Lower Respiratory Tract Drugs Flashcards
Bronchial Asthma
Recurrent and reversible shortness of breath
Airways narrow due to bronchospasms, inflammation of bronchial mucosa, edema of bronchial mucosa, production of viscous mucus
Symptoms include wheezing, difficulty breathing, tightening of the chest, cough
Asthma Categories
Intrinsic (occurring in patients with no history of allergies)
Extrinsic (occurring in patients exposed to a known allergen)
Exercise induced
Drug induced (less common)
Status Astmaticus
Prolonged asthma attack that does not respond to typical drug therapy
MEDICAL EMERGENCY
Chronic Bronchitis
Continuous inflammation and low-grade infection of bronchi
Excessive secretion of mucus due to a prolonged exposure to bronchial irritants
COPD
Chronic, progressive, largely irreversible disorder characterized by airflow restrictions and inflammation
Chronic cough, excessive sputum, wheezing, dyspnea, poor exercise tolerance
Most commonly caused by smoking cigarettes
Emphysema
DESTRUCTION OF ALVEOLAR WALLS
SURFACE AREA WHERE GAS EXCHANGE TAKES PLACE IS REDUCED
EFFECTIVE RESPIRATION IS IMPAIRED
Bronchodilators
RELAX BRONCHI SMOOTH MUSCLE
Beta-adrenergic agonists, anticholinergics, and xanthine derivatives
Short-Acting Beta Agonist Inhalers
ALBUTEROL (VENTOLIN) AND METAPROTERENOL (ALUPENT)
Rapid relief of acute asthma
Long-Acting Beta Agonist Inhalers
SALMETEROL (SEREVENT)
Used for prophylactic and maintenance measures
Glucocorticoid/LABA Combinations
FLUTICASONE/SALMETEROL (ADVAIR)
BUDESONIDE/FORMOTEROL (SYMBICORT)
Indicated for long-term maintenance in adults and children
Not recommended for initial therapy
Beta2 Adrenergic Agonists
Use in asthma and COPD
Contraindications of Beta-Adrenergic Agonists
Known drug allergy, uncontrolled hypertension, cardiac dysrhythmias, high risk of stroke (due to vasoconstrictive drug action)
Adverse Effects of Beta-Adrenergic Agonists
ALPHA AND BETA: RESTLESSNESS, TREMOR, CARDIAC STIMULATION-TACHYCARDIA
ANGINAL PAIN WITH BETA1 AND BETA2
TREMOR WITH BETA2 (ALBUTEROL)
Albuterol (Proventil)
MOST COMMONLY USED DRUG IN THE SHORT-ACTING BETA2 AGONISTS
Must not be used too frequently
Salmeterol (Serevent)
Long-acting Beta2 agonist bronchodilator
NEVER TO BE USED FOR ACUTE TREATMENT
Anticholinergics
IPRATROPIUM (ATROVENT) AND TIOTROPIUM (SPIRIVA)
Indirectly cause airway relaxation and dilation
Help reduce secretions in COPD patients
Indications for Anticholinergics
PREVENTION OF BRONCHOSPASMS ASSOCIATED WITH CHRONIC BRONCHITIS OR EMPHYSEMA
Not used for management of acute symptoms
Adverse Effects of Anticholinergics
DRY MOUTH OR THROAT, nasal congestion, heart palpitations, GI distress
Xanthine Derivatives
ONLY THEOPHYLINE IS USED AS A BRONCHODILATOR
Indications for Xanthine Derivatives
Dilation of airways in asthma, chronic bronchitis, and emphysema
Mild to moderate cases of acute asthma
NOT FOR MANAGEMENT OF ACUTE ASTHMA ATTACK
Not used as frequently because of potential for drug interactions and variables related to drug levels in the blood
Theophyline
Most commonly used xanthine derivative
THERAPEUTIC RANGE FOR THEOPHYLINE BLOOD LEVEL IS 10-20 MCG/ML
Nonbronchodilating Respiratory Drugs
CORTICOSTEROIDS, leukotriene receptor agonists
Leukotriene Receptor Agonist Mechanism of Action
Leukotrienes cause inflammation, bronchoconstriction, and mucus production
LRTAs prevent leukotrienes from attaching to receptors on cells in the lungs and in circulation
Inflammation in the lungs is blocked, and asthma symptoms are relieved (prevent smooth muscle contraction, decrease mucus, prevent vascular permeability, decrease neutrophil and leukocyte infiltration)
MONTELUKAST (SINGULAIR)
Indications for LTRAs
Prophylaxis and long-term treatment and prevention of asthma in adults and children 12 years old and older
NOT for management of acute asthmatic attacks
Approved for treatment of allergic rhinitis
Corticosteroids
Anti-inflammatory properties
Used for CHRONIC ASTHMA, BRONCHITIS, EMPHYSEMA
May take several weeks before full effects are seen
BECLOMETHASONE (DIPROPIONATE)
Indications for Inhaled Corticosteroids
Primary treatment of bronchospastic disorders to control the inflammatory responses that are believed to be the cause of these disorders
Persistent asthma
Often used concurrently with beta-adrenergic agonists
Contraindications for Inhaled Corticosteroids
Hypersensitivity to glucocorticoids, patients with positive Candida sputum tests, patients with systemic fungal infection
Adverse Effects of Inhaled Corticosteroids
Pharyngeal irritation, coughing, dry mouth, oral fungal infections
Nursing Implications for Beta-Adrenergic Agonists
Ensure patients take medications exactly as prescribed
Frequent use of albuterol makes it lose its beta2-specific functions
Report insomnia, jitteriness, restlessness, palpitations, chest pain, or any change in symptoms
Nursing Implications for LTRAs
TEACH PATIENT TO TAKE MEDICATIONS EVERY NIGHT ON A CONTINUOUS SCHEDULE, EVEN IF SYMPTOMS IMPROVE
Assess liver function before therapy and throughout
Nursing Implications for Xanthine Derivatives
Be aware of drug interactions with cimetidine, oral contraceptives, allopurinol, certain antibiotics, influenza vaccine, and others
Cigarettes enhance xanthine metabolism
Nursing Implications for Inhaled Corticosteroids
Teach patients to gargle and rinse the mouth with lukewarm water
