Respiratory AP
Upper
nose, mouth, pharynx (throat), and larynx (voice box)
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
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.
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
Vital signs, breathing pattern, skin color, respiratory status, auscultation, palpation, positioning,
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.
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
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
levalbuterol
short-acting beta2-specific bronchodilating beta agonist.
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.
Area where O2 is exchanged for CO2
Alveoli
Leukotriene modifier
montelukast, zafirlukast, and zileuton are used for the prophylaxis and long-term treatment and prevention of asthma.
What is a black box warning on montelukast regarding serious mood-related changes and behaviors.
salmeterol
long-acting beta2 agonist bronchodilator
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.
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
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.
fluticasone
Hypersensitivity to drug, components or milk proteins, which may result in anaphylaxis, angioedema, rash, and urticaria
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
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
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.
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.
anticholinergics
ipratropium
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.
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.