109: U4: Resp Meds Flashcards
Decongestants Action
Stimulate receptors in nose causing vaso-constriction.
Decongestants SE’s
Insomnia.
Minimal: Jittery, nervousness, seizures in elderly, increased BP (in people prone to it).
Decongestants Drug Names
Pseudophedrine (Sudafed)
ephedrine (Ephedsol): systemic
oxymetazoline (Afrin): local (can only use nasal spray for 3 days max - rebound congestion can occur)
Decongestants Routes
PO
Nasal Inhaler
Decongestants NI’s
Do not give to pts with HTN or pts with glaucoma. Don’t use long term.
Antitussives Action
Suppresses cough center in medulla
Antitussives SE’s
CNS and resp depression only with codeine.
N, V, A, Constipation, Rash, Urine retention
Antitussives Drugs
Codeine
Dextromethorphan (mainly used - not many SE’s)
Antitussives Routs
PO
Antitussives NI’s
Use for a non-productive cough. Increase fluids for constipation and to loosen secretions. Use at HS so people can sleep (suppressing a cough also suppresses the mechanism getting stuff out of the lungs).
Expectorants Action
Loosens secretions so they can be coughed up.
Expectorants SE’s
Nausea/Vomiting, Drowsiness
Expectorants Drugs
Guaifenesin (Robitussin, Mucinex)
Robitussin is short acting, Mucinex is a 12 hour tablet.
Expectorants Route
PO
Expectorants NI’s
Drugs do not work unless you are hydrated! Drink at least 2 liters a day.
Sympathomimetics Action.
Bronchodilators (beta adrenergic agonists). Cause dilation of the bronchi.
Sympathomimetics SE’s
MDI: mouth dryness, throat irritation. Systemic: tremor headache nervousness increased HR cough insomnia palpitations increased blood sugar angina dysrhythmias
Sympathomimetics Drugs
metaproterenol (Alupent) - acute S/S
albuterol (Proventil) - rescue med
levalbuterol (Xopenex) - Less SE’s, short acting
salmeterol (Serevent) - preventative, long acting (starts working after 1 hour)
Sympathomimetics Route
Frequently administered by MDI (1-2 puffs)
Nebulizer
Combinations
Sympathomimetics NI’s
Check HR, RR, breath sounds before and after.
Angina: monitor HR
Diabetics: monitor blood sugar
Can use albuterol before exercise
Methylxanthines Action
Bronchodilators. (Xanthine derivatives). Relaxes bronchial smooth muscle. Well absorbed PO - interacts with beta blockers and cimetidine.
Methylxanthines SE’s
Many Drug Interactions!!
Anorexia, N/V, heartburn, cardiac dysrhythmias, increased BP, increased HR, nervousness, palpitations.
Methylxanthines Drugs
Aminophylline (IV)
Theophylline (PO) (Theodor)
Methylxanthines Routes
IV
PO
Methylxanthines NI’s
Smoking will decrease effectiveness.
Narrow therapeutic range (10-20).
Caffeine intensifies SE’s.
Check drugs for interactions.
Anti-Cholinergics Action
Bronchodilator. Results in bronchodilation by blocking the action of acetylcholine.
Anti-Cholinergics SE’s
N/V, Cramps, dizziness, drying to oral mucosa, cough,, flushing of skin, bad taste, blurred vision, Anticholinergic SE’s.
Anti-Cholinergics Drugs
ipratropium (Atrovent)
tiotropium (Spiriva)
ipratropium and albuterol (Combivent or Duoneb)
Anti-Cholinergics Routes
Discus
HHN
MDI
Nasal spray
Anti-Cholinergics NI’s
Do not over use.
Assess for HTN and glaucoma.
Do NOT use with BPH (urinary retention, blurred vision).
Anti-Inflammatory Uses
Should be used for anyone with persistent asthma s/s. Inflammation symptoms of asthma triggered by allergic and environmental stimuli (release of eosinophils).
Glucocorticoids
Decrease inflammation and bronchoconstriction.
Used in combo with bronchodilators.
Decreases edema.
Blocks late phase response and decreases hyperresponsiveness.
Inhibits release of mediators
Anti-Inflammatory SE’s
MDI: oral fungal infections, hoarseness, dry cough.
PO or IV: many SE’s. Osteoporosis, immunosuppression, GI distress, increased blood sugar, weight gain, skin and muscle breakdown, edema. Especially with long term use. Thrush is the main SE.
Anti-Inflammatory Drugs
MDI’s:
triamcinolone (Azmacort)
beclomethasone (Vanceril)
fluticasone (Flovent)
(Advair diskus is a combo of salmeterol and fluticasone)
PO: prednisone, prednisolone (Orapred)
IV: methylprednisolone (Solu-medrol) : rescue med only when used IV.
Anti-Inflammatory Routes
PO (chewable)
MDI
IV (rescue med)
Anti-Inflammatory NI’s
Wash mouth after use.
PO: Take with food/milk (d/t GI upset).
Watch blood sugar, BP, immune system.
Watch for s/s of Cushings.
Wean off if on >1 week d/t acute adrenal insufficiency (No BP, No BS).
Inhaled takes up to three weeks to get effect.
Leukotriene Action
Decreases inflammation and bronchoconstriction. Used for asthma, not COPD. Controller med.
Leukotriene SE’s
Generally few:
Dizziness, fatigue, headache, GI, cough, nasal congestion.
Leukotriene Drugs
montelukast (Singulair)
Leukotriene Routes
PO and chewable PO
Mast Cell Stabilizers Action
Non-steroidal anti-inflammatory. Used prophylactically. Can be used wlong with bronchodilators. Inhibits the release of histamine and other mediators. Decrease inflammation and irritation: inhibits immediate response and prevents late response.
Mast Cell Stabilizers SE’s
Cough, bad taste, throat irritation, rash, headache, N/V
Mast Cell Stabilizers Drugs
cromolyn (Intal)
nedocromil (Tilade): Inhaled anti-inflammatory.
Not used often. Must give 4x a day = poor compliance.
Mast Cell Stabilizers Routes
MDI
Neb
Nasal (for allergies)
Mast Cell Stabilizers NI’s
Water before and after (for bad taste)
Do NOT d/c abruptly.
Mucolytics Action
Liquify and loosen secretions.
Also increases hepatic glutathione, which is necessary for inactivation of toxic metabolites in Tylenol overdose.
Mucolytics SE’s
N/V, oral sores, dizziness, drowsiness, rhinnorhea, bronchospasm.
Mucolytics Drugs
acetylcysteine (Mucomyst)
Mucolytics Routes
HHN
Mucolytics NI’s
Smells like rotten eggs. Wash face after and provide gum/candy.
Anti-immunoglobulin E antibody Use
Allergic type moderate to persistent asthma
Anti-immunoglobulin E antibody SE’s
Risk for anaphylaxis
Anti-immunoglobulin E antibody Drugs
omalizumab (Xolair) : long term usage
Anti-immunoglobulin E antibody Route
SQ every 2-3 weeks
Anti-immunoglobulin E antibody NI’s
For kids >12 years old.
Dose is based on serum IgE levels.
Must sit for 2 hours after dose is given (d/t risk for anaphylaxis).
