Respiratory and TB Medications Flashcards
Differentiate between asthma and COPD.
COPD: Damage to bronchioles and cilia in the lungs, making it difficult to breathe
- Irreversible damage to the lungs
- Progressive, but can slow it down
- Prolonged exposure to irritants (smoking, environment)
Asthma:
- Reversible shortness of breath
- Sporadic narrowing of airways (allergy, virus, exercise, etc.)
- Wheezing; difficulty breathing
What do bronchodilators do?
- What are the three classes of bronchodilators?
Bronchodilators are the main treatment for constricted/narrowed airways
They help:
- improve airflow
- relax bronchiole smooth msucles
3 Classes:
- Beta-adrenergic agonists
- Anticholinergics
- Xanthine derivatives
Albuterol
- Class?
- Type of inhaler? (Short-acting; Long-acting)
- MOA?
- Onset of action?
- Side effects?
- Nursing considerations?
Class = Bronchodilator
- SHORT-acting
*Rescue inhaler
MOA:
- Binds to beta II adrenergic receptors in the lungs
- Binding produces CAMP
- Production of CAMP dilates the airways
Onset = 30 seconds to a few minutes
Side effects:
- Tachycardia
- Headache
- Tremor/jittery
- Paradoxical bronchospasm (rare; excessive use)
Nursing considerations:
- Good respiratory assessment
- Educate pt on appropriate technique and appropriate inhaler
Levalbuterol
- Class?
- Type of inhaler? (Short-acting/Long-acting)
- MOA?
- Onset of action?
- Side effects?
- Nursing considerations?
Class = Bronchodilator
- SHORT-acting
*Rescue inhaler
MOA:
- Binds to beta II adrenergic receptors in the lungs
- Binding produces CAMP
- Production of CAMP dilates the airways
Onset = 30 seconds to a few minutes
Side effects:
- Tachycardia
- Headache
- Tremor/jittery
- Paradoxical bronchospasm (rare; excessive use)
Nursing considerations:
- Good respiratory assessment
- Educate pt on appropriate technique and appropriate inhaler
Salmeterol (Serevent)
- Class?
- Type of inhaler?
- MOA?
- Onset?
- Side effects?
- Nursing considerations?
Class = Bronchodilator
- LONG-acting
*Maintenance inhaler
- add-on treatment to lower risk of asthma symptoms
MOA:
- Binds to beta II adrenergic receptors in the lungs
- Promotes CAMP production
- CAMP dilates the airways
Onset = 30-40 minutes
Side effects:
- Headache
- Hypertension
Nursing considerations:
- Respiratory assessment
- Educate pt on right inhaler; right technique
Formoterol (Foradil)
- Class?
- Type of inhaler?
- MOA?
- Onset?
- Side effects?
- Nursing considerations?
Class = Bronchodilator
- LONG-acting
*Maintenance inhaler
- add-on treatment to lower risk of asthma symptoms
MOA:
- Binds to beta II adrenergic receptors in the lungs
- Promotes CAMP production
- CAMP dilates the airways
Onset = 30-40 minutes
Side effects:
- Headache
- Hypertension
Nursing considerations:
- Respiratory assessment
- Educate pt on right inhaler; right technique
Arformoterol (Brovana)
- Class?
- Type of inhaler?
- MOA?
- Onset?
- Side effects?
- Nursing considerations?
Class = Bronchodilator
- LONG-acting
*Maintenance inhaler
- add-on treatment to lower risk of asthma symptoms
MOA:
- Binds to beta II adrenergic receptors in the lungs
- Promotes CAMP production
- CAMP dilates the airways
Onset = 30-40 minutes
Side effects:
- Headache
- Hypertension
Nursing considerations:
- Respiratory assessment
- Educate pt on right inhaler; right technique
ipratropium
- Class?
- Type of medication?
- Onset?
- MOA?
- Side effects?
- Nursing implications?
Class = Anticholinergic
- LONG-acting muscarinic antagonist
Onset = longer than bronchodilators; not as effective
MOA:
- Competitively binds to Ach receptors on bronchial tree/bronchioles
- Prevents muscle constriction a.k.a promotes dilation
Side effects:
- Dry mouth/throat (beneficial for COPD)
- Nasal congestion
- Heart palpitations
- GI distress
Nursing implications:
- Respiratory assessment
- Educate pt on appropriate technique and inhaler
Tiotropium
- Class?
- Type of medication?
- Onset?
- MOA?
- Side effects?
- Nursing implications?
Class = Anticholinergic
- LONG-acting muscarinic antagonist
Onset = longer than bronchodilators; not as effective
MOA:
- Competitively binds to Ach receptors on bronchial tree/bronchioles
- Prevents muscle constriction a.k.a promotes dilation
Side effects:
- Dry mouth/throat (beneficial for COPD)
- Nasal congestion
- Heart palpitations
- GI distress
Nursing implications:
- Respiratory assessment
- Educate pt on appropriate technique and inhaler
ipratropium/albuterol
- Class?
- Type of medication?
- Onset?
- MOA?
- Side effects?
- Nursing implications?
Class = Anticholinergic
- LONG-acting muscarinic antagonist
Onset = longer than bronchodilators; not as effective
MOA:
- Competitively binds to Ach receptors on bronchial tree/bronchioles
- Prevents muscle constriction a.k.a promotes dilation
Side effects:
- Dry mouth/throat (beneficial for COPD)
- Nasal congestion
- Heart palpitations
- GI distress
Nursing implications:
- Respiratory assessment
- Educate pt on appropriate technique and inhaler
Theophylline
- Class?
- COPD or asthma?
- MOA?
- Side effects?
- Nursing considerations?
Class = Xanthine derivative
*Used for COPD
MOA:
- Inhibits phosphodiesterase (which breaks down CAMP)
- Prevention of CAMP breakdown causes smooth muscles to relax/airways to dilate
- Also stimulates NS to increase RR
Side effects:
- Heart palpitations
- Nervousness
- Insomnia
- Tremors
- Nausea
- Vomiting
- Anorexia
Nursing considerations:
- Avoid other source of caffeine to lessen side effects
- Good cardiac assessment
- Good respiratory assessment
- *Narrow therapeutic window –> difficult to avoid side effects
Aminophylline
- Class?
- COPD or asthma?
- MOA?
- Side effects?
- Nursing considerations?
Class = Xanthine derivative
*Used for COPD
MOA:
- Inhibits phosphodiesterase (which breaks down CAMP)
- Prevention of CAMP breakdown causes smooth muscles to relax/airways to dilate
- Also stimulates NS to increase RR
Side effects:
- Heart palpitations
- Nervousness
- Insomnia
- Tremors
- Nausea
- Vomiting
- Anorexia
Nursing considerations:
- Avoid other source of caffeine to lessen side effects
- Good cardiac assessment
- Good respiratory assessment
- *Narrow therapeutic window –> difficult to avoid side effects
What is the purpose of Non-bronchodilating respiratory drugs?
- What are the three classes of these?
Non-bronchodilating drugs work to prevent INFLAMMATION
- does NOT dilate airways
Classes:
- Leukotriene receptor antagonists
- Corticosteroids
- Mast cell stabilizers
Montelukast (Singulair)
- Class
- Onset?
- MOA?
- What is the age-range for this medication?
- Side effects?
- Nursing considerations?
Class = Leukotriene Receptor Antagonists (LTRAs)
Onset = ~1 week
- Long-acting/prophylactically
MOA:
- Attach to leukotriene receptors to prevent leukotriene production (leukotriene binding to immune cells is what causes inflammation and mucus production)
- Reduces inflammation and decreases mucus production
Contraindications:
- Can not be given to patients younger than 1-year-old
Side effects: (minimal)
- headache
- nausea
- diarrhea
Nursing considerations:
- Take at night for asthma (allows peak onset to match with symptom onset)
- Take for allergic rhinitis (inflammation of the inside of the nose) at any time
Zafirlukast (Accolate)
- Class?
- Onset?
- MOA?
- Contraindications?
- Side effects?
- Nursing considerations?
Class = Leukotriene Receptor Antagonists (LTRAs)
Onset = ~1 week
- Long-acting/prophylactically for asthma
MOA:
- Attach to leukotriene receptors to prevent leukotriene production (leukotriene binding to immune cells is what causes inflammation and mucus production)
- Reduces inflammation and decreases mucus production
Contraindications:
- Can not be given to patients younger than 12-years-old
Side effects: (minimal)
- headache
- nausea
- diarrhea
Nursing considerations:
- Take at night for asthma (allows peak onset to match with symptom onset)
- Take for allergic rhinitis (inflammation of the inside of the nose) at any time
Fluticasone
- Class?
- Used for?
- Onset?
- MOA?
- Side effects?
- Nursing considerations?
Class = Corticosteroid (Glucocorticoid)
- INHALED
Used for:
- More chronic asthma i.e., if pt is overusing their rescue inhaler and requesting too many refills
Onset = ~1-2 weeks
*Very localized
- Lungs
- Nose (for nasal spray)
MOA:
- Anti-inflammatory –> decreases swelling in the airways
Side effects:
- Thrush
- Dry mouth coughing
Nursing considerations:
- Rinse out pt mouth after every use (thrush)
- Educate pt about proper use and administration
- If pt also has bronchodilator, use first before corticosteroid to ensure more medication can get into the lungs (dilates/opens lungs = more medication can get in)
Budesonide
- Class?
- Used for?
- Onset?
- MOA?
- Side effects?
- Nursing considerations?
Class = Corticosteroid (Glucocorticoid)
- INHALED
Used for:
- More chronic asthma i.e., if pt is overusing their rescue inhaler and requesting too many refills
Onset = ~1-2 weeks
*Very localized
- Lungs
- Nose (for nasal spray)
MOA:
- Anti-inflammatory –> decreases swelling in the airways
Side effects:
- Thrush
- Dry mouth coughing
Nursing considerations:
- Rinse out pt mouth after every use (thrush)
- Educate pt about proper use and administration
- If pt also has bronchodilator, use first before corticosteroid to ensure more medication can get into the lungs (dilates/opens lungs = more medication can get in)
Beclomethasone
- Class?
- Used for?
- Onset?
- MOA?
- Side effects?
- Nursing considerations?
Class = Corticosteroid (Glucocorticoid)
- INHALED
Used for:
- More chronic asthma i.e., if pt is overusing their rescue inhaler and requesting too many refills
Onset = ~1-2 weeks
*Very localized
- Lungs
- Nose (for nasal spray)
MOA:
- Anti-inflammatory –> decreases swelling in the airways
Side effects:
- Thrush
- Dry mouth coughing
Nursing considerations:
- Rinse out pt mouth after every use (thrush)
- Educate pt about proper use and administration
- If pt also has bronchodilator, use first before corticosteroid to ensure more medication can get into the lungs (dilates/opens lungs = more medication can get in)
Fluticasone/Salmeterol
- Class?
- Used for?
- Onset?
- MOA?
- Side effects?
- Nursing considerations?
Class = Corticosteroid (Glucocorticoid)
- INHALED
Used for:
- More chronic asthma i.e., if pt is overusing their rescue inhaler and requesting too many refills
Onset = ~1-2 weeks
*Very localized
- Lungs
- Nose (for nasal spray)
MOA:
- Anti-inflammatory –> decreases swelling in the airways
Side effects:
- Thrush
- Dry mouth coughing
Nursing considerations:
- Rinse out pt mouth after every use (thrush)
- Educate pt about proper use and administration
- If pt also has bronchodilator, use first before corticosteroid to ensure more medication can get into the lungs (dilates/opens lungs = more medication can get in)
Prednisone/Prednisolone
- Class?
- Used for?
- Onset?
- MOA?
- Side effects?
- Nursing considerations?
Class = corticosteroid
- ORAL
Used for:
- Acute asthma exacerbations that are not responding to other medications
- Long-term asthma only if it’s SEVERE
Onset:
- Results in several hours –> several days (effect on whole body)
MOA: Anti-inflammatory –> decreases swelling in the airways
Side effects:
- Hyperglycemia (increased hunger)
- Mood changes (edgy)
Nursing considerations:
- NEED to tape off of medication –> reduces bodies natural production of hormones
- Slowly decrease dose over 7 days of administration
Roflumilast
- Class?
- Used for?
- MOA?
- Side effects?
- Nursing implications? - rare side effect?
Class = Phosphodiesterase-4 inhibitor
Used for:
- COPD exacerbations (coughing/mucus)
- mixed opinions on effectiveness for asthma
MOA:
- Inhibits phosphodiesterase i.e., breakdown of CAMP
- Prevents coughing and excess mucus from worsening
Side effects:
- Nausea
- Diarrhea
- Weight loss
- Headache
- Insomnia
Nursing implications:
- Respiratory assessment
- GI assessment
Rare side effect = psychiatric –> ask pt if they’re experiencing any changes in mood!!
Omalizumab (Xolair)
- Class?
- MOA?
- Side effects?
- Nursing implications?
Class = Monoclonal Antibodies
MOA:
- Competitively binds to IGE to prevent IGE (immunoglobulin) from binding and causes allergic reaction (chemicals to be released)
- Prevents immune system from “overreacting”
*Given 1-2 times per month as an injection
*Not first-line medication
Side effects:
- Injection site reaction
- MI
- Venous thromboembolism
- RARE –> Anaphylaxis (less than 0.1% of people)
Nursing considerations:
- Respiratory assessment
- Cardiac/perfusion assessment
- Stick around for a few minutes to ensure no allergic reaction
What is tuberculosis?
A bacterial infection of the lungs caused by mycobacterium tuberculosis
- It is very infectious
- Spread by inhaling droplets from an infected person into the lungs
- Can remain dormant/undetectable
What’s the difference between active TB and dormant TB?
What form of TB will we treat?
Active:
- Presenting with symptoms (fever, chills, weight loss)
- Highly contagious and able to spread to others
Dormant:
- No symptoms
- Not contagious
- Can eventually become active
We treat both forms of TB. Active treatment is just more aggressive/complex.
Mantoux test
- What is it?
- What does it determine?
Bacille Clamette-Guerin (BCG) vaccine
- What is it?
- What does it do?
Intra-dermal test to determine tuberculosis infection
- Purified protein derivative injected
- Induration if positive
Vaccine which reduces incidence of active TB
- does NOT prevent infection
- not usually given in U.S.
- will have false positive because vaccine contains similar bacteria
Isoniazid
- Prophylactic or first line medication?
- Used to treat/Prevents?
- Taken how often?
- Side effects?
- Nursing considerations?
Both a prophylactic and first-line medication
- Treats latent TB AND active TB
Latent TB:
- Prevents pt from getting an active infection
Active TB:
- Treats active TB by inhibiting cell wall synthesis (causes vitamin B6 deficiency)
Taken daily for 6-9 months
Side effects:
- peripheral neuropathy (numbness, tingling, hand/feet pain) –> related to deficiency
- vitamin B6 deficiency
Nursing considerations:
- Supplement medication with vitamin B6 to counteract deficiency
- Educate patient why it’s crucial they continue taking their medication –> is an annoying regime which many patient’s might not be compliant
- If pt stops taking, they could develop active infection and need to be on an even stricter medication regime
Rifampin
- Prophylactic or first line medication?
- Used to treat/Prevents?
- Taken how often?
- Side effects?
- Nursing considerations?
Both a prophylactic and first-line medication
- Treats latent TB AND active TB
Latent TB:
- Prevents pt from getting an active infection
Active TB:
- Treats active TB by stopping protein synthesis and RNA synthesis
Taken daily for 4 months
Side effects:
- tears, urine, and sweat can turn red-orange color
Nursing considerations:
- Educate patient why it’s crucial they continue taking their medication –> is an annoying regime which many patient’s might not be compliant
- If pt stops taking, they could develop active infection and need to be on an even stricter medication regime
Isoniazid and Rifapentine
- Used to treat/Prevents?
- Taken how often?
- Nursing considerations?
*Prophylactic med
Used to treat dormant (latent) TB after results confirm infection
- Prevents pt from getting an active infection
Taken once a week for 3 months
Nursing considerations:
- Educate patient why it’s crucial they continue taking their medication –> is an annoying regime which many patient’s might not be compliant
- If pt stops taking, they could develop active infection and need to be on an even stricter medication regime
Pyrazinamide (PZA)
- Prophylactic or first-line medication?
- Used to treat/prevent?
- Side effects?
*First-line medication
Treats active TB by:
- inhibiting bacteria growth
- eventually, killing the bacteria
Side effects:
- gout-like symptoms d/t inappropriate uric acid metabolism (inflammation, pain, etc.)
Ethambutol
- Prophylactic or first-line medication?
- Used to treat/prevent?
- Side effects?
*First-line medication
Treats active TB by:
- inhibiting fat/lipid and cell wall synthesis of bacteria
Side effects:
- affects the optic nerve i.e., how precisely we can see –> can lead to colorblindness
- peripheral neuropathy
- hepatotoxicity (Avoid Tylenol; avoid alcohol)
For a person with active TB, how many medications will they be started on?
- What acronym helps us remember this?
A person with active TB will be started on 4 medications.
Four medications of the acronym “RIPE:”
- Rifampin
- Isoniazid
- Pyrazinamide
- Ethambutol
Nursing considerations for TB medications:
- What can happen if the patient doesn’t adhere strictly to the medication regime?
- What’s a cultural consideration?
If a patient does not follow the regime strictly, they can develop multi-drug resistant tuberculosis
Cultural consideration: If someone is living near someone with TB they will likely need to be treated prophylactically
Bedaquiline (Sirturo)
Streptomycin
