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Pharm Exam 2 > Respiratory Meds > Flashcards

Respiratory Meds Flashcards

1
Q

bronchodilation

A

B2 adrenergic receptor stimulations
adrenergic agonist (sympathomimetics)
*cholinergic. antagonist (parasympatholytic)

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2
Q

Bronchoconstriction

A

parasympathetic receptor stimulation in bronchial smooth muscle, irritants & inflammatory mediators
*adrenergic antagonist (sympatholytics)
cholinergic agonist (parasympatholytics)

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3
Q

asthma

A

typically intermittent
airflow limitation
younger age
ICS is highly effective
wheezing, chest tightness (especially @night)
allergic rhinitis or atopic dermatitis (eczema)
predominately mast cell eosinophil inflammation
result in bronchoconstriction & inflammatory cell infiltration

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4
Q

COPD

A

slowly, progressively worsening, persistent Sx
predominately neutrophil inflammation
aiflow obstruction
usually older ppl & smokers
ICS responds poorly
chronic bronchitis
morning cough w/ phlegm

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5
Q

ALL RESP. Pts NEED a …

A

*RESCUE INHALER
short-acting beta2 agonist (SABA) bronchodilators

new practice recommendations: for moteros & corticosteroids (asthma only)

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6
Q

SABA MOA
(2) -buterol

A

Alburéelo & Levalbuterol
(1)binds to b2 adrenergic receptors in airway smooth muscle. increases cAMP activates kinases=> decreases intracellular Ca=> relaxes smooth muscle=> BRONCHODILATION
(2)relatively selective to b2 (pulmonary) receptors

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7
Q

SABA Precautions

A

cardiac disease & hyperthyroidism

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8
Q

SABA ADRs/SE:

A

chest pain
palpitations
nervousness
restlessness
tremors
PARADOXICAL BRONCHOSPASMS

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9
Q

SABA med action

A

R: Inhalation
O: 5-10 mins
P: 1-1.5 hrs
D: 4-6hrs

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10
Q

SABA nursing assessment

A

Lungs, HR, BP,
sputum color, amount, characteristics
may cause transient hypokalemia
*PARADOXICAL BRONCHOSPASM (w/hold med & notify provider)

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11
Q

SABA Pt. EDU

A

shake inhaler well, @ least 1 min between inhalation
New inhaler- prime 1st (4 sprays into air/away from face)
discard after 200 sprays
DONT double or increase doses
if using another inhaler use ALBUTEROL 1st then other med after 5 mins

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12
Q

LABA meds
(5) -terol

A

Salmetorol
Formoterol
Indacaterol
Arformoterol
Olodaterol

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13
Q

LABA MOA

A

(1) airway smooth muscles relaxation through beta-adrenergic receptors
(2) specific for b2-receptors
NOT TO BE USED FOR MONO-THERAPY (increase risk for asthma related death)

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14
Q

LABA ADRs/SE

A

hypersensitivity, PARADOXICAL BRONCHOSPASM

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15
Q

LABA Nursing Assessment

A

lungs, HR, BP
sputum color, amount, characteristics
Paradoxical bronchospasm: stop med & notify provider, may prolong QTC interval
may cause hyperglycemia & hypokalemia

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16
Q

LABA Pt. EDU

A

DONT double dose
Dont use less than 12 hrs apart
(bronchospasms/loss of effectiveness)
Notify HCP immediately for SOB not relieved by SABA

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17
Q

Inhaled corticosteroids - use w/ LABA
meds

2

A

budesonide
fluticasone

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18
Q

Inhaled corticosteroids - use w/ LABA
MOA

A

potent, locally acting anti-inflammatory & immune modifier

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19
Q

Inhaled corticosteroids - use w/ LABA
precautions

A

Diabetes, glaucoma

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20
Q

Inhaled corticosteroids - use w/ LABA
ADRs/SE

A

otitis media, HA, orophangeal fungal infections
**anaphylaxis **

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21
Q

Inhaled corticosteroids - use w/ LABA
nursing assessment

A

Resp. system
s/s life threathening adrenal insufficiency
(anorexia, N, weakness, fatigue, hypotension, hypoglycemia)
Increase in glucose

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22
Q

Inhaled corticosteroids - use w/ LABA
med action

A

R: inhalation & nebulizer
O: w/in 24 hrs & 2-8 days
P 1-4 wks & 4-6 wks
D: unknown

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23
Q

Inhaled corticosteroids - use w/ LABA
pt edu

A

allow 1 min between inhalation
dont use w/ spacer
DONT shake inhaler
gradual decrease is required
if using rescue inhaler wait 5 min after to administer corticosteroid
rinse mouth w/ water after Tx

24
Q

LAMA
Meds

(2) -tropium bromide

A

Ipratropium bromide
Oxitropium bromide

25
Q

LAMA MOA

A

blocks muscarinic receptors in bronchi & produces local bronchodilation

26
Q

LAMA CI

A

soy, atropine, belladonna, peanut allergies

27
Q

LAMA precautions

A

urinary rentention, glaucoma, bladder neck obstruction, prostatic hyperplasia

28
Q

LAMA ADRs/SE

A

minimal, dry mouth, pharynx irritation, constipation, dry eyes intraocular pressure raised w/ glaucoma

29
Q

LAMA med actions

A

R: inhalations
O: 1-3 mins
P: 1-2 hrs
D: 4-6 hrs

30
Q

LAMA nursing assessment

A

soy, peanut, atropine, belladona, allergies & resp. system

31
Q

LAMA pt edu

A

Not to exceed 12 doses w/in 24 hrs
rinse mouth after inhaler use
sugarless candy/gum for dry mouth

32
Q

Leukotriene receptors anatagonist (LTRAs)
Meds

(2) -lukast & (1) *asthma med

A

zileuton
zafirlukast
**montelukast (prototype) **

33
Q

LTRAs MOA

A

(1) suppress effect of leukotrienes (compound promotes smooth muscle constriction, blood vessel permeability, inflammatory response through eosinophil & other inflammatory cell recruitment
(2) decrease edema & mucus in asthma & allergies
NOT A RESCUE MED!

34
Q

LTRAs ADRs/SE

A

suicidal behavior/thoughts

35
Q

LTRAs med actions

A

R: PO swallow & chew
O: w/in 24 hrs
P: 3-4 hrs & 2-2.5 hrs
D: 24 hrs

36
Q

LTRAs nursing assessment

A

resp. system, allergy symptoms, behavior changes - depression/SI

37
Q

LTRAs pt edu

A

take at least 2 hrs prior to exercise
DONT treat acute asthma symptoms
always carry rapid acting inhaler
alertness for anxiety, agitation, worsening, depression, SI

38
Q

Monoclonal Antibodies
meds

(5) -umab

A

anti-IgE: Omaltizumab
interlukin-5: Benralizumab, Mepolizumab, Reslizumab
interlukin-4 Dupilumab

39
Q

Monoclonal Antibodies
MOA

A

Inhibit binding to IgE mast cell & eosinophils receptors, lowering IgE on basophils

40
Q

Monoclonal Antibodies
precautions

A

anaphylaxis to food, meds, or other causes

41
Q

Monoclonal Antibodies
ADRs/SE

A

MI
Venous thromboembolism

42
Q

Monoclonal Antibodies
med actions

A

R: SubQ
O: w/in 1hr
P: unknown
D: up to 1 hr

43
Q

Monoclonal Antibodies
nursing assessment

A

resp. system
allergy Sx/reactions; monitor injection site

44
Q

Monoclonal Antibodies
pt. edu

A

1st 3 injection administered by HCP
reconstitute viscous solutions as directed using 18G needle then replace w/ 25G into thigh, abd (2” away naval) upper arm
teach injection techniques & allergic reactions S/S

45
Q

Phosphodiesterase-4 inhibitors Refractory COPD
med

(1)

A

Roflumilast

46
Q

Phosphodiesterase-4 inhibitors Refractory COPD
MOA

A

decrease neutrophils, eosinophils, & total cells in sputum
decrease COPD exacerbation

47
Q

Phosphodiesterase-4 inhibitors Refractory COPD
MOA

A

diarrhea
reduced appetite
weight loss
hypersensitivity
suicide thought/behaviors

48
Q

Phosphodiesterase-4 inhibitors Refractory COPD
dose

A

250mg once daily X 4wks then increase to 500 mcg once daily

49
Q

Phosphodiesterase-4 inhibitors Refractory COPD
med actions

A

R: PO
O & P: unknown
D: up to 1yr

50
Q

Xanthine- Refractory COPD/Asthma
Med

(1)

A

Theophylline
long-term control 2nd, 3rd line agent

51
Q

Xanthine MOA

A

bronchodilation
cns stimulation
positive inotropic/chronotropic effects
diuresis
gastric acid disease
hypothyroidism
PUD
seizures

52
Q

Xanthine ADR/SE

A

seizures
arrhythmias
anxiety
n/v
tachycardia

53
Q

Xanthine med actions

A

R: Po , PO-ER, IV
O: Rapid, Delayed, Rapid
P: 1-2hrs, 4-8 hrs, end of infusion
D: 6hrs, 8-24 hrs, 6-8 hrs

54
Q

Xanthine nursing assessment

A

resp. system
VS
I & O
weights (FVO)
ECG

55
Q

Xanthine pt edu

A

drink plenty of water (2000ml/day minimum)
serum blood levels 6-12 months

56
Q

ealry asthmatic response

A

30mins-1hrs
activates inflammatory cells & cytokinesis = vasodilation bronchospasms (bronchial smooth muscle contraction) & tenacious mucus secretion which narrows airway & obstructs airflow
clinical manifestations: chest constriction, expiratory wheezing dyspnea, nonproductive cough, prolonged expirations, tachycardia & tachypnea

57
Q

Late asthmatic response

A

4-8 hrs after early response
increase airway hyperresponsiveness
untreated inflammation can cause airway remodeling

Pharm Exam 2 (7 decks)

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