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by: Emily Bretzloff Rohrs

NursingPharmacologyRespiratory 365

Marketplace > Lourdes University > NUR > 365 > NursingPharmacologyRespiratory
Emily Bretzloff Rohrs

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About this Document

These notes are for a nursing pharmacology on the respiratory system and medications. These highlight key aspects of respiratory drug therapy and the diseases
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This 10 page Class Notes was uploaded by Emily Bretzloff Rohrs on Monday September 19, 2016. The Class Notes belongs to 365 at Lourdes University taught by in Fall 2016. Since its upload, it has received 22 views. For similar materials see Pharmacology in NUR at Lourdes University.


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Date Created: 09/19/16
Asthma and COPD medications Drug class MOA/inten Side  AD Administra Drug name  Pt Education  ded  Effect R’s tion response  Short acting albuterol,  bronchodilation  bronchodila pirbuterol,  w/in 10 min, as­ tors metaprotere needed basis. Can  nol.  be given 15 min  prior to exercise. 2  puffs every 4­6  hours.   Long acting Serevent,  inhaled/oral,  bronchodila Proventil  provide 12 hours of tors Repetabs. prolonged  bronchodilation/im proved symptoms  an protection from  triggers.  NOT for  acute problems. anti­ atrovent  good for older  cholinergric combivent patients methylxanth stimulates  theophyllin caution with  ines  CNS,  e cardiac disease  relaxes  patients.  bronchial  smooth  muscle.  Stim.  Resp.,  improves  mucociliar y  clearance. anti­ Before:  take even if you  inflammator check  dont have  ies  mouth for  symptoms.  presnces of infection.  proper technique  After: oral  hygiene  inhaled  improve  Oral  Solu­ Mouth care  corticosteroi lung  Candidi Medrol,  afterwards. ds  function  asis  prednisone, Med’s need to be  and  (Thrush) Flovent,  tapered. decreased  , dry  Pulmicort. bronchial  mouth,  hyper­ hoarsnes responsive s, throat  ness, irritation , cough,  Dyspho nia mast cell  reduce  dry  Intal prevents mediator,  stablizers bronchospa mouth,  Nonsteriodal anti­ sms with  hoarsnes Tilade inflammatory  excerise  s, throat  effect, maintenance  induced  irritation therapy. asthma.  , cough,  Can be used 15­30  decrease  distincti minutes prior to  inflammtio ve taste, exercise/exposure  n­ stope  nasal  to cold air or  mast cell  irratatio allergens­  mediators.  n,  prophylaxis against  long term,  dysphon bronchospasm. preventativ ia e.  anti­ Block  histamines histamines  at receptor  site leukotrine  stops  singular  interfere with  inhibitors luekotrines  Zyflo CR leukotrienes  from  Accolate synthesis, improve  binding to  Zileuton,  symptoms and  receptor,  Zarfirlukast pulmonary  decreases  ,  function, reduce  immune  Montelukas need for  response  t. bronchodilators. and  inflammati on. long term  preventativ e therapy. mucolytics  improve air GI  Guafensin flow by  upset,  (mucinex)  decreasing  headach mucosal  e,  acetlycstien viscosity. dizzines e  typically  s, rash,  (mucomyst COPD can  drowsin ) ­  be used  ess  unpleasant  with  odor/taste asthma  excerbation s BRONCHODILATORS  Cholinergic Antagonists ­ Block parasympathetic nervous system allowing natural epinephrine &  norepinephrine to bind to smooth muscle receptors causing bronchodilation.  ­ PREVENT BRONCHOCONSTRICTION o Ipratropium (Atrovent) o Tiotropium (Spiriva)   Minimal side effects  o CAN COMBINE ATROVENT + ALBUTEROL FOR SHORT ACTING  TO HOLD PT OVER UNTIL LONG ACTING KICKS IN  Methylxanthines ­ Given systemically (PO & IV) ­ Increase c­AMP ­ Related to caffeine o Tachycardia, HTN, jittering, seizure ­ Used when other management ineffective o Aminophylline  o MISSED THIS ­ Administering bronchodilators o Check before  Auscultate lungs  Baselines VS  Use pump for IV methylxanthines always o Check after  Breathing status  Drug levels (should be low)  Wait 5 min b/w different drugs (should show signs of working)  Check VS (esp. on Pt just beginning)  ­ Pt teaching  o Correct administration technique for inhalers o Always have rescue inhaler o Take prevention drugs even w/ absence of symptoms ­ Lifespan considerations o Older adults  More sensitive to cardiac and NS side effects  Anti­inflammatory ­ Will board with steroids but should not just rely on them b/c will be fatal  ­ After using inhaler wash mouth out  ­ Inhaled corticosteroids st o 1  line treatment for asthma after SABA o Long term, preventative  o Attacks inflammation of asthma at 8 different sites o Little systemic absorption when inhaled o Used for acute short term management on asthma/ COPD o May cause  Dry mouth/ throat o As adjunctive therapy  o examples  Budesonide (Pulmicort)  Fluticasone (Flovent) ­ Mast cell stabilizers o Reduce bronchospasm with exercise induced asthma  o Long term, preventative o Decrease inflammation by inhibiting mediators from mast cells o Examples  Cromolyn sodium (Intal)  Nedocromil (Tilade)  Side effects  Dysphoria, hoarseness, throat irritation, dry mouth, cough,  nasal irritation, distinctive  o Short half­life­ is short acting but may take a week before they are  managed well on the drug allowing it to work the way it is needed. Would  st take a SABA for 1  2 weeks taking it.  ­ Leukotriene inhibitors o Decreases immune response/inflammation by preventing leukotrienes from  binding to cell receptors o Long term, preventative o Examples  Montelukast sodium (singulair) ­ Anti­histamines o Block histamine at receptor sites o Used for allergic rhinitis, asthma, anaphylaxis o 1  generation anti­histamines  Cross blood­brain­barrier (BBB)  Diphenhydramine (Benadryl) o 2  generation anti­histamines  Do not cross BBB  Cetirizine (Zyrtec)  Loratidine (Claritin)  Fexofenadine (allegra) COMBINATION MEDICATIONS ­ Bronchodilators and corticosteroids for prevention tx o USE BRONCHODILATOR 1  TO ENSURE MAX ABSORPTION OF  CORTICOSTEROIDS. ANTI­INFLAMMATORY ADMINISTRATION ­ Check before  o Mouth for infection presence (thrush) o Give bronchodilators 1  and wait at least 5 min  ­ Check after o Rinse mouth to decrease bad taste, dry mouth and risk of thrush  MUCOLYTIC DRUGS ­ If Pt cannot cough well is a coughing risk ­ Improves airflow by reducing thickness of mucus in airways  ­ Most often used with COPD ­ Asthmatics use with exacerbations ­ Examples o Guafenesin (mucinex) o Acetylcysteine (muscomyst) ­ Side effects o GI upset, drowsy, headache, dizzy, rash PHARM RESPIRATORY (ASTHMA, COPD)  2 types of non­infectious lung diseases 1. Restrictive lung disease a. Pulmonary interstitial tissue= stiff, inelastic  b. Volume decreased c. Expansion decreased d. Causes= interstitial fibrosis, asbestosis/mesothelioma, sarcoidosis e. Treated with same drugs as COPD 2. Obstructive lung disease a. Characterized by airway obstruction which is worse with expiration b. Asthma  i. Allergy  ii. Occupational/air pollution iii. Exercise induced iv. Stress induced c. COPD i. Emphysema  ii. Chronic bronchitis  Asthma  1. Pathophysiology a. Chronic inflammatory and bronchospastic disorder of airway b. Release of histamines, leukotrienes, mast cells i. Interleukins, prostaglandins, immunoglobulins, nitric oxide  c. Involves bronchioles, not alveoli  2. Asthma symptoms  a. Recurrent episode b. Wheezing (on expiration, then with in inspiration as it worsens), intense  breathlessness, tight chest, gasp for air, cough c. Night and/or early morning  d. PERF (peak expiratory rate flow) e. With= cold air, dry air, exercise, allergens  3. Having bronchospasms= BAD and hard to intubate 4. Treatment a. intubation possible  i. if intubated before= higher chance of new intubation b. medications  COPD 1. Pathophysiology  a. Chronic airflow limitation b. Irreversible progressive c. Inhaled irritants  i. cigarette smoke d. alveolar destruction causing large airspaces  e. impaired ciliary action f. larger airway collapse, further air trapping  2. Symptoms  a. dyspnea b. productive cough w/ tenacious (thick) mucus  c. impaired PERF Drug therapy for asthma and COPD 1. asthma  a. rescue drugs (stop attack in progress) for immediate bronchodilation  b. prevent attacks c. total therapy= rescue + prevention drugs  2. COPD a. Same as asthma with higher, more frequent doses 3. Drug classes a. Bronchodilators, anti­inflammatories, anti­histamines, leukotriene  inhibitors, mucolytics  Bronchodilators 1. Relax smooth muscle, opens airways 2. Rescue drugs and prevention drugs 3. Intended response a. Pulmonary smooth muscles relax b. Airways widen c. Wheezing decreases and PERF increases 4. Side effects a. Rapid heart rate, increased BP, nervousness, dry mouth, difficulty sleeping 5. ADR a. Allergy, angina, heart attack, dysrhythmias, seizures  6. Types a. Beta­2 adrenergic agonists (ABA) i. SABA’s (short acting ABA) 1. Rescue 2. Albuterol, pirbuterol, terbutaline  ii. LABA’s (long acting ABA)  1. END IN –TEROL  2. Preventative drugs 3. Formoterol, salmeterol, arformoterol iii. Bind to beta­2 adrenergic receptor and trigger release of cAMP, causes pulmonary smooth muscle relaxation leading to bronchodilation  *may use SABA until LABA kicks in  b. Cholinergic antagonists  i. Anticholinergic drugs


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