Term
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Definition
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Term
| Mechanism of action for mucolytics. |
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Definition
| Affects the mucoproteins in the respiratory secretions. Splits disulfide bonds that are responsible for holding the mucous material together, result is a decrease in the viscosity of the secretions. Problem is if pts cannot cough secretions up once they are broken up, need to think about how ahead of time. |
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Term
| Indications for mucolytics. |
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Definition
| Therapy for abnormal or viscous mucous secretions in acute and chronic bronchopulmonary disease. For treatment of cystic fibrosis, pneumonia, tuberculosis, COPD. preforming a bronchoscopy to clear the airway, and facilitate removal of secretions post-op, also to facilitate airway clearance and suctioning in patients w/tracheostomies. Med can also be given orally to protect liver if too much Tylenol is taken. |
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Term
| Contraindications for mucolytics. |
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Definition
| Hypersensitivity, Hx of resp compromise (increased secretions can compromise the airway if it is not cleared), Hx of asthma (bronchospasm can occur). Pregnancy category B. Peaks in 5-10 mins, so be prepared to clear mucus if pt needs help. |
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Term
| Serious adverse effects for mucolytics. |
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Definition
| Chest tightness, burning feeling in upper airway, bronchospasm and bronchoconstriction- can be lifethreatening. |
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Term
| Common adverse effects for mucolytics. |
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Definition
| N/V, and rhinorrhea- most common. |
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Term
| Preadministration assessment for mucolytics. |
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Definition
| Resp baseline including ability to cough, abdominal assessment for hepatomegaly (metabolized through the liver), temp, skin eval. |
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Term
| Monitoring of mucolytics. |
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Definition
| usually given under the direct supervision of resp therapist or RN- b/c of resp secretions, airway clearance. Secretions are loosening and the pt is having success coughing and moving secretions up/out |
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Term
| Patient education for mucolytics. |
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Definition
| Instruct pts to report all adverse effects, including difficulty breathing, severe nausea and dizziness. Inform pts that the drug is administered w/the assistance of resp therapist or RN (not done by self). Med has odor like rotton eggs- but transient. |
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Term
| Examples of short acting Beta 2 agonists. |
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Definition
| Levalbuterol (Xopenix), Metaproterenol (Alupent), Pirbuterol (Maxair); |
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Term
| Examples of long acting Oral Beta agonists. |
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Definition
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Term
| Examples of long acting Inhaled Beta-agonists |
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Definition
| Arformoterol (Brovana), Formoterol (Foradil), Salmeterol (Serevent Diskus) |
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Term
| Mechanism of action for beta agonists. |
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Definition
| Beta-adrenergic agonists are symathomimetic agents, mimics the action of norephinephrine which stimulates bronchodilation; suppresses histamine release in lungs. |
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Term
| Indications for Beta-agonists. |
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Definition
| Dilate airways, increased rate and depth of resp; used for acute (inhaled, short-acting) and chronic (inhaled or oral, long-acting) management of asthma and COPD(use is controversial b/c doesn't work as well) |
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Term
| Contraindications for beta-agonists. |
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Definition
| Hypersensitivity, pts w/tachydysrhythmias or tachycardia due to digitalis toxicity. Caution in pts w/ HTN, Cardiac disease, DN, Hyperthyroidism, angina pectoris, cardiac arrhythmias, seizures. Pregnancy category C. |
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Term
| Serious adverse effects of beta-agonists. |
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Definition
| Muscle cramps, dyspepsia, bronchospasm. |
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Term
| Common adverse effects of beta-agonists. |
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Definition
| Throat irritation, N/V, angina, palpitatios, tachycardia, anxiety, tremors, increased BP. |
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Term
| Preadministrations assessment of beta-agonists. |
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Definition
| Respiratory and cardiac systems; record baseline data for efficacy of treatment or potential adverse effects; evaluate patient for potential medical conditions that is contraindicated for medication; assess for use of caffeine, (also a sympathomimetic and may increase adverse effects) |
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Term
| Monitoring of beta-agonists. |
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Definition
| Adverse effects seen more often with oral than inhaled admin and most are involved w/symapthetic nervous system stimulation; Resp system; CNS system (anxiety, tremors, insomnia) Cardiac system (HTN, arrhythmias) |
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Term
| Patient education of beta-agonists. |
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Definition
| Teach pt to use and care for inhaler, may need spacer for proper use; use as directed, don't overuse medication- not working, meds for prophylaxis may be needed; SHORT ACTING IS RESCUE DRUG- should be 1st drug used when acute attack symptoms occur; drug of choice for at home use, used in ER for acute asthma attacks; limit caffeine, inform PCP of OTC meds, limit OTC med usage. |
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Term
| Selective vs Non-selective beta-agonists. |
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Definition
| Selectivity is not absolute; can cause stimulation of cardiac receptors; respond to sympathetic nervous system stimulation. |
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Term
| Long acting beta-agonists. |
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Definition
| For prophylaxis (control), NOT rescue; not to be used alone, used in conjunction w/short acting beta-agonist as well; can increase the risk of severe asthma and asthma-related death, but ONLY when used incorrectly. |
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Term
| Example of anticholinergenics. |
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Definition
| Ipratropium bromide (Atrovent) |
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Term
| Mechanism of action for anticholinergenics. |
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Definition
| Blocks the action of acetylcholine in bronchial smooth muscle (blocks muscarinic receptors in bronchi causing bronchial dilation). |
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Term
| Indication for anticholinergenics. |
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Definition
| For treatment of COPD (approved) and Asthma (off-label); admistered by inhalation; triotropium has a longer duration than ipratropium, so can be administered less often. |
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Term
| Contraindications for anticholinergenics. |
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Definition
| Hyperensitivity to drug or to legumes, soybeans, peanuts (inhaler propellant contains soya). Caution in pts w/ acute bronchospasm (not rescue therapy), prostate hyperplasia, bladder neck obstruction, or glaucoma (arrow angle). |
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Term
| Serious adverse effects for anticholinergenics. |
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Definition
| Rare since little is systemically absorbed- bronchospasm, anaphylaxis, cardiovascular death, or stroke. |
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Term
| Common adverse effects for anticholinergenics. |
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Definition
| Abnormal taste and nasal congestion. |
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Term
| Patient education for anticholinergenics. |
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Definition
| This is NOT a rescue drug- will NOT help during an acute attack; keep using meds daily, even if not experiencing symptoms, use as directed. |
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Term
| Example of bronchodilator. |
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Definition
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Term
| Mechanism of action for bronchodilator. |
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Definition
| Blocks the action of two prosteglandins which promotes bronchial smooth muscle relaxation. |
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Term
| Indications of action for bronchodilator. |
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Definition
| For management of asthma and COPD; symptomatic relief of bronchoconstriction and bronchospasm. |
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Term
| Contraindications of action for bronchodilator. |
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Definition
| Hypersensitivity and status asthmaticus (attack that cannot be broken) Caution in pts who are elderly or very young, have active peptic ulcer, abnormal heart rhythms (except bradycardia), CHF, fever (reduced drug clearance). |
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Term
| Serious adverse effects of anticholinergenics. |
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Definition
| More common w/IV administration. Tachycardia, arrhythmias, and seizure. |
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Term
| Common adverse effects of anticholinergenics. |
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Definition
| N/V, headache, tremor, irritability, insomnia/restlessness. |
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Term
| Preadmistration assessment for anticholinergenics. |
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Definition
| Frequency and severity of asthma attacks. |
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Term
| Monitoring for anticholinergenics. |
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Definition
| Close lab monitoring for serum theophylline is advised b/c narrow therapeutic widow and several potential interactions that can increase or decrease drug levels. |
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Term
| Patient education for anticholinergenics. |
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Definition
| Avoid caffeine and OTC mes; take exactly as prescribed, dont X2 dose. |
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Term
| Examples of glucocorticoid steroids. |
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Definition
| Flunisolide (AeroBid), Fluticozone (Flovent), Budesiide (Pulmicort), Mometasone (Asmanex), Triamcinolone acetonide (Azmacort), Beclomethasone HFA (QVAR). |
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Term
| Mechanism of action for glucocorticoid steroids. |
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Definition
| Decreases syntheses and release of inflammatory mediators; decreases infiiltration ad activity of inflammatory cells; decreases edema of airway mucosa. |
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Term
| Indications for glucocorticoid steroids. |
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Definition
| Anti-inflammatory for respiratory disorders, control of asthma and COPD. Forms: inhaled is preferred, oral is used for severe symptoms, short duration is preferred. |
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Term
| Contraindications for glucocorticoid steroids. |
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Definition
| do not use if active systemis fungal infection (decreases inflammation, but also decreases immune response) Caution in pts w/respiratory infection; bacterial, parasitic, or viral infection; ocular herpes simplex. Pregnancy category C. |
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Term
| Common adverse effects for glucocorticoid steroids. |
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Definition
| Inhalation: dry mouth, dysphonia, oral candidiasis (thrush, which is always present but takes over if immune system is lowered) |
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Term
| Preadministration assessment for glucocorticoid steroids. |
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Definition
| For active lung infection, frequency/severity of attacks, along w/possible triggers |
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Term
| Monitoring for glucocorticoid steroids. |
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Definition
| Decreased incidence of acute asthma attacks; correct use of MDI or DPI; monitor growth in kids- can see lag, but usually no overall difference; monitor for possible infections due to immunosuppression. |
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Term
| Patient education for glucocorticoid steroids. |
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Definition
| Need to make sure that mes are teken daily, not just when symptoms are present; proper use of inhaler keeps meds out of mouth and in lungs (use spacer if needed); good oral hygiene/rinsing mouth after use keeps thrush infection down; high Ca and vit D intake reduces bone loss. Reminder: this is NOT a rescue drug! |
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Term
| Example of mast cell stabilizers. |
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Definition
| Cromolyn sodium (Intal), Nasal-Crom (nasal inhaler). |
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Term
| Mechanism of action for mast cell stabilizers. |
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Definition
| When a mast cell ruptures in responce to an antigen, bronchoconstrictive substances such as histamin, bradykinin, serotonin, and leukotrienes are released. Drug stabilizes the mast cell, preventing the release of these substances. |
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Term
| Indications for mast cell stabilizers. |
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Definition
| Used for prophylaxis (prevention) of allergic symptoms, including asthma. |
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Term
| Contraindications for mast cell stabilizers. |
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Definition
| hypersensitivity and acute symptoms. |
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Term
| Serious adverse effects for mast cell stabilizers. |
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Definition
| Bronchospasm and anaphylaxis |
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Term
| Common adverse effects for mast cell stabilizers. |
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Definition
| Dry throat, cough, and wheezing. |
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Term
| Preadministration assessment for mast cell stabilizers. |
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Definition
| Frquency/severity of asthma and possible triggers. |
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Term
| Patient education for mast cell stabilizers. |
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Definition
| Teach use of delivery systems and use as directed; take meds daily, despite the absence of symptoms; drug is used for prophylaxis- is NOT a rescue drug! |
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Term
| Example of leukotriene receptor agonists. |
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Definition
| Zafirlukast (Accolate), Singulair (Montelukast) |
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Term
| Mechanism of action for leukotriene receptor agonists. |
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Definition
| Leukotriene antagonists block the ability of leukotrienes to bind to their receptor sites. B/c leukotrienes binding to these sites is what causes bronchoconstriction, bronchoconstriction is blocked. |
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Term
| Indications for leukotriene receptor agonists. |
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Definition
| Used for maintenance treatment of asthma and COPD. |
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Term
| Contraindications for leukotriene receptor agonists. |
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Definition
| hypersensitivity to lactose and cellulose; breastfeeding. |
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Term
| Serious adverse effects for leukotriene receptor agonists. |
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Definition
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Term
| Common adverse effects for leukotriene receptor agonists. |
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Definition
| headache, gastritis, pharyngitis, rhinitis |
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Term
| Patient education for leukotriene receptor agonists. |
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Definition
| Take meds daily, despite the absence of symptoms; use only as directed- for prophylaxis- NOT a rescue drug! |
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