Respiratory- Exam 2 Flashcards
1
Q
2 Medications utilized for Asthma
A
Anti-inflammatory medications and Bronchodillation medications
2
Q
What is FEV1
A
An individuals proportion of vital capacity that they are able to expire in the 1st second of forced expiration / full forced vital capacity
3
Q
Normal healthy adults FEV
A
70-85%
4
Q
How is Gold Criteria rated for COPD Patients
A
Gold 1 (Mild) -Gold IV (Very severe) FEV1 greater Less than 30% of than or equal predicted normal to 80% of value. predicted normal value.
5
Q
Two main pharmacological classes to treat asthma and COPD
A
Anti-inflammatory agents (Glucocorticoids) and Bronchodilators (Beta 2-agonists)
6
Q
Generally anti-inflammatory agents are on what type of treatment regimen
A
Fixed schedule typically for chronic asthma and stable COPD
7
Q
Typically bronchodilators will be administered on what type of treatment regimen.
A
Fixed or as needed for acute attacks
8
Q
What are 3 advantage of administering anti-asthma drugs via inhalation route
A
- Delivery is directly to site of action
- Systemic effects on other body organs and sites are generally minimized
- Provides rapid relief of acute attacks
9
Q
Dosage of MRI, and rule for administration as well as patient criteria
A
1 or 2 inhalations
Allow one minute BETWEEN inhalations
Takes hand breath coordination by the patient
Can allow to attach a spacer for the non-coordinated patient (Drug will just chill in the chamber and you breathe normally)
10
Q
Advantage of MDI with Spacer in terms of delivery of medication
A
Utilizing a spacer will double the medication delivery to lungs. This can help with pediatric patients as well as older adults that just don’t have the coordination available for a MDI alone
11
Q
Respimat
Delivery system, particle size, advantage, is there a propellant utilized?
A
Delivered through a fine mist with no propellant like the MDI, has extremely small particle size (Better delivery to lungs) and less drug is deposited in the mouth/oropharynx
12
Q
DPI System
Form of drug in delivery, how to administer, Advantage
A
Dry-Powder Inhalers
Delivered as dry micronized powder directly to the lungs, breath activated so no coordination involved.
Same advantages as Respimat (Less drug deposited in oropharynx and more drug delivered to lungs compared to MDI)
Cant use a spacer for this
13
Q
What is a Nebuilzer
A
Machine requires no coordinated effort to administer inhaled medication to- generally used with pediatric patient. Converts the drug solution to a fine mist that is inhaled though a hose/mask or mouthpiece. Less drug is deposited in the oropharynx and more drug is delivered to the lungs
14
Q
Advantages of Nebulizer
A
- No coordination
- All sorts of attachments for less cooperative patients
- Can administer O2 and med simultaneous for hypoxic patient!
Fun fact- Some meds are only able to be administered through a nebulizer
15
Q
Disadvantages of Nebulizer
A
- Longer delivery for a dose
- Some units require power source
- Some units require compressed oxygen or air
- If not properly cleaned then higher risk of aerosolization of pathogens.
16
Q
Beclomethasone, other name and type of drug
A
QVAR . Inhaled Glucocorticoid
17
Q
Use of Beclomethasone
A
Maintenance treatment of asthma and long term control of COPD
18
Q
MOA of Beclomethasone (3)
A
- Inhibits inflammatory cells (Eosinophils and Leukocytes)
- Inhibits Release of inflammatory mediators (Leukotrienes, histamines, prostaglandins)
- Decreases Edema of airway mucosa
19
Q
Common side Effects of Beclomethasone
A
Headache, dysphonia (abnormal voice), Pharyngitis, oral candidiasis (thrush)
20
Q
Serious adverse effects of Beclomethasone- a Glucocorticoid
A
Adrenal suppression (Possible adrenal crisis), Bronchospasm, Catarct, Glaucoma
21
Q
Pre Assessment for Beclomethasone
A
Assess PFTs, check for growth in child to monitor for any stunting, and check for any active infection
22
Q
MAR Beclomethasone (1)
A
Desmopressin- this treats Diabetes Insepidus, could cause severe hyponatremia
23
Q
PMH- 3 Hard nos of Beclomethasone
A
Immunosuppression of any kind, Bone mineral density issues, Ocular disease
24
Q
Administering Beclomethasone
A
Administer the bronchodilator first and allow 5 minutes to elapse before administering this steroid. This is not for an acute attack!
25
What can be done while taking Baclomethasone to minimize adverse effects
Mouth rinse and because of risk for adrenal suppression do not discontinue this drug randomly, tapering and start low and slow
26
Prednisone MOA (Predator gets in the zone)
The predator prednisone gets in the zone and corners leukocytes, not allowing them to perform their duties as well as reversing leakiness of capillary permeability
27
Prednisone Usage
Used for asthma when symptoms cannot be controlled by inhaled medications alone
Also prescribed for COPD exacerbations
28
A few common side effects of Prednisone (Any glucocorticoid medication and 1 unique)
Adrenal suppression, growth suppression, Possible Hyperglycemia!
29
Prednisone Pre-administration
BP (can cause elevated BP), Blood glucose (can cause hyperglycemia), growth chart for children, any current infection
30
MAR Prednisone- Multiple drug interactions and 1 hard no drug
Desmopressin (HARD NO), Nsaids, anti-diabetic agents, vaccinations, antacids
31
Prednisone is administered in _____ and given with _____.
Given in bursts (40-60mg/day x3 to 10 days. Taken with food or milk to decrease GI distress
32
Hard nos in PMH for Prednisone
GI disease, ocular disease, renal disease, hepatic disease
33
Eval and Intervention of Prednisone (typical of glucocorticoids)
Minimize possible bone loss with calcium and vitamin D intake
Don't discontinue randomly
Monitor for adrenocortical insufficiency (fatigue, muscle weakness, loss of appetite, hypotension)
34
Zafirlukast brand name
Accolate
35
Accolate MOA
Antagonizes leukotienes (which mediate airway edema, smooth muscle constriction, altered cellular activity)
36
Zafirlukast Serious Hard no
Associated with causing depression (Recent finding)
37
Interaction of Accolate
Will inhibit isoenzymes of CYP450- suppressing metabolism of other drugs causing certain drug levels like theophylline and warfarin to elevate or remain in system longer
38
Accolate is a ____ line therapy and administered via what route
Second and oral
39
What is Cromolyn
A mast cell stabilizer, preventing release of histamine
40
Why would someone be prescribed Cromolyn
Alternate therapy if the glucocorticoids are causing issues
41
Cromolyn is prescribed for
Chronic asthma-mild, persistent, seasonal allergies and exercise induced asthma
42
Adverse effects of Cromolyn
Throat irritation, bad taste, coughing, wheezing
| All adverse local effects directly correlate to route adminsitered
43
Phosphodiesterase-4 Inhibitors (PDE)
Roflumilast (Daliresp)
44
Use of Daliresp
Severe COPD patients, with history of chronic bronchitis to treat risk of exacerbations
45
MOA of Daliresp
Selective inhibitor of PDE4- AN enzyme in lung tissue that elevates cAMP in lung tissue but reduces neutrophils and eosinophils in the lungs.
46
Serious side effects of Daliresp
Suicidal thoughts and angioedema
47
Locations of Beta-2 Adrenergic Receptors
Lungs- Bronchial dilation
Uterus- Relaxation of uterine smooth muscle
Arterioles of heart, lungs, and skeletal muscles- vasodilation
Liver- Promote glycogenolysis (glycogen breaking down to glucose)
Muscle- promote glycogenolysis and enhance contraction
48
Albuterol Use
Short acting Beta2 agonist used as quick relief agent for acute bronchospasm and for prevention of exercise induced bronchospasm
49
MOA of Alubterol
Stimulate beta-2 adrenergic receptors in the smooth muscle of bronchi and bronchioles- promoting bronchodilation. Limited role in suppressing histamine release
50
Common side effects of albuterol
nervousness, restlessness, tremor, insomnia
51
Serious side effects of SABA
Angina, arrhythmias, HTN, paradoxical (Intitally cause) bronchospasm
52
Administering Albuterol considerations
Trigger factors, classification of control in how often to use, Caffeine use (can increase risk of adverse effects)
53
Utilizing Albuterol too much can cause what
Tolerance and paradoxical bronchospasms
54
MAR for Albuterol
Beta blockers, thyroid meds, theophylline (Bronchodilator)
55
What to be mindful of if patient starts albuterol and prescribed MAOI
Could cause hypertensive crisis
56
Hard nos of albuterol
Hard nos- Use of system beta agonist with DM, hyperthyroidism, Hypertension
Mindful of- Cardiac disease
57
Albuterol teaching on administration
Oral- inhaled, need a minute between inhalations, use before other inhalants
58
Ongoing evals and interventions of albuterol
monitor and record PFTs, monitor frequency of use to prevent serious side effects
59
Names for LABAs
Long Acting Beta 2 Agonists- Salmeterol (Servent diskus)
60
Use of Salmeterol
Controller of treatment of asthma to prevent bronchospasm and treat exercise induced asthma
61
Salmeterol MOA
Provides accumulation of cAMP at beta2-adrenergic receptors, bronchial smooth muscle relaxation and mediators for immediate hypersensitivity is inhibited
62
Are LABAs a first choice controlled med for treatment
No- glucocorticoids are the first choice med
63
Can LABAs be taken in conjunction with SABA
Yes
64
Severe adverse of LABA, one common adverse
Severe- Prolonged QT interval, asthma-related death when used as monotherapy
Common- headache
65
What is Xanthine
Theophylline
66
Use of Xanthene-Theophylline
Second line agent for long term control of reversible airway obstruction caused by asthma or COPD
67
MOA of theophylline
Relax smooth muscles of bronchi by blocking receptors for adenosine
68
Serious side effects of Theophylline
Narrow therapeutic range- toxicity issues
| Afib, tachy, sezures, toxicity
69
Precautions and Interactions of Theophylline
Cardiac arrhythmias, heart failure pxs, liver or kidney dysfunction, has multiple drug to drug interactions including caffeine
70
Acetlycholine significance
Prominent parasympathetic neurotransmitter in the airway. Drugs binding at muscarinic receptor where ACTH acts creates a block that prevents bronchospasm from taking place.
71
Ipratropium
Atrovent
72
Theophyllne Onset of action and Route
Rapid and PO, PO-ER, IV
73
Ipratropium onset of action and route
1-3 minutesm inhaled or intranasal
74
MOA of Ipratropium
It is the primary anti-cholinergic and blocks the muscarinic receptors in the bronchi, preventing that spasm from occuring
75
Use of Ipratropium
Maintenance therapy of reversible airway obstruction due to COPD (chronic bronchitis and emphysema) off label use for asthma
76
Common adverse effects of Atrovent or Ipratropium
Dry mouth and irritation of pharynx. Raised intraocular pressure
77
Contraindication of administration of Ipratropium
Do not administer during acute bronchospasm
78
Precautions for Ipratropium
Due to anti-cholinergic effects want to be cautious with any patients who have some type of obstruction
Patients with prostatic hyperplasia, glaucoma, urinary retention
79
LAMAs
Long Acting Antimuscarinic Antagonists
80
Tiotropium brand name and what it is
Spiriva and LAMA
81
Can I take LAMA and Ipratropium
NO
82
MOA of LAMA- Tiotropium (spiriva)
Acts as anticholinergic by selectively and reversibly inhibiting M3 receptors in smooth muscle of airways
83
Use of Tiotropium (Spiriva)
Maintenance therapy of bronchoconstriction associated with chronic bronchitis and emphysema
84
Serious side effects of LAMA
Open angle glaucoma, urinary retention, bowel obstruction, immediate hypersensitivity reaction
85
Patient education for Spiriva
Any signs of angioedema (swelling of lips, tongue or throat) call health care professional, any glaucoma signs (eye pain blurred vision)
Repeat inhalation 2-3 times to ensure drug is inhaled- you should hear and audible flutter or rattle
86
Taking Long acting beta-agonist and corticosteroid risk
risk is minimal
87
Asthma treatment goal
Reducing use of SABA 2 days/week or less and preventing recurrent exacerbations
88
Paradigm shift in asthma therapies
Not just single entity, complex biological network of distinct and intersecting inflammatory pathways
- Distinct mechanistic pathways (endotypes- how to treat)
- Variable clinical presentations (phenotypes)
89
Intranasal Glucocorticoids MOA
Acts on cells and mediators of inflammation- most effective drug for seasonal allergies
90
Use of intranasal glucocorticoids
Prevention and treatment of seasonal and perennial rhinitis
91
Common side effect of intranasal glucocorticoids
Drying of nasal mucosa, sore throat, epistaxis and headache
92
Serious side effects of Intranasal glucocorticoids
Adrenal insufficiency, decreased bone density, cataract, glaucoma
93
Beware using Intransal glucocorticoids in patients with
Adrenal suppression, delayed wound healing, ocular disease
94
Anti-histamines are
An antagonist to H1 receptor- prevent histamine from binding on receptor and acting on target tissues
95
What is other name for Dipenhydramine
Benadryl
96
Benadryl is a ____ generation _____ receptor antagonist
First-generation, H1
97
Onset of action of Benadryl and route
- 60 minutes, 30 minutes and rapid
| - PO, IM, IV
98
MOA of Benadryl
Antagonizes the effects on histamines at H1- receptor sites
99
What is Benadryl used for
Hypersensitivity reactions (allergic rhinitis, conjunctivitis, dermatitis) motion sickness, insomnia
100
Common Side effects of Benadryl
Drowsiness, dry mouth, confusion in older adults, urinary retention, constipation, blurred vision
Anti-cholinergic effects
101
Because Benadryl is a an anti cholinergic- what are the precautions for administering this medication to a patient
Any type of obstruction will be worsened
| Narrow angle glaucoma, prostatic hyperplasia, peptic ulcer, bladder neck obstruction
102
What is the second generation H1 receptor Antagonist
Fexofenadine (allegra)
103
Benadryl cannot cross the blood brain barrier, true or false?
False, it can
104
Onset of action and route of Allegra
Within 1 hour and PO
105
MOA of Allegra
Antagonizes the effects of histamine at peripheral histamine 1 (H1) receptors
106
Use of Allegra
Relief for symptoms of seasonal allergies
107
Compare Allegra to Benadryl
Histamine cannot cross the BBB so less sedative effect overall
108
Common side effects of Allegra
Headache , dizziness, drowsiness, stomachache
109
Precaution for patients taking Allegra
Impaired renal function
110
Interactions of Allegra
Taking mag and aluminum containing antacids could decrease absorption and consequently decrease effective of Allegra
111
What is MOA of Intranasal Cromolyn Sodium
Suppresses release of histamine and other inflammatory mediators from mast cells
112
Use of intranasal Cromolyn Sodium
Allergic rhinitis prophylaxis
113
Adverse effects of Cromolyn Sodium
Local effects, sneezing, stinging, headache, hoarseness
114
Cromolyn Sodium is the _____ in treatment compared to _____, and make sure you do not use this medication to treat a sinus infection, asthma or upper respiratory infection
Second, glucocorticoids
115
What is Pseudoephedrine
Sudafed- A topical decongestant
116
Onset of action and Route of Sudafed
30 minutes and given PO- well absorbed- lasts longer
117
MOA of Sudafed
Stimulates alpha and beta adrenergic receptors. Releases norepinephrine. Produces vasoconstriction in nasal mucous membranes
118
Use of Sudafed
Temporary relief of symptoms associated with acute viral upper respiratory tract infection, will only reduce stuffiness in patients allergic rhinitis- will have no effect on sneezing, itching, or other allergic symptoms because it has no effect on inflammatory mediators.
119
Serious side affects of Sudafed
Atrial fibrillation, MI, Premature ventricular contractions
120
Do not give Sudafed to patients who have.....
Severe High BP -stimulating same receptors of BP and cardiac output
MAOI patients dont give
Severe Coronary artery disease
narrow angle glaucoma
121
How long to take sudafed for ideally
Shouldnt use longer than a week, it relieves the symptoms, it is not a cure for the infection
122
Pseudoephedrine: Legal requirements
- Sale and purchase restricted to combat meth epidemic
- Limited to behind the counter sales,
- Require photo id and limit to amount purchased
- Store will maintain record of purchaser for 2 years
- Many products reformulated with alternate- Sudafed PE
123
What is Oxymetazoline
Afrin- Topical- common cold relief
124
Afrin MOA
Acts directly on alpha-2 receptors to produce vasoconstriction
125
How long to use Afrin
3 days
126
Side effects of Afrin
Rebound congestion (rhinitis medicamentosa) - discontinue use of the drug
127
Drugs for Cough include (3)
Dextromethorphan, Guaifenesin, Acetlycysteine
128
Dextromethorphan brand name
Delsym
129
Onset of action and route of Delsym
Onset of action is 15-30 minutes, Given PO (liquid, lozeneges, syrup)
130
MOA of Delsym
Depresses the cough center in the medulla
131
Use of Delsym
Temp relief from dry, hacking, nonproductive cough that interferes with rest and sleep
132
Contraindication drugs for Delsym
Patients taking MAOIs or SSRIs
133
Should diabetic patients be mindful of Delsym
Yes, some contain sucrose can interfere with glucose levels
134
People abuse Delsym how
Increased dosage causes hallucinogens and psych issues, possible liver damage (also interacts with acetaminophen).
Increased dose decreases O2 delivered to brain causing hypoxia
CAN RESULT IN DEATH FROM ABUSE
135
Opiod Antitussive
Codeine
136
MOA of Codeine
Depresses the medullary cough reflex in CNS
137
Codeine used for
Cough suppression, Hydrocodone also used but it is more potent and can cause respiratory depression (increased risk making it not the go to)
138
What is brand name for Guaifenesin
Robitussin or Mucinex
139
Onset of action and route of Mucinex
30 minutes and given PO, PE-ER
140
MOA of Mucinex
Reduces the viscosity of tenacious secretions by irritating the gastric vagal receptors stimulating respiratory tract fluid
141
Specific use of Guaifenesin
Cough associated with viral Upper respiratory infection
142
Do not give sudafed or mucinex to children less than
4 years old
143
Precaution patients Mucinex
- Cough lasting 1 week or longer accompanied by fever, rash, headache
- Diabetic patients- some contain sugar
- OTC and cold products containing this med should be avoided in children 4 years and younger
144
Caffeine is sometimes added to certain medications to offset what
sedative effects
145
Antihistamine medications can cause what
create environment conducive for bacteria to proliferate
146
How long should cold take to subside
7-10 days, any longer and go see PCP
147
Common symptoms of upper respiratory tract infection- viral
Rhinorrhea (runny nose), nasal congestion, cough, sneezing sore throat, hoarseness, malaise, and myalgia
148
Herbal remedies to aid in cold
Vitamin C in adults does show effectiveness but less supportive research in children.
Zinc can aid in symptom relief
