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Pharmacology > Week 6 Lower Resp > Flashcards

Week 6 Lower Resp Flashcards

1
Q

A patient with many adverse reactions to drugs is tried on inhaled steroid for the treatment of bronchospasm. For the first days, the patient does not notice any improvement. You should:
A. switch the patient to a xanthine
B. encourage the patient to continue the drug for 2 to 3 weeks
C. switch the patient to a sympathomimetic
D. try the patient on an anticholinergic.

A

B.
- The medication takes a while to kick in and see change
- Encourage to keep trying and then reassess

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2
Q

Children considerations

A
  • Antihistamines used frequency
  • Incidence in asthma is rapidly increasing
  • Educate on trigger avoidance
  • Growth and hormone changes w/ puberty; may require dosing changes
  • Progression of the disease may also require medication changes
  • More susceptible to adverse effects
  • Teach how to exercise safely
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3
Q

Adult considerations

A
  • Can control asthma well with compliance and trigger avoidance
  • Avoid/ use caution in pregnancy/ lactation
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4
Q

Older adult considerations

A
  • Increased susceptibility to adverse effects
  • May dose adjust based on liver/ kidney function
  • Drug regimen for COPD can be complicated!
  • Treatment should also include a nondrug; plan toileting, positioning, fluids, nutrition, activity
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5
Q

Xanthies prototype drug

A

theophylline

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6
Q

Sympathomimetics prototype drug

A

epinephrine

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7
Q

Anticholinergics prototype drug

A

ipratropium

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8
Q

Inhaled steroids prototype drug

A

budesonide

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9
Q

Therapeutic actions: xanthines

A

Direct effect on the smooth muscles of the respiratory tract
- bronchodilation, increases force of diaphragmatic muscles

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10
Q

Indications: xanthines

A
  • Bronchial asthma, bronchospasm associated w/ COPD
  • not 1st line use
  • used mainly in ICU setting
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11
Q

Pharmacokinetics: xanthines

A

Oral: peak 2 hrs
IV: peak w/in mins
- Widely distributed, metabolized in liver and excreted in urine, crosses placenta/ lactation

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12
Q

Adverse effects: xanthines

A
  • severity of effects are related to levels of drug in the body
  • n/v/ headache, irritability
  • hyperglycemia, hypotension, cardiac arrythmias, seizures, brain damage, and death
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13
Q

Contradictions: xanthines

A
  • GI problems, coronary disease, renal/ hepatic, alcoholism, hyperthyroidism
  • avoid use in pregnancy/ lactation
  • caution in smokers who decrease or d/c smoking
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14
Q

drug-drug interactions: xanthines

A

-Substances in cigarettes
- pt who smoke may require increased dose> doses can lead to toxicity
- many drug interactions for those metabolized in liver

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15
Q

nursing considerations: xanthines

A
  • monitor for adverse effects
  • resp: lung sounds, cough, evaluate effectiveness
  • CV: BP, HR, EKG
  • Labs: serum theophline levels, liver function test
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16
Q

Therapeutic action: sympathomimetics

A

Alpha and beta receptor sites of sympathetic nervous system
- bronchodilation, increase heart rate and respiratory rate and BP

17
Q

indications: sympathomimetics

A
  • Acute asthmatic attacks, respiratory distress of COPD and bronchial asthma, anaphylactic reactions
18
Q

Adverse reactions : sympathomimetics

A
  • fear, anxiety, reslessness, headache, nausea, decreased renal formation, pallor, palpation, tachycardia, local burning, rebound congestion
  • Bronchodialtion > increased VS
19
Q

Contradiction: sympathomimetics

A
  • Avoid/ use caution in conditions that would be aggravated by sympathetic stimulation> unless benefit outweighs risk
  • cardiac disease, vascular disease, arrhythmias, diabetes, hyperthyroidism
  • pregnancy/ lactation
20
Q

Drug-drug interaction: sympathomimetics

A
  • General anesthetics agents; cyclopropane and halogenated hydrocarbons
21
Q

nursing considerations: sympathomimetics

A
  • monitor adverse effects
  • resp: effort, lung sounds, evaluate effectiveness
  • Neuro: orientation, reflexes, and CNS effects
  • Cardiac: HR, BP, EKG
  • use minimal amount needed for shortest period
  • used for acute bronchospam/ rescue
22
Q

Therapeutic actions: anticholinergics

A

Anticolinergics> blocks vagally mediated reflexes

23
Q

Indications: anticholinergics

A
  • Maintenance treatment of bronchospasm of COPD, allergic rhinitis nasal spray
24
Q

Pharmacokinetics: anticholinergics

A
  • inhaled: onset 15 min, peak 1-2 hrs, duration 3-4 hrs
25
Q

adverse effects: anticholinergics

A
  • Effects look like SNS
  • Nervousness, dizziness, headache, nausea, GI distress, cough, palpations
  • DRYING
26
Q

Contraindications: anticholinergics

A
  • Conditions aggravated by anticholinergic effects (relaxation)
  • glaucoma, bladder neck obstruction, prostatic hypertrophy
  • careful use for acute bronchospasm> potential for paradoxical bronchoconstriction
27
Q

Drug-drug interaction: anticholinergics

A
  • Avoid combining w/ other anticholinergics
28
Q

Nursing considerations: anticholinergics

A

Resp: effort, lung sounds, evaluate effectiveness
Neuro: orientation, reflexes, CNS
Cardiac: HR, BP, EKG
GU: urinary output and prostate palpation
- void before each dose
- encourage hydration!
- inhaler demonstration

29
Q

Therapeutic actions: inhaled steroids

A

Decrease the effectiveness of the inflammatory cells
- decreased swelling of the airway

30
Q

Indications: inhaled steroids

A
  • Prevention and treatment of asthma, maintenance treatment of COPD, adjunctive therapy to bronchodilators
31
Q

Pharmacokinetics: inhaled steroids

A

Inhaled: rapidly absorbed but take 2-3 wks to reach peak effectiveness
- metabolized in the liver, excreted in urine
- oral cross the placenta/ lactation

32
Q

Adverse effects: inhaled steroids

A
  • sore throat, hoarseness, coughing, dry mouth, mouth/ throat fungal infections
  • sores can lead to systemic absorptions and effects
33
Q

Contraindications: inhaled steroids

A
  • NOT FOR EMERGENCY USE in asthma
  • caution in pregnacy
  • caution w/ active infections
34
Q

Drug-drug interactions: inhaled steroids

A

NONE

35
Q

Nursing considerations: inhaled steroids

A
  • Wash mouth after use> prevent thrush
  • steroids can impact immune system> do not use w/ resp infections
  • consistent use for the first couple of weeks
  • resp: evaluate effectiveness, monitor for lung infection
    Temp: watch for infection
    mouth/ throat: lesions

Pharmacology (13 decks)

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