N352 Unit 3: Respiratory Drugs

singulair nursing care

3 uses: Prophylaxis and Maintenance (1 year olds and up) Prevent exercise induced bronchospasm (15 years and older) Allergic rhinitis Devoid of serious drug interactions Rare reports of mood changes and suicide Monitor liver function (ALT, AST)

If a patient's peak flow meter levels are less than ________% of personal best, interventions need to be done

80

A client who has the flu has been taking Mucomyst. Which adverse effect would the nurse assess for? A. bronchospasm B. nausea C. fever D. drowsiness

A

A nurse teaches a client about the effects of diphenhydramine (Benadryl), which has been prescribed as an antihistamine. The nurse determines that the client needs further instructions if the client states that he or she will: A. Take the medication on an empty stomach. B. Avoid using alcohol while taking this medication. C. Use sugarless gum, candy, or oral rinses to decrease dry mouth. D. Avoid activities requiring mental alertness while taking this medication.

A

The client with reactive airway disease is taking the oral sympathomimetic bronchodialtor metaproterenol (Alupent) three times a day. Which intervention should the nurse implement? A. Instruct the client to take the last dose a few hours before bedtime. B. Teach the client to decrease the fluid intake when taking this medication. C. Have the client demonstrate the correct way to use the inhaler. D. Encourage the client to take the medication with an antacid.

A

Theophylline is prescribed for a client whit bronchial asthma. The nurse provides dietary instruction to the client and should instruct the client to avoid consuming which item? A. ice tea B. lemonade C. orange juice D. tomato juice

A

Which assessment data best indicated the client with reactive airway disease has "good" control with the medication regimen? A. The client's peak expiratory flow rate (PEFR) is greater than 80% of his or her personal best. B. The client's lung sounds are clear bilaterally, both anterior and posterior. C. The client has only had three acute exacerbations of asthma in the last month. D. The client's monthly serum theophylline level is 19 mcg/mL.

A

management of asthma

A: adrenergics (beta 2 agonists-albuterol) S: steroids T: theophylline H: hydration (IV) A: anticholinergics

Corticosteroids

Action: Antiinflammatory IV (Hydrocortisone) Oral (Prednisone) Inhaled (Nasacort, Flonase, Rhinocort, Vancenase)

Mast cell stabilizers

Action: Block Mast cell action, reduce bronchospasm & allergic rx Nasal spray, oral Examples: Nasalcrom, Tilade, Cromolyn, Intal Cautions: Solely prophylaxis

3 primary classifications of bronchodilators

Adrenergic agents Xanthine or methylxanthine agents Anticholinergics

metered dose inhaler (MDI) tips and terms

Advantages: Lower doses Reduced systemic effects Faster onset Types: Nebulizers (larger dose, more severe sx) Metered Dose Inhaler (MDI)

nursing cares & adverse effects for beta2 adrenergic agents

Adverse Effects: (Short acting) Systemic: tachycardia, angina, tremor (Long acting) Risk of severe attack if not used correctly (Oral) Angina pectoris, tachydysrhythmias, tremors (use lowest dose) May need to use nebulizer if inhalers become ineffective Usually combined with glucocorticoids Virtually all asthma patients use albuterol

examples of Theophylline Derivatives (Xanthine / Methylxanthine)

Aminophylline (short acting, IV, po) Theo-Dur, Slo-Bid, Theobid, Theoclear LA long acting, slow release, po

contraindications of beta2 adrenergic agents

cardiac tachy-arrhythmias, CAD

Asthma is:

chronic inflammatory disorder of the airways

COPD is:

continual bronchial irritation and inflammation or a breakdown of elastin in connective tissue of lungs (a1 antitrypsin deficiency)

leukotriene modifiers MOA

decreased nocturnal asthma related waking Improved morning lung function Decreased need for short acting beta 2 agonists For Exercised induced asthma-take dose 1-2 hours prior to exercise.

Ephysema

destruction of alveolar septa airway instability

nebulizers

disperse fine particles of liquid medication into the deeper passages of the respiratory tract

uses for epectorants

drug for cough stimulates the flow of respiratory tract secretions Guaifenesin (Mucinex, Humibid) Stimulates the flow of respiratory tract secretions Increase fluid intake Watch K+ levels for pts. taking K+ or K+ sparing diuretics.

Signs and symptoms of COPD

dyspnea, frequent coughing, wheezing, tachypnea, tightness in the chest, cor pulmonale

beta2 adrenergic agents "use cautiously"

excessive use leads to hypokalemia

What is the cause/trigger of an asthma attack?

immune response to allergens

anticholinergic bronchodilator prototype

ipratropium (atrovent)

side effects of Theophylline Derivatives (Xanthine / Methylxanthine)

irritability, nervousness,

leukotriene modifiers prototype

montelukast (singulair)

primary use of adrenergic agents

nasal decongestants

a-adrenergic agents MOA

produce vasoconstriction, decongestion stimulate alpha & beta adrenergic receptor triggers release of catecholamines indirectly causing sympathetic effects

Side effects of alpha-adrenergic agents

rebound effect, nervousness, anxiety, insomnia, adrenergic effects

antitussive use

suppresses cough

side effects of beta2 adrenergic agents

tachycardia, palpitations, hypertension, N/v, anxiety, irritability

anticholinergic bronchodilators: other drugs available

tiotropium

COPD most common cause

tobacco smoke and air pollution

Alpha (cold medicines) MOA

vasoconstriction, decongestion

A client diagnosed with hypertension develops a cold. What should the nurse teach? A. Use OTC meds that do not produce drowsiness. B. OTC meds will not be as effective as medicine. C. OTC meds are more expensive than prescription. D. Do not take OTC meds unless approved by the HCP.

D

The male client diagnosed with chronic obstructive pulmonary disease (COPD) tells the nurse that he has been expectorating "rusty-colored" sputum. Which medication would the nurse anticipate the HCP prescribing? A. Prednisone, a glucocorticoid. B. Habitrol, a transdermal nicotine system. C. Dextromethorphan (Robitussin), an anti-tussive. D. Ceftriaxone (Rocephin) a cephalosporin.

D

The nurse is discharging a client diagnosed with chronic obstructive pulmonary disease (COPD). Which discharge instructions should the nurse provide regarding the client's prescription for prednisone, a glucocorticoid? A. Take all the prednisone as ordered until the prescription is empty. B. Take the prednisone on an empty stomach with a full glass of water. C. Stop taking the prednisone if a noticeable weight gain occurs. D. The medication should never be abruptly discontinued.

D

Bronchodilators: Anticholinergic drugs

Dries up secretions and causes bronchial dilation Take effect more slowly than fast-acting bronchodilators, but work for a longer time. Side effects (Can't see, can't spit, can't pee, can't poop) Cardiac: incr. heart rate Exocrine: decreased saliva Smooth muscle: relaxation of smooth muscle Decreased bladder tone Decreased GI motility Eye: dilation of pupil, blurred vision CNS: increased CNS activity, hallucinations, delirium Lung: dilation of bronchi smooth muscle

antihistamines for respiratory drugs

Examples: Benedryl (Diphenhydramine), Claritin, Zyrtec, Allegra Classic Antihistamines vs Non-sedating Action: Block action of histamines (do not block release), reduce bronchospasm and constriction that results from histamine release. Cautions: Glaucoma, PUD, BPH, PG

Class: anti inflammatory glucocorticoids

Foundation of asthma therapy Taken daily for long term control Principal anti inflammatory drugs are glucocorticoids Decrease synthesis and release of inflammatory mediators Prevent dyspnea by decreasing sensitivity of the airways to irritants & allergens Decreases infiltration and activity of inflammatory cells Deceased edema of the airway mucosa

nursing care for glucocorticoids

Gargle/rinse after each administration Teach to use inhaler or nebulizer Teach how to use spacer Orals may be used for acute therapy (for patients with severe asthma r/t metabolic changes, adrenal suppression).

precautions with alpha-adrenergic agents

HTN, glaucoma, DM, BPH, hyperthyroidism, MAO inhibitors

examples of beta2 adrenergic agents

Inhaled: Albuterol, Proventil, Alupent, Maxair Fast onset, lasts 4-8 hours Rescue Inhaled: Serevent Long-acting, lasts 12 hours Maintenance Take effect more slowly but work longer Ephedrine (also works on alpha-receptors) Epinephrine, Adrenalin (beta-agonists, Subcut.)

Theophylline Derivatives (Xanthine/Methylxanthine)

MOA: bronchodilator; Stimulate CNS to directly relax smooth muscle of bronchi and pulmonary blood vessels (relieve bronchospasm).

Adrenergic agents (sympathomimetics)

MOA: mimic sympathetic action mimic action of epinephrine and norepinephrine

ipratropium (atrovent) monitoring

Monitor lung sounds pre and post administration Monitor VS Used as maintenance therapy, not rescue

toxicity for Theophylline Derivatives (Xanthine / Methylxanthine)

N/V, diarrhea (especially in children) tachycardia, palpitations

examples of antitussive

Opiod antitussive (codeine, hydrocodone) Act on CNS to elevate cough threshold Nonopiod antitussive (dextromethorphan, diphenhydramine) Purple drink! Also acts on CNS Benzonatate (Tessalon, Zonatuss) Decreases the sensitivity of respiratory tract stretch reflex

how respiratory drugs will be delivered

Orals and IV Inhalers Metered dose inhalers (MDI) hand held pressurized device, delivers measured dose 1-2 puffs 1 min. between each puff Spacers help Dry powder inhalers (DPI) dry micronized powder deliver to lung No hand lung coordination needed No spacer Nebulizers: machine used to convert solution into a mist

common adverse effects of glucocorticoids

Orpharyngeal candidiasis Dysphonia (hoarseness, speaking difficulty) Can slow growth in children Use only when needed (severe cases) Bone loss with premenopausal women Less than oral Use lowest dose possible Ensure adequate calcium and vit. D Weight bearing exercises May need orals or IV in times of acute attack May need to monitor glucose levels

contraindications for Theophylline Derivatives (Xanthine / Methylxanthine)

PUD, CAD (tachy-arrhythmias)

leukotriene modifier uses and teaching

Primarily for allergy related asthma Maintenance not rescue Other drugs available: Zileuton (Zyflo) and Zafirlukast (Accolate) Administration: once daily in the evening

examples of alpha adrenergic agents

Pseudoephedrine: Afrin, Sudafed Ephedrine (also works on Beta-receptors)

pulmonary hazards of marijuana

Same effects as tobacco smoke plus The amount of tar inhaled by marijuana smokers and the level of carbon monoxide absorbed are three to five times greater than among tobacco smokers.

Mucolytics

Sornase alfa (Plumozyme), acetylcysteine (Mucomyst) Action: decrease viscosity of mucus, mobilizes secretions. Usually given as inhalant or nebulized and usually given with bronchodilator.

Medication step interventions for asthma

Step one: beta 2 agonist (exercise induced asthma-rescue) Step two: beta 2 agonist + inhaled steroid (rescue + maintainer) Step three: beta 2 agonist + low dose inhaled steroid, or long acting beta 2 Step four: beta 2 agonist + + +

Pathophysiology of asthma

Symptoms caused by: Inflammation Bronchoconstriction Treatment must address both

Theophylline Teaching

Take around the clock except LA or XR. More is not better. No smoking (interferes with absorption). Monitor P. Take with food (for GI upset). Limit xanthine containing products (coffee, cola, chocolate). Theophylline levels should be draw (different than the beta and alpha drugs) greater than 20 micrograms is higher risk for adverse effects (want 5-10). Drug-drug interactions (check with Pharmacist or HCP)

ipratropium (atrovent) nursing care

Wait 30-60 seconds between puffs Wait 5 minutes if other inhaled medication is ordered. Rinse mouth

smoking cessation

Zyban, Wellbutrin bupropion (SSRI) Chantix Nicotine Patches Gum Lozenges Accupuncture Hypnosis

spacer

a chamber that is connected to the metered-dose inhaler to collect the medication until it is inhaled

Peak flow meter

a handheld device often used to test those with asthma to measure how quickly the patient can expel air

MOA for beta2 adrenergic agents

activate beta2 adrenergic receptors, which are located in the lungs, resulting in bronchodilation

Signs and symptoms of asthma

breathlessness, tightening of chest, wheezing, dyspnea, cough

Beta-2 (bronchodilators) MOA

bronchial dilation, peripheral vasodilation

chronic bronchitis

bronchial edema hypersecretion of mucus chronic cough bronchospasm

prototype for inhaled glucocorticoids

budesonide (pulmicort)

A nurse has an order to give a client salmeterol (Serevent Diskus), two puffs, and beclomethasone dipropionate (Qvar), two puffs, by MDI. The nurse administers the medication by giving the : A. Qvar first and then the Serevent. B. Serevent first and then the Qvar. C. Alternating a single puff of each, beginning with the Serevent. D. Alternating a single puff of each beginning with the Qvar.

B

The HCP prescribed Augmentin for a client who has a sinus cold. Which intervention should the nurse implement? A. Discuss the med with the HCP because antibiotics do not help viral infections. B. Teach the client to take all the antibiotics as ordered. C. Encourage the client to seek a second opinion. D. Ask the client if he is allergic to sulfa drugs or shellfish.

B

The client diagnosed with chronic obstructive pulmonary disease (COPD) is prescribed morphine sulfate (MS Contin). Which statement is the scientific rationale for prescribing this medication? A. MS Contin will depress the respiratory drive B. Morphine dilates the bronchi and improves breathing. C. MS Contin is not addicting, so it can be given routinely. D. Morphine causes bronchoconstriction and decreased sputum.

B

The nurse is preparing to administer medications on a pulmonary unit. Which medication should the nurse administer first? A. prednisone for a client diagnosed with chronic bronchitis. B. Oxygen via nasal cannula at 2 L/min for a client diagnosed with pneumonia. C. Lactic acidophilus (Lactinex) to a client receiving IVPB antibiotics. D. Cephalexin (Keflex) to a client being discharged.

B

The nurse is teaching the mother of a 9 year old child with severe reactive airway disease. The child is prescribed theophylline (Bronkodyl) 100 mg po every 12 hours. Which instructions should the nurse include when discussing the medication with the mother? A. Instruct the mother to perform and record a daily theophylline level. B. Inform the mother to notify the HCP if the child vomits or becomes dizzy. C. Tell the mother to give the medication at 10:00 A.M. and 10:00 P.M. D. Recommend that the medication be refrigerated at all times.

B

Other inhaled glucocorticoids

Beclomethasone dipropionate (QVAR) Ciclesonide (Alvesco) Flunisone (AeroSpan) Fluticasone propionate (Flovent) Momatasone furoate (Asmanex, Twisthaler)

uses of beta2 adrenergic agemts

Bronchodilation (primarily smaller airways), anaphylaxis, relief of bronchospasm in asthma, emphysema, bronchiectasis, COPD

MOA for leukotriene modifiers

Bronchodilator and anti-inflammatory actions Suppress effects of leukotriene and decreases mucus secretion

metered dose inhaler tips

Bronchodilator first, steroid second Rinse mouth (gargle) after steroid use Mark the inhalers if several are used Reorder based on actuations

A client asks for medication to "break up this thick mucus"? What should the nurse administer? A. Antitussive. B. Decongestive. C. Mucolytic. D. Antibiotic.

C

A client has a prescription to take quaifenesin (Mucinex). The nurse determines that the client understands the proper administration of this medication if the client states that he or she will: A. Take an extra dose if fever develops. B. Take the medication with meals only. C. Take the tablet with a full glass of water. D. Decrease the amount of daily fluid intake.

C

The child with an acute asthma attack is prescribed a 7-day course of the systemic corticosteroid prednisolone. The mother asks the nurse, "Doesn't this medication cause serious side effects?" Which statement is the best response? A. "Yes, this medication does have serious side effects, but your child needs the medication." B. "The doctor would not have ordered a medication that has serious side effects.? C. "A short-term course of steroids should not cause serious side effects." D. "There may be serious consequences if your child does not take the medication."

C

The client admitted for an acute exacerbation of reactive airway disease is receiving intravenous aminophylline. The client's serum theophylline level is 28 mcg/mL. Which action should the nurse implement first? A. Continue to monitor the aminophylline drip. B. Assess the client for nausea and restlessness. C. Discontinue the aminophylline drip. D. Notify the health-care provider immediately.

C

Which priority information should the nurse discuss with the client diagnosed with reactive airway disease who is prescribed theophylline (Slo-Phyllin)? A. Instruct the client to take the medication on an empty stomach. B. Explain that an increased heart rate and irritability are expected side effects. C. Discuss the need to avoid large amounts of caffeine-containing drinks. D. Tell the client to double the next dose if a dose is missed.

C