Respiratory drugs

Histamine:

1. Causes:

2. H1 causes:

3. H2 causes:

A molecule involved in allergic reactions and regulation of gastric secretions

1. allergic conditions and peptic ulcer disease

2. Vasodilation, bronchoconstriction, itching, CNS effects, mucus secretion

3. Increase gastric acid

H1 antagonists

1. Prefix

2. a.k.a

3. MOA:

4. Uses:

5. When are they most effective:

6. What receptor may some block:

7. Nursing considerations:

1. -ine

2. Antihistamine

3. Block H1 receptors and prevent histamine from binding

4. Relieve sneezing, rhinorrhea, itching

5. when taken prophylactically before symptoms become severe

6. Muscarinic receptors= (dry out)

7. Pregnant people not advises. use only if benefit outweighs risk. AVoid late in 3rd trimester

H1 antagonists: 1st and 2nd generation

First generation

1. prototype

2. Major characterstic:

3. Effects?

Second generation

1. prototype

2. major characterstic:

3. effect:

Which one is better as in adverse effects?

1. diphenhydramine (Benadryl)

2. sedation

3. CNS effects, Respiratory depression, anticholinergic effects, excitation

1. cetirizine (Zyrtec)

2. Not sedating

3. No anticholinergic effects

certirizine (Zyrtec)

Nursing considerations for H1 antagonists (antihistamine)

1. Patient teaching: Med adverse effects

2. Patient teaching: lifestyle considerations

3. Contraindications:

1. Monitor ambulation, sedation, urinary rentention, NO alcohol

2. Take w food, take at bedtime

3. AVOID children under 2, breastfeeding, prostatic hypertrophy, acute asthma, narrow-angle glaucoma

Is it appropriate to adminster an antihistamine to Mrs.Thompson?

• CC: Persistent rhinorrhea, sneezing, itchy eyes that worsen every spring & Fall.

• 70 years old

• PMH: HTN, COPD, former smoker

Yes. she should adminster an antihistamine (2nd generation). Bc of its benefits since it doesnt depress or speed the resipratory since she alr has asthma symptoms and she is old

Allergic Rhinitis:

1. Cause:

2. Symptoms

3. Two types?

Inflammatory condition of the eyes, upper and lower airways

1. Release of inflammatory mediators from mast cells

2. sneezing, rhinorrhea, pruritus, congestion, conjunctivitis, asthma symptoms

3. seasonal and perennial (all year long)

Why are first-generation antihistamines often avoided in older adults?

Why should first-generation antihistamines be used cautiously in COPD?

Why should first-generation antihistamines be used cautiously in hypertension?

Which antihistamine generation is generally preferred for patients with COPD?

1. increased risk of falls, confusion and sedation

2. anticholinergic effects can thicken secretions

3. may worsen cardiovascular effects

4. second generation

Fluticasone (Flonase)

1. suffix?

2. Class?

3. Treatment of?

4. What symptoms does it improve?

5. Adverse effects?

6. Patient teaching?

1. -sone

2. Intranasal Glucocorticoids (steroids)

3. Allergic rhinitis most effective by reducing inflammation

4. Congestion, rhinorrhea, sneezing, nasal itching and erythema

5. dry mucosa, epistaxis (nosebleed), headache, sore throat, nasal irritation

6. Watch out b/c some ppl dont like nasal sprays

azelastine (Astelin)

1. suffix

2. Class?

3. Adverse effects?

4. difference between oral ones?

1. -ine

2. Intranasal Antihistamines (2nd generation;zyrtec)

3. nasal dryness, epistaxis, headaches

Is it appropriate to adminster an nasal antihistamine or nsal glucocorticoid to Mrs.Thompson?

• CC: Persistent rhinorrhea, sneezing, itchy eyes that worsen every spring & Fall.

• 70 years old

• PMH: HTN, COPD, former smoker

Nasal glucocorticoid ; most effective for allergic rhinitis, treats all her symptoms, has less systemic effects including sedation. Do she have DM? It long term

oxymetazoline (Afrin)

1. examples of other drugs

2. Drug class:

3. What do this drug do?

4. MOA?

5. Adminstration?

6. Adverse effects?

7. what symptoms does it relive?

1. phenylephrine (Neo-Synephrine) & pseudoephedrine (Sudafed) - oral

2. Alpha 1 agonists (sympathomimetics)

3. ONLY Nasal Decogestant reducing swelling of nasal mucosa

4. Vasoconstriction of nasal blood vessels

5. PO, nasal spray, nasal drops

6. Oral (restlessness, anxiety, vasoconstriction). Nasal (rebound congestion (wean w/ intranasal glucocorticoid). Potiental for abuse (NO LONG TERM USE)

7. Nasal congestion, not effective w/ other symptoms of allergic rhinitis or upper respiratory

1. Which medication class is most effective for allergic rhinitis?

2. Which medication class is best for isolated nasal congestion?

3. Which medication class should be avoided in uncontrolled hypertension?

Is it appropriate to administer a decongestant to Malyn?

• Cold symptoms: mild rhinorrhea, severe nasal congestion, sneezing, and headache

• 19 years old

1. intranasal glucocorticoids

2. decongestants

3. decongestants (a1; vasoconstriction)

yes, b/c her main symptom is nasal congestion and she is young. But make sure she knows decongestant can cause restlessness, anxiety, insomnia and increased BP. Also rebound congestion if used longer than 3-5 days

1. Two major treatment categories for asthma?

1. Bronchodilators (relieve constriction) and Anti-inflammatory medications

Asthma: bronchoconstriction & inflammation

Bronchodilators:

• medication classes

Anti-inflammatory meds:

• medication classes

Relieve bronchoconstriction

• Beta 2 agonists, methylxanthines, and anticholinergics

Reduce airway inflammation

• Glucocorticoids and leukotriene modifiers

1. What are the advantages of inhaled respiratory medications?

MDIs:

• Major disadvantage:

• How much of it reach lungs?

• How to increase delievery?

DPIS (dry-powder inhalers)

• How is it activated?

• advantage?

Nebulizers

• what is it?

• Adminstration

• who benefits?

1. Direct delivery to lungs, rapid relief, and fewer systemic effects

Metered Dose Inhaler

• Requires hand-lung coordination

• 10%

• a spacer

• BY pts inhalation, no propellant (pill type)

• No hand-breath coordination

• A machine that converts medication into a fine mist

• face mask or mouthpiece

• Young children, older adults and ill pts

Inhaled Corticosteroid (ICS):

1. a.k.a?

2. Prototype

3. Rescue or controller meds?

4. Primary purpose?

5. PRN or Rountine?

6. who need that?

7. MOA:

8. Adverse effects:

9. Nursing considerations:

10. Contraindications and Precautions:

Why are inhaled corticosteroids not useful during an acute asthma attack?

1. Glucocorticoids or steroids

2. Beclomethasone dipropionate (QVAR) or fluticasone (Flovent)

3. controller; prevent attack

4. Reduce airway inflammation in asthma

5. Routine

6. all except those with very mild symptoms

7. Decrease, inflammation, hyperactivity,

Increase # of beta 2 receptors and responsiveness of beta 2 agonists (dilation)

8. candidiasis (thrush), dysphonia (hoarse), hyperglycemia (steroids rise glucose, DM!), adrenall suppression, peptic ulcer disease (NO NSAIDS, ppI) , slowing/loss of bone growth (increase Ca, Vita D)

9. Spacer, Antifungal therapy, give routinely, oral hygiene. give beta 2 agonist first to improve delivery after excerbation

10. Watch pts who have PUD, DM, HTN, Renal dysfunction, or NSAIDs.

Dont give to those who take Lasix (Furosemide/loopdiue), systemic fungal infection and who recieved a live virus immunization

They work slowly; not rescue

Prednisone

1. Class of drugs?

2. When commonly used?

3. Rescue or controller?

4. Nursing considerations?

5. Contradictions and precautions?

1. Glucocorticoids- Oral

2. Short-term management of after exacerbation symptoms in ASTHMA

3. Controller short term 3-5 days

4. Dont stop abrupty (risk of adrenal insufficiency), monitor blood glucose/plasma/electrolytes, infection, osteoporosis prevention, gastric protection needed, watch weight gain (steroid sodium retention).

5. Watch pts who have PUD, DM, HTN, Renal dysfunction, or NSAIDs.

Dont give to those who take Lasix (Furosemide/loopdiue), systemic fungal infection and who recieved a live virus immunization

fluticasone (Flonase)

1. Class of drugs?

2. Adminstration ?

3. Important information?

4. Adverse effects?

5. Nursing considerations.

1. Glucocorticoids-Nasal (allergic rhinitits)

2. Nasal metered-dose spray

3. They dont work immediately and initial dose is usually higher than maintanence dose. It can take 2-3 weeks to reach full effect. TAKE EVERY DAY

4. Headache, epistaxis, and sore throat, dry mucus membranes

5. comfort pt with dry mucus membranes, use non-NSAIDs for pain (tylenol), watch out for infection!

Flo= Nose (blood smelly)

Albuterol (Proventil,Ventolin)

1. What type ?

2. Rescue or Controller?

3. Primary use?

4. Primary effect

5. How quickly does it work?

6. When to use it?

7. Adverse affects?

8. WHat should be monitored with DM?

9. What should be monitored with Pt taking frequently

10. Suffix

1. Short acting (SABAs) beta 2 adrenergic agonists

2. Rescue Inhaler

3. Acute asthma symptoms and bronchospasm

4. bronchodilation

5. Rapid

6. PRN for sx or before exercise (EIB)

7. Tachycardia, angina, tremor- temporary, minimal (OK, Expected)

8. blood glucose

9. Potassium levels - avoid dyrrthmias

10. -buterol

Long acting Beta2 Agonist (LABAs)

1. prototype

2. another example

3. rescue or controller?

4. Major point!

5. Primary effect?

6. What adverse effects are similar to SABAs?

7. Inhaled, Nasal, or Oral?

8. Suffx

1. salmeterol (Serevent Diskus)

2. arformoterol (Brovana)

3. Controller- fixed schedule dosing

4. Must be combined with ICS (inhaled corticosteroids) in asthma.. “LABA= Likes to B around → ICS”

5. Long-term bronchodilation

6. Tachycardia,tremors and nervousness

7. Inhaled

8. -meterol

Oral Beta 2 adrenergic Agonists

1. Long term or short term?

2. Why do they have more adverse effects?

3. half-life?

4. examples?

• only for lerm term control- not acute attack

• absorbed systemically

• short

• albuterol, terbutaline

What is an ICS/LABA combination?

• examples?

• Why are they benefical?

• What do they reduce?

A combination inhaler containing an inhaled corticosteroid and a long-acting Beta2 agonist

• Fluticasone/Salmeterol (Advair)…. Budesonide/Formoterol (Symbicort)

• Provide both anti-inflammatory and bronchodilator effects

• Reduce LABA errors only

Methylxanthine

1. prototype

2. What are this group essentailly?

3. MOA:

4. Primary use:

5. NTI?

6. Adverse effects?

7. Interaction to avoid?

1. Theophylline

2. Drugs derived from xanthine (caffeine is most popular)

3. Relaxes bronchial smooth muscle and suppresses airway responsiveness

4. Long-term asthma and COPD management

5. narrow (10-20)

6. n/v/d. insomnia, restlessness. dysrhythmias, angina, tremors, convulsions

7. Caffeine; bc both are CNS stimlants

montelukast (Singulair)

1. MOA

2. Primary effect:

3. Conditions used to treat?

4. Adminstration.. when to take?

5. Controller or rescue?

6. Can montelukast stop an acute asthma attack?

7. Adverse effects:

8. drug-drug interaction:

1. blicks leukotriene receptors

2. Reduced inflmmation & bronchoconstriction

3. Asthma, Allergic rhinitis and EIB

4. PO-oral… hs

5. Controller

6. no

7. liver damage and physcho problems (suicidal thoughts, anxiety, depression)

8. When used with glucocorticoid → lower steroid dose

ipratroprium (Atrovent) & tiotropium (Spiriva)

1. drug class

2. MOA:

3. primary effect?

4. Conditions it treats?

5. adminstration

6. BIG ALERT!

1. Anticholinergics (Muscarinic Antagonists)

2. Block muscarinic receptors in bronchi

3. bronchodilation

4. Asthma (off-label) and COPD

5. inhaled

6. works well with anticgolinergics and beta 2 agonists → dilation