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Final NURS 1114

Nursing 1114 Final Study Set

Which insulins are rapid acting? Novolog, Humalog, Apida
What is the onset, peak, and duration of the rapid acting insulins? Onset: 5-15 minutes Peak: 30-90 minutes Duration: <5 hours
Which insulin(s) are short acting? Regular Insulin
What is the onset, peak, and duration of the short acting insulin(s)? Onset: 30-60 minutes Peak: 2-3 hours Duration: 5-8 hours
Which insulin(s) are intermediate acting? NPH
What is the onset, peak, and duration of the intermediate acting insulin(s)? Onset: 2-4 hours Peak: 4-10 hours Duration: 10-16 hours
Which insulin(s) are long acting? Lantus, Levemir
What is the onset, peak, and duration of the long acting insulin(s)? Lantus: 2-4 hour onset, no peak, 20-24 duration. Levemir: 3-8 hour onset, no peak, 5.7-23.2 hour duration.
What is the onset, peak, and duration of the Humalog and Novolog premixed insulins? (Same for all 3 mixes) Onset: 5-15 minutes Peak: Dual Duration: 10-16 hours
What is the primary reason humans needs glucose? The brain needs a constant supply of glucose since it cannot make or store it. Glucose is the main fuel for the CNS.
What is the difference between type 1 and type 2 diabetes with regard to beta cells and insulin production? Type 1 diabetics are insulin *dependent* due to beta cell *destruction* in the pancreas. Type 2 diabetics have insulin *resistance* due to beta cell *dysfunction*.
What A1C levels are indicative of diabetes? 5.7-6.4 is prediabetes. 6.4 and above is diabetes.
What fasting PG levels are indicative of diabetes? 100-125 is prediabetes; >125 is diabetes.
What OGTT (impaired glucose tolerance test given 2 hours after a big dose of glucose) level is indicative of diabetes? 140-199 is prediabetes; >200 is diabetes.
Why is a blood glucose below 70 important? Anything below 70 in blood glucose increases cell death in the brain.
What should the blood glucose be 2 hours post prandial (post meal)? <200
What is hypernatremia? And what does it affect? High sodium causes increased osmolarity, fluid shift from intracellular to extracellular. Affects cardio, cerebral (confusion), but does not affect the bowels.
What is a normal sodium range? 135-145
What is hyponatremia? And what is a symptom? Low sodium. Causes increased bowel sounds.
What is hypokalemia? And what are symptoms? Low potassium causes shallow respiration, confusion, drowsiness.
What is the normal range for potassium? What can cause abnormal readings? 3.5-5.0. Diarrhea and duiretics cause hypo, kidney disease and salt subs can cause hyper.
What is hyperkalemia? What are the symptoms? High potassium causes muscle twitches, not walking well. Biggest is cardiac changes (tall peaked T waves).
What is the range for calcium? 9.0-10.5
What is hypocalcemia? What 2 signs are used to check for it? Low calcium. Charlie Horses could be caused by low calcium, more so than low potassium. Chvostek's sign and Trousseau's sign are ways to check for hypocalcemia.
Chvostek's sign is what? A facial tic when you tap on the facial nerve in front of the ear.
Trousseau's sign is what? A carpal spasm after leaving a BP cuff inflated on the farm for 2-5 minutes.
What is hypercalcemia? Hypercalcemia is high calcium. It suppresses cellular excitability, which makes you more lethargic and maybe slows reflexes. Hyperparathyroid hormone is a possible cause.
What is hypophosphatemia? Low phosphorous. It is needed to break down vitamins and for cell growth. Monitor output. Muscle weakness is a major issue. Check their hand grip every 12 hours to check for diminished strength. If the grip isn't good, check respirations immediately.
What is hyperphosphatemia? Hyperphosphatemia is high phosphorous. It can be controlled by increasing calcium.
What is the normal range for phosphorous? 3.0-4.5
What is the normal range for magnesium? 1.3 to 2.1
What is the importance of magnesium? Needed for *skeletal muscle contractions*, vitamin activation, cell growth, and carb metabolism. When Ca and Phosphorous are out of balance, it can affect magnesium. Check tendon reflexes when giving magnesium.
What is the normal range for pH? 7.35 to 7.45 is normal. pH below 6.8 or above 7.8 is equal to death.
What can aspirin overdose cause? Metabolic acidosis
What is the range for PC02? 35-45
What is the range for PO2? 80-100
What is the range for HCO3? 22-26
What is a potential side effect of Lasix? Lasix could cause metabolic alkalosis because it is a potassium wasting diuretics. (An acid-base problem a client might have from taking Lasix for HTN could be “Acid deficit secondary to metabolic alkalosis”.)
What is a potential side effect of respiratory alkalosis? Respiratory alkalosis can cause seizures and tingling of extremities.
What is the most important thing to obtain before administering IV fluid? Which fluid you are supposed to use (sounds simple but I swear she said this was important!)
What is infiltration? When the IV fluid goes outside the vein. Causes swelling, tenderness, tingling sensation.
What is phlebitis? Inflammation of the vein. Cause the vein to be hard, red, swollen.
What is extravasation? Formation of necrotic tissue related to IV fluid used. Typically morphine or phenergrine.
Do you ever hang blood by itself? No. It should always be hung with normal saline.
What is it important to record when dc'ing a non tunneled percutaneous catheter? After dc'ing a non tunneled percutaneous catheter, it is very important to record the length of the catheter.
If you are the nurse caring for a client recving an epidural infusion for pain, what action or vital sign has the highest priority? Respirations
Why is pain protective? It is a sign that something needs attention and something is wrong.
What is pain threshold? Pain threshold is the lowest intensity of a pain stimulus that the individual perceives as pain. Things like fatigue and past experience can affect this threshold.
What is pain tolerance? Pain tolerance is the amount of pain a person is willing to endure.
What is nociceptive pain? Nociceptive is when pain impulses are processed normally over intact nerves. The 3 types are somatic, visceral, and referred.
What is somatic pain? Somatic=Originates from bones, joints, muscles, skin, or connective tissue.
What is visceral pain? Visceral=Pain that arises from the body organs
What is referred pain? Referred=Result of the transfer of visceral and somatic pain via the autonomic nervous system to a region distant from the origin. Like shoulder pain during a heart attack.
What is neuropathic pain? Neuropathic is pain that results from an injury to a nerve. It also involves a malfunction of the transmission process. Causes are things like trauma, diabetes, herpes zoster (shingles), cancer, amputation.
What is acute pain? Usually associated with injury, surgery, illness. The distinction is it subsides with medication and goes away once the body is healed. The autonomic system is involved and caused increased BP, HR, etc. Onset is sudden and usually of shorter duration.
What is chronic pain? Sudden or slow and lasts longer than 6 months. Etiology may not be known and can develop from acute pain that was not treated. It is a disease process unto itself. Physical signs normally associated with pain—such as grimacing—are usually not present.
What are the 3 types of cancer pain? Persistent, breakthrough, and intractable.
What is persistent cancer pain? Lasting 12 hours or more
What is breakthrough cancer pain? Breakthrough=“breaks through” the medication treatment. Very common during ADLs. Best to give pain meds before performing ADLs
What is intractable cancer pain? Intractable=when it becomes very difficult to find anything to treat the pain
Would you use a different pain assessment tool for the same patient? There should be consistent use of the same assessment tool for pain with each individual patient. In other words, you wouldn’t use one assessment tool that morning then a different one that afternoon for the same patient.
What are some other ways to treat pain other than meds? Pain is treated through both medication and nonpharmacological methods such as relaxation exercise, laughter, massage, ice, distraction.
Why is it important to treat acute pain promptly? The longer pain stimuli acts on the CNS, the more likely the development of chronic pain.
Should you take NSAIDS with blood thinners? NSAIDS (anti-inflammatory drugs) should not be taken with other drugs that thin the blood like Warfarin (Coumadin)
What is physical dependence? Physical dependence=involuntary, altered physiological state produced by repeated administration of a medication. Can be treated by tapering meds. When we say physical dependence has developed, it does not mean that the person is addicted.
What is addiction? Addiction=compulsive disorder when an individual becomes preoccupied with obtaining and using a substance despite negative consequences.
What is tolerance? Tolerance=occurs when higher dose of the drug is required to achieve the desired resul
What is the main downside of Demerol? The main downside of Demerol is the short duration of action.
What are some contraindications for opioids? Contraindications for opioids: head injuries, renal insufficiency, geriatric, hypotension.
What is the number one side effect of opioids? The number one side effect of opioids is constipation. All should have a bowel regimen like increased fiber.
What are carotenoids? Carotenoids are the cells that give a yellowish color to skin.
What are eccrine? The eccrine glands are the sweat glands. They are involved in the function of the skin.
What is important to note when a patient is severely burned? If a patient is severely burned, skin is not there to synthesize vitamin D and the patient will need a supplement.
What is important when assessing people of color? Remember that in people of color, a darker spot may remain after a legion heals and they are more prone to keloid scarring. In cyanonis, there will be a bluish tinge to palms or soles of feet.
What is ichthyosis? Overly dry scaly skin is ichthyosis.
What is mechanical debridement? Mechanical: Use gauze. Put it on wet, allow to dry, then pull it off.
What is enzymatic debridement? Enzymatic: Use of a chemical, usually an enzyme.
What is autolytic debridement? Autolytic: Use of normal phagocytic action. Phagocytes and leukocytes. Slow process, preferred in the immunosuppressed.
What is sharp debridement? Sharp: necrotic tissue is removed with a cuttery or scalpel. Usually uses anesthesia and operating room.
What is conservative sharp debridement? Conservative sharp: only superficial or loosely adhered tissue is removed. No anesthesia or OR used.
What is MDT debridement? MDT: Maggot debridement therapy. A biobag is used.
What is debridement most effective? Debridements are most effective right after bathing, w/in 3-5 minutes.
Why shouldn't you use group 1 corticosteriods under an inclusive dressing? Don’t use group 1 corticosteriods under an inclusive dressing. Especially if its over a large area over a prolonged length of time. It can lead to systemic adrenal insufficiency.
What are keritonicytes? Keritonicytes are clogs in the follicular duct. Accumulation of sebum and keritonous debris.
What are comodones? Comodones=blackheads; pacules, pustules, nodules=sequence of severity.
What is the treatment for acne? Mild=use a gentle wash with benzol peroxide. Moderate=same with a topical antibiotic added and benzol used twice a day. Severe=Same as moderate with oral antibiotic added. Sometimes they even inject a medication into the lesion.
What is atopic dermatitis? Chronic puritic (itchy) skin condition. Causes inflammation, typically gets better then worse then better then worse. Flares could be triggered by stress, seasonal changes, allergens, etc.
What is the itch-scratch cycle? Itch scratch cycle: The scratching triggers more itching. Chronic scratching causes a thickening of the skin and more inflammation, which causes breaks in the skin, which causes infection. Treatment is aimed at relieving dryness and itching.
What is psoriasis? Psoriasis: genetic inflammatory disease that characterized by epidermal hyperplasia (thickening of tissue). Characterized by thick red skin patches with silvery scales.
Should you teach a diabetic patient to eat low carb? No. Teach them to eat a balanced diet and not low carb.
What is primary prevention for diabetes? Primary prevention is lifestyle changes, weight loss, increasing activity, increasing fiber.
What is secondary prevention for diabetes? Secondary prevention is controlling diabetes and includes things like 130 grams of carbs per day for energy, 40-60 grams per meal and 15-30 carbs per snack. Increased fiber is also important and helps stabilize blood glucose
What is tertiary prevention for diabetes? Tertiary prevention is managing complications from diabetes, such as things like having an annual eye exam by an ophthalmologist, a yearly micro albumin level to check for protein in the urine to check for kidney damage.
What is the treatment for non-severe hypoglycemia? Treatment for hypoglycemia (70 or less): Intake of 15-20 grams of a glucose source, possibly a glucose tablet or a snack like a small glass of milk or OJ.
During illness, why is it important to monitor a diabetic's blood glucose? Blood glucose often drops during illness in diabetics.
What is an important patient teaching regarding exercise in type 1 diabetics? For type 1 diabetes, it is important to teach those patients to exercise vigorously only when blood glucose is 80-250.
What is an important diabetic patient teaching regarding foot care? For type 1 & 2, both need to be taught good food care (check feet daily) and use clippers or a file and not scissors.
What is the treatment for severe hypoglycemia? In hospital settings, treatment for severe hypoglycemia is glucagon. It works by promoting glucose release from the several liver storage sites. It is considered an insulin antagonist.
Which insulin can be given IV? Regular only
What should you always check before administering insulin? Blood glucose
Which insulin cannot be mixed or diluted? Lantus (Glargine)
Insulin is created to help mimic _____ _____ ____ __ ______. normal insulin patterns of release (In the body, insulin is normally released after a meal.)
What are some things that affect insulin absorption? Insulin absorption is affected by injection site, injection depth, type of insulin, dose, timing of the dose, physical activity of patient.
Why is it important to rotate the sites of insulin injection? Make sure you rotate the sites of insulin injection to prevent scar lipodystrophy or lipoatrophy (loss of tissue) or hypertrophy (build up of tissue).
How long can insulin be kept unrefrigerated? 28 days.
What are some important patient teachings regarding insulin storage and injection? Avoid sunlight and extreme temperatures (36-86 Fahrenheit). Patient must inspect bottle for clarity. Teach them to buy the same kind of syringe and never to reuse. Teach them about safe disposal programs.
What is an important note about oral diabetic medications? With oral medications, some insulin must be produced by the patient's body otherwise they won't work.
What is important to remember about sulfonylurea medications? Nsaids increase the hypoglycemic effect of sulfonylureas.
What is a side effect of alpha-glucosidase inhibitors? Delay the absorption of glucose from the small intestine. Main side effect is flatulence.
What is a side effect of biguanides? The main ones are gastro issues such as diarrhea.
What is a side effect of meglitinide? They can cause hypoglycemia.
What is a side effect of thiazolidinediones? They improve insulin sensitivity and have very little to no hypoglycemia, however they do increase the risk for heart related deaths.
When is a insulin most likely to cause hypoglycemia? At the peak of action.
If you see any irritation of any kind, or if the patient complains that an IV is burning them, what do you do? Stop the infusion.
Which arteries supply the heart with oxygen? And of these arteries, which is the smallest and therefore most likely to become blocked? The coronary arteries. The right one is smaller.
What are baroreceptors? And where are they located? Sensors that help regulate BP. They are located in the carotid and aortic arch.
Will increased preload increase the cardiac output indefinitely? No. Generally, increased preload increases CO but after a certain point the increased preload doesn’t increase cardiac output.
What is VEDP? VEDP ventricular end diastolic pressure is the pressure generated by the blood returning to the ventricles and affected by blood volume
What is a normal ejection fraction? The ejection fraction is the % of blood pumped from the ventricle during systole. 60-70% is normal.
What is stroke volume? Stroke volume (blood pumped from ventricle during contraction) affected by heart disease, lack of elasticity of vessels assoc with aging
What is the most accurate way to measure BP? Invasive b/p monitoring with arterial catheters is the most accurate way to measure BP.
What is a normal anteroposterior (AP) diameter? And what is indicative of COPD? 2:1 is normal but 1:1 is a barrel chest, indicative of COPD.
In CV patients, what can cause shiny skin? Malnutrition
In CV patients, what do you look for in the extremities? Color change in lower extremities with position
In CV patients, what are brownish discolorations indicative of? Venous insufficiency
In CV patients, what is localized redness--particularly in the legs--indicative of? DVT
How are pulses graded? 0=none 2=average 4=bounding
What is all pigs eat too much? Aortic-2nd intercostal space to right Pulmonic-2nd intercostal space to left Erbs-3rd intercostal Tricuspid-5th intercostal space left Mitral--5th intercostal mid clavicular
What is an echocardiogram? Non invasive. Basically like an ultrasound. Will show red and blue blood. Takes about 30 to 45 minutes to do. Doesn't have to be NPO. Tell patient it doesn't hurt, no needles, cold gel.
Which patients can't have a pharm stress test? Asthma and COPD patients due to bronchospasms.
What do you need to know about cardiac catheterization? Hot sensation from dye, Remove all metal objects, Premedicate 30 minutes before, Vital signs and distal pulses q15 minutes until stable.
When BP falls, what is the domino effect in the body? GFR falls, promoting Na and H2O retention. Increases blood volume and venous return, increasing CO and BP.
What are the effects on the renal system when BP falls? (Answer is mostly a cut & paste from Cheryl's notes) Renin causes conversion of angiotesinogen to angiotension 1; ACE converts to angiotension II-vasoconstrictor which increases BP and PVR and NA and h2o retention; Angiotension II causes aldosterone release which further increases NA and h2o retention
What releases ADH? And what does ADH do? Posterior pituitary releases ADH. Promotes water reabsorption by the kidneys. Increases blood volume and bp
What is prehypertension? 120-139 over 80-89
What is stage 1 hypertension? Stage 1 is 140-159 over 90-99
What is stage 2 hypertension? Stage 2 is 160 over 100 and greater.
What can headache and visual disturbances be a sign of? hypertension
What is the goal in treating hypertension? GOAL-PREVENT DEATH AND COMPLICATIONS and keep B/P ≤140/90
What are some patient teachings with diuretic hypertension drugs such as Lasix and Aldactone? Know where the restrooms are and increase potassium
What is an undesired side effect of sympatholytic hypertension drugs such as Lopressor or anything ending in lol? Sexual dysfunction and orthostatic hypotension.
What are some common side effects of angiotensin inhibitors? The ones that end in -pril: dry cough The ones that end in -sartan: headache
What is an important patient and patient family teaching with hypertension? Longterm implications—lifelong process, not acute. Can't stop and start medicine. When BP lowers, you feel more tired, making patients want to stop meds.
What are some reasons for BP errors? Too many to list. Things like limb not at heart level, anxiety, caffeine or cigarettes, cuff not applied properly, bladder is not centered over artery, did not wait 1-2 minutes between measurement, etc
What are some questions to ask when assessing chest pain? Duration, intensity, what starts it, where
What is Lasix (Furosemide)? A diuretic. Usually first line treatment for hypertension.
What is Aldactone (Spironolactone)? A diuretic. Treatment for hypertension.
What is Aldomet (Methyldopa)? A sympatholytic antihypertensive. Doesn't end in LOL but is one of the ones that causes sexual dysfunction and orthostatic hypotension.
What is Tenormin (Atenolol)? A sympatholytic antihypertensive.
What is Lopressor (Metoprolol)? A sympatholytic antihypertensive.
What is Zestril (Lisinopril)? An angiotension inhibitor. Causes dry cough.
What is Diovan (Valsartan)? An angiotension inhibitor. Causes headache.
What is Glucidoral (Carbutamide)? Diabetes med. A first generation sulfonylurea.
What is rust colored sputum indicative of? Pneumonia
What is Orinase (Tolbutamide)? Diabetes med. A first generation sulfonylurea.
What are the second generation sulfonylureas? All start with Gli or Gly: Glibenclamide, Glyburide, Glibornuride, Glipizide, Gliquidone, Glisoxepide, Glyclopyramide, Glimepiride, Gliclazide. All generic names.
What is Precose (Acarbose)? Diabetes med. Alpha-glucosidase inhibitors
What is Glyset (Miglitol)? Diabetes med. Alpha-glucosidase inhibitors
What is Voglib (Voglibose)? Diabetes med. Alpha-glucosidase inhibitors
What is Glucophage (Metformin)? Diabetes med. A biguanide.
What is Starlix (Nateglinide)? Diabetes med. A meglitinide.
What is Prandin (Repaglinide)? Diabetes med. A meglitinide.
What is Actos (Pioglitazone)? Diabetes med. A thiazolidinedione.
What is Avandia (Rosiglitazone)? Diabetes med. A thiazolidinedione.
What is Glucotrol (glipizide)? Diabetes med. Second generation sulfonylureas.
What is Micronase (glyburide)? (There are 3 of these with the generic name glyburide.) Diabetes med. Second generation sulfonylureas.
What is DiaBeta (glyburide)? (There are 3 of these with the generic name glyburide.) Diabetes med. Second generation sulfonylureas.
What is Glynase (micronized glyburide)? (There are 3 of these with the generic name glyburide.) Diabetes med. Second generation sulfonylureas.
What is Amaryl (glimepiride)? Diabetes med. Second generation sulfonylureas.
When do you obtain blood from the bank for a transfusion? Right before. Do not store the blood in the frig on the nursing unit. Blood should not be held at room temp for more than 30 min. before the transfusion is initiated.
What are signs of a hemolytic reaction from a blood transfusion? What do you do if your patient experiences signs of a reaction during a transfusion? Hemolytic reaction: chills, fever, HA, backache, dyspnea, cyanosis, chest pain, tachycardia, hypotension. Stop the transfusion immediately.
What does the RO stand for in ROME? Respiratory Opposite. So if the pH is up and the PCO2 is down, then it's respiratory alkalosis. If the pH is down and the PCO2 is up, then it's respiratory acidosis.
What does the ME stand for in ROME? Metabolic Equal. So if the pH is up and the HCO3 is up, it's metabolic alkalosis. If the pH is down and the HCO3 is down, it's metabolic acidosis.
What is dyspnea? Difficulty breathing.
What is orthopnea? The inability to breathe in a supine (flat) position.
How do you differentiate respiratory from cardiac chest pain? Cardiac is described as a crushing type pain that radiates whereas respiratory is described as a rubbing type pain and doesn't radiate.
What is red bloody sputum indicative of? Red or pink, frothy is indicative of pulmonary edema. Red bloody is indicative of left heart failure, mitral stenosis, or trauma to airway.
What is grayish-white mucoid sputum indicative of? Emphysema or tuberculosis.
What is yellow green sputum indicative of? Bronchopulmonary infection.
What is meant by "pack years"? How many packs/day times how many years total. For instance, 1 pack a day for 3 years would be 3 pack years. 2 packs a day for 3 years would be 6 pack years.
What is cervical adenopathy? Swollen lymph nodes around the head or neck.
What is the normal finding when assessing the trachea? Should be midline. If not, this can indicate a problem.
What is Kussmaul breathing? Rapid deep breathing. Usually associated with diabetic ketoacidosis.
What is Biot's (ataxic) breating? periodic breathing with irregular depth and rhythm with periods of apnea. (indicates increased intracranial pressure)
What is Cheyne-Stoke's breathing? cresendo/decresscendo breathing with periods of apnea (associated with heart failure, encephalopathy or stroke)
What is Apnuestic breathing? prolonged inspiration (neurological damage to resp. center of the brain)
What are some *early* signs of hypoxia? Change in mental status, confusion, restlessness, drowsiness, headache, increased respiratory rate and increased heart rate.
What are *late* signs of hypoxia? Hypotension, arrhythmia, cyanosis, coma
What is crepitus? Crepitus – is air trapped under the skin that is felt as a crackling sensation beneath the fingertips. Feels kinda like rice crispies.
What is tactile fremitus? And which mediums transmit sound best--liquids, solids, or gases? Vibration of the chest wall produced when the patient speaks. With alterations in pleural space or lungs fremitus may be either increased or decreased. Ask pt to repeat 99 while palpating chest. Liquid and solid transmit sound better than air.
What does resonance indicate when percussing the respiratory system? Resonance is characteristic of normal lung tissue
What are adventitious breath sounds? Adventitious breath sounds are additional breath sounds superimposed on normal sounds and they indicate pathological changes. Ex: crackles, wheezes, rhonchis, etc.
What are and which classes of drugs are bronchodilators? Increase bronchiolar smooth muscle relaxation but have no effect on inflammation. Beta2 Agonists, Cholinergic Antagonists, and Methylxanthines.
What are short acting Beta2 Agonist? Bronchodilators. Provide rapid/short term relief. These are inhaled medications Used as rescue medications or premedication prior to activity likely to induce asthma attack. (prior to exercise)
What class of drug is albuterol (Proventil, Ventolin)? Bronchodilator: Short Acting Beta2 Agonist
What class of drug is levalbuterol (Xopenex)? Bronchodilator: Short Acting Beta2 Agonist
What class of drug is pirbuterol (Maxair)? Bronchodilator: Short Acting Beta2 Agonist
What class of drug is terbutaline (Brethaire)? Bronchodilator: Short Acting Beta2 Agonist
What are long acting Beta2 agonists? Inhaled medication Use can decrease the need for rescue meds. This group needs time to build up an effect but the effects last longer They are used for prevention NOT rescue
What class of drug is formoterol (Foradil)? Bronchodilator: Long Acting Beta 2 Agonist
What class of drug is salmeterol (Servent)? Bronchodilator: Long Acting Beta 2 Agonist
What are Cholinergic Antagonists? Bronchodilator. Decrease pulmonary secretions. Most are short acting requiring dose adm several times per day. Not considered first line because they are not as effective as the beta 2 agonist.
What class of drug is ipratropium bromide (Atrovent)? Bronchodilator: Cholinergic Antagonist. Most commonly prescribed in that class.
What class of drug is tiotropium (Spriva)? Bronchodilator: Cholinergic Antagonist. Only long acting drug in its class.
What are Methylxanthines? Bronchodilator. Not considered first line. Still used for hospitalized patients with COPD exacerbation. These are systemic medications. Numerous S/E and narrow therapeutic index–require blood drug levels. S/E are cardiac and nervous system related.
What class of drug is theophylline (Theo-dur)? Bronchodilator: Methylxanthines
What class of drug is aminophylline (Truphylline)? Bronchodilator: Methylxanthines
What are corticosteroids? Anti-inflammatory drugs. Used in the treatment of both COPD and Asthma May be administered systemically or inhaled. Both are used for prevention not rescue.
What class of drug is Fluticasone (Flovent)? Anti-inflammatory Agents: Corticosteroids. Inhaled once daily for maintenance.
What class of drug is budesonide (Pulmicort)? Anti-inflammatory Agents: Corticosteroids. Inhaled once daily for maintenance.
What class of drug is mometasone (Asmanex)? Anti-inflammatory Agents: Corticosteroids. Inhaled once daily for maintenance.
What is an important patient teaching regarding inhalers? Very important to teach the patient the difference between rescue inhalers and maintenance inhalers. All corticosteroid inhalers will be maintenance.
What class of drug is prednisone (Deltasone)? Anti-inflammatory Agents: Corticosteroids. Systemic. Taken orally. Reserved for short term tx of moderate asthma and in severe cases daily use and in COPD for exacerbation.
What are NSAIDs (regarding respiratory tx)? This group includes a variety of agents that work to reduce airway inflammation in different ways. May be oral or inhaled. Used for maintenance/prevention not rescue. Administered daily
What class of drug is Nedocromil(Tilade)? Anti-inflammatory agents: NSAIDS
What class of drug is cromolyn sodium(Intal)? Anti-inflammatory agents: NSAIDS
What are Leukotriene Antagonist? Anti-inflammatory agents. Oral drugs- used mainly for asthma, not COPD Maintenance/Prevention drugs administered daily, not used for rescue.
What class of drug is Montelukast (Singulair)? Anti-inflammatory agents: Leukotriene Antagonist
What class of drug is Zafirlukast (Accolade)? Anti-inflammatory agents: Leukotriene Antagonist
What class of drug is Zileuton (Zyflo)? Anti-inflammatory agents: Leukotriene Antagonist
What are Immunomodulators? Anti inflammatory. Used for maintenance/prevention- not for rescue- mainly used for asthma. Only one is Omalizumab (Xolair).
What class of drug is Omalizumab (Xolair)? Anti-inflammatory agents: Immunomodulators. Injected subq every 2-3 weeks High risk of anaphylaxis associated with this drug Because of this risk the drug is Adm. In a clinical setting, not for self administration. Very expensive-approx $10k.
What is the biggest difference between COPD and asthma? COPD is NOT reversible and is progressive. COPD also affects the aveoli and asthma affects the airways only.
Are emphysema and chronic bronchitis forms of COPD? It is important to note that emphysema and chronic bronchitis are no longer included in the formal defintion of COPD but they are still used clinically.
What are the 3 primary symptoms of COPD? Cough Sputum production Dyspnea on exertion
What is the number one priority with COPD patients? Airway maintenance
Why does a COPD patient need a lower level of O2 therapy? A low arterial oxygen level is this the COPD’ers primary drive for breathing. If a high rate of O2 is adm, it can eliminate the patients stimulus to breathe.
What is considered first line bronchodilator for stable COPD patients? Inhaled cholinergic antagonist. Atrovent (MDI or nebulizer), Spiriva (HandiHaler)
Should you give a COPD patient a cough suppressant? No. Avoid use of cough suppressants as coughing has a protective role.
Examples of antibiotics that could be used for a COPD patient. And how soon should treatment be started? should be started within 24 hours of symptom onset (Bactrim DS, Septra, Amoxicillin, Augmentin, Vibramycin, Keflex, Azithromycin, Doxycycline)
Which activities in particular should you limit for COPD patients? Anything that uses the arms.
What are the clinical manifestions of Mild Intermittent Asthma (step 1)? Symptoms occur up to 2/week. Episodes are short < few hours. Symptoms are present at night no more 2/month. Asymptomatic with PFT’s normal between exacerbations. During episodes PEF is at least 80% normal. PEF variability is less than 20%
What are the treatments for Mild Intermittent Asthma (step 1)? No daily meds. Use of short acting beta 2 agonist during episodes. If exacerbations are severe- systemic corticosteroids. *If rescue inhaler used more than twice per week, goes to next step.*
What are the clinical manifestations of Mild Persistent Asthma (step 2)? Symptoms occur more than twice per week but not daily Symptoms are present at night more than twice per month Episodes affect activity and sleep During episodes PEF is at least 80% of normal PEF or FEV 1 variability is 20 – 30 %
What are the treatments for Mild Persistent Asthma (step 2)? Use of daily anti-inflammatory. Inhaled corticosteriod or Leukotriene antagonist or NSAID or a methylxanthine taken orally every day. Rescue inhaler--again, more than 2 days per week moves to next step.
What are the clinical manifestations of Moderate Persistent Asthma (step 3)? Daily symptoms. Episodes affect activity and sleep. Exacerbations at least twice per week and may last for days. Symptoms are present at night more than once per week During episodes PEF is only 60-80% of normal. PEF variability is greater than 30%
What are the treatments for Moderate Persistent Asthma (step 3)? Daily long acting beta agonist inhaled and a low- medium dose Inhaled Corticosteroid *or* simply increase the Inhaled Corticosteroid dose to a medium dose range *or* add low dose Inhaled Corticosteroid or Leukotriene receptor antagonist.
What are the clinical manifestations of Severe Persistent Asthma (step 4)? Symptoms occur daily Episodes are frequent Syptoms are present at night frequently Activities are limited During Episodes PEF is at 60% or less of normal PEF variability is greater than 30%.
What are the treatments for Severe Persistent Asthma (step 4)? high dose Inhaled Corticosteroid Fluticisone (Flovent) and long acting beta agonist Salmeterol (Servent) inhaled Rescue inhaler- short acting Beta 2 agonist
What are the clinical manifestations for Severe Persistent Asthma not responsive (step 5)? Same as step 4 but treatments were ineffective.
What is the treatment for Severe Persistent Asthma not responsive (step 5)? High dose Inhlaled Corticosteroid and Long acting beta agonist. Omalizumab (Xolair) an immunomodulator. Xolair is considered for patients with constant exposure to non seasonal allergens.