Respiratory Drugs

Front 1

Methylxanthines Derivatives

-what meds are included in this cateogory? (2)

Back 1

1. Theophylline (theodur) - given orally and IV

2. Aminophylline - given IV

Front 2

What is the action of methylxanthines Derivatives?

Back 2

chemically related to caffeine; respiratory smooth muscle relaxant results in bronchodilation

Front 3

Methylxanthines side effects

Back 3

SE: nervousness, insomnia, tremors, hyperglycemia, NV, difficulty in urination in elderly men with prostatism, increased reflux/ulcers

Front 4

methylxanthines nursing implications

Back 4

monitor for manifestations of toxicity: irritability, palpitations, tachycardia, circulatory failure

-admin with meals

-IV aminophylline is incompatible with many other IV drugs; use separate line or flush well. Not meant for use with an acute asthma attack. Use blood levels to titrate to therapeutic range

Front 5

Anticholinergics

-what drugs are in this category?

Back 5

1. Atropine (inhalation)

2. Ipratripium Bromide (atrovent) - inhalation or nebulizer

Front 6

action of anticholinergics

Back 6

block input from the parasympathetic nervous system causing bronchodilation

Front 7

nursing implications for anticholinergics and side effect ?

Back 7

SE: dry mouth

-do not give to patients with glaucoma or bladder neck obstruction

-do not take more than prescribed dose

Front 8

Mast cell stabilizers - what two drugs fall under this category?

Back 8

1. Cromolyn (inhalation)

2. Nedocromil (inhalation)

Front 9

Action of mast cell stabilizers

Back 9

inhibit inflammatory (mast) cells in the airway, blocking response to antigens when inhaled and blocking release of histamine

Front 10

nursing implications are side effects of mast cell stabilizers ?

Back 10

SE: Nedocromil may have unpleasant taste

-for prevention only- not intended to treat an acute attack

-may take several weeks for full therapeutic effects

Front 11

Leukotrine modifiers

what two drugs?

Back 11

1. Zafirlukast (accolate) - given orally

2. Montelukast (singulair)

Front 12

action of Leukotrine Modifiers >?

Back 12

-interfere with the inflammatory process by suppressing action of leukotrines **

-leukotrines cause bronchoconstriction and vasodilation

Front 13

Action of leukotrienes:

Back 13

bronchoconstriction, increased mucous secretion, decreased mucous clearance, eosinophil activation, eosinophil infiltration

Front 14

nursing implications for leukotrine modifiers ?

Back 14

*NOT used for an acute attack

-admin on an empty stomach

- may interfere with warfarin or theophylline

-drugs may be toxic to liver: report jaundice or changes in color of stools or urine

-Singulair is avail for children 2 and up

Front 15

Adrenergic Stimulants (beta adrenergic agonist)

name 3 drugs..

Back 15

1. Albuterol - give orally and inhaled

2. salmeterol (serevent) -inhaled

3. Combo drug: salmeterol/fluticasone (advair)

Front 16

Action of adrenergic stimulants

Back 16

affect sympathetic receptors in respiratory tract leading to rapid bronchodilation

Front 17

SE of adrenergic stimulants

Back 17

tachycardia, hypertenstion, tremor, nervousness (report SE to HCP)

Front 18

nursing implications for adrenergic stimulants

Back 18

report to HCP if drug becomes less effective (increased use greater than 1x per month indicated inadequate control and need for inhaled steroid)

-use with caution in patients with hypertension, cardiovascular disease

-salmeterol has been shown to increase the incidence of asthma related deaths; use only as prescribed

Front 19

Corticosteroids (given oral, IV and inhalation)

what 4 drugs?

Back 19

1. Beclomethasone (beclovent)

2. Trimcinilone (azmacort)

3. Flunisolide (aerobid)

4. Combo drug: salmeterol/fluticasone (advair)

Front 20

action of corticosteroids

Back 20

anti-inflammatory effects. To prevent the frequency and severity of asthma attacks. Decrease mucous production in airways and increase the number and receptivity of beta 2 receptors

prevent scarring caused by asthma attacks

Front 21

SE or corticosteroids

Back 21

SE: (oral) hyperglycemia, increased appetite, fluid retention, weight gain, mood alteration, HTN, peptic ulcer, insomnia

Front 22

Nursing implications for corticosteroids

Back 22

admin inhaler dose after bronchodilators.

-rinse mouth after use to prevent thrush

-inhalers not for an acute attach

-may take several weeks to see effects

- to treat moderate to severe persistent asthma can use oral steroid (works as well as IV) - use a 7 day course

Front 23

Med administration guidelines for inhalers

Back 23

Give bronchodilators prior to admin of steroids or other meds

-allow 1 min between puffs of meds

-allow 5 min between different meds

-place inhaler in mouth, not outside of mouth

Front 24

med admin guidelines for dry powder inhalers

Back 24

do NOT contain propellant

-patient has to have enough velocity on inspiration to inhale the powder into the lung

-keep the inhaler dry

- may not feel, taste or smell the medication

-do not blow into DPI

Front 25

med admin guidelines for spacers:

Back 25

-attaches to MDI (metered dose inhaler)

-allows for use of MDI by patients who might otherwise have probs coordinating the inhalation with the compression of the MDI

-research shows that use of these devices deliver most meds to the lung

Front 26

your patient with asthma is complaining of SOB during their morning assessment. What would be the drug of choice to treat this symptom of asthma ?

Back 26

albuterol inhalers

Front 27

your patient has the following meds ordered: albuterol inhaler 2 puffs, cromolyn inhaler 1 puff and azmacort inhaler 2 puffs. which of the inhalers should this patient use first?

Back 27

albuterol inhaler

Front 28

when using the albuterol inhaler how much time should be allowed between the puffs of medication?

Back 28

wait one minute before taking the second puff

Front 29

when administering the subsequent inhaler how much time should elapse? (part 2 of previous question)

Back 29

wait 5 min before using the second inhaler

Front 30

inhaled meds are preferred for treating respiratory conditions because of which of the following reasons

Back 30

1. they go directly to the site of the problem to work

2. they cause less side effects

3. they can provide immediate relief of symptoms

Front 31

which two drugs have the known side effect tachycardia ?

Back 31

theophylline

albuterol

Front 32

what drug classification is albuterol?

Back 32

adrenergic stimulant

Front 33

the primary effect of albuterol is to

Back 33

stimulate the sympathetic nervous system leading to bronchodilation

Front 34

when instructing a pt on the use of a metered dose inhaler what instructions should be given>?

Back 34

1. exhale slowly and completely

2. place mouthpiece into the mouth, closing lips around it. 3. press and hold the canister down while inhaling deeply

4. rinse the mouth after use

Front 35

a pt is being treated for a mild asthma attach with the drug methylprednisolone 4mg for six days with decreasing dosages over the 6 days etc.... what is the purpose of this drug in the treatment of asthma?

Back 35

prevents inflammation

Front 36

the pt asks 'why am I taking a diff dose of this drug (methylprednisolone) each day?

what would your reply be?

Back 36

you are being weaned to prevent adrenal insufficiency

Front 37

in order to minimize the affect of corticosteroids on the gastic mucosa these drugs should be

Back 37

taken with food

Front 38

True or false?

Leukotrine modifiers include the drugs Ipratroprium and Cromolyn.

Back 38

false

Front 39

leukotrine modifiers interfere with the action of ___________?

Back 39

leukotrienes

Front 40

Leukotrines causes broncho___________ and ___________ mucous production (increased or decreased)

Back 40

bronchoconstriction and increased mucus production

Front 41

True or false >?

Leukotriene modifiers should NOT be used for an acute asthma attack

Back 41

TRUE

Front 42

your patient with COPD is hospitalized with an exacerbation. He is very weak and is having a hard time coordinating the use of his albuterol inhaler. Your first action should be:

Back 42

order a spacer to use with the inhaler

Front 43

True or false?>

IV aminophylline is compatible with most other drugs

Back 43

FALSE

Front 44

true or false?

theophylline will be titrated to therapeutic levels using blood tests

Back 44

TRUE

Front 45

T or F

theophylline is not meant to be used for an acute asthma attach

Back 45

true

Front 46

t or f

symptoms of theophylline toxicity include palpitations and circulatory failure

Back 46

true