Exam (elaborations)
N 615 Exam 4 Pharm Study Guide complete solution
- Course
- Institution
N 615 Exam 4 Pharm Study Guide N 615 Exam 4 Pharm Study Guide N 615 Exam 4 Pharm Study Guide
[Show more]
Seller
Follow
BSNGUIDER
Reviews received
Content preview
1Exam 4 Pharm Study Guide
Week 12 Chapters 17, 30 Respiratory, asthma, COPD
Week 13-17, 42, 45 Respiratory meds, pneumonia, TB
Week 14- 20, 34 GI medications, GERD, PUD
Week 15-16 350-359, 47 Diuretics, UTI
Chapter 17
❖ Bronchodilators
❖ BETA 2 RECEPTOR AGONISTS (B2RA) Albuterol (Pro Air, Ventolin, Proventil) Most
common
❖ Short-acting B2RA’s Metaproterenol (Alupent) Terbutaline (Brethine, Brethair),
bitolterol (Tornalate), pirbuterol (Maxair), levalbuterol (Xeopenex)
❖ Short-acting used for acute attacks only
❖ Terbutaline is used in pregnant patients to prevent pre-term labor
❖ Long-Acting B2RA’s arformoterol (Brovana) formoterol (Foradil), indacaterol
(Arcapta), and salmeterol (Serevent)
▪ The use of long-term medications is contraindicated without the
use of an asthma controller medication, such as inhaled
corticosteroid.
▪ African Americans should not be prescribed LABA’s- will worsen
asthma control, causing down-regulation of the b-adrenergic
system and will stimulate the b-receptors
▪ Certain polymorphisms of the human b2 adrenergic receptor
gene has also been implicated. Asthma patients who are
homozygous for the variant with an arginine at the 16th amino
acid position on the b2-adrenergic receptor are at risk for
decreased airflow and worsening asthma with using b-agonists
▪ LABA’s CANNOT be used alone. Not first line therapy-CANNOT
USED ALONE!!!
▪ LABA’s should be used only if short-acting are not working, only
use them for a short time.
▪ Formoterol and indacaterol use a dry powder capsule that is
inhaled, do not swallow!
▪ Beta 2 receptor agonists affect lung and also CNS,
cardiovascular system, and skeletal muscle
Drugs affecting the respiratory system Beta 2 receptor agonists
N 615 Exam 4 Pharm Study Guide
, 2
▪ MOA: Act on the smooth muscle of the bronchial tree to reverse
bronchospasm
▪ Decreasing airway resistance and residual volume
▪ Increases vital capacity and airflow
▪ Stimulate Beta 2 adrenergic receptors in the lungs to increase
the production of cyclic adenosine monophosphate (cAMP) by
activation of adenyl cyclase, the enzyme that catalyzes the
conversion of ATP to cAMP
▪ Increased cAMP concentrations relax bronchial smooth muscle
and inhibit release of mast cells
▪ Beta 2 open large conductions in calcium activated potassium
channels and thereby tending to hyperpolarize airway smooth
muscle cells, the combination of decreased intracellular calcium,
increased membrane potassium conduction and decreased
myocleynase activity leads to smooth muscle relaxation and
bronchodilation
➢ Albuterol is first-line choice of therapy (also called salbutamol)
➢ Albuterol is selective to Beta 2 and minor to Beta 1
➢ Can lead to tremors
➢ Adverse Drug Reactions of all Beta Agonist bronchodilators: Cardiac arrhythmias
associated with tachycardia, or heart-block caused by digitalis intoxication,
angina, narrow-angle glaucoma, organic brain damage, and shock during
general anesthesia are all contraindications to Beta 2 agonists
➢ Side effects are usually transient-do not need to stop medications
➢ Patients with hypertension, heart disease, coronary insufficiency, congestive
heart failure and history of stroke or cardiac arrhythmias should be monitored
closely
➢ Diabetic patients-possibility of drug induced hyperglycemia*Insulin may need to
be increased.
➢ Patients taking digoxin require close monitoring
➢ Patients with pheochromocytoma should avoid beta-adrenergic antagonists due
to possibility of severe hypertension
➢ May need lower doses of bronchodilators in older adults
➢ Supraventricular and ectopic beats have occurred with beta adrenergic inhalation
➢ Beta adrenergic receptors exhibit CNS stimulation
➢ Tremors, dizziness, shakiness, nervousness, restlessness
➢ Headaches
➢ Insomnia-rare
➢ Post-inhalation cough
➢ Overuse can lead to seizures, hypokalemia, angina, hypertension
➢ DRUG INTERACTIONS BETA 2 RECEPTOR AGONISTS
N 615 Exam 4 Pharm Study Guide
, 3
▪ Beta agonists prescribed with digitalis glycosides, caution and
careful monitoring of ECG- due to an increased risk of
arrhythmia’s
▪ TCA’s and MAOI’s with albuterol and metaproterenol, terbutaline
can potentiate the effects of the bronchodilator on the vascular
system
▪ Hypokalemia may be observed with co-administration of beta
agonists combined with drugs that lower potassium level
(Diuretics)
❖ The only short-acting bronchodilator that can be prescribed for children under 4 is
albuterol and metaproterenol
❖ Albuterol is the cheapest
❖ MONITORING-Peak Flow
❖ If on digitalis- an EKG is needed
❖ If on diuretics- K+ monitoring
PATIENT EDUCATION:
◆ Use as prescribed
◆ Store in dry, cool place, out of light
◆ Overuse will lead to an increase in adverse effects, Increased
bronchospasm and decreased pulmonary function
◆ To use inhaler, the patient should first EXHALE, then tilt head back
slightly and place the inhaler mouthpiece about 2 inches from open
mouth or between open lips
◆ While inhaling, the patient should press down the canister
◆ Breathe in slowly and deeply and hold breath for 10 seconds
◆ Tell provider if you have palpitations, tachycardia, chest pain, muscle
tremors, dizziness, headache, or flushing
XANTHINE DERIVATIVES Theophylline, aminophylline, caffeine
MOA: Produces an increase in cAMP, mediated by selective inhibition of specific
phosphodiesterase’s (PDE’s) This leads to bronchial smooth muscle and pulmonary
vessel relaxation
◆ Theophylline and caffeine have an effect on the CNS, causing
insomnia and excitability
◆ Theophylline has a greater impact on the cardiovascular system
◆ Theophylline directly stimulates the myocardium, increasing HR and
myocardial contractility
◆ Both medications can cause GI upset, N/V, tremors
❖ Pharmacokinetics
N 615 Exam 4 Pharm Study Guide
, 4
❖ Monitor usage of theophylline in elderly, hepatic impairment, pregnancy in third
trimester, -TAKE SERUM THEOPHYLLINE LEVELS
❖ CY450
❖ Smoking and high protein diets can increase theophylline excretion rates
❖ High carb diet can decrease theophylline excretion rates
❖
Contraindications to Theophylline
▪ Hypersensitivity to xanthine, PUD, and underlying seizure
disorder
▪ Patients with hypertension, heart disease, coronary
insufficiency, stroke, need to be monitored closely
▪ Toxicity occurs with theophylline doses above 20 mcg/ml
❖ ADR:
❖ Uncommon with theophylline doses below 20 mcg
❖ CNS affects- irritability, nervousness, restlessness, seizure, insomnia
❖ GERD
❖ At serum of theophylline above 20 mg- patient will experience N/V, diarrhea,
headache, GI issues
Caffeine adverse effects- cardiac arrhythmia’s insomnia, agitation, N/V, gastric irritation
Patient teaching
Cannot smoke and use nicotine replacement therapy, increases theophylline clearance
◆ Concurrent use with a Beta 2 agonist may result in additive toxicity
◆ Theophylline elimination may be influenced by high protein or high
carb diet
◆ A diet with a lot of charcoaled foods accelerates hepatic metabolism
◆ Caffeine elimination may be increased with the administration of
phenobarbital and phenytoin
◆ Monitor for toxicity every 6-12 months
◆ Serum theophylline levels need to be drawn 1-2 hours after immediate
release formulas and 5-9 hours after the morning dose of sustained
release
◆ If patient changes brands, then theophylline levels need to be drawn
◆ Take dose in a timely manner, do not crush or chew
◆ Self-monitor with peak flow monitor
◆ Quit smoking, avoid environmental triggers
ANTICHOLINERGICS Ipratropium bromide (Atrovent) Tiotropium bromide (Spiriva)
aclidinium bromide (Tadorza Pressair) Used mainly for COPD, although ipratropium
may be used in combination with albuterol as an emergent treatment of an asthma
exacerbation or when a patient is intolerant to Beta 2 agonists
N 615 Exam 4 Pharm Study Guide
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller BSNGUIDER. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $20.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
85443 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now