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112 Cards in this Set

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What is the purpose of bronchodilators? How is this achieved?
Purpose is to increase size of smooth muscle bands by relaxing and opening bronchial and bronchiole airways.
Name three types of bronchodilators, includes short & long-acting.
Beta2 agonists, cholinergic antagonists, & Methylxanthines
A Beta2 Agonist is a ______ _____.
sympathomimetic bronchodilator
How does a Beta2 Agonist work?
The drug binds to Beta2-adrenergic receptors.
What is the purpose of a Beta2 Agonist? Waht does it trigger?
The purpose is to increase the level of cyclic adenosine monophosphate (cAMP)which triggers smooth muscle relaxation & dilates bronchial bands of the airway.
What effect does the Beta2 agonist cause? Explain why this happens.
It also has a dilating effect on peripheral vaxcular vessels which decreases diastolic BP (Shifts K+ ions from bloodstream to cells which results in a temporary hypokalemia).
What are Beta2 agonists contraindicated for?
Allergy & uncontrolled cardiac dysrhythmias.
What are side effects of Beta2 Agonists?
HTN or hypotension, vascular headaches, & tremor
Name the types of Beta2 Agonists.
Short-acting & Long-acting
What do Short-acting Beta2 Agonists do?
Provide rapid but short-term relief.
When are Short-acting Beta2 Agonists most useful?
When inhaled at beginning of asthmatic attack or as a premedication prior to activities that trigger or induce an asthmatic attack.
Name some common short-acting Beta2 agonistic agents.
Albuterol (Proventil, Ventolin); Bitalterol (Tornalate), & Pirbuterol (Maxair)
How are the long & short-acting Beta2 agonistic agents delivered?
Directly to the site of action by a Metered Dose Inhaler (MDI) or Dry Powder Inhaler.
How can you tell a DPI is empty?
(without a mouthpiece) it will float in water.
When might you observe systemic effects from the use of a short-acting Beta2 agonistic agent?
When it is overused or abused.
If the client is using other drugs, when do you administer the Beta2 agonist bronchodilator?
Five minutes prior to other inhaled drugs (i.e. steroids).
How is a long-acting Beta2 Agonist different from a short-acting one?
It takes more time to build up effects, but lasts longer. Useful to prevent attack, but of no value during an asthmatic attack since they take time for effects to accumulate.
Name some common long-acting Beta2 agonistic agents.
Salmeterol (Serevent); Formoterol Fumarate (Foradil Aerolizer)
Why does the client need to shake the inhaler before each dose?
Because the drug separates easily.
Why should the client not exhale into the inhaler device?
This will cause drug clumping.
What is a cholinergic antagonist?
It is an anticholinergic agent.
What does a cholinergic antagonist do? What does it cause?
It blocks the parasympathetic nervous system which results in bronchodilation & decreased mucus production.
What side effects can occur with the use of cholinergic antagonists?
dry mouth/throat, GI distress, headache, coughing & anxiety
Name a cholinergic antagonist that is commonly used for asthma, but is also used for COPD. Is this agent long or short-acting.
Ipratopium (Atrovert. short-acting.
Name a long-acting cholinergic antagonist agent that is used once a day.
Tiotropium.
Name a cholinergic antagonist agent that is a combination of albuterol & atrovent.
Combivent.
Client teaching regarding cholinergenic antagonist agent use includes:
Increase fluid intake & Report blurred vision, eye pain, headache, nausea, nervousness, or palpitations.
Methylxanthines a.k.a.?
xanthine derivatives
When are methylxanthines used?
When other agents are ineffective to relax smooth muscles of the respiratory tract.
What are methylxanthines used to treat?
asthma, chronic bronchitis, emphysema, & bronchospasm.
Name possible side effects of methylxanthines.
excessive cardiac and CNS stimulation.
What are methylxanthines contraindicated for?
allergy, uncontrolled cardiac dysrhythmias & seizure disorders.
What is the method of delivery for methylxanthines?
systemically by oral or parenteral route.
Name some priority interventions for long-term use of methylxanthines?
Need to monitor blood levels because they have a narrow therapeutic range. Observe for toxicities esp. w/parenteral administration. RN should be assigned to client since frequent assessments will need to be performed.
What are s/s of toxicity w/methylxanthines?
restlessness, insomnia, irritability, tremors, & N/V
What agents can enhance metabolism of xanthines?
cigarettes & St. John's Wort
What might happen if the client quits smoking during xanthine therapy?
The dose could be to high and may need to be reduced.
What meds can cause an increase in drug levels of xanthine?
allopurinol, cimetidine, erythromycin, flue vaccine, & oral contraceptives
Why is xanthine given w/ caution in elderly clients?
They tend to have decreased drug metabolism. Be sure to observe for toxicity.
What should client teaching include for xanthines?
Take med at same time each day.
Name the classic drug in the methylxanthine class.
theophylline (Theo-Dur)
Name some drugs (other than the classic one) in the methylxanthine class. [per v.s.-these parenteral meds are used to treat bronchospasms.
aminophylline (Truphylline); oxtriphylline (Choledyl); & diphylline (Dilor, Lufyllin)
What are anti-inflammatory agents used for?
To decrease the inflammatory responses in the airways.
What does the anti-inflammatory class consist of? includes what delivery methods?
corticosteroids; inhaled anti-inflammatory agents; mast cell stabilizers; monoclonal antibodies; & leukotriene antagonists. systemic and inhalants
What do corticosteroids do?
Decrease inflammatory and immune response by preventing mediator synthesis.
What problems can a client have with the use of inhaled corticosteroids? What is an appropriate intervention to teach the client?
Increased risk of oral infections. Teach the client to rinse mouth after administration to prevent fungal infections.
How often are short-term corticosteroid inhalers used?
frequently.
How often are long-acting corticosteroid inhalers used?
Once a day.
Name some short-term corticosteroid inhalers.
Beclomethasone (Vanceril); Triamcinolone (Azmacort); & Flunisolide (AeroBid)
Name some long-acting once a day corticosteroid inhalers.
Budesonide (Pulmocort); & Fluticasone (Flovent)
What are systemic corticosteroids used to treat?
Severe asthma
Why should systemic corticosteroids be taken w/food?
To decresase GI ulceration.
Name two important side effects to be aware of and monitor for.
immunosuppression & increased blood glucose levels (hyperglycemia)
What is the most common oral systemic corticosteroid agent?
Prednisone
What should client education about systemic corticosteroids include?
Never abruptly discontinue drug, slowly taper only; Need medical alert bracelet; Report weight gain of 5 pounds in 1 week; Take w/food.
Name a new category of inhaled agents?
Inhaled Anti-inflammatory agents
How do inhaled anti-inflammatory agents work?
Inhibit release of inflammatory mediators from respiratory cells & WBCs which stabilizes the mast cell wall.
What do inhaled anti-inflammatory agents effect?
decrease lung nerve stimulation.
What are inhaled anti-inflammatory agents used for?
Prevents asthma events, but not useful during an asthmatic attack.
How long before inhaled anti-inflammatory agents are effective?
4 weeks
What should a client do if symptoms worsen?
discontinue medication
Name the primary agent in the inhaled anti-inflammatory agent class.
Nedocromil (Tilade)
How do mast cell stabilizers prevent asthma attacks?
By preventing mast cell membranes from opening when and allergen binds to the IgE molecule (provides and anti-inflammatory effect)
When are mast cell stabilizers not useful?
during an asthmatic attack.
Mast cell stabilizers used regularly for a _____ _____.
prophylactic effect
How are mast cell stabilizers used to relieve seasonal allergy attacks?
Start tx 3-4 weeks before the season.
What is the most common mast cell stabilizer agent?
Cromolyn Sodium (Intal)
What is the MOA of Monoclonal Antibodies?
Binds to IgE receptor sites on mast cells & basophils thus preventing allergens from triggering release of mediators from these cells.
When/How are monoclonal antibodies effective?
Will prevent attack, but not useful during asthmatic attack.
How are monoclonal antibodies administered?
Administered subcutaneously. Roll vial gently since drug is slow to dissolve.
What is the most common monoclonal antibody agent?
Omalizumab (Xolair)
What do Leukotriene Receptor Agonists do?
Block leukotriene production during inflammation, thus preventing asthma symptoms
What are some side effects of leukotriene receptor agonists?
headache; GI symptoms, dizziness; & insomnia
What is an priority intervention with a client on a leukotriene receptor agonist?
Monitor liver enzymes w/these agents.
Name some leukotriene receptor agonists.
zileuton (Zyflo); zafirlukast (Accolate); montelkast (Singular)
What does zileuton (Zyflo) do?
prevents leukotriene synthesis, but increases plasma concentration of theophylline (Need to decrease theophylline dose)
What do zafirlukast (Accolate) & montelukast (Singular) do?
Block the leukotriene receptor.
If the client is taking aspirin, which leukotriene receptor agonist dosage should be changed? Will it be increased or decreased?
Zafirludast (Accolate) dose should be decreased.
What do mucolytics do?
thin thick, tenacious mucus secretions
Name the commonly used aerosol mucolytics.
acetylcysteine (mucosil, mucomyst); dornase alfa (pulmozyme)
Name an oral systemic mucolytic agent.
guaifenesin.
During mucolytic therapy, what must a client be taught to do?
increase fluid intake
What are antitubercular medication used to treat?
All forms of infection from mycobacterium.
How long does antitubercular treatment last?
Therapy is usually for 6 months or longer until 3 negative sputum cultures for TB occur.
What is antitubercular drug therapy dependent on?
Drug therapy is dependent upon drug-susceptibility tests.
What is the cornerstone of drug regimen for antitubercular therapy?
Client education
How can the general public be protected from TB spread?
Strict client compliance.
How is the noncompliant TB client managed?
Mandate to participate in directly observed therapy (DOT) provide by health clinics.
How is the emergence of drug resistant TB organisms reduced?
By combination therapy to maximize destruction of the organism as rapidly as possible.
Name the primary (first-line) antitubercular agents. What is the cure rate?
isoniazid (INH); Rifampin, Pyraziniamide (PZA); Ethambutol; & Stretomycin. Combination therapy of these drugs produces a 95% cure rate.
What is the MOA of Isoniazid (INH)?
Alters the nicotinamide adenine denucleotide (NAD) of the mycobacterium organism and inhibits cell wall synthesis.
In what clients is INH therapy contraindicated?
allergy, hepatic injury or acute liver disease, & optic neuritis clients.
What are possible side effects of INH?
Can be hepatotoxic & cause peripheral neuritis (numbness & tingling)
What drugs are inhibited if INH therapy is implemented?
phenytoin, carbamazepine, primidone, & warfarin
What client education needs to be given regarding INH therapy?
Should be taken on an empty stomach & it can cause a false positive glucose test.
What is the MOA of Rifampin?
Inhibits protein synthesis of the cell.
What side effects can Rifampin cause?
hepatotoxicity, hepatitis, & hematologic disorders
What client education needs to be given regarding Rifampin therapy?
Teach the client that this drug will turn urine, tears, sweat & sputum and orange/reddish color. Soft contact lenses will be permanently discolored. Women taking oral contraceptives should switch to another form of birth control since this drug causes oral contraceptives to become ineffective.
Why will other medication drug doses have to be adjusted while receiving Rifampin therapy?
It may enhance elimination of theophylline, steroids, opiods, oral hypoglycemics, warfarin, Vitamin D, beta-blockers, & benzodiazepines.
What is the MOA of Pyrazinamide?
Drug action is not understood, but believed to serve as a bacteriostatic or bacteriocidal agent, therby destroying the mycobacterium in the macrophages.
When is Pyrazinamide therapy implemented?
Usually added to INH for the first two months of therapy. because it will prevent some of the neurologic side effects caused by INH (numbness & tingling of extremities)
What side effects does the nurse need to be aware of with Pyraziniamide therapy?
hepatotoxicity and hyperuricemia
How is Ethambutol used for the TB drug regimen?
It is used as the 4th drug agent.
What is the MOA of Ethambutol?
Inhibition of mycolic acid synthesis in the cell
What side effects does the nurse need to be aware of with Ethambutol therapy?
neurotoxicities and blindness.
How are the side effects of Ethambutol monitored?
Eye exams should be performed at drug initiation. Clients should immediately report any visual changes to MD.
Which clients should Ethambutol be used with caution?
Clients w/diabetes, or liver, renal or hematologic disorders.
What drug can be used as a substitute for Ethambutol?
Streptomycin can be used as the 4th agent instead of Ethambutol.
What is the MOA of Streptomycin?
Inhibition of cellular protein synthesis.
What serious side effects can Streptomycin cause?
ototoxicity, nephrotoxicity, & blood dyscrasias
How are the side effects monitored?
Obtain a baseline audiometric test every 1 to 2 months since it can impair the 8th cranial nerve.
Which clients are more prone for drug complications with Streptomycin?
Older clients.