Lower Airway Meds & Antitubercular Meds
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- What is the purpose of bronchodilators? How is this achieved?
- Purpose is to increase size of smooth muscle bands by relaxing and opening bronchial and bronchiole airways.
- Name three types of bronchodilators, includes short & long-acting.
- Beta2 agonists, cholinergic antagonists, & Methylxanthines
- A Beta2 Agonist is a ______ _____.
- sympathomimetic bronchodilator
- How does a Beta2 Agonist work?
- The drug binds to Beta2-adrenergic receptors.
- What is the purpose of a Beta2 Agonist? Waht does it trigger?
- The purpose is to increase the level of cyclic adenosine monophosphate (cAMP)which triggers smooth muscle relaxation & dilates bronchial bands of the airway.
- What effect does the Beta2 agonist cause? Explain why this happens.
- It also has a dilating effect on peripheral vaxcular vessels which decreases diastolic BP (Shifts K+ ions from bloodstream to cells which results in a temporary hypokalemia).
- What are Beta2 agonists contraindicated for?
- Allergy & uncontrolled cardiac dysrhythmias.
- What are side effects of Beta2 Agonists?
- HTN or hypotension, vascular headaches, & tremor
- Name the types of Beta2 Agonists.
- Short-acting & Long-acting
- What do Short-acting Beta2 Agonists do?
- Provide rapid but short-term relief.
- When are Short-acting Beta2 Agonists most useful?
- When inhaled at beginning of asthmatic attack or as a premedication prior to activities that trigger or induce an asthmatic attack.
- Name some common short-acting Beta2 agonistic agents.
- Albuterol (Proventil, Ventolin); Bitalterol (Tornalate), & Pirbuterol (Maxair)
- How are the long & short-acting Beta2 agonistic agents delivered?
- Directly to the site of action by a Metered Dose Inhaler (MDI) or Dry Powder Inhaler.
- How can you tell a DPI is empty?
- (without a mouthpiece) it will float in water.
- When might you observe systemic effects from the use of a short-acting Beta2 agonistic agent?
- When it is overused or abused.
- If the client is using other drugs, when do you administer the Beta2 agonist bronchodilator?
- Five minutes prior to other inhaled drugs (i.e. steroids).
- How is a long-acting Beta2 Agonist different from a short-acting one?
- It takes more time to build up effects, but lasts longer. Useful to prevent attack, but of no value during an asthmatic attack since they take time for effects to accumulate.
- Name some common long-acting Beta2 agonistic agents.
- Salmeterol (Serevent); Formoterol Fumarate (Foradil Aerolizer)
- Why does the client need to shake the inhaler before each dose?
- Because the drug separates easily.
- Why should the client not exhale into the inhaler device?
- This will cause drug clumping.
- What is a cholinergic antagonist?
- It is an anticholinergic agent.
- What does a cholinergic antagonist do? What does it cause?
- It blocks the parasympathetic nervous system which results in bronchodilation & decreased mucus production.
- What side effects can occur with the use of cholinergic antagonists?
- dry mouth/throat, GI distress, headache, coughing & anxiety
- Name a cholinergic antagonist that is commonly used for asthma, but is also used for COPD. Is this agent long or short-acting.
- Ipratopium (Atrovert. short-acting.
- Name a long-acting cholinergic antagonist agent that is used once a day.
- Tiotropium.
- Name a cholinergic antagonist agent that is a combination of albuterol & atrovent.
- Combivent.
- Client teaching regarding cholinergenic antagonist agent use includes:
- Increase fluid intake & Report blurred vision, eye pain, headache, nausea, nervousness, or palpitations.
- Methylxanthines a.k.a.?
- xanthine derivatives
- When are methylxanthines used?
- When other agents are ineffective to relax smooth muscles of the respiratory tract.
- What are methylxanthines used to treat?
- asthma, chronic bronchitis, emphysema, & bronchospasm.
- Name possible side effects of methylxanthines.
- excessive cardiac and CNS stimulation.
- What are methylxanthines contraindicated for?
- allergy, uncontrolled cardiac dysrhythmias & seizure disorders.
- What is the method of delivery for methylxanthines?
- systemically by oral or parenteral route.
- Name some priority interventions for long-term use of methylxanthines?
- Need to monitor blood levels because they have a narrow therapeutic range. Observe for toxicities esp. w/parenteral administration. RN should be assigned to client since frequent assessments will need to be performed.
- What are s/s of toxicity w/methylxanthines?
- restlessness, insomnia, irritability, tremors, & N/V
- What agents can enhance metabolism of xanthines?
- cigarettes & St. John's Wort
- What might happen if the client quits smoking during xanthine therapy?
- The dose could be to high and may need to be reduced.
- What meds can cause an increase in drug levels of xanthine?
- allopurinol, cimetidine, erythromycin, flue vaccine, & oral contraceptives
- Why is xanthine given w/ caution in elderly clients?
- They tend to have decreased drug metabolism. Be sure to observe for toxicity.
- What should client teaching include for xanthines?
- Take med at same time each day.
- Name the classic drug in the methylxanthine class.
- theophylline (Theo-Dur)
- Name some drugs (other than the classic one) in the methylxanthine class. [per v.s.-these parenteral meds are used to treat bronchospasms.
- aminophylline (Truphylline); oxtriphylline (Choledyl); & diphylline (Dilor, Lufyllin)
- What are anti-inflammatory agents used for?
- To decrease the inflammatory responses in the airways.
- What does the anti-inflammatory class consist of? includes what delivery methods?
- corticosteroids; inhaled anti-inflammatory agents; mast cell stabilizers; monoclonal antibodies; & leukotriene antagonists. systemic and inhalants
- What do corticosteroids do?
- Decrease inflammatory and immune response by preventing mediator synthesis.
- What problems can a client have with the use of inhaled corticosteroids? What is an appropriate intervention to teach the client?
- Increased risk of oral infections. Teach the client to rinse mouth after administration to prevent fungal infections.
- How often are short-term corticosteroid inhalers used?
- frequently.
- How often are long-acting corticosteroid inhalers used?
- Once a day.
- Name some short-term corticosteroid inhalers.
- Beclomethasone (Vanceril); Triamcinolone (Azmacort); & Flunisolide (AeroBid)
- Name some long-acting once a day corticosteroid inhalers.
- Budesonide (Pulmocort); & Fluticasone (Flovent)
- What are systemic corticosteroids used to treat?
- Severe asthma
- Why should systemic corticosteroids be taken w/food?
- To decresase GI ulceration.
- Name two important side effects to be aware of and monitor for.
- immunosuppression & increased blood glucose levels (hyperglycemia)
- What is the most common oral systemic corticosteroid agent?
- Prednisone
- What should client education about systemic corticosteroids include?
- Never abruptly discontinue drug, slowly taper only; Need medical alert bracelet; Report weight gain of 5 pounds in 1 week; Take w/food.
- Name a new category of inhaled agents?
- Inhaled Anti-inflammatory agents
- How do inhaled anti-inflammatory agents work?
- Inhibit release of inflammatory mediators from respiratory cells & WBCs which stabilizes the mast cell wall.
- What do inhaled anti-inflammatory agents effect?
- decrease lung nerve stimulation.
- What are inhaled anti-inflammatory agents used for?
- Prevents asthma events, but not useful during an asthmatic attack.
- How long before inhaled anti-inflammatory agents are effective?
- 4 weeks
- What should a client do if symptoms worsen?
- discontinue medication
- Name the primary agent in the inhaled anti-inflammatory agent class.
- Nedocromil (Tilade)
- How do mast cell stabilizers prevent asthma attacks?
- By preventing mast cell membranes from opening when and allergen binds to the IgE molecule (provides and anti-inflammatory effect)
- When are mast cell stabilizers not useful?
- during an asthmatic attack.
- Mast cell stabilizers used regularly for a _____ _____.
- prophylactic effect
- How are mast cell stabilizers used to relieve seasonal allergy attacks?
- Start tx 3-4 weeks before the season.
- What is the most common mast cell stabilizer agent?
- Cromolyn Sodium (Intal)
- What is the MOA of Monoclonal Antibodies?
- Binds to IgE receptor sites on mast cells & basophils thus preventing allergens from triggering release of mediators from these cells.
- When/How are monoclonal antibodies effective?
- Will prevent attack, but not useful during asthmatic attack.
- How are monoclonal antibodies administered?
- Administered subcutaneously. Roll vial gently since drug is slow to dissolve.
- What is the most common monoclonal antibody agent?
- Omalizumab (Xolair)
- What do Leukotriene Receptor Agonists do?
- Block leukotriene production during inflammation, thus preventing asthma symptoms
- What are some side effects of leukotriene receptor agonists?
- headache; GI symptoms, dizziness; & insomnia
- What is an priority intervention with a client on a leukotriene receptor agonist?
- Monitor liver enzymes w/these agents.
- Name some leukotriene receptor agonists.
- zileuton (Zyflo); zafirlukast (Accolate); montelkast (Singular)
- What does zileuton (Zyflo) do?
- prevents leukotriene synthesis, but increases plasma concentration of theophylline (Need to decrease theophylline dose)
- What do zafirlukast (Accolate) & montelukast (Singular) do?
- Block the leukotriene receptor.
- If the client is taking aspirin, which leukotriene receptor agonist dosage should be changed? Will it be increased or decreased?
- Zafirludast (Accolate) dose should be decreased.
- What do mucolytics do?
- thin thick, tenacious mucus secretions
- Name the commonly used aerosol mucolytics.
- acetylcysteine (mucosil, mucomyst); dornase alfa (pulmozyme)
- Name an oral systemic mucolytic agent.
- guaifenesin.
- During mucolytic therapy, what must a client be taught to do?
- increase fluid intake
- What are antitubercular medication used to treat?
- All forms of infection from mycobacterium.
- How long does antitubercular treatment last?
- Therapy is usually for 6 months or longer until 3 negative sputum cultures for TB occur.
- What is antitubercular drug therapy dependent on?
- Drug therapy is dependent upon drug-susceptibility tests.
- What is the cornerstone of drug regimen for antitubercular therapy?
- Client education
- How can the general public be protected from TB spread?
- Strict client compliance.
- How is the noncompliant TB client managed?
- Mandate to participate in directly observed therapy (DOT) provide by health clinics.
- How is the emergence of drug resistant TB organisms reduced?
- By combination therapy to maximize destruction of the organism as rapidly as possible.
- Name the primary (first-line) antitubercular agents. What is the cure rate?
- isoniazid (INH); Rifampin, Pyraziniamide (PZA); Ethambutol; & Stretomycin. Combination therapy of these drugs produces a 95% cure rate.
- What is the MOA of Isoniazid (INH)?
- Alters the nicotinamide adenine denucleotide (NAD) of the mycobacterium organism and inhibits cell wall synthesis.
- In what clients is INH therapy contraindicated?
- allergy, hepatic injury or acute liver disease, & optic neuritis clients.
- What are possible side effects of INH?
- Can be hepatotoxic & cause peripheral neuritis (numbness & tingling)
- What drugs are inhibited if INH therapy is implemented?
- phenytoin, carbamazepine, primidone, & warfarin
- What client education needs to be given regarding INH therapy?
- Should be taken on an empty stomach & it can cause a false positive glucose test.
- What is the MOA of Rifampin?
- Inhibits protein synthesis of the cell.
- What side effects can Rifampin cause?
- hepatotoxicity, hepatitis, & hematologic disorders
- What client education needs to be given regarding Rifampin therapy?
- Teach the client that this drug will turn urine, tears, sweat & sputum and orange/reddish color. Soft contact lenses will be permanently discolored. Women taking oral contraceptives should switch to another form of birth control since this drug causes oral contraceptives to become ineffective.
- Why will other medication drug doses have to be adjusted while receiving Rifampin therapy?
- It may enhance elimination of theophylline, steroids, opiods, oral hypoglycemics, warfarin, Vitamin D, beta-blockers, & benzodiazepines.
- What is the MOA of Pyrazinamide?
- Drug action is not understood, but believed to serve as a bacteriostatic or bacteriocidal agent, therby destroying the mycobacterium in the macrophages.
- When is Pyrazinamide therapy implemented?
- Usually added to INH for the first two months of therapy. because it will prevent some of the neurologic side effects caused by INH (numbness & tingling of extremities)
- What side effects does the nurse need to be aware of with Pyraziniamide therapy?
- hepatotoxicity and hyperuricemia
- How is Ethambutol used for the TB drug regimen?
- It is used as the 4th drug agent.
- What is the MOA of Ethambutol?
- Inhibition of mycolic acid synthesis in the cell
- What side effects does the nurse need to be aware of with Ethambutol therapy?
- neurotoxicities and blindness.
- How are the side effects of Ethambutol monitored?
- Eye exams should be performed at drug initiation. Clients should immediately report any visual changes to MD.
- Which clients should Ethambutol be used with caution?
- Clients w/diabetes, or liver, renal or hematologic disorders.
- What drug can be used as a substitute for Ethambutol?
- Streptomycin can be used as the 4th agent instead of Ethambutol.
- What is the MOA of Streptomycin?
- Inhibition of cellular protein synthesis.
- What serious side effects can Streptomycin cause?
- ototoxicity, nephrotoxicity, & blood dyscrasias
- How are the side effects monitored?
- Obtain a baseline audiometric test every 1 to 2 months since it can impair the 8th cranial nerve.
- Which clients are more prone for drug complications with Streptomycin?
- Older clients.