Oxygenation Flashcards
meter dosed inhaler
- requires hand-breath coordination
- inhale before using device
- can use w spacer
- 10% of drug reaches lungs
respimats
fine mist; no propellant
increased drug deposits in lungs
dry powder inhaler
breath activated
NO hand-breath coordination needed
spacers NOT used
20% of drug reaches lungs
nebulizer
aerosolized droplets; use MACHINE to deliver no hand-breath coordination needed spacers NOT used increased drug delivery to lungs delivers med slowly
pt teaching for oxygenation meds
- how to use inhaler
- time between puffs (1 min, allows bronchodilation)
- how long is the inhaler good? (look at actuations)
- cleaning of inhaler
how much drug reaches lungs, inhaler w NO spacer?
9-10%
how much drug reaches lungs, inhaler WITH spacer
about 21%
what is GINA?
tool that providers use for asthma
diff. types of bronchodilators (3)
beta-2 agonists
anticholinergics
methylxanthines
diff. types of anti-inflammatories (5)
glucocorticoids leukotriene modifiers mast cell stabilizers monoclonal antibodies phosphodiesterase inhibitor
beta-2 adrenergic agonists (naming, MOA, indication, types, SE, admin, special considerations)
bronchodilator or anti-inflammatory?
naming: “-terol”
MOA: relaxes bronchial smooth muscle, results in bronchodilation (sympathomimetic)
indication: bronchoconstriction
type: SABA (short-acting), LABA (long-acting)
SE: tachycardia, tremors, palpitations, angina
admin: start to inhale and activate inhaler; hold the breath for 10 seconds; wait one minute before second inhalation
special considerations: tolerance may develop; becomes systemic if used too often (SABA)
bronchodilator
SABA (prototype, indication, onset)
prototype: albuterol
indication: acute bronchoconstriction; asthma attack
onset: immediate; peak: 30-60 min.
LABA (prototype, indication, special considerations)
prototype: salmeterol
indication: PREVENT asthma issues
special considerations: NEVER monotherapy; NOT PRN (fixed schedule)
anticholinergic (prototype, MOA, action, SE, contraindications, typical order)
bronchodilator or anti-inflammatory?
prototype: ipratropium
MOA: blocks parasympathetic NS
action: onset 30 sec; peak in 3 min; lasts 6H
SE: dry mouth, irritation of pharynx
contraindications: peanut allergy (soy is carrier), glaucoma (can raise IOP)
typical order: ipratropium w albuterol Q6H
bronchodilator
methylxanthines (IV prototype, oral prototype, chemically related to ___)
bronchodilator or anti-inflammitory?
IV proto: aminophylline
oral proto: theophylline
chemically related to CAFFEINE
bronchodilator
aminophylline (class, admin considerations)
bronchodilator or anti-inflammatory
class: methylxanthine IV
admin considerations: SLOW
bronchodilator
theophylline (class, safety considerations)
bronchodilator or anti-inflammatory
class: oral methylxanthine
safety considerations: narrow margin of safety, therapeutic levels (10-20 mcg/mL), NO SMOKING, half life varies 2-15H, drug-drug interactions
bronchodilator
glucocorticoid, general (prototype, how it’s prescribed)
bronchodilator or anti-inflammatory
prototype: beclomethasone
prescribed: sometimes in combo drugs
anti-inflammatory
glucocorticoid, inhaled (indication, SE, special considerations)
indication: PREVENTION
SE: adrenal suppression, candidiasis, dysphonia (hoarseness)
special considerations: should be last inhaler, then swish and spit (to avoid candidiasis), may take 1-4 weeks for full effect, little to no systemic effects
**no proto provided
glucocorticoid, oral/IV (prototype for each, indication, special considerations)
oral proto: prednisone
IV proto: methylprednisolone (Dr. K’s notes says methylpredisone = generic. incorrect but perhaps know this)
indication: acute bronchoconstriction, acute asthma (methylprednisolone then oral therapy at home after discharge)
special considerations: to transition from oral to inhaled… have to be on both and can take a few weeks (renal suppression issue)
leukotriene modifiers (prototype, MOA, indication, admin, onset, SE, special considerations)
bronchodilator or anti-inflammatory
prototype: montelukast
MOA: modifies action of leukotrienes (reduces inflammation)
indication: prophylaxis of chronic asthma
admin: PO daily
onset: maximal effects within 24H of first dose
SE: neuropsychiatric effects
special considerations: not effective for acute attacks
anti-inflammatory
what do leukotrienes do?
a part of the inflammatory response; result in edema, inflammation, bronchoconstriction
mast cell stabilizers (prototype, MOA, indication)
bronchodilator or anti-inflammatory?
proto: cromolyn
MOA: inhibits mast cells from releasing histamine and other chemical mediators of inflammation
indication: prevent asthma attacks; ALSO to prevent allergic rhinitis
anti-inflammatory
cromolyn (prototype for what?, admin, SE, special consideration)
proto of: mast cell stabilizer
admin: nebulizer or inhaler
SE: cough and bronchospasm
special consideration: rebound bronchospasm if stopped abruptly
monoclonal antibody (prototype, MOA, indication, admin, SE, special considerations)
bronchodilator or anti-inflammatory?
prototype: omalizumab
MOA: binds to IgE
indication: severe, persistent asthma; not controlled by high dose steroids
admin: SQ Q2-4 weeks
SE: viral infections, URI, sinusitis, headache, injection site response, ANAPHYLAXIS
special considerations: super duper $$$
anti-inflammatory
PDE4/Phosphodiesterase type 4 inhibitor (prototype, MOA, indication, SE)
bronchodilator or anti-inflammatory
prototype: roflumilast
MOA: blocks action of enzyme PDE4 (breaks down cAMP resulting in decreased release of inflammatory mediators)
indication: severe COPD with chronic bronchitis
SE: loss of appetite, weight loss, psychiatric effects (anxiety, depression, suicide)
anti-inflammatory
allergic rhinitis: preventers (3 meds)
antihistamines
intranasal glucocorticoids
mast cell stabilizers
allergic rhinitis: relievers (2 meds)
oral and nasal decongestants (sympathomimetics)
antihistamines (prototype [2], MOA, indication, route, SE, considerations)
preventer or reliever?
prototype: diphenhydramine (first gen), loratadine (second gen)
MOA: blocks the actions of histamine at the H1 receptor
indication: first line therapy for mild/moderate seasonal allergies
route: oral, intranasal
SE: sedation, anticholinergic effects
considerations: should be taken prophylactically
preventer
intranasal glucocorticoids (prototype, indication, route, SE, considerations)
preventer or reliever?
proto: fluticasone
indication: most effective for seasonal allergies
route: nasal (MDI)
SE: drying/burning sensation, epistaxis
considerations: action and SE limited to nasal passages
preventer
sympathomimetics (prototype [2], MOA, route)
preventer or reliever?
proto: pseudoephedrine (oral), oxymetazoline (intranasal)
MOA: stimulates sympathetic NS to relieve nasal congestion
route: oral or intranasal
reliever
pseudoephedrine (proto of what, SE, contraindications)
proto of oral sympathomimetics
SE: HTN, CNS stimulation (insomnia)
contraindications: cardiac patients
oxymetazoline (proto of what, special considerations)
proto of intranasal sympathomimetics
special considerations: risk for rebound congestion (need more drug to get same results), addictive!, start intranasal glucocorticoid to wean
antitussives: opioid (proto, special considerations)
preventer or reliever?
proto: codeine
special considerations: low dose needed, usually combination drugs
reliever
antitussive: nonopioid (proto)
dextromethorphan
expectorant (proto, MOA)
proto: guaifenesin
MOA: increase bronchial secretions; stimulate flow of secretions
mucolytic (proto, MOA)
proto: acetylcysteine
MOA: increase bronchial secretions; makes mucus more watery so the cough is more productive
