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Hey guys nurse mike here and welcome to simple nursing comm check out our brand new app get access to our new pharmacology and med search mastery courses plus the massive quiz bank loaded with detailed rationales to test your knowledge join for free click the link in our description below now for lower respiratory drugs we have two teams the bam team and the slam
Team so bam is for our bronchodilators that act to dilate the bronchi in the lungs and slam is our anti-inflammatory agents to soothe the inflammation so guys let’s start with our bronco team bam first off we have b for beta-2 agonists these guys end in beuter all like albuterol and leave albuterol so guys just remember the b and beuter all is used for brutal asthma
Attacks since it’s the first drug we use during severe asthma attacks and it’s the fastest acting bronchodilator so the nclex key word here is it’s the only rescue inhaler during acute asthma attacks to be used before steroid inhalers that’s always a common nclex question now guys big caution here celie metro has abated two agonist as well but it’s a slower acting
Not a rescue inhaler so not to be used during an acute asthma attack since it ends in terrell and not butte air all now it’s used commonly with a combination of steroids for a longer term control of moderate to severe asthma now a common nclex question is do not use fluticasone or ass le métro for the first signs of acute asthma attack so during acute asthma
Attacks guys we give three drugs and to be honest sequence is key on the nclex so use the memory trick aim for the acute asthma attack a ferrell butor all which is always used first during brutal asthma and not selling metro which is the slow or acting one is for ipratropium always use second which we’ll be covering next and m is for methylprednisolone brand name
Sulli metro which is our steroid always to be used last since steroids act so slow and it has the word prednisolone which kind of sounds like prednisone so that’s how you know it’s a steroid now for the mechanism action these are beta-2 agonists which activate beta 2 in the lungs which dilates the bronchi resulting in increased airflow but it also activates beta
1 in the heart which makes the heart go crazy fast so the common side effect is a rapid heart rate so just think lb amps up the body now expected side effects for albuterol just think of the three t’s t4 tachycardia and palpitations t4 tremor and t4 tossing and turning at night key word for exams are insomnia and difficulty sleeping so teach patients not to take
It at bedtime and guys don’t let the nclex trick you commonly chosen distractors not constipation that’s a side effect for opioid pain meds and not hives that’s totally an allergic reaction not expected finding now patient education a little side note for asthmatic patients we always avoid beta blockers that end in lol like atenolol which can cause bronchospasms
And avoid nsaids like naproxen and ibuprofen which can worsen asthma now during an attack or a severe asthma attack we instruct patients to take two to four puffs every 20 minutes for three rounds now the big key point here guys write this down if it doesn’t work after three doses then you notify the hcp and how do we evaluate if the med is effective well we have
Decrease in respiratory rate example 34 respirations go down to 24 and guys the oxygen saturation is at least 90% or higher now a common hesse question asks about albuterol nebulizer some expected findings after treatment well there’s going to be increased productive cuff reports of decreased anxiety as well as mild bilateral hand tremors guys these are totally
Normal now as far as administration make sure you shake it before you take it so remember come on shake shake it come come on shake shake yes now guys the key point here is always make sure to shake it well then you breathe all the way out push the inhaler inhale and hold for a few seconds then exhale now if we’re taking with steroids to the correct order is
Albuterol first to bronchodilator and open the lungs and steroids second to get all that powder down into the deep lungs now as far as cleaning the metered dose inhaler we always clean the mouthpiece one to two times per week with warm water now this does not have to be done after every use common nclex question only steroids are washed after every use so guys
Just think steroid inhalers go right in the sink after each use now a common question on exit exams they’ll present a patient with severe asthma but their vital signs all screwed up and they’ll ask which medication would you give select all that apply so guys remember during asthma attacks we give aim albuterol ipratropium and methyl o preta solem so guys our
Correct options here are two for albuterol inhaler 3 nebulizer ipratropium and 5 iv methylprednisolone now our next drug is a 4 anticholinergics ending intro priam like ipratropium or tiotropium now these guys dry the body out so think tro priam you can’t pee with them with your pm’s used for moderate to severe asthma and copd it’s a longer acting bronchodilator
That reduces secretions and commonly given in combination with albuterol now there you second in line during a severe or acute asthma attack remember our acronym aim a for albuterol first ipratropium second and methylprednisolone third guys that is a brand name sully metro always our steroids are given last since steroids x low now the mechanism action is that it
Blocks secretions so you can’t see pee spit or poop now this is called anticholinergic effects and i remember by saying anticholinergic or anti sick cretians since they block sc2 coaling and again you can simply say tro priam means you can’t pee with them so the obvious side effect is dry mouth and hoarseness and we teach patients these key points to treat the dry
Mouth and throat for all anticholinergics we use gum and candy and we also drink fluids now the big key point here and the big test tip is no swallowing tiotropium capsules guys put the capsule inside the inhaler device and then inhale never swallow the pill this came up on both the se and ati exams now a big contraindication to all anticholinergics we never give
For patients who are ready dry so those who can’t see like with glaucoma those who can’t pee like with urinary retention and bph and those who can’t spit or poop like with bal obstructions our last bronchodilator m4 meth nose an things ending in fill in like theophylline or amino fillin it’s kind of like given caffeine that makes your heart race and can be very
Toxic so think fill in has you fill in caffeinated and toxic with a super rapid heart rate now the key points are the three teas tea for toxicity over 20 now that’s the biggest nclex tip there theophylline has a very narrow therapeutic range between 10 and 20 so we constantly need frequent blood draws now the next t is for tonic clonic seizures that’s the number
One sign for severe toxicity and always the first priority as a nurse so guys we report signs and symptoms of toxicity like anorexia nazia vomiting and even restlessness and insomnia now the last t is for tachycardia and dysrhythmias a big nclex tip right there now these are common adverse effects of the drug but two common test questions on the hesi were to teach
Patients to avoid beta blockers that lower the heart rate which can also block the effects of theophylline and also to alert the hcp of tachycardia before administering the next dose now patient education the two drugs that increase toxicity risk and the gun clicks tip again is cimetidine the h2 blocker given for heartburn and also cipro flax and the antibiotic and
Always teach the patients to take in the a.m since you get amped up in the a.m. and avoid caffeine technically avoid all stimulants and lastly we stopped before a cardiac stress test which can augment the tests now three common questions which of the following prescription should the nurse question so number one naproxen for asthmatic patients yes guys we always
Question this one never nsaids or beta blockers for patients with asthma how about number two ipratropium for a patient with glaucoma no we never do tro priam for a patient who can’t see spit or poop you get the idea now option number three losartan for a patient with diabetes oh yeah that’s okay how about option number four theophylline for a patient taking
Cimetidine well guys we’re gonna question this order because it increases the risk for toxicity always cimetidine and sip relaxant and number five atenolol for a patient with asthma yes guys always question this one never give beta blockers to asthmatic patients now question number two what patient teaching should be included with a new prescription of albuterol
Ibuprofen tiotropium and beck low methos owns select all that apply now option number one tinnitus is an expected side-effect no guys tinnitus is a serious side effect basically tells us that the drug is hard on the kidneys usually caused by antibiotics now option number two here tachycardia is expected after albuterol yes guys the t’s of albuterol one of them is
Tachycardia totally normal option 3 report dark stool to the provider yes guys nsaids like ibuprofen can cause gi bleeding so we report dark tarry stools now option number four drink fluids to prevent dry mouth and throat yes guys trope reims dry the mouth so we can’t pee with them with tro p.m. so we get urinary retention as well as dry mouth and last thing guys
Is 5 ipratropium is used first during an attack no we always use beutel’s for brutal asthma commonly elbow – roll now last question which medication prescribed for asthma causes tachycardia and dysrhythmias option number one phenobarbital now guys this is a sedative for anxiety option number two is the correct one and mean offal in guys remember fill ins have you
Fill in caffeinated and amped up now the last two options sell metro and albuterol technically both can cause tachycardia but usually don’t cause dysrhythmias so we have to throw that out here now for anti-inflammatory agents our slam team we have s for steroids which decreases the swelling ending in zone like beck low methos own now the key points know for the
Exam are the for s’s of steroids the first s is for swelling and inflammation cortical inhalers reduce the swelling directly in the respiratory system sobek lameta zone fluticasone and methylprednisolone guys sully medrol is the brand name now by comparison glucocorticoid steroids are for total body swelling so like prednisone dexamethasone and even hydrocortisone
So we say b4 bechler methos own decreases the b bronchi or basically lungs and p for prednisone decreases swelling in the p for person now for patient education we use s for slow onset guys this is not a rescue drug so do not use zones for the first sign of acute asthma detect their use third in line now that’s a common test question and it’s commonly gotten wrong
So nclex keyword here do not use fluticasone or selling metro for the first sign of acute asthma attack and guys selling metro yes it’s a beta-2 agonist but this is just here to remind you not to use those so we use aim for acute attack a4l beuter all that’s the first drug we use first in line for brutal asthma attacks i for ipratropium always use seconds and m for
Meth low prenez o low and brand-name sulli med our steroids always last since steroids acts slow and guys a big test tip here do you not emit steroids even if albuterol works we always use these three in a sequence now for the top two side-effects s for sugar increase so think steroids naturally increase the sugar or just think glucocorticoids naturally increase
The glucose guys this is completely normal so there’s no need to report to the doctor or hcp this is an expected finding now s for sores in the mouth basically infection so just think steroids suppress the immune system leading to slow wound healing and sores in the mouth always a common exam question is who’s most at risk for infection and guys it’s usually a
Patient on xone steroids now the big key points to write down use spacers to prevent oral thrush or basically candida the oral infection in the mouth so we teach patients to rinse the mouth after each use and big one here do not swallow the water always wash mouthpieces out with warm water and guys daily for steroids not weekly weekly as for albuterol so just think
Steroid inhalers go right in the sink after use now next drug is l4 leukotriene inhibitors ending in luke cats like montelukast so the brand name is singular or zafir lu caste so the memory trick is three l’s l4 luke likes to sing since it opens the airway el for long-term management of inflammation commonly given in combo with albuterol and steroids and the last
El for long onset we have to teach the patients that it lasts one to two week to reach therapeutic range now nclex key points here given for prevention of asthma attacks guys not during acute asthma this is not a rescue drug only beutel’s like albuterol are rescue inhalers so the key patient teaching here is this med will prevent inflammation that causes asthma
Attack now it does this by reducing the inflammation response of leuco trains basically it just stops the inflammation response to the irritants so a common test question a patient has been on montelukast for five days and states the medication is not working what’s the best response by the nurse well guys the answer is always to advise the patient it takes about
One to two weeks for the drug to reach that therapeutic effect now the last drug classes m4 mast cell stabilizers drug name is chroma lit so think it blocks massive swelling by blocking the histamine response which inflames the body the key point here is that it prevents activity induced asthma like before sports or exercise now the hesi stress clients to take 15
Minutes before exertion for maximum effects and the ati was similar teaching patients to use 10 to 15 minutes before physical activity now some common questions from this section a client is receiving discharge instructions for inhaled glucose steroid metered dose inhaler which teaching should the nurse include so option number one discard the use of fluticasone
If albuterol provides relief guys no we do not emit steroids even if albuterol provides relief guys steroid acts to soothe and they act more slow so we always take it option number two do not swallow the water as you wash your mouth after each you’s guys yes option number two we always rinse and spit out the water never swallow steroid water this is gonna lead
To more sores option number three if taking albuterol be sure to use after the steroid no guys we always use albuterol first to open the lungs and then steroids after to get that powder deep inside the lungs now option number four theroad inhalers should be used before beta-2 agonist again guys no albuterol should always be used before steroids now question number
Two which statement by the patient requires further teaching so option one i will use chromel in to prevent activity induced asthma yes i will use montelukast to prevent asthma attacks yeah guys it prevents the long term asthma number three i will use spacers to prevent oral thrush while using bethlo methods own yes perfect how about option number four i will take
Chromel in 45 minutes before physical activity now guys option number four is wrong take 10 to 15 minutes before that physical activity so this would require further teaching thanks for watching for our full video and new quiz bank click right up here to access your free trial and please consider subscribing to our youtube channel last but not least a big thanks
To our team of experts helping us make these great videos alright guys see you next time
Transcribed from video
Pharmacology – Respiratory drugs: Memorization Tips for Nursing Students RN PN (MADE EASY) By Simple NursingliveBroadcastDetails{isLiveNowfalsestartTimestamp2020-08-20T024511+0000endTimestamp2020-08-20T030616+0000}
