Term
|
Definition
B2 adrenergic agonists
Methylxantines
Anticholenergics |
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Term
| B2 Adrenergic agonist- drugs types |
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Definition
Short acting- Albuterol and levablbuterol (Xopenex)
long acting- salmeterol (proventil) and Advair |
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Term
|
Definition
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Term
| Benefits of Salmeterol and Advair |
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Definition
| Maintainance inhaler- prevents excerise induced asthma |
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Term
| B2 adrenergic agonist MOA |
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Definition
| beta 2 receptors promote bronchodilation: relieves spasms, suppresses hisamine release and increases ciliary motility ( get the crap up and out) |
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Term
|
Definition
Inhaled= less systemic effects- limited absorption
Oral+ longer duration of action- more systemic side effects-- effects B1 receptors causing increased heart rate and "jitters" |
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Term
| B2 A/A drug drug interactions |
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Definition
MOA inhibitors-- prolong sympathetic activation
B- blockers- inhibit activity (essentially be canceling each other out) |
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Term
|
Definition
Limit caffiene
Immediately report difficulty breathing, heart palitations, tremor, vomiting, nervousness and vision changes
Limit use of OTV sympathominmetics(sudafed and Afrin) |
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Term
| Properties of Methlxanthines |
|
Definition
chemically related to tea
used for hard to treat asthma |
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Term
|
Definition
CNS excitation
BRONCHODILATION
Cardiac stimulation, vasodialtion and diuresis |
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Term
| Methylanthines- Prototype |
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Definition
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Term
|
Definition
narrow margin of safety
only for long term oral prophylaxis of persistant asthma (noctural) or COPD |
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Term
| Theophylline Adverse Effects |
|
Definition
| nausea, vomiting and CNS stimulations- dysrhythmias at high doses |
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Term
| Theophylline Patient Education |
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Definition
Never EVER double up
toxic effect when dose too high |
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Term
|
Definition
| improve lung fuction by blocking muscarinic receptors in bronchi-- bronchodilation |
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Term
| Anticholinergic prototype |
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Definition
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Term
|
Definition
| dry mouth, irritation of pharynx (decrease SLUDD) |
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Term
| Combination Bronchodialation Therapy |
|
Definition
Ipratopium and albuterol- combined in a MDI canister
B2 A/A and anticholinergic= optimal outcome |
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Term
| Types of Anti-inflammatories |
|
Definition
Glucocorticoids
Mast Cell Stabilizers
Leukotriene modifiers
Monocional antibody to IgE |
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Term
|
Definition
Reduce symptoms by suppressing inflammation which reduces bronchial activity
Decrease airway mucus and edema
Increase # of B2 receptors and responsiveness to B2 agonist (more receptors- increased efficacy and increased result) |
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Term
| Glucocorticoid Prototypes |
|
Definition
Inhaled (Pulmicort, aerobid, flovent)
Oral-- given as supplemental to inhaled forms in times of stress- (Prednisone) |
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Term
| Glucocorticoid side effects |
|
Definition
increased susceptibility to infections, adrenal crises in abrupt withdrawal
Cushing's
Hyperglycemia
oesteoporosis
oral candidiasis
peptic ulcer disease |
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Term
| Glucocorticoid Patient Education |
|
Definition
do not stop abruptly, monitor blood glucose for diabetes (increase gluco genesis and erduce glucose utilization)
impaired wound healing |
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Term
| Mast Cell Stabilizers Prototypes |
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Definition
| Cromolyn and Tilade(longer half life) |
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Term
| Mast cell function in the body |
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Definition
| reservior for histamine in the connective tissue |
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Term
| Use of Mast Cell Stabilizers |
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Definition
| Asthma prophylaxis-- not for acute attacks- may take weeks to reach therapeutic effect- short half life--- may have to take 4-6x a day |
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Term
| Mast cell stabilizer side effects |
|
Definition
Burning of nasal mucosa, irration of the throat and nasal congestion
RARE-- bronchospasm and anaphylaxis |
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Term
| Leukotriene Modifiers- Prototype |
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Definition
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Term
| Leukotriene Modifiers MOA |
|
Definition
| Suppress leukotriene to reduce bronchoconstriction, musus production and airway edema |
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Term
|
Definition
| prophylaxis and maintenance |
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Term
| Leukotriene Modifier Education |
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Definition
| do not take tylenol or drink alcohol |
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Term
| Corticosteroids- Inhaled vs Oral |
|
Definition
Inhaled- first line therapy for asthma- very safe- Adverse effects: horseness and speaking difficulty
Oral- reserved for patients with severe asthma because of potential toxicity only when symptoms cannot be controlled with safer medications. Adverse effects: adrenal suppression (decrease the cortex ability to make glucocorticosteroids on its own), osteoporosis, hyperglycemia, peptic ulcer disease and suppression of growth in young patients |
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Term
| Salmeterol and Formoterol |
|
Definition
Both are long acting B2 agonist
Dosing is normally q12h
If a bronchodilators is needed in btwn use a rescue inhaler
Used for patients who experience long and frequent attack |
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Term
|
Definition
Stabilizes mast cells which inhibit release of histamine and other inflammatory mediators
- management of chronic asthma
- prophylaxis of exercise induced
asthma
-prevention of allergen- indicted
attacks |
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Term
|
Definition
Prevent leukotriene effects, suppressing inflammation, bronchoconstriction, airway edema and mucus production
- long term therapy of asthma
- prevent exercise- induced asthma |
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Term
| Therapeutic Advantages of Inhalation Therapy |
|
Definition
Enhanced therapeutic effects because of direst delivery to the site
Systemic effects are MINIMIZED
Relief of acute attacks is RAPID |
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Term
|
Definition
| reduces the viscosity of secretions by increasing respiratory tract fluid; not usually for asthma, but for upper respiratory tract infection; could be used in asthma and COPD because mucus is a problem |
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Term
| Side effects of anticholinergics |
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Definition
| Anti- SLUDD- increases heart rate |
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Term
| Antihistamine- high or low affinity? |
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Definition
| High affinity-- bumps off histamine off the receptor to fill its place, stopping the effects of histamine- bronchodilation and decrease production of mucus |
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Term
| Epinephrine action and category |
|
Definition
Catecholamine- sympathetic nervous system released from adrenal medulla- only one synapse fight, flight, fright, fornicate
Works on alpha and beta receptors
Bronchodilation |
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Term
|
Definition
- Right drug for the right bug
- right time of day for the right lenght of time (compliance and adherence decreases risk of resistance-- maintaining a therapeutic index)
**resistance and tolerance** |
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Term
|
Definition
resistance- drug doesnt work
tolerance- need more of the drug to get the same effect |
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Term
| How to prevent resistance |
|
Definition
-antiboditic only when needed
-narrow spectrum agents are preferable
-use older drugs first
-tell patient to finish all meds |
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Term
|
Definition
prevents alveoli from completely collasping by decreasing surface tension- reduces work
comination of large surface area and surfacant faciliates gas exchange |
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Term
| Diameter and resistance relationship in the bronchioles |
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Definition
| small change in diameter results in large increase in resistance- narrowed airwas cause major respiratory problems because resistance is increased (diameter controlled by parasympathetic nervous system)-- contraction |
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Term
| Signs and Sypmtoms for asthma |
|
Definition
Wheezing- mucus + constriction= harder to get air through
On exhalation, increased intrathoracic pressure closes bronchial lumen
Breathlessness, chest tightness and cough
--infilration and activation of inflammatory cells to release mediators to produce inflammation and bronchial reactivity |
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Term
| What is shock? 3 things that happen |
|
Definition
Imbalance between oxygen supply and requirements at the cellular level
Time sensitive because there is no cellular respiration going on and cells are dying
1. bronchial constriction
2. airway contriction
3. circulatory collapse |
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Term
|
Definition
B-agonist-epi-dilates bronchioles
Cortiosteriods- solumedrol- decreases inflammation
Bronchodilators
Antihistamine- gets rid of the histamines duh |
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Term
|
Definition
both are drug allergies
Urtcaria is localized (hives)
Anaphylaxis is systemic and emergent |
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Term
|
Definition
progressive, irreversible disorder hat restricts airflow in the lungs
--smoking is a big cause |
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Term
| Signs and symptoms of COPD |
|
Definition
| Chronic cough, excessive sputum, wheezing, dyspnea, and poor exercise intolerance- barrel chest and clubbing |
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Term
|
Definition
Bronchodilators
Corticosteriods
Leutrotriene Modifiers
Expectorants and mucolytics |
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Term
| Pt. teaching about tuberculosis meds |
|
Definition
Need to take all meds
DOT
Drugs hepatotoxic- do not drink alcohol or tylenol |
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Term
| Drugs for Tuberculosis and side effects |
|
Definition
Isoniazid-for treatment and prophlyaxis- side effect- peripheral neuropathy and hepatotoxicity
Rifampin- hepatotoxicity and discoloration of bodily fluid
Pyranzinamide- hepatotoxicity
Ethanbutol- optic neuritis |
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Term
| Why treat TB with multidrug regimen? |
|
Definition
| greater efficacy and dcreased resistance-- decreased risk of resistance and reduce the incidence of relapse |
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Term
| Prevention of drug resistant TB |
|
Definition
| adequate drug therapy (multiple drugs)- correct treatmetn, dosage, DOT, regimen needs to contain the right drugs |
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Term
| Nursing interventions for pneumonia |
|
Definition
drugs
keep away from crowds
rest-- pain management
hydrate
vaccinate
monitor respiratory status |
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Term
|
Definition
Benedryl
antihistamines
Nasal glucocorticiods- pulmicort, flovent
Cromolyn- nasal- suppresses bronchial inflammation
Sympthaomietics/Alpha adrenergic agonist
Anticlolingerics- nasal- atrovent and spiriva
Antileukotrienes |
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Term
|
Definition
endogenous mediator of inflammation
potent vasodilator and causes bronchoconstriction and mucus production |
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Term
| what do anti-histamines do |
|
Definition
| work on histamine receptors to block their actions and suppress inflammatory reactions- used for allergic reaction |
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Term
| What really is cystic fibrosis |
|
Definition
obstruction disorder
hypersecretion of thick mucus that obstructs exocrine glands and ducts
--affects primary lung broncials and pancreatic ducts
autosomal recessive disorder (25% of both parents are hetero) |
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|
Term
| drug therapy for cystic fibrosis |
|
Definition
| high dose anitboditics and bronchodialators |
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Term
| Salmeterol used for what kind of asthma |
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Definition
|
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Term
| Contradictions for non-selective adrenergic agonist |
|
Definition
hits alpha, beta 1 and beta two
Not good with cardiac patients |
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Term
| What is selective toxicity |
|
Definition
| the ability for the drug to kill microbials that its supposed to |
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Term
| Why can't catecolemines be given orally? |
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Definition
| they are metabolized too quickly |
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Term
|
Definition
all the cells that circulate in the body
stem cell doesnt know what it wants to be
-in bone marrow
-AKA undifferentiated
Can be a lymphoid or myloid to erythrocyte |
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Term
| Erythropoeisis what is it and why is it produced? |
|
Definition
making red blood cells
kidney senses low O2 in the blood and it secretes eryrthopoietin which in turn stimulates bone marrow to make RBCS |
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Term
|
Definition
| Bone marrow-- mast cells differentiate into reticulocytes |
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Term
|
Definition
| 120 days- 4 months- dead ones removed by the spleen |
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Term
| Why do sickle cells die faster? |
|
Definition
| because they have weaker membrane- lose flexibility because of shape and die faster |
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Term
|
Definition
transport O2 via HGB (carries 4)
contribute to viscosity |
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Term
| Morphological description of RBCs |
|
Definition
| flexible biconcave- allows RBC to fit through various blood vessels throughout the body |
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Term
|
Definition
Protein- kitchen
Bone marrow- oven
INGREDIENTS-- iron, folic acid, B12,B2,B6 |
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Term
| Why are transfusions so important? |
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Definition
| because it takes 2-3 weeks to make more if you lose some |
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Term
| Link btwn hemolysis and jaundice |
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Definition
| at the end of hemolysis the end product is unconjugated bilirubin that attaches to plasma molecule and transported to the liver- if there is an excess in hemolysis there will be jaudice because the liver can not conjugate fast enough |
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Term
|
Definition
product of lysed RBC
old and injured RBCs are deposited in the spleen and split
unconjugated are sent to the liver were it is conjugated and is excreted in bile and urine |
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Term
|
Definition
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Term
|
Definition
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|
Term
|
Definition
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|
Term
|
Definition
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|
Term
| General effects of anemia |
|
Definition
| vasocontriction, pallor, tachypnea, dyspnea, tachycardia, ischemic pain, lethargy, and lightheadedness |
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Term
| Iron deficient amenia- etiology and clinical manifestations |
|
Definition
insufficient dietary intake of iron, blood loss, decreased absorption
early---PICA- pallor, fatigue, dyspnea, palpitations, tachycardia
late---glosstis- dry corners of the mouth, brittle spoon nails |
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Term
| Iron deficient anemia treatment and side effects |
|
Definition
iron supplement-- ferrous sulfate
constipation/diarrhea- teeth staining
**do not take with antacids
**do not combine with anti-antemic agents-- no vitamin b12 or folic acid |
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Term
|
Definition
| for iron deficient patients- indicated for NPO patients |
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|
Term
| Sodium ferric gluconate complex |
|
Definition
| indicated for iron deficient renal patients |
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Term
|
Definition
| ferratin, HgB/Hct, TIBC, Fe, transferrin, MCH, MCV |
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|
Term
| Target group for iron deficiency |
|
Definition
| Women, infants, homeless, alcoholics, pregnant |
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Term
| Pernicious anemia- etiology and clinical manifestations |
|
Definition
megaloblastic-- intrinsic factor not secreted
neurological complications, fatigue, fevers, GI symptoms, jaudice |
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Term
| Schilling test tests what? |
|
Definition
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|
Term
| Aplastic anemia etilogy and clinical manifestations |
|
Definition
bone marrow or stem cell damage
fatigue, pallor, thromcytopenia, leukopenia, reticulocytopenia |
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|
Term
| Aplastic anemia treatment |
|
Definition
|
|
Term
| Aplastic anemia target group |
|
Definition
| exposure to chem, radiation, genes, elderly |
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Term
|
Definition
all the cells are small
RISK- fatigue, infection, bleeding
Stay away from children, no fresh fruit, no silk flowers
do not take NSAIDs or coumadin- fear of GI bleed
Monitor for s/s of respiratory illness
**handwashing and masks |
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|
Term
| Polycythemia- what is it? |
|
Definition
| opposite of anemia- increased production of RBCs or relative blood loss of plasma volume |
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Term
| Polycythemia- clinical manifestation |
|
Definition
thicker blood
hypertension
eye and kidney damage
(stroke in girl from Cincinnati) |
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Term
| Polycythemia- potential etiologies |
|
Definition
1)primary-- Polycythemia vera- neoplastic transformation of bone marrow stem cells- overproduction of normal red cells, white cells and platelets
2)Secondary- Chronic hypoxemia- increase RBC production |
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Term
| Polycythemia- complications |
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Definition
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|
Term
| Polycythemia- nursing teaching and consideration |
|
Definition
| avoid tobacco, exercise to avoid clots, watch for sores and care for skin carefully |
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Term
|
Definition
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Term
| Connection btwn B12 and intrinsic factor. AGE? |
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Definition
Intrinsic factor aids in B12 absorption- if you do not have it need B12 IM shots for life
Body secretes less intrinsic factor as we age |
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Term
|
Definition
| new drug used for sickle cell crises- MOA- decreases RBC sickling and increases RBC lifespan. reduces adhesion of RBC to the vascular epithelium |
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Term
| Treatment for sickle cell crises |
|
Definition
| oxygen, aggressive pain management and hydration |
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Term
|
Definition
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