DRUGS (respiratory) – Flashcards
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Sympathomimetic agents prototype
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- albuterol (Proventil, Ventolin) - short acting rescue inhaler
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What conditions does albuterol (Proventil, Ventolin) treat?
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- asthma
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albuterol (Proventil, Ventolin) pharmacodynamics
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- bronchodilator - Beta₂ adrenergic causes smooth muscle relaxation, bronchodilation & vasodilation
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Life threatening adverse effects albuterol (Proventil, Ventolin)
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- paradoxical bronchospasm - cardiac dysrhythmias - urticaria (hives) - angioedema
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Contraindications/caution albuterol (Proventil, Ventolin)
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- cardiovascular disorders (tacky, anxiety) - hyperthyroid - DM - seizure
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Side effects albuterol (Proventil, Ventolin)
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- CNS: nervous, tremor, HA, dizzy, anxious, insomnia - CVS: tachycardia, palpitations, HTN
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Nursing implications/patient teaching albuterol (Proventil, Ventolin)
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- assess respiratory and cardiac (before & after treatment) - make sure the pt knows this is a "rescue drug"
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1st line inhaled anticholinergics prototype
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- tiotropium (Spiriva)
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What conditions does tiotropium (Spiriva) treat?
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- MAINTENANCE of COPD
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Administration tiotropium (Spiriva)
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- inhalation only
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tiotropium (Spiriva) pharmacodynamics
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- relaxes smooth muscles of bronchi
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Life threatening adverse effects tiotropium (Spiriva)
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- paradoxical bronchoconstriction - cardiac dysrhythmias - cardiac arrest - anaphylaxis - angioedema
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Contraindications/caution tiotropium (Spiriva)
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- lactose intolerance - narrow angle glaucoma
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Side effects tiotropium (Spiriva)
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- anticholinergic (can't see, pee, spit, shit) - hyperglycemia
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Nursing implications/patient teaching tiotropium (Spiriva)
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- make sure pt knows it is for maintenance NOT ACUTE ATTACK - monitor use of inhaler - use bronchodilator before steroid
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Inhaled anticholinergics prototype
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- ipratropium bromide (Atrovent)
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What conditions does ipratropium bromide (Atrovent) treat?
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- MAINTENANCE of COPD
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ipratropium bromide (Atrovent) pharmacodynamics
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- ACH at vagal mediated receptor sites blocks the vagal effect, relaxation of smooth muscle occurs
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Life threatening adverse effects ipratropium bromide (Atrovent)
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- bronchospasm - anaphylaxis
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Contraindications/cautions ipratropium bromide (Atrovent)
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- bladder obstruction - prostatic hypertrophy
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Side effects ipratropium bromide (Atrovent)
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- urticaria - angioedema of tongue, lips and face - larangospasms - epistaxis (bloody nose) - HA - rhinitis - nasal congestion - rhinorrhea
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Nursing implications/patient teaching ipratropium bromide (Atrovent)
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- take BID despite absence of sx
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Administration ipratropium bromide (Atrovent)
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- MDI (metered dose inhaler) - Nebulizer
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Methylxanthine (Xanthine) derivatives prototype
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- theophylline (Slo-Bid, Theo-Dur)
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How is 90% of theophylline (Slo-Bid, Theo-Dur) excreted?
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- by the kidneys
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What conditions does theophylline (Slo-Bid, Theo-Dur) treat?
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- MAINTENCE bronchodilator + asthma + chronic bronchitis + emphysema + neonatal apnea
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What is considered a therapeutic and toxic serum concentration?
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- 10 - 20 mcg/mL - ≥ 20 mcg/mL = toxic - if > 30 mcg/mL = hypotension, high blood sugar, dysrhythmias, seizure, brain damage & death
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theophylline (Slo-Bid, Theo-Dur) pharmacodynamics
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- stimulates 2 prostaglandins that result in bronchodilation - inhibits release of slow-reacting substance of anaphylaxis (SRS-A) and histamine
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Life threatening adverse effects theophylline (Slo-Bid, Theo-Dur)
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- respiratory arrest - hypotension
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Contraindications/caution theophylline (Slo-Bid, Theo-Dur)
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- status asthmatic - pregnant - peptic ulcer - dysrhythmias - seizure disorder + CAD + CHF + HTN + renal and hepatic disease
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Nursing implication/patient teaching theophylline (Slo-Bid, Theo-Dur)
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- ASSESS FOR NICOTINE USE (nicotine may decrease serum theophylline levels ∴ sub therapeutic and need to increase dose - ↓ effects with low-carb, high-protein diet, & charbroiled beef - ↑ effects with xanthines, especially caffeine - never double a dose - take with food and water - contact doctor if any adverse reactions
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Leukotriene receptor antagonist & synthesis inhibitor prototype
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- montelukast (Singulair)
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What conditions does montelukast (Singulair) treat?
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- MAINTENANCE for exercise induced asthma
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montelukast (Singulair) pharmacodynamics
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- binds with leukotrienes receptors to inhibit smooth muscle contraction & bronco constriction ∴ causes dilation
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Life threatening adverse effects montelukast (Singulair)
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+ Stevens-Johnson syndrome ****RARE**** + anaphylaxis - angioedema - bleeding - vasculitis - seizure - edema
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Contraindications/caution montelukast (Singulair)
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- severe acute asthma attack + severe liver disease + suicidal ideation + breast feeding + corticosteroid withdrawal
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Nursing implications/patient teaching montelukast (Singulair)
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- take medication daily even when asymptomatic - take in the evening for max effectiveness
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Inhaled glucocorticoid prototype
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- flunisolide (AeroBid)
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What conditions does flunisolide (AeroBid) treat?
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- MAINTENANCE of COPD - anti-inflammatory disorders
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Administration flunisolide (AeroBid)
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- IV - PO - inhalation + inhalation takes 1-4 weeks to reach full effect
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flunisolide (AeroBid) pharmacodynamics
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- increases the number of Beta receptors - enhances responsiveness of Beta receptors in airway smooth muscle - decreases production of mucus
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Contraindications/caution flunisolide (AeroBid)
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- active fungal infection - active respiratory infection
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Side effects flunisolide (AeroBid)
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- thrush - immunosuppression
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Nursing implications/patient teaching flunisolide (AeroBid)
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- use daily even if asymptomatic - rinse mouth after each use of MDI or DPI
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Oral glucocorticoid prototype
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- prednisone
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Mast cell stabilizer prototype
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- cromolyn sodium (NasalCrom)
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What conditions does cromolyn sodium (NasalCrom) treat?
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- prophylactic tx of bronchial asthma
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cromolyn sodium (NasalCrom) pharmacodynamics
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- prevents mast cell release of histamine - HAS NO BRONCHODILATOR ACTIVITY
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Life threatening adverse effects cromolyn sodium (NasalCrom)
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- bronchospasm - anaphylaxis
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Contraindications/caution cromolyn sodium (NasalCrom)
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- acute asthma attack - pt's with CAD or dysrhythmias - pt's with lactose intolerance
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Side effects cromolyn sodium (NasalCrom)
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- throat irritation - wheezing - lactose intolerance symptoms
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Nursing implications/patient teaching cromolyn sodium (NasalCrom)
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- assess respiratory and cardiovascular status prior to administration - monitor pt's with lactose intolerance - do not d/c abruptly - rebound asthma attack - use bronchodilator before taking
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Mucolytic prototype
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- acetylcysteine (Mucomyst)
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What conditions does acetylcysteine (Mucomyst) treat?
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- cystic fibrosis - acetaminophen overdose - renal protective
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acetylcysteine (Mucomyst) pharmacodynamics
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- thins mucus - normalizes liver stores - antioxidant activity
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Life threatening adverse effects acetylcysteine (Mucomyst)
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- bronchospasm - anaphylaxis
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Contraindications/caution acetylcysteine (Mucomyst)
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- respiratory compromise (can cause increased airway obstruction) - tracheotomy - esophageal varices (dilation of vessels= explode; chokes on own blood)
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Side effects acetylcysteine (Mucomyst)
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- N/V is expected due to horrible smell - sticky - rash
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Nursing implications/patient teaching acetylcysteine (Mucomyst)
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- mix with orange juice - take inhaled beta agonist prior to administration - assess for respiratory difficulty (may need suction) - follow med with chest physiotherapy and postural drainage - wash pt's face and have them gargle
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If given for acetaminophen overdose, what are the time limitations?
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- give 8 hours after ingested - can give up to 24 hours after ingested
