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Ati flash cards 08, medications affecting the respiratory system

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Ati flash cards 08, medications affecting the respiratory system

  1. 1. Respiratory System (General Key Points) N203 ATI (Unit 8) Respiratory System -
  2. 2. β2-Adrenergic Agonists N203 ATI (Unit 8) Respiratory System -
  3. 3. Expected Action: Proto: albuterol (Proventil) — Others: formoterol (Foradil), salmeterol (Serevent), terbutaline (Brethine) · Selectively activate β2 receptors resulting in bronchodilation: bronchospasm is relieved, histamine release is inhibited, and ciliary motility is  Therapeutic Uses: · Albuterol: Inhaled, short-acting and oral, long-acting · Formoterol, salmeterol: Inhaled, long-acting · Terbutaline: Oral, L-A Adverse Effects: · Inhaled: Minimal adverse effects · Oral: Tachycardia/angina d/t β1 in ♥ / tremors d/t β2 in skeletal muscle Contraindications/Precautions: ♀ (C) · CI: tachydysrhythmias Interactions: · · β-blockers like propanolol  negate effects of both · TCAs and MAOIs   risk of tachycardia and angina Education: · Inhale 3-5 sec, hold 10 sec, wait 60 sec for next dose · Use inhaled β2-agonist before using inhaled glucocorticoid
  4. 4. Methylxanthines N203 ATI (Unit 8) Respiratory System -
  5. 5. Expected Action: Proto: Theophylline (Theolair) · Theophylline relaxes bronchial smooth muscle  bronchodilation Therapeutic Uses: · Long-term control of asthma Adverse Effects: · Mild toxicityGI distress & restlessness. Severe reactions · Severe reactions can occur at  therapeutic levels and include dysrhythmias and seizures. Effects unlikely @ <20 mcg/mL. Activated charcoal  absorption, lidocaine for dysrhythmias and diazepam for seizures. Contraindications/Precautions: ♀ (C) · Interactions: · Caffeine:  CNS/♥ effects of theophylline. Also [theophylline] · Phenobarbital, phenytoin:  [theophylline] · Cimetidine, ciprofloxacin:  [theophylline]
  6. 6. Inhaled Anticholinergics N203 ATI (Unit 8) Respiratory System -
  7. 7. Expected Action: Proto: ipratropium (Atrovent) — Others: tiotropium (Spiriva) · Block muscarinic receptors on bronchi  bronchodilation Therapeutic Uses: · Relief of bronchospasms associated with COPD · Relief of allergen-induced and exercise-induced asthma. Adverse Effects: · Local anticholinergic effects Contraindications/Precautions: ♀ (B) · CI: Peanut allergy · Caution in narrow-angle glaucoma Education: · Usual adult dose is 2 puffs (1 minute apart) · If taking two inhaled medications, separate by at least 5 minutes.
  8. 8. Glucocorticoids N203 ATI (Unit 8) Respiratory System -
  9. 9. Expected Action: Proto: beclomethasone (QVAR) — Others: budesonide (Pulmicort), fluticasone (Flovent), triamcinolone (Azmacort), prednisone (Deltasone) · Prevent inflammation, suppress airway mucous production, and promote responsiveness of β2-receptors in bronchial tree. Therapeutic Uses: · Inhaled: Long-term asthma prophylaxis · S-T, oral: Treat symptoms following acute asthma. · L-T, oral: Treat chronic asthma · 1º adrenocortical insufficiency · Promote lung maturity and  RDS in fetuses at risk for preterm birth. Adverse Effects: · Inhaled: Dysphasia, candidiasis, bone loss · Oral (≥10d):  adrenal gland function / bone loss / hyperglycemia / glucosuria / / infection / peptic ulcer disease / myopathy / fluid & electrolyte disturbances. Contraindications/Precautions: ♀ (?) · CI: Live virus / systemic fungal infect. Interactions: · Diuretics:  hypokalemia · NSAIDs:  GI ulceration · Glucocorticoids counteract effects of insulin and oral hypoglycemics. Education: · Oral are for short-term use, 3-10 days following acute attack
  10. 10. Mast Cell Stabilizers N203 ATI (Unit 8) Respiratory System -
  11. 11. Expected Action: Proto: Cromolyn (Intal) — Others: nedocromil (Tilade) · Anti-inflammatory: Stabilize mast cells, inhibiting histamine release. · Suppress inflammatory cells (e.g. eosinophils, macrophages) Therapeutic Uses: · Management of chronic asthma · Prophylaxis of exercise-induced and allergen-induced asthma attacks · Allergic rhinitis by intranasal route Adverse Effects: · Safest of all asthma meds / safe for kids Contraindications/Precautions: ♀ (B) · Propellant  CI: CAD, dysrhythmias, and status asthmaticus Education: · Take 15 min before exercise · Long-term prophylaxis may take several weeks
  12. 12. Leukotriene Modifiers N203 ATI (Unit 8) Respiratory System -
  13. 13. Expected Action: Proto: montelukast (Singulair) — Others: zileuton (Zyflo), zafirlukast (Accolate) · Prevent effects of leukotrienes thus suppressing inflammation, airway edema, bronchoconstriction, and mucus production. Therapeutic Uses: · Long-term asthma therapy in folks ≥ 12 YO Adverse Effects: · Liver injury ĉ zileuton and zafirlukast. (nausea, anorexia, abdominal pain) Contraindications/Precautions: ♀ (?) · Interactions: · · Zileuton / zafirlukast inhibit warfarin metabolism   [warfarin] · Zileuton / zafirlukast inhibit theophylline metabolism   theophylline toxicity Education: · Zileuton given without regard to food. Zafirlukast taken ŝ food
  14. 14. Antitussive – Opioids N203 ATI (Unit 8) Respiratory System -
  15. 15. Expected Action: Proto: codeine — Others: hydrocodone · Suppresses cough center in the medulla oblongata. Therapeutic Uses: · Chronic, non-productive cough Adverse Effects: · GI distress (nausea, constipation) – take ĉ food,  fluid/fiber · CNS sedation effects: Respiratory depression (<12/min) – naloxone · Potential for abuse, schedule II. Contraindications/Precautions: ♀ (C) · · CI: acute asthma, head trauma, liver/renal dysfunction, acute alcoholism
  16. 16. Mucolytics N203 ATI (Unit 8) Respiratory System -
  17. 17. Expected Action: Proto: acetylcysteine (Mucomyst) — Others: hypertonic saline · Enhance flow of secretions in the respiratory passages Therapeutic Uses: · Acute & chronic pulmonary disease ĉ  secretions · Cystic fibrosis · Acetylcysteine is the antidote for acetaminophen poisoning Adverse Effects: · Aspiration and bronchospasm Contraindications/Precautions: ♀ (B) · CI: GI bleeding · Caution: Peptic ulcers / esophageal varices / severe liver disease Education: · Has smell of rotten eggs · Dilute in fruit juice · IV: Loading dose, next dose over 4h, last dose over 16h.
  18. 18. Decongestants N203 ATI (Unit 8) Respiratory System -
  19. 19. Expected Action: Proto: Phenylephrine Others: Ephedrine, naphazoline, phenylpropanolamine · Stimulate α1-adrenergic receptors   inflammation of nasal membranes Therapeutic Uses: · Allergic rhinitis, sinusitis, and common cold Adverse Effects: · Rebound congestion (Max 3-5 days, taper down use) · CNS stimulation (rare ĉ topical) · Vasoconstriction Contraindications/Precautions: ♀ (?) · CI: Chronic rhinitis · Caution: CAD and hypertension Education: · Oral do not lead to rebound congestion

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