Pharm week 1 Flashcards
types of asthma (asthma is persistent)
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
asthma
Recurrent and reversible shortness of breath
Occurs when the airways of the lungs become
narrow as a result of:
Bronchospasms
Inflammation of the bronchial mucosa
Edema of the bronchial mucosa
Production of viscid mucus
asthma - status asthmaticus - does it respond to meds? How long does it last?
Status asthmaticus
Prolonged asthma attack that
does not respond to typical
drug therapy
May last several minutes to hours
Medical emergency
asthma - Alveolar ducts - open or closed?
Alveolar ducts/alveoli remain open, but airflow
to them is obstructed
Symptoms
Wheezing
Difficulty breathing
SOB
emphysema
Air spaces enlarge as a result of the destruction
of alveolar walls
The surface area where gas exchange takes place
is reduced
Effective respiration is impaired
pink puffers or blue bloaters
chronic bronchitis
Continuous inflammation of the bronchi and
bronchioles
Often occurs as a result of prolonged exposure to
bronchial irritants
causes chronic bronchitis
Continuous inflammation of the bronchi and
bronchioles
Often occurs as a result of prolonged exposure to
bronchial irritants
SMOKING!!
Mucokinetic drugs
Promote elimination of excessive respiratory secretions
asthma long-term control (luke and long beta on steroids for the long-haul)
Leukotriene receptor antagonists
Inhaled steroids
Long-acting beta2
-agonists
asthma - quick relief - don’t forget IV
Quick relief
Intravenous systemic corticosteroids
Short-acting inhaled beta2
-agonists
bronciodilators - beta agonists - mimic what body system, and are they short or long term?
Large group, sympathomimetics (mimic sympathetic nervous system)
Used during acute and chronic phases of asthma
beta agonist - 3 types (A BB is beta)
Three types
1) Nonselective (both beta 1 - heart and 2 - lungs) adrenergics
2) Nonselective beta-adrenergics
3) Selective beta2 drugs (just respiratory beta cells)
beta agonist - MOA -dont need to know such detail for MOA (just know they relax smooth muscle)
Begins at the specific receptor stimulated
Ends with dilation of the airways
Activation of beta2
receptors activates cyclic adenosine
monophosphate (cAMP), which relaxes smooth muscle in
the airway and results in bronchial dilation and
increased airflow
beta-agonists indications (Im shocked betta is used for labor)
Relief of bronchospasm related to asthma,
bronchitis, and other pulmonary diseases
Used in treatment and prevention of acute attacks
Used in hypotension and shock
Used to produce uterine relaxation to prevent
premature labor
beta-agonists - side effects - Alpha and beta (epinephrine) (Betta is amped with high sugar)
Insomnia
Restlessness
Anorexia
Vascular headache
Hyperglycemia
Tremor
Cardiac stimulation
Beta-Agonists: metaproterenol - side effects (angina and headache at the met)
Cardiac stimulation
Tremor
Anginal pain
Vascular headache
Hypotension
Beta2 (albuterol) - side effects (Al can go high or low with tension)
Beta2 (albuterol)
Hypotension OR hypertension
Vascular headache
Tremor
Beta-agonist derivatives
Ensure that patients take medications exactly
as prescribed, with no omissions or double doses
Inform patients to report insomnia, jitteriness,
restlessness, palpitations, chest pain, or any change in
symptoms
Three modalities - inhaled drugs
Aerosol by metered-dose inhaler
Aerosol by nebulizer
Aerosol by dry powder inhaler (Never swallow dry powder - can be fatal - always put inside inhaler)
Aerosol therapy promotes: - basically a humidifier
Bronchodilation and pulmonary decongestion
Loosening of secretions
Topical application of corticosteroids and other drugs
Moistening, cooling, or heating of inspired air
anticholinergics - examples (IT are anti - ACH)
Ipratropium bromide (Atrovent®) and tiotropium
(Spiriva®)
anticholinergics - MOA (achhoo opens my lungs)
Acetylcholine (ACh) causes bronchial constriction
and narrowing of the airways
Anticholinergics bind to the ACh receptors,
preventing ACh from binding
Result: bronchoconstriction is prevented, airways
dilate
Anticholinergics: Adverse Effects (achoo makes my mouth dry and my nose run)
Dry mouth or throat
Nasal congestion
Heart palpitations
Gastrointestinal distress
Headache
Coughing
Anxiety
No known drug interactions
Leukotriene Receptor Antagonists
(LTRAs) - examples (luke loves monteLUK, aka singulair)
Newer class of asthma medications
Currently available drugs
montelukast (Singulair®)
zafirlukast (Accolate)
zileuton (Zyflo)
LTA - MOA (anti-lukes put out the fire and dilate)
Leukotrienes are substances released when a
trigger, such as cat hair or dust, starts a series of
chemical reactions in the body
Leukotrienes cause inflammation,
bronchoconstriction, and mucus production
Result: coughing, wheezing, shortness
of breath
LTRA - MOA
LRTAs prevent leukotrienes from attaching to
receptors on cells in the lungs and in circulation
Inflammation in the lungs is blocked, and asthma
symptoms are relieved
how many kids have asthma? (Selene has asthma)
8.6%
pink puffer
they have pursed lips trying to get more O2 in lungs. Barrel chest. thin appearance.
chronic bronchitis
blue bloater - difficulty breathing, blue appearance, O2 is not getting to fingers and toes.
inhaler question
nurse should tell pt to come to office for respiratory evaluation
LRTA - drug effects
By blocking leukotrienes:
Prevent smooth muscle contraction of the
bronchial airways
Decrease mucus secretion
Prevent vascular permeability
Decrease neutrophil and leukocyte infiltration
to the lungs, preventing inflammation
LRTA - long or short term? and what age?
Prophylaxis and chronic treatment of asthma in
adults and children older than age 12
LRTA adverse effects - which one has fewer side effects? (Monte and Luke don’t have side effects)
Zileuton®
Headache, dyspepsia, nausea, dizziness, insomnia, liver
dysfunction
Zafirlukast ®
Headache, nausea, diarrhea, liver dysfunction
Montelukast ® has fewer adverse effects**
LRTA takes how long to kick in? (Luke kicked in a week, maybe 2)
a week to kick in, up to 2 weeks. AND you have to take it every day, even if you feel better. And you will feel better.
LTRTA - nursing implications (Luke might hurt my liver, and comes by in one week)
Ensure that the drug is being used for chronic management of asthma, not acute asthma
Teach the patient the purpose of the therapy
Improvement should be seen in about 1 week
Advise patients to check with physician before taking over-the-counter or prescribed medications—there are many drug interactions
Assess liver function before beginning therapy
Teach patient to take medications every night on a continuous schedule, even if symptoms improve
corticosteroids - used for acute or chronic?
Antiinflammatory properties
Used for chronic asthma
Do not relieve symptoms of acute
asthmatic attacks
types of corticosteroids - ex. (S for steroids, S for end in sone)
beclomethasone dipropionate
(Beclovent®, Vanceril®)
triamcinolone acetonide (Azmacort®)
dexamethasone sodium phosphate (Decadron Phosphate
Respihaler)
fluticasone (Flovent®, Flonase®)
Others
inhaled corticosteroids - indications
Treatment of bronchospastic disorders that are
not controlled by conventional bronchodilators
NOT considered first-line drugs for management
of acute asthmatic attacks or status asthmaticus
inhaled corticosteroids - side effects
Pharyngeal irritation
Coughing
Dry mouth
Oral fungal infections - ***need to rinse mouth after each use and clean inhaler often
Systemic effects are rare because low doses are
used for inhalation therapy
Inhaled Corticosteroids: Nursing
Implications (steroids are not for which ppl?)
Contraindicated in patients with psychosis,
fungal infections, AIDS, TB
Teach patients to gargle and rinse the mouth with
lukewarm water afterward to prevent the
development of oral fungal infections
inhaled corticosteroids - use before or after bronchodilator?
If a beta-agonist bronchodilator and
corticosteroid inhaler are both ordered, the
bronchodilator should be used several minutes before
the corticosteroid to provide bronchodilation
before administration of the corticosteroid
Inhaled Corticosteroids: Nursing
Implications
Teach patients to monitor disease with a peak
flow meter
Encourage use of a spacer (good for kids, and adults too) device to ensure
successful inhalations
Teach patient how to keep inhalers and nebulizer
equipment clean after uses
steroids for COPD patients question
true
Drugs That Improve Clearance of
Respiratory Tract Secretions
Mucokinetic agents (guyphanize - musincex) (expectorants)
Work by thinning hyperviscous mucus
Mucolytic agents
Serve to break down mucus
Agents that suppress bronchial secretions
sputum and mucus
Sputum (phlegm) is an abnormal secretion
originating in the lower respiratory tract.
Mucus is a normal secretion produced by
surface cells in mucous membranes.
common cold
Most caused by viral infection
(rhinovirus or influenza virus)
Virus invades tissues (mucosa) of upper respiratory tract,
causing upper respiratory infection (URI)
Excessive mucus production results from the
inflammatory response to this invasion
Fluid drips down the pharynx into the esophagus and
lower respiratory tract, causing cold symptoms: sore
throat, coughing, upset stomach
understanding the common cold
Irritation of nasal mucosa often triggers the
sneeze reflex
Mucosal irritation also causes release of several
inflammatory and vasoactive substances, dilating
small blood vessels in the nasal sinuses and
causing nasal congestion
treatment of colds
nvolves combined use of antihistamines, nasal decongestants,
antitussives, and expectorants
Treatment is symptomatic only, not curative
Symptomatic treatment does not eliminate the causative
pathogen
Difficult to identify whether cause is viral or bacterial
Treatment is “empiric therapy,” treating the most likely cause
Antivirals and antibiotics may be used, but a definite viral or
bacterial cause may not be easily identified
cold empiric means
- the medications cure the cold.
- the medications only treat the symptoms.
- herbal medications are useful to eliminate
symptoms. - it is prevented with careful use of medications.
antihistamine - what are the histamine receptors (just 1 and 2)
Drugs that directly compete with histamine for specific receptor sites
Two histamine receptors
H1
(histamine1)
H2
(histamine2)
antihistamine - H1 antagonists - ex. (1st take an antihistamine)
H1 antagonists are commonly referred to as antihistamines
Examples: diphenhydramine (Benadryl®), loratadine
(claritin®)
H1 is what symptom (1st take antihistamine)
runny nose
H2 is
GI symptoms
antihistamine - other effects
Skin
Reduce capillary permeability, wheal-and-flare formation, itching
Anticholinergic
Drying effect that reduces nasal, salivary, and lacrimal gland secretions
(runny nose, tearing, and itching eyes)
Sedative
Some antihistamines cause drowsiness
antihistamine nursing contraindicated (hiss at asthma and pneumonia)
Gather data about the condition or allergic reaction
that required treatment; also assess for drug allergies
Contraindicated in the presence of acute asthma
attacks and lower respiratory diseases, such as
pneumonia
antihistamine - nursing implications
Instruct patients to report excessive sedation,
confusion, or hypotension
Instruct patients to avoid driving or operating
heavy machinery; advise against consuming
alcohol or other CNS depressants
Instruct patients not to take these medications
with other prescribed or over-the-counter
medications without checking with prescriber
decongestants - Three main types are used (De andrean is anti-cort)
Adrenergics
Anticholinergics
corticosteroids
oral decongestants - (rebound so it’s oral only) ex.
Prolonged decongestant effects, but delayed
onset
Effect less potent than topical
No rebound congestion
Exclusively adrenergics
Example: pseudoephedrine (Sudafed®)
topical decongestants
Adrenergics
phenylephrine (Neo-Synephrine®)
Others
Intranasal steroids
beclomethasone dipropionate
flunisolide (Nasalide®)
fluticasone (Flonase®)
Others
decongestants - rebound
will work and you stop taking and it comes back. won’t happen with oral, but can happen with inhaled or topical.
nasal decongestants - adverse effects (think ephedrine)
Adrenergics Steroids
Nervousness Local mucosal dryness
Insomnia and irritation
Palpitations
Tremors
(Systemic effects caused by adrenergic stimulation
of the heart, blood vessels, and CNS)
Nasal Decongestants:
Nursing Implications - again, think ephedrine
Decongestants may cause hypertension,
palpitations, and CNS stimulation—avoid in
patients with these conditions
Patients on medication therapy for hypertension
should check with their physician before taking
over-the-counter decongestants
Assess for drug allergies
Antitussives - you know this
Drugs used to stop or reduce coughing
Opioid and nonopioid
Used only for nonproductive coughs!
May be used in cases where coughing is harmful
Antitussives:
Mechanism of Action
Opioids
Suppress the cough reflex by direct action on the cough
center in the medulla
Examples:
codeine (Robitussin A-C®, Dimetane-DC®)
hydrocodone
Antitussives:
Mechanism of Action - non- opioids (the non-opioids are a stretch)
Nonopioids
Suppress the cough reflex by numbing the stretch
receptors in the respiratory tract and preventing
the cough reflex from being stimulated
Examples:
benzonatate (Tessalon Perles®)
dextromethorphan (Vicks Formula 44®,
Robitussin-DM®)
Antitussives: Benzonatate - Adverse Effects (benzos make me dizzy and headachy)
Dizziness, headache, sedation, nausea, and others
antitussives - nursing implications - taking cheweables, what to do?
Perform respiratory and cough assessment, and
assess for allergies
Instruct patients to avoid driving or operating
heavy equipment because of possible sedation,
drowsiness, or dizziness
Patients taking chewable tablets or lozenges
should not drink liquids for 30 to 35 minutes
afterward
expectorants
Drugs that aid in the expectoration (removal) of
mucus
Reduce the viscosity of secretions
Disintegrate and thin secretions
expectorants - MOA
Direct stimulation
Reflex stimulation
Final result: thinner mucus that is easier to
remove
expectorants - implications - caution with who? (what do you expect)
Expectorants should be used with caution in the elderly***
or those with asthma or respiratory insufficiency
Patients taking expectorants should receive more fluids, if
permitted, to help loosen and liquefy secretions
Report a fever, cough, or other symptoms lasting longer
than a week
Monitor for intended therapeutic effects
Herbal Products: Echinacea
Reduces symptoms of the common cold and
recovery time
Adverse effects
Dermatitis
GI disturbance
Dizziness
Headache
drink water to
thin mucus
94 year old severe dry cough
benzonatate
at 58-year old
gauifensesin
beta agonist - non-selective adrenergics and ex - (Adrienne is an agonist)
1) Nonselective (both beta 1 and 2) adrenergics
Stimulate alpha, beta1
(cardiac), and beta2
(respiratory)
receptors
Example: epinephrine
beta agonist - nonselective - example (Al is nonselective at the met)
Stimulate both beta1 and beta2
receptors
Example: metaproterenol (Alupent®),
beta agonist - selective beta 2 drugs - example (selective is the best)
(just respiratory beta cells)
Stimulate only beta2 receptor
Example: albuterol (Proventil®, others)
anti-cholernagenics - fast or slow?
Slow and prolonged action
anti-cholernagenics used for what? And don’t use them for what?
Used to prevent bronchoconstriction
NOT used alone for acute asthma exacerbation!
LTRA - when not to use?
NOT meant for management of acute asthmatic
attacks
Montelukast® (luke) is used for what age and treatment of what?
Montelukast® is approved for use in children
ages 2 and older**, and for treatment of allergic
rhinitis
beta agonists (bronchodilators) work fast or slow?
Quickly reduce airway constriction and restore normal airflow
Stimulate beta2
-adrenergic receptors throughout
the lungs
corticosteroids - inhaled form reduces what? How long do they take to work? (muscles don’t happen overnight)
Oral or inhaled forms
Inhaled forms reduce systemic effects
May take several weeks before full
effects are see
antihistamine properties (anti-hist, anti-chol, and sedative)
Antihistamines have several properties
Antihistaminic
Anticholinergic
Sedative
antihistamine H2 (2 dine on my stomach)
H2 blockers or H2 antagonists
Used to reduce gastric acid in peptic ulcer disease
Examples: cimetidine (Tagamet), ranitidine (Zantac),
famotidine (Pepcid)
antihistamine contraindications (antihistamines are NOT for the eyes, heart, and kidneys)
Use with caution in increased intraocular pressure,
cardiac or renal disease, hypertension, asthma,
COPD, peptic ulcer disease, BPH, or pregnancy
decongestants - Adrenergics (Adrienne is large)
Largest group
Sympathomimetics (mimic sympathetic system)
decongestants - Anticholinergics (anti-common)
Less commonly used
Parasympatholytics
decongestants - Corticosteroids - two forms
Topical, intranasal steroids
Two dosage forms
Oral
Inhaled/topically applied to the nasal membranes
antitussives - Dextromethorphan - adverse effects (Dex for DDN - the usual)
Dizziness, drowsiness, nausea
antitussives - opioid - adverse effects
Sedation, nausea, vomiting, lightheadedness,
constipation
H2 - cimetidine trade name (T for tagamet)
cimetidine (Tagamet)
H2 , ranitidine trade name (rant about zant)
ranitidine (Zantac)
H2 famotidine trade name (Pepcid if fam)
famotidine (Pepcid)
BAM
bronchodilators
SLM
anti-inflammatory
anticcccholernegics - anti-cccccecretions
you can’t pee with em tropium
Ipratropium bromide trade name (Peeum with atrovent)
(Atrovent®)
tiotropium trade name (Tito eats spira)
(Spiriva®)
