Asthma Bronchodilators and Anti-Inflammatories PDF

KV ------------------------------------------------------------------------------------------------------------------------------- Asthma Bronchodilators Drug What it treats Distinguishing Characteristics Sympathomimetics Acute asth...

KV ------------------------------------------------------------------------------------------------------------------------------- Asthma Bronchodilators Drug What it treats Distinguishing Characteristics Sympathomimetics Acute asthma Causes bronchodilation - opens airway albuterol EIB - Exercise AMPS up the body - 3 Ts of albuTerol levalbuterol induced ○ Tachycardia (Increased HR) bronchospasm ○ Tremors ○ Tossing & Turning (Restlessness/ Jittery) RESCUE MED - Monitor/report SEVERE dizziness, heart 2-4 puffs 3x every palpitations, chest pain, SOB, tremors 20 minutes Use PRN - 30 minutes before exercise via MDI (metered dose inhaler) Clean 1-2 times a week with warm water Beta 2 Adrenergic Long term Cause bronchodilation Agonists management of Takes days to work - works slowlyyyy - so used salmeterol asthma and COPD in long term management BLACK BOX WARNING: should not be used as Salm the turtle is not a monotherapy (using a single med to manage alone. a medical condition - asthma attack) Anticholinergics COPD Causes bronchodilation ipratropium Relieves Anticholinergic effects - can’t see, pee, spit, bronchoconstriction or shit ~ give candy and water & secretions Pharynx irritation - bc its dried out produced w/ COPD Increases intraocular pressure - pt should get tested for glaucoma Methylxanthines Long term Long-acting bronchodilator theophylline management of Has to stay within a therapeutic level (< 20 asthma mcg/mL) or else they become TOXIC When outside of therapeutic level: ○ Seizures ~ prepare to start anticonvulsants Theo has asthma. He is therapy if reaches toxic lvl having a seizure, ○ Tachycardia, dysrhythmias ~ monitor HR heart problems, and can't sleep. and rhythms ○ Restlessness, insomnia ~ take in AM because its a stimulant / avoid other stimulants ○ N/V  KV Asthma Anti-Inflammatories Drug What it treats Distinguishing Characteristics GlucocorticoidS COPD, allergic Used for anti inflammatory quality prednisone reaction, arthritis, Peptic ulcers methylprednisolone psoriasis, lupus, Headache PO: suppression of adrenal function Long-term 7S: swollen (fluid electrolyte imbalance - Systemic: IV, PO, IM management of body holds onto liquid ), sepsis (Infection), chronic asthma sugar (hyperglycemia ), skinny bones (bone The president ate meth Inflammation demineralization, muscle wasting - and it got into his system. osteoporosis ), sight (cataracts), slowly taper, stress surgery (increase dose). Inhaled Prevention/Tx of Taken daily for prevention Glucocorticoids inflammation Oral candidiasis for inhaled admin. beclomethasone Dry mucous membranes, epistaxis, & sore budesonide Long/short - term throat for nasal admin. fluticasone management of Fewer side effects when inhaled chronic asthma Sore throat, hoarseness coughing, dry mouth inhaled/nasal Pharyngeal and laryngeal infection Beck and Bud got the Flu Headache and had a runny nose. Long term same as above ^^^ 7s (inhaled/nasal) Mast Cell Stabilizer Allergic rhinitis Prevents release of inflammatory substance cromolyn EIB Used for long-term management because it is Long-term slow acting (takes 4 weeks to take full management of effect) asthma NO LONGER A PART OF Tx STANDARDS bc it needs to be administered 4x daily on a fixed Nobody uses chrome schedule - nobody wants to do that. anymore. Chrome has 4 colors for 4 weeks to Use 15 mins before exercise work and 4x a day Can cause rebound bronchospasm schedule. (taper/titer) Give epi/antihistamine to reverse anaphylaxis from allergic reaction Leukotriene Asthma - prophylactic Used for antiinflammatory quality Receptor Tx Available as tabs, chewables, or oral Antagonists Allergic rhinitis granules (give w/ applesauce/ food or place montelukast (PO) EIB on tongue) Upper resp infections, pharyngitis, cough, HA, Monte is on suicide dizziness, N/V, diarrhea, abdominal pain watch so we give him his Elevated liver enzymes (monitor liver labs) meds in his apple sauce, so his tummy wont hurt. Serious neuro psychiatric effect (suicide risk)  KV Treat Upper Respiratory Infections - Clear secretions Antitussives - block cough reflex Decongestants - decrease the blood flow to the upper respiratory tract and decrease the production of secretions Antihistamines - block the release or action of histamine, a chemical that increases secretions and narrows airways Expectorants - increase productive cough to clear airways Mucolytics - increase or liquefy respiratory secretions to aid clearing of airways Drug What it treats Distinguishing Characteristics Antitussives Chronic non- Blocks cough reflex codeine productive coughs CNS depression dizzy & lightheaded - fall dextromethorphan risk Respiratory depression GI upset - constipation Don’t give to pts who need to cough to maintain an airways (COPD) or pts w/ head injuries Opioids - potential for abuse Topical Nasal / Oral Nasal congestion Shrinks the nasal mucosa Decongestants Allergic rhinitis CNS stimulation with PO med phenylephrine Sinusitis ○ Monitor agitation, anxiety, insomnia pseudoephedrine Common cold ○ Give mild hypnotic so they can sleep Seasonal allergies Tachycardia/palpitations Otitis media (pain / Overdose or systemic absorption congestion) symptoms: HTN, tachycardia, & palpitations ○ Monitor HR and BP Teach pts to read label so they don't accidentally overdose Stimulates sympathomimetic effect (Fight or flight) Rebound congestion w/ prolonged use of topical agents ~ only use for 3-5 days Recommend nasal glucocorticoids to minimize symptoms of CONGESTION while discontinuing after prolonged use. Steroid Nasal Allergic rhinitis Anti-inflammatory Decongestant Nasal Polyp removal Needs 1 week to work budesonide Nasal Congestions Shouldn't be absorbed systemically bc AE. fluticasone (1st line med) Don't give to pt with active infection Can cause burning/stinging of mucosa / HA Can suppress healing in those who just had  KV inhaled surgery Shouldn't be taken with any other nasal med Flu-bud needs a week to at the same time without contacting HCP work Antihistamine Mild allergic reaction Block effects of histamines 1. diphenhydramine Anaphylaxis (edema) Don't give to pt with renal or hepatic 2. Cetirizine Motion sickness impairment Insomnia Adverse effects less likely with 2nd gen Allergic conjunctivitis Antipruritic effects ~ itchy skin Angioedema Anticholinergic effects (can't see, can’t pee, Allergic rhinitis can’t spit, can't shit) Idiopathic Urticaria ○ Encourage liquid intake 1.5-2K mL daily You put a baby to sleep (hives) ○ Give hard candy to suck on dry. Pruritus - itchy skin Drowsiness and fatigue ○ Monitor clients when ambulating Expectorants Unproductive cough Makes a more productive cough guaifenesin related to viral upper Notify if cough worsens or fever develops respiratory tract infection Don't take w other meds that have guaifenesin Respiratory CNS effects - Dizzy, drowsy, HA - enact safety conditions symptoms interventions - monitor pt when ambulating Not indicated for prolong use GI effects - give with food or water Encourage fluid intake of 1.5 - 2K mL daily~ it prob helps their throat Mucolytics Atelectasis (caused by Liquifies and cleans out secretions ~ have acetylcysteine thick mucous suction available or give pt. a bag/tissues secretions) - CF SE: bronchospasm (don't give to asthma pts) ○ Monitor resp status & administer Acetaminophen bronchodilators if needed overdose Smells like eggs GI upset - makes sense bc it smells like eggs ○ Give antiemetic if needed (stop them from vomiting) Stomatitis - inflammation of mouth Rhinorrhea - runny nose Rash  KV Blood Pressure Medications Drug What it treats Distinguishing Characteristics ACE Inhibitors Hypertension Decreases BP by stopping aldosterone benazepril Heart failure production captopril Left ventricular Place on renal watch bc works in RAAS enalapril dysfunction BLACK BOX WARNING: Preggos lisinopril DM neuropathy Not for acute HF / salt/volume depletion Orthostatic hypotension (careful when changing position) Severe hypotension with 1st dose (normal) -pril General 1st line ******* Dry, non productive cough ******* except w African Allergic reaction results in angioedema Americans (CCB) Hyperkalemia / Hyponatremia No NSAIDs, other hypertensives, potassium supplements, drugs that affect RAAS, other ACE inhibitors, ARBS, renin inhibitors Angiotensin HTN (alone or in Brings with angiotensin receptors to block Receptor Blockers combo) vasoconstriction ~ block BP raising effects (ARBs) Heart failure Less chance of cough/angioedema than ACE losartan After MI HA, dizziness, syncope (fainting) valsartan Slow progression of Hyperkalemia renal disease GI complaints, dry mouth, tooth pain causes Rash, dry skin, alopecia Not for preggos, hep/renal failure, ppl w. Hypovolemia (low BP already) - sartans Monitor BUN and creatinine (kidneys) No NSAIDs, other hypertensives, potassium supplements, lithium - same as ACE Aldosterone HTN (in combo bc its Gets rid of fluids but keeps potassium Antagonists a weaker drug) Blocks aldosterone receptors = excretion of eplerenone HF after MI Na and water and retention of K spironolactone Hyperkalemia - potassium sparing effect ~ - one make sure they stay below 5.0. Monitor palpitations, muscle twitching, weakness, parentheses, slow HR Take daily weights to monitor fluid loss (edema) Increased urine output - Monitor I&O / kidney labs Direct Renin HTN Kills renin (eventually makes angiotensin) Inhibitors Never a first line Tx aliskiren Kills slowly - absorbed slowly in GI - GI upset  KV BLACK BOX: Teratogenic Dry cough Risk of hyperkalemia Angioedema with respiratory involvement Renal impairment (renin released from there) No furosemide, antihypertensives, ACE inhibitors, ARBs, K sparing diuretics Calcium Channel Hypertension Decreases BP, cardiac workload, and Blockers Angina myocardial oxygen consumption amlodipine 1st Tx for African Americans diltiazem Extended release - don't chew nicardipine Not for Heart block, sick sinus syndrome, HF, nifedipine and acute MI or preggos Verapamil Reflex tachycardia - dizzy, lightheaded ~ can give a Beta blocker to prevent this bc they lower HR My tia named veranica CNS effects - Headache - caution w/ driving ate dipine-dots. CV effects -peripheral edema (check legs and feet), , dysrhythmias GI effects note: calcium makes Skin flushing and rash vessels constrict so the blockers make them No grapefruit juice (increases med dilate effectiveness) Nonselective HTN Decreases myocardial oxygen demand and Beta Blockers Heart Failure contractility. labetalol SVT Lowers heart rate and pulse propranolol HCM GI effects when given PO Angina CV & Respiratory effects (B1-heart B2-lungs) MI Decreased exercise tolerance IV or PO Hypoglycemia or hyperglycemia -lol Not for those w/ bradycardia (bc it lowers it more), or heart block, shock, no preggos, no diabetics, no asthmatic or COPD (bronchospasm) Take HR and pulse at the same time each day Don't discontinue abruptly Don't give with anesthetics, diabetic agents, CCBs, and antiarrhythmics that affect QT Alpha 1 Blockers - HTN A1 receptors (located in smooth muscle) Selective Benign prostatic cause vasoconstriction, so the blockers Adrenergic hyperplasia prevent this, so vasodilation = lower BP Blocking Agent CNS effects: syncope (fainting) - fainting at 1st use because of the low BP - start at low  KV doxazosin nitroglycerin doses & careful when driving Allows urine to flow easily -osin GI effects (given PO) CV effects - hypotension Effects related to vasodilation Not for preggos, HF, or those in renal failure. No vasodilators and antihypertensives Beta 1 Blockers HTN Preferred for pts with pulmonary Selective Cardiac arrhythmias diseases/ problems Adrenergic Chronic angina CNS effects - dizzy Blocking Agents After MI CV effects - HR less than 60 atenolol Glaucoma (decrease IOP) Pulmonary effects (less than nonselective) metoprolol GI/GU effects Decreased exercise tolerance Absorbed from GI after Hyperglycemia / Hypoglycemia given (PO) but works Okay for preggos better when administered via IV - dont give Not for those w/ bradycardia, heart block, ophthalmically (eye) cardiogenic, shock, HF, hypotension, diabetics, thyroid disease, COPD Alpha 2 Agonists HTN Titrate / taper meds to reduce CNS effects clonidine Severe pain (Cancer) Rotate patches if given transdermal ADHD Take at bedtime because it can cause drowsiness & dizziness 3Ds of cloniDine: dizziness, drowsiness, PO Not mentioned: and dry mouth Transdermal Opioid withdrawal Can give feelings of euphoria, so monitor for misuse Don't give to those on anticoagulant therapy Vasodilators HTN EMERGENCIES Acts directly on smooth muscles (vein) to hydralazine relax to drop BP nitroglycerine Rapidly absorbed Reflex tachycardia Cyanide toxicity Headache Not to those with CAD, HF (crackles in lungs, edema), tachycardia, PVD Cardiac Glycosides HF Increased force of myocardial contractions, (Inotropic Agents) Atrial problems slowed HR = increased cardiac output. Heart digoxin Sudden attacks beats slower but each contraction has Paroxysmal more purpose/ it's more effective Take apical pulse for 1 min prior to admin SE: HA, weakness, drowsiness, hypokalemia and vision changes, bradycardia, arrhythmias  KV Monitor serum levels Toxicity is a concern. 1st sign is GI upset. Keep levels < 2.0 ng/ mL Signs of Toxicity: n/v, fatigue, visual changes : yellow tinge, halos around dark objects Antidote: Digoxin Immune Fab Don't take with ginseng (more chance of toxicity) or St. John's Worts (lowers digoxin) Inotropic Inhibitors Emergency HF Stronger contraction and prolonging effects milrinone (only!!!) - hasn't of sympathetic stimulation responded to digoxin SE: arrhythmias, hypotension, chest pain /diuretics Thrombocytopenia: harder time clotting Burning at IV site IV only Monitor vitals continuously Not for ppls w/ SL valve disease, acute MI, ventricular arrhythmias, hypovolemia, or preggos Assess if they have any of those ^^^ & their cardiac status and heart sounds Diuretics Drug What it treats Distinguishing Characteristics Thiazide and HTN (1st line) Gets rid of fluid and sodium Thiazide-Like Edema Monitor BUN and Creatinine Diuretic Monitor I & Os , report less than 30mL/hr hydrochlorothiazide Take daily weight to see if its working on edema Causes GI upset, All: Take them in the Electrolyte imbalance: hypokalemia (take K morning bc they make supplement), decreased calcium excretion you pee and you don't want to be up all night - Prolonged use: Hyperglycemia no later than 3 PM Hypotension Can cause gout- check their feet Not with digoxin, antidiabetics, lithium, antihypertensive Loop Diuretics HTN Decreases reabsorption of Na and Cl Furosemide Edema Makes you pee to get rid of fluid. Monitor I&O Acute HF Hypokalemia. Monitor signs: irregular Pulmonary edema pulse, , anxiety, confusion, hypoactive Edema bowels, skeletal muscle weakness and Ascites polyuria Hyperglycemia  KV Hypocalcemia Alkalosis Problems related to electrolyte depletions: CNS effects: N/V, irregular HR Ototoxicity Educate on what foods have potassium Potassium Sparing Hypokalemia Gets rid of fluids/sodium but keeps Diuretics Edema potassium spironolactone HF Blocks aldosterone receptors = excretion of Hyperaldosteronism Na and water and retention of K Hyperkalemia - potassium sparing effect ~ make sure they stay below 5.0. Monitor palpitations, muscle twitching, weakness, parentheses, slow HR Take daily weights to monitor fluid loss (edema) Increased urine output - Monitor I&O / kidney labs Type of steroid which has hormonal effects - hair growth and gynecomastia No salicylates, antihypertensives, and RAAS Weaker drug so used in combo w/ other drugs  KV Angina Meds Drug What it treats Distinguishing Characteristics Nitrates Prevention of angina Blows veins up, veins dilate, BP lowers, less nitroglycerin Stable angina pressure means increased oxygen to heart isosorbide - mononitrate Unstable angina tissues - workload less so heart is pumping Vasospastic angina better- so less pain Don't give to those with hypotension, -Rapid-acting form (SL) hypovolemia, have limited cardiac output, -Long-acting from (sustained-release oral severe head injury, erectile dysfunction meds capsules/ transdermal) Causes HA that diminish with time Reflex tachycardia Postural hypotension - take laying down Tolerance may develop - take off patch at night Store: airtight, dark, with metal cap If it hurts when you’re taking it the med its working Check BP before giving in hospital Long term - transdermal - take off for at least 8 hours - drug vacay If angina occurs: 1. Stop activity or lie down, and take SL tablet 2. If there's no relief in 5 mins, call 911 & take another tab 3. If there’s no relief in 5 mins, take a third SL tab, & pray paramedics get there probably. Beta adrenergic Angina prevention Decreases workload to heart to help antagonists (BB) HTN for preggos angina propranolol Caution on ppl w/ pulmonary and cardiac metoprolol problems labetalol Fatigue and bradycardia BLACK BOX: don't stop abruptly, can cause cardiac effects (taper/titer) Misc Angina chronic Prolong QT interval ranolazine When other meds don't work Don't give if hepatic problems You ran a race, but came in 6th place. You came 6th not first, so it's not a first line only when other things don't work. 6 months is chronic so it's for chronic angina. It was a long race so it caused QT proLONGation.  KV Antiarrhythmic Meds Administered via IV Not for block, shock or sick All can cause asystole Dizziness, HA, blurred vision, prolong QT interval Measure baseline BP, pulse, I & O, cardiac rhythms Take serum levels before administering Instruct patient to report adverse effects to physicians Not for those with QT prolongations Monitor: toxic effects, cardiac rhythms, HR, BP, well-being, skin color, temp, heart and lung sounds, QT prolongation Report: worsening SOB, edema, dizziness, syncope, chest pain, GI distress, blurred vision Drug What it treats Distinguishing Characteristics Class I - Na CB Block sodium channels A. procainamide Arrhythmias All treat V-tach B. lidocaine Ventricular Lidocaine with Epi cannot be given via IV & dysrhythmias only as a local anesthetics C. flecainide Propafenone Severe ventricular cain prop dysrhythmias Class II - BB Angina Slows impulse conduction - SLOWS HR so labetalol HTN, HF take HR before giving med - hold if under 60 PSVT Makes each beat a little better Ventricular dysrhythmias Class III - K CB Difficult dysrhythmias Increase APD amiodarone V-tach, v-fib, a-fib, Pulmonary toxicity - hypoxia a-flutter Class IV- CCB PSVT Reduce AV node conduction verapamil A-fib, A-flutter Inhibits channel pathways diltiazem Adenosine PSVT Slows conduction and resets the heart Sinus rhythms Only administered fast IV push WILL cause asystole Short half life 10 seconds Have them on ECG, have crash cart ready Don’t give in places where there no proper equipment to restart the heart Be ready to start the heart; before it stops  KV SE: chest pain, dyspnea, flushing of skin Hyperlipidemia Meds Drug What it treats Distinguishing Characteristics HMG-CoA Hyperlipidemia Decreases LDLs, slightly increases HDLs reductase ASCVD Take in evening because this is when inhibitors MI, stroke, cholesterol synthesis happens atorvastatin revascularization Can cause liver problems so don't give to pts rosuvastatin prevention with liver problems simvastatin SE: Hepatotoxicity, Rhabdomyolysis (mel) N/V, diarrhea, HA -statin No grapefruit PCSK9 Inhibitors Hyperlipidemia Prevents LDL receptor breakdown; allows alirocumab Homozygous familial liver to process more LDL evolocumab hypercholesterolemia Used when they can't take statins Given via SQ injections. Every 2-3 weeks Risk for infection Injection site reaction Bile acid Hyperlipidemia LDL + bile = poop out the fat sequestrants hypercholesterolemia CNS effects (HA, drowsiness, fatigue, anxiety) cholestyramine Pruritus - biliary GI irritation - constipation, hemorrhoids colesevelam obstruction More likely to bleed Vitamine A and E deficiencies Muscle aches and pain Take hours before other medications No thiazides, warfarin, thyroid hormone, birth control, corticosteroids Cholesterol Hyperlipidemia Stops cholesterol absorption - lowers LDL absorption hypercholesterolemia Add on to statin therapy or on its own inhibitors Homozygous CNS effects HA, dizziness, fatigue, ezetimibe sitosterolemia Back pain, muscle aches GI upset: diarrhea If combined w/ statins: liver problems Fibrates Hypertriglyceridemia Lowers LVDL (triglycerides) fenofibrate Increases risk of gallstones Thiazide - long term, HF, peripheral edema - make you pee; hypokalemia Loop - make you pee - more intense- quickly need to get rid of fluid; hypokalemia Spirol - not as harsh - potassium sparing