Lower Respiratory Drugs

Question 1

What drugs are classified as Xanthines?

Answer 1

Aminophylline, Caffeine, and Theophylline

Question 2

What drugs are classified as Sympathomimetics?

Answer 2

Albuterol, Terbutaline, Epinephrine, isoproterenol, etc

Question 3

What drugs are classified as anticholinergics?

Answer 3

Ipratropium, Tiotropium

Question 4

What are the drug classes that affect inflammation?

Answer 4

Inhaled steroids and Leukotriene receptor antagonists

Question 4

What is the common purpose for xanthines, anticholinergics, and sympathomimetics?

Answer 4

Bronchodilation ( They all promote bronchial smooth muscle relaxation)

Question 5

Cheye-Stokes Respiration

Answer 5

Abnormal breathing is characterized by apneic periods followed by tachypnea.

Question 6

Define: Leukotriene receptor antagonists

Answer 6

They block receptors for the production of leukotrienes D4 and E4, which are components of slow-reacting substances of anaphylaxis)

Question 7

Define: Mast Cell Stabilizer

Answer 7

Drugs that prevent the release of inflammatory and bronchoconstriction substances from mast cells.

Question 8

Define: xanthines

Answer 8

A naturally occurring substance that directly affects the smooth muscle of the resp tract, both in the bronchi and blood vessels.

Question 9

What drugs are classified as inhaled steroids?

Answer 9

Budesonide, Beclomethasone

Question 10

1. What is the M.O.A. for methylxanthines?
2. In what forms are they available?
3. Indications?

Answer 10

1. They inhibit Phosphodiesterase (PDE), leading to smooth muscle relaxation.
2. PO or IV
3. Relief of sx or prevention of bronchial asthma and reversal of bronchospasm related to COPD.

Question 11

What drugs are classified as leukotriene receptor antagonists?

Answer 11

Montelukast, Zafirlukast

Question 12

1. What is the M.O.A for B2 agonists or sympathomimetic?
2. What forms are available?
3. Indications?

Answer 12

1. Dilate the bronchi and increase the rate and depth of respiration.
2. Metered dose inhalers or nebulizers, also depending on the drugs
3. There are two categories: SABA and LABA. Saba is indicated for quick symptom relief in acute asthmatic attacks. Labas are used in combination with inhaled corticosteroids as prophylactic or maintenance treatment of asthma or COPD.

Question 13

What is a critical pharmacokinetic detail to remember when it comes to xanthines?

Answer 13

They have a narrow margin of safety and often interact with other drugs.
- They also cross the placenta and can enter milk

Question 14

What are some unlabeled uses of xanthines?

Answer 14

Stimulation of respirations in Cheyne-Stokes and tx of apnea & bradycardia in premature infants.

Question 15

What are the cautions and contraindications for xanthines?

Answer 15

Caution in pts with GI problems, coronary disease, respiratory dysfunction, renal or hepatic disease, seizure disorders, alcoholism, or hyperthyroidism.

Question 16

What is the purpose of parenteral xanthines?

Answer 16

Emergency and acute use only. Switch to oral ASAP

Question 17

What are the adverse/side effects of xanthines?

Answer 17

The adverse effects of theophylline are related to the serum blood levels.
Toxicity effects include nausea, vomiting, irritability, tremors, nervousness, insomnia, and tachyarrhythmias.

Question 18

What are the adverse/side effects of sympathomimetics?

Answer 18

Adverse effects attributed to sympathomimetic stimulation.
- CNS stimulation, GI upset, cardiac arrhythmias, hypertension, angina, sweating, pallor, and flushing.
- Life-threatening paradoxical bronchospasm

Question 19

What are the adverse/side effects of anticholinergics?

Answer 19

Local adverse effects include dry mouth and/or hoarse throat. Adverse effects are related to the anticholinergic effects of the drug if absorbed systemically. (dizziness, headache, fatigue, nervousness, eyesight changes, palpitations, and urinary retention)

Question 20

What are the adverse/side effects of inhaled steroids?

Question 21

What are the adverse/side effects of leukotriene receptor antagonists?

Question 22

What are the therapeutic theophylline levels?

Answer 22

10-20 mcg/mL

Question 23

What are the sx of severe theophylline toxicity?

Answer 23

Seizures, life-threatening arrhythmias, hypotension, and coma

Question 24

What are some nursing considerations for patients receiving xanthines?

Answer 24

1. Assess for any contraindications/ cautions 2. Monitor respiratory status, baseline vitals, lung sounds 3. Complete liver eval and monitor liver and renal function tests 4. Evaluate serum theophylline levels 5. Administer oral drug with food or milk to relieve GI irritation 6. Provide education regarding medication, warning signs, proper use, etc.

Question 25

What are some drug interactions for sympathomimetics?

Answer 25

1. Avoid the combination of sympathomimetics with general anesthetics cyclopropane and halogenated hydrocarbons. 2. Beta-blocking meds may decrease the sympathomimetic medication's effects if both are administered systemically.

Question 26

What are some drug interactions for inhaled steroids?

Question 27

What are some drug interactions for leukotriene receptor antagonists?

Question 28

What are some systemic effects of sympathomimetics?

Answer 28

Increased BP, HR, and decreased renal and GI blood flow

Question 29

What forms of Albuterol are available?

Answer 29

Oral and Inhaled

Question 30

What are the contraindications/cautions for sympathomimetics?

Answer 30

Whether they should be cautioned or completely avoided depends on the severity of the underlying condition and the possibility that sympathetic stimulation could aggravate it. - Caution in pts with concurrent heart/renal disease, hyperthyroidism, diabetes mellitus, and pregnancy

Question 31

What are some nursing considerations for sympathomimetics?

Answer 31

1. Assess reflexes and orientation to evaluate CNS effects 2. Monitor respirations and adventitious sounds 3. Monitor Baseline vitals, resp. status, and ECG 4. Advise a pt on short-term therapy to use the minimum amount needed for the shortest period necessary 5. Advise pt to use an inhaler 30 to 60 mins before exercise

Question 32

1. What is the M.O.A. for anticholinergics? 2. What forms are available? 3. Indications?

Answer 32

1. They block vagus nerve activity and dilate the bronchi. They block the action of ACh. 2. Inhaler, but Ipratropium is also available as a nasal spray for seasonal rhinitis. 3. Bronchospasm in COPD ( Less effective for asthma but drugs of choice for COPD)

Question 33

1. What is the M.O.A. for inhaled steroids? 2. What forms are available? 3. Indications?

Answer 33

1. They block inflammation of the respiratory mucosa.

Question 34

1. What is the M.O.A for leukotriene receptor antagonists? 2. What forms are available? 3. Indications?

Answer 34

1. The receptors block specific inflammatory effects.

Question 35

What does the usual vagus nerve stimulation of the smooth muscle cause?

Answer 35

Contraction

Question 36

What are the contraindications/cautions for anticholinergics?

Answer 36

Caution should be used for any condition aggravated by anticholinergic or atropine-like effects. -Examples include narrow-angle glaucoma, bladder neck obstruction or prostatic hypertrophy, and conditions aggravated by dry mouth and throat—caution in pregnancy and lactation, hyperthyroidism, and heart disease. - Contraindicated in hypersensitivity or known allergy

Question 37

What are some nursing considerations for anticholinergics?

Answer 37

1. Assess for any allergies or possible contraindications 2. Assess the skin color and lesions for dryness or allergic reaction and evaluate oxygenation 3. Evaluate orientation and CNS effects 4. Assess pulse and blood pressure and evaluate urinary output 5. Ensure adequate hydration and inform of any changes in voiding.