cadiac and resp

ventilation

moving air into and out of the lungs

profusion

allows gas exchange across the capillaries

what devices are used to deliver drugs via inhalation? (3)

• nebulizers

• metered dose inhalers

• dry powder inhalers

what are the two components of asthma?

inflammatory and bronchospasm components

what medication class treats inflammation with asthma? (4)

• glucocorticoids

• mast cell stabilizers

• leukotriene modifiers

• monoclonal antibodies

what medication class treats bronchospasm with asthma? (3)

• beta-adrenergic agonists

• methlyxanthines

• anticholinergics

what are beta receptors?

Beta receptors are responsible for signaling the sympathetic nervous system. They are present on various tissues throughout the body

what is the dominant receptor for the heart and kidneys?

beta 1

what is the dominant receptor for smooth muscle relaxation at the lungs, blood vessels, gi tract, and liver?

beta 2

what is the dominant receptor for adipose tissue and the bladder?

beta 3

what do beta-adrenergic agonists do for asthma?

relieves bronchospasms by opening the airway by relaxing the smooth muscle of the bronchi

why can beta-adrenergic agonists make you feel jittery and anxious?

it can act on some beta cells in the heart

what do glucocorticoids do for asthma?

supress airway inflammation

what form of glucocorticoid is used for long term prevention of asthma attacks?

inhaled glucocorticoids

what form of glucocorticoids is used for acute, severe attacks?

oral glucocorticoids

what is an important teaching for patients using glucocorticoid inhalers?

always rinse mouth after use, because it can cause infection of the mouth/nose

what is an important teaching for patients using oral glucocorticoids?

if taken for more than 10 days, do not discontinue abruptly, as it will cause side effects

what are the most common anticholinergics? (2)

• ipratropium (Atrovent)

• tiotropium (Spirivia)

what do anticholinergics treat?

COPD, asthma

how do anticholinergics work?

Anticholinergics block acetylcholine from binding to its receptors on certain nerve cells. They inhibit parasympathetic nerve impulses, which are responsible for involuntary muscle movements

what do methylxanthines treat?

asthma

what do methylxanthines do?

it is a bronchodialator, so it opens the airway

what drug is chemically related to caffeine?

methylxanthines

how do mast cell stabilizers work?

inhibit degranulation of mast cells by trigger stimuli by blocking calcium channels and inhibiting the release of histamines.

AKA

prevent the mast cells from releasing the substances that cause inflammation

prophylaxis

an action taken to prevent disease

ex. taking a drug to prevent an asthma attack

how are mast cell stabilizers administered?

administered as an areosol through a metered dose inhaler

what is a teaching point for mast cell stabilizers?

needs to be taken 4-6 times daily because of the short half-life

how do leukotriene modifiers work?

used to block the bronchoconstrictor / inflammatory activity of leukotrines

how and when are leukotriene modifiers administered?

orally, every 12 hours

how do monoclonal antibodies work?

they are laboratory made proteins that mimic the immune systems ability to fight antigens, and inhibits a person's immune response to certain triggers

how are monoclonal antibodies administered?

injection

what medication dampens the cough reflex?

antitussives

what is a medication used for severe coughs?

opioids, like codiene and hydrocodone

what medication is used for mild coughs?

dextromethorphan

antigen

any foreign substance that triggers an immune response

what is released in the body in response to antigens?

histamines

how do antihistamines work?

block / inhibit H1 receptors

what is another name for antihistamines?

H1-receptor antagonists

what are drugs that inhibit H1 (histamine) receptors used to treat?

allergic reactions

what are drugs that inhibit H2 (histamine) receptors used to treat?

gastric reflux disease

what are the 2 generations of antihistamines?

1st gen - central effect, also a sedative

2nd gen - less central effect, do not have a sedative effect

what conditions contraindicate the use of antihistamines? (3)

• pregnancy

• glaucoma

• use of alcohol or other CNS depressants

anti-infective

general term describing any medication that is effective against a pathogen

what are the 2 classes of antibacterial medications?

• narrow spectrum (targets few types)

• broad spectrum (targets many types)

pathogen

any organism that can cause disease, includes:

• viruses

• bacteria

• fungi

• unicellular organisms (protozoans)

• multicellular animals

pathogenicity

ability of an organism to cause disease

virulence

a quantitative measure of an organism’s pathogenicity (how harmful it is)

does a pathogen with high virulence have a high or low chance of transmission? why?

high virulence = less chance of transmission

why? because people who are very sick usually stay home

does a pathogen with low virulence have a high or low chance of transmission? why?

low virulence = more chance for transmission

why? because people who are less sick (ex. cold) will still go in public

what are 3 bacteria shapes

• spheres (cocci)

• rods (bacilli)

• spirals

what is the difference between gram positive rods and gram negative rods?

gram positive rods have thicker plasma membrane with more layers

bacteriocidal

drugs that kill bacteria

bacteriostatic

drugs that inhibit bacterial reproduction

selective toxicity

drug is toxic to the bacteria, but not the host

sensitivity

the drug is toxic to the bacteria causing the infection

antibiotic resistance

the bacteria is no longer affected by a particular antibiotic that was once effective

antibiotic stewardship

the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients

what are common resistant microbes? (3)

• MRSA

• VRE

• Multi-drug resistant tuberculosis

what type of antibiotics are patients usually started on?

broad spectrum -targets lots of bacteria

what cannot be taken with antibiotics?

aluminium or calcium containing antacids

why are antibiotics administered on a strict schedule?

because adequate levels of antibiotics must be maintained in the blood, or bacteria has a chance to grow

what are possible adverse effects of antibiotics? (3)

• destruction of normal gut flora (causes diarrhea).

• suprainfection - infection with a second, resistant organism.

• allergy (most common with penicillins).

what are teaching points for patients taking antibiotics? (4)

• complete full dose.

• take missed dose asap.

• signs + symptoms of hypersensitivity.

• may need a backup method of birth control.

what is tuberculosis?

a chronic, recurrent, infectious disease caused by Mycobacterium tuberculosis

who is at higher risk of contracting tuberculosis? (4)

• newcomers.

• patients with HIV/AIDS.

• racial + ethnic minorities.

• individuals in dense / overcrowded places.

what is the vaccine for tuberculosis?

Bacille Clamette-Guerine (BCG) vaccine

direct observation therapy

patient takes medication while being observed by HCP for adherence

what is important to know about the drug isoniazid?

impacts vitamin B6, patient will need supplement

what is important to know about the drug rifampin?

turns body fluids orange

what is important to know about the drug pyrazinamide?

it is very hard on liver, sight, and hearing

what is important to know about the drug ethambutol?

can cause vision problems

how is tuberculosis treated? (4)

multidrug therapy of oral antituberculosis drugs:

• isoniazid

• rifampin

• pyrazinamide

• ethambutol

angina pectoris

acute chest pain due to insufficient O2 to myocardium

stable angina

relieved with rest

what are lifestyle changes for angina? (4)

• limit alcohol

• limit smoking

• exercise

• diet

what drug terminates acute angina episodes?

nitroglycerin

how do nitrates work?

relaxes both arterial and venous smooth muscle; dilate coronary arteries

WHICH

reduces the hearts workload and lowers oxygen demand

what do short-acting nitrates do?

terminate acute angina episodes

what do long-acting nitrates do?

decrease severity and frequency of episodes

what are the potential adverse effects of nitroglycerin? (4)

• hypotension

• dizziness

• headache

• flushing of face

What should you teach a patient for using Nitroglycerin at home? (5)

• take one tablet every 5 minutes until pain is relieved.

• do not take more than 2 doses, and call EMS of chest pain is not relieved.

• place SL tab or spray under tongue.

• lie down before taking.

• wait 24 hours before taking sidenafil or a phosphodiesterase-5 inhibitor (viagra lol)

How do beta blockers work?

reduce the cardiac workload by slowing heart rate and reducing contractility.

what are the potential adverse effects of beta blockers? (5)

• fatigue

• drowsiness

• bradycardia

• insomnia

• confusion

what is atenolol (Tenormin)?

a beta blocker

how do calcium channel blockers work?

inhibit the transport of calcium into myocardial cells, and relaxes arteriolar smooth muscle

this reduced cardiac workload and brings more O2 into the myocardium

what is diltiazem (Cardizem)?

calcium channel blocker

what are potential adverse effects of calcium channel blockers? (5)

• hypotension

• bradycardia

• constipation

• headaches

• dizziness

what causes myocardial infarction to occur?

when a coronary artery becomes completely occluded

what do thrombolytics do?

“clot busters”

dissolve clots obstructing coronary arteries

what is important to remember about thrombolytics?

they have a narrow margin of safety

what is reteplase (Retavase)?

thrombolytic

what medication for angina has the highest risk of hypotension?

iv nitrates

what is contraindicated with nitrates?

alcohol

what teaching should be given to a patient taking beta-adrenergic blockers?

do not stop taking medications abruptly

what should the nurse do for a patient taking calcium channel blockers? (4)

• hold medication if HR is 60 or less.

• obtain BP.

• obtain daily weights.

• assess bowel function.

what should the nurse do for a patient taking thrombolytics? (4)

• assess patients risk of bleeding.

• foley catheter.

• monitor intake and output.

• assess for dysrhythmia.

what are the three factors that work together to effect blood pressure?

• cardiac output

• blood volume

• peripheral resistance (diameter of arterioles)-

remember: pump, fluid, and pipes.

change in one = change in others

what medications lower blood pressure by effecting the blood volume (THE FLUID!!) (1)

• diuretics

how do diuretics lower blood pressure?

increases urination > decreases blood volume > decreases blood pressure

what is the renin-angiotensin-aldosterone system?

a hormone system that regulates blood pressure