RESPIRATORY MEDS Flashcards
Treatment for Chronic Respiratory disorders often include multiple drug therapies
1 med for asthma attacks?
ALBUTEROL before any other drug during asthma attack
During Asthma attacks you give [ AIM ]
A— Albuterol
I— Ipratropium
M — Methyl-predniso-lone (Solu-Medrol)
you should take a ___ ____ before inhaled glucocorticoid (steroid), to increase steroid absorption
Beta-2 adrenergic agonist
(ALBUTEROL / FORMOTEROL, SALMETEROL / TERBUTALINE)
instructions for inhalation respiratory meds
Remove mouthpiece cap.
shake container if needed.
stand up/sit upright; exhale deeply
place mouthpiece between teeth, close lips tightly around inhaler
- breathing in press down on inhaler to activate and release.
- long,slow steady inhalation
- hold breath for 5-10 seconds
- breath in/out normally
*examine mouth for irritation
* perform frequent oral care
Medications that are Beta-2 Adrenergic Agonists?
Albuterol
Formoterol, Salmeterol
Terbutaline
Which B2 med helps with Acute Bronchospasms?
Albuterol
Which B2 med helps with LOOOng-term control of asthma?
Formoterol, Salmeterol, Terbutaline
Which B2 med helps with long term control of asthma and is Oral?
Terbutaline (Oral BUT stuff)
Precautions/interactions for B2 medications?
- Contraindicated in clients with Tachydysrhythmias
- ## Caution: DM (^ sugar), Hyperthyroidism, Heart disease, HTN, Angina, Hypokalemia ( can lower serum potassium levels)BETA BLOCKERS –> will reduce effects
- MAOIs will INCREASE effects
what medications can exacerbate asthma symptoms?
NSAIDS / Beta Blockers
Ibuprofen / Aspirin
When ALbuterol is used in LARGE amounts its loses its selectivity and activates beta-1 receptors promoting _____ _____. Adverse effects mimic the SNS and include : _____?
Tachycardia, Palpitations
Insomnia, Mild tremors, Nausea, Vomiting
Side effects of B2 meds?
Tachycardia, Palpitations, Tremors, Headaches, Hyperglycemia, Hypokalemia, Increased lactic acid accumulation, HTN
Interventions/Education?
Caution against using Salmeterol more freq. than every 12 hours.
What are Methylxanthines & what are they used for?
Relaxation of bronchial smooth muscle= BRONCHODILATION
- works in the airways by relaxing muscles, opening breathing passages, and decreasing the lungs’ response to irritants
- must be used regularly to be effective
Types of Methylxanthine meds?
“ my uncle ___ & Aunt ____takes Meth”
Aminophylline
Theophylline
precautions/interactions of Methylxanthines?
- contraindicated with Active peptic ulcer disease
Caution: DM, hyperthyroidism, Heart disease, HTN, Angina
DO NOT mix parenteral form with other meds.
- PHENOBARBITAL & PHENYTOIN decrease theophylline levels.
- Caffeine, Furosemide, Cimetidine/Ciprofloxacin
Fluoroquinolones( Antibx class), Tyenol, Phenylbutazone= falsely elevate theophylline levels
3 T’s when TOXIC for Methylxanthines ?
T– Toxic! > 20? do frequent blood draws norm: 10-20
T– Tonic Clonic Seizures 1st priority
T—Tachycardia, Dysrhythmias
2 drugs that increase toxicity risk ! —>(Cimetidine (h2 blocker)
Ciprofloxacin (abx)
Methylxanthines assoc with risk of toxicity include?
Advanced age >60
drug interactions (alcohol, macrolide, quinolone antibx)
Liver Disease
CNS stimulation (headache, insomnia, seizures)
GI Disturbances N/V
Cardiac Toxicity *arrhythmias
SIDE EFFECTS- of Methylxanthines?
“think of someone on Meth”
Irritability, restlessness, Headache, Nausea, Sleeplessness
nursing interventions/client education for Methylxanthines?
-monitor therapeutic levels for ‘AMINOPHYLLINE/THEOPHYLLINE’
- avoid caffeine intake
- monitor for signs of toxicity
- smoking will decrease effects
- alcohol abuse will increase effects.
Methylxanthines will _____ HR & therapeutic range
toxic and fast HR
10-20 therapeutic range
“ ‘phyllines will have you feelin toxic and tachycardic”
how to treat toxicity for Methylxanthines?
- stop parenteral infusion
- activated charcoal to decrease absorption in oral overdose
- Lidocaine for dysrhythmias
- Diazepam to control seizures
What are Inhaled Anticholinergics?
used for BRONCHODILATION & secretions
Anticholinergic Medications?
IPRATROPIUM
TIOTROPIUM - shouldn’t be swallowed, its an inhaler capsule
Anticholinergics will ____ secretions and ____ airways.
Decrease
Dilate
Anticholinergics will block secretions (4 S’s)
cant SEE, Pee, Spit, Shit
-block acetylcholine
*tropium– can’t see with them.
therapeutic uses of Anticholinergic medications
- To prevent bronchospasms
- Manage allergen-exercise induced asthma
- COPD
Precautions/Interactions with Anticholinergics
contraindicated for people with peanut allergy (contains soy) “RATS DON’T LIKE PEANUTS”
- EXTREME CAUTION in people with narrow-angle glaucoma & BPH
- do not use for treatment of acute bronchospasms.
Side/adverse effects of Anticholinergics?
Dry mouth and Eyes
urinary retention
Interventions/client education of Anticholinergics?
Max effect can take up to 2 weeks
- shake inhaler before admin.
- when using 2 different inhaled meds- wait 5 min between
- via nebulizer? use within 1 hours reconstitution
Glucocorticoids (corticosteroid/Steroid)
PREVENT INFLAMMATORY RESPONSE –> by suppression of airway mucus production, immune responses, adrenal function.
Glucocorticoid medications?
ORAL
Prednisone
Prednisolone
Betamethasone
Glucocorticoid medications?
INHALATION
Beclomethasone
Diproprionate
Budesonide
Fluticasone
Triamcinolone
Anti-inflammatory; S-Steroids (Beclomethasone)–what are they used for?
DO NOT USE _______ for first sign of Acute Asthma Attack
-Swelling & inflammation (cortico-reduced inflammation)
-Slow onset (DO NOT USE FLUTICASONE FOR THE FIRST SIGN OF ACUTE ASTHMA ATTACK)
Glucocorticoid medications?
IV
‘sone
hydrocortisone
methylprednisone
betamethasone sodium phosphate
–Reduce total body swelling
Glucocorticoid therapeutic use (SHORT TERM)
IV agents: status asthmaticus
ORAL: symptom trt after an acute asthma attack
Glucocorticoid therapeutic use (LONG TERM)
Inhaled: prophylaxis of asthma
Oral: treatment of chronic asthma
Steroids– Sepsis, Sickness, Sugars (NORMAL) increased, Sores in mouth (suppress immune system-slow wound healing)
^ risk for infection
^ WBC count
Precaution/Interaction with Glucocorticoids?
DM patient may need a higher dose
- Never stop abruptly
Side/ Adverse effects (Glucocorticoids/Steroids)
Euphoria, Insomnia, Psychotic behavior
- Hyperglycemia
- Peptic Ulcer
- Fluid retention
- Withdrawal symptoms
- Increased appetite
interventions/Education for Glucocorticoids?
DO NOT take with _____.
Teach client about gradual reduction of dose to prevent ______ _______.
- assess client activity and behavior
- administer med with meals
- teach symptoms to report
- DO NOT take with NSAIDs (Naproxen)
- ADDISONIAN CRISIS (low BP, Low sugar levels, HIGH K+)
Bronchodilators (BAM)
B: Beta-2 Agonist (albuterol)
A: Anticholinergics (Ipratropium)
M: Methylxanthines (Theophylline)
Anti-inflammatory (SLM)
S: Steroids (Beclomethasone)
L: Leukotriene Inhibitor (Montelukast)
M: Mast cell stabilizers (Cromyolyn)
Steroids– Sepsis & Sickness & Sugars increased
^ risk for infection
^ WBC count
what are Leukotriene Modifiers used for?
Reduce inflammation, Bronchoconstriction, Airway edema, & mucus inflammation
Leukotriene Modifiers medications?
Montelukast, Zileuton, Zafirlukast
Key Points for Leukotriene modifiers?
Not during acute attacks given
Not a rescue drug
This med will prevent inflammation that causes asthma attacks
Therapeutic use of Leukotriene Modifiers?
long term management of asthma in children/adults.
- prevention of exercise-induced bronchospasms.
Montelukast can be given to clients over the age of?
Zileuton can be given to clients over ?
Zafirlukast “”
- 1 +
- 12 + “have to be older to go to Zileuton”
- 5 +. “ZAFIR” 5 letters
Precaution/Interactions of Leukotriene Modifiers?
DO NOT use for asthma attacks
- high risk of liver disease, increased Warfarin effects, theophylline toxicity
- Phenobarbital will DECREASE circulating levels of Montelukast
- chewable tabs contain phenylalanine.
Side/Adverse Effects of Leukotriene Modifiers?
Elevated liver enzymes
- Warfarin & theophylline toxicity (zafirlukast)
- May ^ levels of BB leading to hypotension & bradycardia (propanolol)
Nursing interventions/Education of Leukotriene Modifiers?
Never abruptly substitute for corticosteroid therapy
- Teach client to take daily in the evening
- DO NOT decrease or stop taking other prescribed asthma drugs
- use open packs within 15 min of taking med.
Antitussives, Expectorants, Mucolytics what do they do?
- Suppress cough through action in the CNS
- Promote increased mucus secretion to increase cough production
- Enhance the flow of secretions in the respiratory tract
Examples of Antitussive medications?
Hydrocodone, codeine
- Suppress cough
used for chronic nonproductive cough
Examples of Expectorants?
Guaifenesin (promote ^ mucus secretion to increase cough production)
- often combined w/other agents to manage respiratory distress
Examples of Mucolytics?
Acetylcysteine (Mucomyst) - given via nebulizer to loosen and liquefy secretions to easily clear from the airway. Inhaled Acetylcysteine can be used for clients with CF or other conditions w/thick bronchial mucus; NO therapeutic effect on airway smooth muscle (works primarily on secretions)
**clarify order is pt. has asthma.
& Hypertonic Saline (enhance flow of secretions in respiratory tract
- Acute/chronic pulmonary disorders with copious secretions
- Cystic Fibrosis
- Antidote for Tylenol Poisoning
Acetylcysteine (Mucomyst): given via nebulizer to help loosen/liquefy respiratory secretions to more easily clear them.
Can be used for clients with CF.
Has no therapeutic effect on airway smooth muscle –> works
Primarily for secretions & can CAUSE/WORSEN Bronchospasms! :(
Precaution/Interactions with Antitussive/Expectorants/Mucolytics
only saline solutions should be used in children younger than 2 years
Opioid antitussives have potential for abuse
Caution with OTC meds — potentiate effects
Side/adverse effects
Drowsiness
Dizziness
Aspiration/Bronchospasm risk with mucolytics
Constipation
interventions/Education for Antitussive/Expectorants/Mucolytics
-monitor cough freq. effort, & ability to expectorate
-monitor character & tenacity of secretions
-auscultate for adventitious lung sounds
- teach client mult theapies needed
- promote fluid intake
During Asthma attacks you give [ AIM ]
A— Albuterol
I— Ipratropium
M — Methyl-predniso-lone
Which of the following prescription should the nurse question?
1. Losartan for a patient with Diabetes
2. Theophylline for a patient taking Cimetidine “dont LINE and DINE” coke
3. Atenolol for a patient with asthma
4. Ipratropium for a patient with Glaucoma
5. Naproxen (NSAID) for an asthmatic patient
-Theophylline- increases the risk for toxicity
-naproxen: never NSAIDS/BB
- Ipratropium –see spit shit poop
- Atenolol– NEVER BB for asthmatic patients
which patient teaching should be included with a new prescription of Albuterol, Ibuprofen, Tiotropium, Beclomethasone?
1. Tinnitus is an expected side effect.
2. Tachycardia is expected after Albuterol
3. Report dark stool to the provider
4. Drink fluids to prevent dry mouth and throat
5. Ipratropium is used FIRST during an attack
- NO serious SE; drug is hard on kidneys
- yes expected; T’s of albuterol; Tachycardia/Palpitation, Tremor, Toss & turning at night
- yes Ipratropium can cause dark stools
- yes
- NO– always albuterol first for brutal asthma
Which medication prescribed for asthma causes tachycardia & dysrhytmias?
Aminophylline - feelin caffeinated and amped up
(Methylxanthine)
MOA of Decongestants and Antihistamines?
- D: stimulate alpha adrenergic receptors which reduces inflammation of nasal membranes
- A: decreases the allergic
Decongestant medications & therapeutic use?
- Phenylephrine, pseudoephedrine, naphazoline
- allergic rhinitis, sinusitis, common cold
Antihistamine meds & therapeutic use?
diphenhydramine (Benadryl)
loratadine (Claritin)
cetirizine (Zyrtec)
fexofenadine (Allergra)
desloratadine
- Relieve/prevent hypersensitivity reactions
Precautions/Interactions with Decongestants/Antihistamines?
- use cautiously in patients with HTN, glaucoma, peptic ulcer disease, urinary retention
when children take Decongestants/Antihistamines?
Can have symptoms of excitation, hallucinations, incoordination, seizures
you want to avoid what when taking Decongestants/Antihistamines?
Alcohol intake
Products containing pseudoephedrine shouldn’t be used longer than 7 days
Side/Adverse effects of Decongestants/Antihistamines?
Anticholinergic effects
Drowsiness
Interventions/Education for Decongestants/Antihistamines?
Assess for Hypokalemia
Monitor BP
Teach client to manage anticholinergic effects
Advise to take at NIGHT
When ALbuterol is used in LARGE amounts its loses its selectivity and activates beta-1 receptors promoting _____ _____. Adverse effects mimic the SNS and include : _____?
Tachycardia, Palpitations, Insomnia, Mild tremors, Nausea, Vomiting
EVERYTHING’S HIGH!
