Respiratory Disorders PDF

Influenza Pathophysiology Spread by a virus droplet that is deposited through the respiratory track (congestion, sore throat, cough) Body mounts an inflammatory response (headache, fever, weakness, malaise) Incubation period: 18-72 hours Infectious period: 7-10 days Pharmacology Vaccines Yea...

Influenza Pathophysiology Spread by a virus droplet that is deposited through the respiratory track (congestion, sore throat, cough) Body mounts an inflammatory response (headache, fever, weakness, malaise) Incubation period: 18-72 hours Infectious period: 7-10 days Pharmacology Vaccines Yearly for anyone over 6 months of age (inactive) Over 2 years of age (active) Symptom management Antipyretics Analgesics Antivirals Oseltamivir (Tamiflu) Zanamivir Peramivir Pneumonia Pathophysiology  Pharmacology Antibiotics +-----------------------------------+-----------------------------------+ | **Antivirals** | | +===================================+===================================+ | **Oral:** | | | | | | - *oseltamivir (Tamiflu)* | | | | | | - *zanamivir* | | | | | | - *peramivir* | | +-----------------------------------+-----------------------------------+ | **Mechanism of Action/Purpose** | - Prevent viral escape from the | | | host cell | +-----------------------------------+-----------------------------------+ | **Therapeutic Affect** | - Stops spread of virus | | | (treatment should begin | | | within 48 hours of symptom | | | onset) | +-----------------------------------+-----------------------------------+ | **Therapeutic Use** | - Used to treat influenza A & B | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - Skin reactions | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | - Worsening respiratory status | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Vaccines** | | +===================================+===================================+ | **Mechanism of Action/Purpose** | | +-----------------------------------+-----------------------------------+ | **Therapeutic Affect** | | +-----------------------------------+-----------------------------------+ | **Therapeutic Use** | | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - Swelling, redness, tenderness | | | at site | | | | | | - Hoarseness, fever, malaise, | | | HA, cough, aches | | | | | | - Nasal congestion, runny nose | +-----------------------------------+-----------------------------------+ | **Contraindications** | - 2-17 who are taking | | | aspirin-containing products | | | | | | - Age 2-4 with asthma, wheezing | | | in past year | | | | | | - Antivirals in 48 hours | | | | | | - Egge allergies | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Antibiotics** | | | | | | **(Macrolides)** | | +===================================+===================================+ | **Oral:** | | | | | | - *azithromycin* | | | | | | - *clarithromycin* | | | | | | - *erythromycin* | | +-----------------------------------+-----------------------------------+ | **Mechanism of Action/Purpose** | - inhibits protein synthesis | +-----------------------------------+-----------------------------------+ | **Therapeutic Affect** | - slows the growth of | | | micro-organisms | +-----------------------------------+-----------------------------------+ | **Therapeutic Use** | - community-acquired pneumonia | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - GI discomfort (NV) (take | | | erythromycin with meals) | | | (take others on empty | | | stomach) | | | | | | - Prolonged QT intervals | | | | | | - Ototoxicity (monitor and | | | report hearing loss, vertigo, | | | tinnitus) | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | | +-----------------------------------+-----------------------------------+ | **Contraindications** | - Liver disease | | | | | | - QT prolongation | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Antibiotics** | | | | | | **(Tetracyclines)** | | +===================================+===================================+ | **Oral:** | | | | | | - *doxycycline* | | +-----------------------------------+-----------------------------------+ | **Mechanism of Action/Purpose** | - inhibits protein synthesis | +-----------------------------------+-----------------------------------+ | **Therapeutic Affect** | - inhibits the growth of | | | micro-organisms | +-----------------------------------+-----------------------------------+ | **Therapeutic Use** | - community-acquired pneumonia | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - GI discomfort (NVD) (take on | | | empty stomach) (monitor I | | | & O) (Don't take at bedtime) | | | (milk products and antacids | | | separated by 2 hours) | | | | | | - Tooth discoloration and | | | enamel erosion (yellow or | | | brown) (don't give to kids | | | less than 8) | | | | | | - Hepatotoxicity (at high | | | doses) | | | | | | - Photosensitivity (wear | | | protective clothing and | | | sunscreen with SPF or higher) | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Beta-Lactams** | | | | | | **Penicillins** | | +===================================+===================================+ | **Oral:** | | | | | | - *penicillin (narrow | | | spectrum)* | | | | | | - *amoxicillin* | | | | | | - *piperacillin tazobactam* | | +-----------------------------------+-----------------------------------+ | **Mechanism of Action/Purpose** | - destroys bacterial cell walls | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - allergies, anaphylaxis | | | (observe for reaction 30 | | | minutes after giving IV form) | | | | | | - renal impairment | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Beta-Lactams** | | | | | | **Cephalosporins** | | +===================================+===================================+ | **Oral:** | | | | | | - *ceftriaxone* | | | | | | - *cefepime* | | +-----------------------------------+-----------------------------------+ | **Mechanism of Action/Purpose** | - destroys bacterial cell walls | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - allergies, anaphylaxis | | | (observe for reaction 30 | | | minutes after giving IV form) | | | (allergy to penicillin) | | | | | | - bleeding tendencies | | | | | | - renal insufficiency | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Beta-Lactams** | | | | | | **Carbapenems** | | +===================================+===================================+ | **Oral:** | | | | | | - *meropenem* | | +-----------------------------------+-----------------------------------+ | **Mechanism of Action/Purpose** | - destroys bacterial cell walls | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - allergies, anaphylaxis | | | (observe for reaction 30 | | | minutes after giving IV form) | | | (allergy to penicillin) | | | | | | - GI upset (NVD | +-----------------------------------+-----------------------------------+ Asthma Pathophysiology Intermittent, reversible airway obstruction resulting from inflammation of the small airways Edema Excess mucus Bronchoconstriction Pharmacology Corticosteroids Leukotriene Antagonists Anticholinergics Xanthine Derivatives LABAs Inhalers Types Metered Dose Inhaler (MDI) --patient determines dose Dry Powder Inhaler (DPI) --predetermined dose Soft Mist inhaler (SMI) Use: Rinse mouth before and Wash hands before and after Exhale, then inhale while pressing on cannister (MDI or SMI) or sucking in (DPI) Hold for 10 seconds if possible Use a spacer if the patient has trouble with MDI +-----------------------------------+-----------------------------------+ | **Corticosteroids | | | (Glucocorticoids)** | | | | | | **EDEMA** | | +===================================+===================================+ | **Inhaled:** | **Oral:** | | | | | - *fluticasone* | - *prednisone* | | | | | - *beclomethasone* | - *prednisolone* | | | | | - *budesonide* | | +-----------------------------------+-----------------------------------+ | **Mechanism of Action/Purpose** | - **Prevents** inflammation by | | | decreasing inflammatory | | | response and chemical | | | mediators | +-----------------------------------+-----------------------------------+ | **Therapeutic Affect** | - Decrease edema (decreased | | | wheezing, dyspnea, | | | restlessness, anxiety) | +-----------------------------------+-----------------------------------+ | **Therapeutic Use** | - Inhaled: Long-term | | | prophylaxis of asthma | | | | | | - Oral: short-term use (3-10 | | | days) for after acute episode | | | or long-term use for chronic, | | | severe asthma | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - Inhaled: See teaching for | | | inhalers | | | | | | - Oral: (when used for 10 or | | | more days) | | | | | | - Bone loss (Osteoporosis) | | | (Weight-bearing exercise, | | | Ca & Vit D) | | | | | | - Hyperglycemia (Diabetes | | | Mellitus) (Monitor BG, | | | increase insulin) | | | | | | - Glycosuria | | | | | | - Increased appetite and | | | weight gain | | | | | | - Insomnia | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | - Oral: | | | | | | - Myopathy (Report muscle | | | weakness) | | | | | | - Infection (Report sore | | | throat, weakness, avoid | | | large crowds, hand | | | hygiene) | | | | | | - Fluid and electrolyte | | | disturbances | | | (Hypertension or heart | | | failure) (observe for | | | weight gain, peripheral | | | edema, hypokalemia- | | | careful with | | | potassium-depleting | | | diuretics) | | | | | | - GI Bleeds (Peptic ulcer | | | disease) (give with food, | | | avoid NSAIDs, report | | | black, tarry stools) | +-----------------------------------+-----------------------------------+ | **Contraindications** | - Oral: | | | | | | - Live virus vaccine | | | | | | - Fungal infection | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Leukotriene Antagonists** | | | | | | **EDEMA & MUCUS & | | | BRONCHOCONSTRICTION** | | +===================================+===================================+ | **Oral:** | | | | | | - *zafirlukast* | | | | | | - *montelukast* | | +-----------------------------------+-----------------------------------+ | **Mechanism of Action/Purpose** | - Suppress the acts of | | | leukotrienes | +-----------------------------------+-----------------------------------+ | **Therapeutic Affect** | - Reduces inflammation, | | | bronchoconstriction, airway | | | edema, and mucus production | | | (decreased wheezing, dyspnea, | | | mucus) | +-----------------------------------+-----------------------------------+ | **Therapeutic Use** | - Long-term therapy for asthma | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - - | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | - Suicidal ideation (monitor | | | for mood changes and behavior | | | changes) | +-----------------------------------+-----------------------------------+ | **Contraindications** | | +-----------------------------------+-----------------------------------+ | **Interactions** | - Increased Warfarin levels | | | (Monitor for PT and INR | | | levels, monitor for signs of | | | bleeding- gums, bruising) | | | | | | - Increased theophylline levels | | | (monitor for toxicity-NV, | | | seizures) | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Anticholinergics** | | | | | | **MUCUS & BRONCHOCONSTRICTION** | | +===================================+===================================+ | **Inhaled:** | | | | | | - *ipratropium* | | | | | | - *tiotropium* | | +-----------------------------------+-----------------------------------+ | **Mechanism of Action/Purpose** | - Block muscarinic receptors of | | | the bronchi | +-----------------------------------+-----------------------------------+ | **Therapeutic Affect** | - Bronchodilation (decreased | | | wheezing, dyspnea) | +-----------------------------------+-----------------------------------+ | **Therapeutic Use** | - Prevent bronchospasm from | | | allergens and exercise | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | | +-----------------------------------+-----------------------------------+ | **Precautions** | - Narrow-angle glaucoma | | | (anticholinergic drying | | | effects) | +-----------------------------------+-----------------------------------+ | **Contraindications** | - Soy or peanut allergy | +-----------------------------------+-----------------------------------+ | **Interactions** | | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Xanthine Derivatives** | | | | | | **BRONCHOCONSTRICTION** | | +===================================+===================================+ | **Oral:** | | | | | | - *theophylline* | | +-----------------------------------+-----------------------------------+ | **Mechanism of Action/Purpose** | - Relaxation of bronchial | | | smooth muscle through | | | stimulation of the central | | | nervous system | +-----------------------------------+-----------------------------------+ | **Therapeutic Affect** | - Bronchodilation (decreased | | | wheezing, dyspnea) | +-----------------------------------+-----------------------------------+ | **Therapeutic Use** | - Long-term control of asthma | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - - - | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | - Dysrhythmias | | | | | | - Seizures | | | | | | - Toxicity: nausea, diarrhea, | | | restlessness (Therapeutic | | | range: 5-15 mcg/mL, signs | | | start at greater than 20) | +-----------------------------------+-----------------------------------+ | **Contraindications** | | +-----------------------------------+-----------------------------------+ | **Interactions** | - Caffeine (caffeine can | | | increase levels and cause | | | increased cardiac and CNS | | | effects) | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Long-Acting Beta 2 Adrenergic | | | Agonists (LABA)** | | | | | | **BRONCHOCONSTRICTION** | | +===================================+===================================+ | **Inhaled:** | | | | | | - *salmeterol* | | | | | | - *formoterol* | | | | | | **Oral:** | | | | | | - *albuterol* | | | | | | - *terbutaline* | | | | | | **Combination:** | | | | | | - *budenoside/formoterol* | | | | | | - *When taking an inhaled | | | beta-2 agonist and | | | inhaled corticosteroid, | | | take beta-2 agonist first | | | (bronchodilation before | | | inflammation) Wait 5 | | | minutes in between | | | medications* | | +-----------------------------------+-----------------------------------+ | **Mechanism of Action/Purpose** | - Activating Beta-2 receptors | | | in the bronchial smooth | | | muscle | +-----------------------------------+-----------------------------------+ | **Therapeutic Affect** | - Bronchodilation (decreased | | | wheezing, dyspnea) | +-----------------------------------+-----------------------------------+ | **Therapeutic Use** | - Long-term control of asthma | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - - - | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | | +-----------------------------------+-----------------------------------+ | **Contraindications** | - Tachydysrhythmias | +-----------------------------------+-----------------------------------+ | **Interactions** | - Beta-adrenergic blockers | +-----------------------------------+-----------------------------------+ Chronic Obstructive Pulmonary Disease (COPD) Pathophysiology Airflow limitation that is progressive and not fully reversible Two disease: (most patients have both) Emphysema Lost of elasticity and hyperinflation of the alveoli Chronic Bronchitis Inflammation of the bronchi and bronchioles Pharmacology Anticholinergics Xanthines Leukotriene Modifiers Mucolytics +-----------------------------------+-----------------------------------+ | **Mucolytics** | | +===================================+===================================+ | **Oral:** | | | | | | - *acetylcysteine* | | +-----------------------------------+-----------------------------------+ | **Mechanism of Action/Purpose** | - thin and enhance flow of | | | secretions | +-----------------------------------+-----------------------------------+ | **Therapeutic Affect** | - decrease mucus build-up | +-----------------------------------+-----------------------------------+ | **Therapeutic Use** | - chronic pulmonary disorders | | | exacerbated by large amounts | | | of secretions | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - - | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | - aspiration and bronchospasm | | | (asthma) (have suction at | | | bedside for secretions) | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Expectorants** | | +===================================+===================================+ | **Oral:** | | | | | | - *guaifenesin* | | +-----------------------------------+-----------------------------------+ | **Mechanism of Action/Purpose** | - thins secretions (should take | | | with large amounts of water | | | to help with secretions) | +-----------------------------------+-----------------------------------+ | **Therapeutic Affect** | - promotes increased cough | | | production | +-----------------------------------+-----------------------------------+ | **Therapeutic Use** | - cough caused by lower | | | respiratory disorders (report | | | cough lasting longer than a | | | week if not taking for COPD) | +-----------------------------------+-----------------------------------+ | **Complications/Side Effects** | - - | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | - Bronchospasm (asthma) | +-----------------------------------+-----------------------------------+