Medications affecting the respiratory system Flashcards
For optimal gas exchange to occur what has to be functioning properly?
vetilation and perfusion
What are the advantages of a nebulizer?
They work much faster and allow for more administration to be administered which makes them great for emergency situations.
what are short acting B2 adrenergic agonists used for?
acute episodes! immediate onset (intravenous), considered a rescue medication
What are intermediate-acting B2 adrenergic agonists used for?
Acute episodes!
peak at 1-2 hours, but have onset of 5 minutes
What does B2 stimulation cause?
bronchodilation
What diseases are generally treated with the same medications?
COPD and Asthma
Does short acting B2 also affect B1?
YES YES YES
What is the longer acting B@ adrenergic agonist used for?
used to require less dosing
lasts 12 hours, peaks at 2 hours (MDI)
onset 10-20 minutes for PREVENTION NOT RESCUE
What is the therapeutic use for B2 adrenergic agonists?
dilation of bronchioles from B2 stimulation
What are some adverse effects of B2 adrenergic agonists?
tachycardia (b1 stimulation)
Angina (beta 1 stimulation increases HR and contractility making the heart work more)
Tremors (activation of b2 in skeletal muscle)
What are some nursing considerations for B2 adrenergic agonists?
assess HR (if it increases more than 20-30 beats/minute then treatment should be stopped… or 25%)
report chest pain (angina)
tremors usually resolve with long term use (usually seen in hospital with large dosing
When are B2 adrenergic agonists contraindicated?
non-selective beta blockers (Dont want to block beta 2 when we are trying to stimulate it)
MAOI/tricyclic antidepressants (increase the risk of tachycardia, heart disease, HTN, hyperthyroidism)
What is the administration technique for a MDI?
Shake inhaler, remove cap, attach spacer
Exhale, put inhaler to mouth, press canister and inhale
hold breath for 10 seconds (or as long as possible)
exhale through pursed lips
Wait 1 minute before repeating (allow absorption of medication before repeating exhalation and inhalation process for next dose)
clean and rinse case, put cap back on
What are some patient teaching points for B2 adrenergic agonists?
Administration techniques!
Make sure they know the difference between rescue inhaler and prevention inhaler (use short acting to terminate acute attacks)
Take beta-agonist first then take glucocorticoid inhaler!!!!!!!!!!!!! (beta agonists work faster, and opens up airways for glucocorticoid absorption)
Monitor for effects, especially in diabetics (hyperglycemia from b2 stimulation) GENERALLY NOT A PROBLEM IN NON-DIABETICS
keep a log of frequency of attacks
What is the therapeutic action of methylxanthines?
Relaxation of bronchial smooth muscle resulting in bronchial dilation
What are methylxanthines generally used for?
long term control of asthma and COPD
TAKEN PO
What are some nursing considerations for methylxanthines?
toxicity - monitor serum drug levels (5-15 mcg/ml)
Avoid caffeine - can increase theophylline (methylxanthine) levels
many drug-drug interactions that can increase or decrease levels
What are some adverse effects of methylxanthines?
TOXICITY:
Mild GI symptoms
restlessness
dysrhythmias
seizures
What is the therapeutic action of inhaled anticholinergics?
block the vagus nerve (parasympathetic nervous system) which prevents contraction, bronchodilation occurs
by blocking the parasympathetic stimulation the sympathetic system will take over and dilate the bronchioles
What suffix should you remember inhaled anticholinergics by?
troprium
What are inhaled anticholinergics used for?
long-term control
exercise induced asthma
NOT A RESCUE INHALER, DOESNT DIRECTLY DILATE BRONCHIOLES, IT IS A PREVENTER
IT IS AN MDI
When are inhaled anticholinergics contraindicated?
glaucoma (decreases outflow of viscous humor increas IOP)
BPH (causes bladder contractions which further aggrevates problem)
What are some nursing considerations for inhaled anticholinergics?
administration techniques
rinse mouth to reduce bad taste (sour metallic taste)
if used with other inhalers wait 5 minutes before
dosing
Monitor for adverse effects (dry mouth, hoarseness)
USE ONLY FOR PREVENTION NOT FOR ACUTE ATTACKS
What is the therapeutic action of glucocorticoids?
decrease inflammation in airways, suppress airway mucous, increase effect of b2 agonists
NOT FOR IMMEDIATE RELIEF BUT DECREASE FREQUENCY AND SEVERITY OF ATTACKS
What is a suffix to remember glucocorticoids by?
one
What are some adverse effects of glucocorticoids?
pharyngeal and laryngeal fungal infections
MDI increases risk (beclomethasone)
look for sore throat, hoarseness, coughing
adrenal gland suppression (long-term use of prednisone PO… greater than 10 days)
medication is doing some of what the kidneys do so they stop functioning (release of cortisol)
bone loss (long-term prednisone PO)
hyperglycemia/glucosuria
What are some nursing considerations for glucocorticoids?
rinse mouth out after using inhaler (help prevent fungal infections)
monitor for symptoms of pharyngeal or laryngeal fungal infections (sore throat, hoarseness, coughing)
do not stop abruptly, taper dose (decreased adrenal gland function and abrupt stop can cause adrenal crisis)
can cause electrolyte imbalances, water retention, weakness, fatigue, depression, ect…
use alternate day dosing (prevents adrenal gland suppression and bone loss)
increase calcium and vitamin D (bone loss)
monitor BG levels (prednisone PO and solu-medrol IV)
YOU WILL SEE THIS PROFOUNDLY (especially in diabetics)
What are some more adverse effects and nursing considerations for glucocorticoids?
Peptic ulcer disease (long term prednisone PO) - avoid NSAIDs/aspirin (increase risk for bleeding and ulcers), report black tarry stools, administer with food
Infection (long-term prednisone PO) - monitor for and report signs of infection from systemic suppression of inflammation (sore throat,weakness, malaise, decreased wound healing)
Fluid/electrolyte imbalances (prednisone PO) - weight gain, hypokalemia
When are glucocorticoids contraindicated?
Live virus vaccines and systemic fungal infections
What are some patient teaching points for glucocorticoids?
Administration techniques for inhalers
take B2 agonist inhaler first then glucocorticoid inhaler
rinse mouth after use - reduces oral fungal infections
monitor for signs of adverse effects (sings of infection, black tarry stools, hyperglycemia)
May need to increase dose during times of stress
dont prednisone suddenly, taper off
Avoid taking aspirin/NSAIDs
Avoid live virus vaccines
what is the therapeutic action of leukotriene modifiers?
blocks the release of leukotrienes to suppress airway edema, bronchconstriction, mucous production, airway inflammation
What are leukotriene modifiers used for?
long term control of asthma and to prevent exercise-induced bronchospasms
VERY COMMONLY USED IN CHILDREN WITH ASTHMA
what is an adverse effect of leukotriene modifiers?
liver injury
What are some nursing considerations for patients taking leukotriene modifiers?
use cautiously in patients with liver dysfunction
monitor labs for liver function
