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Wwall Rx Test 2
wwall RX Review Chap 12, 14, 15 06/08
| Question | Answer |
|---|---|
| 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
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