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Pharmacology > Nurs 605 Module 16 > Flashcards

Nurs 605 Module 16 Flashcards

1
Q

What is asthma? What are the clinical manifestations of asthma?

A

chronic inflammatory airway disease

wheezing, SOB, chest tightness, cough, varies in intensity

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2
Q

Identify some differences between asthma and COPD

A

asthma: early onset, not caused by smoking, infreqeunt sputum, normalizes, stable
COPD: later onset, causal relationship with smoking, frequent sputum production, not stable, can worsen with time

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3
Q

What are some non pharmalogical approaches to preventing COPD and asthma?

A 
smoking cessation
physical activity
avoid triggers
avoid ASA, NSAIDs 
pnuemoccocal and influenza vaccines
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4
Q

What are the risk factors for developing COPD?

A 
smoking
air pollution
occupational
repeated infections
genetics
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5
Q

How do you diagnose COPD

A

spirometry (FEV <0.7)

radiograph of chest

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6
Q

What are the main classes of pharmacological options for asthma? Name some common drugs in each class

A

inhaled corticosteroids (ICS) qvar, pulmicort (budesonide), flovent (fluticasone)
ICS/long acting bronchodilator (ICS/LABA)- symbicort, advair, breo
leukotriene receptor antagonists (LTRA) -singular(montelukast)
Short acting beta 2 agonist (SABA) -ventolin salbutamol

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7
Q

What is the MOA of ICS? common side effects? important patient information?

A

decrease mucous production
decrease inflammation
s/e: thrush, sore throat, drymouth
rinse mouth after use

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8
Q

What is the MOA of ICS/LABA? side effects? important patient information?

A

decrease mucous production
decrease inflammation and bronchoconstriction
s/e: tachycardia, headache, cramps
LABA cannot be used as monotherapy in asthma
cannot abruptly stop, must taper

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9
Q

What is the MOA of SABA? common side effects? important patient information?

A

relieves bronchocontriction
PRN use only
s/e: tremor, tachcardia, nervousness, palpitations
always use in rescue plan

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10
Q

Describe the step up or step down approach in patients with asthma

A

• Rescue inhaler (PRN SABA) 100mcg 1-2 puffs TID-QID
• Low regular dose ICS plus SABA 50-100mcg BID
• ICS/LABA combo plus SABA- low dose 100/6mcg 1-2 puffs BID
• ICS/LABA combo plus SABA-medium dose 200/6 1-2 puffs BID
• Controlled? Step down the approach
increased use of SABA means therapy ineffective, step up approach

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11
Q

Describe the essential messages of patient education for asthma care

A
  • smoking cessation
  • physical activity
  • avoid triggers
  • avoid ASA, NSAIDs
  • pnuemoccocal and influenza vaccines
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12
Q

Recommend appropriate immunizations for the patient with COPD.

A
  • Annual flu vaccine
  • Pneumococcal vaccine- evidence mixed, but safer to give anyway
  • One, and then another 5 years later
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13
Q

Outline medication management for mild/stable COPD

A
  • SAMA (ipotropium) or SABA is appropriate first line therapy
  • Both are effective, not one is superior to the other
  • If symptoms worsen, can use as a combination of both (combivent)
  • Relieves dyspnea
  • Preferred over oral corticosteroids
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14
Q

Outline medication management for moderate COPD

A
  • Moderate COPD
  • Increasing exacerbations or dyspnea
  • Can add a LAMA (tiotropium) or LABA (salmeterol)
  • Evidence does not show which is superior to the other
  • LAMA for those who are have increasing exacerbations -group c
  • Combo therapy can be used (inspiolto) but little evidence to prove superiority
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15
Q

Outline medication management for severe COPD

A
  • Severe COPD
  • Triple therapy may be needed
  • LABA, LAMA + ICS
  • ICS is reserved for very severe COPD due to increased risk of pneumonia
  • May be used in those that have uncontrolled exacerbations despite adequate bronchodilator therapy
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16
Q

Describe the stages of change as they relate to motivational interviewing.

A
  • Relevance – how is this relevant to the patient? d/c smoking=better health outcomes etc
  • Risks- short term and long term risks of not quitting
  • Rewards-benefits of smoking cessation-tailor to patient
  • Roadblocks- what have they tried, what worked and dint’ work
  • Repetition/encouragement-repeat above, encourage to stop
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17
Q

Describe the drug therapies available to assist clients in smoking cessation.

A
  • Nicotine replacement therapy
  • Patch, gum, lozenges and inhalers
  • Patch- transdermal nitcoine delivery
  • Gum-chew, park,
  • Lozenge- suck, do not chew or swallow
  • Inhaler- provides hand to mouth motion
  • Buproprion (Wellbutrin, zyban)
  • Varenicline (champix)
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18
Q

What is the MOA of bupropion? side effects? contraindications?

A
  • inhibits reuptake of dopamine, serotonin, norephinephrine
  • S/E: insomnia, agitation, dry mouth, nauseas, seizures (rare)
  • Contraindications: not to be used in those with hx of seizures or active seizures
  • Start 2 weeks prior to quit date,
  • Ok to use in combo with other NRT products
19
Q

What is the MOA of varenicline? side effects? contraindications?

A
  • Varenicline – Champix
  • Nicotine receptor partial agonist
  • S/E: nausea, sleep disturbances, vivid dreams., headaches, impaired ability to operate machinery, depression mood; suicide and suicidal ideation (but no cause and effect link has been found!)
  • DO NOT COMBINE WITH OTHER NRT-can increase risk of adverse effects
20
Q

What are the clinical manifestations of conjunctivitis?

A

• Conjunctivitis: normal pupils, redness, lid swelling, discharge or watery mucoid, conjunctival edema

21
Q

What are the recommended therapies for conjunctivitis?

A
  • Opthamlic abx- not one is better than another; bexifloxacin, moxifloxacin, cipro eye drops
  • Viral conjunctivitis- ophthalmic lubricants
  • Refresh, natural tears etc.
  • Both self-limitiing, no improvement abd 4-5 days with abx therapy-refer to opthamologist
22
Q

List the recommended therapy for a child with croup

A
  • Oral dexamethasone 0.15mg-0.60mg/kg
  • Oral not tolerated? Nebulized budesonide
  • Severe croup- nebulized epinephrine 1:1000 5mL
23
Q

What are the clinical manifestations of croup?

A
  • Common in children- 6mos-3 years, can affect up to 15 years of age but rare
  • Caused by upper airway obstruction, viruses is most common cause
  • Seal like cough, stridor, worsens at night, ok during the day, fever, rhinorrhea
24
Q

Pharm management of allergic rhinitis

A
  • Saline rinses, nose sprays to decrease congestion
  • Eye drops to alleviate itching eyes
  • Antihistamines
  • Loratadine
  • Cetirizine- sedating at higher doses
  • Older gen. antihistamines can cause sedation
  • Decongestants
  • Nasal sprays, intranasal corticosteroids- fluticasone, budesonide
  • Oral decongesntats
  • Topical nasal corticosteroids
  • Eye drops-olopatadine
  • Immunotherapy-allergy shots
25
Q

Non pharm management of allergic rhinitis

A
  • Non pharm:
  • Avoid irritants and triggers
  • Air conditioning
  • Remove pets to reduce dander
26
Q

List medications which should be avoided or are contraindicated in a patient with glaucoma.

A
  • Antihistamines
  • Anticholinergic drugs
  • COPD ipratroprium
  • Incontinent drugs
  • Anti-depressants
  • Ephedrine- OTC cold and flu
27
Q

Describe the reason for limiting the duration of nasal decongestants and recommend a management plan for a patient suffering from rebound congestion.

A
  • Nasal decongestants- >3-5 days use can cause rebound congestion
  • Mitigated with nasal corticosteroids
  • If using topical nasal corticosteroids as monotherapy increases risk of rebound congestion
28
Q

Outline a management plan for a patient with acute asthma.

A
  • Worsening can be life threatening
  • SABA 2-6 puffs q 20 min x 1 hour until stabl
  • Unstable? Oral corticosteroids
  • Revisit/modify plan
  • Assess compliance, technique, triggers, lifestyle
29
Q

Which medications are first line in COPD and asthma?

A

COPD-SAMA/SABA; LAMA
Asthma- SABA; ICS
ICS last line in COPD due to steroids increasing risk of pneumonia

30
Q

What is the pro and con of a MDI? metered dose inhaler?

A

dexterity and coordination
not all devices have counters
more effective with spacer-bulky

31
Q

What are the pros and cons of a diskus?

A

dry powder inhalation
more costly than MDIs
bulky

32
Q

What are the pros and cons of turbohalers?

A

dry powder device
dose counter despite being empty
small amount, patient may not feel the dose
avoid overdosing

33
Q

What are the pros and cons of twisthalers?

A

dry power device
twist caps
dexterity

34
Q

What are the pros and cons of handihaler?

A

dry powder
capsules
many steps, needs lots of dexterity
not good for cognitive concerns

35
Q

What are the pros and cons of ellipta?

A

expires within 6 weeks of package

36
Q

PRN dose of SABA

A

low 100mg TID-QID

37
Q

In the step wise approach for asthma, when is it appropriate to add a LABA to the therapy?

A

ICS dose isn’t effective

can add LABA but must be combined

38
Q

Discuss LTRA and their use in astham

A

monotherapy is not as effective as ICS therapy

s/e: headache, abdominal pain, fly like symptoms and diarrhea

39
Q

Discuss the components of dx of COPD

A
  1. smoker
  2. > 40 years of age
  3. syptoms: cough, SOB, wheeze, persistent colds, URTI
  4. FEV1 <0.7 with short acting bronchodilator
40
Q

What is the MOA of SAMA? side effects? dosing?

A

ipratropium-binds to muscarinic receptors to prevent bronchoconstriction
dosing: 2-4 puffs q6h
used for chronic symptoms

41
Q

What is the MOA of LAMA? side effects? dosing?

A

tiotroprium- selective for M1 and M3 muscarinic receptors
s/e: metallic taste, glaucoma in eyes, more dry mouth, urinary retention
dosing: 18mg inhaled and once daily

42
Q

Who should use caution in use of LAMA?

A

cardiovascular cautions
MI in past 6 months
unstable cardiac dysrythmmias
heart failure

43
Q

What would be the pharmaceutical choices for patients with frequent COPD exacerbations?

A
  1. LAMA over LABA
  2. LAMA + LABA
  3. LAMA+LABA+ICS
44
Q

Discuss the management of acute exacerbation in COPD

A

increase use of short acting bronchodilator
oral prednisone as last choice (30-50mg daily x 5-14 days)
abx: only if increasing sputum, purulence and dyspnea

Pharmacology (13 decks)

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