Respiratory Pharmacology: Corticosteroids and Solu-Medrol

In this respiratory pharmacology review, we will be going into corticosteroids like methylprednisolone and prednisone.

Definition

Corticosteroids bring down inflammatory response that can be caused by numerous health issues. Anytime the body is ill or diseased there will be increased inflammation, which will result in decreased perfusion. Other than that, corticosteroids also reduce allergic reactions and itching.

Corticosteroids aid in decreasing inflammation for clients with the following conditions:

  • Asthma
  • Types of chronic obstructive pulmonary disease (COPD)
  • Types of systemic inflammation like Lupus, Cushing’s disease
  • Chronic ailments like rheumatoid arthritis (joint inflammation)

Solu-Medrol

Solu-Medrol is the brand name for methylprednisolone, a type of potent corticosteroid. Take note that methylprednisolone is the generic name. A generic name is the trade name given by the Food and Drug Administration (FDA) and government that pharmaceutical companies have to indicate in the medicine’s packet, box, and leaflet.

Spotting Corticosteroids

To easily remember corticosteroids, they are medications usually ending in:

  • “-lone”
  • “-one”

The primary examples are methylprednisolone and prednisone.

Before going into the pertinent details about corticosteroids, let’s go into quick anatomy and physiology regarding the natural source of corticosteroids inside the body.

The Adrenals

The body naturally produces corticosteroids as a mechanism to ward off stress. Located on top of the kidneys are two glands called the adrenals. The adrenal glands’ main function is to react to stress that causes inflammation, whether systemic or localized.

When the body gets stressed or irritated due to internal or external factors, free radicals are released into the system, compromising the immune system, prompting the inflammation. The adrenal glands will be activated to respond by releasing natural hormones that will decrease swelling.

Causes of Inflammation

When the adrenals are ineffective or insufficient, the body will experience systemic conditions like Cushing’s disease and Lupus. On the other hand, a hyper-inflamed respiratory tract can be caused by the following:

  • Chronic smoking
  • Toxin and smog inhalation

Though the adrenals try to eliminate the swelling by producing steroids, sometimes, they also need help, and that’s when methylprednisolone and prednisone come in.

Remember, Solu-Medrol is not only given for respiratory problems, but it is also given for rheumatoid arthritis or joint inflammation.

Client Teaching

So, there are three crucial corticosteroid essentials that you have to educate your clients with.

  1. It will increase blood sugar.

Corticosteroids tend to decrease insulin sensitivity on the blood cell level, messing up the mechanism of action. When this happens, blood sugar will shoot up. This teaching is important especially for diabetic clients who are already insulin-resistant because corticosteroids will further increase that resistance.

  1. It will increase the chances of infection.

Corticosteroids will bring down the immune system. Therefore, if the client has increased white blood cells because of the presence of infection, inform the client that the infection will be aggravated because the corticosteroids will bring down the immune system.

  1. Increased edema.

Clients on corticosteroids will hold sodium. Sodium attracts and retains water, resulting in weight gain.

So, that’s it for our corticosteroids review. For more topics related to respiratory pharmacology and nursing in general, drop by Simple Nursing’s website and YouTube channel.

Steroid Pharmacology: Corticosteroids in a Nutshell

We’ve mentioned before in a summary lecture of our respiratory drugs the two main categories – BAM and SLM. B-A-M are the bronchodilators, and S-L-M are anti-inflammatories.

In this article, we’ll be discussing the “S” in our SLM category. The “S” stands for steroids, or it can also be referred to as Solu-Medrol, which is a brand name for methylprednisolone, and the suffix “-son” or “-sone.”

Let’s begin.

The Corticosteroids Team

Corticosteroid medications usually end in either “-son” or in “-sone.” So, this tip alone can help you remember that drugs having those two suffixes are corticosteroids. Some examples would be prednisone and methylprednisolone (Solu-Medrol).

Mechanism of Action

Corticosteroids help to relieve the lungs of inflammation.

So, going back to the lungs’ anatomy, we know that inside the lungs are branches called bronchi which extend to smaller branches called bronchioles. At the end of these bronchioles are alveoli. Inside these alveoli, a lot of issues can arise.

When there is inflammation along the branches of the lungs, this results in:

  • Backing up of airflow
  • No airflow at all

Therefore, if there are a lot of inflammation happening inside the lungs, the client will get suffocated.

Remember that oxygen is the currency used by the body to live. Without proper access to airflow, there will be no oxygen, and without oxygen, the body becomes broke and dies. Always remember that nine out of 10 issues inside the body are always related to the lack of oxygen.

Corticosteroids are primarily given to give the lungs sufficient oxygen access.

The Inflammation Process

The inflammation process usually happens due to the presence of prostaglandins and histamines. Histamines cause the allergic reaction while prostaglandins cause the pain. The other causes of inflammatory responses are:

  • Substance P
  • COX-1 and COX-2

The worst part about having an allergic reaction is that the body will experience numerous responses wherein the abovementioned elements will immediately react and cause the different manifestations of inflammation.

Adrenal Insufficiency

During an inflammatory response, the adrenal glands usually step up to go against the inflammation and decrease the reaction. However, there will be moments of adrenal insufficiency wherein the adrenals are over-fatigued. This happens when there’s just too much inflammation than the adrenals can tolerate.

The adrenals will do the best they can to fight the inflammation but sometimes, the reaction is so severe that the adrenals can no longer take it.

During episodes of adrenal insufficiency, clients are given albuterol to help get the prednisone down into the lungs for better absorption. Albuterol is used to dilate the branches of the lungs.

The Last Line of Therapy

Corticosteroids are considered the last drugs a respiratory client will receive after receiving other medications. Mostly, inflammatory conditions like COPD are given steroids.

Remember that steroids act slower, but the effects are more extensive.  

Side Effects

Every drug has a side effect. As for corticosteroids, one of the major side effects, that is also a favorite topic during nursing exams, is immunosuppression. Corticosteroids like prednisone will suppress the immune system which means that the drug is bound to kill off the white blood cells in the body, like what is happening with chemotherapy.

Other side effects that you have to watch-out-for with clients taking corticosteroid are the following:

  • Increased blood sugar
  • Fluid retention
  • Increased muscle weakness
  • Potassium loss

There you have it, corticosteroids in a nutshell. For our next lecture, we’ll be focusing on leukotrienes and Singulair.

Main Categories of Respiratory Pharmacology – Part 2

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Here at SimpleNursing.com, we will be going over the respiratory drugs and the two main categories that you need to remember.

We have categorized these respiratory medications to make it easier for you to recall and identify which drugs have to be used for a particular respiratory condition, namely:

  • Bronchodilator Team
  • Anti-inflammatory Team

How do these categories act and alleviate respiratory ailments? What are the goals of your respiratory drugs? One main condition that can happen to a person’s respiratory system is increased constriction which causes inadequate oxygen exchange within the distal portions of the lung alveoli.

But before thoroughly discussing the drug categories, let’s do a bit of anatomy and physiology of the lungs.

Quick Anatomy and Physiology

Think of your lungs as an inverted tree with a stump and some branches. At the end of those branches are even smaller branches that bear apples. To apply this thought, the lungs, as your tree, have a tree stump and that stump is broken off into two bronchioles. At the distal portions of the lungs, are the alveoli (apples) – this is the area where oxygen and carbon dioxide exchange occurs.

What Can Go Wrong

What are the things that can go wrong with your lungs?

  1. Bronchiole constriction – the airways are being obstructed from allergens to different types of triggers like smoking. Without sufficient oxygen going into the distal portions of the lungs, the body won’t be getting any oxygen either.
  2. Cholinergic effects – increased mucus secretions. If there’s increased and thick mucus secretions along the branches of your lungs, there won’t be enough oxygen exchange. The client will be sluggish and will be coughing and hacking a lot of mucus which leads to infection. The lungs will drown in all the mucus and oxygen exchange will be impaired, which, technically, what happens in pneumonia.
  3. Emphysema – causes alveoli expansion and hardening it. This causes the inability of oxygen exchange and carbon dioxide build-up inside the lungs, causing increased pressure.
  4. Bronchitis – persistent infection caused by increased mucus production, leading to inadequate oxygen exchange. The lungs are unable to expectorate or cough up all the secretion from the lungs.
  5. Asthma – bronchiole constriction.

Respiratory Drug Categories

After knowing the different types of common lung problems, we’ll go into the primary drugs that help in relieving mucus production and constriction. As previously mentioned, two categories or teams work together in making the client’s lungs function properly. What are these teams?

  1. Bronchodilator Team
  2. Anti-Inflammatory Team

Bronchodilator Team

With your broncho team, three main drug types fall under this category, and they have the acronym BAM. BAM stands for:

  • Beta-2 agonists – relaxes smooth muscles
  • Anticholinergic – dilate the bronchiole tubes
  • Methylxanthines – acts as a sympathomimetic by increasing circulation inside the lungs to expand the airways, much like the effects of caffeine

In the majority of nursing exams, you’ll encounter a question that goes: What is albuterol – anti-inflammatory or bronchodilator? The answer is beta-2 agonist which is a bronchodilator.

So, what are the drugs under BAM?

  • B – Albuterol, Solu-Medrol (long-term beta-2 agonist), Pirbuterol (Maxair – fast-acting)
  • A – Ipratropium (Atrovent); or anything that ends in “-pium”
  • M – Theophylline (Theo Dur)

Anti-Inflammatory Team

With your anti-inflammatory team, three main drug types fall under this category, and they have the acronym MAL. MAL stands for:

  • Mast cell stabilizers – control or prevent specific allergic disorders
  • Anti-inflammatory steroids – decrease swelling by decreasing prostaglandins
  • Leukotrienes – bronchoconstriction

Again, in a nursing test, you’ll encounter a question that goes: What is Singulair? The answer is leukotriene which is an anti-inflammatory. A quick way to remember this is to remember that, “Luke likes to sing,” which translates to leukotriene is Singulair.

So, what are the drugs under MAL?

  • M – Cromolyn
  • A – Prednisone, beclomethasone
  • L – Singulair

Tip: You can remember cromolyn as a mast cell stabilizer by thinking about a car which has a “mass of chrome.”

Take Away

As a summary, the acronym for the bronchodilator category is BAM; while the acronym for the anti-inflammatory category is MAL.

Hopefully, this helped you differentiate bronchodilators from anti-inflammatory agents. For a more comprehensive summary, don’t forget to download the notecard on this subject at SimpleNursing.com. This notecard separates the drugs and helps you better understand every indication and how they can relieve the constriction and inflammation at the major highways of the respiratory tract.

Furthermore, if you want all the concept maps that you’ll ever need for nursing regarding respiratory lectures, drop by SimpleNursing.com to get a copy of our Pathophysiology Bible which maps out 70 different diagnoses and concept maps – from bronchitis to restrictive airway disease to asthma, COPD, and even emphysema. All of this, plus a more concise breakdown of intensive, useful lectures of over 135 pages.

See you there!

GI Disorders: GERD, Gastritis, & Peptic Ulcer Disease Pt 5

In this portion of our lecture, we will be talking about the common GI disorders, namely: gastroesophageal reflux disease (GERD), gastritis, and peptic ulcer.

There’s one thing in common when it comes to these three GI disorders: increased acid production. So, whether it’s GERD, gastritis or peptic ulcer, the cause is the same.

Anatomy and Physiology – Stomach

The normal physiology of your stomach regarding ingestion is first, food has to be swallowed down to the esophagus then passes through the esophageal-gastric sphincter muscle. The esophageal-gastric sphincter muscle is basically the muscle that “clamps up” to prevent stomach contents and acid from traveling back into the esophagus. Another sphincter is located at the base of your stomach. So, whenever a client undergoes a lap-band surgery, the lap-band squeezes both sphincters to make clients feel like they’re full.

Acid Production Affectation

Whether it’s gastritis, GERD, or peptic ulcer, you have to remember that they all relate to one cause: too much acid production inside the stomach. Differentiation of each disorder entirely depends on where the acid production acts on and the effects on the areas of the digestive tract.

GERD

If acid production creeps up to the GI tract and “burns away” the esophagus, gastroesophageal reflux disease (GERD) or what is also known as heartburn, occurs. Some of the causes of heartburn or GERD are:

  • Coffee due to caffeine
  • Meats
  • Alcohol
  • Smoking

Therefore, to avoid suffering from heartburn, you have to inform your clients to:

  • Limit the coffee and alcohol intake
  • Cease smoking
  • Lessen meat in the diet

As for medication, GERD clients are given Tums or anti-acids to decrease and neutralize acid production and preventing it from creeping up into the esophagus.

Gastritis and Peptic Ulcer

Gastritis merely is the inflammation of the lining of your stomach. In GERD, it’s about the lining of the esophagus, whereas with gastritis, it’s focused on the mucous membrane of the stomach that is gradually being eroded by too much acid. Because of this, clients who have gastritis experience severe stomach pain.

However, if the acid becomes increasingly high, that’s when ulcer or peptic ulcer occurs. Peptic ulcer is just a fancy term meaning the acid has eaten away or broken down the lining of the stomach, causing a hole or a tear. When this happens, the client will start to bleed out due to the corrosion caused by the acid on the lining of the stomach.

Prevention and Treatment

With GERD clients, anti-acids are given to neutralize the condition.

With gastritis, the goal is to protect the lining of the stomach. Therefore the parietal cells that are responsible for acid production inside the stomach must be blocked or stopped which is why H2 blockers are administered. H2 blockers block the histamine production of the inflammatory response of the gastric lining. In a way, H2 blockers protect the stomach from ulcers.

Aside from H2 blockers, clients with gastritis are given proton pump inhibitors (PPI). Proton pump inhibitors aids in decreasing secretions inside the GI tract.

The Difference between Medications

Proton pump inhibitors work longer than anti-acids; their duration is similar to Lantus, a kind of long-acting insulin. PPIs can provide almost 24 hours of protection, which is not going to be effective in acute situations like GERD. Therefore, if your clients have GERD and you administered a PPI, the effects won’t be immediate. On the other hand, if you give anti-acids on your clients with GERD, the outcome would be quick, much like rapid-acting insulin that is frequently used for diabetic clients.

The analogy of these GI disorder medications is also similar to asthmatic clients. If they use an albuterol inhaler, the effects are immediate; whereas, if they use a steroid, it will take time for the effects to be experienced.

Remember, if you have a GERD client, instant neutralization is important; therefore, you give anti-acids. PPIs and H2 blockers are like Lantus for diabetes or steroids for asthma – their effects are not immediate but have longer duration and effects. Basically, what PPIs and H2 blockers do is decrease secretions created by the GI tract to prevent gastric lining irritation and peptic ulcer disease.

At SimpleNursing.com, PPIs and H2 blockers have been included in the Pharmacology Boot Camp. Here, Mike has elaborately explained and have given depth to the effects the said medications.

If you want to know more about those medications or just want to find out about other useful nursing information, drop by SimpleNursing.com.

Learning All about Magnesium in 2 Minutes or Less Pt 2

In this two-minute piece about magnesium, there are just two things that you need to remember:

  1. Magnesium = Magnum (gun)
  2. When there is magnesium, there is less excitement

The Magnum

To easily recall what magnesium is, you can think about it as a magnum which is a type of gun. How can we put magnesium in a magnum scenario?

When you are at a party, and someone suddenly pulls out a magnum, people would refrain from moving, jumping, and having a good time. When there’s a gun, people would usually hit the deck, the music stops, and everyone’s quiet. This is also true if applied in a scenario with a bank robbery. Basically, when there’s a magnum, the excitement stops.

Hypermagnesemia

Hypermagnesemia is an electrolyte imbalance wherein increased levels of magnesium are present in the blood. Therefore, bringing a gun to a party which causes everything to shut down, can be considered as hypermagnesemia.

If there is hypermagnesemia, there is increased magnesium inside the body, so there will be less cell excitability.

Hypomagnesemia

On the other hand, if there is decreased magnesium in the blood, lower than its standard levels, that’s hypomagnesemia. Again, back to the guns at a party; if you didn’t bring your magnum to a party, a festival, or a spring break, there’s no threat so people will be partying, dancing and singing, the music’s blaring, basically, everyone’s’ having a good time. This scenario is really not a bad thing, right?

However, if you have hypomagnesemia and you shift your perspective by relating that to what’s happening inside the body, that’s when things become dangerous. If there is a lot of excitement, like for example, in the heart, due to the increased electrical stimulant, there will be the presence of a tornado (Torsades de Pointes).

Magnesium Sulfate

To pacify elevated excitement happening inside the heart, magnesium sulfate must be administered to the client. Magnesium sulfate is like bringing in the big guns, doing crowd control in a rally and bringing the outlaws to justice.

What are the leading indicators for infusing magnesium sulfate?

  1. The tornado (Torsades de Pointes) is a specific type of polymorphic ventricular tachycardia that is mainly characterized by erratic and rapid QRS complexes with a tornado-like baseline. Torsades de Pointes is seen on your EKG strip.
  2. Any form of irregular ventricular rhythms like ventricular fibrillation (V-fib) or ventricular tachycardia (V-tach).
  3. Cardioversion or in layman’s term, “Big Shock.” Here, a shock is sent through the SA node down to the AV node, then to the Purkinje fibers, and through the bundle branches to get good, clean contractions and getting the heart rhythm back on track.

A Bit of Review

Remember, when you see in your EKG strip that tornado (Torsades de Pointes), magnesium sulfate is usually given to bring down the excitability. Remember, if you have a magnum, there’s no reason to be excited about that. On the other hand, magnesium sulfate will do crowd control, bring down the excitement, and get the baseline back to normal.

So that’s your two-minute rundown of magnesium, hypo and hyper magnesium, and magnesium sulfate. Hopefully, this helped with your magnesium dilemma.

Until our next lecture!

Identifying Isotonic, Hypertonic, & Hypotonic Solutions Pt 2

Hello guys.

Mike’s back for part 2 of your IV solutions namely: isotonic, hypertonic, and hypotonic. At SimpleNursing.com, we turn your frown upside down by filtering all those unnecessary details and focusing on the ones that matter… the ones that will definitely show up on your exams.

A brief recap

In part 1, we’ve discussed how to easily identify your intravenous solutions. You can do it by remembering the following:

  1. Hypotonic fluids are hippotonic cells because all the fluid goes into the cell causing it to swell.
  2. Hypertonic fluids are for skinny cells because the fluid goes out of the cell, making it skinny. When people are hyper, they become skinny.
  3. Isotonic fluids are isoperfect cells, like “I’m so perfect.” This means that there’s no osmosis or shifting is happening with the cell.

Now that we were able to refresh your memory, the next thing that you have to keep in mind is how to pinpoint an IV solution once you have spotted one.

IV Solution Numbers

Mike got this wrong on his test and because of his frustration, he committed himself to finding a simpler way to remember these IV solutions. Mind you, it will come out of your test and when it does, it will be very difficult if you didn’t know how to find your way around it.

There are a couple of different types of IV solutions created based on how they’re used. Sometimes, remembering all these numbers can be quite overwhelming because they are confusing. How do you do it?

  1. Hypotonic – all the fluid rushes into the cell. What do hypotonic solutions consist of?
  • ½ Normal Saline (0.45%)
  • ¼ Normal Saline (0.225%)
  • 1/3 Normal Saline (0.33%)

Remember: Anything above 0.30% Normal Saline is considered as a hypotonic solution.

  1. Hypertonic – all the fluid rushes out of the cell. What do hypertonic solutions consist of?
  • 3% Normal Saline
  • 5% Normal Saline
  • D10W
  • D5W

Remember: Numbers that don’t go beyond 30% are considered as hypertonic solutions. People who are hyper are skinny, therefore, their numbers are limited to a single digit and can go as far as double digits but not over 30%. Those solutions that have Ws labeled on them is a hypertonic solution.

  1. Isotonic – isoperfect, nothing is happening inside and outside the cell. Osmosis is not present.
  • Normal Saline
  • NS 0.09
  • Sodium Chloride (NaCl)

Remember: Blood has the same consistency as isotonic solutions. Therefore, during post-op surgeries, Lactated Ringer’s solution is given.

One for the books

Nursing tests love inserting questions about isotonic solutions primarily because it is one of the most commonly used solutions in a hospital setting. They will keep on adding those questions in your exams until you get it right because isotonic solutions are integral in healthcare.

A scenario that usually gets placed in exams is the one wherein a client is hypovolemic, having low blood volume inside the body. What solution should you use? So first, you need to consider these:

  1. Hypovolemic clients require fluid within the intravascular space
  2. Hypovolemic clients require fluid to fill their veins
  3. Fluid is not necessary inside the cells
  4. Fluids do not come out from the cells
  5. You need something just right

Answer: Isotonic. Because you just want things to be perfect (isoperfect).

Memorize this by heart. And hopefully, when you encounter IV solution questions in your exams, you can efficiently identify what specific solution to use.

You can check out other lectures on a wide variety of nursing topics on our website, simplenursing.com and at our YouTube channel.

Until next time!

Antihypertensive Drugs: A Closer Look at Beta-Blockers

Beta-blockers are, in the simplest sense, heart medications for clients with hypertension that is mainly focused on the conduction system of the heart.

Just to refresh your memory, there are two ways to lower blood pressure.

  1. Relieving pressure from the pipes by decreasing fluid volume. These are your ACE inhibitors and diuretics.
  2. Decrease rate of conduction in the heart. These are your beta-blockers and calcium channel blockers.

Mechanism of beta-blockers

Beta-blockers are negative, chronotropic drugs that block that SA node from contracting excessively. Beta-blockers block the beta-adrenergic receptor also known beta-1 and beta-2. Beta-1 are receptors in the heart stimulates increased heart contraction. If stimulated, these beta receptors can cause contraction at higher rates. Similarly, this concept applies to beta-2 in the lungs.

Study tip: Beta-2 is for the lungs (since you have two lungs) and beta-1 is for the heart (since you have one heart)

Beta-2 agonist causes bronchial dilation. One typical example is albuterol. Dosing someone with albuterol will antagonize beta-2. However, it will also affect beta-1 which means that there will be a noticeable rise in your heart rate. This is the reason why treatment of beta-2 causes tachycardia in clients.

Beta-blockers block beta. Beta excited the heart. When the beta is blocked, the heart rate decreases. It’s as simple as that. Cool!

Beta-blockers make you LOL

According to the FDA, identification of these types of drugs must be through their suffix. One of the easiest ways to identify your beta-blockers is to know, by heart, that it can make you laugh out loud (LOL). Meaning, beta-blockers generic names end in –lol. A typical example is atenolol and metoprolol. 

Beta-blocker warnings – the 4 Bs

When giving beta-blockers to your clients, you have to watch out for these adverse effects.

Bradycardia

This is a condition wherein the heart rate of your client drops below 60 per minute. Yes, the goal of beta-blockers is to slow down the heart rate but that doesn’t mean killing your client in the process.

In giving anti-hypertensives, it is advised to give the client the least heavy doses first. Meaning, give your volume depleters first; this will be your diuretics, ACE inhibitors, ARBs, and potassium-sparing diuretics. Don’t opt for electrical or chronological conduction drugs until you have given the volume-depleting drugs and have thoroughly assessed your client’s vitals.

This thought is going to be very useful during exams with borderline, tricky questions. Remember, the most likely answer is holding the drug if the systolic pressure drops to 100.

Blood pressure is decreased

If you’re going to administer a couple of anti-hypertensive drugs, make sure that you ask yourself how safe is it to give. Always run scenarios inside your head especially in terms of the possible out if you gave beta-blockers with other anti-hypertensive drugs. Getting the blood pressure is the best way to assess the necessity of administering the drug. If the blood pressure has significantly dropped after an hour or so, chances are, you won’t be giving the drug.

Yes, we have mentioned that beta-blockers do not decrease blood pressure and only affects Beta-1 in the heart; however, if the stroke volume is decreased, the cardiac output is decreased as well. Low blood pressure is a possible side effect.

Bronchi constriction

Yes, it was mentioned that beta-blockers are for blocking Beta-1; however, there is a probability that Beta-2 can also be blocked. Though it may be specific, it can happen.

Blood sugar masking

If your client has low blood sugar, beta-blockers can mask the signs and symptoms of bradycardia.