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Kol- Pharm 323 Spring > Oxygenation- Breathe Baby Breathe > Flashcards

Oxygenation- Breathe Baby Breathe Flashcards

1
Q

4 ways to breathe in drugs

A
  1. MDI
  2. Respimat
  3. Dry Powder Inhaler
  4. Nebulizer
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2
Q

Which inhaled drug method uses a spacer and requires hand/breath coordination?

A

MDI

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3
Q

Which inhaled drug method is a fine mist and does not have a propellant?

A

Respimat

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4
Q

Which inhaled drug method is breath activated and does not require hand/breathe coordination?

A

Dry Powder inhaler

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5
Q

Which method of inhaled drug uses a machine to deliver aerosolized droplets?

A

Nebulizer

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6
Q

Order the drugs in terms of least to most amount of drug that reaches the lunglies

A

MDI (10%)
Respimat
Dry Powder Inhaler (20%)
Nebulizer

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7
Q

Which method of inhaled drug is a pressurized device?

A

MDI

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8
Q

Time b/w puffs with an inhaler, patient teaching….

A
  • -need to wait at least 1 minute b/w puffs to increase amt of drug into lung
  • -5 minutes with glucocorticoid + MDI
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9
Q

what are actuations

A

of puffs listed on the container

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10
Q

Patient teaching for inhaler usage

A
  • how to use
  • time b/w puffs
  • how long the inhaler is good for
  • cleaning the inhaler
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11
Q

what is GINA?

A

GINA = Global Initiative for Managing Asthma, guidelines for prescribing
-can help nurse determine where someone is in stage of asthma

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12
Q

Respiratory meds are divided into 2 broad categories what are they?

A

Bronchodilators (3) and Anti-Inflammatory (5)

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13
Q

Which 2 respiratory rescue drugs work on the ANS?

A
  1. Beta 2 Agonist = sympathomimetic

2. Anticholingeric (aka muscarinic antagonist–> blocks parasymp actions of Ach)

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14
Q

List 3 classes of bronchodilators

A
  1. Beta 2 Adrenergic Agonist (long and short acting)
  2. Anticholinergic
  3. Methylxanthines
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15
Q

List 5 classes of Anti-inflammatory respiratory meds

A
  1. Glucocorticoids
  2. Leukotriene modifiers
  3. Mast cell stabilizers
  4. Monoclonal Antibodies
  5. Phosphodiesterase Inhibitor
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16
Q

What is the difference b/w SABA and LABA?

A

short acting = albuterol = rescue

long acting = salmeterol = prevention

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17
Q

How does beta 2 adrenergic Agonists work?

A

-Sympathomimetics = emergency life-saving drugs

FXN: Act by relaxing bronchial smooth muscle; resulting in bronchodilation

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18
Q

What is the drug of choice for bronchoconstriction?

A

Beta2-Adrenergic Agonists

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19
Q

Beta2-Adrenergic Agonists end in what?

A

-terol!

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20
Q

Beta2-Adrenergic Agonists are divided based on what?

A
  • Divided based on onset and duration of action:
    • Short acting (SABA) (albuterol)
    • Long acting (LABA) (salmeterol)
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21
Q

Tell me about the duration and orders for Albuterol (proventil HFA)

A

Beta2-Adrenergic Agonists

  • Onset : immediate
  • Peak 30-60 min
  • order every 6 hours w/in hospital for maintenance
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22
Q

Tell me about orders and frequency of LABA Salmeterol

A

Beta2-Adrenergic Agonists

  • Used for PREVENTION
  • Never used as monotherapy–> increased risk of death
    • usually combined with glucocorticoid
  • Not PRN, fixed schedule taken daily
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23
Q

which respiratory drug when used alone can increase risk of death ?

A

Salmeterol (Servent Diskus)
(Beta2-Adrenergic Agonists- “terol”)

-use with glucocorticoid

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24
Q

SE of Beta2-Adrenergic Agonists

A

tachycardia, tremors, palpitations, angina (usually occurs with high doses)

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25
Q

Special consideration for Beta2-Adrenergic Agonists

A

Tolerance may develop

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26
Q

Prototype for Anticholinergic Respiratory drugs?

A

Prototype: Ipratropium (Atrovent)

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27
Q

How does Ipratropium (Atrovent) work?

A

Anticholinergic

Blocks the parasympathetic nervous system causing bronchodilation

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28
Q

Tell me about orders and onset for Ipratropium (Atrovent)

A

Anticholinergic
-Typical order: ipratropium neb with albuterol neb Q 6 hrs

  • Onset: 30 seconds
  • Peak: in 3 min
  • Duration: 6 hours
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29
Q

Side effects of Ipratropium (Atrovent)

A

.Anticholinergics

dry mouth, irritation of pharynx

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30
Q

Ipratropium (Atrovent) is contraindicated in which patient populations

A

Anticholinergic

  • Contraindicated if peanut allergy (10% affected)
  • Contraindicated with glaucoma as it can raise IOP
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31
Q

aminophylline (Somophyllin) is prototype for which respiratory class?

A

bronchodilator

Methylxanthines

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32
Q

how is aminophylline (Somophyllin) given?

A

-SLOW IV administration

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33
Q

Theophylline (Theodur) is prototype for which class of resp. drugs?

A

bronchodilator

Methylxanthines

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34
Q

Route forTheophylline (Theodur)

A

oral

(bronchodilator

Methylxanthines)

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35
Q

2 special consideration for Theophylline (Theodur)

A

bronchodilator -Methylxanthines

  1. Narrow window for therapeutic level
  2. NO SMOKING on drug
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36
Q

List 5 classes of anti-inflamm resp drugs

A
  1. Glucocorticoids
  2. Leukotriene modifiers
  3. Mast cell stabilizers
  4. Monoclonal Antibodies
  5. Phosphodiesterase Inhibitor
37
Q

What class does beclomethasone fall under and what is its fxn?

A

Glucocorticoid- Anti-inflammatory

-Suppress inflammation to treat Asthma and COPD

38
Q

Route of administration for beclomethasone?

A

Glucocorticoid- Anti-inflammatory

1.Inhaled: used daily as prevention
Effects:
-Little to no systemic effects (inhaled)
-May take 1-4 weeks to reach full effect

  1. Oral/IV: given for acute bronchoconstriction
    • Prednisone (oral)
    • methylpredisone (Solumedrol) IV
39
Q

Side effects of inhaled glucocorticoid?

A

(anti-inflammatory, prototype beclomethasone)

SE: adrenal suppression, candidiasis, dysphonia

40
Q

How do you transition from oral to inhaled glucocorticoids

A

(anti-inflammatory, prototype beclomethasone)

  • be on both drugs for a while, then taper off oral
    • risk adrenal crisis so must be done slowly
41
Q

What class is Montelukast (Singulair) and wha is its fxn

A

Leukotriene Modifiers- Anti-Inflammatory
Used to reduce inflammation
-Act by modifying the action of leukotrienes
(>important in the inflammatory response resulting in edema, inflammation and bronchoconstriction)

42
Q

Is Montelukast (Singulair) used for prevention or rescue? route/onset?

A

prevention

  • PO Daily
  • Maximal effects develop within 24 hours of first dose
43
Q

Side effect of Montelukast (Singulair)

A

Leukotriene Modifiers- Anti-Inflammatory

neuropsychiatric effects

44
Q

what class is Cromolyn (Intal) and what is its fxn?

A

Mast Cell Stabilizers- Anti-inflammatory Resp Med/ Allergic Rhinitis preventer

Inhibits mast cells from releasing histamine and other chemical mediators of inflammation

45
Q

is Cromolyn (Intal) used for rescue or prevention?

A

Mast Cell Stabilizers- Anti-inflammatory Resp Med/ Allergic Rhinitis preventer

Prevention

46
Q

Cromolyn (Intal) route and onset?

A

Mast Cell Stabilizers- Anti-inflammatory Resp Med/ Allergic Rhinitis preventer

Route: Inhaler, nebulizer
Onset: several weeks

47
Q

What can happen if you stop Cromolyn (Intal) suddenly? what are the side effects?

A

Mast Cell Stabilizers- Anti-inflammatory Resp Med/ Allergic Rhinitis preventer

  • Rebound bronchospasm is stopped abruptly
  • SE: cough and bronchospasm
48
Q

What class od drugs is Omalizumab (Xolair) and how does itt fxn?

A

Monoclonal Antibody- Antiinflammatory

FXN: Binds to IgE in the body

49
Q

What does Omalizumab (Xolair) treat?

A

Monoclonal Antibody- Antiinflammatory

-Severe, persistent allergic asthma to dust mites/dander not controlled by high dose steroids

50
Q

Which anti-inflammatory resp. drug is given by sub q injection every 2-4 weeks? Why does this med suck?

A

Omalizumab (Xolair)

$10,000/ year cost!

(Monoclonal Antibody- Antiinflammatory )

51
Q

is Omalizumab (Xolair) for rescue or prevention?

A

prevention!

Monoclonal Antibody- Antiinflammatory

52
Q

Omalizumab (Xolair) side effects?

A

(Monoclonal Antibody- Antiinflammatory )

SE: viral infections, URI, sinusitis, headache, injection site response
*Serious SE: anaphylaxis (observe for 2 hours after first few doses then 30 minutes for following doses)

53
Q

What class of drug is Roflumilast? How does it fxn?

A

Phosphodiesterase type 4 (PDE4) Inhibitor - Anti-Inflammatory

-It blocks the action of an enzyme (PDE4) that breaks down cAMP resulting in decreased release of inflammatory mediators

54
Q

Indication for using roflumilast?

A

Phosphodiesterase type 4 (PDE4) Inhibitor - Anti-Inflammatory

Indication: Severe COPD with chronic bronchitis

55
Q

Side effects of Roflumilast?

A

Phosphodiesterase type 4 (PDE4) Inhibitor - Anti-Inflammatory

Common SE: loss of appetite, weight loss
Serious SE: psychiatric effects (anxiety, depression, suicide)

56
Q

Which two anti-inflammatory resp. drugs have psych effects?

A
  1. Montelukast (Singulair)
    Leukotriene Modifiers

2.roflumilast
Phosphodiesterase type 4 (PDE4) Inhibitor

57
Q

Which drug falls into 2 categories- Anti-inflammatory Resp Med/ Allergic Rhinitis preventer

A

Cromolyn (Intal)- Mast Cell Stabilizer

58
Q

Drugs for allergic rhinitis are divided into what 2 categories?

A

Preventers (3) and Relievers

59
Q

What are the 3 kinds of allergic rhinitis preventers

A
  1. Antihistamines
  2. Intranasal glucocorticoids
  3. Mast Cell Stabilizers
60
Q

Antihistamines are divided into what 2 categories

A

1st gen and 2nd gen

61
Q

How do antihistamines work?

A

Allergic Rhinitis Preventer

Work to block the actions of histamine at the H1 receptor

62
Q

What are Antihistamines indicated for?

A

1st line therapy for mild/mod seasonal allergies

-Most effective when taken prophylactically

63
Q

What class is diphenhydramine (Benadryl) and what is its side effect?

A

Prototype 1st generation Antihistamine
-Allergic Rhinitis Preventer

SE: sedation anticholinergic effects

64
Q

What class is loratadine and what are its side effects?

A

Prototype 2nd generation Antihistamine
-Allergic Rhinitis Preventer
SE: sedation can occur

65
Q

What class is fluticasone (flonase) and what is it used for?

A

Intranasal glucocorticoids
-Allergic Rhinitis Preventer

-MOST effective for seasonal allergies

66
Q

What is are most effective treatment for seasonal allergies?

A

fluticasone (flonase)
Intranasal glucocorticoids
-Allergic Rhinitis Preventer

67
Q

fluticasone (flonase) route?

A

Intranasal glucocorticoids
-Allergic Rhinitis Preventer

Route: Administered with a metered dose spray device

68
Q

Patient education for fluticasone (flonase)

A

Intranasal glucocorticoids -Allergic Rhinitis Preventer

Education for using intranasal: opposite hand for nostril, point nose to toes, try to keep spray off of septum, gently sniff in

69
Q

Side effects of fluticasone (Flonase)

A

Intranasal glucocorticoids -Allergic Rhinitis Preventer

SE: drying/burning sensation, epistaxis

70
Q

fluticasone (Flonase)- does it have systemic or localized effects?

A

Intranasal glucocorticoids -Allergic Rhinitis Preventer

Action and SE limited to nasal passages

71
Q

What are the two prototype for Allergic Rhinitis Relievers? What class do they fall under

A

pseudoephedrine (Sudafed)
oxymetazoline (Afrin)

–Sympathomimetics (Decongestants)

72
Q

What class pseudoephedrine (Sudafed) and how does it fxn?

A

Sympathomimetics (Decongestants) - Allergic Rhinitis Reliever

Fxn: Stimulate the sympathetic nervous system to relieve nasal congestion
-Alpha 1 agonist , causes vasoconstriction

73
Q

What route can pseudoephedrine (Sudafed) be given?

A

Sympathomimetics (Decongestants) - Allergic Rhinitis Reliever

Route: oral or intranasal
-Oral: slower onset of action

74
Q

Side effects of pseudoephedrine (Sudafed)?

A

Sympathomimetics (Decongestants) - Allergic Rhinitis Reliever

HTN, CNS stimulation (insomnia)

75
Q

Which patient population should avoid pseudoephedrine (Sudafed)?

A

Sympathomimetics (Decongestants) - Allergic Rhinitis Reliever

-Should not be used in cardiac patients

76
Q

What class of drug is oxymetazoline (Afrin) and what is its route?

A

Sympathomimetics (Decongestants) - Allergic Rhinitis Reliever

77
Q

What can happen with prolonged use of oxymetazoline (Afrin) and what we gonna do about it?

A

Sympathomimetics (Decongestants) - Allergic Rhinitis Reliever
–>Rebound congestion: prolonged use causes escalating congestion requiring more drug to
get the same results (build up tolerance)
Ways to come off of it:
1. cold turkey
2. use in 1 nostril at a time
3. use nasal glucocorticoid for 2-6 weeks, start it 1 week before coming off of Afrin

78
Q

What is recommended duration of use for oxymetazoline (Afrin)

A

Sympathomimetics (Decongestants) - Allergic Rhinitis Reliever
use no longer than 3-5 days lest ye end up with a case of the Rebound Congestion

79
Q

Antitussives are divided into what 2 categories?

A

Opioid - Codeine

Non-Opioid - dextromethorphan (robitussin)

80
Q

What is Codeine the prototype for?

A

Opioid antitussive

81
Q

What schedule of drug is Codeine?

A

(Opioid antitussive)

  • Usually combination drugs
  • Schedule II if alone or Schedule IV if combined
82
Q

How big of a dose do ya need to suppress a cough with codeine?

A

(Opioid antitussive)

low dose!

83
Q

What class of drug is dextromethorphan (robitussin) ?

A

Nonopioid antitussive

84
Q

High doses of dextromethorphan (robitussin) can lead to what?

A

(Nonopioid antitussive)

-High doses can lead to euphoria and can be abused

85
Q

What is the most frequently used OTD formulation?

A

dextromethorphan (robitussin)

Nonopioid antitussive

86
Q

When do we want to use cough medicine?

A

Stopping a cough is NOT always beneficial

  • can be good to expectorate mucus
  • use if interrupting daily life/sleep –> give at bed
87
Q

What the heck is guaifenesin (mucinex)? what does it do?

A
  • Fxn: Drugs that increase bronchial secretions

- Expectorant–>Stimulate flow of secretions

88
Q

What in the hairy hell is acetylcysteine (Mucomyst) and how does it work?

A

Mucolytic –> makes mucus more watery; cough more productive

89
Q

hat route do we give acetylcysteine (Mucomyst) for its mucolytic properties?

A

Nebulizer

Kol- Pharm 323 Spring (41 decks)

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