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52 Cards in this Set

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beta-adrenergic agonists
albuterol
formoterol (Foradil Aerolizer)
beta-adrenergic agonists
salmeterol (Serevent)
beta-adrenergic agonists
terbutaline (Brethine)
beta-adrenergic agonists
beta-adrenergic agonists MOA
acts by selectively activating the beta2- receptors in the bronchial smooth muscle, resulting in bronchodilation
as a result:
bronchospasm is relieved
histamine release is inhibited
ciliary motility is increased
beta-adrenergic agonists albuterol (Proventil, Ventolin) use
inhaled, short-acting- prevention of asthma episode (exercise-induced)
prevention of asthma

oral, long-acting- (treatment for bronchospasm)
long-term control of asthma
beta-adrenergic agonist formoterol (Foradil Aerolizer)
Salmeterol (Servent) use
inhaled, long-acting- long-term control of asthma
beta-adrenergic agonist terbutaline (Brethine) use
oral, long-acting- long term control of asthma
beta-adrenergic agonist adverse
oral agents can cause tachycardia and angina because of activation of alpha receptors in the heart- check pulse and report an increase of greater than 20-30 beats per minute, avoid caffeine

tremors caused by activation of beta receptors in skeletal muscle- tremors usually resolve with continued med use, dosage may need to be reduced
beta-adrenergic agonist contraindications
tachydysrhythmia
diabetes, hyperthyroidism, heart disease, hypertension, angina
beta-adrenergic agonist interactions
beta-adrenergic blockers should not be used together
MAOI, TCA can increase risk of tachycardia and angina
beta-adrenergic agonist admin
when taking beta2 agonist and glucocorticoid together: inhale beta 2 first because it promotes bronchodilation and enhances absorption of glucocorticoid

formoterol and salmeterol are both long-acting beta-agonist inhibitors. These inhalers are used every 12 hours for long term control and not used to abort an acute asthma attack, or exacerbation.
These long-acting agents are not used alone but are prescribed in combination with an inhaled corticosteroid
short-acting beta 2 is used to treat an acute episode
beta-adrenergic agonist effectivenss
long-term control of asthma
prevention of exercise-induced asthma
resolution of asthma exacerbations
methylxanthines
theophylline (Theolair, theo-24)
methylxanthines MOA (theophyline)
casues relaxation of bronchial smooth muscle, resulting in bronchodilation
methylxanthines uses (theophyline)
long-term control of chronic asthma or COPD
oral or IV
methylxanthines adverse
mild toxicity reaction: GI distress and restlessness- monitor theophylline levels to keep within therapeutic range 5-15 mcg/mL
severe reactions can occur with higher therapeutic ranges that can include dysrhythmias and seizures
methylxanthines contraindications
heart disease, hypertension, liver and kidney dysfunction and diabetes
methylxanthines interactions
caffeine increases CNS and cardiac adverse effects of theophylline
caffeine can increase theophylline levels
phenobarbital and phenytoin decrease theophylline levels- when these meds are used with theophylline, increase dosage of theophylline
cimetidine (Tagament), ciprofloxacin (Cipro), and other fluroquinone antibiotics increase theophylline levels- decrease dosage of theophylline
methylxanthines effectiveness
long term control of asthma and COPD
inhaled anticholinergics
ipratropium (Atrovent)
tiotropium (Spiriva)
inhaled anticholinergics MOA
block muscarine receptors of the bronchi, resulting in bronchodilation
inhaled anticholinergic use
relieve bronchospasm associated with COPD
allergen-induced and exercise induced asthma
inhaled anticholinergic adverse
local anticholinergic effects (dry mouth, hoarseness)
inhaled anticholinergic contraindications
peanut allergy because medical preparations may contain soy lectin
caution with narrow-angle glaucoma and benign prostatic hyperplasia due to anticholinergic effects
inhaled anticholinergic admin
usual adult dosage is two puffs, instruct clients to wit the length of time directed between puffs
of two inhaled meds are prescribed, instruct clients to wait at least 5 min between meds
inhaled anticholinergic effectiveness
control of bronchospasm in clients who have COPD
prevention of allergen-induced and exercise induced asthma
glucocorticoids
inhalation: beclomethasone (QVAR)
Oral: prednisone (Deltazone)
budesonide (Pulmicort)
glucocorticoid
budesonide and formoterol (Symbicort)
glucocorticoid
fluticasone and salmetrerol (Advair)
glucocorticoid
fluticasone (Flovent)
glucocorticoid
mometasone furoate and formoterol fumarate dihydrate (Dulera)
glucocorticoid
prednisolone (Prelone)
glucocorticoid
hydrocortisone sodium succinate (Solu-Cortel)
glucocorticoid
methylprednisolone sodium succinate (Solu-medrol)
glucocorticoid
glucocorticoid MOA
prevents inflammation, supress airway mucus production, and promote responsiveness of beta 2 receptors in the bronchial tree
does not provide immediate effects, but rather promotes decreased frequency and severity of exacerbations and acute attacks
glucocorticoid Use
short-term IV agents are used for status asthmaticus
inhaled agents are used for long-term prophylaxis of asthma
short-term oral therapy is used to treat manifestations following an acute asthma episode
long-term oral therapy is used to treat chronic asthma
promote lung maturity and decrease respiratory distress in fetuses at risk for preterm birth
glucocorticoid adverse
difficulty speaking, hoarseness, and candidiasis
prednisone when used 10 days or more adverse
suppression of adrenal gland function-administer oral glucocorticoid on an alternate day dosing schedule
bone loss, hyperglycemia and glucosuria
myopathy as evidenced by muscle weakness
PUD- avoid NSAIDS
Infection
fluid and electrolytes, edema, hypokalemia
glucocorticoid contraindications
clients who have received a live virus vaccine and those with systemic fungal infections
caution in children, diabetes, hypertension, PUD, kidney dysfunction
NSAIDS
glucocorticoid interactions (prednisone)
concurrent use of postassium-depleting diuretics increases the risk of hypokalemia
concurrent use of NSAIDS
concurrent use of glucocorticoids and hypoglycemic agents (oral and insulin) counteract the effects
glucocorticoid admin
inhaled glucocorticoids are to be used on a fixed schedule for long term therapy of asthma- they are not to be used to treat acute episodes
oral glucocorticoids are used for short-term, 3-10 days following an acute asthma exacerbation
glucocorticoid effectiveness
long-term control of asthma
resolution of acute exacerbation
leukotriene modifiers
proto: montelukast (Singulair)
other: zileuton (Zyflo), zafirlukast (Accolate)
leukotriene modifier MOA
prevent effects of leukotrienes, thereby suppressing inflammation, bronchoconstriction, airway edema, and mucus production
leukotriene modifier use
long-term therapy of asthma in adults and children, and to prevent exercise-induced bronchospasm
leukotriene modifier adverse
liver injury with use of zileuton (Zyflo) and zafirlukast (Accolate)
leukotriene modifier contraindications
liver dysfunction
Singulair and Accolate pregnancy category B
leukotriene modifier interactions
zileuton and zafirlukast inhibit metabolism of warfarin leading to increased warfarin levels
zileuton and zafirlukast inhibit metabolism of theophylline, leading to increased theophylline levels
leukotriene modifier admin
zileuton can be given with or without food
avoid taking zafirlukast with food, and take it 1 hour before or 2 hours after meals
take montelukast once daily at bedtime
leukotriene modifier effectiveness
long-term control of asthma