Unit 6 pt 2 - Respiratory meds Flashcards
What is asthma?
Bronchoconstriction, swelling of the airway, and thickening of mucus.
Status asthmaticus
An emergency situation when an asthma attack does not respond to epi and albuterol.
What is chronic bronchitis?
No bronchoconstriction, but thickening of mucus and swelling of the airway.
What is emhysema?
The alveoli don’t work well anymore.
What is COPD?
Combination of chronic bronchitis and emphysema. No bronchoconstriction, but alveoli are not working well and there is mucus and swelling of the airways.
What do leukotrienes cause?
These are released when an allergic substance (like cat hair, dust) starts a series of chemical reactions in the body -> causing inflammation, bronchoconstriction, and mucus production.
Antihistamines
MOA: Compete for H1/H2 receptors to block the histamine from binding.
Uses: Vertigo, motion sickness, insomnia, allergies.
Considerations:
1. discontinue a couple days before allergy testing.
2. Check for contraindicated conditions (asthma, lower respiratory infection). They can also aggravate peptic ulcer disease, BPH, hypertension, and glaucoma.
3. These meds are used very cautiously if at all in pregnancy.
4. Teach pt’s to avoid alcohol and driving when sedated.
5. Tell them to take with meals!
H1 blockers (1st vs 2nd gen)
H1 blockers 1st gen: Benadryl (diphenhydramine), meclizine, promethazine - work both peripherally and centrally (on the nervous system). These have anticholinergic effects so they can be pretty sedating (drowsiness, dizziness) and drying out (dry mouth).
H1 blockers 2nd gen: Loratidine, cetirizine, fexofenadine. Peripherally acting so no sedating effects. Still can get anticholinergic side effects of dry mouth/dry nose, and fatigue.
Andrenergic decongestants (pseudoephedrine)
Causes rebound congestion if used more than 3 days. May not be taken with caffeine. Watch for other OTC meds interactions. Teach the pt. that it can make you feel jittery and overstimulated. Contraindications in CNS stimulation, hypertension, and heart palpitations. Can aggravate BPH, hyperthyroid or any hyper condition, and diabetes.
Anticholinergic decongestants (ipratropium)
Doesn’t cause rebound congestion. May cause sedation and dry mouth/sinuses. Contraindications in CNS stimulation, hypertension, and heart palpitations. Can aggravate BPH, hyperthyroid or any hyper condition, and diabetes.
Opioid antitussives (cough syrups containing morphine, hydrocodone) and nonopioid (dextromethorphan, tessalon-perles)
MOA: Suppress cough reflex in the brain (opioid) and the back of the throat (non-opioid)
Side effects: N/V, constipation, drowsiness, dizziness, headache, respiratory depression.
Considerations: Give this for a dry cough, not a wet cough! We WANT them to cough if it’s a productive cough. Don’t drive due to sedation. May be contraindicated in head injuries, and if they’re taking any other sedating meds or opioid meds.
Expectorants (Guaifenesin)
MOA: Thins out mucus so that you can cough better.
Uses: Lower respiratory issues like colds, pertussis, measles.
Side effects: dry mouth, dizziness, weakness, headache, constipation.
Considerations: Used for a wet cough, not a dry cough! Cautious use in elderly patients and in asthma. Teach pt. to increase fluid intake
Echinacea
MOA: reduces symptoms of common cold and the recovery time.
Side effects: GI upset, dermatitis (or rash), dizziness, headache.
Considerations: If someone has spring allergies they may not tolerate this product well because it is from a daisy.
Bronchodilators
MOA: Dilate the muscles in the airway.
Selective beta 2 agonists
Albuterol (short-acting), levalbuterol (short-acting), and salmeterol (long-acting).
Uses: Asthma.
Side effects: N/V, insomnia, hyperglycemia, tremors/jitters, chest pain, palpitations, anxiety.
Considerations: Severe restlessness, anxiety, and chest pain should be reported to the provider
Non-selective drugs
Epinephrine, metaproterenol.
Uses: Asthma.
Side effects: N/V, insomnia, hyperglycemia, tremors/jitters, chest pain, palpitations, anxiety.
Considerations: Severe restlessness, anxiety, and chest pain should be reported to the provider.
Anticholinergics (Ipratropium aka atrovent)
Uses: Often for COPD, not asthma.
Side effects: GI upset, headache, anxiety, dry mouth.
Considerations: Cautious use in elderly patients.
Xanthines (caffeine, theophylline)
MOA: On top of bronchodilation, they can stimulate the CNS and cardio systems.
Uses: Any resp issue - adjunct management of COPD, asthma, bronchitis, emphysema. Caffeine is literally given to NICU babies to help them breathe better! Crazy.
Side effects: N/V, tachycardia, anxiety, increased urine output, hyperglycemia.
Considerations: Same as the other ones, but if there’s severe anxiety and palpitations, the provider needs to know. Also, with theophylline, the person on it has to watch how much chocolate and caffeine (coffee, energy drinks) they consume. Drug interactions with lots of abx and influenza vaccines.
Leukotriene receptor antagonists (LRTAs) - Monteleukast
MOA: prevent leukotrienes from attaching to receptors in the lungs, therefore blocking inflammation and relieving asthma symptoms.
Uses: asthma, allergic rhinitis, MCAS. Mainly used as prophylaxis and long-term treatment - not for short-term reactions.
Side effects: Headache, GI upset (nausea) are the main ones, hepatotoxicity.
Black Box Warning for neuropsych events (mood swings, depression, psychosis, suicidal ideation).
Considerations: Assess liver function before therapy and throughout it. Take meds every single night; don’t stop when symptoms are relieved. Give to pt’s 12 years and older; cautious use in pregnancy and breast-feeding.
Corticosteroids - Prednisone, Methylprednisolone, Fluticasone (Flonase)
MOA: Decreasing overall inflammation in the body.
Uses: Chronic asthma, not used for relieving acute symptoms.
Side effects: Nasal irritation, headache, hyperglycemia, GI upset, PUD, weight gain, osteoporosis, adrenal insufficiency.
Considerations: May take several weeks before seeing full effect. Watch for fungal infections. Never stop taking oral form abruptly
Monoclonal Antibody - Omalizumab
MOA: Selectively binds to IgE and limits the release of inflammatory mediators (mast cell mediators - histamine, leukotrienes). It brings down the overall allergic response.
Uses: Chronic asthma, chronic allergies, MCAS.
Side effects: injection site warmth/redness/stinging, headache, joint and muscle pain, dizziness, sore throat, potential immunosuppression. ‘
Considerations: This does have the potential to cause anaphylaxis. They will need to avoid exposure to triggers for bronchospasms. Also they will need to avoid excessive exposure to heat or fatiguing conditions
Inhaler instructions
Take 1 minute in between each puff of the same medication, no matter the inhaler.
Albuterol used before corticosteroids - wait 5 minutes in between.
Swish and spit after corticosteroid inhalers.
Spacers used for people who have coordination issues.
Pseudoephedrine is contraindicated in what conditions?
Hypertension, glaucoma, and any heart disease.
How does albuterol work?
Stimulating the fight-or-flight (SNS) system to bronchodilate.
