Respiratory Drugs (Lower) Flashcards
Inflammation of the airways
chronic bronchitis
Destruction of the alveolar wall w/ dilation of the airspace
emphysema
Chronic inflammatory disorder of the airway
Characteristic signs and symptoms
Cause: immune- mediated airway inflammation
asthma
Drugs for lower airway disorders like COPD and asthma
Bronchodilators (beta2 adrenergic agonists, anticholinergics, methylxanthines)
Anti-inflammatories (corticosteroids, leukotriene antagonists, cromolyn, monteukast)
Mucolytics
Antibiotics (COPD)
Advantages of inhalation drug therapy
Therapeutic effects are enhanced (directly to lung tissue)
Systemic effects are minimized
Relief of acute attacks is rapid
Disadvantages of inhalation drug therapy
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
INSTRUCTIONS: INHALATION (AEROSOL) THERAPY
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
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
BETA2 ADRENERGIC AGONISTS
Non-selective sympathomimetic
epinephrine
Short acting beta2 adrenergic agonist
Rapid onset of action (5-15 min) for acute bronchospasm
Rescue inhaler
Albuterol
Long acting beta2 adrenergic agonist
For long term control of asthma
Formoterol- onset 1-3 minutes, duration 10 hours
Salmeterol- onset 10-20 minutes, duration 12 hours
Side effects and adverse effects of beta2 adrenergic agonists
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 *
Blocks muscarinic cholinergic receptors and antagonizes (blocking) acetylcholine action, relaxes smooth muscle of bronchi; dilates bronchi.
Prevents bronchospasm, manage asthma and treat COPD
ANTICHOLINERGICS
Ex: Tiotropium (Spiriva)
Long-acting prototype
Side effects and adverse effects of Tiotropium (Spiriva)
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
NURSING INTERVENTIONS AND PATIENT EDUCATION-INHALED ANTICHOLINERGICS
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
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
METHYLXANTHINES
Ex: Theophylline
Theophylline has a low therapeutic index & narrow desired therapeutic range. What is it?
5-15mcg/mL
Why has the use of theophylline declined?
the potential danger of adverse effects (dysrhythmias, seizures, cardiac arrest)
Side effects and adverse effects of theophylline
Side effects and Adverse effects include: Nausea, vomiting, irritability, CNS stimulation, tachycardia, palpitations, nervousness, restlessness, seizures, insomnia
Methylxanthine reminders
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
NURSING INTERVENTIONS:
BRONCHODILATORS
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
Prevent inflammatory response by suppression of airway mucus production, immune responses, and adrenal function
Glucocorticoid medications
Side effects and adverse effects of glucocorticoid meds
Euphoria, insomnia, psychotic behavior
Hyperglycemia
Peptic ulcer
Fluid retention
Withdrawal symptoms
Increased appetite
Never stop medication abruptly!
Oral glucocorticoids
Prednisone
Prednisolone
Betamethasone
Inhaled glucocorticoids
Beclomethasone dipropionate
Budesonide
Fluticasone propionate
Triamcinolone acetonide
Intravenous glucocorticoids
Hydrocortisone sodium succinate
Methylprednisolone sodium succinate
Betamethasone sodium phosphate
