CORTICOSTEROID
(ICS & IV)
(ICS & IV)
TRUE OR FALSE: The inhaled corticosteroid [ICS] called beclomethasone (Qvar RediHaler) is not to be used for long-term management of respiratory conditions like COPD, but should only be used during acute exacerbations
FALSE
On the contrary, beclomethasone (Qvar RediHaler) should only be used for scheduled long-term control of COPD, and should be replaced by an IV or PO type of corticosteroid during acute episodes
TRUE OR FALSE: According to lecture, the short-acting (SABA) and long-acting (LABA) forms of Beta2 Adrenergic Agonist inhalers are basically the same drug, with the exact same side effects, only difference being that the long-acting (LABA) form CANNOT EVER
effectively be used for acute bronchoconstriction
TRUE
The LABA is for long-term maintenance doses; it is NOT a "rescue inhaler" the way a SABA is
TRUE OR FALSE: The prototype drug in the Anticholinergic (anti-mucarinic ACh receptor) category of acute respiratory meds is called ipratropium (Atrovent)
BONUS: TRUE OR FALSE -- The drugs in this category are only used to treat COPD
TRUE
BONUS: TRUE in terms of "on-label" approved uses, for bronchospasm associated with COPD only, BUT "off-label" it can be used for acute exacerbations of stable asthma as well
TRUE OR FALSE: Although normally antibiotic drugs need to be taken EVERY DAY until the prescribed amount is used up, when taken for COPD exacerbation prevention, certain abx such as erythromycin (Azithromycin) should be taken as directed just
TWO or THREE TIMES PER WEEK
TRUE
TRUE OR FALSE: According to lecture, research shows that it takes a discussion of a
MINIMUM OF 15 MINUTES with a patient who smokes to make a difference in helping them on the path of smoking cessation
FALSE
According to lecture, research shows that even talking about smoking cessation for LESS THAN THREE MINUTES to a patient who smokes can make a tangible difference in helping them to quit
In addition to ARs such as HA and nausea, many of the other ARs such as pharyngitis, fungal infection (candidiasis), cough, hoarseness, and dry mouth ALL help to explain THIS KEY ASPECT OF PATIENT TEACHING for those who use beclomethasone (Qvar RediHaler)
GARGLE WITH WATER AFTER ADMINISTRATION
Because SABA and LABA drugs are Beta2 adrenergic AGONISTS, the therapeutic effect of these respiratory drugs is decreased if the patient taking them is on THIS other class of drugs (e.g. to lower their BP)
BETA BLOCKERS
TRUE OR FALSE: ipratropium (Atrovent) only rarely has Adverse Reactions beyond the respiratory system itself since absorption is poor beyond the respiratory system, given that the drug does not diffuse into the bloodstream
BONUS: List AT LEAST TWO potential ARs (rare)
TRUE
BONUS: Cough; Dry Mouth (typical anticholinergic reaction);
nervousness, HA, dizziness;
nausea, GI upset
The general respiratory use of the drug
acetylcysteine (NAC) is to:
(a) dilate the bronchi in the lungs
(b) dry up the production of mucus through anticholinergic effect
(c) suppress inflammation in the lungs making it easier to breath
(d) liquifying mucus, making it easier to cough up
(D) liquifying mucus,
making it easier to cough up
In terms of palliative care, small doses of
THIS CATEGORY OF DRUGS, used in small and judicious doses, can help treat acute respiratory conditions by lowering the patient's
respiratory rate
BONUS: Give TWO OR MORE examples of specific drugs in this category (generic names)
OPIOIDS
BONUS: codeine, morphine, fentanyl, oxycodone, hydromorphone, hydrocodone, tramadol....
Name both the generic and the Trade name of the IV (systemic) version of corticosteroid that we learned in this week's lesson
It is methylprednisolone
or Solu-Medrol
NOTE: The generic name ends in the suffix
"-one" just as does the generic name of the ICS that is the inhaled (not IV) form, beclomethasone
While available for personal use in Metered Dosed Inhaler (MDI) form, in emergency settings (such as in an ambulance or hospital ED) you also see the SABA albuterol (Ventolin) administered in THIS form
NEBULIZER
Given potential typical "anticholinergic" effects of ipratropium (Atrovent), LIST AT LEAST TWO key Patient Teaching elements related to those AEs
*HARD CANDY can help with dry mouth
*RINSE MOUTH after use
*AVOID TAKING WITH OTHER ANTICHOLINERGICs as that combo could significantly increase anticholinergic SEs (constipation, urinary retention, dry mouth, blurred vision, tachycardia, etc.)
Name the drug in this unit -- both in its generic form and the Trade name -- that can sometimes cause SIGNIFICANT WEIGHT LOSS, a side effect that the patient is told to watch for by weighing themselves regularly, and to REPORT if they experience significant or unexplained weight loss
It is the PDE4 inhibitor called
roflumilast (Daliresp)
List AT LEAST THREE
key points that are part of the PATIENT EDUCTION for
theophylline (Theo-Dur)
*Report signs of toxicity immediately: nausea, vomiting, tremors, rapid heartbeat, restlessness, or seizures;
*Take exactly as prescribed and have blood levels checked regularly because the drug has a narrow therapeutic range;
*Avoid excessive caffeine (coffee, tea, cola, energy drinks) to reduce jitteriness and palpitations;
*Notify the healthcare provider before starting new medications, especially antibiotics such as Ciprofloxacin or Erythromycin;
*Tell the provider if you start or stop smoking, since this can significantly change drug levels.
We learned that methylprednisolone (Solu-Medrol) has few AE if taken for less than 10 days, but if taken for longer, it can have serious adverse effects.
LIST AT LEAST FOUR OF THEM
HYPERGLYCEMIA
HYPERNATREMIA
INSOMNIA
OSTEOPOROSIS
FLUID RETENTION
MANIC DEPRESSION
ADRENAL SUPPRESSION
DIMINISHED IMMUNE RESP/HIGHER RF INFECTION
PEPTIC ULCER DISEASE; LOWER K
Both SABAs and LABAs when taken in high doses can significantly effect the blood serum balance of THIS ELECTROLYTE in particular (say which electrolyte, and whether it raises or lowers blood serum levels)
POTASSIUM (K+)
which high levels of this drug will LOWER
(causing hypo-kalemia)
Explain the Method of Action, completing the following: By blocking the muscarinic acetylecholine receptors in the smooth muscles of the bronchi in the lungs,
ipratropium (Atrovent)
inhibits _______________
and __________________ ______________
inhibits _BRONCHOCONSTRICTION_
(thus causing bronchodilation!)
and
inhibits _MUCUS SECRETION_
(thus drying up excessive mucus/sputum)
What are some of the Adverse Effects of theophylline (Theo-dur), a non-inhaled type of bronchodilator that can be given PO or IV?
NAUSEA/VOMITING
HEADACHE
IRRITABILITY
LIGHTHEADEDNESS
DIZZINESS
INCR. STOMACH ACID SECRETIONS / GERD
List AT LEAST 3 advantages of combo therapy,
such as that found in the Respimat combination inhaler
sold under the brand name Combivent
*better adherence;
*easier to administer (don't need to remember the order or timing);
*fewer inhalers to carry;
*synergistic effect, thus lower doses of each drug needed (meaning fewer SEs, in general)
Explain the important PATIENT TEACHING points that should be included when administering methylprednisolone (Solu-Medrol) to a patient who has Peptic Ulcer Disease (PUD)
BONUS: How about to a patient with Diabetes?
This drug can increase the risk for PUD (or exacerbations of existing PUD), especially if taken together with NSAIDs
BONUS: This drug may cause hyperglycemia, so a patient with Diabetes may need to adjust the dose(s) of their diabetes management med(s) when on this drug
Give AT LEAST TWO key parts of Patient Teaching for those patients taking a selective long-acting Beta2 adrenergic agonist (LABA)
*This is NOT a rescue inhaler; don't use for acute emergencies, rather take as scheduled each day
*This drug should never be used alone; use together with a glucocorticoid /corticosteroid like beclomethasone (Qvar)
*If you take this drug in its common Dry Powder Inhaler (DPI) form, be sure to take in a
NICE DEEP BREATH after triggering the device
We are unlikely to get tested on this factoid, but the lecture slides tell us that with a patient who has a soy or peanut allergy, they should avoid using COMBIVENT, a type of MDI that combines these two respiratory drugs
ipratropium bromide
(anticholinergic/SAMA or LAMA)
and
albuterol (SABA)
There are a number of other drugs roflumilast (Daliresp) interacts with ("doesn't play well with")
to raise or lower
roflumilast (Daliresp) levels --
LIST AT LEAST THREE of these others
*The following drugs decrease roflumilast (Daliresp) levels: Rifampin, Phenytoin, Carbamazepine, Phenobarbital
The following drugs increase roflumilast (Daliresp) levels: Erythromycin, Ketoconazole, Cimetidine
The drug acetylecysteine (NAC), discussed in this unit as a respiratory "mucoregulator" (reducing the viscosity of mucous secretions, making them easier to clear from the lungs), should also be remembered as the "rescue drug" to counter the toxicity of
THIS OTHER common drug
acetaminophen (TYLENOL)