NUR 2474 Exam 2 Study Guide

NUR 2474 Exam 2 Study Guide
ANTI-INFLAMMATORY DRUGS
GLUCOCORTICOIDS
- Foundation of asthma therapy
- Does nothing for acute attacks
- Taken daily for long-term control
- Considered the most effective for prophylaxis
○ Used usually with leukotriene modifiers (Singulair)
- Dosing by fixed schedule (not PRN)
- Mechanism of Action
○ Decrease synthesis and release of inflammatory mediators
○ Suppress airy mucous production
○ Decrease edema of airway mucosa caused by beta-2 agonists
- Usually inhaled (can be PO or IV)
○ Inhaled is safer than oral due to systemic side effects
- Adverse Effects
○ Dysphonia
○ Oropharyngeal candidiasis (rinse mouth/use spacer)
○ Bone loss
○ Infection
○ Hyperglycemia
○ Increased appetite
○ Insomnia
○ Adrenal suppression
- Prolonged use = Must be discontinued slowly
Beclomethasone (Inhaled)
- Rinse mouth after use to avoid thrush and vocal changes
Prednisone (oral)

BRONCHODILATORS
- Does not alter the underlying disease process
- Provides symptomatic relief
- Is usually combined with glucocorticoid for long-term suppression of inflammation
- Used for acute episodes
BETA-2 ADRENERGIC AGONISTS
- Used in asthma and COPD
- Interaction: Negated by beta blockers
- Education:
○ Wait 1 minute between puffs of same med
○ Wait 5 minutes between puffs of different meds
○ Bronchodilator before glucocorticoid
Albuterol (SABA) AccuNeb, Proventil HFA, Pro Air HFA, Venntolin HFA
- Used for acute attack
- Fast on, fast off
- Take PRN

ANTICHOLINERGICS
Ipratropium
- Improves lung function by blocking muscarinic receptors in the bronchi
- Administered via inhalation to relieve bronchospasm
Therapeutic effect onset 30 Seconds
- 50% Maximum 3 Minutes
D u ra ti on 6 Hours
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, - Adverse Effects
○ Dry mouth
○ Hoarseness
○ Pharyngeal irritation
- Patient Education
○ Fluid and hard candy for dry mouth
○ Rinse mouth to reduce taste

INHALED CORTICOSTEROID
Fluticasone
- Rinse mouth after use to avoid thrush and vocal changes

SYMPATHOMIMETIC
Pseudoephedrine

ANTITUSSIVE
Codeine

FOR SEVERE EXACERBATION
Oxygen Relieves hypoxemia
IV Glucocorticoid Reduces airway inflammation
Nebulized High-Dose SABA Relieves airflow obstruction
Nebulized Ipratropium Further reduces obstruction
- Pulmonary Hypertension
○ Affects right side of the heart
○ Arteries and veins harden, increasing BP
○ Causes
▪ COPD, Interstitial lung disease
▪ Scleraderma, Portal hypertension
▪ AIDS, Immune disorders

PROTON PUMP INHIBITORS
Omeprazole

H2 RECEPTOR ANTAGONISTS
Cimetidine
- Take at least 1 hour apart from antacids

OSMOTIC LAXATIVES
Magnesium Hydroxide
- Also used as antacid

SEROTONIN ANTAGONISTS
Ondansetron
- Side Effects
○ Headache
○ Dizziness
○ Fall risk

BULK-FORMING AGENTS
- Take with at least 8 oz of water
Methylcellulose

SURFACTANTS
Docusate Sodium Colace