35+36: Upper and Lower Respiratory Meds Flashcards
guidelines for starting antibiotics for sinusitis
- sxs last 2 weeks or longer
- new/worsening sxs after 1 week of sxs
What is the drug class of diphenhydramine
antihistamine
MOA of diphenhydramine
blocks the effects of histamine by competing for and occupying H1 receptor sites (antagonizes histamine effects)
uses of diphenhydramine
- allergic rhinitis
- common cold
- cough/sneezing
- pruritus
- urticaria
- motion sickness
- sleep aid
side effects of diphenhydramine
- drowsiness (main)
- dizziness
- headache
- urinary retention
- blurred vision
- dry mouth/throat
- hypotension
- ABD pain/constipation
- photosensitivity
- palpitations
life threatening effects of diphenhydramine
- agranulocytosis
- hemolytic anemia
- thrombocytopenia
administration of diphenhydramine
- PO w/ food
- IM
- IV
pt teaching for diphenhydramine
- avoid driving or performing other dangerous activities if drowsiness occurs
- avoid alcohol and other CNS depressants
- sugarless candy for dry mouth
- not recommended for breastfeeding mothers
paradoxical side effects of diphenhydramine
- agitation/restlessness
- insomnia
explain the difference between first and second generation antihistamines
- diphenhydramine is first generation
- 2nd generation: less sedating, less side effects, longer acting BUT not as effective
examples of 2nd generation antihistamines
- fexofenadine (Allegra)
- loratadine (Claritin)
- cetirizine (Zyrtec)
at what age can you take diphenhydramine
- 2 y/o and older can take diphenhydramine
- under 2 if under direct supervision of provider
- 2nd generation approved starting at 6 months old
What class of drugs is pseudoephedrine
nasal decongestants
MOA of pseudoephedrine
- acts directly on adrenergic receptors
- produces vasoconstriction which shrinks nasal mucus membranes -> decreases nasal congestion
adverse effects of pseudoephedrine
- HTN
- dysrhythmia
- impaired coordination
- dizziness/vertigo
- excitability
- HA
- insomnia
- seizures
- urinary retention
- thrombocytopenia
- blurred vision
- tinnitus
- chest tightness
- dry nose
- wheezing
which pts are recommended not to take pseudoephedrine
cardiovascular pts (due to HTN and dysrhythmias)
administration of pseudoephedrine
- behind the counter tablets (used to make meth)
- nasal spray (only use 3 days or can cause rebound congestion)
What class of drugs is dextromethorphan
antitussives/expectorant
MOA of dextromethorphan
- suppresses cough by depressing cough center in medulla oblongata or cough receptors in the throat, trachea, or lungs
- reduces viscosity and adhesiveness of tenacious secretions
uses of dextromethorphan
- dry, hacking, nonproductive cough
- to ease expelling secretions from lower respiratory tract and to produce a productive less frequent cough
adverse effects of dextromethorphan
- nausea
- drowsiness
- rash
- difficulty breathing
what do high doses of dextromethorphan cause
- hallucinations
- disassociation
- serotonin syndrome
- respiratory depression
at what age can you take dextromethorphan
6 y/o and older (due to possible respiratory depression)
What can be used as a cough suppressant in children
honey after a year of age (prevent botulism)
What class of drugs is guaifenesin
expectorants
MOA of guaifenesin
loosens bronchial secretions so they can be eliminated by coughing
uses of guaifenesin
productive cough
side effects of guaifenesin
- skin rash
- headache
- N/V
parts of the upper respiratory tract
- nares
- nasal cavity
- pharynx
- larynx
most prevalent URI
common cold
acute inflammation of the mucous membranes of the nose; usually accompanies the common cold
acute rhinitis
nasal irritation caused by pollen or foreign substances like animal dander
allergic rhinitis
onset of action of diphenhydramine
- within 15 minutes (PO or IM)
- for motion sickness: take 30 minutes before and also before meals and at bedtime during the event
parts of lower respiratory tract
- trachea
- bronchi
- bronchioles
- alveoli
- alveolar capillary membrane
types of restrictive lung diseases
- pulmonary edema
- fibrosis
- pneumonitis
- lung tumors
- thoracic deformities
types of obstructive lungs diseases
- chronic bronchitis
- bronchiectasis
- emphysema
- asthma
usual initial treatment for COPD
bronchodilator (steroids added to most serious patients)
preferred management of asthma
- all adults and adolescents w/ asthma should receive regular low dose inhaled corticosteroids (ICS) to reduce risk of exacerbations (decrease need of rescue inhalers)
what type of drug is albuterol
sympathomimetic (beta 2 adrenergic agonist)
MOA of albuterol
stimulate beta 2 adrenergic receptors in smooth muscle of bronchi and bronchioles (bronchodilator)
use of albuterol
prevention of bronchospasm, asthma, reversible obstructive airway disease, and exercise induced asthma
administration of albuterol
- PO
- inhalation (2 puffs every 4 hours)
adverse effects of albuterol
- muscle tremor
- excessive cardiac and CNS stimulation
what type of inhaler is albuterol
“rescue medication” when given via MDI or inhalation
what class of drug is tiotropium
anticholinergic
MOA of tiotropium
- blocks muscarinic cholinergic receptors and antagonizes ACh action by inhibiting M3 receptor response to ACh
- relaxes smooth muscle of bronchi and dilate bronchi
uses of tiotropium
maintenance treatment of asthma and COPD
adverse effects of tiotropium
- dysrhythmias
- angioedema
- chest pain
- hyperglycemia
- insomnia
- cough/dry mouth (suck on candy)
- urinary rentention
what class of drugs is theophylline
xanthines
MOA of theophylline
relaxes bronchial smooth muscle promoting bronchodilation
- suppresses airway responsiveness to bronchospam triggers
uses of theophylline
second line drug for severe asthma, emphysema, and bronchitis
administration of theophylline
- short and long acting forms
- IV or PO
adverse effects of theophylline
- N/V, anorexia
- agitation/nervousness
- insomnia
- tachycardia
- dysrhythmias (toxic)
- convulsions (toxic)
- cardiac collapse (toxic)
therapeutic range for theophylline
5-15 mcg/mL (narrow; drug levels should be monitored)
what class of drug is montelukast
leukotriene modifiers
MOA of montelukast
binds w/ leukotriene receptors to inhibit smooth muscle contraction and bronchoconstriction
uses of montelukast
- prophylactic treatment for long term treatment of asthma
- prevent acute asthma attacks induced by allergens, exercise, cold air, hyperventilation, irritants, and NSAIDs
adverse effects of montelukast
- headache
- nausea
- diarrhea
- infection
- suicidal ideation
- SJS
- aggressive behavior and restlessness
T/F: montelukast is effective in relieving acute asthma attacks
False
when are glucocorticoids giving for asthma
when bronchodilator therapy alone is not enough
administration of glucocorticoids
- MDI
- tablet
- IV
side effects from inhaled version fo glucocorticoids
- Candida albicans (thrush)
- dry mouth/irritation
- hoarseness
what class of drugs is cromolyn (Nasalcrom)
mast cell stabilizers
MOA of cromolyn
prevent release of bronchoconstrictive and inflammatory substances in response to allergens or other stimuli
use of cromolyn
prophylaxis of acute asthma in mild persistent asthma
administration of cromolyn
- inhalation (also a nasal preparation)
- must be taken daily
adverse effects of cromolyn
- dysrhythmias
- hypotension
- chest pain
- restlessness
- dizziness
- convulsions
- anorexia, N/V
- sedation
- rebound bronchospasm is a serious adverse effect
T/F: cromolyn is not effective in acute bronchospasm or status asthmaticus
True
what class of drugs is acetylcysteine
mucolytics
MOA of acetylcysteine
liquifies and loosens thick secretions
uses of acetylcysteine
- cystic fibrosis
- any condition to liquefy thick secretions
administration of acetylcysteine
- nebulizer (smells like rotten eggs)
- PO or IV
adverse effects of acetylcysteine
- drowsiness
- N/V
- bronchospasm
2 categories of beta adrenergic albuterol
- SABA: short acting beta agonist
- LABA: long acting beta agonist
2 categories of anticholinergics
- SAMA: short acting muscarinic antagonists
- LAMA: long acting muscarinic antagonists
pt teaching for albuterol
- avoid caffeine
- notify provider if experiencing palpitations, chest pain, or tachycardia
how to prevent thrush w/ inhaled glucocorticoids
- use a spacer with the inhaler (decreases amount of drug that comes into contact w/ mouth
- rinse mouth after use
