Medications Flashcards by Chavez Girls

The overall goal of pulmonary medication is to:

Increase:

Decrease:

Sympathetic

Decrease parasympathetic

Therefore INCREASE Lumen size in lungs

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What are side effects of most medications that enhance sympathetic output

Arrythmias

High HR

High BP

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4 Mechanisms that Pulmonary meds can work?

Bronchodilation

Facilitation of mucociliary action

Increased alveolar ventilation/improved oxygen

Improved control of breathing pattern

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three main causes of abnormal bronchomotor tone

inflammation (allergic, immune response)

Excessive PNS activity

reduced SNS activity

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type 1 sensitivity allergic reaction

immediate response, IgE interacts with mast cell to release histamine

Life-threatening anaphylaxis - bronchoconstriction, hypotension

USE EPI PEN

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Type IV allerigc reaction

delayed (48 hrs)

due to macrophages release of enzymes, not histamine

seasonal allergies

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How do inhales affect bronchomotor tone?
What about typical COPD meds?

Inhalers increase SNS activity

COPD meds decrease PNS activity

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Sympathetic NS primary messenger

Norepi

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When norepi binds to adrenergic receptor B2, what happens?

B2 - cause increased production of cAMP

(REMEMBER cAMP = smooth muscle relaxation)

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when norepi binds to alpha 1 receptors, what happens?

reduced production of cAMP

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In the PNS, Ach binds to cholinergic (muscarinic) receptors, causing what?

reduced cGMP

bronchoconstriction

(cGMP allows bronchodilation)

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What do sympathomimetics do

Immitate sympathetic NS by stimulating Beta 2 Receptors

increase cAMP and promote dilation

used for anaphlaxis and acute asthma

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What is a SABA?

Short acting Beta 2 agonist

works in 3-5 mins, lasts 4-6 minutes

THIS IS FOR ACUTE ASTHMA ATTACKS

rescue inhaler

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Your pt is having an asthma attack and SABA isn’t working, what do you do?

epi pen

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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

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What should be considered when giving epi to a patient? (specifically one with cardiac issues)

bc epi is non-selective, it will also trigger vasoconstriction and can cause HTN

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What medications are used to treat bronchospasms experienced by a COPD pt?

SABAs (albuterol, salbuterol)

LABA (formoterol, salmeterol)

-ROL

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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

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Albuterol is an example of a

SABA

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LABA effects kick in how fast, and last for how long?

3-30 minutes after inhalation

last up to 12 hours

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What is for chronic issues, SABA or LABA?

LABA

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When a patient first starts taking SABA or LABA, what should we do?

Monitor for side effects - make cause arrythmias due to mimicing the SNS, and may also cause hypokalemia especially if pt is taking a diuretic

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You should only take decongestants ____________

To get over the initial hump of the problem, do not use chronically!

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What do decongestants do?

Stimulate alpha-adernergic receptor vasoconstriction of capillaries threfore sreducing fluid secretion in nose

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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 (especially emphysema and chronic bronchitis) example: asbestos exposure

parasympatholytics suffix

-pivm

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 parasympatholytic subset, decreases PNS activity

most common muscarinic antagonist

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? (whats suffix)

-Positive inotrope Increases sympathetic output Blocks breakdown of cAMP -line

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 do corticosteroids do

control excessive inflammation suppress histamine, macrophages, cytokines

What is the good thing about corticosteroids What is the bad thing?

Good: Can help open up airway indirectly Bad: RIP Immune system (its an immunosuppressant)

What are other side effects of corticosteroids

Myopathy Edema - watch for face rounding infection risk Osteopenia Hyperglycemia - check for ketone bodies in diabetics HYPOKALEMIA THROMBUS FORMATION

what is a life-threatening side effect of corticosteroids?

laxity in cervical spine

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?

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?

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