Unit 8.2 Lower Respiratory Drugs PDF

Drugs for Lower Respiratory Disorders NUR 210/BSL 101 Unit 8  Action Stimulates beta 2 adrenergic receptors in the lungs, which relaxes the Bronchodilators – bronchial smooth muscle causing Adrener...

Drugs for Lower Respiratory Disorders NUR 210/BSL 101 Unit 8  Action Stimulates beta 2 adrenergic receptors in the lungs, which relaxes the Bronchodilators – bronchial smooth muscle causing Adrenergic – bronchodilation Rapid onset albuterol Longer duration and fewer side effects than epi Uses Treat bronchospasm, asthma, bronchitis, COPD Rescue inhaler Examples of administration Bronchodilators – Side effects/adverse reactions Adrenergic – Tremors, anxious, nervous, sweating Insomnia albuterol Palpitations Hyper/Hypo-tension Hyperglycemia  Contraindications Cardiac disease Bronchodilators – Hypertension Adrenergic – Hyper/Hypo-thyroidism albuterol Diabetes Interactions Increase effects with other adrenergic/sympathomimetic drugs Decreases the effects of antihypertensives, antidysrhythmics  Anticholinergics Tiotropium ◦ Used for maintenance treatment of bronchospasms associated with COPD, - Bronchodilators Asthma ◦ Inhalation (dry-powder capsule inhaler) – anticholinergics - tiotropium Action ◦ Relaxes smooth muscle of the bronchi ◦ Maintenance inhaler - Bronchodilators Side effects/adverse reactions – anticholinergics - tiotropium Insomnia, dizzy Oral ulcerations, infection Cardiac dysrhythmias  Contraindications - Bronchodilators Allergy – anticholinergics Children Caution - tiotropium Glaucoma Interactions Increased anticholinergic effects with other like drugs  Fluticasone & salmeterol (Advair) For respiratory inhaler use - powder Bronchodilators – Combines a steroid for decreased inflammation and adrenergic for combination bronchodilation drugs Not a rescue inhaler Same side effects as a steroid and adrenergic but not as severe because of inhalation versus systemic Must rinse mouth after use to prevent oral fungal infection Examples  Nursing care: Assessment Medical/medication drug history Bronchodilators Baseline vital signs, O2 sat 1 Lung sounds/respiratory status Hydration status  Interventions/teaching Monitor VS Increase fluids to help with secretions Monitor for side effects/adverse reactions Nursing care: Teach client to monitor bp and pulse Bronchodilators Check with HCP prior to administering cold 1 medications Discuss anxiety reducing measures Teach proper use of inhaler (in care plan) clients who use a beta-agonist inhalant should administer it 5 minutes before using other inhalers Leukotriene receptor antagonist - Montelukast Action Binds with leukotriene receptors to reduce inflammatory process and bronchoconstriction Uses Prevention of exercise-induced bronchospasm and maintenance treatment of asthma  Contraindications Severe asthma attack Leukotriene Caution receptor ◦ Liver disease antagonist - ◦ Suicidal Montelukast Interactions Can increase liver function tests Anticoagulants Aspirin, ibuprofen (cause bleeding and Block drug action) Leukotriene receptor antagonist - Assessment Montelukast Medical/medication history Baseline vital signs Lung assessment  Interventions/teaching Monitor vs, breath sounds Leukotriene Observe for side effects/adverse reactions Increase fluids to thin secretions receptor Monitor I’s & O’s antagonist - Do not take with anticoagulants and aspirin, Montelukast ibuprofen Teach to stop smoking Teach its use is to prevent attacks – do not take during an attack Inform hcp if dyspnea increases Take medication daily in the evening (asthma symptoms usually worse at night) ◦ include teaching for when to take for exercise induced bronchospasm Practice Question #1 A client is ordered the following inhalers, a bronchodilator (ipratropium) and a gluco- corticoid (Beclamethasone). The nurse will A. administer the bronchodilator 5 minutes before the glucocorticoid. B. mix the drugs and administer them together. C. administer the glucocorticoid 10 minutes before the bronchodilator. D. administer the glucocorticoid immediately after the bronchodilator. Practice Question #1 Answer: A Rationale: When a bronchodilator and a glucocorticoid inhaler are ordered together, the bronchodilator is administered first. The nurse should then wait for 5 minutes before administering the glucocorticoid. This allows time for bronchodilation to occur so the glucocorticoid is deposited deep into the respiratory system. Practice Question #2 A client has just received a nebulizer treatment of albuterol. It is most important for the nurse to assess the client for the development of which side effect/adverse effect? A. Tremors B. Bradycardia C. Hypotension D. Hypoglycemia Practice Question #2 Answer: A Rationale: Tremors are a side effect of Albuterol, as are tachycardia, hypertension, and hyperglycemia Practice Question #3 A client with chronic obstructive pulmonary disease asks the nurse what the albuterol (Proventil) he is taking does. The nurse should inform the client that albuterol is used to A. mobilize respiratory secretions. B. decrease the cough response. C. increase the work of breathing. D. dilate the larger airways. Practice Question #3 Answer: D Rationale: Albuterol (Proventil, Ventolin) is a selective beta2 drug that is effective for treatment and control of asthma by causing bronchodilation with long duration of action. Practice Question #4 The nurse is preparing class for clients with asthma. The nurse will inform the clients that leukotriene modifiers are used in the treatment of asthma to A. assist in opening narrowed airways. B. suppress the release of histamine and other mediators from the mast cells. C. loosen mucus from the airways. D. prevent serious complications from bacterial infections. Practice Question #4 Answer: B Rationale: Leukotriene modifiers are used in the treatment of clients with asthma to suppress the release of histamine and other mediators from the mast cells. In the treatment of clients with COPD, bronchodilators such as sympathomimetics, parasympatholytics, and methylxanthines are used to assist in opening narrowed airways; expectorants are used to loosen mucus from the airways, and antibiotics may be prescribed to prevent serious complications from bacterial infection. Practice Question #5 A client is using a glucocorticoid inhaler. The client asks the nurse why he has to rinse his mouth out after using the glucocorticoid inhaler. The nurse should inform the client that rinsing the mouth is done to A. avoid mucous membrane breakdown. B. increase hydration of the oral mucosa. C. decrease risk of infection. D. slow the development of cavities. Practice Question #5 Answer: C Rationale: Side effects associated with orally inhaled glucocorticoids are generally local (throat irritation, hoarseness, dry mouth, coughing) rather than systemic. Oral, laryngeal, and pharyngeal fungal infections have occurred. Oropharyngeal infections may be prevented by using a spacer with the inhaler to reduce drug deposits in the oral cavity, rinsing the mouth and throat with water after each dose, and washing the apparatus daily with warm water. Practice Question #6 A home care nurse is visiting a client with asthma who suddenly experiences an acute asthma attack. Which drug should the nurse prepare to administer? A. Ipratropium B. Montelukast C. Albuterol D. Fluticasone Practice Question #6 Answer: C Rationale: Albuterol is used to treat bronchospasm of asthma to promote bronchodilation. The remaining drugs are used as maintenance treatment for asthma.