Medications Flashcards
The overall goal of pulmonary medication is to:
Increase:
Decrease:
Sympathetic
Decrease parasympathetic
Therefore INCREASE Lumen size in lungs
What are side effects of most medications that enhance sympathetic output
Arrythmias
High HR
High BP
4 Mechanisms that Pulmonary meds can work?
Bronchodilation
Facilitation of mucociliary action
Increased alveolar ventilation/improved oxygen
Improved control of breathing pattern
What do sympathomimetics do
Immitate sympathetic NS
by stimulating Beta 2 Receptors
What is a SABA?
Short acting Beta 2 agonist
works in 3-5 mins, lasts 4-6 minutes
THIS IS FOR ACUTE ASTHMA ATTACKS
What is epinephrine used for?
Given to promote bronchodilation/increase BP
Used in emergent situations (also asthma attack)
This is not a SABA because it’s nonselective
What is a LABA?
Long acting Beta 2 Agonist
this is NOT for acute asthma attacks
-used to help patients breathe in their sleep or for maintence therapy
Albuterol is an example of a
SABA
LABA effects kick in how fast, and last for how long?
3-30 minutes after inhalation
last up to 12 hours
What is for chronic issues, SABA or LABA?
LABA
When a patient first starts taking SABA or LABA, what should we do?
Monitor for side effects
You should only take decongestants ____________
To get over the initial hump of the problem, do not use chronically!
What do decongestants do?
Stimulate alpha-adernergic receptor vasoconstriction of capillaries threfore sreducing fluid secretion in nose
What are side effects of decongestants
dizziness hypertension nausea, headache, insomnia, arrythmias
What is a parasympatholytic
Supressed parasymp nervous system
What nerve supplies parasympathetic input to lungs?
Vagus nerve
Parasympatholytics are used to stop ____________
Bronchoconstriction
They’re usually given for any kind of inflammatory lung disease
example: asbestos exposure
What is a S.A.M.A and a L.A.M.A
Short acting muscarinic antagonist or Long acting muscarinic antagonist
note: Used in outpatient
reduces secretions in mouth and airways, used to treat paralysis of respiratory system due to poisoning
Most common kind: atropine
Are muscarinic agents (SAMA and LAMA) used for asthma?
What are side effects of muscarinic agents?
NO
Dry mouth, headache, tachycardia, blurred vision
Caffine is an example of what
Methylxanthine
What does a Methylxanthine do?
-Positive inotrope
Increases sympathetic output
Blocks breakdown of cAMP
How do methylxanthines helpful to patients
Increases exercise tolerance w/ improved contractility and reduces fatigue of diaphram
note: These drugs can be preformance enhancing
How will a patient feel taking methylxanthines?
Theyll feel sick
Side effects: Chest pain, tremors, urination, insomnia, dizziness, nausea
CHECK THEIR VITALS
What is the good thing about corticosteroids
What is the bad thing?
Good: Can help open up airway indirectly
Bad: RIP Immune system
What are other side effects of corticosteroids
Myopathy
Edema
Osteopenia
Hyperglycemia
HYPOKALEMIA
THROMBUS FORMATION
Is a corticosteroid a bronchodilator?
No, but it indirectly helps
Can we do aggressive manual manipulations for patients on corticosteroids long term
No because their bones are wittle bitty toothpicks
How are patients divided when deciding what drugs to administer?
By amount of moderate exacerbations leading to hospitalization and by dyspnea ranked on a scale of 1-10
What is a meter dosed inhaler?
Delivers specific amount of meds per short burst from device
drug in aresol form
must coordinate inhalation with puff from inhaler
What are spacers used for w/ inhalers?
Used to reduce speed of meds into mouth so you dont have to time it perfectly
What is the most common breathing treatment method of delivery
Jet Nebulizer
Tubing connected to compressed air soruce
connected to patient w/ nose piece or face mask
What is bad about Respiratory stimulant drugs?
These medications can reduce the natural drive to breathe by the CNS
note: too much oxygen can damage lungs
These drugs are usually used to combat excessive use of drugs like narcotics that depress respiratory center
Can a PT put someone on oxygen if they feel the patient needs it
what about turn up their current level of oxygen
NO, oxygen is a medication given in a specific amount by the doctor
no touchy touchy you dumb PTs!
Respiratory depressants like Morphine, Midazoam, Propofol, and Diazepram are often used as a mild sedative for surgical procedures, are these appropriate for patients w/ respiratory disease?
NO AVOID THESE
What is the typical path that a DVT follows?
Lower extremity -> RA -> RV -> Pulmonary Trunk -> gets stuck in lung somewhere
Whats more dangerous, a DVT in the thigh or in the calf?
Thigh
Proximal DVTs are more dangerous
What should a PT do during a patient interview
Screen for risk of DVT
Is screening for risk the same thing as screening for DVTs
NO!
What can PTs recommend to individuals at high risk of DVT
Mechanical compression
Example: Compression stockings
What criteria is used to establish the likihood of a DVT
Wells Criteria
Is Wells criteria diagnostic for a DVT?
no
Physical therapist should verify patients with a DVT are ___________
and initiate mobilization when _____________________
Patient is on anticoagulant
Therapeutic levels of anticoagulant have been reached
Can we mobilize patients with an IVC?
(inferior vena cava filter)
Yes, when hemodynamically stable
talk to physician first
What are 4 ways a PT can decrease risk of DVT
Encourage mobility
use mechanical compession
consult physican about medication
provide education about prevention
What is the Padua Prediction score
Assesses RISK of DVT, not SYMPTOMS
What should you use if you want to establish the likelihood a patient has a DVT
Wells Criteria
What are classic signs of a DVT
Localized pain, swelling, discoloraton, warmth
Symptoms cannot diagnose a DVT!
Physical Exam findings are not sensitive or specific and in 50% of DVTs there are none of these symptoms
Wells Criteria and other scoring algorthms are HIGHLY SENSITIVE, what does this mean?
Very sensitive to what theyre suppose to pick up, but can produce many false positives
What is Homan’s sign
USELESS
How is a DVT usually diagnosed
With a D-dimer test followed by a Doppler Ultrasound
What is prothrombin time?
The average time it takes for a clot to form
A D Dimer test will typically show what?
Under 500 ng/ML firinogen in blood.
If there is OVER 500, this is positive for potential clots
What is normal pro-thrombin time?
If this time is increased what happens?
Normal 11-13
Helps prevent clots, however too much of an increase puts you at risk of bleeding
What is INR
International Normalized Ratio
Used to monitor affectiveness of warfarin for blood thinning
Too low INR means what?
Too high INR means what?
too low: risk of clots
too high: risk of bleeding
INR helps you determine if it’s safe to get a patient up when they’re taking anti-coagulants, but before this you should…
check w/ medical team
What is diagnostic test is used first for patients w/ high chance of DVT
For patients w/ low chance?
High chance: Bedside ultrasound (doppler)
Low chance: D-Dimer
If a patient took anticoagulants less than _____ hours ago do not get them up
2 hours
However all meds are different, check w/ physician before mobilizing
The algorthm seems to go:
Under 2: NO mobility
3-5: check w/ physician
Over 5: Mobilize
Will an IVC help w/ a DVT in your arm?
No
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