ALE 1. Airflow Respiratory System Drugs

Theolair

Theophylline

Theophylline class

Methylxanthines

Theophylline route

Oral and IV

Theophylline therapeutic use

long term management of chronic asthma

What happens when Theophylline exceeds its therapeutic levels?

restlessness and insomnia

What happens when Theophylline reaches toxic level?

seizures and dysrhythmias

What is the normal therapeutic level for Theolair?

10-20mcg/mL

What is the toxic level for Theophylline?

above 20mcg/mL

Theolair interventions

monitor plasma med levels

discontinue med at toxic levels

monitor hr and rhythm

What do you give to a patient taking Theophylline to decrease absorption?

activated charocoal

What do you give to a patient taking Theophylline to restore the hr and rhythm?

antidysrhythmics

if a dose of Theophylline is missed..

do not double

if the Theophylline is sustained release or enteric coated

do not crush / chew

We tell our patients who are taking Theolair to

reduce / eliminate caffeine

have periodic lab testing for medication levels

When having what symptoms should a patient discontinue Theophylline and notify the provider?

seizures and dysrthymias

Theophylline contraindications

patients with impaired metabolism

tobacco / marijuana use

caffeine

Theophylline precautions

heart disease

liver dysfunction

acute pulmonary edema

Theophylline interactions

caffeine increases risk for toxicity

QVAR

Beclomethasone

What is the class for Beclomethasone

glucocorticoid

What is the route for Beclomethasone

inhalation

Beclomethasone therapeutic use

long term management of chronic asthma and copd

Beclomethasone adverse drug reactions

oral candidias

hoarseness/difficulty speaking

muscle wasting / bone demineralization

hyperglycemia

fluid electrolyte imbalance

headache

Beclomethasone interventions

attach spacer to MDI

anti fungal therapy

You should not use

QVAR for

acute asthma attack

When using a Beta 2 adrenergic agonists inhaler and

Beclomethasone

use the beta2 first to dilate airway

After a patient uses

Beclomethasone they should

rinse mouth out

Beclomethasone contraindications

recent live virus immunization

oral candidas

systemic fungal infection

Beclomethasone precautions

peptic ulcer disease

hypertension

renal dysfunction

nasaids

When taking potassium depleting diuretics and

Beclomethasone what happens?

increase risk for hypokalemia

Why should we avoid giving our patient NSAIDS and

QVAR

avoid GI bleeding

Effects of insulin and hypoglycemics when taking

Beclomethasone are

decreased

Atrovent

Ipratropium

Ipratropium class

anticholinergic bronchodilator

Ipratropium route

inhaled or intranasal

Ipratropium therapeutic use

relief of bronchospasm in clients with copd

decreases secretions in clients with copd

Ipratropium adverse drug reactions

dry mouth

increased intraocular pressure

urinary retention

What should we be scheduling our clients who are taking

Atrovent for?

routine testing for glaucoma

If a patient who is taking

Ipratropium complains of dry mouth, what should you do?

provide water and hard candy to client

What should we be monitoring on a patient taking

Ipratropium

urinary elimination patterns

A patient taking Atrovent should not take it for

emergency rescue medication

After taking Ipratropium a patient should

rinse their mouth out

Ipratropium contraindications

Hypersensitivity to ipratropium, atropine, alkaloids, peanuts.

Ipratropium precautions

Glaucoma

Prostatic hypertrophy

Bladder neck obstruction

urinary retention

If a patient is taking Ipratropium and Beta 2 adrenergic agonists what can increase?

bronchodialation

Proventil

Albuterol

Ventolin

Albuterol

Albuterol class

Bronchodilator

Albuterol route

inhalation

Albuterol therapeutic use

long term management of asthma

prevention of exercise induce bronchospasm

treatment of ongoing asthma exacerbations

Albuterol adverse drug reactions

chest pain

palpitations

tachycardia

restlessness

tremors

Albuterol interventions

Monitor and report dizziness, heart palpitations, chest pain, and shortness of breath.

Monitor and report tremors.

When do you administer short acting Proventil

acute exacerbations

When do you administer long acting albuterol

long term control

Do you inhale glucocorticoids or bronchodilators first?

bronchodilators

We should instruct our patients who are taking albuterol to

report chest pain and heart palpitations

avoid caffeine

avoid triggers

Ventolin precautions

Diabetes mellitus

Hyperthyroidism

Cardiovascular disease

Hypertension

Angina pectoris

Tachydysrhythmias

Tachycardia due to digitalis toxicity

Beta adrenergic blockers reduces

effectiveness of beta 2 adrenergic agonist

Monoamine oxidase inhibitors and tricyclic antidepressants

increase risk for angina, tachycardia and hypertension

Hypoglycemic (antidiabetic) meds require

increase dosing because of albuterol's hyperglycemic effects

Prednisone class

Glucocorticoid

Prednisone route

oral

Prednisone therapeutic use

short term management of post exacerbation manifestations

Prednisone adverse drug reaction

adrenal function suppression

hyperglycemia

peptic ulcer disease

increase risk for infection

fluid and electrolyte imbalance

headache

Our patient is taking prednisone we should recommend

alternate day dosing

Our patient is taking

Prednisone we should monitor blood glucose for

hyperglycemia

Our patient is taking

Prednisone which mean they should avoid

NSAIDS

Prednisone administration

twice daily 5-10 days

Should patients abruptly stop

Prednisone?

no, taper dose slowly

To prevent osteoporosis while taking prednisone, patients should

increase vitamin D and calcium

weight bearing exercises daily

Patients who take

Prednisone and are monitoring their blood sugar should report?

polyphagia

polydipsia

polyuria

Patients taking

Prednisone should also report what as a sign of fluid and electrolyte imbalance?

weight gain, edema, generalize weakness

Patients who take NSAIDs and

Prednisone are at risk for GI bleeding, what are some s/s?

black starry stool and bloody vomit

Prednisone contraindications

recent live virus immunization

systemic fungal infection

oral candiasis

Prednisone precautions

Use of NSAIDs

Peptic ulcer disease

Diabetes mellitus

Hypertension

Kidney dysfunction

Myasthenia gravis

Osteoporosis

If a patient is taking

Prednisone and furosemide

increase risk of hypokalemia

Why does

Prednisone and furosemide increase risk of hypokalemia

furosemide is potassium-depleting diuretic medication

Montelukast class

Leukotriene Modifier

Montelukast route

oral

Montelukast therapeutic use

treats rhinitis, asthma and exercise induces bronchospasms

Montelukast adverse drug reaction

slight risk of neuropsychiatric manifestations

If a patient is having neuropsychiatric manifestations, they are having or exhibiting

suicidal thoughts / behaviors

A patient complains of having an headache after montelukast was administer what do you do next?

administer mild analgesic

Our patient is on montelukast, we are monitoring for?

suicidal thoughts and liver function

How many times should our patient take montelukast and when?

once in the evening

Available oral, chewable tablet and oral granule

montelukast

The montelukast oral granule can be mixed in what foods or placed directly on tongue

applesauce, cooked carrots, rice and icecream

If we want to prevent EIB, when do we administer montelukast?

2 hours before exercising

Montelukast should be taken how many times in a 24 hour span?

once

Our patient is on montelukast, we should instruct them to report

anxiety, agitation, irritability

Our patient is on montelukast, we instruct them to have

liver function lab test checked regularly

Montelukast contraindications

Acute asthma exacerbations

Status asthmaticus

Montelukast precautions

severe asthma

If a patient is taking phenobarbital, rifampin, phenytoin, we as nurses need to ask the provider to do what for the Montelukast medication?

increase the dose, if needed

The safest mast cell stabilizer drug

cromolyn

Cromolyn class

mast cell stabilizer

Cromolyn route

oral inhalation

Cromolyn therapeutic use

Long-term treatment of allergy-related asthma

Prophylaxis for exercise-induced bronchospasm

Prophylaxis for seasonal allergy symptoms

Management of allergic rhinitis (intranasally)

Cromolyn adverse reactions

allergy to cromolyn

If a patient is experiencing anaphylaxis when taking Cromolyn we should administer?

epinephrine and /or antihistamines