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Wwall Rx Test 2

wwall RX Review Chap 12, 14, 15 06/08

Antitusuve anti cough
Expectorants increase fluid in resp tract and stimulate cough
SSKI potassium iodine-expectorant for asthma and bronchitis (no longer used)
Bronchorrhea condition associated with excess thin watery pulmonary secretions, most often with head injury, drug of choice- glycopyrrolate (Robinal), hazard is mucus plugging
Mucomyst n-acetylcysteine, mucolytic, breaks down disulfide bonds
Mucus molecule mucopolysaccaride chain, strands of amino acids and amino sugars connected by disulfide bonds
Mucolytics drugs dornase alfa (Pulmozyme), n-acetylcysteine (Mucomyst), sodium bicarb
Dornase Alfa aka Pulmozyme, mucolytic, lyces bacteria and cellular debri DNA, most often used with CF & bronchiectisis, never mix with other drugs, need special jet neb
Sodium Bicarb mucolytic, alters PH to disrupt amino acid chain
mucolytic indicators thick inspissated secretions, aerosol - able to cooperate & deep breath, trach or endotrach by direct instillation
Bland aerosol aerosols that do not have a direct effect on mucus molecule and usually no side effects. Normal saline (.9%NaCl), hypo (.45%NaCl) and hypertonic saline (5%NaCl), and sterile distilled water
Secretion patients CF, bronchiectisis and chronic bronchitis
increased secretion indicators tactile fremitise (you can feel it), rhonchi (low pitch rumble), caused by ineffective cough and muscle fatigue
Mucolytics agents that disrupt musus molecule so that secretions can be removed (coughed or suction), cause mucolysis (breaking apart)
Sterile distilled water most common solution in LVN for humidification of airway, also used as a dilute in SVN
Sputum induction used when pt has dry non-productive cough, hypertonic saline (5% to 10%) not to exceed 1500 mg/day
Hypotonic osmotic pressure is less than body fluid, most common is .45% NaCl (1/2 NS), used in LVN when pt cannot tolerate distilled water and as dilute in SVN for pt with severe salt restriction
Hypertonic osmotic pressure is greater than body fluid, used for sputum production, most common 5-10% NaCl (hygroscopic droplets attract humidity and grow larger)
NS normal Saline, osmotic pressure is same as body fluid (0.9% NaCl), most common bronchodilator dilute, unlikely to cause bronchospasm, but can increase sodium
Bland aerosol indicators pt who require humidity of resp tract, intubated or trach. As thinning agent prior to postural drainage and chest percussion, sputum induction. (continuous jet, Babington or USN)
n-acetylysteine aka Mucomyst, indicated for pt with excessive purulent thick or inspissated secretions, breaks disulfide bond, also used in acetaminophen (Tylenol) overdose, 10-20 % solution, bad smell, max 72 hrs
zafirlukast aka Accolade, anti-asthmatic, selective and competitive antagonist of leukotriene receptors, hazard is renal failure, can’t be taken with food, so poor pt compliance
budesonide aka Pulmacort, aerosol corticosteroid (only SVN steroid) needs a specific jet neb
fluticasone aka Flovent, aerosol corticosteroid,
flunisolide aka Aerobid, aerosol corticosteroid
triamcinolone aka Azmacort, aerosol corticosteroid intermediate duration 5-10 days ramp up
SVN steroid budesonide aka Pulmacort
Asthma attack anatomy mast cell exposed to allergen (antigen-antibody), mast cell degranulates releasing histamines (edema, mucus, constriction), cytokines (recruiters-cause late stage) and leukotrines (inflammatory mediator)
Bronchial asthma most common chronic lung disease, 4% of population and increasing, symptoms, dyspnea, diffuse wheezing, airway obstruction from bronchospasm, edema and mucus.
Asthma mucus thickened & viscid (sticky) with eosinophils
a-adrenergic drugs & mucosal edema indications-difficulty breathing, tachypnea, tachycardia, wheezing. aerosol a-adrenergics give rapid response, with decreased side effects, severe or life threatening cases give in IV or instilled, racemic epi is most common drug
Mucosal edema accumulation of fluid in the mucosal membrane, caused by infection, trauma, disease, or conditions like anaphylaxis or allergic reaction (most often treated with alpha racemic epi
Asthma attack progression coughing, exp wheezes, I:E wheezes, insp wheeze (air trapping), vent failure (intibate)
Anti-asthmatic drug classes mast cell stabilizers & leukotriene blockers
Corticosteroid side effects long term oral- cushing syndrome, immunosuppressant & diabetes’s, aerosols- throat irritation, horsiness, coughing, dry mouth, fungals-candidiasis (do not use w/bronchiectisis, pneumonia)
Corticosteroid indicators aerosolized should always be considered if long term use is ordered, pt who are unresponsive to B2 bronchodilators, IV or IM with status asthmaticus
Corticosteroids anti-inflammatory, steroids produced by the adrenal cortex
Aerosol steroid advantage decreased systemic side effects, no addiction, no cushings
Aerosol steroid disadvantage increased expense, not for status asthmaticus, increased risk of superinfection, horseness, cough, requires pt effort and coordination
Severe asthma protocol 1st line-O2, B2 bronchodilator, steroid-(prednisone IV), 2nd line – anticholenergic-Atrovent, 3rd line- epinephrine-IM or aerosol. if all fails then intibate and mech vent
Asthma attach management 1-B2 agonist, 2-steroids/anti-inflammatory, 3-increase 1 and 2
leukotrine blockers competitive antagonist for leukotrines receptors, Accolade aka zafirlukast, Singular aka montelukast, Zyflo aka zileutin
Mast cell stabilizers prophylactic-prevent extrinsic asthma by stabilizing mast cell wall so it will not burst, Intal aka cromolyn sodium and Tilade aka nedocromil sodium
Created by: annabannana