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STUDY CARDS > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Diseases of the Lower Respiratory Tract? 2

What they do to the system?

A

Chronic obstructive pulmonary disease

Asthma (persistent and present most of the time despite treatment)

Obstruct airflow through the airways

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2
Q

Respiratory system:
Anatomy

A

Lower Respiratory Tract (trachea, bronchial tree, lungs)

URT (nose, nasopharynx, oropharynx, laryngopharynx, larynx)

4 accessory structures (oral cavity/ mouth, rib cage, muscle of ribs, and diaphragm)

Function:
gas exchange in alveoli (O2 and C02)

Filter, warm, and humidify the air

Speech, sense of smell, regualtion of pH

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3
Q

Bronchial Asthma

A

Chronic airway inflammation resulting in
bronchial constriction and hyper responsiveness to various triggers (allergen)

Recurrent and reversible shortness of breath

Occurs when the airways of the lungs become narrow

The alveolar ducts and alveoli remain open, but airflow to them is obstructed (prevents CO2 to leave and O2 in)

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4
Q

Bronchial Asthma occurs when the airways of the lungs become narrow as a result of: 4

A

Bronchospasms

Inflammation of the bronchial mucosa

Edema of the bronchial mucosa

Production of viscous mucus

Onset of asthma- before age 10 in 50% of pts and before 40 in 80% of pts

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5
Q

Bronchial Asthma’s alveolar ducts and alveoli remain open, but airflow to them is obstructed: What are the symptoms?5

A

Wheezing
Difficulty breathing

SOB
chest tightness
cough

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6
Q

Asthma attack

A

A sudden and dramatic onset

Most are short and responds to medication

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7
Q

status (continuing) asthmaticus

A

Prolonged asthma attack that does not respond to typical drug therapy

May last several minutes to hours

Medical emergency: requires hospitalization

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8
Q

early phase response

late phase response

A

mediated by antibodies already present that recognizes the antigen

Antibody for asthma- IgE

Late phase peaks 5 to 12 hours after initial response, may last for hours/ days

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9
Q

Chronic Obstructive Pulmonary Disease
Define& symptoms

A

Progressive respiratory disorder

Characterized by chronic airflow limitation, systematic manifestations, and significant comorbidities

Hypersecretion of mucus, chronic cough, and increased susceptibility to bacterial infection

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10
Q

Assessment of COPD

A

is based on symptoms, future risks of exacerbations, severity of the spirometric abnormality, and identification of comorbidities.

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11
Q

Chronic Bronchitis

A

Presence of cough and sputum for at least 3 months in each of 2 consecutive years

Separate from COPD

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12
Q

Focus of treatment of Lower RT

A

role of inflammatory cells and their mediators

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13
Q

Bronchodilators mechanism of action 3

A

Relax bronchial smooth muscle, which dilates the bronchi and bronchioles (that are narrowed)

Reduce airway constriction and restore normal airflow

Agonists, or stimulators, of the adrenergic receptors in the sympathetic nervous system

Sympathomimetics

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14
Q

Bronchodilators 3 CLASSES

A

β-adrenergic agonists

anticholinergics

xanthine derivatives

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15
Q

Bronchodilators:

ß-Adrenergic Agonists [sympathomimetic bronchodilators]

  1. Indication
  2. Action
  3. Medication (2)
A

Acute phase of asthmatic attacks to reduce airway constriction and restore normal airflow

Agonists/ stimulators of adrenergic R in the sympathetic NS

B agonists imitate the effects of NE and E

Short-acting: Salbutamol (SABA)

Long-acting: Salmetarol (LABA)

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16
Q

Bronchodilators: ß-Adrenergic Agonists [1 medication each]

A

Short-acting ß-agonist (SABA) inhalers
SALBUTAMOL (Ventolin®)
Terbutaline sulphate (Bricanyl®)

Long-acting ß-agonist (LABA) inhalers
formoterol (Foradil®, Oxeze®)
SALMETEROL (Serevent®)

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17
Q

ß-Adrenergic Agonists

LABAs are always prescribed with?

A

Inhaled glucocorticoids

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18
Q

Bronchodilators: β-Adrenergic Agonists: Newest [1 medication]

A

Long-acting ß-agonist and glucocorticoid steroid combination inhaler
budesonide/formoterol fumarate dihydrate (Symbicort®)

To relieve moderate to severe asthma

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19
Q

Bronchodilators: β-Adrenergic Agonists: budesonide/formoterol fumarate dihydrate (Symbicort®) [Indication]

A

Use as a reliever or rescue treatment for moderate to severe asthma when symptoms worsen

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20
Q

Bronchodilators: ß-Adrenergic Agonists – Three Subtypes

A

Nonselective adrenergic

Nonselective ß-adrenergic

Selective ß2 drugs

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21
Q

Bronchodilators: ß-Adrenergic Agonists:

Nonselective adrenergic

  1. mechanism of action
  2. 1 drug
  3. What does this stimulate?
A

Stimulate ß-, ß1- (cardiac), and ß2- (respiratory) receptors

Example: epinephrine (EpiPen®)

Also, stimulate a-adrenergic receptors which cause constriction within the BVs. Vasoconstriction reduces edema and swelling.

Also stimulates B1 receptors which results in cardiovascular AEs such as increased HR, force of contraction, and BP(increased renin), nervousness, tremor

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22
Q

Bronchodilators: ß-Adrenergic Agonists:

Nonselective ß-adrenergics

  1. mechanism of action
  2. 1 drug
A

Stimulate both ß1- and ß2-receptors

Example: isoproterenol hydrochloride

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23
Q

Bronchodilators: ß-Adrenergic Agonists:

Selective ß2 drugs

  1. mechanism of action
  2. 1 drug
  3. stimulates?
  4. Additionally treats?
  5. Also causes?
A

Stimulate only ß2-receptors

Example: salbutamol

stimulate sodium-potassium adenosine triphosphate ion pump in cell membranes, results in a temporary decrease in potassium

B2 agonists effective in treating acute hyperkalemia

Also causes uterine relaxation

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24
Q

ß-Adrenergic Agonists:

TWO Mechanism of Action

A

Dilate airways by stimulating the B2 adrenergic receptors located in lungs

Activation of ß2-receptors activates cyclic adenosine monophosphate

Increased levels of cAMP relaxes smooth muscle in the airway and results in bronchial dilation and increased airflow.

Begins at the specific receptor-stimulated. Ends with the dilation of the airways

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25
Q

ß-Adrenergic Agonists: Indications

A

Relief of bronchospasm related to asthma, chronic obstructive pulmonary disease (COPD), and other pulmonary diseases

Used in treatment and prevention of acute attacks

Used in hypotension and shock

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26
Q

ß-Adrenergic Agonists: Contraindications

A

Known drug allergy

Uncontrolled cardiac dysrhythmias

High risk of stroke (because of the vasoconstrictive drug action)

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27
Q

ß-Adrenergic Agonists: Adverse Effects

Mixed α and ß (epinephrine)

A

Produce most AEs because they are nonselective

Mixed α and ß (epinephrine)

Insomnia
Restlessness
Anorexia
Vascular headache
Hyperglycemia
Tremor
Cardiac stimulation

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28
Q

ß-Adrenergic Agonists: Adverse Effects

Nonselective ß1 and ß2

A

Limited to B-adrenergic effects

Nonselective ß1 and ß2

Cardiac stimulation
tachycardia
Tremor
Anginal pain
Vascular headache

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29
Q

Overdose management

A

include careful admin of a B-blocker due to risk of bronshospasm

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30
Q

ß-Adrenergic Agonists: Adverse Effects

Selective ß2 drugs (salbutamol)

A

Hypotension or hypertension
Vascular headache
Tremor

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31
Q

ß-Adrenergic Agonists: Interactions

A

Diminished bronchodilation when nonselective ß-blockers are used with the ß-agonist bronchodilators

Monoamine oxidase inhibitors- HTN

Sympathomimetics - HTN

Monitor patients with diabetes; an increase in blood glucose levels can occur (esp. with epinephrine)

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32
Q

ß-Adrenergic Agonists:

Salbutamol Sulphate (Ventolin®)

Forms?
If used too frequently….

A

Short-acting ß2-specific broncho-dilating ß-agonist

Most commonly used drug in this class

Oral, parenteral, and inhalational use

Inhalational dosage forms include metered-dose inhalers as well as solutions for inhalation (aerosol nebulizers).

If used too frequently, it loses its B2 specificity: and B1 Receptors are stimulated which causes nausea, anxiety, palpitations, tremors, and increased HR

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33
Q

ß-Adrenergic Agonists: Salmeterol (Serevent®)

MAX DOSE

A

Long-acting ß2-agonist bronchodilator

Never to be used alone but in combination with an inhaled glucocorticoid steroid

Used for the maintenance treatment of asthma and COPD; salmeterol maximum daily dose (one puff twice daily) should not be exceeded

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34
Q

Anticholinergics [muscarinic antagonists]

Mechanism of Action

A

Used in the treatment of COPD

When PNS release ACh , it binds to ACh R on bronchial tree- which results in bronchial constriction and narrowing

Acetylcholine (ACh) causes bronchial constriction and narrowing of the airways.

Anticholinergics bind to the ACh receptors (block ACh R), preventing ACh from binding. Prevents constriction- indirectly causes airway dilation.

Result: bronchoconstriction is prevented, and airways dilate

Reduce secretions

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35
Q

Antichollinergic indication

A

slow and prolonged actions- used to prevent bronchospasm associated with COPD

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36
Q

Antichollinergic

Contraindication 3

Intercations 1

A

allergy
glaucoma
prostate enlargement

other antichollinergic drugs

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37
Q

1 MEDICATION of Anticholinergics

A

ipratropium (Atrovent®),

tiotropium bromide monohydrate (Spiriva®)

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38
Q

Antichollinergic:

Ipratropium (Atrovent®), tiotropium bromide monohydrate (Spiriva®)

Two mechanism of action

A

Indirectly cause airway relaxation and dilation

Help reduce secretions in COPD patients

Indications: prevention of the bronchospasm associated with COPD; not for the management of acute symptoms

oldest and most commonly used

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39
Q

Anticholinergics: Adverse Effects

A

Dry mouth or throat
Nasal congestion
Heart palpitations
Gastrointestinal distress
Urinary retention
Increased intraocular pressure
Headache
Coughing
Anxiety

can be used during pregnancy-outweighs potential risks

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40
Q

Anticholinergics: Ipratropium Bromide

1._____ and ____ ________ used anticholinergic bronchodilator

  1. Available both as a?
  2. Dosing?
A

Oldest and most commonly used anticholinergic bronchodilator

Available both as a liquid aerosol for inhalation and as a multidose inhaler

Usually dosed twice daily

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41
Q

Xanthine Derivatives

A

Consist of plant alkaloids: caffeine, theobromine, and theophylline

Only theophylline and caffeine are currently used clinically.

Synthetic xanthines: aminophylline

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42
Q

Xanthine Derivatives:
Mechanism of Action
What hormone do they inhibit? so that..

A

Causes bronchodilation by increasing the levels of energy-producing cyclic adenosine monophosphate (cAMP)

Inhibt phosphodiesterase, the enzyme that breaks down cAMP.

cAMP- maintains open airways, increased levels of cAMP leads to smooth muscle relaxation and inhibit IgE

Result: increased cAMP levels, smooth muscle relaxation, bronchodilation, and increased airflow

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43
Q

Xanthine Derivatives: 3Drug Effects and 1 result

A

Cause bronchodilation by relaxing smooth muscle in the airways

Result: relief of bronchospasm and greater airflow into and out of the lungs

Also cause central nervous system stimulation

Also cause cardiovascular stimulation: increased force of contraction and increased heart rate, resulting in increased cardiac output and increased blood flow to the kidneys (diuretic effect)

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44
Q

Xanthine Derivatives:
Indications
Caffeine indications

A

Dilation of airways in asthmas and COPD

Mild to moderate cases of acute asthma

Not for management of acute asthma attack

Adjunct drug in the management of COPD

Not used as frequently because of potential for drug interactions and variables related to drug levels in the blood

Caffeine- used without a prescription as a CNS stimulant or analeptic to promote alertness/ heart stimulant for infants IN PICU

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45
Q

Xanthine Derivatives: Contraindications

A

Known drug allergy
Uncontrolled cardiac dysthymias
Seizure disorders
Hyperthyroidism
Peptic ulcers

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46
Q

Xanthine Derivatives: Interactions

A

Increased serum level: allopurinol, cimetidine, macrolide abx (erythromycin), quinolones (cipro), influenza vaccine, rifampin, and oral contraceptives

Use with sympathomimetics/ caffeine- produce additive heart and CNS stimulation

Rifampin increases the metabolism of theophylline- and decrease theophylline levels

St. John wort- increases the rate of xanthin drug metabolism

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47
Q

Xanthine Derivatives: Adverse Effects

A

Nausea, vomiting, anorexia
Gastroesophageal reflux during sleep
Sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias
Transient increased urination
Hyperglycemia

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48
Q

Overdose and toxicity of xanthine derivatives are treated

A

repeated admin of activated charchoal

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49
Q

Xanthine Derivatives: Caffeine Indications 3

A

Used without prescription as a central nervous system stimulant or analeptic to promote alertness (e.g., for long-duration driving or studying)

Cardiac stimulant in infants with bradycardia

Enhancement of respiratory drive in infants in Neonatal Intensive Care Units (NICUs)

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50
Q

Xanthine Derivatives: Theophylline

A

Most commonly used xanthine derivative

Oral and injectable (as aminophylline) dosage forms

Aminophylline: PRODRUG of theophylline; intravenous (IV) treatment of patients with status asthmaticus who have not responded to fast-acting ß-agonists such as epinephrine

Therapeutic range for theophylline blood level is 55 to 100 mmol/L.

Canadian Asthma Consensus guideline recommends levels between 28 to 55 mmol/L.

Can also stimulate CNS (lesser degree than caffeine)

Stimulation of CNS has beneficial effects- enhance respiratory drive

In large doses, theophylline may stimulate the cardiac system- increased force of contraction (increases CO and BF to kidneys) and an increased HR (this plus xanthines ability to dilate BVs in kidneys- increases GFR- producing a diuretic effect)

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51
Q

Xanthine Derivatives: Theophylline

Canadian Asthma Consensus guideline recommends levels between?

A

28 to 55 mmol/L.

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52
Q

Nonbronchodilating Respiratory Drugs [3 medication]

A

Leukotriene receptor antagonists (montelukast, zafirlukast)

Corticosteroids (beclomethasone, budesonide, dexamethasone, flunisolide, fluticasone, ciclesonide, and triamcinolone)

Mast cell stabilizers

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53
Q

Mast cell stabilizers:

A

rarely used and no longer included in Canadian Asthma Management Continuum

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54
Q

Corticosteroids medication names

A

(beclomethasone, budesonide, dexamethasone, flunisolide, fluticasone, ciclesonide, and triamcinolone)

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55
Q

Leukotriene enzyme function in body
Three symptoms

A

causes inflammation
bronchoconstriction
mucus production

> results in coughing, wheezing, and SOB

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56
Q

Leukotriene Receptor Antagonists

  1. Type of medication
  2. Currently available drugs
A

Nonbronchodilating
Newer class of asthma medications

Currently available drugs
montelukast (Singulair®)
zafirlukast (Accolate®)

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57
Q

Leukotriene Receptor Antagonists:

Mechanism of Action

only affects which organ

A

LTRA Montelukast acts directly by binding to the D4 leukotriene-receptor subtype

Drug effects are limited primarily to the lungs

Prevents leukotrienes from attaching to receptors- this alleviates asthma symptoms and reduces inflammation. Prevent smooth muscle contraction of the bronchial airways, decrease mucus secretion, and reduce vascular permeability (reduces edema) through reducing leukotriene synthesis.

Reduce airway inflammation

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58
Q

Leukotriene Receptor Antagonists:

  1. What are Leukotrienes?
  2. Leukotrienes causes?
  3. Result?
A

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, shortnessof breath

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59
Q

Leukotriene receptor antagonists prevent?

A

Leukotriene receptor antagonists 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.

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60
Q

Leukotriene Receptor Antagonists:Drug Effects

What happens to blocking Leukotriene?

A

Prevent smooth muscle contraction of the bronchial airways

Decrease mucus secretion

Prevent vascular permeability

Decrease neutrophil and leukocyte infiltration to the lungs, preventing inflammation

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61
Q

Leukotriene Receptor Antagonists: Indications

  1. Indication
  2. Montelukast safe in children ____ years of age and older
  3. Zafirlukast safe in children ___ years of age and older
  4. Not meant for?
  5. Montelukast is also approved for?
  6. Improvement with their use is typically seen in about?
A

Prophylaxis and long-term treatment and prevention of asthma in adults and children
*Montelukast safe in children 2 years of age and older
*Zafirlukast safe in children 12 years of age and older

Not meant for management of acute asthmatic attacks

Montelukast is also approved for treatment of allergic rhinitis

Improvement with their use is typically seen in about 1 week

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62
Q

Leukotriene Receptor Antagonists: Contraindications

A

Known drug allergy

Previous adverse drug reaction

Allergy to povidone, lactose, titanium dioxide, or cellulose derivatives—important to note because these are inactive ingredients in these drugs

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63
Q

Leukotriene Receptor Antagonists: Adverse Effects

A

Montelukast- headache, nausea, and diarrhea (nightmare in children and adults)

Both drugs (montelukast, and zafirlukast) may lead to liver dysfunction.

zafirlukast
**Headache, nausea, diarrhea

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64
Q

Leukotriene Receptor Antagonists: Interaction

A

Phenobarbital and rifampin- are enzyme inducers, that decrease montelukast concentrations.

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65
Q

Corticosteroids (Glucocorticoids) effects

A

Anti-inflammatory effects

Naturally occurring/ synthetic drugs

66
Q

Corticosteroids (Glucocorticoids)

Indication 2

A

Anti-inflammatory properties

Pulmonary diseases

67
Q

Corticosteroids (Glucocorticoids)

ROUTES

A

IV
Oral or inhaled forms
Inhaled forms reduce systemic effects.

68
Q

Corticosteroids (Glucocorticoids) onset

A

May take several weeks before full effects are seen

69
Q

Corticosteroids: Two Mechanism of Action

A

Reduce inflammation & enhance the activity of B agonists

prevent nonspecific inflammation and altered vascular permeability (antiinflammatory)

Stabilize membranes of cells that release harmful broncho-constricting substances

**These cells are called leukocytes
**WBC normally releases Inflammatory mediators

Increase responsiveness of bronchial smooth muscle to ß-adrenergic stimulation

Dual effect of both reducing inflammation and enhancing the activity of ß-agonists

70
Q

Corticosteroids have also been shown to?

A

to restore or increase the responsiveness of bronchial smooth muscle to ß-adrenergic receptor stimulation, which results in more pronounced stimulation of the ß2-receptors by ß-agonist drugs such as salbutamol.

71
Q

Inhaled Corticosteroids drugs

A

beclomethasone dipropionate (Qvar®)

budesonide (Pulmicort Turbuhaler®)

fluticasone propionate (Flovent Dickus®)

Other:

fluticasone furoate (Avamys®)

ciclesonide (Omnaris®)

72
Q

Inhaled Corticosteroids: Indications

A

Primary treatment of bronchospastic disorders to control the inflammatory responses that are believed to be the cause of these disorders

Persistent asthma

Often used concurrently with the ß-adrenergic agonists

Systemic corticosteroids are generally used only to treat acute exacerbations or severe asthma.

IV corticosteroids: acute exacerbation of asthma or other COPD

73
Q

Inhaled Corticosteroids: Contraindications

A

Drug allergy

Not intended as the sole therapy for acute asthma attacks

Hypersensitivity to glucocorticoids

Patients whose sputum tests are positive for Candida Albicans organisms

Patients with systemic fungal infection

74
Q

Inhaled Corticosteroids: Adverse Effects

A

Pharyngeal irritation

Coughing

Dry mouth

Oral fungal infections

Systemic effects are rare because low doses are used for inhalation therapy. (Increasing dose can lead to CNS effects- insomnia, nervousness, seizures, infection…)

75
Q

Corticosteroids when switching from systemic to inhaled that the dose is

A

tapered drug doses slowly

death results if switched too quickly/ dose reduced abruptly

Pts dependent on this may need up to a year of recovery time after discontinuation

76
Q

Corticosteroids:

Drug interactions are more likely to occur with?

A

Drug interactions are more likely to occur with systemic (versus inhaled) corticosteroids.

77
Q

Inhaled Corticosteroids: Drug Interactions

A

May increase serum glucose levels, possibly requiring adjustments in dosages of antidiabetic drugs

May raise the blood levels of the immunosuppressants cyclosporine and tacrolimus; itraconazole may reduce clearance of the steroids

Phenytoin, phenobarbital, and rifampin

Greater risk of hypokalemia with concurrent diuretic use (e.g., furosemide, hydrochlorothiazide)

78
Q

Costicosteroids: Fluticasone

A

Lowest dose to control asthma should be used. If good control is maintained, reduce the dose

Combined with salmeterol- Advair diskus

79
Q

Phosphodiesterase Type 4 Inhibitor

1 medication

A

roflumilast (Daxas®)

80
Q

Phosphodiesterase Type 4 Inhibitor:

roflumilast (Daxas®)

  1. Indication?
  2. Adverse effects
A

Indicated to prevent coughing and excess mucus from worsening and to decrease the frequency of life-threatening COPD exacerbations

Adverse effects include nausea, diarrhea, headache, insomnia, dizziness, weight loss, and psychiatric symptoms (anxiety and depression).

81
Q

Monoclonal Antibody Antiasthmatic

1 medication

A

omalizumab (Xolair®)

82
Q

Monoclonal Antibody Antiasthmatic

omalizumab (Xolair®)

  1. Mechanism of action
  2. Route?
  3. Adverse effect?
  4. Monitor closely for?
A

Selectively binds to immunoglobulin E, which in turn limits the release of mediators of the allergic response

Omalizumab is given by injection.

Potential for producing anaphylaxis

Monitor closely for hypersensitivity reactions.

83
Q

Encourage patients to take measures that promote a generally good state of health so as to prevent, relieve, or decrease symptoms of COPD

How to prevent, relieve/ decrease symptoms of COPD? (4)

A

Avoiding exposure to conditions that precipitate bronchospasm (allergens, smoking, stress, air pollutants).

Maintaining an adequate fluid intake

Complying with medical treatment

Avoiding excessive fatigue, heat, extremes in temperature, and caffeine.

84
Q

Perform a thorough assessment before beginning therapy, including:

A

Skin colour

Baseline vital signs

Respirations (should be between 12 and 20 breaths/min)

Respiratory assessment, including pulse oximetry

Sputum production

Allergies

History of respiratory problems

Other medications

85
Q

Nursing Implications

A

Teach patients to take bronchodilators exactly as prescribed.

Ensure that patients know how to use inhalers and metered-dose inhalers, and have patients demonstrate the use of the devices.

Monitor for adverse effects.

86
Q

Nursing Implications: ß-Adrenergic Agonists

  1. Salbutamol, if used too frequently LOSES ITS? ______ AT LARGER DOSES.
  2. As a result, ß1-receptors are stimulated, causing? (SYMPTOMS)
  3. Inform patients to report?
A

Salbutamol, if used too frequently, loses its ß2-specific actions at larger doses.

As a result, ß1-receptors are stimulated, causing nausea, increased anxiety, palpitations, tremors, and increased heart rate.

Inform patients to report insomnia, jitteriness, restlessness, palpitations, chest pain, or any change in symptoms.

Ensure that patients take medications exactly as prescribed, with no omissions or double doses.

87
Q

Nursing Implications: Leukotriene Receptor Antagonists

  1. Ensure that the medication is being used for?
  2. Improvement should be seen in about?
A

Ensure that the medication is being used for long-term management of asthma, not acute asthma.

Improvement should be seen in about 1 week

Teach the patient the purpose of the therapy.

Advise patients to check with prescriber before taking over-the-counter or prescribed medications, to determine drug interactions.

Assess liver function before beginning therapy and throughout therapy.

Teach patients to take medications every night on a continuous schedule, even if symptoms improve.

88
Q

Monitor for Respiratory Drugs therapeutic effects: 5

A

Decreased dyspnea

Decreased wheezing, restlessness, and anxiety

Improved respiratory patterns with return to normal rate and quality

Improved activity tolerance

Decreased symptoms and increased ease of breathing

89
Q

Nursing Implications: Xanthine Derivatives

  1. CONTRAINDICATIONS

2.CAUTIONS

  1. TIME RELEASED PREPARATIONS
A

Contraindications: history of peptic ulcer disease or gastrointestinal disorders

Cautious use: cardiac disease

Timed-release preparations should not be crushed or chewed (causes gastric irritation).

90
Q

Nursing Implications: Xanthine Derivatives

WHAT TO REPORT TO DOCTOR?

A

Nausea
Vomiting
Restlessness
Insomnia
Irritability
Tremors

91
Q

Nursing Implications: Xanthine Derivatives

  1. Be aware of drug interactions with?
  2. _______ enhances xanthine metabolism.
  3. Interacting foods include?
  4. These foods may reduce?
A

Be aware of drug interactions with cimetidine, oral contraceptives, allopurinol, certain antibiotics, influenza vaccine, and others.

Cigarette smoking enhances xanthine metabolism.

Interacting foods include charcoal-broiled, high-protein, and low-carbohydrate foods.

***These foods may reduce serum levels of xanthines through various metabolic mechanisms.

92
Q

Nursing Implications: Inhaled Corticosteroids

  1. Teach patients to gargle and rinse the mouth with lukewarm water afterward to prevent the
  2. If a ß-agonist bronchodilator and corticosteroid inhaler are both ordered?
  3. Teach patients to monitor disease with a?
  4. Encourage the use of a ________ to ensure succesful inhalations
A

Teach patients to gargle and rinse the mouth with lukewarm water afterward to prevent THE development of oral fungal infections.

If a ß-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.

Teach patients to monitor disease with a peak flow meter.

Encourage the use of a spacer device to ensure successful inhalations.

Teach the patient how to keep inhalers and nebulizer equipment clean after use.

93
Q

For any inhaler prescribed, ensure that the patient is able to self-administer the medication BY?

A

Provide a demonstration and a return demonstration.

Ensure that the patient knows the correct time intervals for inhalers.

Provide a spacer if the patient has difficulty coordinating breathing with inhaler activation.

Ensure that the patient knows how to keep track of the number of doses in the inhaler device.

94
Q

Hypoxia

A

Low oxygen

95
Q

Hypercapnia

A

High CO2

96
Q

Taking salbutamol often can cause?

A

beta 1 receptor defects

97
Q

Tiotropium bromide/ Spiriva nursing consideration

A

comes in a pill form – do not swallow it; have to inhale it to breathe the powder

98
Q

How often do we wash aerochamber

A

once a week with soap and water

99
Q

Explain theophylline levels

A

high carb and low protein diet increase theophylline levels (too high)

low carb, high protein- decreases the level of theophylline

100
Q

1st priority

A

Airway, breathing, circulation- 1st priority

101
Q

short-acting bronchodilator

A

salbutamol; Short-acting ß-agonist (SABA) inhalers; Selective ß2 drugs

Opens up the bronchioles during acute phases

102
Q

Types of Bronchodilators

A

corticosteroids, beta-adrenergic agonists, anticholinergics

103
Q

Order to give inhalers?

A

beta-adrenergic
anticholinergic corticosteroids

104
Q

When not to give anticholinergics?

A

glaucoma

105
Q

Beclomethasone with corticosteroids (or anything to do with corticosteroids)

A

monitor BG, wean them off gradually- Addisonian crisis- causes mortality

106
Q

Wean medications when giving?

A

Epileptic
Costicosteroids

107
Q

Oral corticosteroids can cause

A

fungal infections, systemic AE

108
Q

ß1 and ß2 agonists

A

Stimulate both heart and lungs hence AE can include cardiac effects

109
Q

Xanthine Derivatives causes?

A

Bronchodilation

Not for management of acute asthma attack

110
Q

Xanthine Derivatives: Theophylline

Aminophylline

A

Aminophylline- IV version of Theophylline; can be easy to get toxic

111
Q

Leukotriene Receptor Antagonists action

A

LRA- stops inflammation from happening, asthma symptoms are relived

112
Q

Corticosteroids (Glucocorticoids)

A

Prevent inflammation form occurring

Not for asthma attack

Enhance effects of ß-adrenergic (Enhance effects of salbutamol)

Reduce inflammation, the narrowing of airwyas

113
Q

Inhaled corticosteroids instructions

A

Swish, gargle, and spit water out- may lead to oral fungal infection

Corticosteroid inhaled- water, swish and spit it out

114
Q

Used for long term management of asthma

A

Leukotriene Receptor Antagonists (motelukast)

Prevent inflammation

115
Q

Xanthine Derivatives

A

Hard on the GI system- may worsen GI upset

May increase cardiac symptoms

116
Q

Metered dose inhaler

A

best way to use with a spacer/ aerochamber- recommend using spacer device

117
Q

B agonists

xanthine derivatives

antichollinergics

LTRAs

Corticosteroids

A

improve airflow in airway passages

increase oxygen supply

-assess vital sigs (SPO2)

-assess for dyspnea, cough, orthopnea, or hypoxia (respiratory distress)

-assess cough for character and frequency, presence of sputum and its colour

assess for sternal retractions, cyanosis, restlessness, activity intolerance, heart irregularities, palpitations, HTN, tachycardia, or use of accessory muscles to breathe, AP diameter

-collect allergies, environmental exposures, smoking habits

-assess cardiac status- BP, HR, heart sounds, ECG, blood gas, nail beds for cyanosis/ clubbing

118
Q

B agonists

A

contraindication: dysrhythmias, risk for stroke

assess intake of caffeine (chocolate, tea) because of its sympathomimetic effects (restlessness, tachycardia, tremor, hyperglycemia, vascular headache, hypotension, HTN)

MAOIs- increases HTN

119
Q

Antichollinergics

A

assess history of heart palpitations, GI distress, BPH, urinary retention, or GLAUCOMA (CAN POTENTIATE THESE CONDITIONS)

Ipratropium aerosol forms- assess bronchospasms

120
Q

Corticosteroids

A

get baseline vitals, breath sounds, and heart sounds

assess for adrenal disorders- this drug can cause adrenal suppression

the systemic impact of corticosteroids on pediatric pts- suppress growth

systemic vs inhaled corticosteroids- assess the use of antidiabetic drugs, antifungals, phenytoin, phenobarbital, rifampin, and potassium sparring diuretics.

121
Q

Respiratory drugs

A

glucocorticoids- antiinflammatory

xanthines and B agonists- broncho-dilating effect

antichollinergic- blockage of cholinergic receptors

122
Q

Xanthines derivatives

A

cardiovascular assessment

Hard on the GI system- may worsen GI upset

May increase cardiac symptoms

HR, BP, Hx of cardiac disease (because AE such as sinus tachycardia and palpitations may occur)

assess for GI reflux- assess bowel pattern, GERD,

assess urinary patterns- may cause urinary frequency

drug interactions- allopurinol, cimetidine, erythromycin, Cipro, oral contraceptives, caffeine, or sympathomimetics

assess diets such as high carb, low protein diets (may lead to decreased theophylline elimination and increased theophylline levels)

Low carb, high protein diet (intake of charbroiled meat)- increases theophylline elimination and decreases therapeutic serum theophylline levels

123
Q

LTRAs

A

liver function

OAs sensitive to this drug

124
Q

PDE4

A

not for acute bronchospams

omalizumab- monoclonal antibody; assess malignancies

125
Q

Hypoxia

Hypercapnia

A

Hypoxia- low oxygen

Hypercapnia- high CO2

126
Q

Salbutamol

A

too often can cause beta 1 defects

127
Q

Tiotropium bromide/ Spiriva

A

comes in a pill form – do not swallow it; you have to inhale it to breathe the powder

Wash the spacer / aero-chamber with soap and water once a week

128
Q

theophylline levels and diet relationship

A

theophylline levels- high carb and low protein diet increase theophylline levels (too high)

low carb, high protein- decreases the level of theophylline

129
Q

THE ORDER

A

beta-adrenergic, anticholinergic then corticosteroids

130
Q

Beclomethasone with corticosteroids

A

Beclomethasone with corticosteroids (or anything to do with corticosteroids)- monitor BG, wean them off gradually- Addisonian crisis- causes mortality

Epileptic meds too- wean them off gradually

131
Q

Oral corticosteroids-

A

Oral corticosteroids- can cause fungal infections, systemic AE

132
Q

Aminophylline

A

IV version of Theophylline; can be easy to get toxic if they don’t respond to salbutamol

133
Q

LRA

A

stops inflammation from happening, asthma symptoms are relived

134
Q

Corticosteroids (Glucocorticoids)

A

Prevent inflammation form occurring

Enhance effects of ß-adrenergic

Reduce inflammation, the narrowing of airways

135
Q

Inhaled Corticosteroids:

A

Swish, gargle, and spit water out- may lead to oral fungal infection- to prevent dryness and mucosal irritation (oral candidiasis)

136
Q

MDIS

A

10 to 40% drug delivery

if a second puff is required, wait 1 to 2 minutes between puffs

if a second type of inhaled drug is prescribed, wait 2 to 5 minutes

reduce hospitalization and improves cost savings for children

137
Q

DPI- dry powder inhaler

A

small hand-held device that delivers a specific amount of dry micronized powder with each inhaled breaths

138
Q

Nebulizer

A

delivers an aerosol of small amounts of misted dropletsof the drug to lungs through a small mouthpiece/ mask

increased risk of pathogen transmission

139
Q

Rapid infusion of xanthine derivatives

A

lead to profound hypotension- syncope, tachycardia, seizures, cardiac arrest

140
Q
A

inhaled B agonist, before inhaled glucocorticoid

to provide bronchodilation before anti-inflammatory

inhaled bronchodilator is taken 2 to 5 minutes before corticosteroid.

141
Q

Peak flow meter

A

handheld device used to monitor pts ability to breathe out air- reading reflects airflow through bronchi; thus the degree of obstruction in the airways

142
Q

PDE4

A

report changes in psychiatric status

143
Q

theophylline level

A

55 and 110 micromol/L

144
Q

Use of multiple inhalers

A

LABA (b-agonist)

antichollinergic

corticosteroid

-b agonist will open airway and allow other 2 drugs to travel deeper into the lungs for improved effects

145
Q

xanthines

A

educate interaction between smoking and xanthines (smoking decreases blood concentrations of aminophylline and theophylline)

charcoal-broiled food- decreased serum levels of xanthine

report AEs: epigastric pain, N&V, tremor, headache

learn to take HR

146
Q

antichollinergics

A

ipratropium is used prophylactically to decrease frequency and severity of asthma

encourage fluids to decrease the viscosity of secretions

wait 2-5 mins before other inhalers

take no more than 2 puffs

147
Q

Leukotriene receptor antagonists

A

prevent leukotriene which prevents/decrease inflammation

148
Q

corticosteroids

A

practice good oral hygiene
to prevent oral fungal growth

divide the number of doses in the canister by the number of puffs used per day to determine number of days it will last

149
Q

intranasal dosage form

A

tilt head slightly forward, point spray tip toward inflamed turbinates

150
Q

excess use of corticosteroids may lead to Cushings syndrome\

what causes addisonian crisis?

A

moon faces, acne, increased fat pads, swelling

systemic corticosteroid is abruptly discontinued, This drug requires weaning prior to discontinuation.

151
Q

b agonists stimulate

A

b1 and b2 receptors

152
Q

xanthines function

A

theophylline- relaxes the smooth muscles of the bronchioles by inhibiting phosphodiesterase (P-breaks down cAMP which is needed to relax smooth muscles)

153
Q

corticosteroids

A

stabilize cells that release harmful bronchoconstricting substances

154
Q

LTRAs (montelukast & zafirlukast) AEs

A

headache, dizziness, insomnia, dyspepsia

155
Q

Omalizumab

A

monoclonal antibody

prevent release of mediators that lead to allergic responses. Preventative

156
Q

salbutamol

A

immediate release

157
Q

nebulizer treatment with the b agonist salbutamol; pt is feeling a little shaky with slight tremors of the hands- HR is 98/min, increased from the pretreatment rate 88/min. This is a result of?

A

an expected AE of the drug

158
Q

Aminophylline (xanthine derivative) infusion for 24 hrs- AEs

A

sinus tachycardia

159
Q

LTRA montelukast

A

reduces inflammation in the airway

160
Q

corticosteroids such as fluticasone, action after the dose

A

rinse mouth with water

161
Q

teach pts about inhaler Advair (salmeterol and fluticasone)

A

I will rinse my mouth with water after each dose

this medication is taken BID, q12h

I will call my doctor if I notice white patches inside my mouth

STUDY CARDS (17 decks)

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