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NUR 326: exam 1 (resp + hematology) > obstructive pulmonary pharm > Flashcards

obstructive pulmonary pharm Flashcards

1
Q

long-term control medications to treat asthma

A

PREVENTERS
-anticholinergics
-xanthine derivative
-inhaled corticosteroids
-leukotriene modifiers
-mast cell stabilizers
-long-acting beta agonist (LABA)

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2
Q

quick-relief medications to treat asthma

A

RESCUE/RELIEF
-short-acting beta agonist (SABA)
-albuterol

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3
Q

bronchodilators and classes

A

relaxes bronchial smooth muscle + dilates bronchi

3 classes:
1. beta-adrenergic agonist
2. anti-cholinergics
3. xanthine derivatives

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4
Q

beta-adrenergic agonists meds

A

long or short acting
short: albuterol + levabuterol –> rescue (4-6hr)
long: salmeterol + formeterol –> preventer (12-24hr)

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5
Q

beta-adrenergic agonists: MOA

A

mimic SNS - fight or flight
relax/dilate airway by stimulating beta2 adrenergic receptors throughout lungs

*goal: bronchial dilation and increased airflow in and out of lungs

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6
Q

3 subtypes of beta adrenergic agonists

A
  1. non-selective adrenergic
  2. non-selective beta-adrenergic: stimulate beta1 and beta2 (metaproterenol)
  3. selective beta2 receptors: (albuterol) preferred for pulmonary conditions
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7
Q

non-selective beta-adrenergic agonist

A

epinephrine
*stimulate beta 1 (CV effects- increased HR, BP), beta 2, alpha receptors (vasoconstriction)
*decreases edema/swelling in mucous membranes, limits amt of secretions
*CNS stimulation –> nervousness, tremors

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8
Q

beta-adrenergic agonist: indications/contraindications

A

prevention or relief of asthma, bronchitis, other pulmonary conditions

*contraindications: uncontrolled HTN, cardiac dysrhythmias, high risk for stroke

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9
Q

beta-adrenergic agonist: nursing considerations

A

effects may be diminished with beta blockers

avoid use with MAOI’s and sympathomimetics (ephedrine, Sudafed) –> HTN

raises BS –> diabetics may need higher doses of meds (insulin)

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10
Q

beta-adrenergic agonist: side effects

A

non-selective have the most
beta2: HTN or hypotension
short half life
can reverse effects with beta blockers ***WATCH for bronchospasm

**insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, vascular headache

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11
Q

MDI

A

metered dose inhaler - non breath activated
(+): portable, convenient

(-): pt coordination essential, high pharyngeal deposition, difficult to deliver high doses

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12
Q

DPI

A

dry powder inhaler - breath activated
(+): propellant not required, convenient, portable

(-): diff to deliver high doses, high pharyngeal deposition, cannot use with endotracheal or tracheotomy tubes

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13
Q

nebulizer

A

(+): pt coordination not required, high doses possible
(-): expensive, possible contamination, device prep required

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14
Q

selective beta-agonist: albuterol

A

RESCUE!! ASTHMA ATTACKS!!! acute episodes of wheezing, SOA, chest tightness
mostly asthma - also bronchitis, emphysema

SABA - onset in minutes
inhalation: q 4-6hr

delivery method: MDI or nebulizer

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15
Q

albuterol: teaching points

A

regularly scheduled daily use is NOT recommended
*use of more than 1 canister (200 actuations) per month indicates inadequate control of asthma and need for initiating or intensifying anti-inflammatory therapy

*take 15 min before exercise for exercise-induced asthma

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16
Q

salmeterol

A

LABA - MAINTENANCE/PREVENTION
2x/day - DPI

indications: worsening COPD, mod-severe asthma

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17
Q

salmeterol: teaching points

A

associated with increased asthma-related deaths (common in African Americans)

always given with an inhaled corticosteroid - not intended for use by itself

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18
Q

anticholinergics

A

bronchodilator - work on acetylcholine receptors
turns off cholinergic (PNS) and turns on SNS –> bronchodilation –> increases perfusion to heart, lungs, brain

*by blocking acetylcholine, we inhibit normal physiological response (mucous production and bronchoconstriction)

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19
Q

anticholinergic: ipratropium

A

blocks action of acetylcholine - creates bronchodilation

used for prophylaxis and maintenance

often given in combo with albuterol

20
Q

side effects of anticholinergics

A

dry as a bone, hot as a hare, blind as a bat, red as a beet, mad as a hatter

dry throat, dry mouth, dry eyes, constipation, hot, decreased sweating, blurred vision, tachycardia, sedation, dizziness, confusion, hallucinations

21
Q

theophylline and aminophylline: class and MOA

A

bronchodilators - xanthine derivatives
MOA: increases levels of the cAMP enzyme by inhibiting phosphodiesterase - stimulates CNS and CVD system

22
Q

theophylline and aminophylline: indication

A

preventive for asthma and COPD exacerbation

23
Q

theophylline and aminophylline: contraindications

A

uncontrolled cardiac dysrhythmias, seizure disorders, hyperthyroid, peptic ulcers

interactions: caffeine (increase SE’s), smoking (decrease absorption)

24
Q

theophylline and aminophylline: side effects

A

toxicity - N/V/D, insomnia, headache, tachycardia, dysrhythmias, seizures (elders)

25
Q

xanthine derivatives: theophylline and aminophylline: nursing considerations

A

second-line bc high risk of toxicity/drug interactions
*macrolide ATB, allopurinol, cimetidine, quinolones, flu vaccine, oral contraceptives
narrow therapeutic index - monitor serum levels

26
Q

anti-inflammatories

A

LTRA’s, inhaled corticosteroids, mast cell stabalizers

27
Q

leukotriene receptor antagonist

A

montelukast
zafirlukast

28
Q

montelukast
zafirlukast

MOA

A

prevent leukotrienes from attaching to receptors located on immune cells and within lungs –> prevents inflammation

*leukotrienes cause: inflammation, bronchoconstriction, mucus production

29
Q

montelukast
zafirlukast

nursing considerations

A

montelukast: > 12 months old
zafirlukast: > 5 years old

30
Q

montelukast
zafirlukast

indications

A

oral prophylaxis and chronic treatment of asthma in adults and children + allergies

route: PO (chewable or granules)

31
Q

montelukast
zafirlukast

side effects

A

headache, nausea, dizziness, insomnia, diarrhea

montelukast: few drug interactions
zarfirlukast: several drug interactions

32
Q

inhaled corticosteroid

A

beclomethasone diproprionate
budesonide
fluticasone

33
Q

inhaled corticosteroids: MOA

A

reduce inflammation and enhance activity of beta agonists
help with bronchodilation

34
Q

inhaled corticosteroids: indications/considerations

A

may take several weeks to see effect
route: nebulizer or MDI

for prevention of persistent asthma attacks + long-term maintenance of severe COPD

35
Q

inhaled corticosteroids: side effects

A

pharyngeal irritation, dry mouth, coughing, oral fungal infections
**RINSE MOUTH AFTER USE

36
Q

teaching point for asthma w/ inhaled corticosteroids

A

take on a regular schedule, not as needed!
give bronchodilator first –> will allow more absorption of steroid

37
Q

inhaled glucocorticoids and bronchodilators are used in combination for

A

moderate to severe asthma
long half lives + onset in minutes

*budesonide+formeterol
*fluticasone+salmeterol

38
Q

mast cell stabilzer

A

cromolyn

39
Q

cromolyn: MOA

A

stabilize membranes of mast cells and precent release of broncho-constrictive inflammatory substances

40
Q

cromolyn: indication

A

prevention of acute asthma attacks
*take 15-20 min prior to known triggers

41
Q

monoclonal antibody anti-asthmatic

A

omalizumab
*newest generation

42
Q

omalizumab: MOA

A

monoclonal antibody which selectively binds to immunoglobulin IgE, which limits release of mediators of allergic response
(decreases hyper responsiveness)

43
Q

omalizumab: indications/considerations

A

add on therapy for asthma
route: injection

*monitor closely for hypersensitivity rxn –> anaphylaxis big risk

44
Q

selective PDE-4 inhibitor

A

roflumilast

45
Q

roflumilast: MOA

A

selectively inhibits PDE4 enzyme in the lung cells –> decreases inflammation in lungs

46
Q

roflumilast: indications

A

prevention of COPD exacerbations

route: oral

47
Q

roflumilast: side effects

A

N/V/D, headaches, muscle spasms, decreased appetite, uncontrollable tremors

NUR 326: exam 1 (resp + hematology) (11 decks)

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