respiratory medications Flashcards
albuterol (Proventil)
C:
MOA:
I: SABA vs LABA
CI: SABA vs LABA
C: bronchodilator; beta 2 receptor agonist
MOA: stim B2 receptors in lungs –> relax SM in bronchioles = dilation, dec resist, inc cAMP
I:
- SABA: PRN, intermittent, emergency, acute
- LABA: daily use, maintenance
CI:
- SABA: nonemergency
- LABA: emergency/severe situations
albuterol (Proventil)
K:
- SABA O, P, D
- LABA O, P, D
K:
- SABA: O = 5min (strong), P = fast, D = 4-8hrs
- LABA: O = 5min (weak), P = slow, D = 12hrs
SE of albuterol (Proventil)
SNS stimulation
- rebound b.spasms
- throat irritation
- tremor/nervous/arrythmias (adult)
- tachy, palpitations
what route of B2 agonists lead to less side effects
inhaled
name short acting beta agonists (SABAs)
-“LAMP”
levalbuterol, albuterol, metoproterenol, pirbuterol
name long acting beta agonists (LABAs)
formoterol, salmeterol
pt education with albuterol (Proventil)
limit caffeine, SABA vs LABA
what should the nurse monitor when giving albuterol (Proventil)
monitor O2 sats, VS, lung sounds
theophylline
C:
MOA:
I:
CI:
C: bronchodilator; xanthine derivative
MOA: direct effect –> SM in lungs –> inhib phosphodiesterase = inc cAMP = b.dilation
I: chronic asthma (prevent/maintenance), modest bronchodilator
CI: acute attack, cardiac arryth, heart/seizure/PUD/liver pts, no babies or elders
theophylline
K: TR?
INT:
K: TR = 5-20 mcg/mL
INT: everything, check compatibility w other meds
SE of theophylline
hyperglycemia, HA, seizures, insomnia, inc HR, inc RR, dec BP, theophylline toxicity
SE of theophylline toxicity
- measurements for mild and severe theophylline toxicity
- tx?
irritable, arrythmias
- mild: 20-25 mcg/mL
- severe: >30 mcg/mL
tx: charcoal and wait
what is another xanthine derivative
aminophylline
pt education with theophylline
take without food
limit caffeine
low carb, high protein help with elimination
don’t smoke
ipratropium (Atrovent)
C:
MOA:
I:
CI:
C: bronchodilator; anticholinergic
MOA: inhib muscarinic receptors, dec cGMP, dec SM contract = b.dilation
I: maintenance
CI: bladder obs (prostate hyper.), glaucoma, peanut/soybean allergy
ipratropium (Atrovent)
K: longer D than _____
SE:
K: longer duration than B2 agonists
SE: can’t see, can’t spit, can’t pee, can’t shit
HA, dizzy, anxiety
what are other anticholinergic bronchodilators
tiotropium (long acting)
aclidinium (for COPD)
name the bronchodilator respiratory medications
albuterol (Proventil)
theophylline
ipratropium (Atrovent)
cromolyn sodium (Intal)
C:
MOA:
I:
CI:
C: anti-inflammatory; mast cell stabilizer
MOA: inhib mast cell rupture = inhib release of histamine/leukotrienes
I: prophylaxis to b.spasms/asthma
CI: acute attacks, cardiac pts (arryth), lactose intolerance
cromolyn sodium (Intal)
K: O, TR in___, exc thru___?
O = 15min
TR = 2-4wks
exc thru poop
SE of cromolyn sodium (Intal)
abrupt cessation = rebound b.spasms
HA, throat irritation, bad taste, nausea
pt education with cromolyn sodium (Intal)
drink water b4/after to sooth throat
take 15-20min before strenuous activity
what are other mast cell stabilizer anti-inflammatory medications
nedocromil, omalizumab
omalizumab (Zolair)
C:
MOA:
I:
CI:
C: anti-inflammtory; mast cell stabilizer
MOA: inhib IgE receptors = no IgE bind = no allergic response
I: pts >12yrs, mod-severe asthma
CI: acute attacks, cardiac, lactose intolerance
omalizumab (Zolair)
K: route and TR in___
SE:
K: SUBQ, TR in 2-4 weeks
SE: inj site rxn, life threatening anaphylaxis, viral infections
pt education with omalizumab (Zolair)
stay in Dr’s office for a few min to monitor for allergic rxn
what respiratory medication to take if inhaled corticosteroids don’t help
omalizumab (Zolair): anti-inflammatory mast cell stabilizer
zafirlukast (Accolate)
C:
MOA:
CI:
C: anti-inflammatory; leukotriene receptor antagonist [2nd LINE AGENTS]
MOA: inhib receptor for leukotrienes = no cysteine = no b.constriction
CI: neuropsychiatric events, liver disease
zafirlukast (Accolate)
K: route, take without ____
INT:
K: PO, take without food
INT: warfarin, theophylline, erythromycin
SE of zafirlukast (Accolate)
HA #1, dizzy, fever, rash, anaphylaxis, inc LFT
pt education with zafirlukast (Accolate)
take without food
name other leukotriene receptor antagonist anti-inflammatory medications
montelukast, zileuton
SE of zafirlukast (Accolate)
HA #1, dizzy, fever, rash, anaphylaxis, inc LFT
montelukast (Singulair)
C:
MOA:
I:
CI:
C: anti-inflammatory; leukotriene receptor antagonist [2ND LINE AGENTS]
MOA: inhib receptor for leukotrienes = no cysteine, no b.constriction
I: better option for liver disease
CI: neuropsychiatric events
montelukast (Singulair)
K: best abs at ____, how many times daily
INT:
K: best abs at night, once daily
INTR: phenobarbital, rifampin
SE of montelukast (Singulair)
HA, dizzy, fever, rash, inc LFT
pt education with montelukast (Singulair)
take at night
zileuton (Zyflo)
C:
MOA:
I:
CI:
C: anti-inflammatory leukotriene receptor antagonist [2ND LINE AGENTS]
MOA: inhib enzyme in lipoxygenase pathway = dec prod of leukotrienes
I: pts >12yrs
CI: neuropsychiatric events
zileuton (Zyflo)
K: 1/2 life
INT:
K: short 1/2 life
INT: warfarin, theophylline, propanolol
SE of zileuton
HA, fever, rash, anaphylaxis, inc LFTs
name the second line agent anti-inflammatory medications
zafirlukast, montelukast, zileuton
leukotriene receptor antagonists
flunisolide (Aerobid)
C:
MOA:
I:
C: anti-inflammatory; corticosteroids
MOA: inhib cytokine, leukotriene, prostaglandin prod = no release of inflammatory mediators
inc # of B2 receptors = promote b.dilation
airway eosinophil recruitment = immunosuppressive
I: best anti-inflammatory effect (high effective, high potent)
CI of flunisolide (Aerobid)
acute attacks
systemic fungal infections
live virus vax
HTN, CHF, PUD, diabetes, resp infections
INT with flunisolide (Aerobid)
azole antifungals, ASA
BC, barbs, diuretics, theophylline
warfarin
SE of inhaled flunisolide (Aerobid)
- what are inhaled corticosteroids for
oral fungal infections
PNA
delayed child growth
- inhaled corticosteroids are 1st line asthma tx
SE of PO/IV flunisolide (Aerobid)
- what are PO/IV corticosteroids for
anxiety, seizures, insomnia
hirsutism, obesity, buffalo hump
electrolyte imb (hyperkalemia)
striae, osteoporosis
- PO/IV corticosteroids are for short term tx
pt education with flunisolide (Aerobid)
- how many days to taper off?
- why do we need to taper off?
- don’t abruptly stop, taper off over 7 days
- taper off due to adrenal suppression
why can corticosteroids cause hirsutism
structurally similar to sex steroids
which corticosteroids are MDI
flunisolide (Aerobid), fluticasone (Advair), beclomethasone
which corticosteroids are PO
prednisone, methylprednisone
which corticosteroid is available IV
methylprednisone
