Oxygenation- Breathe Baby Breathe Flashcards
4 ways to breathe in drugs
- MDI
- Respimat
- Dry Powder Inhaler
- Nebulizer
Which inhaled drug method uses a spacer and requires hand/breath coordination?
MDI
Which inhaled drug method is a fine mist and does not have a propellant?
Respimat
Which inhaled drug method is breath activated and does not require hand/breathe coordination?
Dry Powder inhaler
Which method of inhaled drug uses a machine to deliver aerosolized droplets?
Nebulizer
Order the drugs in terms of least to most amount of drug that reaches the lunglies
MDI (10%)
Respimat
Dry Powder Inhaler (20%)
Nebulizer
Which method of inhaled drug is a pressurized device?
MDI
Time b/w puffs with an inhaler, patient teaching….
- -need to wait at least 1 minute b/w puffs to increase amt of drug into lung
- -5 minutes with glucocorticoid + MDI
what are actuations
of puffs listed on the container
Patient teaching for inhaler usage
- how to use
- time b/w puffs
- how long the inhaler is good for
- cleaning the inhaler
what is GINA?
GINA = Global Initiative for Managing Asthma, guidelines for prescribing
-can help nurse determine where someone is in stage of asthma
Respiratory meds are divided into 2 broad categories what are they?
Bronchodilators (3) and Anti-Inflammatory (5)
Which 2 respiratory rescue drugs work on the ANS?
- Beta 2 Agonist = sympathomimetic
2. Anticholingeric (aka muscarinic antagonist–> blocks parasymp actions of Ach)
List 3 classes of bronchodilators
- Beta 2 Adrenergic Agonist (long and short acting)
- Anticholinergic
- Methylxanthines
List 5 classes of Anti-inflammatory respiratory meds
- Glucocorticoids
- Leukotriene modifiers
- Mast cell stabilizers
- Monoclonal Antibodies
- Phosphodiesterase Inhibitor
What is the difference b/w SABA and LABA?
short acting = albuterol = rescue
long acting = salmeterol = prevention
How does beta 2 adrenergic Agonists work?
-Sympathomimetics = emergency life-saving drugs
FXN: Act by relaxing bronchial smooth muscle; resulting in bronchodilation
What is the drug of choice for bronchoconstriction?
Beta2-Adrenergic Agonists
Beta2-Adrenergic Agonists end in what?
-terol!
Beta2-Adrenergic Agonists are divided based on what?
- Divided based on onset and duration of action:
- Short acting (SABA) (albuterol)
- Long acting (LABA) (salmeterol)
Tell me about the duration and orders for Albuterol (proventil HFA)
Beta2-Adrenergic Agonists
- Onset : immediate
- Peak 30-60 min
- order every 6 hours w/in hospital for maintenance
Tell me about orders and frequency of LABA Salmeterol
Beta2-Adrenergic Agonists
- Used for PREVENTION
- Never used as monotherapy–> increased risk of death
- usually combined with glucocorticoid
- Not PRN, fixed schedule taken daily
which respiratory drug when used alone can increase risk of death ?
Salmeterol (Servent Diskus)
(Beta2-Adrenergic Agonists- “terol”)
-use with glucocorticoid
SE of Beta2-Adrenergic Agonists
tachycardia, tremors, palpitations, angina (usually occurs with high doses)
Special consideration for Beta2-Adrenergic Agonists
Tolerance may develop
Prototype for Anticholinergic Respiratory drugs?
Prototype: Ipratropium (Atrovent)
How does Ipratropium (Atrovent) work?
Anticholinergic
Blocks the parasympathetic nervous system causing bronchodilation
Tell me about orders and onset for Ipratropium (Atrovent)
Anticholinergic
-Typical order: ipratropium neb with albuterol neb Q 6 hrs
- Onset: 30 seconds
- Peak: in 3 min
- Duration: 6 hours
Side effects of Ipratropium (Atrovent)
.Anticholinergics
dry mouth, irritation of pharynx
Ipratropium (Atrovent) is contraindicated in which patient populations
Anticholinergic
- Contraindicated if peanut allergy (10% affected)
- Contraindicated with glaucoma as it can raise IOP
aminophylline (Somophyllin) is prototype for which respiratory class?
bronchodilator
Methylxanthines
how is aminophylline (Somophyllin) given?
-SLOW IV administration
Theophylline (Theodur) is prototype for which class of resp. drugs?
bronchodilator
Methylxanthines
Route forTheophylline (Theodur)
oral
(bronchodilator
Methylxanthines)
2 special consideration for Theophylline (Theodur)
bronchodilator -Methylxanthines
- Narrow window for therapeutic level
- NO SMOKING on drug
List 5 classes of anti-inflamm resp drugs
- Glucocorticoids
- Leukotriene modifiers
- Mast cell stabilizers
- Monoclonal Antibodies
- Phosphodiesterase Inhibitor
What class does beclomethasone fall under and what is its fxn?
Glucocorticoid- Anti-inflammatory
-Suppress inflammation to treat Asthma and COPD
Route of administration for beclomethasone?
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
- Oral/IV: given for acute bronchoconstriction
- Prednisone (oral)
- methylpredisone (Solumedrol) IV
Side effects of inhaled glucocorticoid?
(anti-inflammatory, prototype beclomethasone)
SE: adrenal suppression, candidiasis, dysphonia
How do you transition from oral to inhaled glucocorticoids
(anti-inflammatory, prototype beclomethasone)
- be on both drugs for a while, then taper off oral
- risk adrenal crisis so must be done slowly
What class is Montelukast (Singulair) and wha is its fxn
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)
Is Montelukast (Singulair) used for prevention or rescue? route/onset?
prevention
- PO Daily
- Maximal effects develop within 24 hours of first dose
Side effect of Montelukast (Singulair)
Leukotriene Modifiers- Anti-Inflammatory
neuropsychiatric effects
what class is Cromolyn (Intal) and what is its fxn?
Mast Cell Stabilizers- Anti-inflammatory Resp Med/ Allergic Rhinitis preventer
Inhibits mast cells from releasing histamine and other chemical mediators of inflammation
is Cromolyn (Intal) used for rescue or prevention?
Mast Cell Stabilizers- Anti-inflammatory Resp Med/ Allergic Rhinitis preventer
Prevention
Cromolyn (Intal) route and onset?
Mast Cell Stabilizers- Anti-inflammatory Resp Med/ Allergic Rhinitis preventer
Route: Inhaler, nebulizer
Onset: several weeks
What can happen if you stop Cromolyn (Intal) suddenly? what are the side effects?
Mast Cell Stabilizers- Anti-inflammatory Resp Med/ Allergic Rhinitis preventer
- Rebound bronchospasm is stopped abruptly
- SE: cough and bronchospasm
What class od drugs is Omalizumab (Xolair) and how does itt fxn?
Monoclonal Antibody- Antiinflammatory
FXN: Binds to IgE in the body
What does Omalizumab (Xolair) treat?
Monoclonal Antibody- Antiinflammatory
-Severe, persistent allergic asthma to dust mites/dander not controlled by high dose steroids
Which anti-inflammatory resp. drug is given by sub q injection every 2-4 weeks? Why does this med suck?
Omalizumab (Xolair)
$10,000/ year cost!
(Monoclonal Antibody- Antiinflammatory )
is Omalizumab (Xolair) for rescue or prevention?
prevention!
Monoclonal Antibody- Antiinflammatory
Omalizumab (Xolair) side effects?
(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)
What class of drug is Roflumilast? How does it fxn?
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
Indication for using roflumilast?
Phosphodiesterase type 4 (PDE4) Inhibitor - Anti-Inflammatory
Indication: Severe COPD with chronic bronchitis
Side effects of Roflumilast?
Phosphodiesterase type 4 (PDE4) Inhibitor - Anti-Inflammatory
Common SE: loss of appetite, weight loss
Serious SE: psychiatric effects (anxiety, depression, suicide)
Which two anti-inflammatory resp. drugs have psych effects?
- Montelukast (Singulair)
Leukotriene Modifiers
2.roflumilast
Phosphodiesterase type 4 (PDE4) Inhibitor
Which drug falls into 2 categories- Anti-inflammatory Resp Med/ Allergic Rhinitis preventer
Cromolyn (Intal)- Mast Cell Stabilizer
Drugs for allergic rhinitis are divided into what 2 categories?
Preventers (3) and Relievers
What are the 3 kinds of allergic rhinitis preventers
- Antihistamines
- Intranasal glucocorticoids
- Mast Cell Stabilizers
Antihistamines are divided into what 2 categories
1st gen and 2nd gen
How do antihistamines work?
Allergic Rhinitis Preventer
Work to block the actions of histamine at the H1 receptor
What are Antihistamines indicated for?
1st line therapy for mild/mod seasonal allergies
-Most effective when taken prophylactically
What class is diphenhydramine (Benadryl) and what is its side effect?
Prototype 1st generation Antihistamine
-Allergic Rhinitis Preventer
SE: sedation anticholinergic effects
What class is loratadine and what are its side effects?
Prototype 2nd generation Antihistamine
-Allergic Rhinitis Preventer
SE: sedation can occur
What class is fluticasone (flonase) and what is it used for?
Intranasal glucocorticoids
-Allergic Rhinitis Preventer
-MOST effective for seasonal allergies
What is are most effective treatment for seasonal allergies?
fluticasone (flonase)
Intranasal glucocorticoids
-Allergic Rhinitis Preventer
fluticasone (flonase) route?
Intranasal glucocorticoids
-Allergic Rhinitis Preventer
Route: Administered with a metered dose spray device
Patient education for fluticasone (flonase)
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
Side effects of fluticasone (Flonase)
Intranasal glucocorticoids -Allergic Rhinitis Preventer
SE: drying/burning sensation, epistaxis
fluticasone (Flonase)- does it have systemic or localized effects?
Intranasal glucocorticoids -Allergic Rhinitis Preventer
Action and SE limited to nasal passages
What are the two prototype for Allergic Rhinitis Relievers? What class do they fall under
pseudoephedrine (Sudafed)
oxymetazoline (Afrin)
–Sympathomimetics (Decongestants)
What class pseudoephedrine (Sudafed) and how does it fxn?
Sympathomimetics (Decongestants) - Allergic Rhinitis Reliever
Fxn: Stimulate the sympathetic nervous system to relieve nasal congestion
-Alpha 1 agonist , causes vasoconstriction
What route can pseudoephedrine (Sudafed) be given?
Sympathomimetics (Decongestants) - Allergic Rhinitis Reliever
Route: oral or intranasal
-Oral: slower onset of action
Side effects of pseudoephedrine (Sudafed)?
Sympathomimetics (Decongestants) - Allergic Rhinitis Reliever
HTN, CNS stimulation (insomnia)
Which patient population should avoid pseudoephedrine (Sudafed)?
Sympathomimetics (Decongestants) - Allergic Rhinitis Reliever
-Should not be used in cardiac patients
What class of drug is oxymetazoline (Afrin) and what is its route?
Sympathomimetics (Decongestants) - Allergic Rhinitis Reliever
What can happen with prolonged use of oxymetazoline (Afrin) and what we gonna do about it?
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
What is recommended duration of use for oxymetazoline (Afrin)
Sympathomimetics (Decongestants) - Allergic Rhinitis Reliever
use no longer than 3-5 days lest ye end up with a case of the Rebound Congestion
Antitussives are divided into what 2 categories?
Opioid - Codeine
Non-Opioid - dextromethorphan (robitussin)
What is Codeine the prototype for?
Opioid antitussive
What schedule of drug is Codeine?
(Opioid antitussive)
- Usually combination drugs
- Schedule II if alone or Schedule IV if combined
How big of a dose do ya need to suppress a cough with codeine?
(Opioid antitussive)
low dose!
What class of drug is dextromethorphan (robitussin) ?
Nonopioid antitussive
High doses of dextromethorphan (robitussin) can lead to what?
(Nonopioid antitussive)
-High doses can lead to euphoria and can be abused
What is the most frequently used OTD formulation?
dextromethorphan (robitussin)
Nonopioid antitussive
When do we want to use cough medicine?
Stopping a cough is NOT always beneficial
- can be good to expectorate mucus
- use if interrupting daily life/sleep –> give at bed
What the heck is guaifenesin (mucinex)? what does it do?
- Fxn: Drugs that increase bronchial secretions
- Expectorant–>Stimulate flow of secretions
What in the hairy hell is acetylcysteine (Mucomyst) and how does it work?
Mucolytic –> makes mucus more watery; cough more productive
hat route do we give acetylcysteine (Mucomyst) for its mucolytic properties?
Nebulizer
