N720 Pulm_Psych_Neuro_Pain_Anticonvulsants_Derm Exam 2 PDF

**N720 Pulmonary Medications- Week 6** **[1. Compare the advantages and disadvantages of the various types of devices used to deliver aerosol therapies for the administration of pulmonary medications.]** \-- Lauren H +-----------------------+-----------------------+-----------------------+ | **Aer...

**N720 Pulmonary Medications- Week 6** **[1. Compare the advantages and disadvantages of the various types of devices used to deliver aerosol therapies for the administration of pulmonary medications.]** \-- Lauren H +-----------------------+-----------------------+-----------------------+ | **Aerosol Therapies** | **Advantages** | **Disadvantages** | +=======================+=======================+=======================+ | MDI/ Inhaler | More effective with | It is harder with | | | the spacer | younger kids for | | | | coordination, | | | \*\*To use an inhaler | deposited at back of | | | properly, the patient | through not getting | | | should first exhale | to lung tissue; hard | | | and then tilt the | to get the timing of | | | head slightly back | release of medication | | | and place the inhaler | w/ a deep breath | | | mouthpiece either | | | | about 2 inches from | | | | the open mouth or | | | | between the open | | | | lips. While inhaling, | | | | the patient should | | | | press down on the | | | | canister, breathe in | | | | slowly and deeply, | | | | and hold their breath | | | | for 10 seconds (count | | | | of 10) or as long as | | | | comfortable. If two | | | | puffs are prescribed, | | | | the patient should | | | | wait at least 1 full | | | | minute between | | | | inhalations. | | +-----------------------+-----------------------+-----------------------+ | Disk | | Patient should not | | | | exhale or blow into | | (e.g. Salm | | DISKUS; DISKUS | | | | shouldn\'t be washed | | | | or taken apart | +-----------------------+-----------------------+-----------------------+ | Nebulizer | More effective with | It is harder with | | | the spacer | younger kids for | | | | coordination, | | | | deposited at back of | | | | through not getting | | | | to lung tissue | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ **[2. Compare and contrast pharmacotherapy necessary for the treatment of acute versus chronic asthma and COPD.]** \-- Kristen C Acute Asthma Chronic Asthma -------------- ---------------- SABA Acute COPD Chronic COPD ------------ -------------- SABA **[3. For each of the following drug classes, explain mechanism of action, primary actions (respiratory focus), dosing, important adverse effects and special considerations: Bronchodilators (Beta-Adrenergic Agonists \[Albuterol, Levalbuterol, Formoterol, and Salmeterol\], Anticholinergics \[Ipratropium and Tiotropium\]) , and Anti-inflammatory Drugs (Inhaled Corticosteroids \[Beclomethasone, Budesonide, and Fluticasone\]), Others (Leukotriene Modifiers \[Montelukast\], and Antihistamines \[Diphenhydramine, Brompheniramine, Cetirizine, Fexofenadine, and Azelastine\], Decongestants \[Phenylephrine, Pseudoephedrine, and Oxymetazoline\], and Cough Preparations \[Dextromethorphan and Guaifenesin\]]** \-\-\-\-\-\-\-\-\-\-- EVERYONE +-------------+-------------+-------------+-------------+-------------+ | **Name/Type | **MOA** | **Indicatio | **SE** | **Considera | | ** | | ns** | | tions** | +=============+=============+=============+=============+=============+ | Beta-Adrene | | | | | | rgic | | | | | | Agonists | | | | | | | | | | | | MOA: binds | | | | | | the beta 2 | | | | | | receptor | | | | | | which | | | | | | activates | | | | | | adenylate | | | | | | cyclase, | | | | | | which | | | | | | increases | | | | | | cyclic AMP, | | | | | | decreases | | | | | | cytosolic | | | | | | calcium | | | | | | leading to | | | | | | bronchodila | | | | | | tion | | | | | | or | | | | | | bronchial | | | | | | smooth | | | | | | muscle | | | | | | relaxation | | | | | | | | | | | | Indications | | | | | | : | | | | | | Reversible | | | | | | bronchospas | | | | | | m | | | | | | | | | | | | \--After | | | | | | age 2 not | | | | | | considered | | | | | | RAD anymore | | | | | | AKA | | | | | | Bronchiolit | | | | | | is | | | | | | | | | | | | \--COPD and | | | | | | Asthma PRN | | | | | | | | | | | | SE: | | | | | | tremors, | | | | | | heart | | | | | | palpitation | | | | | | s, | | | | | | hypokalemia | | | | | | (clinically | | | | | | significant | | | | | | unless PO, | | | | | | seen with | | | | | | stacked or | | | | | | back to | | | | | | back | | | | | | nebulizer | | | | | | treatments) | | | | | | , | | | | | | reduction | | | | | | in O2 | | | | | | sats(those | | | | | | not on O2 | | | | | | supplementa | | | | | | tion) | | | | | | | | | | | | --Positive | | | | | | response in | | | | | | asthma is a | | | | | | increase of | | | | | | 200 ml or | | | | | | 12% in FEV1 | | | | | | compared to | | | | | | baseline; | | | | | | (not the | | | | | | case for | | | | | | COPD) | | | | | | | | | | | | Considerati | | | | | | ons: | | | | | | Metabolized | | | | | | in liver, | | | | | | excreted in | | | | | | urine | | | | | | (renal), | | | | | | lower dose | | | | | | in elderly\ | | | | | | -Monitor | | | | | | EKG if | | | | | | prescribed | | | | | | w/ Digoxin | | | | | | dt inc. | | | | | | risk | | | | | | arrhythmias | | | | | | \ | | | | | | -Avoid | | | | | | NSAIDs -One | | | | | | minute | | | | | | between | | | | | | puffs -Use | | | | | | BEFORE | | | | | | controller, | | | | | | not after\ | | | | | | -All age | | | | | | groups | | | | | | \*\*Monitor | | | | | | ing | | | | | | includes | | | | | | seeing if | | | | | | being | | | | | | controlled | | | | | | w/ it via | | | | | | peak flow | | | | | | measurement | | | | | | s | | | | | | | | | | | | \*\*NO | | | | | | SPECIFIC | | | | | | MONITORING | | | | | | REQUIRED | | | | | | FOR | | | | | | BRONCHODILA | | | | | | TORS | | | | | +-------------+-------------+-------------+-------------+-------------+ | Albuterol | Short-actin | Tx | -Increase | -Drug of | | (SABA) | g | bronchospas | HR | choice for | | | beta-2 | m | | first-line | | | adrenergic | w/ Asthma, | -Heart | therapy | | | agonist, | COPD, RAD, | palpitation | | | | works by | Bronchitis | s | \- Pts on | | | stimulating | | | digoxin | | | B2 | | -Tremors | require | | | receptors | | | close | | | in smooth | | \- Anxiety | monitoring | | | muscles of | | | as | | | airways→ | | \- | albuterol | | | muscle | | Heachache | increase | | | relaxation | | | Vol of | | | & | | \- Throat | distributio | | | bronchodila | | irritation/ | n | | | tion | | cough | and | | | | | | decrease | | | | | \- | dig lvls in | | | | | Dizziness | blood | | | | | | | | | | | \- muscle | -Pts w/ | | | | | cramps | pheochromoc | | | | | | ytoma | | | | | -Insomnia | should | | | | | | avoid B2 | | | | | -Nausea | agonists→ | | | | | | cause | | | | | -Dec. In | severe | | | | | diastolic | hypertensio | | | | | BP | n | | | | | | | | | | | | \- Can | | | | | | interfere | | | | | | w/ uterine | | | | | | contractili | | | | | | ty | | | | | | | | | | | | \- Safe for | | | | | | infants & | | | | | | children | | | | | | | | | | | | \- Hepatic | | | | | | metabolism | | | | | | & renal | | | | | | elimination | | | | | | | | | | | | -Thyroid | | | | | | hormones | | | | | | enhance | | | | | | cardiac | | | | | | effects of | | | | | | both drugs | | | | | | | | | | | | -Contraindi | | | | | | cated | | | | | | in CAD | | | | | | | | | | | | \- | | | | | | | | | | | | \- Drug | | | | | | interaction | | | | | | s | | | | | | w/: | | | | | | Digoxin, | | | | | | MAOIs, | | | | | | TCAs, BB, | | | | | | Cocaine, | | | | | | Thyroid | | | | | | hormones, | | | | | | Ritodrine | +-------------+-------------+-------------+-------------+-------------+ | Levalbutero | Short-actin | Prevention | -Headache | -FDA | | l | g | & | | approved | | (half the | B2 agonist | | -Tremors: | for | | dose of | stimulates | | | children | | albuterol)\ | the enzyme | | -Nervousnes | \ | | | | | | inactive | | | | | | metabolites | | | | | | ; | | | | | | 50% drug | | | | | | excreted | | | | | | unchanged | | | | | | in urine | +-------------+-------------+-------------+-------------+-------------+ | Tiotropium | Long acting | -COPD | -Bronchospa | \- CrCl\99% | | | | | | PROTEIN | | | | | | BOUND, no | | | | | | human | | | | | | studies (rt | | | | | | BBB & | | | | | | breast | | | | | | milk) (in | | | | | | rats it did | | | | | | cross) | +-------------+-------------+-------------+-------------+-------------+ | Antihistami | | | | | | nes | | | | | | | | | | | | MOA: block | | | | | | action of | | | | | | histamine | | | | | | at H1 | | | | | | receptors, | | | | | | do not | | | | | | block H2 | | | | | | receptors, | | | | | | some bind | | | | | | to | | | | | | muscarinic | | | | | | receptors | | | | | | | | | | | | Strongly | | | | | | block the | | | | | | action of | | | | | | histamines | | | | | | physiologic | | | | | | al | | | | | | effects - | | | | | | decrease | | | | | | flare and | | | | | | itch | | | | | | response | | | | | | | | | | | | \*\* can | | | | | | cause CNS | | | | | | depression | | | | | | in | | | | | | therapeutic | | | | | | doses | | | | | | | | | | | | Considerati | | | | | | ons: | | | | | | | | | | | | Drug | | | | | | overdose | | | | | | includes: | | | | | | CNS | | | | | | stimulation | | | | | | , | | | | | | convulsions | | | | | | , | | | | | | sensitivity | | | | | | in children | | | | | | | | | | | | Drug | | | | | | interaction | | | | | | s: | | | | | | CNS | | | | | | depressants | | | | | | | | | | | | Acute | | | | | | toxicity: | | | | | | large | | | | | | margin of | | | | | | safety | | | | | | | | | | | | Use with | | | | | | caution in: | | | | | | 3rd | | | | | | trimester, | | | | | | nursing/new | | | | | | born | | | | | | infants, | | | | | | the | | | | | | elderly, | | | | | | young | | | | | | children, | | | | | | patients | | | | | | whose | | | | | | conditions | | | | | | may be | | | | | | aggravated | | | | | | by blocking | | | | | | the | | | | | | muscarinic | | | | | | receptors | | | | | | | | | | | | Indications | | | | | | : | | | | | | allergic | | | | | | rhinitis | | | | | | \[& | | | | | | conjunctivi | | | | | | tis- | | | | | | seasonal\] | | | | | | | | | | | | \*\*NO LAB | | | | | | MONITORING | | | | | | | | | | | | Txtbook: | | | | | | | | | | | | 1ST GEN: | | | | | | lipid-solub | | | | | | le | | | | | | amines | | | | | | well-absorb | | | | | | ed | | | | | | from GI | | | | | | tract, | | | | | | metabolized | | | | | | in live, | | | | | | CONTRA | | | | | | breastfeedi | | | | | | ng | | | | | | & giving to | | | | | | newborns/pr | | | | | | emature | | | | | | infants | | | | | | (convulsion | | | | | | s), | | | | | | caution in | | | | | | children dt | | | | | | paradoxical | | | | | | CNS | | | | | | stimulation | | | | | | | | | | | | 2ND GEN: | | | | | | Rapidly | | | | | | absorbed | | | | | | from GI | | | | | | tract (take | | | | | | w/ food | | | | | | dec./delays | | | | | | absorption) | | | | | | , | | | | | | more | | | | | | generic | | | | | | forms - | | | | | | inexpensive | | | | | | | | | | | | \-\--do not | | | | | | impair | | | | | | daytime | | | | | | functioning | | | | | | ; 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