Chapter 30 Drugs used to treat Lower respiration Disease

Term Definition
Human lungs contain millions of alveolar sacs surrounded by capillaries. If these were spread out on a flat surface, what would the size of that surface compare to? c) Tennis court
COMMON LOWER RESPIRATORY DISEASES •Chronic obstructive pulmonary disease (COPD) •Chronic airflow limitation disease (CALD) •Asthma •Chronic bronchitis •Emphysema
ARTERIAL BLOOD GASES (ABGS) Components •pH—7.35-7.45 •PaCO2—35-45 mm Hg •PaO2—80-100 mm Hg •HCO3—21-28 mEq/L •SaO2(oxygen saturation)—95%
Nursing assessment review for Lower respiratory diseases Cardiovascular health, sleep pattern, psychosocial health, laboratory and diagnostic data, smoking history recorded in pack years •Multiply number of packs smoked per day by number of years smoking
A person who has smoked 1? packs of cigarettes for 30 years has a pack-year history of how many years? c) 45
•Review with patients during each visit •Demonstration of how to use the inhaler •Exhale completely before inhaling •Hold breath at least 10 seconds afterward •Administer bronchodilator first, wait several minutes, give steroid inhalant •Rinse mouth after steroid medication
The health care provider has ordered the use of an inhaler for an 8-year-old patient newly diagnosed with asthma. To use the inhaler correctly, what does the nurse instruct the patient to do? c) Use a spacer between the inhaler and lips to control the medication
•Management principles rely on patient’s understanding of treatment •Nutrition—well-balanced diet, increase fluid •Exercise— to reduce fatigue •Eliminate risk factors—stop smoking, avoid irritants •Proper administration of medications •Use of peak flowmeter and record readings, pursed-lip breathing, postural drainage
DRUG THERAPY FOR LOWER RESPIRATORY DISEASES •Attempt to relieve symptoms of cough by liquefying thick secretions to prevent mucus plugs, or suppressing cough ; •Expectorants •Antitussives •Mucolytic agents •Bronchodilators •Antiinflammatoryagents •Immunomodulators
EXPECTORANTS – guaifenesin (Robitussin) •Actions •Enhance output of respiratory tract fluid, decrease mucus viscosity, promote ciliary action
EXPECTORANTS – guaifenesin (Robitussin) •Uses •Relieve dry, nonproductive cough •Treat symptoms of common cold, bronchitis, laryngitis, pharyngitis, sinusitis
EXPECTORANTS – guaifenesin (Robitussin) Common adverse effects •GI upset, nausea, vomiting
POTASSIUM IODIDE Drug: SSKI Actions •Expectorant; stimulates increased secretions, making it easier to cough
POTASSIUM IODIDE – Drug: SSKI Uses •Treat CHRONIC pulmonary diseases such as bronchial asthma, bronchitis, emphysema
POTASSIUM IODIDE – Drug: SSKI Common adverse effects •Nausea, vomiting, diarrhea
POTASSIUM IODIDE – Drug: SSKI •Assess for pregnancy; excessive use may result in goiter in newborn •Potentially dangerous hyperkalemia when administered with potassium supplements, salt substitutes high in potassium, or potassium-sparing diuretics
SALINE SOLUTIONS •Actions •Hydrate mucus, reduce viscosity
SALINE SOLUTIONS •Uses •Expectorant, administered by nebulization
SALINE SOLUTIONS Common adverse effects •None noted
ANTITUSSIVE AGENTS Actions •Suppress cough center in brain
ANTITUSSIVE AGENTS Uses •Suppress disruptive spasms
ANTITUSSIVE AGENTS Common adverse effects •Dry mouth, drowsiness, constipation
Codeine. •Hydrocodone . ANTITUSSIVE AGENTS . opioids.
•A pt reports a harsh, nonproductive cough and muscle aches for 5 days. No sore throat, temp elevation, or swollen lymph nodes, but the patient is coughing so much that sleeping at night is difficult. Which type of med will likely be prescribed ? b) Antitussive
MUCOLYTIC AGENTS – acetylcysteine(Mucomyst) •Actions •Dissolve chemical bonds in mucus
MUCOLYTIC AGENTS – acetylcysteine(Mucomyst) Uses •Dissolve abnormally viscous mucus •Treat chronic emphysema, emphysema with bronchitis, asthmatic bronchitis, pneumonia
MUCOLYTIC AGENTS – acetylcysteine(Mucomyst) •Common adverse effects •Nausea and vomiting due to odor similar to rotten eggs
MUCOLYTIC AGENTS – acetylcysteine(Mucomyst) •Serious adverse effects •Bronchospasm
BETA-ADRENERGIC BRONCHODILATINGAGENTS •Actions •Stimulate beta receptors within smooth muscle of tracheobronchial tree . ex. albuterol.
BETA-ADRENERGIC BRONCHODILATINGAGENTS •Uses •Reverse airway constriction •Mainstay of all asthma therapy
BETA-ADRENERGIC BRONCHODILATINGAGENTS •Serious adverse effects •Tachycardia, palpitations, tremors, nervousness, anxiety, restlessness, headache, dizziness, nausea and vomiting
BETA-ADRENERGIC BRONCHODILATINGAGENTS – formoterol •Long-acting beta agonists (LABA) to prevent acute deterioration •not used for acute episodes; pt should have asthma controller med * for prevention, to decrease severity of attacks; stop once controlled •may make attacks that do occur more severe
formoterol Long acting beta adrenergic agent
ANTICHOLINERGIC BRONCHODILATINGAGENTS Uses •Long-term treatment of reversible bronchospasm associated with COPD
ANTICHOLINERGIC BRONCHODILATINGAGENTS •Common adverse effects •Mouth dryness, throat irritation
ANTICHOLINERGIC BRONCHODILATINGAGENTS Serious adverse effects •Tachycardia, urinary retention, exacerbation of symptoms
•Drugs: ipratropium bromide (Atrovent), tiotropiumbromide (Spiriva) ANTICHOLINERGIC BRONCHODILATINGAGENTS prototype.
ANTICHOLINERGIC BRONCHODILATINGAGENTS Do not give to people with peanut allergy
XANTHINE DERIVATIVE BRONCHODILATINGAGENTS Actions •Act directly on smooth muscle of tracheobronchial tree to dilate bronchi
XANTHINE DERIVATIVE BRONCHODILATINGAGENTS •Uses •Reverse airway constriction •Treat acute and chronic bronchial asthma, bronchitis, emphysema
XANTHINE DERIVATIVE BRONCHODILATINGAGENTS Common adverse effects •Nausea, vomiting, epigastric pain, abdominal cramps
XANTHINE DERIVATIVE BRONCHODILATINGAGENTS •Serious adverse effects •Tachycardia, palpitations, tremors, nervousness, restlessness, anxiety, headache
TIOTROPIUM BROMIDE (SPIRIVA) •Not a rescue med with acute episodes •One capsule daily, administered with HandiHaler inhaler •Cap placed in center chamber, press piercing button in and release •Close lips tightly around mouthpiece and inhale
RESPIRATORY ANTIINFLAMMATORYAGENTS Uses •For patients unresponsive to sympathomimetic agents or xanthine derivatives •Prevent symptoms of asthma
RESPIRATORY ANTIINFLAMMATORYAGENTS •Actions •Inhibit inflammatory responses
RESPIRATORY ANTIINFLAMMATORYAGENTS •Common adverse effects •Hoarseness, dry mouth
ANTILEUKOTRIENE AGENTS •Drugs •Montelukast(Singulair)
ANTILEUKOTRIENE AGENTS •Actions •Selective and competitive receptor antagonist of cysteinylleukotriene receptor
ANTILEUKOTRIENE AGENTS Uses •In combination with other drugs to treat asthma
ANTILEUKOTRIENE AGENTS Common adverse effects •Headache, nausea, dyspepsia
ANTILEUKOTRIENE AGENT always check liver function with this
PHOSPHODIESTERASE-4 INHIBITOR ROFLUMILAST(DALIRESP) Uses: reduces frequency of flareupsof inflammation in patients with chronic bronchitis, severe COPD; used with bronchodilators and corticosteroids
PHOSPHODIESTERASE-4 INHIBITOR ROFLUMILAST(DALIRESP) •Common adverse effects: dyspepsia, cramps, nausea, diarrhea, weight loss, headache
PHOSPHODIESTERASE-4 INHIBITOR ROFLUMILAST(DALIRESP) Severe adverse effects: insomnia, anxiety, depression, suicidal thoughts, mood changes
IMMUNOMODULATORAGENT •Actions •Binds to circulating IgEantibodies, inhibiting mast cell release of inflammatory chemicals
IMMUNOMODULATORAGENT •Uses •Treats moderate to severe persistent allergic asthma
IMMUNOMODULATORAGENT Common and serious adverse effects •Hypersensitivity, injection site reactions
IMMUNOMODULATORAGENT •Special medication preparation technique .
•Drug: omalizumab(Xolair) IMMUNOMODULATORAGENT prototype
•Drug: cromolynsodium (Intal) •Actions •Mast cell stabilizer; inhibits release of histamines and other mediators of inflammation
•Drug: cromolynsodium (Intal) Uses •In combination with other agents to treat severe bronchial asthma or allergic rhinitis
•Drug: cromolynsodium (Intal) Common adverse effects •Oral irritation, dry mouth
•Drug: cromolynsodium (Intal) •Serious adverse effects •Bronchospasm, coughing

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