RESPIRATORY MEDICATIONS-PART 2.pdf

RESPIRATORY MEDICATIONSPART 2 HLTENN007 ADMINISTER & MONITOR MEDICINES AND INTRAVENOUS THERAPY Learning Outcomes At the end of this session and with further reading, you should be able to: • Describe the action, common adverse effects and drug interactions of drugs used on the upper respiratory sy...

RESPIRATORY MEDICATIONSPART 2 HLTENN007 ADMINISTER & MONITOR MEDICINES AND INTRAVENOUS THERAPY Learning Outcomes At the end of this session and with further reading, you should be able to: • Describe the action, common adverse effects and drug interactions of drugs used on the upper respiratory system. • Describe the use, storage and complications of oxygen therapy 2 The Lower Respiratory System HLTENN007 ADMINISTER AND MONITOR MEDICINES AND INTRAVENOUS THERAPY A & P Review of lower airway Lower Respiratory Tract      lower trachea bronchi bronchioles alveoli lungs Chronic Obstructive Airways Disease (COPD) •COPD is either one or a combination of: chronic bronchitis emphysema •COPD is progressive & irreversible •COPD is characterised by reduced inspiratory and expiratory capacity of the lungs • http://www.youtube.com/watch?v=aktIMBQSXMo&feature=fvw • http://www.youtube.com/watch?v=k77vqaUnd1Y&feature=channel Chronic Bronchitis • An inflammatory condition affecting the trachea and bronchial tree. • Prolonged, non-specific bronchial irritation characterised by increased production of mucous • Complicated by an increased risk of being infected with a bacterial or viral infection Emphysema Primarily a smokers disease. • Cigarette smoking causes irritation, damage and inflammation to the alveoli • Characterised by destruction of the walls of the alveoli producing abnormally large air spaces that remain filled with air during expiration • Alveolar destruction results reduced surface area in a for gas exchange Asthma • Characterised by bronchospasm, ↑mucus secretion and swelling/oedema of the tissues lining the airways • Leads to narrowing or complete obstruction of the airways. • Impaired gas exchangedifficulty for 02 and CO2 to cross the alveoli • With repeated events, chronic inflammation occurs, restricting air flow in and out of lungs https://www.bing.com/videos/search?q=asthma+attack&&view=detail&mid=E7DEB80746DB12EDC AA8E7DEB80746DB12EDCAA8&rvsmid=0B9A0C8570F04600C0260B9A0C8570F04600C026&FORM= VDQVAP • http://www.youtube.com/watch?v=82gn_rDRpHk&feature=channel Aims of Treatment • Annual vaccinations for prevention of pneumonia and influenza • Identify triggers and reduce risk factors (smoking, allergens) • Airway monitoring: peak flow meter/spirometry to assess response to treatment • Maximise treatment with combination of relievers and controllers/preventers • http://www.youtube.com/watch?v=aGDi5tI5vTk&feature=channel Drug treatment for lower airways All lower airway diseases are treated with one or more of the following medications: •Relievers to open constricted airways •Preventers/controllers with low dose steroids to reduce swelling of airway tissues when exposed to allergen •Anti-inflammatories for acute presentations •Oxygen therapy for relief of hypoxia Medication formulations contain medication as a dry powder. Relievers Beta receptor agonists •Bronchodilators that act directly on β receptor in bronchial smooth muscle •Cause Smooth muscle relaxation & bronchial dilatation •Stabilise cells that cause inflammation, and prevent release of chemical mediators that release histamines http://www.gsk.com.au/resources.ashx/prescriptionmedicinesproductschilddatadownloads/61 Relievers Beta receptor agonists Salbutamol (Asmol, Ventolin) Terbutaline (Bricanyl) Actions •Relieve symptoms in a few minutes •Effect lasts 3 to 6 hours •May be used before exercise to prevent exercise – induced asthma •Schedule 3 – available without prescription Side Effects •Tachycardia, palpitations, hypertension •Anxiety Control of Symptoms Longer acting Bronchodilators Eformoterol (Foradile, Oxis) Salmeterol (Serevent) •Doesn’t replace the shorter acting bronchodilators •Effect can be significant up to12 hours after inhalation •Used as stabilizers and are used with corticosteroids Eformoterol onset of action is 3 – 4 min Salmeterol onset of action 30 min Relief and Control of Symptoms Anti-muscarinic relievers Inhalers to relieve and control symptoms over an extended period of time Ipratropium (Atrovent) Tiotropium (Spiriva) Action •Bronchodilation – esp. in severe, chronic disease & when used in conjunction with other treatment •Reduced mucous secretion Relief and Control of Symptoms Often combined with Beta agonists (e.g Salbutamol)but potential for more side effects when both drugs are used together Slower onset of action than β agonists but longer lasting Side Effects •Urinary retention •Dry skin •Decreased secretions Relief and Control of Symptoms – Methylxanthines- Theophylline (Nuelin/ Theo-Dur) Aminophylline Action: Increased bronchial smooth muscle activity producing bronchodilation. Used in conjunction with other medications to prevent asthma. Side Effects: Tachycardia, tremor, anxiety Inhaled Corticosteroids Steroids are potent anti-inflammatory medications that reduce swelling, inflammation and mucous production. They: • Suppress activity of immune cells • Reduce synthesis of inflammatory mediators such as histamine and prostaglandins • Overall reduction of oedema, mucus production and broncho-constriction Examples: Beclomethasone (Beconase) Budesonide (Pulmicort) Fluticasone (Flixotide) http://www.gsk.com.au/resources.ashx/prescriptionmedicinesproductschilddatadownloads/61 Combination inhalers • Contain a corticosteroid preventer and a symptom controller in one inhaler. • Taken each day to prevent and control symptoms Examples: • Symbicort (eformoterol and budesonide) – may be used for symptom relief • Seretide (salmeterol and budesonide) Inhaled Corticosteroids Clinical considerations: • Patient to rinse mouth following inhalation to avoid oropharyngeal candidiasis and systemic absorption • Cover eyes during nebulisation (or use of mouthpiece) to reduce risk of cataract formation or glaucoma • Lowest possible dose used • Inhaled steroids can cause systemic effects Corticosteroids Administration • Daily or alternate days • Inhalation, oral, topical, IV • Combination therapy with β receptor agonist such as salbutamol Adverse effects • • • • • • • Depends on dose and duration of treatment Reduced bone density Adrenal & growth suppression, hyperglycaemia Immuno-suppression, infections Fluid retention Hypertension Mood changes Spacers • There are fewer side effects from the medication • It is easier to use as it requires less coordination than a puffer alone • More medication is inhaled into the lungs file:///E:/HLTENN007/LABS%20SESSIONS%202018/LAB%201/5%20routes%20activities/Asthma%20Medications%20and%20Devices%20PR%20October%202014.pdf SPACERS 1. 2. 3. 4. 5. 6. Assemble spacer (if necessary) Remove inhaler cap Check dose counter (if device has one) Hold inhaler upright and shake well Insert inhaler upright into spacer Put mouthpiece between teeth (without biting) and close lips to form good seal 7. Breathe out gently, into the spacer 8. Keep spacer horizontal and press down firmly on inhaler canister once 9. Breathe in and out normally for 3 or 4 breaths 10.Remove spacer from mouth 11.Breathe out gently 12.Remove inhaler from spacer 13.If more than one dose is needed, repeat all steps starting from step 4 https://www.nationalasthma.org.au/living-with-asthma/how-to-videos/how-to-use-astandard-mdi-and-spacer Nebulisers • converts a liquid drug from a solution into an aerosol form by means of a compressor/compressed gas source. https://www.nursingtimes.net/clinical-archive/respiratory/respiratory-procedures-use-of-a-nebuliser/200213.article • In patients with COPD (hypoxic drive) , give the bronchodilator through an airdriven nebuliser. https://www.youtube.com/watch?v=IDFrFxRBqlI https://www.nps.org.au/australian-prescriber/articles/acute-use-of-oxygen-therapy https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwjOl_Hf3YfcAhUT87wKHT3_DpcQjRx6BAgBEAU&url=https%3A%2F%2Fwww.convatec.com.au%2Fprodu cts%2Fpc-ccc-family-nebulizers%2Fnebuliser&psig=AOvVaw0w8jZOw-o-_jhmSAw0Suyz&ust=1530872260524136 Pneumonia Definition: An acute lower respiratory tract infection affecting the lung alveoli structures and small airways Characterized by: • inflammation of the lung tissue • exudate fill the alveoli and small airways and impair gas exchange Infections can be: bacterial, viral or fungal Drug Treatment of Pneumonia Antibiotics •Specific antibiotic treatment depends on cause: Streptococcus, Mycoplasma, Legionella Pneumococal vaccines Management •Treatment of cause, e.g virus •Physiotherapy •0xygen therapy to prevent and reverse hypoxia •Monitoring – vital signs, 02 sats%, chest xray •Expectorants •Reduction of pain and fever with anti-inflammatories and paracetamol Anaesthetic Agents Anaesthetics • General anaesthesia • • • • Premedication Induction of anaesthesia Maintenance of anaesthesia Reversal of anesthesia • Local anaesthetics • Local infiltration • Nerve blocks • Epidurals General anaesthesia • Premedication (less common now) • Relieve anxiety (Anxiolytic) • Reduce saliva anticholinergic (atropine) • Increase stomach pH (ranitidine) General anaesthesia • Induction of anaesthesia • Thiopentone • Rapid acting but metabolised slowly & may accumulate in the tissues. Used to induce anaesthesia • Propofol • Ketamine • Also has analgesic properties General anaesthesia • Maintenance of anaesthesia • Inhalational anaesthetics • Nitrous oxide • Halophane etc • Muscle relaxants +/• Vecuronium • Suxamethonium • Pancuronium etc General anaesthesia • Reversal of anaesthesia • Anticholinesterase + anticholinergic (↓S/E) • Neostigmine + atropine https://www.youtube.com/watch?v=6jEHvEuHxOc Reference List Asthma Council Australia. (2006). Asthma Management Hanbook. National Asthma Council Australia: South Melbourne, Australia (accessed at http://www.nationalasthma.org.au/ The Australian and New Zealand COPD Reference Site (n.d.)http://www.copdx.org.au/ Galbraith, A, Bullock, S & Manias, E. (2006). Fundamentals of Pharmacology, 5th Edition. Prentice-Hall Health, Pearson Education, Australia. Reference List Crisp, J. & Taylor, C. (2012). Potter & Perry’s Fundamentals of Nursing. (8th ed). Marrickville, Australia: Mosby Elsevier. Koutoukidis, G., Stainton, K. & Hughson, J. (2013). Tabbner’s Nursing Care: Theory and Practice. (6th ed). Chatswood, Australia: Elsevier. Lippman, J. (2005). Oxygen First Aid. Divers Alert Network. National Asthma Council Australia. http://www.nationalasthma.org.au/content/view/301/403/ 37