respiratory drugs Flashcards by Glen McCormick

what medications are used for upper respiratory disorders?

antihistamines
medications to control bronchial secretions:
antitussives
expectorants
mucolytics
decongestants

How well did you know this?

Not at all

Perfectly

what are the medication classes to control bronchial secretions?

antitussives
expectorants
mucolytics
decongestants

How well did you know this?

Not at all

Perfectly

What is the method of action of antihistamines?

compete with histamine at receptor sites

How well did you know this?

Not at all

Perfectly

What are the effects of antihistamines?

Bronchial smooth muscle relaxation
Prevent or alleviate pruritis (itching)
Reduce secretions (runny nose, scratchy throat, watery eyes…)

How well did you know this?

Not at all

Perfectly

antihistamines work best when?

early in response cycle

How well did you know this?

Not at all

Perfectly

What are the first generation antihistamines?

Diphenhydramine
Promethazine
Dimenhydrinate

How well did you know this?

Not at all

Perfectly

what are the second generation antihistamines?

Loratadine
Cetirizine

How well did you know this?

Not at all

Perfectly

are great at treating nasal allergies- hay fever and helping with the symptoms of a common cold

first and second generation antihistamines

How well did you know this?

Not at all

Perfectly

Which drug class causes CNS depression?

1st generation antihistamines

How well did you know this?

Not at all

Perfectly

which drugs have anticholinergic effects?

promethazine
dimenhydrinate

How well did you know this?

Not at all

Perfectly

are antihistamines useful in extreme anaphylaxis?

How well did you know this?

Not at all

Perfectly

are antihistamines useful as monotherapy in asthma attacks?

How well did you know this?

Not at all

Perfectly

Blocking acetylcholine can cause?
which drugs do this?

temporary drowsiness, confusion, and memory loss
first generation antihistamines

How well did you know this?

Not at all

Perfectly

this drug is used to prevent N/V and motion sickness

promethazine -bc of its anticholinergic effects

How well did you know this?

Not at all

Perfectly

______ may be used for an allergic reaction causing itching, hives, but in a true anaphylactic emergency reaction, epinephrine (epi pen) needs to be used.

diphenhydramine

How well did you know this?

Not at all

Perfectly

Airway: SOB, wheezing, chest pain or tightness, tightening of throat, difficulty swallowing

Skin: hives, swelling, itchiness, widespread redness, warmth

brain: anxiety, confusion, headache, feeling that something is about to happen

heart: faint, pale or blue color, dizziness, weak pulse, shock, loss of consciousness,

Stomach: N/V, diarrhea, stomach pain or cramps

S/S of anaphylaxis

How well did you know this?

Not at all

Perfectly

What are the anticholinergic antihistamine drugs?
What are negative side effects of the drugs?

dimenhydrinate
promethazine

Cants: see, spit, piss, shit

How well did you know this?

Not at all

Perfectly

Nasal allergies
hay fever
hives
mild blood transfusion reactions

What are the primary uses for antihistamines? (4)

How well did you know this?

Not at all

Perfectly

What are the secondary uses for antihistamines? (5)

motion sickness
vertigo
Parkinson’s
anaphylactic reactions (with other drugs)
sleep aid

How well did you know this?

Not at all

Perfectly

which drug is used to treat motion sickness and vertigo?

dimenhydrinate

How well did you know this?

Not at all

Perfectly

_______ and _______ are often used before a blood transfusion to prevent possible reactions.

Benadryl and acetaminophen

How well did you know this?

Not at all

Perfectly

_____ and _____ are first gen antihistamines that are not going to be used for nasal allergies.

promethazine and dimenhydrinate

How well did you know this?

Not at all

Perfectly

When are maximal plasma concentrations reached for antihistamines?
epinephrine?

1-3 hours for antihistamines
<10 minutes for epi

How well did you know this?

Not at all

Perfectly

Has both CNS depressant and Anticholinergic properties

diphenhydramine

How well did you know this?

Not at all

Perfectly

does diphenhydramine cross the placenta and go into breast milk?

yes

Appears on BEERS list- geriatric more susceptible to drug reactions- dose should be decreased or other antihistamine recommended

diphenhydramine

what is diphenhydramine used for?

anaphylaxis allergic rhinitis parkinson's symptoms insomnia pruritis

Decreases skin response to allergy testing. Stop 4 days before testing. Can be given PO, IV, or topically. Avoid use of alcohol with ______

diphenhydramine

Avoid when breast feeding. CNS depressant- avoid driving or things that require alertness antiCholinergic- sugarless gum, frequent liquids, good oral hygiene

education for diphenhydramine

what can diphenhydramine cause in young children?

paradoxical excitation

how long should you avoid diphenhydramine before an allergy test?

four days

how is promethazine administered?

PO IM IV (caution) suppository ointment

Used for nausea, vomiting, often used as an adjuvant with pain med postop. In some cough syrups

promethazine

is promethazine a BEERS drug?

yes

because promethazine is a high alert drug, what can happen if it is given incorectly or in the wrong dose? what age should it not be administered to?

respiratory depression dont use under 2 years old

what happens if promethazine is not diluted or given too rapidly?

tissue damage and fall of BP must be given slowly

is promethazine given subcutaneously?

no, can cause tissue necrosis

IV- Assess for pain and burning at IV site. Avoid IV administration if possible. Risk of CNS depression/respiratory depression with other CNS depressants.

promethazine cautions and assessments

IV –if not properly diluted or given too fast it can actually be dangerous –resp depression, pain and burning at IV site. has to be diluted well and given slowly not usually given when pregnant

promethazine

can alcohol be taken with promethazine?

Life threatening reaction to some medications Altered Mental Status Muscle rigidity Fever (102-104) Irregular, rapid pulse May have high or low blood pressure

adverse effects of promethazine (6) (Promethazine & some antipsychotics)

Anticholinergic Antihistamine (antiemetic) PO/IM

dimenhydrinate

Used for nausea, vomiting, dizziness accompanying motion sickness Decreased vestibular (inner ear) stimulation, which may prevent motion sickness BEERS Drug Causes CNS depression: drowsiness, dizziness Can cause paradoxical excitation in children Increased CNS depression with other CNS depressants Pregnancy Risk B dry mouth (anticholinergic)

dimenhydrinate

CNS depression- teach to avoid driving or other activities requiring alertness. Avoid use of other CNS depressants- alcohol, sedative/hypnotics, other antihistamines, opoids. pregnancy risk B used for motion sickness, anticholinergic antihistamine

dimenhydrinate

do second generation antihistamines cause as much sedationas the first generation?

no, they do not

because second generation antihistamines do not cross the blood brain barrier, they do not cause which adverse effect as much?

respiratory depression

are the second generation antihistamines or the first generation histamines longer acting?

second generation are longer acting

these are often given more often daily because they can be taken during the day and don’t cause the drowsiness.

second generation antihistamines

which antihistamines typically have to be given every four hours?

promethazine diphenhydramine

taken once a day and decrease symptom of allergies

second generation antihistamines

Decreased symptoms of allergic symptoms (nasal stuffiness, red swollen eyes, itching) Daily dosing Cautious use in children under 2. Geri- Increased risk of adverse reactions Dry mouth.. Avoid CNS depressants

loratadine

can cause photosensitivity, pregnancy risk B, and available in rapidly disintegrating tablet

loratadine

what is the only contraindication to the OTC drug loratadine?

allergy to the drug

PO/IV- most PO Given for allergic/seasonal rhinitis and urticaria (hives) Children: Contraindicated in children under 6 with renal/hepatic impairment Geri: Lower dose Caution in renal/hepatic impairment Mouth dryness.. Pregnancy B; risk vs benefit (also breastfeeding) Avoid CNS depressants with medication Side effect of dizziness/drowsiness although not as significant as 1st generation

cetirizine

what do you need to assess for with first generation antihistamines?

drowsiness/dizziness symptom resolution toxicity

what do you need to increase you fluid intake to when taking a 1st generation antihistamine?

2-3 liters per day

t/f: you should administer an antihistamine prior to contact with allergens if possible?

true

t/f: antihistamines may cause a false negative on an allergy test?

true

what are the four drug classes used to control bronachial secretions?

anti-tussives expectorants mucolytics decongestants

these medication shrink swollen nasal mucosa

nasal decongestants

what are decongestants used to treat?

rhinitis common cold sinusitis hay fever allergies

these medications are used for visualization of membranes prior to procedures

nasal decongestants

what are the three primary nasal decongestants?

phenylephrine ephedrine pseudoephedrine

Decrease the swollen nasal mucosa and decrease stuffiness

nasal decongestant

this drug is used to make meth and is controlled by pharmacists

pseudoephedrine

how do adrenergics or (sympathomimetic) nasal decongestants work?

constrict small blood vessels in the nasal passage and sinuses

adrenergics

how do anticholinergic nasal decongestants work?

decrease secretions

these nasal decongestants decrease secretions

anticholinergics

how do corticosteroid nasal decongestants work?

reduce inflammatory response in nasal passage

corticosteroid nasal decongestants

oxymetazoline is an example

adrenergic decongestants

______ nasal decongestants are addictive and can cause ______ ______ if used over 3-5 days

adrenergic, rebound congestion

fluticasone propionate is a ?

corticosteroid nasal decongestant

takes longer to receive full benefit and can be used for longer periods of time without rebound congestion.

corticosteroid decongestant

is the only intranasal anticholinergic

ipatropium bromide

Most decongestants are OTC while many ______ are by prescription

corticosteroids

Causes dilated arterioles in the nose to constrict Reduces congestion

adrenergic decongestants (oxymetazoline)

Use these drugs no more than 3 days at a time to prevent?

adrenergic (oxymetazoline) rebound congestion

is an alpha adrenergic agonist

oxymetazoline

causes vasoconstriction of dilated arterioles and reduces blood flow.

oxymetazoline

Sympathomimetic drug (Increase heart rate/blood pressure)

oxymetazoline

During a cold, the blood vessels that surround the nasal sinus are dilated and engorged with plasma, white blood cells, mast cells, histamines, and many other blood components that are involved in fighting infections of the respiratory tract. This swelling, or dilation, blocks the nasal passages, which results in nasal congestion. When these drugs are administered intranasally, they cause dilated arterioles to constrict, which reduces nasal blood flow and congestion. ______ should be used for no more than 3 days at a time.

Oxymetazoline

can cause you to be nervous –high heart rate, high bp, (IMPORTANT)

oxymetazoline

this decongestant decreases secretions and must be primed y spraying before first use? what class is it in as well?

ipratropium, anticholinergic decongestant

good for treating runny nose in patients with both allergic and nonallergic rhinitis

ipratropium (anticholinergic decongestant)

These work by blocking acetylcholine which decreases secretions from the glands in the nasal passage. Common reactions include dry mouth and bad taste. It doesn’t have to be stopped after 3 days although there are differing opinions on length of time)

anticholinergics, ipratropium

what are the side effects of ipratropium ?

sore throat nasal dryness/irritation

does not have to be stopped after three days, does not cause rebound congestion

anticholinergic decongestants Corticosteroids

fluticasone propionate is a ?

corticosteroid nasal spray

treat allergic rhinitis caused by airborne allergens Children: Less than 4 years safety not established OB: Safety not established Lactation: Risks vs benefits

corticosteroid nasal sprays (fluticasone propionate)

side effect of these drugs are decreased growth in long term use by children

corticosteroid nasal spray

what are some of the side effects of cortiocosteroid nasal sprays?

nasal burning and irritation

) takes longer to receive full benefit and can be used for longer periods of time without rebound congestion

Corticosteriod- (fluticasone propionate)

It works in your nose to block the effects of substances that cause allergies (such as pollen, pet dander, dust mites, mold) and to reduce swelling

Corticosteriod- (fluticasone propionate)

Don’t use adrenergic nasal sprays longer than ___ days

Avoid with Hypertension; uncontrolled cardiovascular disease; dysrhythmias Narrow angle glaucoma Stroke

adrenergic

Increase fluids if not contraindicated Report fever over 100.4 F or any other symptoms (indicate infection) lasting longer than 3-4 days Caution with caffeine (adrenergic) Smoking = vasoconstriction Adrenergic: longer than 3 days, take oral preparation If rebound congestion, taper use Drops preferred for children (rather than nasal spray)

nursing notes for nasal decongestants

usually use a saline drop rather than a nasal decongestant in?

children

need to avoid caffeine with ___ meds (fast heart beat, restlessness or fidgeting)

adrenergic

what are the two types of anti tussives?

opioids, non-opioids

Suppress cough reflex Analgesic and drying effect

opioids

non-opoid medication that suppresses cough reflex?

dextromethorphan

non-opioid medication that numbs receptor cells that cause cough?

benzonatate

can you drive while taking an opioid cough medicine?

what opioid antitussive is used?

codeine

what are the nonopiod antitussives?

dextromethorphan benzonatate [diphenhydramine]

when is the ONLY time you want to use an antitussive to suppress a cough?

when it is NON productive that interferes with sleep health or healing

t/f: May give cough medicine after surgery if the patient has a major cough to prevent them from coughing and busting open those sutures.

true

what are antitussives contraindicated in?

individuals at high risk for respiratory depression/sedation trail elderly those on other CNS depressants opoid antitussives, concern with opioid dependency

Mild nausea, dizziness, and sedation Euphoria in high doses

nonopioid antitussive adverse effects

CNS effects (Sedation, dizzy, lightheaded, respiratory depression) GI effects (N/V, constipation) Abuse potential

opioid adverse effects

Avoid drinking liquids within half hour of taking _____ of this form of antitussive

lozenge

t/f: avoid smoking with antitissives?

true

take oral codeine with?

food

how much water should you drink in a day with antitussives?

2-3 liters (helps with dry mouth and nose)

how do expectorants work?

Stimulate glands in respiratory tract Breakdown and thin secretions in respiratory tract

are used for secretions in the bronchi and NOT in the nose

expectorants

what is the prototype expectorant?

guaifenesin

what are the adverse effects of expectorants?

GI upset drowsy/dizzy rash

used for thick secretions that need to be thinned

expectorant

what are drugs that interact with guaifenesin ?

none are known

Minimal adverse effects (Yay!) Fluid intake of 2-3 liters a day if not contraindicated Check OTC expectorants for ingredients and combinations Report fever or cough that lasts more than a week Short half life; repeat dosing

nursing notes for expectorants

Sometimes acetaminophen may be mixed in with ______ and we want to make sure they aren’t taking a mixed medication and separate acetaminophen. If they are coughing longer than a week then we need to check for a different dx.

expectorants

used for babies and little kids to help them absorb inhalant

spacer

s/s: inflammation bronchoconstriction mucosal edema viscous mucus

asthma

constriction of airway, mucus becomes thick, drying of the mucosa

symptoms of asthma

is destruction of the respiratory wall characterized by one or both: chronic bronchitis and emphysema

COPD -chronic obstructive pulmonary disease

what are the two indications that someone has COPD?

chronic bronchitis emphesema

what are three indications for acetylcstine?

Acute and/or chronic pulmonary disorders with large amounts of secretions (cystic fibrosis/COPD) Acetylcysteine (Mucomyst) is antidote for acetaminophen (Tylenol) poisoning Prevent renal dysfunction due to administration of radiocontrast

acetylcystine is a ?

mucolytic

what are the mucolytics?

acetylcystine hypertonic saline (3-7%)

How does it work? Thin and liquefy mucus Uses enzymes to break down mucus (some) Muscle relaxant properties for easier expectoration (some) Enhance flow of secretions in respiratory tract

how mucolytics work

crackles in the lungs- thins and liquifies the mucous so they are able to cough up the mucous.

mucolytics

this mucolytic smells like rotten eggs

acetylcysteine

Hx of hypothyroidism, CNS depression, renal or liver disease, seizure disorders, asthma

caution with mucolytics

Bronchospasm and possible aspiration of the liquid, sore throat, cough, dizziness, drowsiness, hypotension, tachycardia, hepatoxicity

adverse effects associated with acetylcysteine

Increased coughing, sore throat, chest tightness are adverse effects associated with?

hypertonic saline

If they already have severe asthma- acetylcysteine could cause a _______

bronchospasm (airway goes into spasm)

Fluid intake 2-3L per day unless contraindicated Mix with fruit juices, sodas, water Usual dosage: q 4 hours for 3 days Monitor Labs Liver function tests, PT, BUN, creatinine, glucose, electrolytes and acetaminophen levels

administration and education for mucolytics

prothrombin (PT) is an enzyme produced by?

the liver

what are the kidney function labs?

BUN, creatinine

What are the three different classes of bronchodilators?

beta adrenergic agonists anticholinergics xanthines

what are the beta2 adrenergic agonists?

albuterol levabuterol formoterol salmeterol terbutaline

these drugs work by relaxing smooth muscle in the airway

beta2 adrenergic agonists

these drugs imitate norepinephrine and quickly open airway

beta 2 adrenergic agonists

t/f: beta 2 adrenergic agonists can be short or long acting?

true

beta-adrenergic agonists work by ______ beta 2 adrenergic receptors in lungs

stimulating

which drug type and specific drug should a patient take when they immediately need help breathing?

short acting beta 2 agonist bronchodilators , albulterol

Contraindicated Client with tachydysrhythmia/severe artery disease High risk for stroke Using MAOIs Other sympathomimetics (epinephrine, norepinephrine, and dopamine or cocaine and methamphetamines)

contraindications with beta 2 agonist bronchodilators

______ is the most commonly used short acting beta specific beta agonist

Albuterol

alternative for patient with tachycardia Less Beta 1 (cardiac) effects More expensive

levabuterol

Frequent, large doses Increase in cardiac side effects Palpitations, increased HR Anxiety, tremors, nausea

albuterol

Assess for chest, jaw, or arm pain or palpitations and notify the provider if they occur (cardiovascular problem?) Check pulse, report an increase of greater than 20-30 beats/min Teach patient how to use inhalers, spacers, etc. and which medication is “rescue” and which one is “prevention”

nursing notes for albuterol

Albuterol inhaler works in _______ minute(s). Inhale as they push the button. Hold breath and then slowly let it out slowly.

1 minute

acetycholine causes broncho______

chronchoconstriction

_________ block acetylcholine receptors = indirect bronchodilation

Anticholinergics

t/f: inhaled anticholinergics reduce secretions in respiratory tract

true

Prevents bronchospasm Not for acute symptom management

inhaled anticholinergics

Airway relaxation and dilation. Can indirectly reduce secretions.. Dry them up.

inhaled anticholinergics

what are the two inhaled anticholinergics?

ipratropium tiotropium

Used for the prevention of bronchospasm and not for management of acute symptoms

anticholinergic bronchodilators

Peanuts, soy allergy (this would only be because of an inactive ingredient- shouldn’t be in new formulations)

contraindications for anticholinergic bronchodilators

Narrow-angle glaucoma and benign prostatic hypertrophy Taking other _______

anticholinergic bronchodilators

Rinse mouth after administration due to unpleasant taste and to prevent oral yeast infection Manage ______ effects Wait____minutes between puffs for same inhaler Wait _____ minutes between different types of inhaler Not a rescue inhaler

anticholinergic 1-2 2-5

Increases cyclic adenosine monophosphate (cAMP) levels Smooth muscle relaxation (bronchial dilation) Decreases allergic reaction Enhances respiratory drive

how xanthines work

Higher levels of ______ _____ _____ contribute to smooth muscle relaxation

cyclic adenosine monophosphate

relax smooth muscle and dilates bronchi, decreases allergic reaction, and enhances respiratory drive (opens up the airways)

xanthines

What are the two xanthine examples?

methylxanthines theophylline

Increases the ease of breathing. These decrease seizure threshold so they can cause seizures should not be used in someone who already has seizures

xanthines

May be used for asthma (often allergy related) or COPD. Slow onset medication.

xanthines

what are the indications for xanthines?

mild to moderate asthma COPD adjunct

are xanthines a rescue drug?

no, they are not

Contraindications History of uncontrolled cardiac dysrhythmias History of peptic ulcer disease or seizure disorders History of hyperthyroidism

contraindications with xanthines

what is the therapeutic blood level of theophylline?

5-15 mcg/mL

adverse effects associated with theophylline occur with drug levels of ?

20-25 mc/mL

adverse cardiac effects are more frequent with levels above ______ with theophylline

30mcg/mL

______ can be seen with theophylline levels above 40 mcg/mL

seizures

what do you do with an overdose of theophylline?

stop med administer activated charcoal monitor vitals seizure precautions

______ are now deemphasized because of their potential for drug interactions and the interpatient variability in therapeutic drug levels in the blood.

Xanthines

CNS - confusion, tremors, dizziness, hallucinations, restlessness, agitation, headache, insomnia GI - N/V, anorexia, stomach cramps, diarrhea, increased urination CV - palpitations, tachycardia, arrhythmias, chest pain, flushing

toxicity/overdose to theophylline

GI N/V, anorexia, gastroesophageal reflux during sleep Cardiovascular Tachycardia, palpitations, dysrhythmias Others Temporary hyperglycemia and increase in urination

side effects of theophylline

Dosages usually started low and titrated up to relieve symptoms Aminophylline IV occasionally used for Status Asthmaticus If used with oral contraceptives or some antibiotics can increase blood levels

xanthines

Aminophylline IV occasionally used for ______ _____

Status Asthmaticus

Drink 2-3 liters to decrease viscosity of secretions Minimize intake of xanthine containing foods (colas, coffee, chocolate). Notify prescriber of any signs/symptoms of toxicity

patient education for xanthines

what are the non broncho dilating respiratory medication classes?

leukotriene receptor antagonists mast cell stabilizers corticosteroids/glucocorticosteroids

are leukotriene modifiers bronchodilators?

what are the three leukotriene modifiers?

montelukast zafirlukast zileuton

Allergen -> _________ are released - >inflammation + bronchoconstriction + mucus production = ->Coughing, sneezing, wheezing, and shortness of breath! Inhibits an enzyme or blocks receptor sites Also prevents migration of neutrophils and lymphocytes (keep from going to lungs)

how leukotriene modifiers work

Prevent asthma attacks, NOT for current acute attacks Chronic treatment of asthma in adults and teens Drug effects primarily limited to lungs: Prevent smooth muscle contraction of bronchial airways Decrease mucus secretions Reduce vascular permeability = decreases edema improvement is usually seen in ~a week

leukotriene modifier indication

Allergy to povidone, lactose, titanium dioxide, cellulose derivatives (inactive ingredients in drug)

contraindications for leukotriene modifiers

Liver injury with use of zileuton (zyflo) and zafirlukast (accolate) Normal AST is 0-45 IU/liter, Normal ALT is 0-40 IU/liter Hold the medication if AST/ALT levels 3x higher Check PT/INR

contraindications for leukotriene modifiers

IT IS MAINLY _______ THAT CAUSES LIVER INJURY WHEN GIVEN WITH a leukotriene WATCH LIVER ENZYMES

ZILEUTON

PT/INR

measures how long it take your blood to clot

Liver Dysfunction is associated with which leukoriene modifier?

zafirlukast

this leukotriene modfier causes dizzines, insomnia, liver dysfunction

zileuton

this leukotriene modfier causes heartburn

montelukast

what are adverse side effects of all leukotriene modifiers?

headache, nausea, eiarrhea, sucicdal ideation, depression

Zileuton 1 hr before or after a meal Avoid taking Zafirlukast with food Take Montelukast once daily at bedtime For exercise‑induced bronchospasm, take 2 hr before exercise Monitor liver function tests, PT, and INR DARK URINE, ITCHING, JAUNDICE, ABDOMINAL PAIN & SWELLING, CLOTTING ISSUES, Monitor for signs of liver damage How would you know?

leukotriene modifier nursingg notes

what are s/s of liver damage?

Yellow skin and eyes Itching Dark urine Abdominal pain and swelling Elevated liver enzymes (AST and ALT) Prolonged PT and increased INR (time required to form a clot)

signs of liver damage

do inhaled corticosteroids bronchodilate?

no, they do not

Anti-inflammatory effects Stabilizes cell membranes that release bronchoconstricting substances Less inflammatory mediators released from Leukocytes Restores responsiveness of bronchial smooth muscle to beta adrenergic receptor stimulation Better stimulation of Beta 2 receptors by Beta agonist drugs

how inhaled corticosteroids work

what are the inhaled glucocorticoid steroids?

fluticaseone and salmeterol methyl prednisone IV

what are oral glucocorticoid steroids?

prednisone prednisolone

what are IV glucocorticoid drugs?

hydrocortisone methylprednisolone

how is methylprednisolone usually administered?

it is usually given IV

what are the indications for inhaled corticosteroids?

status asthmaticus long term prophylaxis of asthma bronchitis COPD Cystic fibrosis severe asthma

It may take several ______ of inhaled corticosteroid for real effects to be seen.

weeks

contraindicated in client with infections or suppressed immune systems: Systemic fungal infections, AIDS, tuberculosis (TB) Positive sputum test for Candida organisms Those who have received a live virus vaccine

contraindications for corticosteroids

Common Inhaled Effects: Pharyngeal irritation/sore throat Coughing Dry mouth Oral fungal infections such as thrush (candidiasis)

common INHALED corticosteroid effects

Suppression of adrenal gland function Bone loss FOR CHILDREN Hyperglycemia and glycosuria Infection

adverse effects associated with corticosteroids

Oral doses may need to be increased during times of stress (long term treatment) Oral ________ are used short‑term, 3 to 10 days Rinse mouth after using inhaled ________ Take bronchodilator inhaler 2-5 minutes before ________ inhaler Use as a maintenance drug, not a rescue drug

corticosteroid

stabilize ______ cell membranes to prevent release of inflammatory mediators such as histamine

mast

are mast cell stabilizers rescue ihalers or for long term control?

for long term control

3-5 minutes after rescue inhaler OB/breastfeeding: Safety not established Pedi- Children under 2: safety not established More often used for mild persistent asthma medication is not used a lot anymore do not work as well as inhaled corticosteroids

mast cell stabilizers

Desired effect is Improved airflow in the air passages Increased oxygen supply Perform a thorough assessment of respiratory status- Skin color, temperature Respiratory rate, depth, rhythm Breath sounds Blood pressure, pulse Signs and symptoms of respiratory distress Pulse ox

assessment with any respiratory drugs

______ REACTS WITH MANY MEDS AND CAN CAUSE VASO CONSTRICTION AND EXASERBATES RESPIRATORY ISSUES

NICOTINE

May take longer to deliver than MDI May be more effective in some patients

nebulizer

Less portable Can be easier to get doses for small children (under 8) who are unable to use inhaler correctly. More expensive (DME) They require more cleaning.

nebulizer

Used to monitor a patient’s ability to breathe out air

peak flow meter

red zone for peak flow meter

50% or less

yellow zone for peak flow meter

50-80%

green zone for peak flow meter

>80%