Respiratory Medications Flashcards
What are two types of bronchodilators?
Beta 2 adrenergic agonist
Anticholinergic
What type of drugs can Beta 2 adrenergic agonist be and the onset these work plus the duration?
Short Acting (SABA) - fast relief
(Immediate action, lasts 4-6 hours)
Long Acting (LABA)
(Delayed onset, lasts 8-12 hours)
What are examples of SABA and LABA?
Salbutamol (SABA)
Salmeterol (LABA)
What is the indication for use of SABA?
Short acting beta agonists are used for relief of symptomatic asthma, asthma induced by exercise, bronchospasm in COPD and for allergic reactions caused by smoke inhalation.
What is the MOA for Beta 2 Adrenergic Agonist?
Stimulates beta 2 receptors in the smooth muscles causing bronchodilation, this allows increased airflow to the lungs. Inhibit mediator release from mast cells
What are the pharmacokinetics for SABA?
rapid onset between 1-3 minutes, peak effect 1-2 hours and duration action of between 4-6 hours. Metabolised by the liver and excreted in the kidneys
What are some adverse drug reactions associated with SABA?
tremor, palpitations, anxiety, restlessness, tachycardia, headaches, hyperglycaemia
What are some patient education related to SABA?
SABA have rapid onset; administration occurs via inhalation utilising a spacer or pump (50% more medicine enters the lungs via use of a spacer and less medicine is left in the throat or mouth), relief short term symptoms. Only use when needed
What are some monitoring requirements associated with SABA?
spirometry testing, monitoring RR, HR and BP (baseline vitals), positioning to maximise air entry.
What is a caution for use of SABA?
Frequent use can result in decreased β2 agonism due to down regulation of beta receptors, results in decreased bronchodilation. β1 stimulation results in increased HR; increased anxiety; tremors
What is the indication for use for LABA?
control of asthma and COPD
What are the pharmacokinetics for LABA?
prolonged actions and half lives in the range of 6-12 hours.
What is a caution of use associated with LABA
LABA are used in combination with inhaled corticosteroids
Not to be used in the treatment of acute asthma symptoms
Where are Beta 1 receptors located?
Receptors located on the smooth muscle of the heart
Where are Beta 2 receptors located?
Smooth muscle of bronchioles
Blood vessels supplying brain, heart, kidneys and skeletal muscles
Uterus
Liver
Why are Beta-2 Agonists ideally administered through the inhaled route?
beta-2 agonists are best given by the inhaled route, which provides immediate access to the airways. The single layer of epithelial cells, the large surface area of the alveoli and the rich blood supply within the airways promote fast absorption of the drug & a rapid onset of action. Using the inhaled route rather than the oral route also means a smaller dose is required. This helps to minimise systemic side effects
What are the two forms of Anticholinergics and give an example for each?
Short acting muscarinic antagonists(SAMA) e.g. Ipratropium (Atrovent)
Long acting muscarinic antagonists (LAMA) e.g. Tiotropium (Spiriva)
What is the indication for use of Anticholinergics?
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What is the MOA of anticholinergics?
Antimuscarinic = muscarinic antagonist
Block the parasympathetic stimulation of the Vagus nerve resulting in smooth muscle relaxation and bronchodilation
What are some adverse drug reactions associated with anticholinergics?
Dry mouth
Metallic taste
Nausea
Constipation
Headache
Tachycardia
Glaucoma- with nebs and face mask
What are some patient education associated with anticholinergics?
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What is an example of inhaled corticosteroids? (preventers)
Fluticasone, Beclomethasone, Budesonide
What is the indicator for use of inhaled corticosteriods?
Used in asthma and COPD. Current guidelines specify the use of ICS for all persons with asthma
What should someone use first before the inhaled corticosteroid and why?
..
What is the MOA for inhaled corticosteroids?
Corticosteroids mimic the action of the natural glucocorticoids, the stress hormones secreted from the adrenal gland.
Specific action in the lungs:
decrease- early + late stages of inflammatory response
decrease- bronchial mucosal inflammation
decrease- bronchial hyper-reactivity
increase- responsiveness to β-agonists
What happens in the lungs with inhaled corticosteroids?
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What are some adverse drug reactions associated with inhaled corticosteroids?
Dysphonia
Oropharyngeal candidiasis (oral thrush)
In order to minimise these effects, the patient should be taught to administer their medication via a spacer and to rinse the mouth and throat after each dose.
What are some adverse drug reactions associated with oral corticosteriods?
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What are some monitoring requirements associated with corticosteroids?
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What is the patient education associated with corticosteroids?
Must be taken continuously (full effect may take weeks) and not stopped without consultation with prescriber
Inhaled corticosteroids given via inhalation (with a spacer) greatly reduces systemic adverse effects
Why would a patient with diabetes require closer monitoring of blood glucose while taking a corticosteroid?
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What measures can be taken to reduce the risk of adverse effects for inhaled corticosteroids?
In order to minimise these effects, the patient should be taught to administer their medication via a spacer and to rinse the mouth and throat after each dose.
Oral corticosteroids are best administered in the morning. Why is this?
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Discuss the nursing role in supporting the patient/client taking both bronchodilator and corticosteroids medications for asthma and COPD.
Identify the major key points to include in an education plan for someone prescribed respiratory medications
Inhaler technique
Use of a spacer – technique & care of the spacer
Action plans for managing symptoms – available on several NZ websites
ADR’s – for both inhalers and oral medications
