Where do Lower Respiratory Agents work?

A

Where gas exchange occers
* Bronchial tree
* Alveoli

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2
Q

Which diseases are treated with lower respiratory drugs?

A
  • Asthma
  • COPD (Emphysema, Chronic Bronchitis)
  • Pneumonia
  • Respiratory Distress Syndrome (neonates)
  • Adult Respiratory Distress Syndrome
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3
Q

What forms do lower respiratory drugs come in?

A

Oral, nebulizer, injection

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4
Q

Considerations for Lower Respiratory Tract agents
In Children

A

Prevention is KEY
* Avoid allergens, smoke, crowds, dusty areas

Used frequently:
* Long-Acting inhaled steroid
* Short-Acting Beta2 agonist (SABA)
* Leukotriene receptor agonist (best for prevention)

Theophylline ONLY if nothing else works

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5
Q

Considerations for Lower Respiratory Tract agents
In Adults

A
  • Avoidance of aggravating factors/triggers
  • Periodic review of treatment regimen
  • Periodic spirometry to measure lung capacity
  • Safety in pregnancy has not been established: benefit vs. risk
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6
Q

Considerations for Lower Respiratory Tract agents
In Older Adults

A
  • Used frequently in this population
  • More likely to experience adverse effects
  • Renal and hepatic impairment can alter metabolism and excretion
  • START LOW, GO SLOW
  • Close monitoring
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7
Q

Considerations for Lower Respiratory Tract agents - Adjuvant Therapy
In Older Adults

A
  • Pulmonary hygiene (toileting) - positioning, coughing, deep breathing, head of bed up
  • Positioning
  • Fluids
  • Nutrition
  • Humidification
  • Rest
  • Activity Plans
  • Support for complicated drug regimen
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8
Q

Xanthines
Mechanism of Action

A
  • Direct effect on the smooth muscles of the resp. tract, both in the bronchi and in the blood vessels (vasodilation)
  • Exact MOA unknown
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9
Q

Xanthines
Indications

A
  • Symptomatic relief or prevention of asthma and COPD
  • Reversal of bronchospasm
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10
Q

Xanthines
Drug Names

A
  • Caffeine
  • Theophylline (most common)
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11
Q

Other name for Xanthines

A

Methylxanthines

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12
Q

Xanthines
Safety Considerations

A
  • Narrow margin of safety
  • Interact with MANY drugs
  • Numerous adverse effects
  • Reserved for when other drugs don’t work or critical situation in ICU
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13
Q

Xanthines
Contraindications

A

Absolute:
* Allergy

Cautions: (worsened with xanthines)
* GI problems
* Heart disease
* Renal or hepatic disease
* Alcoholism
* Hyperthyroidism

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14
Q

Xanthines
Drug Interactions

A
  • ANY drug metabolized in the liver has the potential to interact with xanthines
  • Substances in CIGARETTES => need for higher dose to be therapeutic (if pt. decreases or stops smoking, risk for toxicity with the higher dose)
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15
Q

Xanthines
Adverse Effects

A

Related to theophylline levels in blood
* GI issues: Nausea & Vomiting
* Cardiac: Tachycardia
* CNS: Tremors, Irritability, Insomnia

SEVERE TOXICITY:
* Seizures
* Life-threatening arrhythmias
* Hypotension
* Coma

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16
Q

Xanthines
Assessment

A

History:
* Allergy
* Pregnancy/lactation
* Cautions
* Smoking history

Physical:
* Respiratory
* Cardiac
* Abdomen
* ECG

Labs:
* Liver and Renal funtion tests
* Theophylline levels

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17
Q

Xanthines
Nursing Conclusions

A
  • Impaired comfort (r/t adverse effects)
  • Altered sensory perception (r/t adverse CNS effects)
  • Knowledge deficit
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18
Q

Xanthines
Implementation/Patient Teaching

A
  • Administer WITH food or milk to relieve GI upset
  • Swith from IV to oral ASAP to avoid systemic effects
  • Comfort measures (rest periods)
  • Patient Teaching (sig. adv. effects - how to manage, report)
  • Lab tests regularly
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19
Q

Sympathomimetics
Mechanism of Action

A

Bronchodilators
* Beta2 selective adrenergic agonists
* Dilates bronchi
* Increases respiratory rate
* Increases depth of respirations
* SABA (short-acting) and LABA (long-acting)
* Mimics sympathetic nervous system stimulation

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20
Q

Sympathomimetics
Indications

A
  • ACUTE Asthma Attack SABA
  • Bronchospasm SABA
  • Prevention of exercise-induced asthma SABA
  • Maintenance medication for chronic respiratory distress - LABA
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21
Q

Sympathomimetics
Drug Names

A

Epiniphrine (Drug of choice in bronchospasm)
“-terol”
* Levalbuterol
* Salmeterol
* Albuterol (rescue inhaler)
* Formoterol

“-proterenol”
* Isoproterenol
* Metaproterenol

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22
Q

Sympathomimetics
Contraindications

A

Absolute:
* Allergy

Cautions:
* Conditions that would worsen with SNS stimulation: (cardiac pts), heart disease, vasular disease, hypothyroidism

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23
Q

Sympathomimetics
Drug Interactions

A
  • Beta Blockers - can block symp. drugs (if administered systemically)
  • Other drugs that increase BP or HR
  • Substances in cigarettes
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24
Q

Sympathomimetics
Adverse Effects

A
  • Occasionally CAUSES bronchospasm
  • Sympathetic Stimulation: CNS stimulation (anxiety, dizziness, headache)’; GI Upset; Cardiac (arrhythmias, hypertension, sweating, pallor, flushing)
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25
Q

Sympathomimetics
Assessment

A

History:
* Allergy
* Pregnancy/lactation
* cigarette use (affects metabolism of drug)
* conditions that require cautions

Physical:
* Respiratory
* Cardiac
* Neuro
* Vital Signs

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26
Q

Sympathomimetics
Nursing Conclusions

A
  • Altered tissue perfusion
  • Impaired comfort
  • Anxiety or restlessness
  • Knowledge deficit
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27
Q

Sympathomimetics
Implementation

A
  • Proper administration
  • Safety measures
  • Take 30-60 minutes before exercise for exercise-induced asthma
  • Comfort measures: small, frequent meals and nutritional consult
  • Patient Education
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28
Q

Anticholinergics
MOA

A

Bronchodilation
* Blocks the vagal effect leading to relaxation of smooth muscle in bronchi

29
Q

Anticholinergics
Indications

A

Maintenance treatment for COPD

For patients that cannot tolerate sympathomimetics - not as effective

30
Q

Anticholinergics
Drug Names

A

“-tropium”
* Ipatropium
* Tiotropium

“-clidinium”
* Aclidinium
* Umeclidinium

31
Q

Anticholinergics
Contraindications

A

Absolute
* Allergy
* Acute bronchospasm requiring imm. intervention

Cautions:
* Any condition aggravated by anticholinergic effects: Glaucoma, urinary retention

32
Q

Anticholinergics
Adverse Effects

A
  • Dry Mouth, hoarseness, sore throat
  • Dizziness, headache, fatigue, nervousness, palpitations, urinary retention (from small systemic effects)
  • Paradoxical bronchospasm
33
Q

Anticholinergics
Drug Interactions

A

Other anticholinergics

34
Q

Anticholinergics
Assessment

A

History:
* Allergy to drug, acute bronchospasm
* Pregnancy/lactation
* Conditions exacerbated by anticholinergics

Physical:
* Respiratory
* Cardiac
* Skin/mucus membranes (color, dryness, lesions)
* CNS: Orientation, affect, and reflexes
* Urinary output
* Vital Signs

35
Q

Anticholinergics
Nursing Conclusions

A
  • Impaired comfort
  • Knowledge Deficit
36
Q

Anticholinergics
Interventions/Patient Teaching

A
  • Void prior to med. administration
  • Safety measures for CNS effects
  • Comfort measures: small, frequent meals; sugarless lozenges; humidification; adequate hydration
  • Patient Teaching
37
Q

Inhaled Steroids
Mechanism of Action

A
  • Decreases the inflammatory response in the airways
  • Takes 2-3 weeks to be effective
38
Q

Inhaled Steroids
Indications

A
  • Prevention and treatment of asthma
  • Maintenance treatment of COPD
39
Q

Inhaled Steroids
Drug Names

A

“-one”
* Beclomethasone (Qvar)
* Fluticasone
* Triamcinolone

“-esonide”
* Budesonide
* Ciclesonide

40
Q

Inhaled Steroids
Implementation/Patient Teaching

A
  • Comfort measures
  • Safety measures
  • Patient Teaching: NOT for emergencies
  • Rinse mouth after using inhaler (to prevent fungal infections)
  • Clean mouthpiece after every use
  • Monitor for signs of respiratory infection
41
Q

Inhaled Steroids
Contraindications

A

Absolute:
* Allergy
NOT a drug for acute asthma attack!

Caution:
* Active respiratory infection (because of suppressed immune function by steroids)

42
Q

Inhaled Steroids
Adverse Effects

A
  • Sore throat/hoarseness
  • Coughing
  • Dry Mouth
  • Pharyngeal and laryngeal fungal infections
43
Q

Inhaled Steroids
Drug Interactions

A

NONE/UNKNOWN

44
Q

Inhaled Steroids
Assessment

A

History:
* Allergy
* Pregnancy/lactation
* Systemic infections

Physical:
* Respiratory
* Vital Signs (temperature) - Baselines
* CV: BP, pulse, cardiac auscultation
* Look for fungal infections

45
Q

Inhaled Steroids
Nursing Conclusions

A
  • Impaired Comfort
  • Infection Risk
  • Knowledge Deficit
46
Q

Leukotriene Receptor Antagonists
MOA

A
  • Block (antagonize) receptors for the production of leukotrienes
  • They DO NOT have an immediate effect: 1-2 weeks for therapeutic effect
47
Q

Leukotriene Receptor Antagonists
Indications

A

Long term treatment of Asthma

48
Q

Leukotriene Receptor Antagonists
Drug Names

A

“-lukast”
* zafirlukast (Accolate)
* Montelukast (Singulair)

49
Q

Leukotriene Receptor Antagonists
Contraindications

A

Absolute:
* Allergy
* Acute Asthma Attack

Caution:
* Hepatic Impairment

50
Q

Leukotriene Receptor Antagonists
Adverse Effects

A
  • Flu-like symptoms: pharyngitis, cough, generalized pain, fever, myalgia
  • CNS: Headache, dizziness
  • GI: nausea, diarrhea, vomiting, abdominal pain, elevated liver enzymes

Black Box Warning
* Aggressive behavior, depression & suicide, hallucinations => in children

51
Q

Leukotriene Receptor Antagonists
Drug Interactions

A
  • metabolized by p450 system along with MANY others => check drug guide before administration
52
Q

Leukotriene Receptor Antagonists
Assessment

A

History:
* Allergy, hepatic impairment, pregnancy/lactation

Physical:
* Respiratory: rule out acute asthma attack
* Temp, resp, lung sounds
* CNS: orientation and affect
* Abdomen

Labs:
* Liver function tests (LFTs)

53
Q

Leukotriene Receptor Antagonists
Nursing Conclusions

A
  • Injury Risk (Black box warning)
  • Impaired comfort
  • Knowledge deficit
54
Q

Leukotriene Receptor Antagonists
Implementation/Patient Teaching

A
  • Not for use in acute asthma attack
  • Monitor for infection
  • Safety measures r/t adverse effects
  • Patient Teaching
55
Q

Lung Surfactants
MOA

A
  • Replace the surfactant that is missing in the lungs of neonates with RDS
  • Begins to work IMMEDIATELY
56
Q

Lung Surfactants
Indications

A

Rescue treatment for infants who have developed RDS (missing surfactant)

57
Q

Lung Surfactants
Contraindications

A

NONE

58
Q

Lung Surfactants
Adverse Effects

A

NONE

59
Q

Lung Surfactants
Drug Names

A

“-actant”
* Beractant (most common)
* Calfactant
* Lucinactant
* Poractant

60
Q

Lung Surfactants
Assessment

A

History:
* Time of birth and exact weight for dosing

Physical:
for effectiveness of drug
* Respiratory assessment
* Vital Signs
* Blood gases and O2 saturation

61
Q

Lung Surfactants
Nursing Conclusions

A
  • Decreased Cardiac Output
  • Injury Risk (medication through trachea)
  • Knowledge deficit
62
Q

Lung Surfactants
Implementation/Patient Teaching

A
  • Monitor continuously
  • Ensure tube placement before administration
  • Suction before administration but wait TWO hours after administration
  • Teaching and support for parents
63
Q

BAM
Bronchodilators

A
  • Beta2 Agonists (sympathomimetics)
  • Anticholinergics
  • Methylxanthines (xanthines)
64
Q

SLM
Soothes Inflammation

A
  • Steroids
  • Leukotriene Receptor Antagonists
  • Mast Cell Stabilizers (Not used anymore)
65
Q

Treatment for
Acute Asthma Attack

A

A: Albuterol (sympathomimetic/Beta2 agonist)
I: Ipratropium (anticholinergic)
M: Methylprednisolone (steroid)

66
Q

Way to remember
Anticholinergic
Side effects

A

Can’t see
Can’t pee
Can’t spit
Can’t shit
Block secretions, dry out

67
Q
A
68
Q

Inhaler
Patient Teaching

A

Multiple puffs of the same inhaler: Wait 1 minute between puffs

Sympathomimetic & Steroid Inhalers:
Sympathomimetic 1st, wait 5 minutes, then steroid

Container Inhalers: Shake it before you take it

Steroid Inhalers: Swish and spit
Clean the mouthpiece after EVERY use

Pharmacology (10 decks)

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