Respiratory Drugs (Lower)

Question 1

Inflammation of the airways

Answer 1

chronic bronchitis

Question 2

Destruction of the alveolar wall w/ dilation of the airspace

Answer 2

emphysema

Question 3

Chronic inflammatory disorder of the airway
Characteristic signs and symptoms
Cause: immune- mediated airway inflammation

Answer 3

asthma

Question 4

Drugs for lower airway disorders like COPD and asthma

Answer 4

 Bronchodilators (beta2 adrenergic agonists, anticholinergics, methylxanthines)
 Anti-inflammatories (corticosteroids, leukotriene antagonists, cromolyn, monteukast)
 Mucolytics
 Antibiotics (COPD)

Question 5

Advantages of inhalation drug therapy

Answer 5

 Therapeutic effects are enhanced (directly to lung tissue)
 Systemic effects are minimized
 Relief of acute attacks is rapid

Question 6

Disadvantages of inhalation drug therapy

Answer 6

 Difficult to measure precise dose
 Instruction may be complicated for some patients
 Side effects occur if patient swallows drug or does not rinse mouth after inhalation

Question 7

INSTRUCTIONS: INHALATION (AEROSOL) THERAPY

Answer 7

 Remove mouthpiece cap
 If appropriate, shake container
 Stand up or sit upright, exhale deeply
 Place mouthpiece between teeth, close lips tightly around inhaler
 While breathing in, press down on inhaler to activate and release
medication; continue breathing in slowly for several more seconds
 Hold breath for 5-10 seconds
 Breathe in/ out normally

Important to perform mouth care afterwards

Question 8

Stimulates beta2-adrenergic receptors in the lungs, relaxing the bronchial smooth muscle, causing bronchodilation.

Given for chronic asthma or COPD

Systemic effects include increased BP, increased HR, vasoconstriction, decreased renal and GI blood flow

Answer 8

BETA2 ADRENERGIC AGONISTS

Question 9

Non-selective sympathomimetic

Answer 9

epinephrine

Question 10

Short acting beta2 adrenergic agonist

Rapid onset of action (5-15 min) for acute bronchospasm

Rescue inhaler

Answer 10

Albuterol

Question 11

Long acting beta2 adrenergic agonist

For long term control of asthma

Answer 11

 Formoterol- onset 1-3 minutes, duration 10 hours
 Salmeterol- onset 10-20 minutes, duration 12 hours

Question 12

Side effects and adverse effects of beta2 adrenergic agonists

Answer 12

 Side effects: Tremor, nervousness, restlessness, agitation, dry mouth, urinary retention

 Adverse reactions: Palpitations, tachycardia, HTN, dysrhythmia, bronchospasm, increased blood glucose

• Excessive use of aerosol drug can lead to tolerance and loss of drug effectiveness *

Question 13

Blocks muscarinic cholinergic receptors and antagonizes (blocking) acetylcholine action, relaxes smooth muscle of bronchi; dilates bronchi.

Prevents bronchospasm, manage asthma and treat COPD

Answer 13

ANTICHOLINERGICS

Ex: Tiotropium (Spiriva)
Long-acting prototype

Question 14

Side effects and adverse effects of Tiotropium (Spiriva)

Answer 14

 Side effects: dry mouth, constipation, NV, oral ulceration, insomnia
 Adverse effects: tachycardia
 Use with caution in patients with narrow-angle glaucoma and benign prostatic hypertrophy

Question 15

NURSING INTERVENTIONS AND PATIENT EDUCATION-INHALED ANTICHOLINERGICS

Answer 15

 Instruct patient that maximum effects could take up to 2 weeks
 Shake inhaler well before administration
 When using 2 different inhaled medications, wait 5 minutes between each
 If using a nebulizer, use within 1 hour of reconstitution

Question 16

Relaxes smooth muscles of the bronchi, bronchioles, and pulmonary vessels (bronchodilates). Also stimulates CNS & respirations.

Prescribed mostly for maintenance therapy in patients with chronic stable asthma and COPD when other drugs have failed to show improvement

Answer 16

METHYLXANTHINES

Ex: Theophylline

Question 17

Theophylline has a low therapeutic index & narrow desired therapeutic range. What is it?

Answer 17

5-15mcg/mL

Question 18

Why has the use of theophylline declined?

Answer 18

the potential danger of adverse effects (dysrhythmias, seizures, cardiac arrest)

Question 19

Side effects and adverse effects of theophylline

Answer 19

Side effects and Adverse effects include: Nausea, vomiting, irritability, CNS stimulation, tachycardia, palpitations, nervousness, restlessness, seizures, insomnia

Question 20

Methylxanthine reminders

Answer 20

 Contraindicated with active peptic ulcer disease
 Caution in patients with diabetes mellitus, hyperthyroidism, heart disease, HTN, angina
 Not prescribed for patients with seizure disorders
 Drug interactions- avoid caffeine (has same properties as theophylline, can increase toxic effects of drug); beta blockers, propranolol, erythromycin (increase half-life and effects); barbiturates decrease its effects; interactions with digoxin, lithium, phenytoin
 Smoking will decrease effects

Question 21

NURSING INTERVENTIONS:
BRONCHODILATORS

Answer 21

 Monitor vital signs
 Provide adequate hydration
 Observe for side effects
 Administer medication at regular intervals around the clock to have a sustained therapeutic level
 Advise patient having asthmatic attacks to wear an identification bracelet or MedicAlert tag
 Teach patients to carry rescue inhaler

Question 22

Prevent inflammatory response by suppression of airway mucus production, immune responses, and adrenal function

Answer 22

Glucocorticoid medications

Question 23

Side effects and adverse effects of glucocorticoid meds

Answer 23

 Euphoria, insomnia, psychotic behavior
 Hyperglycemia
 Peptic ulcer
 Fluid retention
 Withdrawal symptoms
 Increased appetite

Never stop medication abruptly!

Question 24

Oral glucocorticoids

Answer 24

Prednisone
Prednisolone
Betamethasone

Question 25

Inhaled glucocorticoids

Answer 25

Beclomethasone dipropionate
Budesonide
Fluticasone propionate
Triamcinolone acetonide

Question 26

Intravenous glucocorticoids

Answer 26

Hydrocortisone sodium succinate
Methylprednisolone sodium succinate
Betamethasone sodium phosphate