lower respiratory disorders Flashcards
What are the two umbrella terms that are lower respiratory diseases?
COPD and Restrictive lung disease
What is COPD?
Airway obstruction with increased airway resistance of airflow to lung tissues caused by inflammation, bronchoconstriction, and increased secretions
What is restrictive lung disease?
These diseases don’t allow the lungs to expand properly
What diseases are under COPD?
Chronic bronchitis, Bronchiectasis, Emphysema, Asthma
What diseases fall under restrictive lung disease?
Pulmonary edema, Pulmonary fibrosis, Pneumonitis, Lung tumors, Thoracic disorders (scoliosis, kyphosis)
What drugs are used to treat COPD?
Bronchodilators (sympathomimetics, Beta 2 adrenergic agonists), Methylxanthines, Leukotriene antagonists, Glucocorticoids (steroids), Cromolyn, Anticholinergics, Mucolytics
What is asthma?
Inflammatory disorder with varying amounts of airway characterized by bronchospasm
What are asthma triggers?
Stress, allergens, pollutants
What occurs that leads to airway constriction and obstruction in asthma?
Inflamed and edematous airways cause constriction, and the bronchial cells produce more mucus which causes obstruction
What are signs and symptoms of asthma?
Wheezing, SOB, cough (at first dry but then after the attack becomes productive), chest tightness (mostly at night and in the morning)
What is chronic bronchitis?
Progressive lung disease caused by smoking or chronic lung infections
What occurs that leads to airway obstruction in chronic bronchitis?
Bronchial inflammation and excessive mucus production
What can be heard during auscultation of chronic bronchitis?
Productive cough with rhonchi
What can chronic bronchitis cause?
Hypercapnia, hypoxemia, respiratory acidosis
What are preventative and treatment measures for COPD?
Prevent exacerbations by reducing environmental exposure to irritants, stop smoking, filter allergens from air, remove rugs in home, avoid exposure to known irritants/allergens, open the conducting airways using bronchodilators, decrease the effects of inflammation on the airway lining
What type of drug are sympathomimetics?
Bronchodilators, alpha and beta 2 adrenergic agonists
What is epinephrine?
A non-selective sympathomimetic that promotes bronchodilation and elevated BP in emergency situations
What is a bronchospasm selective beta 2 adrenergic agonist?
Given as aerosol/tablet and has less side effects than the non-selective
What are sympathomimetic medications?
Albuterol, Proventil, Ventolin, Metaproterenol
What drug class is albuterol?
Sympathomimetic beta 2 adrenergic
What is albuterol indicated for?
Acute asthma attacks, to control asthma, for exercise induced asthma
Albuterol is the only med considered a…
Rescue med
What is the onset of albuterol?
30 minutes
What pregnancy category is albuterol?
Pregnancy category C
What meds are considered the same as albuterol?
Ventolin, Proventil, Xopenex
What is Xopenex good for?
Patients with AFIB or tachycardia because it causes a less rapid HR
What are the two types of aerosol inhalers?
Metered dose inhaler and dry powder inhaler
How is an aerosol inhaler used?
Test spray the inhaler if it hasn’t been used recently, insert the canister into plastic mouthpiece, shake before using and remove the cap from mouthpiece, breathe out the mouth and place mouthpiece 1-2 inches from mouth, take a slow deep breath while pressing the top of the canister once, hold breath for a few seconds and exhale slowly through pursed lips, wait 2 minutes and repeat starting from shaking again.
What should be administered first, a bronchodilator or a steroid inhaler?
Bronchodilator because it helps open the airways so the steroid inhaler can work, wait 5 minutes before administering steroid inhaler
What med is the prototype for anticholinergics?
Ipratropium (Spiriva)
What is Ipratropium (Spiriva) indicated for?
Maintenance of bronchospasm associated with COPD
How does Ipratropium (Spiriva) work?
Relaxes smooth muscle of the bronchioles
Does Ipratropium (Spiriva) have systemic effects?
Very few when administered by aerosol
If also using a sympathomimetic, steroids, or cromolyn, which should be given first?
Administer the sympathomimetic first, wait 5 minutes, then administer Ipratropium (Spiriva), or the steroid, or cromolyn
What are side effects of Ipratropium (Spiriva)?
Hoarseness and dry mouth
What are the adverse effects of Ipratropium (Spiriva)?
Angioedema, dehydration, hyperglycemia
What are the contraindications of Ipratropium (Spiriva)?
Peanut allergy, pregnancy
Who should we take caution with when giving Ipratropium (Spiriva)?
Patients with lactose sensitivity, hypersensitivity, breastfeeding, narrow-angle glaucoma
What are methylxanthines used for?
Treatment of asthma
How do methylxanthines work?
Stimulate CNS and respiration, dilate coronary and pulmonary vessels, cause diuresis
What is the therapeutic range of methylxanthines?
10-20 mcg/mL
What meds are considered methylxanthines?
Theophylline, aminophylline, and caffeine
What are contraindications of Theophylline?
GI problems, coronary disease, respiratory dysfunction, renal/hepatic disease, alcoholism, hyperthyroidism
What are adverse effects of theophylline?
More side effects will occur with higher levels of theophylline in the blood (>20 mcg/mL), side effects include GI upset, nausea, irritability, tachycardia, seizure, brain damage, and death
What is leukotriene?
Chemical mediator that causes inflammatory changes in the lungs
What do leukotriene antagonists do?
Promote an increase of eosinophil migration, mucus production, and airway wall edema, resulting in bronchoconstriction
What are leukotriene antagonists used for?
Only used for exercise induced asthma
What are medications that are leukotriene antagonists?
Montelukast sodium (Singulair), Zafirlust (Accolate), Zileuton (Zyflo CR)
What pregnancy category is Montelukast Sodium (Singulair)?
Pregnancy category C
What are the indications of Montelukast Sodium (Singulair)?
Prevention and maintenance treatment of asthma
How does Montelukast Sodium (Singulair) work?
Binds with leukotriene receptors to inhibit smooth muscle contraction and bronchoconstriction
How is Montelukast Sodium (Singulair) given?
PO NOT inhaled
What are contraindications of Montelukast Sodium (Singulair)?
Hypersensitivity, severe asthma attack, status asthmaticus
What are the side effects of Montelukast Sodium (Singulair)?
Fever, HA, dizziness, fatigue, nasal congestion, cough, sore throat
Who should we take caution in when giving Montelukast Sodium (Singulair)?
Patients with severe liver disease
Why is Montelukast Sodium (Singulair) a black box warning?
It can cause depression, agitation, and suicidal ideas in children
What are glucocorticoids (steroids) used for?
To treat respiratory disorders specifically asthma
What type of action do glucocorticoids (steroids) have?
Anti-inflammatory action
What are indications of glucocorticoids (steroids)?
If the patient’s asthma is unresponsive to a bronchodilator, or if the patient still experiences asthma attacks on the highest doses of theophylline
What type of effect do glucocorticoids (steroids) have when given with sympathomimetics?
Synergistic effect
How are glucocorticoids (steroids) given?
MDI, tablet, or IV
How long does the MDI take for full effect?
1-4 weeks and it’s not effective for a severe asthma attack
Which route helps improve system control and decrease attacks?
MDI
What does the MDI reduce the risk of?
Adrenal suppression associated with systemic steroid
Which route is preferred for glucocorticoids (steroids)?
MDI
How would you administer glucocorticoids (steroids) for an acute asthma exacerbation?
IV for rapid effectiveness, then tablet doses
How should the PO version of glucocorticoids (steroids) be taken?
Taken with food to avoid gastric ulcers
What is Advair?
A combination of fluticasone propionate and salmeterol, used to alleviate constriction
What are side effects of the PO version of glucocorticoids (steroids)?
Generally local effects, throat irritation, hoarseness, dry mouth, oral and pharyngeal fungal infections that are reversed with discontinuation of glucocorticoids (steroids) and antifungal treatment
What are candida albicans?
An oral infection that can be prevented by rinsing mouth with water after using inhaler, and washing apparatus daily
What are the indications of Cromolyn (Intal)?
Prophylactic treatment of bronchial asthma, not for acute asthma attacks
How is Cromolyn (Intal) given?
Given by inhalation and must be taken daily
How does Cromolyn (Intal) work?
Inhibits the release of histamine to prevent asthma reaction
What are the side effects of Cromolyn (Intal)?
Bad taste and rebound bronchospasm
Why should we not discontinue Cromolyn (Intal) abruptly?
It can cause a rebound asthma attack
How does Nedocromil work?
Suppresses the release of histamine, leukotrienes, and mediators from mast cells
What is Nedocromil not used for?
Acute asthma attacks
What are the side effects of Nedocromil?
Bad taste
Which is more effective, Cromolyn or Nedocromil?
Nedocromil
How do mucolytics work?
Liquify and loosen thick mucus secretions so they can be expectorated
What are the indications of mucolytics?
Patients with active airway disease or asthma have excess secretions, pt who has difficulty coughing up secretions, pt who has atelectasis, pt undergoing diagnostic bronchoscopy, post op patients, pts with tracheostomies
For which one of these patients would we use the mucolytic AND a bronchodilator?
Asthma and active airway disease pt
Which one would be taken first, the mucolytic or the bronchodilator?
The mucolytic should be taken 5 minutes after the bronchodilator
How are mucolytics given?
Nebulizer, PO (diluted with water or juice), or direct instillation into trachea
Take caution when giving mucolytics to who?
Patients with acute bronchospasm, peptic ulcer, and esophageal varices
What are side effects of mucolytics?
N/V, stomatitis, runny nose, rash, bronchospasm
Mucolytics are the antidote for what?
Acetaminophen overdose if given within 12-24 hours
What are the indications for Mucomyst (Acetylcysteine)?
Adjunctive therapy for abnormal, thick mucus secretions in acute and chronic bronchopulmonary disorders. To lessen hepatic injury in cases of acetaminophen toxicity
How does Mucomyst (Acetylcysteine) work?
Breaks the links in the mucoproteins contained in the respiratory mucus secretions, decreases the viscosity of the secretions, and protects liver cells from acetaminophen toxicity
How is Mucomyst (Acetylcysteine) given?
Instillation, inhalation, PO
What is the onset for installation/inhalation of Mucomyst (Acetylcysteine)?
1 minute
What is the peak for installation/inhalation of Mucomyst (Acetylcysteine)?
5-10 minutes
What is the duration for installation/inhalation of Mucomyst (Acetylcysteine)?
2-3 hours
What is the onset for PO of Mucomyst (Acetylcysteine)?
30 - 60 minutes
What is the peak for PO of Mucomyst (Acetylcysteine)?
1-2 hours
