Pharm Respiratory Drugs Flashcards
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Albuterol INH
always keep with pt to reduce risk of bronchospasm
Levalbuterol INH
- Monitor HR
- Use 5 mins before other INH meds.
Which meds are considered SABA?
- Albuterol INH
- Levalbuterol INH
What class are Albuterol and Levalbuterol in?
Bronchodilators
Bronchodilators
rapid bronchodilation relaxing smooth muscle
SABA
Rescue INH (used before AA or before trigger)
LABA
- slow acting w/ long duration
- AA prevention
Which meds are considered LABA?
- Salmeterol INH
- Indacaterol INH
- Formoterol
Salmeterol INH
Not a rescue medication; med is slow-acting & will not help acute symptoms
Indacaterol INH; Formoterol
used in COPD only!
Not a rescue medication; med is slow-acting & will not help acute symptoms
Cholinergic Antagonist (anticholinergic drugs or LAMAs)
Prevent AA or COPD bronchospasms & improve gas exchange
Which medications are considered LAMAs?
- Ipratropium INH
- Tiotropium INH
Ipratropium INH; Tiotropium
- Always keep with pt to reduce bronchocontriction
- MDI use, shake med INH well
- Increase oral fluids, med causes dry mouth
- Observe + Report blurred vision, eye pain, headache, nausea, palpitations, tremors, inability to sleep
Anti-inflammatories
improve bronchiolar airflow & increased gas exchange by decreasing inflammatory response of mucous membranes
2 Medication classes that are Anti-inflammatories/ respiratory pham
- Corticosteroids
- Leukotriene Modifier
Corticosteroids
prevent AA caused by inflammation or allergies
Medications that are considered Corticosteroids
- Fluticasone MDI INH
- Beclomethasone MDI INH
- Budesonide MDI INH
- Prednisone ORAL
Fluticasone MDI INH
- use medication daily even when no symptoms are present
- effectiveness requires 48- 72 hrs of continued use & depends on regular use
Beclomethaasone MDI INH; Budesonide MDI INH
Requires good oral care!
Not a rescue medication- med is slow-acting & will not help acute symptoms
Prednisone ORAL
- monitor for side effects
- avoid acitivities that lead to injury- fragile blood vessels, causes bruising or petichiae
- take with food- reduce GI upset/ ulceration
DO NOT STOP ABRUPTLY
What medications are Leukotriene Modifiers?
Montelukast ORAL
Leukotriene Modifiers
prevent AA triggered by inflammation/ allergies
Monteluklast ORAL
- use medication daily even when no symptoms are present
- effectiveness requires 48- 72 hrs of continued use & depends on regular use
- DO not decrease dose or stop taking othere Asthma meds unless direcrted by HCP
- used for long-term ashtma control & does not replace other medications
Mucolytics
thin secretions
What medications are considered Mucolytics?
- Guaifenesin ORAL
- Acetylcysteine NEB
Gaifenesin ORAL
- increase fluid intake
- can cause drowsiness
Acetylcysteine NEB
- can cause bronchospasms in asthmatics
- open vials should be refridgerated & used within 90 hrs
- pts should clear airway by coughing prior to med administration
What is the FOCUS for COPD interventions/ goals?
- long-term control therapy with longer-acting medications
- INH medications can be used in combination (i.e., Fluticasone Salmeterol)
- Instruct pt on proper use of inhaler
this medication used in practice is controversial for respiratory system emergencies-
Magnesium Sulfate
COPD specifc meds
- Indacaterol INH
- Formoterol
- Guaifenesin ORAL
- Acetylcysteine NEB
What classes do Magnesium Sulfate belong to?
- Electrolyte
- Anticonvulsant
- Saline Laxative
- Antacid
Magnesium Sulfate mech of action:
increases osmotic pressure, draws fluid into colon, neutralizes HCI
Magnesium Sulfate uses:
constipation, dyspepsia; bowel preparation before surgery or exam; anticonvulsant for preeclampsia, eclampsia (magnesium sulfate); electrolyte; cardiac glycoside- induced arrhythmias, nutritional supplement
Side effects of Magnesium Sulfate
- CNS: Muscle weakness, flushing, sweating, confusion, sedation, depressed reflexes,* flaccid paralysis*, hypothermia
- CV: Hypotension, heart block, circulatory collapse, vasodilation
- GI: Nausea, vomiting, anorexia, cramps, diarrhea
- HEMA: Prlonged bleeding time
- META: Electrolyte, fluid imbalances
- RESP: Respiratory depression/ paralysis
Nursing Considerations for Magnesium Sulfate
ASSESS:
* Laxative: cause of constipation; lack of fluids, bulk, exercise; cramping, rectal bleeding, nausea, vomiting; product should be discontinued
* Eclampsia: seizure precautions, B/P, ECG; magnesium toxicity: thirst, confusion, decrease in reflexes; I&O ratio; check for decrease in urinary output
* Pregnancy/ breastfeeding: use only oif clearly needed (chloride), contraindixated in labor, toxemia during 2hr prior to delivery, appears in breast milk
S/S of magnesium toxicity
- > 30mL/ hr urine output
- decreased RR (8 or <)
- DTR
- slurred speech
- lethargic –> unresponsive
Nursing considerations for a magnesium toxicity
- monitor urine output (strict I&Os)
- monitor RR
- assess hourly
- DTR & clonus
- decrease stimulation
Antedote for magnesium toxicity
Calcium Gluconate
neuro protectant; relaxes smooth muscles; anticonvulsant
magnesium sulfate
Amantadine
antiviral for influenza
- Primary use is an prophylaxis against influenza A, although it is no longer recommended due to resistance in circulating Influenza A.
- IF USED, should be started within 24- 48hrs of onset of signs/ symptoms and continued for 24- 48hrs after resolution\
- can be taken without regard to food
Amantadine
Children who have the influenza virus and taking Amantadine or Rimantadine should avoid what medications?
aspirin- containing products
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Amantadine is contraindicated in who?
patients with kidney failure
influenza A is sensitive to what 2 medications?
oseltamivir and zanamivir
oseltamivir
antiviral for influenza A & B
Amantadine: route and dosage
A: PO: 200mg/ d in 1-2 divided doses
- treatment should begin within 48hrs of flu symptoms
- may be taken without regard to food
- monitor renal function
oseltamivir
Tamiflu
oseltamivir
Oseltamivir: route and dosage
A: PO: 75mg bid for 5 days
* Prophylaxis (start within 48hrs of exposure) 75mg daily x 10 days
rimantadine: route and dosage
A: PO: 100mg bid; max 200mg/ d
formerly used for prophylaxis and treatment against influenza A virus- because of resistance in circulating influenza A, this medication is no longer recommended
* IF USED, monitor renal and hepatic functions- dosing may need to be adjusted
rimantadine
Relenza Diskhaler
zanamivir
zanamivir
antiviral for influenza
zanamivir: route and dosage
Inhaler
A: 2 oral inhalations bid for 5 days
* Prophylaxis: A: 2 oral inhalations once daily for 10 days
Nursing Implications for Isoniazid
- instruct patients to avoid antacids and to take the drug on an empty stomach (1hr before or 2hr after meals) to prevent slowing of drug absorption in the GI tract
- teach patients to take a daily multi-vitamin that contains the B-complex vitamins while on this drug because the drug can deplete the body of this vitamin
- remind patients to avoid alcoholic beverages whle on this drug because the liver-damaging effects of this drug are potentiated by alcohol
- tell patients to report darkering of the urine, a yellow appearance to the skin or white of the eyes, and an increased tendency to bruise or bleed, which are signs and symptoms of liver toxicity or failure
isoniazid
antitubercular
kills actively growing mycobacteria outside the cell and inhibits the growth of dormant bacteria inside macrophages and caseating granulomas
isoniazid
- Effective against influenzas A and B
- Treatment should being within 36hrs of exposure or 48hrs of onset of symptoms
- take bronchodilators BEFORE this medication
zanamivir
rifampin
antitubercular
Kills slower- growing organisms, even those that reside inside macophages and caseating granulomas
rifampin
Nursing Implications for Rifampin
- warn patients to expect an orange- reddish staining of the skin and urine and all other secretions to have a reddish- orange tinge; also, soft contact lenses will become permanently stained because knowing the expected side effects decreases anxiety when they appear
- instruct sexually active woemn using oral contraceptives to use an additional method of contraceptive while taking this drug and for 1 month after stopping it because this drug reduces the effectiveness of oral contraceptives.
- remind patients to avoid alcoholic beverages while on this drug because the liver- damaging effects of this drug are potentiated by alcohol
- tell patients to report darkening of the urine, a yellow appearance to the skin or whites of the eyes, and an increased tendency to bruise or bleed, which are signs and symptoms of liver toxicity or failure
- ask patients about all other drugs in use because this drug interacts with many other drugs
pyrazinamide
antitububerculotic
- can effectively kill organisms residing within the very acidic environment of macrophages (which is where the tuberculosis bacilius sequesters)
- available only in combinations with other anti-TB drugs
pyrazinamide
Nursing Implications for Pyrazinamide
- ask patient if they have ever had gout because the drug increases uric acid formation and will make gout worse
- instruct patients to drink at least 8 ounces of water when taking this tablet and to increase fluid intake to prevent uric acid from precipitating, making gout or kidney problems worse
- teach patients to wear protective clothing, a hat, and sunscreen when going outdoors in the sunlight because the drug causes photosensitivity and greatly increases the risk for sunburn
- remind patients to avoid alcoholic beverages while on this drug because the live- damaing effects of this drug are potentiated by alcohol
- tell patients to report darkening of the urine, a yellow appearance to the skin or whites of the eyes, and an increased tendency to bruise or bleed, which are signs and symptoms of toxicity or failure
ethambutol
antitubercular
- inhibits bacterial RNA synthesis, thus suppressing bacterial growth
- slow acting and bacteriostatic rather than bactericidal; thys it must be used in combination with other anti-TB drugs
ethambutol
Nursing Implications for Ethambutol
- instruct patients to report any changes in vision, such as reduced color vision, blurred vision, or reduced visual fields, immediately to his or her primary health care provider because the drug can cause optic neuritis, especially at high doses, and can lead to blindness. Minor eye problems are usually reversed when the drug is stopped
- remind patients to avoid alcoholic beverages while on this drug because the drug induces severe nausea and vomiting when alcohol is ingested
- ask patients if they have ever had gout because the drug increases uric acid formation and will make gout worse.
- instruct patients to drink at least 8 ounces of water when taking this drug and to increase fluid intake to prevent uric acid from precipitating, making gout or kidney problems worse
