Nursing Pharm - Respiratory

olanjones's version from 2016-07-10 22:06

Pulmonary Disorders

Question Answer
What is the goal of pharmocotherapy in regards to asthma?Stop bronchospasms during an acute attack and reduce inflammation to decrease attack frequency
What common triggers are associated with asthma?air pollutants, allergens, chemical & foods, respiratory infections, stress
What conditions are associated with COPD?asthma, bronchitis, emphysema
What are the primary and secondary causes of non-asthmatic chronic bronchitis and emphysema?Primary - smoking (85-90%), Secondary - air pollution
What are the physical changes of the lung that occur with chronic inflammation?Loss of elasticity of the alveoli causes dilation to compensate for impaired gas exchange, mucus accumulates and results in ineffective airway clearance
What are the goals of pharmocotherapy in regards to COPD?Symptom relief and avoidance of complications (cannot be cured)
What are three types of inhalation devices?metered dose inhalers, dry power inhalers, nebulizers
Why is inhalation the preferred route of administration for asthma medications?medication is delivered directly to site of action reducing time of onset allowing for smaller effective dosing and minimizing systemic side effects

Asthma Bronchospasm

Question Answer
What class of medication treats bronchospasms?Bronchodilators: includes beta-adrenergic agonists, anticholinergics, methylxanthines
What is the mechanisms of action for beta-adrenergic agonists (drug of choice) such as albuterol or salmeterol (prototypes)?activation of the sympathetic nervous system, can be short acting (rapid onset for acute attacks - albuterol) or long acting (salmeterol)
How do anticholinergics such as ipratropium / Atrovent (prototype) treat bronchospasm?by blocking the parasympathetic nervous system, are useful alternatives to beta-agonists
Methylxanthines such as theophylline (once a mainstay treatment for bronchospasm) have a narrow therapeutic window and are therefore used in?patients who are unresponsive to beta-agonists or inhaled corticosteroids - are chemically similar to caffeine
When using bronchodilators, what nursing assessments are performed?Assessment of lung sounds, signs of adequate perfusion, peak expiratory flow rate (PEFR)
Why should patients be encouraged to limit caffeine and increase fluid intake?caffeine increases SE of bronchodilators, fluids thin out mucus secretions which allows them to be expectorated
Although albuterol is used to to terminate bronchospasm there is a risk of what uncommon SE?Paradoxical bronchospasm - can be life threatening

Asthma Inflammation

Question Answer
Corticosteroids, Leukotriene modifiers, and Mast cell stabilizers all work to reduce inflammation, what important patient education point is related to this?These meds will not terminate an acute asthma attack
Beclomethasone / Qvar, Beclovent (prototype - corticosteroid) are the drug of choice for asthma prevention & management, how are they administered?Inhaled for long-term control, Oral & IV for short-term exacerbation (5-7 days)
Why is it important to teach patient to rinse and spit after after each use of inhaler beclomethasone?remaining steroid in the mouth cause oral candidiasis, if steroid is swallowed there is potential for systemic effects
Why is it important for patients to report any signs or symptoms of infection when using beclomethasone?corticosteriods may mask s/s of infection and use is contraindicated in active infection
Why should patients using beclomethasone have regular eye exams and be encourage to report visual changes?corticosteroid use is associated with cataracts
What is the mechanism of action for zafirlukast / Accolate (prototype - leukotriene modifer)?modification of the immune response to reduce inflammation (increased infections have be found in pts >65 years)
Although zafirlukast / Accolate has few SE, its oral route administration is associated with more systemic SE than inhaled drugs, what are these SE?headache, cough, nasal congestion, GI upset
Why is zafirlukast / Accolate use contraindicated in hepatic disease?it is metabolized by the liver
How do mast cell stabilizers such as cromolyn work?by preventing release of histamine
If a bronchodilator is being used concurrently with cromolyn (mast cell stabilizer) in what order should the drugs be administered?Bronchodilator should be administered first, wait 5 minutes, then administer cromolyn

Allergic Rhinitis

Question Answer
What are the goals of pharmocotherapy in regards to allergic rhinitis?Control symptoms and prevent complications (nonpharm interventions include identification & elimination/control of allergens)
What acute symptoms are associated with allergic rhinitis?tearing eyes, sneezing, nasal congestion, post-nasal drip, scratchy throat
What complications are associated with allergic rhinitis?loss of taste or smell, chronic cough, hoarseness, middle ear infections in children
Which drug classes are considered allergic rhinitis preventers?antihistamines, intranasal corticosteroids, intranasal mast cell stabilizers
Which drug classes are considered allergic rhinitis relievers?decongestants, antitussives, expectorants & mucolytics

AR Preventers

Question Answer
How do antihistamines such as diphenhydramine / Benedryl (prototype - 1st generation) work to prevent allergic rhinitis, motion sickness & insomnia? By selectively blocking H1 histamine receptors
How do 1st generation antihistamines differ from 2nd generation?1st generation cause significant drowsiness
Some people (especially children) may experience what CNS stimulation SE when using diphenhydramine?insomnia, nervousness, tremors
Why should patients be informed not to use OTC cold/allergy medications with diphenhydramine?It is widely used in these combination OTC meds and causes anticholinergic effects (urinary hesitance, vision changes)
Intranasal corticosteroids (drug of choice) such as fluticasone / Flonase (prototype) work by?suppressing histamine release and reducing local inflammation in nasal passages
Why may some patients who are newly prescribed fluticasone feel it is not working ?benefits are not immediate, can take 3-4 weeks for peak response
Why is it important to assess a patients nares for excoriation when administering fluticasone?breaks in the nasal mucosa may allow systemic absorption
What is the most common SE associated with fluticasone?epistaxis, also ask patients to report excessive burning and drying of nasal mucosa which may be tx with humidifiers, saline nasal spray, or Vaseline
Under what circumstances are intranasal mast cell stabilizers such as cromolyn / NasalCrom most often used?As an alternative treatment for patients who do not respond to intranasal steroids

AR Relievers

Question Answer
Nasal decongestants such as oxymetazoline / Afrin have what serious/limiting SE?Rebound congestion - should only be used 3-5 days at a time, should not be used concurrently with OTC decongestants
What conditions should be evaluated by a PCP before using oxymetazoline?thyroid disorders, HTN, CAD, DM
What should be remembered about children and the usage of oxymetazoline?Do not give to children under age 6, consult PCP for children under age 12
Although different mechanisms are used depending on the drug, what is the action of antitussives?suppress the cough reflex
Why should a cough not always be suppressed?coughing is defense mechanism to remove excess secretions & foreign material (only dry, hacking cough that interferes with needed rest should be treated)
How do opioids such as codeine suppress cough?act on CNS to increase cough threshold – most effective cough suppressant (potential for bronchoconstriction in patients with asthma)
How do Tessalon Perles (non-opioid) suppress cough?by anesthetizing stretch receptors in lungs - Do not chew (will numb mouth & pharynx)
The fact that dextromethorphan / Robitussin (non-opioid prototype) is chemically similar to opioids may be responsible for what SE?slurred speech, dizziness, ataxia (Do not drive until effects are known, avoid ETOH, don’t take with OTC meds)
Why should patients using dextromethorphan / Robitussin avoid grapefruit?grapefruit / grapefruit juice can increase levels & toxicity
Expectorants such as guaifenesin or water (considered the best expectorant) work by doing what?thinning out (watering down) mucus secretions (guaifenesin should not be used in children under age 4)
How do mucolytics such as acetylcysteine work?by directly breaking down the chemical structure of viscous secretions - used for conditions that produce thick bronchial secretions
What are some other uses for acetylcysteine?as antidote for Tylenol OD and to protect kidneys from contrast dye when renal function is diminished

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