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Selective beta2-adrenergic agonists - Bronchodilators
- Terbutaline (Brethine)
- Metaproterenol (Alupent)
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What is the MOA for Terbutaline (Brethine) & Metaproterenol (Alupent)?
- relaxes smooth muscle of bronchi
- keep from going into labor (Brethine)
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How is Terbutaline (Brethine) & Methaproterenol (Alupent) administered ?
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What are side effects of Terbutaline (Brethine) and Methaproterenol (Alupent)?
tremors, restlessness, anxiety, headaches, nervousness, tachycardia, palpitations, dysrhythmias, hyperglycemia
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Anticholinergics – bronchodilator
Is an Alternative bronchodilator but SABA first choice
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Names of anticholinergics
- Ipratropium bromide (Atrovent)
- ipratropium (Combivent)
- tiotropium(Spiriva)
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Action of anticholinergics?
dilates bronchioles
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How is anticholinergic bronchodilator administered?
- aerosol inhaler
- Caution : Narrow-angle glaucoma
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Methylxanthine (Xanthine) derivatives are:
- Aminophylline (Somophyllin)
- theophylline (Theo-Dur)
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Action of Methylxanthine (Xanthine) derivatives?
- relaxes smooth muscle of bronchi
- bronchioles increasing cAMP promoting bronchodilation
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What is the use for methylxanthine?
maintenance therapy for chronic stable asthma
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What is the therapeutic range for methylxanthine (Xanthine)?
- Therapeutic range: 10-20 mcg/ml
- (toxicity greater than 20)
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Aminophylline (Somophyllin), theophylline (Theo-Dur) Contraindications
seizure, cardiac, renal, or liver disorders
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Administration of Aminophylline (Somophyllin), theophylline (Theo-dur)
oral, IV
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Side effects of Aminophylline (Somophyllin) & theophylline (Theo-Dur)
dysrhythmias, nervousness, irritability, insomnia, dizziness, flushing, dizziness, hypotension, seizures, GI distress, intestinal bleeding, hyperglycemia, tachycardia, palpitations, cardiorespiratory collapse
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Leukotriene Receptor Antagonists
Zafirlukast (Accolate), montelukast (Singulair)
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Action of Leukotriene Receptor Antagonists
- reduce inflammatory process
- decrease bronchoconstriction
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Use of Leukotriene Receptor Antagonists
- Prophylactic
- maintenance for chronic asthma
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Side effects of Leukotriene Receptor Antagonists
dizziness, HA, GI distress, abnormal liver enzymes, nasal congestion, cough, pharyngitis
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Glucocorticoids
- Beclomethasone (Beclovent, Vanceril)
- dexamethasone (Decadron)
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Action of Glucocorticoids
antiinflammatory effect
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how is the Glucocorticoids fluticasone (Flovent) administered?
Aerosol inhaler
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How is the glucocorticoid triamcinolone (Aristocort) administered?
Tablet
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How is dexamethasone (Decadron) (glucocorticoid) administered?
Injection
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Cromolyn and Nedocromil is used as
- Prophylactic treatment of bronchial asthma
- Not to be used for acute asthmatic attack
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Action of Cromolyn and Nedocromil?
antiinflammatory effect and suppresses the release of histamine
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Administration of cromolyn and nedocromil?
Inhalation
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Side effects of Cromolyn and Nedocromil?
- Cough
- bad taste
- rebound bronchospasm
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Mucolytics drug?
Acetylcysteine (Mucomyst)
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What is the MOA of acetylcysteine (Mucomyst)
liquefies and loosens thick mucus secretions
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Administration of acetylcysteine (Mucomyst)?
- Administer 5 minutes after a bronchodilator
- Should not be mixed with other drugs
- Also an antidote for acetaminophen overdose if within 12-24 hours
- Give orally diluted in juice or soft drink
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A client with COPD is admitted to the hospital for exacerbation. The client has severe dyspnea.
- A selective beta2-adrenergic agonist, albuterol (Proventil) is ordered to increase airway patency.
- Critical Thinking
- Compare the action and side effects of albuterol with isoproterenol and metaproterenol.
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Practice Question #1
- When ipratropium, a bronchodilator, and a glucocorticoid inhaler are ordered together, the:
- (Select all that apply.)
- a. bronchodilator is given 5 minutes before a glucorticoid.
- b. combination is more effective than when given alone.
- c. glucocorticoid is administered 10 minutes before the bronchodilator.
- d. glucocorticoid should be administered immediately after the bronchodilator.
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Answer: A, B. Rationale: When a bronchodilator and a glucocorticoid inhaler are given together, the bronchodilator is given first. The nurse should wait for 5 minutes before administering the
glucocorticoid. This drug combination is more effective than when given alone.
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General Nursing Implications of Metered Dose Inhalers (MDI’s)
Hand held pressurized devices that deliver a measured dose of drug with each “puff”
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When two “puffs” are needed, how much time should elapse between the two “puffs”
- 1 minute
- A spacer may be used to increase the delivery of the medication
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Aerosol inhaler
- Metered-dose inhaler (MDI)
- Dry powdered inhaler (DPI)
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Frequent dosing cause
- Tremors, nervousness, tachycardia
- Administration
- Teach client to use inhaler correctly and take care of equipment correctly
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