Week 6: Lower Respiratory Drugs

Question 1

Intrinsic asthma?
Extrinsic asthma?

Answer 1

no hx of allergies

clients with known allergy exposed to the allergen

Question 2

Status asthmaticus

What is it?
Last how long?

What is used to treat status asthmaticus?

Answer 2

Prolonged asthma attack that does not respond to typical drug therapy

May last several minutes to hours

MEDICAL EMERGENCY!!!!

AIM:
Albuterol
Ipratropium
methelynespresilone

Question 3

Drugs to Treat Asthma
Quick Relief

3

Answer 3

Short-acting inhaled beta2 agonists

Anticholinergic agents

IV systemic corticosteroids

Question 4

Drugs to Treat Asthma
Long-Term Control/Maintenance

4

Answer 4

Long acting beta2 agonists (LABAs)

LABAs combined with inhaled corticosteroids

Inhaled corticosteroids

Leukotriene receptor agonists
Anticholinergic agents
Mast cell stabilizers

Question 5

Drugs to Treat the LRT: Beta-
Adrenergic Agonists

SHORT ACTING?

Answer 5

albuterol

Question 6

Albuterol (SABA)

What may negate therapeutic effect?
Don’t give with what? and why?

Answer 6

Short acting beta agonist

Must not be used too frequently

**Beta-blockers may negate therapeutic effect!!!!!

DON’T give with caffeine-containing herbs (cola nut, guarana, mate, tea, coffee) can increase stimulant effect

Question 7

SABAs

Nursing Implications

How are inhalers used?
same inhaler?
2nd inhaler?

Answer 7

For ANY inhaler:

if 2 puffs from the same inhaler, wait 1-2 minutes in between puffs;

if using a 2nd inhaler wait 2-5 minutes or the Rx’d amount of time after the first inhaler

Question 8

Beta-Adrenergic Agonists- LABAs

LONG ACTING?

Answer 8

Salmeterol

Question 9

Salmeterol

Never use for what?
Don’t give more than?
What may negate therapeutic effect?
Don’t give with what? and why?

Answer 9

Never to be used for acute tx

Should never be given more than twice daily, nor should the maximum daily dose (one puff BID) be exceeded

**Beta-blockers may negate therapeutic effect!!!!!

DON’T give with caffeine-containing herbs (cola nut, guarana, mate, tea, coffee) can increase stimulant effect

Question 10

Beta-Adrenergic Agonists- LABAs
Nursing Implications

never use as?
dont use to treat what symptoms?

Answer 10

These drugs should be used alongside an inhaled corticosteroid, NOT AS MONOTHERAPY!!!

DO NOT USE LABA TO TREAT ACUTE SYMPTOMS

Question 11

Anticholinergics

Ipratropium (Maintenance therapy for COPD)

used with what?
Asses for what?
Side effects?

Answer 11

DuoNebs (albuterol + ipratropium)
Bronchodilator

Assess for allergies to other anticholinergics such as atropine

Cant see
Cant pee
Cant spit
Cant shit

Question 12

Xanthine Derivatives

Natural xanthines? 2
Synthetic xanthines? 1

Answer 12

Theophylline
caffeine

aminophylline

Question 13

Xanthine Derivatives

Therapeutic range for theophylline?

What assessment should u do?

What should you avoid? and why?

Answer 13

Therapeutic range for theophylline blood level is 10 to 20 mcg/mL

Make sure you do a thorough cardiac assessment

Avoid charcoal broiled
High protein
Low-carb food

(will reduce serum levels of xanthines)

Question 14

theophylline adverse effects for cv?

Note what?

Answer 14

Sinus tachycardia
Extrasystole
Palpitations
Ventricular dysrhythmias

*note intake of caffeine

Question 15

What happens if theophylline is infused too quickly?

Answer 15

hypotension w/ possible syncope tachycardia
seizures
cardiac arrest

Question 16

Leukotriene Receptor Antagonists

Montelukast (CHRONIC)

Can be used in who and cause what?

Dont use with what drug?

Why might some clients need to avoid this drug?

Answer 16

Can be used in children 1 year old and older

Can cause suicidal thoughts/behaviors

do not use with rifampin

chewable tablets contain aspartame,
assess for allergies as some clients may need to avoid it

Question 17

Corticosteroids (Glucocorticoids)

Used for acute or chronic?

Answer 17

Used for chronic respiratory symptoms

Question 18

Corticosteroids (Glucocorticoids)

fluticasone propionate (long acting)

dont give if? two

Answer 18

CONTRAINDICATION:
hypersensitivity to glucocorticoids

Clients with Candida (yeast) organisms (Thrush)

Question 19

Inhaled
Corticosteroids (Glucocorticoids)

fluticasone propionate

Do what after taking it?
What do u use first? bronchodilator or cortecosteroid?

Answer 19

Gargle and rinse the mouth with lukewarm water afterward to prevent oral fungal infections

If a beta agonist bronchodilator and corticosteroid inhaler are both ordered

bronchodilator should be used several minutes before the corticosteroid to provide bronchodilation before
administration of the corticosteroid

Question 20

Corticosteroids (Glucocorticoids)

aiM
methylprednisolone

What is it used for?
May increase requirement for what?
Monitor what?
avoid what?

Answer 20

acute exacerbation of asthma or COPD

May increase requirement for insulins or oral hypoglycemic
agents

Monitor serum glucose levels

Avoid live vaccines

Question 21

PDE4 Inhibitor

roflumilast (COPD)

What is it used for?
adverse effetcs?

Answer 21

prevent cough and excess mucous from worsening and decrease the frequency of life-threatening COPD exacerbations

suicidal thoughts/behavior
weight loss