PHARMACOTHERAPY OF THERESPIRATORY SYSTEMThe Laryngospasms - Breathe

CONCEPT: Oxygenation

CONCEPT: OxygenationBreath Sounds

CONCEPT:OxygenationGAS EXCHANGEAnxietyAcid Base BalancePerfusionFatigueMobilityNutritionInterrelated Concepts

Altered Respiratory FunctionHypoxia what are the signs and symptoms?

Assessment of Oxygenation StatusWhat does the nurse assess?

IN CLASS CASE STUDY ACTIVITY

Mr. Jimmy Bley

Marital StatusMarried to Cecelia for 60 yearsChildren/ Grand-children8 grown children and many grandchildren and great grandchildren, all of whom live in the areaReligionPresbyterianHobbiesBuilding computers, playing computer games, surfing the internetVolunteer ServiceDonates the computers he makes to an organization that sends them to AfricaSupport SystemVery close to his wife, children, and grandchildrenEthnicityCaucasian

JobRetired veteran, electronics technicianSalaryVeteran pension of $2230 per month. Social security of $1531 plus Cecelia's benefit of $765 per month.EducationHigh school graduate. Army training in electronicsBenefitsRetired N/AHealth InsuranceMedicare A and BHousingOwns a 4 bedroom, 2-story house outside of town DebtHouse is paid off. No debt. Lives frugally on monthly income

Jimmy has been experiencing increasing shortness of breath over the past several months with activities such as mowing the lawn and household chores as well as walking any distancesHe has an Albuterol inhaler that expired 2 years ago but he refuses to refill it stating it is a waste of money this one still works fineHe has come to see his MD for his 6 month visit

After the visit Dr. Rowe adds Salmeterol 50 mcg/inhalation MDI one inhalation twice daily to Jimmys medication regimeJimmy's MD visit

Jimmy's Cigarette LogNicotine gum - no cigarettes# of cigarettes in the jar: Mon 10, Tues 8, Wed 7, Thurs 10, Fri 12, Sat 5, Sun 14

Jimmy's nighttime coughing fitTwo weeks PTA

Feels it is a bad coldCecilia puts a humidifier in the bedroom

One Week PTA

Productive coughIncreased fatigueDecreased appetiteDecreased thirst

Night of Admission

Wakes up unable to take a breath

Hospital Admission

Group ActivityLook up Pain Medications and identify the following:Pharmacokinetics

Any concerns related to absorption; distribution; metabolism; excretion?Any contraindications?How will the medication prescribed benefit the patient? (Mechanism of Action and Indications) Is the prescribed dose appropriate? Any concerns with the medication orders?Side effects to be alert for?Drug Interactions to be concerned about?Food Interactions to be concerned about?Nursing Implications:Patient teaching: key points

Route(s)Onset of ActionPeak Plasma ConcentrationHalf LifeDuration of Action

Group In Class Assignment

123456AlbuterolSalmeterolAtroventPharmacokineticsQuestions 1, 2, 5 and 6Questions 3, 4, 7 and 8PharmacokineticsQuestions 1, 2, 5 and 6Questions 3, 4, 7 and 8PharmacokineticsQuestions 1, 2, 5 and 6Questions 3, 4, 7 and 8

Pathophysiology of an Allergic ReactionDescribe the steps in an allergic reaction

Category: Anti-Inflammatory Classification: Mast Cell StabilizerPrototypes:cromolyn (Intal)nedocromil (Tilade)

DrugRouteOnset of ActionPeak Plasma ConcentrationHalf LifeDurationIntalInhalation2-4 weeksunknownunknownunknown

Indications:Mechanism of Action:Chronic management of asthmaChronic management of airway inflammation in allergic asthmaStabilizes mast cells -> prevents histamine and other inflammatory mediators release (ie: eosinophils, neutrophils, macrophages)Contraindications:hypersensitivityPregnancy: Category B

Side Effects

RESP: Cough; Bronchospasm

Category: Anti inflammatoryClassification: Leukotriene Modifiers AKA :Leukotriene Receptor AntagonistsPrototypes:montelukast (Singulair)zafirlukast (Accolate)zileuton (Zyflo) (actually a leukotriene synthesis inhibitor)

RouteOnset of ActionPeak Plasma ConcentrationHalf LifeDurationPO30 minutes3-4 hours2.7-5 hrs24 hrs

Indications:Mechanism of Action:Chronic asthma in adults and children older than 12 years of age (except montelukast)

prevent leukotrienes from attaching to receptors on cells in the lungs and in circulationInflammation in the lungs is blocked, and asthma symptoms are relieved

Contraindications:HypersensitivityCaution with pre-existing hepatic impairmentPregnancy: Category B Zyflo CR: Category C

Side Effects:CNS: headache, dizziness, insomniaGI: nausea, vomiting, anorexiaEndo: liver dysfx

***************

**Watch theophylline level15-30mg/deciliter *