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What are the drugs categories for Lower Respiratory Disorders?
- Alpha & Beta2 Adrenergic Agonsits
- Anticholinergics
- Corticosteroids
- Xanthines
- Leukotriene Receptor Agonsits
- Cromolyn/Nedocromil
- Mucolytics
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What is COPD caused by?
Airway obstruction with ^airway resistance of airflow to lung tissues.
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What are the four major pulmonary disorders that cause COPD?
- Chronic Bronchitis
- Bronchiectasis
- Emphysema
- Asthma
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Why do issues such as Chronic Bronchitis, Bronchiectasis, Emphasema & Asthma cause COPD?
They frequently cause irreversible lung tissue damage.
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What is the etiology of Chronic Bronchitis?
Progressive lung disease caused by smoking or chronic lung infections.
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What is the etiology of Bronchiectasis?
An abnormal dilation of the bronchi & bronchioles secondary to frequent infection & inflammation.
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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)
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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.
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What is the action of Bronchodilators?
- Stimulate the SNS receptors
- Relaxes bronchial smooth muscles
- Dilates bronchioles
- Imitates the effects of Norepinephrine
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What are the other names for Bronchodialtors?
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What are bronchodilators indicated for?
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What forms can Bronchodilators come in?
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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)
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What are the effects of the adrenergic Alpha 1 receptor sites?
- ^cardiac contractility
- Vasoconstriction
- Dilate pupils (midriosis)
- <salivary gland secretion
- ^bladder & prostate contraction
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What are the effects of the adrenergic Alpha 2 receptor sites?
- Inhibit norepinephrine release - promotes vasodilation
- <GI motility & tone
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What are the effects of the adrenergic Beta1 receptor sites?
- ^cardiac contractility: ^Pulse
- ^renin secretion: ^BP
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What are the effects of the adrenergic Beta2 receptor sites?
- <GI tone & motility
- Bronchodilation
- ^blood flow in skeletal muscles
- Activates liver glycogenolysis= ^blood glucose
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What are the s/e of the Beta-Agonist Bronchodilators?
- Rapid HR
- Tremors
- Arrhythmias
- Palpitations
- Restlessness, Agitation
- Insomnia
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Bronchodilators are Beta-Agonsitst, & need to be given with caution in clients with what other disease processes?
- Cardiac problems
- HTN
- DM
- Seizure disorders
- Hyperthyroidism
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What should a client starting on Bronchodilators be taught?
- s/e
- 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
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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)
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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
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What diseases are the Anticholinergic Bronchodilator Inhalers indicated for?
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What are the s/e of Anticholinergic Bronchodilators?
- cough
- nervousness
- nausea
- GI upset
- HA
- dizziness
- **caution in pt's w/narrow angle glaucoma**
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Name the Anticholinergic Bronchodialtors.
- Ipratropium bromide (Atrovent)
- Tiotropium bromide (Spiriva Handihaler)
- Combo drug: Ipratropium/Albuterol (Combivent)
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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
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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
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What are the Methylxanthine (Xanthine) derivatives?
- Aminophylline (Somophyllin)
- Theophylline (Theo-Dur)
- Caffeine
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What disease processes are the Xanthines indicated for?
- Maintenance therapy for chronic stable:
- Asthma
- COPD
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What is the therapeutic range for Xanthines?
10-20mcg/mL
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What disease processes or disorders are Xanthines contraindicated in?
- Seizures
- Cardiac
- Renal
- Liver disorders
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How can Xanthines be administered?
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What are the s/e of Xanthine derivatives?
- Dysrhythmias
- Nervousness
- Irritability
- Insomnia
- Dizziness
- Flushing
- Hypotension
- Seizures
- GI distress
- Tachycardia
- Palpitations
- Cardiorespiratory collapse
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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
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What is Leukotriene (LT)?
- A chemical mediator that can cause inflammatory changes in the lung.
- ^eosinophil migration
- ^mucus production
- airway wall edema
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Leukotriene Receptor Antagonists are effective in doing what?
- Reducing the inflammatory symptoms of asthma triggered by allergic & environmental stimuli
- <bronchoconstriction
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Name the Leukotriene Receptor Antagonists.
- Montelukast (Singulair)
- Zafirlukast (Accolate)
- Zileuton (Zyflo)
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Leukotrien Receptor Antagonists like Singulair are used how?
As prophylactic & maintenance for chronic Asthma
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What are the s/e of Luekotriene Receptor Antagonists?
- dizziness
- HA
- GI distress
- abnormal liver enzymes
- nasal congestion
- cough
- pharyngitis
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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
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The drugs Cromolyn & Nedocromil are used for what?
- Phrophylactic tx of Bronchial Asthma
- **NOT to be used for acute asthmatic attacks**
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What is the action of the drugs Cromolyn & Nedocromil?
Anti-inflammatory effect & suppresses the release of histamine
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Cromolyn does NOT have bronchodilator properties, so how does it act on the lungs?
Inhibiting the release of histamine to prevent an asthma reaction
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How are Nedocromil & Cromolyn administered?
Inhalation
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What are the s/e of Cromolyn & Nedocomil?
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Cromolyn needs to be taken daily and should NOT be discontinued abruptly because of what possible s/e?
Rebound bronchospasms (asthma attack)
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What is the action of Nedocromil?
- Has an anti-inflammatory effect
- Suppresses the release of histamine, leukotrienes & other mediators from the mast cells.
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List the Anti-inflammatory drugs used for COPD.
- LT Receptor Antagonists
- LT Synthesis Inhibitors
- Glucocorticoids
- Cromolyn
- Nedocromil
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What is the action of Mucolytics like Mucomyst?
Liquefies & loosens thick mucus secretions so they can be expectorated
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How is Acetylcysteine (Mucomyst) administered?
Nebulizer
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When should Mucomyst (Acetylcysteine) be administered?
- 5min after a bronchodilator
- NOT to be mixed w/other drugs
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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
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