Respiratory AP
Pharmacologic Overview
Hall Monitor
Short or long?
Teach me!
100

Upper

nose, mouth, pharynx (throat), and larynx (voice box)

100

Bronchodilators

drugs relax bronchial smooth muscle, which causes dilation of the bronchi and bronchioles that are narrowed as a result of the disease process.

Three classes: beta-adrenergic agonists, anticholinergics, and xanthine derivatives

100

theophylline

Xanthine Derivatives

serum levels:

The therapeutic range 10-20 mg/L but many advise between 5-15 (to avoid getting too close to toxic level)

many side effects and drug interactions

Cardiac adverse effects include sinus tachycardia, extrasystole, palpitations, and ventricular dysrhythmias.

Theophylline turns to caffeine in the body and consuming large amounts of caffeine can magnify or potentiate the side effects experienced from theophylline. Theophylline is a daily preventative medication, a SABA should be taken if difficulty breathing. The client may experience insomnia, headache, and diarrhea when taking theophylline when they are in the therapeutic range. Theophylline blood levels are drawn while taking this drug to monitor for toxicity.

100

epinephrine

epinephrine is a non-selective beta-adrenergic agonist, meaning it acts on both alpha- and beta-adrenergic receptors. Epinephrine is a potent adrenergic agonist with a short duration of action -status asthmaticus

100
Respiratory assessment

Vital signs, breathing pattern, skin color, respiratory status, auscultation, palpation, positioning, 

200

Lower

trachea (windpipe) and within the lungs, the bronchi, bronchioles, and alveoli. Deep in the lungs, each bronchus divides into secondary and tertiary bronchi, which continue to branch to smaller airways called the bronchioles.

200

Beta 2 adrenergic agonist

shot-acting, for acute episodes 

albuterol (Ventolin, ProAir, others), levalbuterol (Xopenex), terbutaline (Brethine), and metaproterenol (Alupent). 

Long-acting beta agonist (LABA) inhalers  arformoterol (Brovana), formoterol (Foradil, Perforomist), salmeterol (Serevent), olodaterol (Striverdi), vilanterol in conjunction with fluticasone (Breo Ellipta), formoterol in conjunction with budesonide and glycopyrrolate (Breztri), vilanterol in combination with fluticasone and umbeclidium (Trelegy Ellipta), and vilanterol in conjunction with the anticholinergic umeclidinium (Anoro Ellipta). 

The term Ellipta refers to a new delivery system. Because the LABAs have a longer onset of action, they must never be used for acute treatment.

bronchorelaxation/bronchodilating effects

200

corticosteroids

inhaled: Oral infections with inhaled

Systemic effects: adrenocortical insufficiency, increased susceptibility to infection, fluid and electrolyte disturbances, endocrine effects, CNS effects (insomnia, nervousness, seizures), and dermatologic and connective tissue effects, including brittle skin, bone loss, osteoporosis, and Cushing’s disease

200

levalbuterol

short-acting beta2-specific bronchodilating beta agonist.

200

bronchodilator or corticosteroid

The bronchodilator inhaled drug is generally taken 2 to 5 minutes (or as ordered) before the corticosteroid aerosol. why?...

they quickly open up the airways, allowing the corticosteroid medication to reach the inflamed areas of the lungs more effectively and exert its anti-inflammatory action;

Corticosteroid- wash out mouth, dry mouth and cough, do good dental hygiene. 

300

Area where O2 is exchanged for CO2

Alveoli

300

Leukotriene modifier

montelukast, zafirlukast, and zileuton are used for the prophylaxis and long-term treatment and prevention of asthma.

300
montelukast

What is a black box warning on montelukast regarding serious mood-related changes and behaviors.

300

salmeterol

 long-acting beta2 agonist bronchodilator

300

Peak flow meter

What is a handheld device used to monitor a patient’s ability to breathe out air and reflects the airflow through the bronchi and thus the degree of obstruction in the airways. Encourage using a journal to record peak flow levels, signs and symptoms of the disease, any improvement, and the occurrence of adverse effects associated with therapy.

400

Asthma

What is recurrent and reversible shortness of breath

Occurs when the airways of the lungs (bronchi and bronchioles) become narrow as a result of:

Bronchospasms, Inflammation of the bronchial mucosa, Edema of the bronchial mucosa, Production of viscous mucus

The alveolar ducts and alveoli remain open, but airflow to them is obstructed.

Symptoms: Wheezing, Difficulty breathing

400

Xanthines

theophylline- bronchorelaxation/broncho-dilating effects,

Perform a careful cardiovascular assessment, noting heart rate, blood pressure, and history of cardiac disease. This is important because of the adverse effects of sinus tachycardia and palpitations. Gastroesophageal reflux may occur with these drugs. Assess bowel patterns and for preexisting disease, such as reflux and/or ulcers. Because of possible drug-induced transient urinary frequency, conduct a baseline assessment of urinary patterns.

400

fluticasone

Hypersensitivity to drug, components or milk proteins, which may result in anaphylaxis, angioedema, rash, and urticaria

400

beclomethasone

inhaled corticosteroid: primary treatment of bronchospastic disorders to control the inflammatory responses that are thought to be the cause of these disorders; they are indicated for persistent asthma. They are often used concurrently with the beta-adrenergic agonists

400

Used with caution in clients with diabetes, glaucoma, or active untreated infections. 

corticosteroids anti-inflammatory effects

Inhaled corticosteroids, like fluticasone, should not be used by clients with severe milk protein allergies. This medication can also increase blood sugar, reduce immune response, and increase ocular pressure. It should, therefore, be used with caution in clients with diabetes, glaucoma, or active untreated infections.

The systemic impact on the pediatric patient is suppressed growth

500

Status Asthmaticus

What is severe asthma unresponsive to repeated courses of beta-agonist therapy such as inhaled albuterol, levalbuterol, or subcutaneous epinephrine. It is a medical emergency that requires immediate recognition and treatment.

500

Anticholinergics

ipratropium (cause airway relaxation and dilation, decreases secretions in COPD)

NOT acute

work by blocking the bronchoconstrictive effects of ACh.

Currently six anticholinergic drugs used in the treatment of COPD: ipratropium (Atrovent), tiotropium (Spiriva), aclidinium (Tudorza), umeclidinium (Incruse Ellipta), revefenacin (Yupelri) and glycopyrrolate (Seebri).

 Caution is necessary in patients with acute narrow-angle glaucoma and prostate enlargement.

500

anticholinergics

ipratropium


  • constipation.
  • a cough.
  • headaches.
  • nausea.
  • a dry mouth.
500
montelukast

Leukotriene receptor antagonists

No more than one dose in 24 hours. Leukotriene receptor antagonists are used to treat allergic rhinitis, long-term treatment of asthma not acute, and decreased mucous secretions. 

It takes about one week to see improvement in symptoms. 

The most common side effects of montelukast include headache, dizziness, nausea, and diarrhea.

500

Chronic obstructive pulmonary disease (COPD)

 A lung disease depicted by chronic obstruction of lung airflow that interferes with normal breathing. COPD is not fully reversible. The terms “chronic bronchitis” and “emphysema” are no longer used, but are now included within the COPD diagnosis.

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