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N317: Pharmacology > Respiratory and TB Medications > Flashcards

Respiratory and TB Medications Flashcards

1
Q

Differentiate between asthma and COPD.

A

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

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2
Q

What do bronchodilators do?
- What are the three classes of bronchodilators?

A

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

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3
Q

Albuterol
- Class?
- Type of inhaler? (Short-acting; Long-acting)
- MOA?
- Onset of action?
- Side effects?
- Nursing considerations?

A

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

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4
Q

Levalbuterol
- Class?
- Type of inhaler? (Short-acting/Long-acting)
- MOA?
- Onset of action?
- Side effects?
- Nursing considerations?

A

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

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5
Q

Salmeterol (Serevent)
- Class?
- Type of inhaler?
- MOA?
- Onset?
- Side effects?
- Nursing considerations?

A

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

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6
Q

Formoterol (Foradil)
- Class?
- Type of inhaler?
- MOA?
- Onset?
- Side effects?
- Nursing considerations?

A

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

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7
Q

Arformoterol (Brovana)
- Class?
- Type of inhaler?
- MOA?
- Onset?
- Side effects?
- Nursing considerations?

A

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

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8
Q

ipratropium
- Class?
- Type of medication?
- Onset?
- MOA?
- Side effects?
- Nursing implications?

A

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

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9
Q

Tiotropium
- Class?
- Type of medication?
- Onset?
- MOA?
- Side effects?
- Nursing implications?

A

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

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10
Q

ipratropium/albuterol
- Class?
- Type of medication?
- Onset?
- MOA?
- Side effects?
- Nursing implications?

A

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

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11
Q

Theophylline
- Class?
- COPD or asthma?
- MOA?
- Side effects?
- Nursing considerations?

A

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

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12
Q

Aminophylline
- Class?
- COPD or asthma?
- MOA?
- Side effects?
- Nursing considerations?

A

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

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13
Q

What is the purpose of Non-bronchodilating respiratory drugs?
- What are the three classes of these?

A

Non-bronchodilating drugs work to prevent INFLAMMATION
- does NOT dilate airways

Classes:
- Leukotriene receptor antagonists
- Corticosteroids
- Mast cell stabilizers

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14
Q

Montelukast (Singulair)
- Class
- Onset?
- MOA?
- What is the age-range for this medication?
- Side effects?
- Nursing considerations?

A

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

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15
Q

Zafirlukast (Accolate)
- Class?
- Onset?
- MOA?
- Contraindications?
- Side effects?
- Nursing considerations?

A

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

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16
Q

Fluticasone
- Class?
- Used for?
- Onset?
- MOA?
- Side effects?
- Nursing considerations?

A

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)

17
Q

Budesonide
- Class?
- Used for?
- Onset?
- MOA?
- Side effects?
- Nursing considerations?

A

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)

18
Q

Beclomethasone
- Class?
- Used for?
- Onset?
- MOA?
- Side effects?
- Nursing considerations?

A

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)

19
Q

Fluticasone/Salmeterol
- Class?
- Used for?
- Onset?
- MOA?
- Side effects?
- Nursing considerations?

A

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)

20
Q

Prednisone/Prednisolone
- Class?
- Used for?
- Onset?
- MOA?
- Side effects?
- Nursing considerations?

A

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

21
Q

Roflumilast
- Class?
- Used for?
- MOA?
- Side effects?
- Nursing implications? - rare side effect?

A

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!!

22
Q

Omalizumab (Xolair)
- Class?
- MOA?
- Side effects?
- Nursing implications?

A

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

23
Q

What is tuberculosis?

A

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

24
Q

What’s the difference between active TB and dormant TB?

What form of TB will we treat?

A

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.

25
Q

Mantoux test
- What is it?
- What does it determine?

Bacille Clamette-Guerin (BCG) vaccine
- What is it?
- What does it do?

A

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

26
Q

Isoniazid
- Prophylactic or first line medication?
- Used to treat/Prevents?
- Taken how often?
- Side effects?
- Nursing considerations?

A

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

27
Q

Rifampin
- Prophylactic or first line medication?
- Used to treat/Prevents?
- Taken how often?
- Side effects?
- Nursing considerations?

A

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

28
Q

Isoniazid and Rifapentine
- Used to treat/Prevents?
- Taken how often?
- Nursing considerations?

A

*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

29
Q

Pyrazinamide (PZA)
- Prophylactic or first-line medication?
- Used to treat/prevent?
- Side effects?

A

*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.)

30
Q

Ethambutol
- Prophylactic or first-line medication?
- Used to treat/prevent?
- Side effects?

A

*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)

31
Q

For a person with active TB, how many medications will they be started on?
- What acronym helps us remember this?

A

A person with active TB will be started on 4 medications.

Four medications of the acronym “RIPE:”
- Rifampin
- Isoniazid
- Pyrazinamide
- Ethambutol

32
Q

Nursing considerations for TB medications:
- What can happen if the patient doesn’t adhere strictly to the medication regime?
- What’s a cultural consideration?

A

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

33
Q

Bedaquiline (Sirturo)

A
34
Q

Streptomycin

A

N317: Pharmacology (7 decks)

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