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69 Cards in this Set
- Front
- Back
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#1 thing for respiratory response
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Position and oxygen
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Perfusion and ventilation
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Lung is better perfused than ventilated (normal is 0.8)
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4 things of asthma
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- airway obstruction
- variable and reoccuring symptoms - bronchial hyperresponsiveness - underlying inflammation |
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Inflammation causes:
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Airway obstruction and Airway hyperresponsiveness
this leads to clinical S/S |
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Bronchospasms and Inflammation casue:
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Airflow limitation (bronchial hyperreactivity plays into this with triggers as well)
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Mild intermittent asthma
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Symptom < 2 times per week
Asymptomatic between episodes Normal pulmonary function between exacerbations Exacerbations last several hours to day; intensity varies Nocturnal symptoms less than 2 times/month |
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Mild persistent
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Symptoms > 2 times/week but < 1 time/day
Exacerbations affect activity Nocturnal symptoms > 2 times/month (doesn’t have to be wheezing, can be as simple as a nightime cough) FEV (forced expiration volume)1 > 80% of predicted |
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Moderate persistent
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Daily symptoms
Daily use of short term beta agonist Exacerbations affect activity Exacerbations > 2 times/wk; may last days Nocturnal symptoms > 1 time/week FEV1 > 60% and < 80% predicted |
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Severe presistent
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Continual symptoms
Limited activity tolerance Frequent exacerbations Nocturnal symptoms frequent FEV1 < 60% of predicted |
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Short Acting Inhaled Beta agonists names
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--buterol
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Long Acting Inhaled Beta Agonists names
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--moterol
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Inhaled and oral glucocorticoid names
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--sone or --son(e)--
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Short Acting use
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quick relief, rescue inhaler
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Adverse effects of short acting beta agonists
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- tachycardia
- tremor - excitable, nervousness, anxiety, agitation - angina |
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Order of inhalers
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**Inhale bronchodilator (beta agonist) before steroid inhaler
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Long acting inhales adverse effects
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- may increase severe risk of death if used incorrect
- not a rescue inhaler!!! - NEVER used for acute or changes in peak flow - NEVER a first line of therapy! |
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Inhaled glucocorticoids use
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- prophylaxis
- Never used to treat actue exacerbation - decreases airway edema and bronchial hyperactivity |
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Adverse effects of inhaled glucocorticoids
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- ADRENAL SUPPRESSION
- GROWTH DELAY IN CHILDREN - boen loss - thrush (rinse mouth) - dysphoria - cataracts and glaucoma |
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Oral glucocorticoid specific names
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- Prednisone
- Medrol Dose pack - Prednisolone - liquid *verify concentration* |
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Adverse effects of oral glucocorticoids
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- Endocrin emergency if premature withdrawal
- Administer with food - Hyperglycemia - Infection - Myopathy - F&E imbalance - Growth retardation - Osteoporosis - Cataracts - Peptic Ulcer Disease - Cushing's Disease |
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Long Acting Inhaled Beta Agonists names
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--moterol
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Inhaled and oral glucocorticoid names
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--sone or --son(e)--
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Short Acting use
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quick relief, rescue inhaler
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Adverse effects of short acting beta agonists
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- tachycardia
- tremor - excitable, nervousness, anxiety, agitation - angina |
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Order of inhalers
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**Inhale bronchodilator (beta agonist) before steroid inhaler
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Long acting inhales adverse effects
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- may increase severe risk of death if used incorrect
- not a rescue inhaler!!! - NEVER used for acute or changes in peak flow - NEVER a first line of therapy! |
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Inhaled glucocorticoids use
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- prophylaxis
- Never used to treat actue exacerbation - decreases airway edema and bronchial hyperactivity |
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Adverse effects of inhaled glucocorticoids
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- ADRENAL SUPPRESSION
- GROWTH DELAY IN CHILDREN - boen loss - thrush (rinse mouth) - dysphoria - cataracts and glaucoma |
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Oral glucocorticoid specific names
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- Prednisone
- Medrol Dose pack - Prednisolone - liquid *verify concentration* |
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Adverse effects of oral glucocorticoids
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- Endocrin emergency if premature withdrawal
- Administer with food - Hyperglycemia - Infection - Myopathy - F&E imbalance - Growth retardation - Osteoporosis - Cataracts - Peptic Ulcer Disease - Cushing's Disease |
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Cromolyn (Intal)
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- prophylaxis of asthma
- will not treat acute exacerbations - safest of all asthma meds - not a bronchodilator - must be taken BEFORE bronchospasm |
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Methylxanthines names
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Theophylline
Theodur (prolonged duration) |
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Methylxanthine therapeutic range
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Plasma monitoring needs to be between 10-20 mcg.ml (very narrow range)
20-25 mild symptoms >30 serious symptoms (atrial fib, seizures) |
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Leukotriene modifiers names
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-- ukast
Zileuton Zafirlukast Montelukast |
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Leukotriene modifiers
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- Preventive, does not treat exacerbation
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Montelukast
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- Singulair
- longest acting - Daily dosing in evening - max effects in 24 hrs - may allow for reduction of inhaled corticosteroids - does not cause liver injury like others |
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Mucolytics name
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Acetylcysteine (Mucomyst)
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Mucolytic adverse reaction
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may CAUSE bronchospasm, impairs instead of improving
- also used in dye procedures **Smells like rotten eggs |
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Decongestants (pseudoephedrine) names
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-- oline
--rine -- drine |
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Decongestant action
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causes vasoconstriction of nasal passagways
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Adverse effects of decongestants/pseudoephedrine
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Rebound congestion after 3 days
- CNS stimulation - HTN, CAD vasoconstriction - hemorrhagic stroke - Abuse (amphetamines) |
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Contrainidcations for pseudoephedrine/decongestant
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- HTN
- HEart disease - DM - Thyroid disease ore replacement - Prostate enlargement/ urinary retention - careful because other products are often combined with this |
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Inhaled anticholinergics action
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Decreases secretions in chronic bronchitis (COPD exacerbation)
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Inhaled anticholinergic name
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--tropium (Spiriva)
combivent/duoneb (combined with albuterol) |
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Adverse effects of Inhaled anticholinergics
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- dry mouth
- pharyngeal irritation - increased ocular pressure (glaucoma) |
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Which inhaled anticholinergic is only available by nebulizer?
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Spiriva (tiotropium)
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What 2 inhaled anticholinergics can not be used in those with a peanut allergy?
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Atrovent (ipratropium)
Combivent (combine with duoneb albuterol) |
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1st generation antihistamines names
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--mine, ine
- Diphenhydramine (Benedryl) |
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1st generation antihistamines use
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allergy, motion sickness, 1st line drug for allergic rhinitis
-cough suppressant associated with allergy |
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Adverse effects of 1st generation antihistamines
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- sedation
- dizziness, incoordination, confusion, fatigue (all of theses are non CNS) - Anticholindergic effects (dry mouth, nasal pasageways and throat, constipation, urinary retention) - cardiac arrhythmias - potentiate other sedating drugs - confusion and agitation in elderly |
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antihistamine contraindications
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- narrow angle glaucoma
- prostate hypertrophy - bladder neck obstruction - AVOID in 3rd trimester of pregnancy |
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2nd generation antihistamin names
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-- adine
--ine |
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use of 2nd generation antihistamins
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rhinitis, common cold (minimal therapeutic effects)
- contact dermatitis - allergic reactions to food, drug, or environment - insomnia |
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Adverse effects of 2nd generation antihistamines
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- does not cross blood brain barrier
- fatigue, headache, drowsiness (less than 1st), HTN - dry mouth, GI upset - QT prolongation |
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Codeine cough suppressant
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- most effective cough suppressant
- can suppress respiration - significant for abuse (II is highly addictive, V not as much) - 1/10 of analgesia amount - rarely given to children |
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Benzonatate (Tessalon Pearls)
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- analog of tetracaine
- swallow whole (don't give to infants or any dysphagia pts) - may impair swallowing if comes in contact with throat (numbing) |
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Dextromethrphan (Robitussin DM)
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- relatively safe in recommended dosage (10-30mg q 4-8h)
- respiratory and side effects not common - does not slow heart, so can taken with beta blockers - no drowsiness - no potential for addiction - CAN OVERDOSE!- new agents kids are getting high on, risk for abuse! |
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OTC asthma med cause what?
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vasoconstriction and HTN
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Tx of asthma exacebations
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- relieve airway obstruction
- prevent hypoxemia - normalize lung function ASAP |
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Inhaler care
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- room temp
- shake before use - rinse mouth |
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OTC inhalers
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- have epinephrine
- cause tachycardia, lethal rhythms, HTN, death - starting 12/31/11 no longer going to be OTC |
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Rusty colored sputum
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not normal in COPD, sign of infection
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COPD exacerbation S/S
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- increased sputum (purulent esp)
- increased dyspnea |
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COPD exacerbation tx
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- O2
- inhaled beta agonists - inhaled anticholinergic - antibiotics - system corticosteroid - methylxanthine (if don't response to bronchodilator) |
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Dry poweder inhalers
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require less coordination
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tx for mild intermittent asthma
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- no daily med
- PRN short acting beta agonist |
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tx for mild persistent asthma
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- daily low dose inhaled glucocorticoid
- prn short acting beta agonist |
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moderate persistent asthma tx
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- daily low dose inhaled glucocorticoid
- long acting beta agonist - prn short acting beta agonist |
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Severe persistent asthma tx
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- High dose inhaled glucocorticoid
- Long acting beta agonist - oral glucocorticoid if required - short acting prn beta agonist |
