when are oral asthma medications indicated?
children who cannot manipulate an inhalersevere asthma exacerbation where inhaler cannot be used
what is the downside of oral asthma medications?
increased SE:tremorcrampstachyarrhythmiasmetabolic disturbances
what are the different types of inhalation devices? (3)
metered dose inhalerdry powder inhalernebulizers
what may be prescribed to assist with getting medication via MDI? who is this important in?
spacersimportant for young children with coordination difficultiesalso recommended with any inhaled glucocorticoid to avoid thrush
how are dry powder inhalers used?
medication released when pt takes a deep, rapid breath
who are nebulizers particularly useful in?
young children or pts with severe/acute asthma
what maintenance should be done on inhalation devices?
wash all nebulizer parts except tubing/finger valve in soap/waterwash hands prior to usedisinfect nebulizer every other day
what is the MOA of B2 agonists?
stimulates B2 receptors to relax airway smooth muscle
which B2 agonists are short acting rescue inhalers?
albuterol sulfatelevalbuterol
which long acting beta 2 agonist can be used in asthma and COPD? route?
salmeterol (Serevent diskus)DPI
which long acting beta 2 agonist is used in COPD only and is delivered via DPI?
indacaterol inhaled (Arcapta Neohaler)
which long acting beta 2 agonist is used in COPD only and is delivered via MDI?
olodaterol (Striverdi Respimat)
which long acting beta 2 agonists are used in COPD only and are delivered via nebulizer?
arformoterol (Brovana)formoterol (Perforomist)
how should long acting beta 2 agonists be used in asthma?
in conjunction with inhaled steroids
primary use of anticholinergics?
primary COPD, some asthma
which anticholinergic medications are dry powder inhalers? indication?
aclidinium bromide (tudorza pressair)glycopyrrolate (Seebri Neohaler) umeclidinium (Incruse Ellipta)tiotropium inhaled (spiriva handihaler)COPD only
which COPD medication can also be used in asthma? (2)
ipratropium bromide/albuterol MDIipratropium HFA
is inhaled corticosteroid monotherapy use recommended in asthma or COPD?
only asthma
which inhaled corticosteroid can be used in COPD?
nebulized budesonide
which inhaled corticosteroids are indicated in asthma only and delivered via MDI? (2)
beclomthasone dipropionate (QVAR redihaler)ciclesonide (Alvesco)
which inhaled corticosteroids are indicated in asthma only and delivered via DPI? (4)
budesonide (pulmicort flexhaler)fluticasone furoate (Arnuity Ellipta)fluticasone propionate (Flovent Diskus)mometasone (Asmanex twisthaler
which intermediate acting systemic corticosteroids may be used in asthma/COPD? (3)
prednisoneprednisolonemethylprednisolone
which long acting systemic corticosteroids may be used in asthma/COPD? (2)
betamethasonedexamethasone
what is the black box warning for montelukast?
behavioral psychiatric changespossible depression and suicidality
what is the MOA of roflumilast?
PDE-4 inhibitor which decreases intracellular cAMP levels
indication of roflumilast?
COPD
which drugs are inhaled combined low dose glucocorticoid and fast acting long acting beta 2 agonists? (4)
Symbicort (budesonide/formoterol)Advair (fluticasone propionate/salmeterol)Breo ellipta (fluticasone furoate/vilanterol)Dulera (mometasone/formoterol)
what are the 2 types of supplemental oxygen therapy?
continuous (24 hr/day)non-continuous (during sleep, walking, exercise)
what is the indication for supplemental O2?
evidence of persistent hypoxemia in a stable pt receiving optimal medical management otherwise
what is the indication of blow by oxygen?
providing oxygen to a child requiring < 30% oxygen incapable of using a mask
what is the typical rate of a low flow nasal cannula? high flow?
1-4 L/minuteup to 60 L/min in adults
what must be done for high flow nasal cannula oxygen?
O2 must be heated and humidified to avoid nasal irritation
which oxygen delivery system is MC used in acute care and hospitalization?
face masks
what is the flow rate of a simple face mask?
6-10 L/min
what is the flow rate of a partial rebreathing face mask?
10-12 L/min
how do simple and partial rebreathing masks differ?
simple masks are loose fitting and mix oxygen with room airrebreathing is a tighter fit and allows less room air within
what is the flow rate of a nonrebreathing mask?
10-15 L/min
what are risks of high FiO2? (3)
absorptive atelectasishypercapniadamage to airways and parenchyma
what should the goal SpO2 be for pts on supplemental oxygen?
90%
how frequently should pts SpO2 be checked on supplemental oxygen? what if it is at a good level?
every 2 hoursin SpO2 > 90%, decrease flow rate by 0.5 L/min every 2 hours until on room air
what does oxygen need to remain 5 feet away from?
open flamesheat sourceselectrical devices
what is the difference between cough suppressants and expectorants?
both are indicated for coughbut expectorants do not suppress cough, but instead reduce viscosity of secretions
what is the MOA of dextromethorphan?
decrease cough receptor sensitivity and depresses medullary cough center
which pts should not use dextromethorphan?
children under 2 yearscaution in children under 6possible caution in pts with opiate abuse hx
SE of dextromethorphan?
dizzinessdrowsinessrestlessnessnausea
MOA of benzonatate?
peripheral antitussive; anesthetizes stretch receptors in lungs and pleura
indication of benzonatate?
cough in pts > 10 y/o
which cough suppressants are opioid based?
codeine/guaifenesinpromethazine/codeine
MOA of guaifenesin?
stimulates respiratory tract secretions, increasing respiratory fluid volumes and decreasing viscosity
what medication is best for use with a wet cough?
expectorant
what medication is best for use with a dry cough?
cough suppressant
what are ER precautions for cough?
SOBhigh feverchest painhemoptysis
what anticoagulant is preferred for initial tx of venous thromboembolism?
low molecular weight heparinmore accurate dosing