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AE1 > PHARM WEEK 2 RESPIRATORY AGENTS > Flashcards

PHARM WEEK 2 RESPIRATORY AGENTS Flashcards

1
Q

In order to go to Bioavailability, meds need to go first pass____.

A

metabolism and absorption

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2
Q

Med dose goes through the stomach and intestines for what process?

A

metabolism and absorption

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3
Q

after absorption of meds, the remaining meds goes to what organ to metabolize?

A

liver

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4
Q

what is half life?

A

Time it takes for ½ drug concentration to be eliminated

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5
Q

what two process affect half life?

A

metabolism and elimination

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6
Q

what can prolongs half life? hint: this involves two organs

A

liver and kidney dysfunction

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7
Q

how many half lives are needed to completely saturates the biologic system?

A

3 to 5

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8
Q

what is steady state?

A

biologic system is saturated so that the

intake of the drug equals the amount metabolized

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9
Q

steady state is attained after about how many half-times?

A

about 4

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10
Q

the time to steady state is dependent or independent of dosage?

A

independent

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11
Q

Each “hop” on the same concentration value on the steady state concentration picture is a what?

A

a steady state concentration, specifically from ingestion of med to metabolism of med. note that the concentration values are stable so intake and output is the same, which is what steady state is all about.

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12
Q

When the therapeutic index is low, the margin of safety is…

A

narrow

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13
Q

when the margin of safety is wide, the therapeutic index is…

A

high

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14
Q

what is the “peak” of pharmacodynamics?

A

Time of highest plasma drug concentration & shows rate of absorption

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15
Q

when the blood work is drawn at prescribed time, the drug …

A

peaks!

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16
Q

Lowest plasma drug concentration & shows rate of excretion is known as

A

trough

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17
Q

when is the trough of pharmacodynamics reflected in the blood work

A

When the blood work is drawn just before next dose of drug

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18
Q

should the trough be documented?

A

Of course dawg!

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19
Q

how do you classify or categorize medications?

A

by using the CHEMICAL NATURE OF THE DRUG (ex: benzodiazepines), SYMPTOMS OR DISEASE (ex: antipsychotic), AFFECTED ORGAN SYSTEM (ex: respiratory meds), and GENERATION (ex 1st generation (typical) and 2nd generation (atypical) antipsychotics)

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20
Q

what is the ligand-binding domain?

A

it is the site on the receptor in which drugs bind

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21
Q

where are the receptors ?

A

they are found on the cell membranes

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22
Q

explain receptor theory

A

the ligand (hormones, drugs, neurotransmitters) binds to the receptor on the ligand binding domain. It then triggers the cell to act accordingly.

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23
Q

Does the neurotransmitter give pharmacological response?

A

yes.

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24
Q

does the agonist give pharmacological response?

A

yes.

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25
Q

does antagonist give pharmacological response?

A

NO!

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26
Q

The CNS includes which two organs

A

brain and Spinal cord

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27
Q

what two nervous systems are under peripheral nervous system?

A

Autonomic nervous system and somatic nervous system

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28
Q

what two nervous systems are under autonomic nervous system?

A

sympathetic and parasympathetic

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29
Q

what is the neurotransmitter for the sympathetics NS?

A

Norepinephrine

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30
Q

what are the stimulants of sympathetics NS?

A

adrenergics, adrenomimetics, or adrenergic agonists

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31
Q

what are the depressants of the sympathetics NS?

A

Sympatholytics, Adrenergic Blockers, Adrenolytics or Adrenerigc Antagonists

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32
Q

What is the neurotransmitter for the parasympathetics NS?

A

Acethylcholine

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33
Q

What are the stimulants of the parasympathetics NS?

A

Cholinergics, Cholinergic Agonists

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34
Q

what are the depressants of the parasympathetics NS?

A

Parasympatholytics Anticholinergics, Cholinergic Antagonists, or Antispasmodics

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35
Q

what is the sympathetic response of the eyes?

A

dilate pupils

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36
Q

what is the sympathetic response of the lungs?

A

dilates bronchioles

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37
Q

what is the sympathetic response of the heart?

A

increase heart rate

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38
Q

what is the sympathetic response of the blood vessels?

A

constricts blood vessels

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39
Q

what is the sympathetic response of the gastrointestinal?

A

relaxes smooth muscles of the GI tract

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40
Q

what is the sympathetic response of the bladder

A

relaxes bladder muscle

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41
Q

what is the sympathetic response of the uterus?

A

relaxes uterine muscle

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42
Q

what is the parasympathetic response of the eyes?

A

constricts pupils

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43
Q

what is the parasympathetic response of the lungs?

A

constricts bronchioles and increases secretions

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44
Q

what is the parasympathetic response of the heart

A

decreases heart rate

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45
Q

what is the parasympathetic response of the blood vessels

A

dilates blood vessels

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46
Q

what is the parasympathetic response of the gastrointestinal?

A

increase peristalsis

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47
Q

what is the parasympathetic response of the bladder

A

constricts bladder

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48
Q

what is the parasympathetic response of the salivary gland?

A

increase salivation

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49
Q

alpha 1 receptor’s response on blood vessels

A

vasoconstriction, increased bp, increased contractibility of the heart

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50
Q

alpha 1 receptor’s response on the eyes

A

mydriasis (puil dilation)

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51
Q

alpha 1 receptor’s response on bladder

A

relaxation

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52
Q

alpha 1 receptor’s response on prostate

A

contraction

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53
Q

alpha 2 receptor’s response on blood vessels

A

decreased bp (reduced norepinephrine)

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54
Q

alpha 2 receptor’s response on smooth muscle (GI tract)

A

decreased gastrointestinal tone and motility

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55
Q

Beta 1 receptor’s response on heart

A

increased heart contraction and increase heart rate

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56
Q

beta 1 receptor’s response on kidney

A

increased renin secretion, increased angiotensin and increased bp

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57
Q

beta 2 receptor’s response on the smooth muscle (GI tract)

A

decreased GI tone and motility

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58
Q

beta 2 receptor’s response on on the lungs

A

bronchodilation

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59
Q

beta 2 receptor’s response on the uterus

A

relaxation of uterine smooth muscle

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60
Q

beta 2 receptor’s response on on the liver

A

activation of glucogneolysis and increased blood sugar

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61
Q

respiratory agents are for… hint: top and bottom

A

the upper respiratory infection and the acute and chronic lower respiratory disorders

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62
Q

what is included in the upper respiratory tract (4)?

A

nares, nasal cavity, pharynx, larynx

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63
Q

what is included in the lower respiratory tract (5)?

A

trachea, bronchi, bronchioles, alveoli and alveolar-capillary membrane

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64
Q

the movement of air from the atmosphere through the upper and lower airways to the alveoli is known as what process?

A

ventilation

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65
Q

the process whereby gas exchange occurs at the alveolar-capillary membrane is known as what process?

A

respiration

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66
Q

what are the 3 phases of respiration in order?

A

ventilation, perfusion, diffusion

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67
Q

what is happening during the ventilation process?

A

oxygen passes through the airways

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68
Q

what is inspiration?

A

when air moved into lungs

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69
Q

what is expiration

A

air transported out of lungs

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70
Q

what is perfusion?

A

when blood flow at the alveolar-capillary bed

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71
Q

what is influenced by the alveolar pressure?

A

perfusion

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72
Q

for gas exchange, what must happen?

A

perfusion must be matched by adequate ventilation

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73
Q

how will mucosal edema, secretions and bronchospasm affect respiration? ( related to resistance and ventilation)

A

increased resistance to airflow, and decreased ventilation and diffusion of gases

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74
Q

what happen during diffusion(3)?

A

gas move from high to low concentration, O2 passes into capillary bed into circulation, and CO2 leaves capillary bed to alveoli for ventilatory excretion

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75
Q

what is lung compliance

A

ability of the lungs to stretch

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76
Q

what are the 2 factors that can influence lung compliance?

A

connective tissue and surface tension

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77
Q

COPD has increased or decreased lung compliance?

A

increased!

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78
Q

restrictive disease has increased or decreased lung compliance?

A

decreased

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79
Q

What does decreased lung compliance mean?

A

it takes greater than normal pressure to expand lung tissue

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80
Q

respiration is influenced by what 3 concentration in the blood?

A

O2, CO2 and H+

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81
Q

how is chemoreceptors stimulated?

A

by changes in gases and ions

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82
Q

where are the central chemoreceptors? they are controlled by what two ions/molecules?

A

near the respiratory center, controlled by CO2 and H+

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83
Q

where are the peripheral chemoreceptors? what are they controlled by?

A

in the carotid and aortic bodies, controlled by O2 concentration.

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84
Q

the muscles in the tracheobronchial tube are composed of what types of muscle?

A

smooth muscle

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85
Q

bronchodilation is stimulated by what two chemical molecules/hormones?

A
  1. epinephrine from the sympathetic NS, 2. cyclic AMP (cyclic adenosine monophosphate)
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86
Q

bronchoconstriction is stimulated by what chemical?

A

acetylcholine from the parasympathetic NS.

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87
Q

what are the 4 types of Upper respiratory infections?

A

common cold, acute rhinitis, sinusitis, acute pharyngitis

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88
Q

what is the etiology of common cold? what precaution to use? Where does it affect?

A

rhinovirus, droplet precautions, and it affects the nasopharyngeal tract

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89
Q

what is acute rhinitis?

A

the inflammation of nasal mucous membranes

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90
Q

what is sinusitis

A

inflammation of mucous membranes of sinuses

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91
Q

what is acute pharyngitis?

A

inflammation of throat

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92
Q

what is the contagious period of common cold?

A

1 to 4 days before onset of symptoms and during the first 3 days of cold

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93
Q

how is common cold transmitted?

A

by touching contaminated surfaces, and then touching nose or mouth or via viral droplets from sneezing

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94
Q

what are the symptoms of common cold?

A

nasal congestion, nasal discharge, cough, and increased mucosal secretions

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95
Q

drugs for upper respiratory infections are (2) …

A

generally not curative, but aim to lessen or control the symptoms of URI

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96
Q

what are some meds for the common cold, acute rhinitis and allergic rhinitis (5)?

A 
antihistamines
decongestants (nasal or systemic)
intranasal glucocorticoids
expectorants
antitussives
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97
Q

what is one type of antihistamines?

A

H1 blockers (H1 blockers or H1 antagonists)

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98
Q

side effects of H1 blockers

A

drowsiness, dizziness, fatigue, and impaired coordination

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99
Q

an example of first generation antihistamines?

A

diphenhydramine (Benadryl)

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100
Q

what are the 2 categories (types) of antihistamines?

A

first generation antihistamines, and second generation antihistamines (ex: non sedating antihistamine)

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101
Q

what are the 4 examples of non sedating antihistamines?

A

cetirizine (Zyrtec)
Fexofenadine (Allegra)
Loratadine (Claritin)
Azelastine (Astelin)

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102
Q

what are the actions of benadryl (diphenhydramine) (2)?

A

it competes with histamine fore receptor sites preventing a histamine response and it reduces nasopharyngeal secretion, itching, and sneezing

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103
Q

what is benadryl used for?

A

to treat acute and allergic rhinitis, antitussive and as a pre-med prior to blood transfusion in some cases

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104
Q

what are the contraindication/ cautions for benadryl?

A

severe liver disease, narrow-angle glaucoma, and urinary retention.

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105
Q

benadryl (diphenhydramine) can be administer via (3)…

A

oral, IM, IV

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106
Q

what are the interactions of benadryl (diphenhydramine)?

A

it increases CNS depression with alcohol and other CNS depressants and avoid use of MAOIs.

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107
Q

what are the side effects of diphenhydramine (benadryl)?

A

drowsiness, dry mouth, dizziness, blurred vision, wheezing, photosensitivity, urinary retention, constipation, GI distress, blood dycrasias .

108
Q

benadryl

A

diphenhydramine

109
Q

additional side effects of benadryl (diphenhydramine) for elderly.

A

elderly are at greater risk for side effects. the usual ones and decreased bp and confusion. so give lower dosage and consider the second generation meds

110
Q

non-sedating antihistamines has…

A

fewer anticholinergic symptoms

111
Q

nasal congestion are due to what 2 reasons?

A
  1. dilation of nasal blood vessels due to infection, inflammation and allergy
  2. transudation of fluid into tissue spaces, leading to swelling nasal cavity
112
Q

nasal decongestants; systemic decongestants stimulate what?

A

alpha- adrenergic receptors

113
Q

stimulation of alpha- adrenergic receptors causes what effects (4)?

A
  1. produces nasal vascular vasoconstriction
  2. shrinks nasal mucous membranes
  3. reduces nasal secretion
  4. rebound nasal congestion
114
Q

systemic decongestants are used primarily for what?

A

for allergic rhinitis, including hay fever and acute coryza (inflammation of the membranes of the nasal cavity)

115
Q

what are 3 examples of systemic decongestants?

A
  1. ephedrine (ephedrine)
  2. phenyephrine (neo-synephrine)
  3. pseudoephedrine (sudafed)
116
Q

what are 6 examples of nasal decongestants?

A
  1. Ephedrine HCl (Primatene)
  2. Naphazoline HCl (Privine)
  3. Oxymetazoline (Afrin)
  4. Phenylephrine HCl (Neo-Synephrine Nasal)
  5. Pseudoephedrine (Sudafed)
  6. Tetrahydrozoline (Tyzine)
117
Q

what are the different types of nasal decongestants administration methods (5)?

A
  1. nasal spray
  2. nasal drops
  3. tablet
  4. capsule
  5. liquid
118
Q

what are the side effects of nasal decongestants?

A

nervousness, restlessness, “jitters”, alpha-adrenergic effect (hypertension, hyperglycemia)

119
Q

frequent use of nasal decongestants may lead to (2)

A

tolerance and rebound nasal congestion (so it should not be used more than 5 days)

120
Q

Intranasal Glucocorticoid is effective for what?

A

allergic rhinitis

121
Q

Intranasal Glucocorticoid has what type of effect?

A

anti-inflammatory

122
Q

Intranasal Glucocorticoid may be used alone or with ____?

A

H1 antihistamine

123
Q

Dexamethasone should not be used longer than __ days to avoid ___ ____

A

30 days, systemic effects

124
Q

continuous use of Intranasal Glucocorticoids may cause …

A

nasal mucosa dryness

125
Q

an example of Intranasal Glucocorticoids is

A

fluticasone (Flonase)

126
Q

what are 2 things about Intranasal Glucocorticoids?

A
  1. systemic steroid effects are rare

2. rapid deactivation after absorption

127
Q

what is an example of expectorants?

A

guaifenesin (robitussin)

128
Q

what is the action of guaifenesin?

A

lossens bronchial secretions by reducing surface tension of secretions

129
Q

what is guaifenesin used for?

A

dry, nonproductive cough

130
Q

what are the side effects of guaifenesin?

A

drowsiness, nausea

131
Q

Antitussives act on what?

A

the cough-control center in the medulla to suppress the cough reflex

132
Q

what are the Three types of antitussives?

A

nonnarcotic
narcotic
combination preparations

133
Q

what is an example of non-narcotic antitussive?

A

dextromethorphan (benylin)

134
Q

what is an example of narcotic antitussive?

A

hydrocodone (hycodan)

135
Q

The evidence for effectiveness for antitussive medications in adults are ___.

A

Scant; barely sufficient or adequate

136
Q

Serious adverse events for cough and cold medicines are seen in children under the age of __.

137
Q

US Food and Drug Administration (FDA) recommendation on (date), to avoid use of cough and cold meds to treat infants and children ___ years of age, “because serious and potentially life-threatening side effects can occur.”

A

January 17, 2008

less than 2

138
Q

COPD: Airway obstruction with ____ to airflow to lung tissues

A

↑ airway resistance

139
Q

COPD is generally…

A

progressive – extra-pulmonary effects

140
Q

COPD may be accompanied by _____

A

airway hyper-reactivity

141
Q

COPD is

A

Not a disease in itself

142
Q

COPD is the ___ leading cause of death worldwide (___ in US)

A

Fourth, 3rd in US

143
Q

More than one half of COPD patients die within __ years of diagnosis

144
Q

Primary cause of COPD in the U.S. is

A

Exposure to tobacco smoke

145
Q

Two types of COPD:

A

emphysema and Bronchitis

146
Q

Emphysema is

A

Abnormal permanent enlargement of the air space distal to the terminal bronchioles

147
Q

Emphysema is

A

Accompanied by destruction of bronchioles without obvious fibrosis

148
Q

Emphysema lacks

A

alpha1-antitrypsin protein

149
Q

Bronchitis is

A

the presence of chronic productive cough for 3 or more months in each of 2 successive years in a patient whom other causes of chronic cough have been excluded

150
Q

Bronchitis has

A

Peribronchial Fibrosis

151
Q

emphysema is the hyperinflation of ___, destruction of ___ ___, and destruction of ___ ___ ___

A

alveoli, alveolar walls, alveolar capillary walls

152
Q

Emphysema is characterized by (3)

A
  1. narrowed airways
  2. loss of lung elasticity
  3. repeated cycles of inflammation and repair, increases collagen and scarring of small airways
153
Q

Bronchitis is characterized by

A

Chronic inflammation –The primary pathology causes vasodilation, congestion, mucosal edema (mucus production)

154
Q

Bronchitis is characterized by (3)

A
  1. greater airflow resistance
  2. Hypoxemia and hypercapnia
  3. Tendency to hypoventilate and retain CO2
155
Q

retention of CO2 via bronchitis causes

A

respiratory acidosis

156
Q

Emphysema is aka

A

Pink Puffers

157
Q

emphysema is characterized by (8)

A 
Increasing dyspnea
Little or no cough
Marked chest overexpansion
No cyanosis
No peripheral edema
Quiet breath sounds
Arterial PO2 only slightly depressed
Arterial PCO2 normal
158
Q

Chronic Bronchitis is aka

A

Blue Bloater

159
Q

Chronic Bronchitis is characterized by (8)

A 
Increasing dyspnea 
Frequent cough with sputum
Moderate or no increase in chest expansion
Cyanosis
Rales, rhonchi
Peripheral edema
PO2 often low
PCO2 often raised
160
Q

What is cor pulmonale/pulmonary hypertension

A

Right side of the heart must increase to push blood into the lungs

161
Q

What can develop due to for pulmonale/pulmonary hypertension?

A

Right-sided heart failure

162
Q

Since the right side of the heart has to push harder to pump blood into the lungs, what can this lead to (before and after the heart)?

A

Subsequent intravascular volume expansion and later systemic venous congestion.

163
Q

Cor pulmonale is

A

right-sided heart failure

164
Q

Cor pulmonale is an enlargement of …

A

enlargement of the right ventricle due to high bp in the lungs usually caused by chronic lung disease.

165
Q

signs and symptoms of Cor Pulmonale (7)

A

Ventricular diastolic gallop (S3)
Distended neck veins (JVD)
Hepatomegaly with upper quadrant tenderness
Ascites, epigastric distress
Peripheral edema, weight gain
Acute exacerbations of chronic bronchitis
Acute respiratory failure

166
Q

The pathophysiologic changes of restrictive lung disease is

A

Decrease in total lung capacity from
fluid accumulation
and loss of elasticity of the lung tissues

167
Q

The etiologies of restrictive lung disease include (5)

A 
Pulmonary fibrosis
Pneumonitis
Lung tumors
Thoracic deformities (scoliosis)
Myasthenia gravis
168
Q

Asthma is …

A

Inflammatory disorder of the airway walls associated with a varying amount of airway obstruction

169
Q

Asthma is triggered by (3)

A

stress, allergens, pollutants

170
Q

what are the manifestations of asthma?

A

bronchospasm, wheezing, mucus secretions and dyspnea

171
Q

Bronchiectasis is…

A

abnormal dilation of the bronchi and bronchioles

172
Q

Bronchiectasis is caused by

A

frequent infection and inflammation

173
Q

During Bronchiectasis, bronchioles become obstructed by what?

A

by the breakdown of the epithelium of the bronchial mucosa

174
Q

what can result due to bronchiectasis?

A

tissue fibrosis

175
Q

What is an agonist?

A

it is a drug which has affinity for the cellular receptors of another drug or natural substance and which produces a physiological effect.

176
Q

effects of alpha 1 adrenergic agonists

A

vasoconstriction and increased contractility of heart

177
Q

effects of alpha 2 adrenergic agonists

A

decreased bp, reduced norepinephrine

178
Q

effects of beta 1 adrenergic agonists

A

increased heart rate

179
Q

effects of beta 2 adrenergic agonists

A

bronchodilation

180
Q

What is the action of Selective Beta2 Receptor Agonists?

A

It works specifically with beta 2 receptors in the bronchi causing bronchodilation

181
Q

what is the systemic effects of selective beta 2 receptor agonists?

A

increased BP/HR, decreased GI/renal blood flow

182
Q

What is an example of selective beta 2 receptor agonists?

A

Albuterol (Proventil, Ventolin)

Metaproterenol (Alupent)

183
Q

what are some things about albuterol (proventil, Ventolin)?

A

Rapid onset of action
Longer duration of action
Few side effects

184
Q

What are Metaproterenol (Alupent) administered?

A

Administered oral, inhalation, metered-dose inhaler nebulizer

185
Q

albuterol is aka

A

proventil, ventolin

186
Q

metaproterenol is aka

187
Q

what is the action of Sympathomimetics?

A

It mimics the effects sympathetic nervous system causing bronchial dilation and increased rate and depth of respiration

188
Q

what is an example of sympathomimetics

A

Epinephrine (Adrenalin)

189
Q

what are the actions of epinephrine (adrenalin)(3)?

A
  1. Increases cAMP in lung tissue. Cyclic adenosine monophosphate (cAMP) is a second messenger transferring the effects of hormones like glucagon and adrenaline into the cell, promoting bronchodilation bronchodilation
  2. Restores circulation and increases airway patency
  3. First line of defense in acute asthma attack or anaphylaxis, given sub Q
190
Q

What are some side effects of sympathomimetics?

A

Palpitations, dizziness (caution in cardiac patients)

Nervousness, tremors, tachycardia, dysrhythmia, hypertension

191
Q

What is the action of Nonselective Beta-adrenergic Agonists

A

It relaxes smooth muscle of bronchi

192
Q

What is an example of nonselective Beta-adrenergic agonists?

A

Isoproterenol (Isuprel)

193
Q

What is one severe side effect due to nonselective Beta-adrenergic agonists?

A

Severe side effects from beta1 response; it is seldom prescribed due to cardiac side effects (tachycardia)

194
Q

How is nonselective Beta-adrenergic agonists administered?

A

IV or inhalation

195
Q

What are some side effects of nonselective Beta-adrenergic agonists?

A

nervousness, tremors, restlessness, flushing, headache, tachycardia, palpitations, hypertension

196
Q

What is the action of Anticholinergics?

A

Blocks or antagonizes acetylcholine at the vagal-mediated receptor sites relaxes smooth muscle of bronchi (blocks parasympathetic response)

197
Q

What is an example of Anticholinergics?

A

Tiotropium (Spiriva)

198
Q

What is Tiotropium (Spiriva) used for?

A

It is used for maintenance treatment of bronchospasms associated with COPD (once daily)

199
Q

How is Tiotropium (Spiriva) administered?

A

by inhalation only with the HandiHaler device (dry-powder capsule inhaler)

200
Q

What are some adverse effects of Tiotropium (Spiriva)?

A

dry mouth, constipation, vomiting, dyspepsia, abdominal pain, depression, insomnia, headache, joint pain, peripheral edema, and chest pain

201
Q

What is another example of anticholinergics?

A

Ipratropium bromide (Atrovent)

202
Q

What is Ipratropium bromide (Atrovent) used for?

A

As a maintenance treatment for COPD/bronchospasm

203
Q

Combination of ipratropium bromide with albuterol sulfate (Combivent) can be used to treat what?

A

used to treat chronic bronchitis

204
Q

What is the action of Combivent?

A

To dilates bronchioles

205
Q

How is combivent administered?

A

aerosol inhaler

206
Q

What are some cautions for combivent (2)?

A

Narrow-angle glaucoma, urinary retention

207
Q

Patients who use a beta-agonist inhalant should administer it _ minutes before using ____.

A

5, ipratropium

208
Q

When using the ____ agent in conjunction with an inhaled glucocorticoid (steroid) or cromolyn, the ___ ___ should be used 5 minutes before the steroid or cromolyn.

A

anticholinergic, ipratropium bromide

209
Q

What is the action of Methylxanthine (xanthine) Derivatives?

A

It relaxes smooth muscle of bronchi, bronchioles increasing cAMP (cyclic adenosine monophosphate). cAMP is a second messenger transferring the effects of hormones like glucagon and adrenaline into the cell, promoting bronchodilation

210
Q

What are some examples of Methylxanthine (xanthine) Derivatives (3)?

A
  1. Aminophylline—theophylline 2. ethylenediamine (Elixophyllin, Theo-24)
  2. dyphylline (Lufyllin)
211
Q

What is Methylxanthine (xanthine) Derivatives

1. Aminophylline—theophylline 2. ethylenediamine (Elixophyllin, Theo-24
3. dyphylline (Lufyllin)) used for?

A

As a maintenance therapy for chronic stable asthma

212
Q

What is the therapeutic range of Methylxanthine (xanthine) Derivatives?

A

10 to 20 mcg/mL (toxicity greater than 20)

213
Q

What are some contraindications for Aminophylline?

A

seizure, cardiac, renal, or liver disorders

214
Q

How is Aminophylline administered?

215
Q

What are some side effects of Aminophylline?

A

dysrhythmias, nervousness, irritability, insomnia, flushing, dizziness, hypotension, seizures, GI distress, intestinal bleeding, hyperglycemia, tachycardia, palpitations, cardiorespiratory collapse

216
Q

What is the action of Leukotriene Receptor Antagonists?

A

It selectively and competitively blocks or antagonizes receptors for the production of leukotrienes D4 and E4 (components of slow-reacting substance of anaphylaxis [SRSA]).
Reduce inflammatory process and decrease bronchoconstriction

217
Q

What are some examples of Leukotriene Receptor Antagonists (3)?

A
  1. Zafirlukast (Accolate)
  2. montelukast (Singulair)
  3. zileuton (Zyflo CR)
218
Q

What are Leukotriene Receptor Antagonists

1. Zafirlukast (Accolate
2. montelukast (Singulair)
3. zileuton (Zyflo CR)) used for?

A

prophylactic and maintenance for chronic asthma, not for acute attacks

219
Q

What are the side effects of Leukotriene Receptor Antagonists?

A

dizziness, HA, GI distress, abnormal liver enzymes, nasal congestion, cough, pharyngitis

220
Q

What is the action of glucocorticoids (steroids)?

A

It decreases swelling and promote (anti-inflammatory effect) beta-adrenergic receptor activity promoting smooth muscle relaxation

221
Q

What are some examples of glucocorticoids (steroids) (2)?

A
  1. Beclomethasone (Beclonase)

2. dexamethasone (Decadron)

222
Q

Which glucocorticoid medications can be administered orally as a tablet?

A
  1. triamcinolone (Aristospan)
  2. dexamethasone (Decadron)
  3. prednisone
  4. prednisolone
  5. methylprednisolone
223
Q

Which glucocorticoid medications can be administered Intravenously (2)?

A
  1. dexamethasone (Decadron)

2. hydrocortisone

224
Q

Which glucocorticoid medication can be administered via a MDI inhaler (1)?

A

beclomethasone (Beconase)

225
Q

What are two information regarding inhaled glucocorticoids?

A
  1. Not helpful in treating a severe asthma attack

2. May take 1 to 4 weeks for an inhaled steroid to reach its full effect

226
Q

Which type of asthma attack is good to use intravenous glucocorticoids?

A

acute asthma exacerbations

227
Q

Tablet glucocorticoids are best for treating…

A

asthma that requires prolonged glucocorticoid therapy

228
Q

What is an example of Mast Cell Stabilizer?

A

Cromolyn (NasalCrom)

229
Q

What is the action of Cromolyn (NasalCrom)?

A

It inhibits the release of histamine from mast cells and inhibits the release of SRSA (slow-reacting substance of anaphylaxis). NO BRONCHODILITATION

230
Q

What are some examples of Cromolyn (2)?

A
  1. Intal (cromolyn)

2. tilade (nedocromil)

231
Q

What are some information of Cromolyn (3)?

A
  1. It is used for prophylactic treatment of bronchial asthma
  2. Must be taken daily
  3. Not to be used for acute asthmatic attack
232
Q

How is Cromolyn administered?

A

inhalation

233
Q

what are some side effects of cromolyn?

A

cough, bad taste, rebound bronchospasm

234
Q

What is Nedocromil used for (2)?

A
  1. Prophylactic treatment of bronchial asthma

2. Not to be used for acute asthmatic attack

235
Q

How is Nedocromil administered?

A

inhalation

236
Q

what is a side effect of Nedocromil?

237
Q

What is one fact about Nedocromil?

A

Nedocromil is believed to be more effective than cromolyn.

238
Q

Drug Therapy for Asthma is prescribed according to ___

239
Q

For Young Children with asthma… (2)

A
  1. Cromolyn and nedocromil are drugs used to treat the inflammatory effects of asthma.
  2. Oral glucocorticoids may be prescribed for the young child to control a moderate to severe asthmatic state.
240
Q

For Older Adults with asthma… (1)

A

requires careful consideration due to adverse effects

241
Q

What is the action of Mucolytics?

A

Splits apart disulfide bonds that are responsible for holding mucus together. Liquefies and loosens thick mucus secretions.

242
Q

What is the two examples of Mucolytics

A
  1. Acetylcysteine (Mucomyst)

2. Dornase alfa (Pulmozyme)

243
Q

How is Acetylcysteine (Mucomyst) administered?

A

Administer 5 minutes after a bronchodilator.

Should not be mixed with other drugs.

244
Q

Acetylcysteine (Mucomyst) is an antidote for what?

A

an antidote for acetaminophen overdose if within 12 to 24 hours
–Give orally diluted in juice or soft drink

245
Q

What is Dornase alfa (Pulmozyme)?

A

It is an enzyme that digests deoxyribonucleic acid (DNA) in thick sputum secretions of patients with cystic fibrosis (CF)

246
Q

What is the Client Education for the Use of Metered Dose Inhaler (7 step procedure)?

A
  1. Insert canister into holder
  2. Shake well before using & remove cap
    - –if new inhaler do test spray
  3. Breathe out thru mouth, open mouth wide, & hold 1-2” from mouth
    - –If spacer used, put in mouth
  4. Simultaneously open mouth, take slow deep breath & push top of canister once.
  5. Hold breath few seconds & exhale slowly
  6. Wait 2 minutes if 2nd dose ordered & repeat.
  7. Wait 5 min if giving steroid inhaler
247
Q

The nursing process for Bronchodilators is … (hint: ADPIE)

A
  1. Assessment
  2. Nursing diagnoses
  3. Planning
  4. Nursing interventions
    —–Patient teaching
    —–Cultural considerations
  5. Evaluation
    – assess peak flow readings, breath sounds, O2 sat, color, ability to perform ADLS
248
Q

What is two nursing diagnoses for bronchodilators?

A
  1. Ineffective airway clearance related to retained secretions in bronchi
  2. Activity intolerance related to fatigue and imbalance between oxygen demand and supply
249
Q

What are four plannings (goals) appropriate for Bronchodilators?

A
  1. Client will be free of wheezing & lung fields clear
  2. O2 saturation will return to baseline
  3. Rate of respirations will be between 12 to 20
  4. Patient states “I am breathing better”
250
Q

Is COPD an individual disease?

A

No! It can be a combo of different conditions; bronchitis with emphysema/ asthma

251
Q

Fibrosis is…

A

it is the hardening of tissues thus affecting expansion of the lungs

252
Q

During emphysema, the alveoli are

A

the alveoli are distended with air, can’t breathe out because structures around the bronchioles are not there anymore, they collapsed, can’t open bronchioles so air is trapped.

253
Q

During Chronic Bronchitis, the pt does not require high O2 concentration, because…

A

you can take away the hypoxia drive if the pt is high on O2. Pt is alway high on CO2 so main stimulus for them to breath is the hypoxia drive.

254
Q

Blue Bloater’s rhonchi breath sound is due to?

A

due to sputum trapped inside the airway

255
Q

Blue Bloater’s rales breath sound is due to?

A

due to CHF, RHF, and fluid in alveoli

256
Q

Blue Bloater’s peripheral edema is due to?

A

due to RHF

257
Q

Blue Bloater is blue (cyanosis) because?

A

The O2 can’t go into the cells and tissues.

258
Q

Asthma can exacerbate COPD and vice versa?

259
Q

agonists are …

A

producing an effect!

260
Q

Beta 2 adrenergic agonist’s effect of vasodilation is vasodilation of what tissue?

A

skeletal muscle! not blood vessel!

261
Q

When cAMP is increased…

A

there are more 2nd messengers transferring the effects of hormones (glucagon and adrenaline) into the cell nucleus, promoting bronchodilation.

262
Q

Tiotropium (Spiriva) is used for…

A

it is for maintenance of COPD, not for acute management of exacerbation.

263
Q

When pt is using Combivent, the nurse should…

A

monitor urine output, because urinary retention can increase prostate enlargement r

264
Q

When pt is using Combivent, the nurse should monitor pt’s pupil because….

A

Combivent can cause dilation of pupils, so it can block the opening where the fluid drains. If fluid builds up, it can exacerbate glaucoma.

265
Q

Overuse of glucocorticoids can lead to…

A

Cushing’s syndrome

266
Q

Acetylcysteine (Mucomyst) can be used to prevent what?

A

can be used to prevent kidney damage due to contrast media’s side effects, prevent nephron toxic.

267
Q

When planning goals for pts with COPD, O2 saturation should be…

A

aimed for 90 to 95%, don’t aim for 100% because he has COPD!!

AE1 (12 decks)

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