Week 9 - Respiratory System PDF

PHARMACOLOGICAL MANAGEMENT UTILIZING THE NURSING PROCESS ON THE RESPIRATORY MEDICATIONS At the end of the session, the student will be able to: Determine the therapeutic actions Determine the indication of the drug Identify the pharmacokinetics of the drug Identify the contr...

PHARMACOLOGICAL MANAGEMENT UTILIZING THE NURSING PROCESS ON THE RESPIRATORY MEDICATIONS At the end of the session, the student will be able to: Determine the therapeutic actions Determine the indication of the drug Identify the pharmacokinetics of the drug Identify the contraindications and cautions Determine the adverse effects of the drug Explain the drug interactions. Identify antidotes for over-dosage. Determine the nursing considerations when giving the drug INTRODUCTION NURSING CONSIDERATIONS L - ung sound, RR, cough, and O2 sat monitoring U – sage of special equipment eduction N – o smoking and avoid pollutants/allergens G – argle after using inhaler S – uction secretion prn INHALED STEROIDS DRUGS: budesonide (Budecort), budesonide/formoterol (Symbicort), fluticasone (Flovent HFA) fluticasone propionate/salmeterol (Seretide) INHALED STEROIDS DRUGS: Decrease the formation of cytokines (an inflammatory mediator). Decrease microvascular permeability. Inhibit influx of eosinophils into the lung, reducing overall inflammation. INDICATIONS treatment of choice in preventing asthma exacerbations in patients with persistent asthma., COPD INHALED STEROIDS INTERVENTIONS: 1. Monitor for CBC, Chest Xray or PFT. 2. Oral Care to prevent oral thrush 3. If with missed dose, take it immediately but do not overdose. 4. Drug are reduced gradually before stopping the medication 5. Do not swallow capsule use for inhalers or nebules use for nebulization.  INHALED STEROIDS PROPER ASSEMBLE & USE: BETA2 ADRENERGIC AGONIST DRUGS: albuterol/salbutamol (Proventil,Ventolin, Asmalin), bitolterol (Tornalate), isoetharine (Bronkosol), metaproterenol (Alupent), pirbuterol (Maxair), salmeterol (Serevent), terbutaline (Bricanyl).  BETA2 ADRENERGIC AGONIST ACTION: Stimulates beta receptors in lungs. Relaxes bronchial smooth muscles. Increases vital capacity, decreases airway resistance. INDICATIONS: Asthma, bronchitis, emphysema, relief of bronchospasm occurring during anesthesia, exercise induced bronchospasm.  BETA2 ADRENERGIC AGONIST UNDESIRABLE EFFECTS: Nervousness, tremors, restlessness, insomnia, headache, nausea, vomiting, tachycardia, irregular heart beat, hypertension, cardiac dysrhythmia. OTHER SPECIFIC INFORMATION: ↑ effects with other sympathomimetic, ↓ with beta blockers. INTERVENTIONS: 1. Monitor breath sounds, sensorium levels for confusion and restlessness due to hypoxia, and vital signs (pulse & BP can ↑ greatly). 2. Check for cardiac dysrhythmias. XANTHINES DRUGS: aminophylline (Theofil), theophylline immediate release (Aerolate), extended release (Slo – bid, Theodur, Unidur) XANTHINES ACTION: Inhibits phospodiesterase, an enzyme responsible for breaking down cylclic adenosine monophosphate (cAMP) resulting in bronchodilation and reducing airway resistance. INDICATIONS: Asthma, emphysema, COPD, or chronic airway limitations.  XANTHINES UNDESIRABLE EFFECTS: Uncommon at serum levels below 20mcg/ml > 20mcg/ml - nausea (1st sign of toxicity), vomiting, headache, dizziness, insomnia, irritability, levels > 35mcg/ml – tremors (later sign of toxicity), nervousness, tachycardia, palpitation, hypotension, cardiac dysrhyrthmias, seizures, death. XANTHINES OTHER SPECIFIC INFORMATION: Cimetidine, oral contraceptives and several antibiotics (ciprofloxacin, norfloxacin, erythromycin) ↑ toxicity, ↓ effects of neuromuscular blockers, MGA GINOO phenytoin, lithium. ↓ effects with AT BINIBINI, smoking, rifampicin, HINDI ITO phenobarbital/corticosteroids. High MAAARI protein, low carbohydrate diet may increase theophylline elimination. ILALABAS LANG NG KATAWAN  XANTHINES INTERVENTIONS: 1. Monitor ABG and theophylline levels ( normal level is 10 -20mcg/ml. Peak serum concentration should be taken 1 hr. after IV , 1 – 2 hrs following immediate release dose, 3 – 8 hrs following extended release. Take through level just before next dose. 2. Take oral preparation 1 hr before or 2 hrs after meals. 3. Monitor vital signs, respiration and breath sounds. 4. Avoid caffeine and chocolates ANTICHOLINERGIC BRONCHODILATOR DRUGS: Ipratropium (Atrovent), Tiotropium (Spiriva, Spiolto). ANTICHOLINERGIC BRONCHODILATOR ACTION: Bronchodilator that blocks or antagonize the action of the neurotransmitter acetylcholine at vagal mediated receptor sites. INDICATIONS: Maintenance treatment of bronchospasm associated with COPD. ANTICHOLINERGIC BRONCHODILATOR UNDESIRABLE EFFECTS: Nervousness, dizziness, headache, nausea, GI distress, cough, palpitations. INTERVENTION: 1. Ensure adequate hydration and provide environmental controls such as the use of humidifier; 2. Provide small frequent meals and sugarless lozenges; 3. Caution the patient not to exceed 12 inhalations in 24 hours to prevent adverse effects; 4. Advise not to drive or use hazardous machinery. TAHOL NG TAHOL  EXPECTORANTS DRUGS: guaifenesin (Mucinex, Robitussin), sodium or potassium citrare, guaifenesin + sodium citrate ( Mucobron) potassium iodide (Losat) EXPECTORANTS ACTION: Enhances the output of RT fluid by reducing the adhesiveness and surface tension of the fluid, facilitating the removal of viscous mucus. INDICATION: Symptomatic relief of respiratory conditions characterized by dry, non productive cough and in the presence of mucus in the RT. EXPECTORANTS UNDESIRABLE EFFECTS: Nausea, vomiting, rash, headache, dizziness. INTERVENTION/EDUCATION: 1. Caution not to use for longer than 1 week and seek medical attention if cough still persist to evaluate for underlying conditions. 2. Advise the use of small, frequent meals to alleviate GI discomfort. 3. Advise to avoid driving or performing dangerous task. 4. Increase fluid intake to loosen the mucus.  MUCOLYTICS DRUGS: acetylcysteine (Explem, Fluimucil, Pneumotyl), dornase alfa, ambroxol (Mucosolvan) carbocysteine (Flemex), edrosteine (Ectrin)  MUCOLYTICS ACTION: Split links in the mucoproteins contained in the respiratory mucus secretion, decreasing the viscosity of the secretions; protect lever cells from acetaminophen effects. INDICATIONS: Mucolytic adjunctive therapy for abnormal, viscous mucus secretion in acute and chronic bronchopulmonary disorders; to lessen hepatic injury in cases of acetaminophen toxicity. MUCOLYTICS UNDESIRABLE EFFECTS: Nausea, stomatitis, urticaria, bronchospasm, rhinorrhea. INTERVENTION: 1. Avoid combining with other drugs in the nebulizer to avoid the formation of precipitates. 2. NAC tablet or sachet should be dissolved with water before intake. 3. Deep breathing exercise 4. Suction prn ANTITUSSIVES DRUGS: codeine, hydrocodone (Hycodan), benzonatate (Tessalon) butamirate citrate (Sinecod Forte), dextromethorphan (Benylin, , Respimax), lagundi (Ascof), levodropropizine (Levopront) ANTITUSSIVES ACTION: Depresses the cough center in the medulla to control cough spasm. INDICATIONS: Control of non productive cough. ANTITUSSIVES UNDESIRABLE EFFECTS: Dizziness, respiratory depression, dry mouth. INTERVENTION/EDUCATION: 1. Advise not to do mental alertness like driving, it can cause sedation and drowsiness. 2. Codeine may cause withdrawal syndrome 3. May give Hard candy to lessen irritation  ANTIHISTAMINES DRUGS: Azatadine (Optimine), azelastine (Astelin), brompheniramine (Dimetapp), buclizine (bucladin–S), cetirizine (Zyrtec,Virlix), Chlorpheniramine (chlor-trimeton), clemastin (tavist), diphenhydramine (Benadryl), hydroxyzine (Atarax), loratadine (Claritin), levocetirizine (promethazine (Phenergan), meclizine (Antivert) montelukast (Kastair), levocetirizine+montelukast (Zykast)  ANTIHISTAMINES ACTION: Blocks histamine release at H1 receptors. INDICATION: Upper respiratory allergic disorders, anaphylactic reactions, blood transfusion reactions, acute urticaria, motion sickness. UNDESIRABLE EFFETCS: Depression, sedation, dry mouth, GI upset, bronchospasm, thickening of secretions, arryhythmias. ANTIHISTAMINES OTHER SPECIFIC INFORMATION: Alcohol, CNS depressants may ↑ CNS depressant effect. Ketoconazole may alter metabolism of antihistamine. ↑ levels and possible toxicity with ketoconazole, erythromycin when given with fexofenadine. Avoid MAO inhibitors. INTERVENTIONS: 1. Monitor vital signs, I and O. 2. If secretions are thick use a humidifier. 3. Some may cause drowsiness, provide safety DECONGESTANT DRUGS: Topicals; Ephedrine (Pretz – D), Tetrahydrozoline (Tyzine), Xylometazoline (Otrivin): Oral; Pseudoephedrine, phenylephrine (Coricidin, Disudrin, Neozep), Topical Nasal Steroid; Beclomethasone (Beclovent), Budesonide (Pulmicort), Dexamethasone (Decadron), Flunisolide (Aerobid), Fluticasone (Flovent), Triamcinolone (Azmacort) Nasal Spary: Oxymetazoline (Clariclear)  DECONGESTANT ACTION: Sympathomimetic effects, partly due to release of norepinephrine from nerve terminals; vasoconstriction leads to decrease edema and inflammation of the nasal membrane. INDICATIONS: Symptomatic relief of nasal and nasopharyngeal mucosal congestion due to the common cold, hay fever or other respiratory allergies; adjunctive therapy of middle ear infections to decrease congestion around the eustachian ostia. Allergic rhinitis.  DECONGESTANT INTERVENTION: 1. Do not take caffeine or caffeine – containing drinks 2. Monitor for allergy, VS and urine output 3. Evaluate orientation and reflexes to evaluate the central nervous system (CNS) 4. Evaluate nasal mucous membrane to monitor for lesions 5. Safety prec LETS WRAP IT UP