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What are the drugs categories for Lower Respiratory Disorders?
- Alpha & Beta2 Adrenergic Agonsits
- Leukotriene Receptor Agonsits
What is COPD caused by?
Airway obstruction with ^airway resistance of airflow to lung tissues.
What are the four major pulmonary disorders that cause COPD?
- Chronic Bronchitis
Why do issues such as Chronic Bronchitis, Bronchiectasis, Emphasema & Asthma cause COPD?
They frequently cause irreversible lung tissue damage.
What is the etiology of Chronic Bronchitis?
Progressive lung disease caused by smoking or chronic lung infections.
What is the etiology of Bronchiectasis?
An abnormal dilation of the bronchi & bronchioles secondary to frequent infection & inflammation.
What is the etiology of Emphysema?
A progressive lung disease caused by cigarette smoking, atmospheric contaminants, or lack of the alpha1-antitrypsin protein that inhibits proteolytic enzymes that destroy alveoli (air sacs)
What is the etiology of Asthma?
Inflammatory disorder of the airway walls associated w/a varying amount of airway obstruction. Triggered by stimuli such as stress, allergens & pollutants.
What is the action of Bronchodilators?
- Stimulate the SNS receptors
- Relaxes bronchial smooth muscles
- Dilates bronchioles
- Imitates the effects of Norepinephrine
What are the other names for Bronchodialtors?
What are bronchodilators indicated for?
What forms can Bronchodilators come in?
Name the Bronchodilators (Beta-Agonists).
- Epinephrine: alpha & beta
- Isopreterenol (Isuprel): Beta1 & 2
- Albuterol (Proventil): selective beta 2
- Pirbuterol (Maxair): selective beta 2
- Slameterol (Serevent): Selective beta 2
- Advair= Salmeterol + Fluticasone (corticosteroid)
What are the effects of the adrenergic Alpha 1 receptor sites?
- ^cardiac contractility
- Dilate pupils (midriosis)
- <salivary gland secretion
- ^bladder & prostate contraction
What are the effects of the adrenergic Alpha 2 receptor sites?
- Inhibit norepinephrine release - promotes vasodilation
- <GI motility & tone
What are the effects of the adrenergic Beta1 receptor sites?
- ^cardiac contractility: ^Pulse
- ^renin secretion: ^BP
What are the effects of the adrenergic Beta2 receptor sites?
- <GI tone & motility
- ^blood flow in skeletal muscles
- Activates liver glycogenolysis= ^blood glucose
What are the s/e of the Beta-Agonist Bronchodilators?
- Rapid HR
- Restlessness, Agitation
Bronchodilators are Beta-Agonsitst, & need to be given with caution in clients with what other disease processes?
- Cardiac problems
- Seizure disorders
What should a client starting on Bronchodilators be taught?
- Proper use of MDI
- Should have <dyspnea in 1-2min
- Albuterol is a RESCUE inhaler
- Salmeterol for prophylaxis only
- How to know if canister is empty
What should a client be taught about PDI (powdered dose inhalers)?
- need Rapid deep inhalation
- Mouth tightly closed around mouth piece
- Dose can be greater than w/MDI
- Can be used for children <4yrs
- Salmeterol + Fluticasone = Advair diskus
- Tiotropium Bromide = Spiriva (Handihaler Powdered capsules)
What is the action of Anticholinergic bronchodilators?
- Block the effects of acetylcholine at the PSMS receptors of the bronchial tree
- Prevents/reduces bronchoconstriction of smooth muscles of bronchus
What diseases are the Anticholinergic Bronchodilator Inhalers indicated for?
What are the s/e of Anticholinergic Bronchodilators?
- GI upset
- **caution in pt's w/narrow angle glaucoma**
Name the Anticholinergic Bronchodialtors.
- Ipratropium bromide (Atrovent)
- Tiotropium bromide (Spiriva Handihaler)
- Combo drug: Ipratropium/Albuterol (Combivent)
What teaching is done for a client starting on Tiotropium (Spiriva)?
- Do NOT swallow capsule
- Keep casule in blistercard until ready to use
- Peel foil back only to the "stop" line in blistercard
- Place capsule in center chamber of Handihaler
- Pierce capsule by pressing & releasing button on side of device
- Inhale one deep breath while mouth is tightly around mouth piece
What is the action of Methylxanthine (Xanthine) derivatives?
- Relaxes smooth muscle of bronchi, bronchioles
- ^cAMP promoting bronchodialation
- Stimulate the CNS
- Stimulate respirations
- Dilate coronary & pulmonary vessels
- Cause diuresis
What are the Methylxanthine (Xanthine) derivatives?
- Aminophylline (Somophyllin)
- Theophylline (Theo-Dur)
What disease processes are the Xanthines indicated for?
- Maintenance therapy for chronic stable:
What is the therapeutic range for Xanthines?
What disease processes or disorders are Xanthines contraindicated in?
- Liver disorders
How can Xanthines be administered?
What are the s/e of Xanthine derivatives?
- GI distress
- Cardiorespiratory collapse
What should a client starting on the Xanthine derivative Theo-Dur be taught?
- Take w/food
- Theophylline blood levels
- NO OTC meds w/o dr approval
- Sustained Release: do NOT crush
- Avoid Caffeine products
What is Leukotriene (LT)?
- A chemical mediator that can cause inflammatory changes in the lung.
- ^eosinophil migration
- ^mucus production
- airway wall edema
Leukotriene Receptor Antagonists are effective in doing what?
- Reducing the inflammatory symptoms of asthma triggered by allergic & environmental stimuli
Name the Leukotriene Receptor Antagonists.
- Montelukast (Singulair)
- Zafirlukast (Accolate)
- Zileuton (Zyflo)
Leukotrien Receptor Antagonists like Singulair are used how?
As prophylactic & maintenance for chronic Asthma
What are the s/e of Luekotriene Receptor Antagonists?
- GI distress
- abnormal liver enzymes
- nasal congestion
What should a client starting on an LT Receptor Antagonist be taught?
- Singulair can be w/or w/o food
- Accolate 1hr before or 2hrs after meals
- Monitor liver enzymes
- typically well tolerated drugs
- Accolate interacts w/theophylline
The drugs Cromolyn & Nedocromil are used for what?
- Phrophylactic tx of Bronchial Asthma
- **NOT to be used for acute asthmatic attacks**
What is the action of the drugs Cromolyn & Nedocromil?
Anti-inflammatory effect & suppresses the release of histamine
Cromolyn does NOT have bronchodilator properties, so how does it act on the lungs?
Inhibiting the release of histamine to prevent an asthma reaction
How are Nedocromil & Cromolyn administered?
What are the s/e of Cromolyn & Nedocomil?
Cromolyn needs to be taken daily and should NOT be discontinued abruptly because of what possible s/e?
Rebound bronchospasms (asthma attack)
What is the action of Nedocromil?
- Has an anti-inflammatory effect
- Suppresses the release of histamine, leukotrienes & other mediators from the mast cells.
List the Anti-inflammatory drugs used for COPD.
- LT Receptor Antagonists
- LT Synthesis Inhibitors
What is the action of Mucolytics like Mucomyst?
Liquefies & loosens thick mucus secretions so they can be expectorated
How is Acetylcysteine (Mucomyst) administered?
When should Mucomyst (Acetylcysteine) be administered?
- 5min after a bronchodilator
- NOT to be mixed w/other drugs
What is the other use for Acetylcysteine (Mucomyst)?
- Antidote for Acetaminophen OD if w/in 12-24hrs
- **given orally diluted in Juice or soft drink