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76 Cards in this Set
- Front
- Back
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2 primary forms of lipids in the blood |
Triglycerides & Cholesterol |
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Are these lipids lipid or water soluble, what does this mean? |
Water soluble, must bind to be active |
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What are apolipoproteins? |
Specialized lipid-carrying cells that lipids |
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Where are triglycerides stored? What are they used for? |
Stored in fat;used for energy |
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What are cholesterol used for? |
Used to make steroid hormones cell membranes, & bile acids |
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What are lipoproteins? Where are they metabolized? |
A combination of triglycerides or cholesterol with apolipoproteins used to transport lipids through the blood; metabolized in the liver |
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What are 3 types of lipoproteins? |
Very low density lipoprotein (VLDL)
Low density lipid protein (LDL)
High density lipoprotein (HDL) |
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Very low density lipoprotein: how much lipid vs protein content? Where is it produced? What does it do? What happens once they circulate? |
Least protein, most lipid content Produced by the liver Transports endogenous lipids to peripheral cells Once circulated, they become LDLs |
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High density lipoproteins: what is the protein vs lipid content? What do they do? What is it called the good lipid? |
Most protein, least lipid content Responsible for recycling cholesterol Good lipid because its cardioprotective |
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What is a pt at risk for once they're cholesterol levels are >300? Why are they at risk for thrombi? How does hypercholesteremia work? |
CAD Plaque can cause thrombi & embolisms If the liver has an excess amount of cholesterol,the number of LDL receptors on the liver decreases which results in an accumulation of LDL in the blood |
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What are antilipemics used for? What is the drug type based on? What should be done before starting a pt on antilipemics? |
Antilipemics are used to lower lipid levels & as an adjunct in diet therapy. Drug choice is based on the specific lipid profile (type of hyperlipidemia) of pt (aka phenotyping) All non drug means if controlling cholesterol levels should be tried for atleast 6 mo. & found to fail before therapy |
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6 types of antilipemics |
HmG-CoA reductase inhibitors (HMGs/statins) Bile acid sequestrants Niacin Frolic acid derivatives Cholesterol absorption inhibitors Omega 3 fatty acids |
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HMG-CoA reductase inhibitors: family name** MOA** Indications Adverse effects** Contraindications Interactions Nursing care |
"Statins" Most potent LDL reducers
MOA: inhibit HMG-CoA reductase, which is an enzyme used by the liver to produce & regulate cholesterol. By doing this it slows the rate of cholesterol production.** When less cholesterol is produced, the liver increases LDL receptors so that LDL Can be recycled
Indications 1st-line drug x hypercholesteremia (most dangerous/common dyslipidemia) Treats type IIa & IIb hyperlipidemias Decreases LDL BY 30-40% Decreases triglycerides by 10-30% Increases HDL by 2-15%
Adverse effects Mild GI disturbances Rash Headache Myopathy (muscle pain)** possibly leading to rhabdomyolysis (break down of muscles) Elevations in ALT, clotting time, thrombocytopenia, & eosinophilia
Contraindicated Pregnancy Liver disease
Interactions Oral anticoagulants Drugs metabolized byCYP3A4: Erythromycin,-azole antifungals, verapamil, diltiazem, HIV inhibitors, amiodarobe, & grapefruit juice (>myopathy; limit 1 qt daily)
Nursing care Take at night Liver panel baseline, ck q 6 mo. Monitor creat,may increase Monitor for muscle pain, change in urine color,fever, malaise, N/V Teach it takes 6-8 wks to see results Monitor for protein in urine Simvastatin - report memory loss, confusion, hyperglycemia, & increase a1c levels |
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Bile acid sequestrates/iron exchanging resins Drugs MOA Indications Contraindications Adverse effects Nursing care |
Bile acid sequestrates: drugs: Cholestyramine (Questran), colestipol (Colestid), colesevelam (Welchol)
MOA Prevent resorption of bile acids from small intestines so that cholesterol cannot be absorbed. Bile acid is then insoluble so it is excreted through the feces. The more the bile acids are excreted in the feces, the more the liver converts cholesterol to bile acid. Decreases LDL by 15-30% Increases HDL by 3-8%
Indications 2nd line of drug therapy Type II hyperlipoproteinemia Relief of pruritis associated with biliary obstruction (cholestyramine) May be used along with "statins"
Contraindications Bowel/biliary obstruction PKU (Phenylketonuria)
Adverse effects Constipation H/A, nausea, belching, bloating Adverse effects tend to disappear overtime Toxicity can lead to obstruction
Nursing Compliance is an issue, d/t powder form Teach to increase fiber & water intake &admin with food to decrease GI effects All drugs must be taken at least 1 hr before of 4-6 hr after admin d/t decreased absorption Asses for PKU d/t inability to process aspartame appropriately Powder form must be mixed thoroughly but not stirred & nevertaken dry; do not dilute or sprinkle on food |
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Niacin (Nicotinic acid) What is it? What dose must be used? MOA Indications Adverse effects Contraindications |
Niacin Vitamin B3 (OTC) Lipid lowering properties require high doses than when used as a vitamin; effective, ineffective, often used in other lipid lowering drugs
MOA Thought (unknown) to increase activity of lipase, which breaks down lipids. Decreases cholesterol/triglyceride metabolism & catabolism Decreases triglycerides 30-70% Increases HDL 20-30%
Indications All phenotypes of hyperlipidemia except type I
Adverse effects Take with meals & start on low dose & gradually increase to minimize adverse effects Small doses of ASA/NSAIDs may be taken to minimize flushing Flushing (d/t histamine release) Pruritis (itchiness) GI distress (d/t histamine release increasing GI secretions & motility) Breaks down fibrin clots
Contraindications PUD/GI ulcer Hemorrhagic processes |
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Fibric acid derivatives/Fibrates Drugs MOA Indications adverse affects Interactions Contraindications Nursing care |
Fibric acid derivatives Drugs gemfibrozil (Lopid) Febofibrate (Tricor)
MOA Believed to activate lipase (which breaks down cholesterol). Also suppresses release of free fatty acid from adipose tissue, inhibits synthesis of triglycerides in the liver, & increase secretion of cholesterol in the bile Primary affect triglycerides Also increase plasmafibrolysis (break down of blood clots) Decrease triglycerides and increase HDL by 25%
Indications Hyperlipidemias type III, IV, & V
Adverse effects Abd discomfort, diarrhea, nausea Blurred vision, headache Increase PT & LFTs
Interactions Oral anticoagulants Statins (r/f myosotis) Decrease H&H & WBC Increase clotting time, AST, ALT, & bilirubin (by-product of RBCs)
Contraindications Liver, kidney, & gall bladder disease
Nursing care Must be monitored closely if on Coumadin Monitor LFTs & x gallstones |
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Cholesterol Absorption inhibitors
Drug(1) MOA What is it enhanced by? Indication |
Exetimibe (Zetia) Inhibits absorption of cholesterol & related sterols from the small intestine. Results in decreased LDL & triglycerides & increased HDL Often enhanced with Statins Trials continue; recommended only when pt have not responded to other therapy |
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Cholesterol Absorption inhibitors
Drug(1) MOA What is it enhanced by? Indication |
Exetimibe (Zetia) Inhibits absorption of cholesterol & related sterols from the small intestine. Results in decreased LDL & triglycerides & increased HDL Often enhanced with Statins Trials continue; recommended only when pt have not responded to other therapy |
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Herbal: omega-3 fatty acids Adverse effects Interaction |
Fish oil products Used to reduce cholesterol Rash, belching, allergic reaction Potentially interacts with anticoagulants |
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Cholesterol assessment |
Risk Factors of hyperlipidemia Male >45 Family hx if premature CAD (MI or death before 55 y/o in father or other male first degree relative or before 65 in first degree female relative) Current cigarette smoking BP >140/90/ current antihypertensive therapy HDL <40 mg/dL Diabetes
Assess for alcohol/recreation drug use d/t liver dysfunction
Assess LFT: AST CPK & ALT before & during therapy |
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Coagulation cascade |
The series of steps beginning with the intrinsic & extrinsic pathways of coagulation & proceeding through the formation of a fibrin clot |
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Coagulation cascade |
The series of steps beginning with the intrinsic & extrinsic pathways of coagulation & proceeding through the formation of a fibrin clot. Fibrin is a stringy insoluble protein produced by thrombin & fibrinogen during the clotting process. Each activated factor serves as a catalyst that amplifies the next reaction. |
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2 types of cascade pathways |
Extrinsic pathways are activated by external penetration (bullet), factors VII & X are then activated by thromboplastin from is vessel wall
Intrinsic pathways are activated when factor XII (inactive throughout blood) comes in contact with exposed collagen on the inside of damaged vessels. |
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Fibrinolysis system |
Once a clot is formed & fibrin is present, the fibrinolysis system is activated. This system initiates the breakdown of clots and serves to balance the clotting process. Fibrinolysis is the reverse of the clotting process. In this process, fibrin bind to plasminogen so that it can convert to plasmin. The plasmin break down the fibrin thrombus to a lesser form so that it does not become an embolus |
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Anticoagulants/antithrombolytics MOA Indications Adverse effects |
MOA Inhibit the action or formation of clotting factors Does not "thin" the blood, it prevents clot formation Has no direct effect on an already formed clot Used prophylactically to prevent thrombi/emboli
The MOA depends on the drug (where it works in the clotting cascade)
Indications MI, unstable angina, a-fib, in dwelling devices, & major orthopedic surgeries Warfarin prevents Heparins, LMWHs, direct thrombin inhibitors, & factor Xa inhibitors are used to prevent AND treat
Adverse effects Bleeding (localized or systemic) Heparin-induced thrombocytopenia (HIT) (from decreased plat) N/V, abdominal cramps, thrombocytopenia |
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Anticoagulants/antithrombolytics MOA Indications Adverse effects |
MOA Inhibit the action or formation of clotting factors Does not "thin" the blood, it prevents clot formation Has no direct effect on an already formed clot Used prophylactically to prevent thrombi/emboli
The MOA depends on the drug (where it works in the clotting cascade)
Indications MI, unstable angina, a-fib, in dwelling devices, & major orthopedic surgeries Warfarin prevents Heparins, LMWHs, direct thrombin inhibitors, & factor Xa inhibitors are used to prevent AND treat
Adverse effects Bleeding (localized or systemic) Heparin-induced thrombocytopenia (HIT) (from decreased plat) N/V, abdominal cramps, thrombocytopenia |
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6 types of anticoagulants |
Heparin Warfarin Thrombin inhibitors Antiplatelets Methylxanthine derivatives GP IIb/IIIa inhibitors |
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Heparin: Dose, route, where/how is it given? Onset/half-life MOA What is HIT treated with? What should happen with OD? Can it be given with pregnancy? PTT therapeutic range |
Dose is weight based SQ (abd) or IV & cked by 2 RNs Do not aspirated or massage site Onset is immediate half-life is 1-2hr MOA: binds to Antithrombin III, turns off factors II, IX, & X (thrombin is most sensitive to factor II)
HIT tx with direct thrombin inhibitors - lepirudin or argatroban
If OD occurs, may be able to just drop machine, depending on dose, if dose is intentionally larger for certain cases protamine sulfate should be admin
Can be given with pregnancy
PTT between 45-70 |
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Heparin: Dose, route, where/how is it given? Onset/half-life MOA What is HIT treated with? What should happen with OD? Can it be given with pregnancy? PTT therapeutic range |
Dose is weight based SQ (abd) or IV (preferably upper quads) & cked by 2 RNs Do not aspirated or massage site Onset is immediate half-life is 1-2hr MOA: binds to Antithrombin III, turns off factors II, IX, & X (thrombin is most sensitive to factor II)
HIT tx with direct thrombin inhibitors - lepirudin or argatroban
If OD occurs, may be able to just drop machine, depending on dose, if dose is intentionally larger for certain cases protamine sulfate should be admin
Can be given with pregnancy
PTT between 45-70 |
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Heparin: Low Molecular Weight Heparins (LMWHs) 2 drugs Why is this drug preferred? Admin where? MAO Contraindicated |
Enoxparin (Lovenox) & dalteparin (Fragmin)
Preferred because it has a predictable anticoagulant response & does not require labs
Admin in abd (prefer upper quads)
Inhibits ONLY factor X
Contraindicated in in dwelling epidural catheters = hematoma |
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Warfarin MOA Adverse effects Interactions Antidote Contraindications Teaching Therapeutic & Normal PT level |
MOA Inhibits vit K synthesis by bacterian in GI tracts which inhibit the production of clotting factors II, VII, & X (vit k-dependent clotting factors are normally synthesized in liver)
Adverse effects Skin necrosis & "purple toes" syndrome
Drug/food interactions Amiodorone, fluconazole, erythromycin, metronidazole, sulfonamide atbs, & cimetidine Capsium pepper, feverfew, dong quia, garlic, ginkgo, & St. John's wort
Antidote vitamin k (phytonadione)
Contraindicated in pregnancy
Teach drug is for long term use Takes 3 days to reach active level Tomatoes and green leafy veggies can decrease effectiveness
PT normal - 1.5-2.5 therapeutic - 2-3 |
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Bridge therapy |
When pt is being switched from heparin/LMWH to warfarin OR vice versa, there needs to be several days overlap, during which bleeding risk increases
Warfarin has a very long half-life, when pt is having surgery, they will switch to heparin/LMWH so that it can be quickly d/c'd before surgery because heparin has a shorter half-life |
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Thrombin inhibitors Drugs (5)** Indications How to take Side effects & adverse effects Teaching
Thrombin factor Xa inhibitor drug (2) MOA Contraindications |
Human Antithrombin III (Thrombate) lepirudin (Refludan) bivalirudin (Andriomax) argatroban (Argratroban) dabigatran (Pradaxa)**
Prophylactic for A-Fib & DVT
Oral: do not chew or crush
Side effect abdominal discomfort Can have serious adverse effects (d/t no lab monitoring/no antidote--half life is 12-17 hrs**)
Teach to discontinue 1-2 days before surgery or dental procedure Lapses in therapy increases stroke risk
Factor Xa inhibitors Same effects as direct thrombin inhibitors but more selective fondaprainus (Arixtra) Contraindicated with a creat of <30mL/min or body wt <50kg Stop therapy if PLAT <100,000/microliter
rivaroxaban (Xarelto) |
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Antiplatelet drugs Drugs (4) MOA Indications |
Aspirin (acetylsalic acid) ADP inhibitors: clopidogrel (Plavix) prasugrel (Effient) ticagrelor (BRILINTA)
MOA Prevent platelet aggregation; works before the clotting process
Indications Prevent stoke Acute unstable angina & MI |
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Antiplatelets: Aspirin**
MOA How long do effects last Indication Interactions Contraindications Teaching Adverse effects |
MOA Prevents platelet aggregation, results in dilation if vessels & inhibition if platelet aggregation
Effects last up to the plat life (7 days)
81 mg/day to px MI
Do not take with anticoagulants
Contraindicated in children/teens with flulike symptoms because it can cause Reye's syndrome to occur
Teach to d/c 8 days before surgery or invasive procedures
Adverse effects Drowsiness, dizziness, confusion Flushing, N/V, GI bleed, heart burn, diarrhea (thorough GI assessment) Bone marrow suppression (low WBC, RBCS, PLAT Ototixicity with high doses |
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Antiplatelets: ADO inhibitors 3 drugs** |
clopidogrel (Plavix) prasugrel (Effient) ticagrelor (BRILINTA) |
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Treatment of common cold |
Antihistamines Nasal decongestants Antitussive Expectorants
Treatment is symptomatic - not curative
Difficult to identify whether cause is viral or bacterial |
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MOA of ADP Inhibitors (Plavix) |
Inhibits platelet aggregation by altering platelet membrane so that it can no longer receive the signal to aggregate
Inhibits the activation of glycoprotein receptors (GP IIb/IIIa) on a surface of the platelet |
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ADP Inhibitors: clopidogrel (Plavix) Adverse effects |
Adverse effects Bone marrow suppression Flu-like symptoms Nose bleed |
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ADP Inhibitors (Plavix)** Indications |
Used to prevent CVA, TIA, & PE |
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Methylxanthine Deriratives MOA Indication (1) Drug (1)** Side effects |
Decreases blood viscosity to improve peripheral circulation; has antiplatelet effects that make blood cells more flexible Treats Raynauds Disease; rarely used pentoxifylline (Trental) CNS stimulation SE |
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GP IIb/IIIa Inhibitors What is GP IIb/IIIa? MOA Route Indication 3 Drugs Adverse effects Nursing care |
GP IIb/IIIa are a component of the platelet membrane which is a potent stimulator for platelet adhesion MOA Blacks the receptor protein in the platelet wall membranes Prevents thrombi formation Route - IV Indication - Px thrombi formation in critical situations like cardiac life support to increase perfusion Drugs tirofan (Aggrastat) eptifibatide (Integrilin) abciximad (ReoPro)
Adverse effects Increased Risk for stroke Bradycardia, hypotension, edema, dizziness, thrombocytopenia
NC Continuous C/V monitoring |
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INR therapeutic range & control
PTT therapeutic range** |
INR therapuetic - 2-3 control - 1.5 - 2.5
PTT 45-70
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Decongestants 3 main types |
Adrenergic Anticholinergic Corticosteroids (Inhaled intranasal steroids) |
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Adrenergic decongestants What does it stimulate? Contraindications Drug (1) Adverse effects |
Constricts/Sympathomimetic Contricts small blood vessels of nasal sinuses via alpha receptors. Tissue shinks & nasal secretions in the swollen mucous membranes are better able to drain.
Avoid with MOAIs phenylephrine (Neo-Synephrine)
Adverse effects Nervousness, insomnia, palpitations, tremors, HTN, tachycardia (Caused by SNS effects caused by stimulation of heart, blood vessels, & CNS) |
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Anticholinergics Popularity What does it stimulate? Drugs (1) |
Less commonly used Parasympathomimetics
ipratropium (Atrovent) |
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Common cold Most caused by: 2 types |
Most caused by viral infection Rhinovirus Influenza |
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Corticosteroids (Inhaled Intranasal steroids)
MAO Contraindications Drugs (5) Adverse effects |
Anti-inflammatory effect - work to turn off the immune system cells involved in the inflammatory response. Decreased inflammation = decreased congestion.
Contraindicated with nasal mucosal infection
Beconase, Rhinocort, Nasalide, Flonase, Nasacort, Omnaris
Adverse effects Local mucosal dryness & irritation |
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Decongestants: Route -- differences Drug effects Indications Contraindications/Precautions Nursing Care |
Oral (Systemic) Delayed onset, prlonged duration Less effective d/t first pass No rebound congestants Exclusively adrenergics Ex - pseudophedrine (Sudafed)
Inhaled/Topical Fast onset - quick duration Potent No systemic effects Sustrained over several days causes rebound congestion, tamper medication with oral route***
Drug Effects Shrink engorged nasal mucous membrane Relieve nasal stuffiness
Indications Rhinitis Common cold Sinusitis Hay fever Allergies Surgery/diagnostic procedures to facilitate viewign
Contraindications Cardiovascular/CNS disorders Narrow angle glacoma, Diabetes Hyeprthyroidism Prostate disease (d/t adverse effects) Caffeine-containing products
Caution with antihypertensive meds
Nursing care Report sx that exceed 1 week |
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Coughing |
In some cases, couhging can be harmful, such as after hernia repair surgery
Cough center is stimulated by stretching of bronchi alveoli, & pleura being stretched |
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Antitussives: Indication 2 types Drugs (2) MOA of each Adverse effects Contraindications Cautions Nursing Care |
Indication For nonproductive cough & cases where cough is harmful
2 types Opoiods Nonopoiods
MOA of each Opoiods Suppresses the cough reflex by direct action on the cough center in the medulla Ex - codeine (Robitusin A-S, Dimetant-DC), hydrocodone) Have a drying effect on mucosa, to thicken secretions (to px runny nose)
Non-opioids Suppress the cough reflex by numbing the stretch receptors in the respiratory tract & preventing the cough reflex from being stimulated Ex - benzonatate (Tessalon Perles), dextromethorphan (Vicks Formula 44, Robitussin-DM--^r/f abuse*) Benzonatate - suppresses the cough relfex by anesthetizing (numbing) the stretch receptors in the resp. tract, which prevents reflex stimulation of the medullary cough center Dextromethorphan - contraindicated in hyperthyroidism, cardiovascular disease, HTN, glaucoma, & MAOI use
Adverse effects Decreased CNS effects: dizziness, H/A, sedation, N/V, drowsiness, sedation, lightheadedness, constipation, respiratory depression
Contraindications Alcohol use, MAOIs, Antihistamines, Opioid drugs
Cautions With CNS depression, anoxia, hypercapnia, respiratory depression, COPD, & renal impairment
Nursing Care -Perform respiratory & cough assessment -Instruct to avoid driving/operating machinery because of CNS effects -Don't administer with adventitious lung sounds because it needs expectorated -Report cough that last >1wk, persistent H/A, fever, or rash -Safety assessment r/t SE of dizziness, sedation, & drowsiness |
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Traditional What makes them bettter than non-sedating? 6 drugs
Can you stop them abruptly? |
Older
Work peripherally & centrally; cross blood-brain barrier (increased r/f fall) Have anticholinergic effects, making them more effective than nonsedating drugs in some cases
diphenhydramine (Benadryl), brompheniramine, chlorpheniramine, dimenhydrinate, meclizine, promethazine
Rebound effect if stopped abruptly** |
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COPD: Asthma Stepwise therapy for the management of asthma |
Step Drug Class Step 1 - Short-acting inhaled beta2, agonist PRN Step 2 - Low- dose inhaled corticosteroid Step 3 - Low- dose ICS & long acting beta 2 agonist or medium-dose ICS Steph 4 - Medium dose inhaler plus LABA Steph 5 - High-dose ICS & LABA; + omalizumab x allergies Step 6 - High dose ICS & LABA & corticosteroid & consider omalizumad for allergies |
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COPD: Chronic Bronchitis |
Chronic inflammation & low grade infection of the bronchi) |
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COPD: Emphysema |
Condition of the lungs characterized by enlargement of the air spaces distal to the bronchiales |
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COPD Def & Sx |
Obstruction of air flow through small airways; asthma has chronic aspects & acute episodes during which there is: Bronchospasms Inflammation of the bronchial mucosa Edema of bronchial mucosa Production of viscous mucus |
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Bronchodilators What do they do 2 classes |
Relax Bronchial smooth muscle, which causes dilation of the bronchi & bronchiales that are narrows as a result of the disease process
Beta-adrenergic agonists Anticholinergics |
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MOA of ADP Inhibitors (Plavix) |
Inhibits platelet aggregation by altering platelet membrane so that it can no longer receive the signal to aggregate
Inhibits the activation of glycoprotein receptors (GP IIb/IIIa) on a surface of the platelet |
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Bronchodilators: Beta-Adrenergic agonists MOA Indications Contraindications SE to report
Short-acting Drugs (5) Long-acting Drugs (5) MOA
3 types of Beta agonists Nonselective Adrenergics MOA Indication Drug (1) Adverse Effects
Nonselective beta-adrenergics MOA Drug (1) Adverse effects
Selective Beta2 adrenergics MOA Drug Adverse effects What happens if used too long
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Beta-Adrenergic agonists MOA Activation of beta2 receptors activates a beta agonist called adenylate cyclase which makes cAMP, which relaxes smooth muscle in the airway & results in bronchial dilation & increased airflow
Indications -Relief of bronchospasm r/t asthma, bronchitis, & other pulmonery disease; used to treat & px acute attacks -Hypotension & shock -Produces relaxation to px premature labor
Contraindications HTN, dysrhythmias, CVA Use of beta blockers or MAOIs
Caution with Dm
SE to report Insomnia, jitteriness, restlessness, palpitations, chest pain, or any change in sx
Short-acting Drugs albuterol (ventolin) levabuterol (Xonpenex) pirbuterol (Maxair) terbutaline (Brethine) metaproterenol (Alupent) Long-acting Drugs Arformoterol (Brovana) formoterol (Forafil, Performist) salmeterol (Serevent) MOA Stimulates adrenergic receptors in SNS
3 types of Beta agonists Nonselective Adrenergics MOA stimulate alpha, beta 1 (cardiac), & beta2 (resp) receptors; emergencies only; alpha receptors cause constriction within the blood vessels which reduce the edema of the mucous membranes & limits secretions normally made Drug (1) epinephrine (epipen) Adverse Effects insomnia, restlessness, anorexia, vascular h/a, hyperglycemia, tremor, cardiac stimulation (SNS respon
Nonselective beta-adrenergics MOA Stimulate both beta1 & beta2 receptors Drug metaproterenol (Alupent) Adverse effects (from beta1 cardioselective receptors) Cardiac stimulation, tremor, angina pain, vascular H/A, HTN
Selective Beta2 adrenergics MOA Stimulates only beta2 receptors Drug albuterol (Proventil) Adverse effects (Less effects) Hypotension/Hypertension, vascular h/a, tremor
What happens if used too long? If used to often, may lose beta2 effects & start using beta1 receptors--causing such (heart) SE
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Anticholinergics MOA Drugs (2) Adverse effects Indications Contraindications Precautions |
MOA Causes bronchial constriction & narrowing of the airways. Anticholinergics bind to Ach (PSNS) receptors on the bronchial tree, preventing Ach from binding. Results in airway dilation, preventing bronchoconstriction
Drugs ipratropium bromide (Atrovent) triotropium (Spiriva)
Adverse effects Dry mouth/throat, nasal congestion, heart palpitations, GI distress, H/A, coughing, anxiety
Indications Used to px brochoconstriction Chronic bronchitis or emphysema bronchospasms -- NOT used for acute symptoms - action is slow & prolonged
Contraindications Allergy to drug (ex - atropine), or peanuts or legumes;
Caution Narrow angle glaucoma & prostate enlargement |
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Xanthine derivative 2 types MOA Drug effects Indications Adverse effects What to report Contraindicated Interactions |
2 types Plant Alkaloids - Caffeine, theobromine, theophylline (metabolizes to caffeine) Only theophylline is used clinically Synthetic Xanthines: aminophylline (metabolized to theophlline) & dyphilline
MOA Increases levels of E-producing cAMP-=this is done by competitively inhibiting phosphodiesterase (PDE), the enzyme that breaks down cAMP. Results in decreased cAMP levels, smooth muscle relaxation, brocnhodilation, increased airflow
Drug effects Causes bronchodilation by relaxing smooth muscle in the airways. Results in relief of bronchospasm & greater airflow into & out of the lungs. Also causes CNS stimulation (increases RR) -Causes cardiovascular stimulation: increases force of contraction, increased HR, resulting in increased CO & increased blood flow to the kidneys/GFR (diuretic effect)--increased perfusion -Higher intracellular levels of cAMP contribute to smooth muscle relaxation & inhibit IgE-induced release of chemical mediators that drive allergic reactions
Indications -Dilation of airways in asthmas, chronic bronchitis, & emphysema -Mild to moderate cases of acute asthma -Adjunct drug in tx of COPD -Not used as frequently because of potential for drug interactions & variables related to drug levels in the blood; more as a preventative dose than for acute tx; Usually only used with end-stage COPD
Adverse effects Sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias, anorexia, GERD while sleeping, increased urination, hyperglycemia
What to report N/V, restlessness, insomnia, irritability, tremors
Contraindicated Dysrhythmias, seizure, hyperthyroid, PUD
Interactions allopurinol, cimetidine, marcolide atb (erythromycin), Cipro, flu vaccine, oral contraceptives; smoking increases xanthine metabolism; foods: charcoal-broiled, high protein, low carb foods = low serum levels |
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ADP Inhibitors: clopidogrel (Plavix) |
Adverse effects Bone marrow suppression Flu-like symptoms Nose bleed |
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ADP Inhibitors (Plavix) |
Used to prevent CVA, TIA, & PE |
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Methylxanthine Deriratives MOA Indication (1) Drug (1) Side effects |
Decreases blood viscosity to improve peripheral circulation; has antiplatelet effects that make blood cells more flexible Treats Raynauds Disease; rarely used pentoxifylline (Trental) CNS stimulation SE |
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GP IIb/IIIa Inhibitors What is GP IIb/IIIa? MOA Route Indication 3 Drugs Adverse effects Nursing care |
GP IIb/IIIa are a component of the platelet membrane which is a potent stimulator for platelet adhesion MOA Blacks the receptor protein in the platelet wall membranes Prevents thrombi formation Route - IV Indication - Px thrombi formation in critical situations like cardiac life support to increase perfusion Drugs tirofan (Aggrastat) eptifibatide (Integrilin) abciximad (ReoPro)
Adverse effects Increased Risk for stroke Bradycardia, hypotension, edema, dizziness, thrombocytopenia
NC Continuous C/V monitoring |
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INR therapeutic range & control
PTT therapeutic range |
INR therapuetic - 2-3 control - 1.5 - 2.5
PTT 45-70
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Types of URI |
common cold, laryngitis, pharyngitis, rhinitis, sinusitis, tonsilitis |
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Pathophys of URI |
Infection & Allergens cause inflammatory response
Histamine bind to H1 receptors on membranes & vessels
Excessive mucus production results from inflammatory response to histamine invasion
Fluid drops down the pharynx into esophagus & lower resp tract, causing cold symptoms: sore throat, cough, upset stomach
Irritation of nasal mucosa triggers: Sneeze reflex Release of inflammatory vasoactive substances, dilating small blood vessels in the nasal sinuses & causing nasal congestion |
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Non Bronchodilating Drugs (4) |
Leukotiene Receptor Antagonists (LTRAs)
Inhaled Corticosteroids (glucocorticoids)
Phosphodiesterase-4 Inhibitor
Monoclonal Antibody
Antiasthmatic |
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Non Bronchodilating Drugs (4) |
Leukotiene Receptor Antagonists (LTRAs)
Inhaled Corticosteroids (glucocorticoids)
Phosphodiesterase-4 Inhibitor
Monoclonal Antibody
Antiasthmatic |
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Leukotreine Receptor Antagonists (LTRAs) 2 types 3 drugs What are leukotrienes? MOA Drug Effects Indications Adverse effects Contraindications Nursing care |
What are leukotrienes? Substances released when a trigger, such as car hair, starts a series of chemical reactions in the body. The leukotrienes cause an allergic reaction.
MOA LTRAs prevent leukotrienes from attaching to receptors on cells in the lung and in circulation. Inflammation is blocked, & asthma symptoms are relieved.
Drug Effects LTRAs are the first medication to focus on the immune response of asthma rather than treating with bronchodilators. -Prevent smooth muscle contraction of the bronchial airways -Decrease mucus secretion -Prevent vascular permeability (thus decrease congestion) -Decrease neutrophil &leukocyte mobility to the lungs preventing inflammation
Indications Prophylaxis & treatment of asthma in pt >12 y/o NOT meant for management of asthma attacks Montelukast is treats allergic rhinitis
Adverse effects H/A, nausea, dizziness, insomnia, liver dysfunction (AST/ALT*), diarrhea
Contraindications Allergy to povidine, lactose, titanium dioxide, or cellulose; don't take with phenobarbital or rifampin
Nursing care Effects take 1 wk Med red for drug interactions Liver tests before therapy Take q night even if sx improve Narrow therapeutic range - monitor lab values* |
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Non-Bronchodialating drugs: Inhaled corticosteroids (aka glucorticoids) Drugs (7) MOA What does it work as? Routes? -- whats the difference? Indications Adverse effects Contraindications Nursing care |
Drugs beclomethasone dipropionate (Beclovent) budesonide (Pulmicort Turbuhaler) dexomethasone sodium phosophate (Decadron Phosphate Respihaler) fluisolide (AeroBid) fluticasone (Flunase) triamcinolone acetonide (Azmacort) ciclesonide (Omnaris)
MOA Stabilize membranes of WBCs that release harmful bronchoconstricting substances. Increase responsiveness of bronchial mooth muscle to beta-adrenergic stimulation. Reduces inflammation & enhance beta agonist activity.
What does it work as? Anti-inflammatory
Routes? -- whats the difference? Oral & inhaled form - inhaled from reduces systemic effects
Indications Persistent Asthma; often used concurrently with beta-adrenergic agonists
Adverse effects - pharyngeal irritation, coughing, dry mouth, oral fungal infection (RINSE MOUTH*), systemic effects are rare
Contraindications Candida infection (corticosteroids suppress immune system)
Nursing care Takes several weeks for full effect Teach pt to monitor dx with peak-flow meter Encourage spacer device x successful inhalation |
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Phosphodiesterase-4 Inhibitor Drug (1) Indication Adverse effects |
roflumilast (Daliresp) Indicated to prevent coughing & excess mucus; used to decrease fatal COPD exacerbations Adverse effects - N/V/D, H/A, insomnia, dizziness, wt loss, psychiatric symptoms |
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Phosphodiesterase-4 Inhibitor Drug (1) Indication Adverse effects |
roflumilast (Daliresp) Indicated to prevent coughing & excess mucus; used to decrease fatal COPD exacerbations Adverse effects - N/V/D, H/A, insomnia, dizziness, wt loss, psychiatric symptoms |
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Monoclonal Antibody Antiasthmatic Drug (1) MOA Route (1) Nursing care (1) |
omalizumab (Xolair) MOA selectively binds to IgE, which in turn limits the release of mediators of the allergic response Route - injection NC Potential for producing anaphylaxis - monitor closely x hypersensitivity - not given to take at home |
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Nursing care for drugs treating the lower respiratory tract |
Encourage pt to take measures to promote generally good state of health so as to prevent, relieve, or decrease symptoms of COPD - Avoid exposure to conditions to precipitate bronchospasms (allergens, smoking, stress, air pollutants) - Adequate fluid intake - Compliance with medical tx - Avoid exercise, fatigue, heat, cold, & caffeine
Encourage prompt tx for flu & to get vaccinated against flu/pm
Perform thorough assessment before beginning therapy -Skin color, VS, SaO2, Sputum character, Allergies, PMH, Medications
Teach use of MDIs
Monitor for therapuetic effects: Deceased dyspnea, wheezing, restlessness, anxiety Increased respiratory pattern, activity tolerance, & ease of breathing |
