N-10B Mid-Term Respiratory Drugs

Front 1

Bronchodilators Description
Most act by: stim ???-??? ??? receptors &/or directly relaxing ???
smooth muscle (usually shorter-acting)
or
Some act by inhibiting interaction of ????? at bronchial smooth muscle receptor
sites, thereby causing bronchodilation (longer-acting)

Back 1

Bronchodilators Description
Most act by: stim beta-adrenergic SNS receptors &/or directly relaxing bronchial
smooth muscle (usually shorter-acting)
or
Some act by inhibiting interaction of acetycholine at bronchial smooth muscle receptor
sites, thereby causing bronchodilation (longer-acting)

Front 2

Bronchodilators categories
1. ???
2. ????
3. ?? RX:
4. ??:

Back 2

Bronchodilators categories
1. Adrenergic
2. Anticholinergic
3. Combined RX:
4. Xanthines:

Front 3

Adrenergic categories
1. ?
2. ?

Back 3

Adrenergic categories
1. rapid-acting ones (SABAs)
2. longer-acting ones (LABAs)

Front 4

Adrenergic rapid-acting ones (SABAs)
used for ??? symptoms & ??? relief
referred to as
“???? drugs;” not rec for use more than ???? X’s weekly

Back 4

Adrenergic rapid-acting ones (SABAs)
used for intermittent symptoms & fast relief
referred to as
“rescue drugs;” not rec for use more than 2 X’s weekly

Front 5

Adrenergic rapid-acting ones (SABAs)
drugs to know:
????erol (Proventil, Ventolin) - liq/po or MDIs/SVNs or po
* ????erol (Xopenex) - SVN
* ????erol acetate (Maxair) – MDIs
* ????? sulfate (Brethene, Brethaire) - MDIs/SVNs or po
* ????? (Adrenalin; Susphrine) - SQ or IV

Back 5

Adrenergic rapid-acting ones (SABAs)
drugs to know:
albuterol (Proventil, Ventolin) - liq/po or MDIs/SVNs or po
* levalbuterol (Xopenex) - SVN
* pirbuterol acetate (Maxair) – MDIs
* terbutaline sulfate (Brethene, Brethaire) - MDIs/SVNs or po
* epinephrine (Adrenalin; Susphrine) - SQ or IV

Front 6

Adrenergic longer-acting ones (LABAs):
used as a component of ???? therapy (not monotherapy) of
???? & prevents nocturnal asthma
??? levels of cAMP
which relaxes smooth muscle

Back 6

Adrenergic longer-acting ones (LABAs):
used as a component of maintenance therapy (not monotherapy) of
asthma & prevents nocturnal asthma
incr levels of cAMP
which relaxes smooth muscle

Front 7

Adrenergic longer-acting ones (LABAs):
drugs to know:
* ????? (Serevant) – MDI

Back 7

Adrenergic longer-acting ones (LABAs):
drugs to know:
* salmeterol (Serevant) – MDI

Front 8

Bronchodilators Anticholinergic:
how it works = inhibits interaction of ????? at receptor sites
used for more ???? disease, as alternative to LABAs

Back 8

Bronchodilators Anticholinergic:
how it works = inhibits interaction of acetylcholine at receptor sites
used for more advanced disease, as alternative to LABAs

Front 9

Bronchodilators Anticholinergic:
drugs to know:
(????) - inh (ie 2 pufs tid to qid q 4h)
(???) – inh (ie 1 inh QD); more longer-acting than
Ipratropium

Back 9

Bronchodilators Anticholinergic:
drugs to know:
(Atrovent) - inh (ie 2 pufs tid to qid q 4h)
(Spiriva) – inh (ie 1 inh QD); more longer-acting than
Ipratropium

Front 10

Bronchodilators Combined RX: like
????? (albuterol & ipratropium) – MDI; very popular
???? (salmeterol-fluticasone) – MDI

Back 10

Bronchodilators Combined RX: like
Combivent (albuterol & ipratropium) – MDI; very popular
Advair (salmeterol-fluticasone) – MDI

Front 11

Bronchodilators ??????:
act directly on bronchial smooth muscle, decreasing spasm & relaxing
smooth muscle of vasculature
due to problems with ????, recommended only
as ??? therapy when pt not responding sufficiently to inhaled bronchodilators
???? (Theolair, Theodur, Slo-phyllin, Elixophyllin, Sustaire) liq/po

Back 11

Bronchodilators Xanthines:
act directly on bronchial smooth muscle, decreasing spasm & relaxing
smooth muscle of vasculature
due to problems with toxicity, recommended only
as add-on therapy when pt not responding sufficiently to inhaled bronchodilators
theophylline (Theolair, Theodur, Slo-phyllin, Elixophyllin, Sustaire) liq/po

Front 12

Major Side Effects of Bronchodilators
1. ???? (decr BP; in some pts an incr in BP)
2. CNS stim (SNS; ???? ???? with theophylline)
3. ???? (beta-adrenergic stim), unless B2 selective
4. ??? irritations (N/V w/ theophylline)

Back 12

Major Side Effects of Bronchodilators
1. dizziness (decr BP; in some pts an incr in BP)
2. CNS stim (SNS; tremors seizures with theophylline)
3. palpitations (beta-adrenergic stim), unless B2 selective
4. gastric irritations (N/V w/ theophylline)

Front 13

Bronchodilators - Nursing Care & Responsibilities
1. avoid admin to clients with ???, hyper????, & ???
2. avoid concurrent ??? stim & ??? ???
3. give during ??? hours
4. assess VS, esp ???; O2 Sats & Peak flows &/or spirometry
5. give with ??? & FF's
6. eval ???? & teach appropriate techniques
7. get theophylline level if taking that med (????normal range; >??? = toxic;
<??? = nontherapeutic)

Back 13

Bronchodilators - Nursing Care & Responsibilities
1. avoid admin to clients with HTN, hyperthyroidism, & CVD
2. avoid concurrent CNS stim & beta blockers
3. give during waking hours
4. assess VS, esp resp; O2 Sats & Peak flows &/or spirometry
5. give with food & FF's
6. eval responsive & teach appropriate techniques
7. get theophylline level if taking that med (10-20 normal range; >20 = toxic;
<10 = nontherapeutic)

Front 14

Antileukotiene Agents (LTRAs)
Description
1. newer class of astma med that works by modifying or inhibiting the activity of
?????, which decreases arachidonic acid-induced inflammation & allergan-
induced broncho????
2. also ??? mucus secretion & prevents vascular ????
3. used to provide long-term control of asthma thru ???? & ???? tx in adults &
children 12 & older, but not recommended as ????

Back 14

Antileukotiene Agents (LTRAs)
Description
1. newer class of astma med that works by modifying or inhibiting the activity of
leukotrienes, which decreases arachidonic acid-induced inflammation & allergan-
induced bronchoconstriction
2. also decr mucus secretion & prevents vascular permeability
3. used to provide long-term control of asthma thru prophylaxis & chronic tx in adults &
children 12 & older, but not recommended as monotherapy

Front 15

Antileukotiene Agents (LTRAs)
1. ????-receptor blockers (LTRAs):
montelukast (Singulair) - rec for age 2 & >
zafirlukast (Accolate) – rec for age 7 & >
2. inhibitors of enzyme ??? - ie zileuton (Zyflo)

Back 15

Antileukotiene Agents (LTRAs)
1. LTD4-receptor blockers (LTRAs):
montelukast (Singulair) - rec for age 2 & >
zafirlukast (Accolate) – rec for age 7 & >
2. inhibitors of enzyme 5-lipoxygenase - ie zileuton (Zyflo)

Front 16

Antileukotiene Agents (LTRAs)
Major Side Effects
1. headaches, ????, nausea, dizziness, insomnia, diarrhea
2. ???? dysfunction with zileuton & zafirlukast

Back 16

Antileukotiene Agents (LTRAs)
Major Side Effects
1. headaches, dyspepsia, nausea, dizziness, insomnia, diarrhea
2. liver dysfunction with zileuton & zafirlukast

Front 17

Antileukotiene Agents (LTRAs)
Nursing Care & Responsibilities
1. taken ???
2. watch for allergic responses
3. needs to be taken over time – not a drug for acute ???
4. can react with other meds: see chart on pp 558
5. periodic ??? function lab studies

Back 17

Antileukotiene Agents (LTRAs)
Nursing Care & Responsibilities
1. taken orally
2. watch for allergic responses
3. needs to be taken over time – not a drug for acute asthma
4. can react with other meds: see chart on pp 558
5. periodic liver function lab studies

Front 18

Mast Cell Stabilizers
Description
1. used in tx of ??, ??? & ????
2. stabilizes the cell membranes that the antigen-antibody reactions take place on (the
mast cell), thereby ????? release of substances (such as histamine) that cause
constriction
3. used to provide ????? control of asthma thru prophylaxis & chronic tx
4. drug has slow ???? to peak action, ergo not good for use during ???? attack

Back 18

Mast Cell Stabilizers
Description
1. used in tx of asthma, bronchitis & emphysema
2. stabilizes the cell membranes that the antigen-antibody reactions take place on (the
mast cell), thereby preventing release of substances (such as histamine) that cause
constriction
3. used to provide long-term control of asthma thru prophylaxis & chronic tx
4. drug has slow onset to peak action, ergo not good for use during acute attack

Front 19

Mast Cell Stabilizers
Examples:
* ???? (Intal; Nasalcrom)
???? (Tilade)

C. Major Side Effects :
1. coughing, sore throat, ????, ????;
2. also ??? changes, dizziness & headache

Back 19

Mast Cell Stabilizers
Examples:
* cromolyn (Intal; Nasalcrom)
nedrocromil (Tilade)

C. Major Side Effects :
1. coughing, sore throat, rhinitis, bronchospasms;
2. also taste changes, dizziness & headache

Front 20

Mast Cell Stabilizers
Nursing Care & Responsibilities
1. need to reinforce that this is not for ????? use, but rather is ?????
2. need to teach about specific administration (???? vary)
3. may need ???? for increased effects
4. teach about ???? nebulizer pieces & ????

Back 20

Mast Cell Stabilizers
Nursing Care & Responsibilities
1. need to reinforce that this is not for emergency use, but rather is preventative
2. need to teach about specific administration (preps vary)
3. may need spacer for increased effects
4. teach about cleaning nebulizer pieces & spacers

Front 21

Corticosteroids with Respiratory Issues (* most important anti-inflammatory drugs)

A. Systemic Corticosteroids (to reduce body’s ???? response & ?????, esp with
asthma);
large doses (ie 50-60 mg prednisone daily) for a short duration (ie 5 days) creates
fast/effective response without causing adrenal ?????; can be used as a
rescue drug with SABAs in acute asthma to ???? recovery & prevent recurrence
of exacerbations;
chronic systemic use is reserved for the most severe, hard-to-
control asthma cases & can be given ??? ???? day to help prevent adverse effects

Back 21

Corticosteroids with Respiratory Issues (* most important anti-inflammatory drugs)

A. Systemic Corticosteroids (to reduce body’s immune response & inflammation, esp with
asthma);
large doses (ie 50-60 mg prednisone daily) for a short duration (ie 5 days) creates
fast/effective response without causing adrenal insufficiency; can be used as a
rescue drug with SABAs in acute asthma to speed recovery & prevent recurrence
of exacerbations;
chronic systemic use is reserved for the most severe, hard-to-
control asthma cases & can be given every other day to help prevent adverse effects

Front 22

Corticosteroids with Respiratory Issues
Common meds
* ??????
* ????? (better for pediatric use)
????? (IV Solu-Cortef)
* ?????? (IV Solu-Medrol)

Back 22

Corticosteroids with Respiratory Issues
Common meds
* prednisone
* prednisolone (better for pediatric use)
hydrocortisone (IV Solu-Cortef)
* methylprednisolone (IV Solu-Medrol)

Front 23

Corticosteroids with Respiratory Issues
Major Side Effects: * ?????: effects ???? body system
Common problems:
GI problems: PUD, ?????
???? wound healing
Thin, fragile ????, tears, bruising
Na+ & water ????? wt gain
Increased glucose steroid-induced DM
Suppressed immune response incr susceptibility to infection
???? changes: mood swings; depression; those with mental
dysfunction are more susceptible
Adrenal suppression

Back 23

Corticosteroids with Respiratory Issues
Major Side Effects: * widespread: effects every body system
Common problems:
GI problems: PUD, perforation
Impaired wound healing
Thin, fragile skin, tears, bruising
Na+ & water retention wt gain
Increased glucose steroid-induced DM
Suppressed immune response incr susceptibility to infection
Mental changes: mood swings; depression; those with mental
dysfunction are more susceptible
Adrenal suppression

Front 24

Inhaled Corticosteroids or ICSs (topically: causes vasoconstriction inhibits release of
chemical ???? & decr ????? of cell membranes to suppress local inflammatory
process; thereby reduces ????? of bronchioles; also inhibits both airway
microvascular leakage & incr mucus secretion in the airways; also helps ???? beta-
adrenergic bronchodilator ?????)
1. most effective ????? control drug for ????? asthma; can be used as a rescue
drug with SABAs in acute asthma to speed recovery & prevent recurrence of
exacerbations; generally safe & well-tolerated; doesn’t create systemic ????
issues

Back 24

Inhaled Corticosteroids or ICSs (topically: causes vasoconstriction inhibits release of
chemical mediators & decr permeability of cell membranes to suppress local inflammatory
process; thereby reduces inflammation of bronchioles; also inhibits both airway
microvascular leakage & incr mucus secretion in the airways; also helps magnify beta-
adrenergic bronchodilator responsiveness)
1. most effective long-term control drug for persistent asthma; can be used as a rescue
drug with SABAs in acute asthma to speed recovery & prevent recurrence of
exacerbations; generally safe & well-tolerated; doesn’t create systemic steroid
issues

Front 25

Common meds:
* ?????? acetonide (Azmacort; Nasocort AQ)
* ?????? propionate (?????; Flonase AQ)
Budesonide (Pulmicort)
?????? dipropionate (Vanceril, Beclovent; Vancenase AQ; Beconase AQ)
** some meds used in combinationwith bronchodilator (ie ????: consists of
salmeterol & fluticasone together as an inh powder MDI)

Back 25

Common meds:
* triamcinolone acetonide (Azmacort; Nasocort AQ)
* fluticasone propionate (Flovent; Flonase AQ)
Budesonide (Pulmicort)
beclomethasone dipropionate (Vanceril, Beclovent; Vancenase AQ; Beconase AQ)
** some meds used in combinationwith bronchodilator (ie Advair: consists of
salmeterol & fluticasone together as an inh powder MDI)

Front 26

Inhaled Corticosteroids or ICSs
3. Major Side Effects: ?????; ???? mouth & throat; wheezing; cough; oral fungal
infections; facial ????; nasal congestion/discharge; URI; H/A; * May inhibit
linear ???? in children within 1st yr & then growth velocity usually returns to
normal
4. Nursing Care:
a. use other MDIs ???? & save inh corticosteroids for last inh in a series
b. ???? mouth well after each inh use
c. good, regular oral ???

Back 26

Inhaled Corticosteroids or ICSs
3. Major Side Effects: hoarseness; dry mouth & throat; wheezing; cough; oral fungal
infections; facial edema; nasal congestion/discharge; URI; H/A; * May inhibit
linear growth in children within 1st yr & then growth velocity usually returns to
normal
4. Nursing Care:
a. use other MDIs first & save inh corticosteroids for last inh in a series
b. rinse mouth well after each inh use
c. good, regular oral hygiene

Front 27

Decongestants
A. Description
1. Used to decrease nasal ???? and swelling of nasal passages
2. stim alpha-adrenergic SNS receptors on resp mucosal membranes decr congestion,
hyperemia, edema; very minimal ????? sec to beta-adrenergic effects
3. some (like ephedrine) also have beta1-?????? effect & stim ???

Back 27

Decongestants
A. Description
1. Used to decrease nasal congestion and swelling of nasal passages
2. stim alpha-adrenergic SNS receptors on resp mucosal membranes decr congestion,
hyperemia, edema; very minimal bronchodilatation sec to beta-adrenergic effects
3. some (like ephedrine) also have beta1-adrenergic effect & stim HR

Front 28

Decongestants
Examples
* ????? (Sudafed, Actifed, Claritin-D)
ephedrine HCL
* ???? HCL (Neo-Synephrine)
Major Side Effects
1. tachy???? tachy?????(ie PAT)
2. hypotension shock vs hypertension
3. tremors & anxiety seizures
4. anorexia; N/V; dry mouth
5. * ???? congestion
6. dysuria

Back 28

Decongestants
Examples
* pseudoephedrine (Sudafed, Actifed, Claritin-D)
ephedrine HCL
* phenylephrine HCL (Neo-Synephrine)
Major Side Effects
1. tachycardia tachyarrythmias (ie PAT)
2. hypotension shock vs hypertension
3. tremors & anxiety seizures
4. anorexia; N/V; dry mouth
5. * rebound congestion
6. dysuria

Front 29

Decongestants
Nursing Care & Responsibilities
1. monitor ??
2. check for nasal ???
3. check for ??? bronchial secretions; not recommended for long-standing asthma
4. space ???? so not close to HS
5. careful with ???? use of CNS stimulants

Back 29

Decongestants
Nursing Care & Responsibilities
1. monitor VS
2. check for nasal congestion
3. check for tenacious bronchial secretions; not recommended for long-standing asthma
4. space dosing so not close to HS
5. careful with concurrent use of CNS stimulants

Front 30

Antihistamines

A. Description
1. used to relieve sx's of common ??? & ????, mediated by ????
2. acts by blocking action of ????? at recptor sites via competitive ????
3. also exerts anti????, anti????& CNS ???? effects

Back 30

Antihistamines

A. Description
1. used to relieve sx's of common cold & allergies, mediated by histamines
2. acts by blocking action of histamine at recptor sites via competitive inhibition
3. also exerts antiemetic, anticholinergic & CNS depressant effects

Front 31

Antihistamines

B. Examples
* ???ine meleate (Chlor-Trimeton)
dimenhydrinate HCL (Dramamine)
* ?????mine HCL (Benadryl)
* ???ine HCL (Phenergan)
* ????ine (Claritin; Claritin-D) – non-sedative
azelastine HCl (Astelin) – newer nasal spray

Back 31

Antihistamines

B. Examples
* chlorpheniramine meleate (Chlor-Trimeton)
dimenhydrinate HCL (Dramamine)
* diphenhydramine HCL (Benadryl)
* promethazine HCL (Phenergan)
* loratadine (Claritin; Claritin-D) – non-sedative
azelastine HCl (Astelin) – newer nasal spray

Front 32

Antihistamines
Major Side Effects
1. drowsiness & dizziness (CNS depression; esp in elders)
2. GI irritation & dry mouth
3. ???? in children (paradoxic effect)
4. “?????” effect, esp in elders (Benadryl)
5. can be problematic in children and/or adults with ???? (faulty histamine sites)

Back 32

Antihistamines
Major Side Effects
1. drowsiness & dizziness (CNS depression; esp in elders)
2. GI irritation & dry mouth
3. excitement in children (paradoxic effect)
4. “hangover” effect, esp in elders (Benadryl)
5. can be problematic in children and/or adults with asthma (faulty histamine sites)

Front 33

Antihistamines
Nursing Care & Responsibilities
1. assess orient & ????
2. avoid admin with other ??? ????
3. caution pt about operating ????
4. offer c ??? or ???
5. offer gum or hard candies ?????
6. eval ????? & teach appropriate techniques

Back 33

Antihistamines
Nursing Care & Responsibilities
1. assess orient & LOC
2. avoid admin with other CNS depressants
3. caution pt about operating machinery
4. offer c food or milk
5. offer gum or hard candies salivation
6. eval responsive & teach appropriate techniques

Front 34

Expectorants (Mucolytics)

A. Description
1. used to ???? secretions in resp tract promoting ????
2. mucolytics act directly to break up ???? plugs in the tracheobronchial passages
3. expectorants act indirectly to liquify mucus by incrresp tract secretions via oral
absorption
4. mucolytics agents are available in ???? preps; expectorants are availabe in ????
prep

Back 34

Expectorants (Mucolytics)

A. Description
1. used to liquify secretions in resp tract promoting cough
2. mucolytics act directly to break up mucous plugs in the tracheobronchial passages
3. expectorants act indirectly to liquify mucus by incrresp tract secretions via oral
absorption
4. mucolytics agents are available in inhalation preps; expectorants are availabe in oral
prep

Front 35

Expectorants (Mucolytics)
Examples
1. mucolytic: ie acetylcysteine (???????)
2. expectorants:
* guaifenesin (?????? Plain)
iodinated glycerol (Organidin)
* potassium iodide (??????)

Back 35

Expectorants (Mucolytics)
Examples
1. mucolytic: ie acetylcysteine (Mucomyst)
2. expectorants:
* guaifenesin (Robitussin Plain)
iodinated glycerol (Organidin)
* potassium iodide (SSKI)

Front 36

Anti-tussives

A. Description
1. used to ????? cough reflex
2. either by: direct action on the ???? cough center or ???? action on sensory
nerve endings
3. comes in ???? preps

Back 36

Anti-tussives

A. Description
1. used to suppress cough reflex
2. either by: direct action on the medullary cough center or indirect action on sensory
nerve endings
3. comes in oral preps

Front 37

Examples
1. Opioids
* ?????
hydrocodone (hycodan)
2. Nonopioids
* dextromethorphan hydrobromide (Benylin, ?????? DM)
diphenhydramine HCL (Benadryl cough syrup)
* ????? (Tessalon Perles) – anesth/numbs stretch receptor cells ????? reflex
stim of medullary cough center

Back 37

Examples
1. Opioids
* codeine
hydrocodone (hycodan)
2. Nonopioids
* dextromethorphan hydrobromide (Benylin, Robitussin DM)
diphenhydramine HCL (Benadryl cough syrup)
* benzonatate (Tessalon Perles) – anesth/numbs stretch receptor cells prevents reflex
stim of medullary cough center