DRUGS (respiratory)

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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 – Betaâ‚‚ 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

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