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NR-NUR124 | Pharmacology > [8] MIDTERMS | RESPIRATORY DRUGS > Flashcards

[8] MIDTERMS | RESPIRATORY DRUGS Flashcards

1
Q

LOWER RESPIRATORY DISORDERS (3)

A
  • Common colds
  • Acute Rhinitis
  • Allergic Rhinitis
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2
Q

ANTIHISTAMINE

  • Compete with Histamine receptors
A

H1 Blocker or H1 Antagonist

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3
Q

ANTIHISTAMINE

  • Histamine is synthesized and stored in ____ and ____
  • Histamine release may be triggered by ____ and ____ mechanisms.
A
  • Histamine is synthesized and stored in mast cells and basophils
  • Histamine release may be triggered by allergic and nonallergic mechanisms
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4
Q

ANTIHISTAMINE

  • There are two major classes of histamine receptors, called ____ and ____.
  • Activation of ____ causes vasodilation, increased capillary permeability, pain, itching, bronchoconstriction, and CNS effects.
  • Activation of ____ causes release of gastric acid from parietal cells of the stomach.
A
  • There are two major classes of histamine receptors, called H1 receptors and H2 receptors.
  • Activation of H1 receptors causes vasodilation, increased capillary permeability, pain, itching, bronchoconstriction, and CNS effects.
  • Activation of H2 receptors causes release of gastric acid from parietal cells of the stomach.
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5
Q

ANTIHISTAMINE

  • Histamine is an important mediator of ____, but is only a minor contributor to ____.
A
  • Histamine is an important mediator of mild allergic reactions, but is only a minor contributor to severe (anaphylactic) reactions.
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6
Q

ANTIHISTAMINE

  • There are two major classes of histamine receptor antagonists: ____, which are used to treat mild allergic reactions, and ____, which are used to treat gastric and duodenal ulcers.
  • ____ relieve allergic symptoms by blocking histamine receptors on small blood vessels, capillaries, and sensory nerves. These drugs do not block release of histamine from mast cells and basophils.
A
  • There are two major classes of histamine receptor antagonists: H1 receptor antagonists, which are used to treat mild allergic reactions, and H2 receptor antagonists, which are used to treat gastric and duodenal ulcers.
  • Histamine 1 receptor antagonists relieve allergic symptoms by blocking histamine receptors on small blood vessels, capillaries, and sensory nerves. These drugs do not block release of histamine from mast cells and basophils.
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7
Q

Used to block the release or action of histamine; a chemical mediator of inflammation that increases secretions and constricts air passageway

A

ANTI-HISTAMINE

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8
Q

ANTIHISTAMINE

  • ____ frequently cause sedation and anticholinergic effects; ____ rarely cause either.
  • ____ from first-generation H1 receptor antagonists can be intensified by alcohol and other drugs with ____ actions.
A
  • First-generation H1 receptor antagonists frequently cause sedation and anticholinergic effects; second-generation agents rarely cause either.
  • CNS depression from first-generation H1 receptor antagonists can be intensified by alcohol and other drugs with CNS-depressant actions.
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9
Q

ANTIHISTAMINE

____ can cause severe respiratory depression, especially in very young patients. Not used in children < 2 years old. Use cautiously for children > 2 years old.

A

Promethazine [Phenadoz] can cause severe respiratory depression, especially in very young patients. Not used in children < 2 years old. Use cautiously for children > 2 years old.

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10
Q

ANTIHISTAMINE

1st GENERATION
S/E

  • Drowsiness
  • ____
  • Fatigue
  • ____

Anticholinergic effects

  • Dry mouth
  • ____
  • ____
  • Wheezing
A

1st GENERATION
S/E

  • Drowsiness
  • Dizziness
  • Fatigue
  • Disturbed coordination

Anticholinergic effects

  • Dry mouth
  • Urine retention
  • Blurred vision
  • Wheezing
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11
Q

ANTIHISTAMINES

SECOND GENERATION

  • No ____ antihistamine
  • Little or no effect of ____
  • Fewer anticholinergic symptoms
  • ____ (Zyrtec)
  • ____ (Allegra)
  • ____ (Claritin)
A

SECOND GENERATION

  • No sedating antihistamine
  • Little or no effect of sedation
  • Fewer anticholinergic symptoms
  • Cetirizine (Zyrtec)
  • Fexofenidine (Allegra)
  • Loratidine (Claritin)
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12
Q

ANTIHISTAMINES

NURSING CONSIDERATIONS:

  • Avoid use of ____
  • Advise to avoid ____ and operating dangerous equipment
  • Administer with foods or milk to avoid GI upset
  • Increase ____
  • Antihistamines should be avoided during the ____ of pregnancy and in nursing mothers and newborn infants.
  • Exercise caution when treating young children, older adults, and patients with conditions that may be aggravated by ____, including asthma, urinary retention, ____, hypertension, and ____
A

NURSING CONSIDERATIONS:

  • Avoid use of alcohol
  • Advise to avoid driving vehicles and operating dangerous equipment
  • Administer with foods or milk to avoid GI upset
  • Increase Oral Fluid Intake (OFI)
  • Antihistamines should be avoided during the third trimester of pregnancy and in nursing mothers and newborn infants.
  • Exercise caution when treating young children, older adults, and patients with conditions that may be aggravated by muscarinic blockade, including asthma, urinary retention, open-angle glaucoma, hypertension, and prostatic hypertrophy
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13
Q

ANTIHISTAMINES

Administration Routes

  • All H1 blockers used for systemic therapy can be given PO.
  • Some can also be administered IM, IV, or by rectal suppository.
A

Administration Routes

  • All H1 blockers used for systemic therapy can be given PO.
  • Some can also be administered IM, IV, or by rectal suppository.
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14
Q

ANTIHISTAMINES

Administration
* Advise patients to take ____ antihistamines with food if GI upset occurs.
* Warn patients not to ____ enteric-coated preparations.
* Teach patients how to administer ____ tablets

A

Administration
* Advise patients to take oral antihistamines with food if GI upset occurs.
* Warn patients not to crush or chew enteric-coated preparations.
* Teach patients how to administer orally disintegrating tablets

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15
Q

ANTIHISTAMINES

Minimizing Adverse Effects
* ____ - Caution patients to exercise extreme caution when driving or doing other hazardous activities
* ____ - Advise patients that dryness of the mouth and throat can be reduced by using hard sugarless candy and taking frequent sips of liquid
* ____ - Advise patients that GI disturbances (nausea, vomiting) can be minimized by taking antihistamines with meals
* ____ – Warn patient against the use of alcohol

A

Minimizing Adverse Effects
* Sedation - Caution patients to exercise extreme caution when driving or doing other hazardous activities
* Anti-cholinergic effects - Advise patients that dryness of the mouth and throat can be reduced by using hard sugarless candy and taking frequent sips of liquid
* Gastrointestinal Distress - Advise patients that GI disturbances (nausea, vomiting) can be minimized by taking antihistamines with meals
* CNS Depressants – Warn patient against the use of alcohol

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16
Q

NASAL AND SYSTEMIC DECONGESTANT

Dilation of nasal vessels due to infection, inflammation, or allergy

A

Nasal Congestion

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17
Q

NASAL AND SYSTEMIC DECONGESTANT

NASAL AND SYSTEMIC DECONGESTANT (4)
* ____ - stimulate the alpha adrenergic receptor producing vascular constriction of capillaries within the nasal mucosa
* ____
* ____
* ____

Systemic Decongestant (3)
* Epherine (Ephidrine)
* ____
* Pseudoephedrine

S/E:
* Jitery
* Nervous
* Increased BP and Blood Glucose

NOTE: use after ____ (rebound tenderness)

A

NASAL AND SYSTEMIC DECONGESTANT (4)
* Nasal Decongestant - stimulate the alpha adrenergic receptor producing vascular constriction of capillaries within the nasal mucosa
* Nasal spray or drops
* Tablet/Capsule
* Liquid form

Systemic Decongestant (3)
* Epherine (Ephidrine)
* Phenylephrine
* Pseudoephedrine

S/E:
* Jitery
* Nervous
* Increased BP and Blood Glucose

NOTE: use after 5 days (rebound tenderness)

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18
Q

NASAL AND SYSTEMIC DECONGESTANT

  • ____ (e.g., phenylephrine, pseudoephedrine) reduce nasal congestion by activating ____ receptors.
  • This causes ____, which in turn causes shrinkage of swollen membranes, followed by nasal drainage.
  • In patients with allergic rhinitis, sympathomimetics relieve only ____ . They do not reduce rhinorrhea, sneezing, or itching.
  • In addition to their use in allergic rhinitis, sympathomimetics can ____ associated with sinusitis and colds.
A
  • Sympathomimetics (e.g., phenylephrine, pseudoephedrine) reduce nasal congestion by activating alpha1-adrenergic receptors.
  • This causes vasoconstriction, which in turn causes shrinkage of swollen membranes, followed by nasal drainage.
  • In patients with allergic rhinitis, sympathomimetics relieve only stuffiness. They do not reduce rhinorrhea, sneezing, or itching.
  • In addition to their use in allergic rhinitis, sympathomimetics can reduce congestion associated with sinusitis and colds.
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19
Q

INTRANASAL GLUCOCORTICOIDS

INTRANASAL GLUCOCORTICOIDS
* Treatment for ____
* Decrease allergic rhinitis symptoms (Rhinorrea, Sneezing, Congestion)
* Ex. (4)

A

INTRANASAL GLUCOCORTICOIDS
* Treatment for allergic rhinitis
* Decrease allergic rhinitis symptoms (Rhinorrea, Sneezing, Congestion)
* Ex. Beclomethasone, Budesoniode, Dexamethasone, Flunisolide

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20
Q

ANTITUSSIVE

ANTITUSSIVE
* Suppresses cough reflex on the ____
* ____ and ____ cough suppressants
* Used when coughing becomes ____

A

ANTITUSSIVE
* Suppresses cough reflex on the Medulla Oblongata
* Narcotic and non-narcotic cough suppressants
* Used when coughing becomes detrimental to pt’s progress

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21
Q

ANTITUSSIVE

NARCOTICS
* Codeine
* ____ (Robbitusin AC)
* Benzonatate
* ____
* Can cause drowsiness, dizziness, nause, constipation, and ____

NON-NARCOTICS
* ____ (Tessalon)
* Butamirate Citrate
* ____ - does not depress the respiratory system

A

NARCOTICS
* Codeine
* Guiafenessin and Codeine (Robbitusin AC)
* Benzonatate
* Hydrocodone
* Can cause drowsiness, dizziness, nause, constipation, and respiratory depression

NON-NARCOTICS
* Benzonatate (Tessalon)
* Butamirate Citrate
* Dextromorphan Hydrobromide - does not depress the respiratory system

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22
Q

ANTITUSSIVE

  • ____ is the most effective cough suppressant available. The drug is active ____ and can decrease both the frequency and intensity of cough.
  • Like all other opioids, codeine can ____. Accordingly, the drug should be employed with caution in patients with reduced respiratory reserve. In the event of overdose, respiratory depression may prove ____.
  • An ____ should be used to reverse toxicity.
A
  • Codeine is the most effective cough suppressant available. The drug is active orally and can decrease both the frequency and intensity of cough.
  • Like all other opioids, codeine can suppress respiration. Accordingly, the drug should be employed with caution in patients with reduced respiratory reserve. In the event of overdose, respiratory depression may prove fatal.
  • An opioid antagonist (e.g., naloxone) should be used to reverse toxicity.
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23
Q

ANTITUSSIVE

  • ____ [Tessalon, Zonatuss] is a structural analog of two local anesthetics: ____ and ____.
  • The drug suppresses cough by decreasing the ____ (components of the cough-reflex pathway).
  • Adverse effects are usually mild (e.g., sedation, dizziness, constipation). Nonetheless, severe effects can occur in children and adults.
  • In children younger than ____, accidental ingestion of just one or two capsules has been fatal. In older children and adults, overdose can cause ____, dysrhythmia, and ____. Smaller doses can cause confusion, chest numbness, visual hallucinations, and a burning sensation in the eyes.
  • If the capsules are sucked or chewed, rather than swallowed, the drug can cause laryngospasm, bronchospasm, and ____. Accordingly, benzonatate capsules should be ____.
A
  • Benzonatate [Tessalon, Zonatuss] is a structural analog of two local anesthetics: tetracaine and procaine.
  • The drug suppresses cough by decreasing the sensitivity of respiratory tract stretch receptors (components of the cough-reflex pathway).
  • Adverse effects are usually mild (e.g., sedation, dizziness, constipation). Nonetheless, severe effects can occur in children and adults.
  • In children younger than 2 years, accidental ingestion of just one or two capsules has been fatal. In older children and adults, overdose can cause seizures, dysrhythmia, and death. Smaller doses can cause confusion, chest numbness, visual hallucinations, and a burning sensation in the eyes.
  • If the capsules are sucked or chewed, rather than swallowed, the drug can cause laryngospasm, bronchospasm, and circulatory collapse. Accordingly, benzonatate capsules should be swallowed intact.
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24
Q

ANTITUSSIVE

  • Dextromethorphan is the most effective over-the-counter (OTC) nonopioid cough medicine, and the most widely used of all cough medicines.
  • Like the opioids, dextromethorphan acts in the CNS. Dextromethorphan is a derivative of the opioids; however, it does not produce typical opioid-like euphoria or physical dependence.
  • Nonetheless, when taken in high doses, dextromethorphan can cause euphoria, and is sometimes abused for this effect
A
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25
Q

ANTITUSSIVE

Nursing Considerations:
* Evaluate ____ frequently to determine if secretions are being appropriately removed now and that cough is suppressed
* Do not give ____ after administration
* Assess ____ and ____ of cough and nature of secretions
* Observe for Sign of ____
* Warn pt about engaging in activities that require ____
* Do not give to patients who have undergone ____ → post-surgery includes the need to cough to maintain ____.

A

Nursing Considerations:
* Evaluate lung sounds frequently to determine if secretions are being appropriately removed now and that cough is suppressed
* Do not give water after administration
* Assess frequency and nature of cough and nature of secretions
* Observe for Sign of Dependency
* Warn pt about engaging in activities that require mental alertness
* Do not give to patients who have undergone thoracic and abdominal surgeries → post-surgery includes the need to cough to maintain airway patency.

26
Q

EXPECTORANT

EXPECTORANT
* Add ____ to sputum or decrease the ____ of bronchial secretions
* Loosen ____ so they can eliminate by coughing
* ____ (Robitusin)
* ____ (Robitusin DM)

A

EXPECTORANT
* Add bulk or fluid to sputum or decrease the viscosity of bronchial secretions
* Loosen bronchial secretions so they can eliminate by coughing
* Guafenesin (Robitusin)
* Guafenesin and Dextromethorpan (Robitusin DM)

27
Q

EXPECTORANT

  • An ____ is a drug that renders cough more productive by stimulating the flow of respiratory tract secretions.
  • A variety of compounds (e.g., ammonium chloride, iodide products) have been promoted for their supposed expectorant actions.
  • However, in almost all cases, efficacy is questionable. One agent—____ [Mucinex, Humibid, others]—may be an exception. However, for this drug to be effective, ____ may be needed
A
  • An expectorant is a drug that renders cough more productive by stimulating the flow of respiratory tract secretions.
  • A variety of compounds (e.g., ammonium chloride, iodide products) have been promoted for their supposed expectorant actions.
  • However, in almost all cases, efficacy is questionable. One agent—Guaifenesin [Mucinex, Humibid, others]—may be an exception. However, for this drug to be effective, doses higher than those normally employed may be needed
28
Q

EXPECTORANT

Nursing Considerations:
* Used with caution in patients with hepatic and renal failure
* Well-hydrated
* Have strong cough effort and energy to cough
* Avoid alcohol
* Elderly patients need lower dosage

A

Nursing Considerations:
* Used with caution in patients with hepatic and renal failure
* Well-hydrated
* Have strong cough effort and energy to cough
* Avoid alcohol
* Elderly patients need lower dosage

29
Q

MUCOLYTICS

MUCOLYTICS
* Cause the ____ or ____ of mucus in the ____
* A mucolytic is a drug that reacts directly with mucus to make it less viscous. This action should help make cough more productive.
* Two preparations — ____ and ____ — are employed for their mucolytic actions. Unfortunately, both can trigger bronchospasm
* ____ (Flumucil) and ____ (Solmux)
* S/E: chest pain, sore throat, laryngitis, ____

A

MUCOLYTICS
* Cause the breakdown of secretion or reduces the viscosity of mucus in the bronchial tree
* A mucolytic is a drug that reacts directly with mucus to make it less viscous. This action should help make cough more productive.
* Two preparations—hypertonic saline and acetylcysteine—are employed for their mucolytic actions. Unfortunately, both can trigger bronchospasm
* Acetylcesteine (Flumucil) and Carbocisteine (Solmux)
* S/E: chest pain, sore throat, laryngitis, hoarseness

30
Q

MUCOLYTICS

CAUTION in patients with:
* ____
* Peptic Ulcer
* ____
* COPD
* Cystic Fibrosis
* Pneumonia
* Tubercolosis
* ____

NURSING IMPLEMENTATION:
* Instruct client to avoid ____ in the nebulizer to avoid formation of ____
* Can be administered via nebulizers diluted with ____.
* Can irritate ____
* Provide patient teaching of drug name and dosage
* ____ available

A

CAUTION in patients with:
* Acute bronchospasms
* Peptic Ulcer
* Esophageal varices
* COPD
* Cystic Fibrosis
* Pneumonia
* Tubercolosis
* Atelectasis

NURSING IMPLEMENTATION:
* Instruct client to avoid combining with other drugs in the nebulizer to avoid formation of precipitates
* Can be administered via nebulizers diluted with sterile water.
* Can irritate respiratory mucosa
* Provide patient teaching of drug name and dosage
* Suction machine available

31
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

BRONCHODILATORS
* For COPD: (3)

A

BRONCHODILATORS
* For COPD: Asthma, Emphysema, and Chronic Bronchitis

32
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

**BRONCHODILATORS: DRUGS FOR ASTHMA AND COPD **
* Anti-Inflammatory Drugs: ____ - ____ (inhaled), ____ (oral)
* Anti-Inflammatory Drugs: ____ - ____ (mast cell stabilizer, inhaled), ____ (leukotriene modifier, oral)
* Bronchodilators: ____ - Albuterol (inhaled, short acting), Salmeterol (inhaled, long acting)
* Bronchodilators: ____
* Anticholinergic Drugs: ____

A

**BRONCHODILATORS: DRUGS FOR ASTHMA AND COPD **
* Anti-Inflammatory Drugs: Glucocorticoids - Beclomethasone (inhaled), Prednisone (oral)
* Anti-Inflammatory Drugs: Others - Cromolyn (mast cell stabilizer, inhaled), Zafirlukast (leukotriene modifier, oral)
* Bronchodilators: Beta 2-Adrenergic Agonists - Albuterol (inhaled, short acting), Salmeterol (inhaled, long acting)
* Bronchodilators: Methylxanthines Theophylline
* Anticholinergic Drugs: Ipratropium

33
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

BRONCHODILATORS
* Bronchodilators provide ____ in patients with asthma and COPD but ____ that is part of the disease process.
* Accordingly, most patients who require a bronchodilator also use an inhaled ____ for long-term suppression of inflammation.
* Monotherapy with a bronchodilator is appropriate only when ____ and ____.

A

BRONCHODILATORS
* Bronchodilators provide symptomatic relief in patients with asthma and COPD but do not alter the underlying inflammation that is part of the disease process.
* Accordingly, most patients who require a bronchodilator also use an inhaled glucocorticoid for long-term suppression of inflammation.
* Monotherapy with a bronchodilator is appropriate only when asthma is very mild and attacks are infrequent.

34
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

BRONCHODILATORS: SYMPATHOMIMETICS
* ____ and ____ Adrenergic Agonist
* Increase ____ causing dilation of the bronchioles

A

BRONCHODILATORS: SYMPATHOMIMETICS
* Alpha and Beta 2 Adrenergic Agonist
* Increase cAMP causing dilation of the bronchioles

35
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

SELECTIVE BETA 2 RECEPTORS
* ____ absorbed from the GI tract
* Inhaled formulation exert effects ____
* Do not cross ____

A

SELECTIVE BETA 2 RECEPTORS
* Minimally absorbed from the GI tract
* Inhaled formulation exert effects locally
* Do not cross brain barrier

36
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

SELECTIVE BETA-2 RECEPTORS
Short-Acting: (5)

Long-Acting: (2)

A

SELECTIVE BETA-2 RECEPTORS
Short-Acting: (5)
* Albuterol
* Levalbuterol
* Bitolterol
* Metaproterenol
* Terbutaline

Long-Acting: (2)
* Salmeterol
* Formeterol

37
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

SELECTIVE BETA-2 RECEPTORS
* Inhaled Beta 2 agonists are the ____ available for relieving ____ and ____.
* Virtually all patients with asthma use these first-line drugs as a component of an asthma management regimen
* The Beta 2 agonists are sympathomimetic drugs that activate ____
* By activating Beta 2 receptors in smooth muscle of the lung, these drugs promote ____ and thus relieve bronchospasm.
* In addition, Beta 2 agonists have a limited role in suppressing ____ release in the lung and increasing ____

A

SELECTIVE BETA-2 RECEPTORS
* Inhaled Beta 2 agonists are the most effective drugs available for relieving acute bronchospasm and preventing EIB.
* Virtually all patients with asthma use these first-line drugs as a component of an asthma management regimen
* The Beta 2 agonists are sympathomimetic drugs that activate Beta 2-adrenergic receptors.
* By activating Beta 2 receptors in smooth muscle of the lung, these drugs promote bronchodilation and thus relieve bronchospasm.
* In addition, Beta 2 agonists have a limited role in suppressing histamine release in the lung and increasing ciliary motility

38
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

SELECTIVE BETA-2 RECEPTORS: Inhaled Short-Acting Beta 2 Agonists
* SABAs are taken ____ to abort an ongoing attack. In patients with EIB, they are taken ____ to prevent an attack from occurring.
* For hospitalized patients undergoing a severe acute attack, a ____ is the traditional treatment of choice.
* However, delivery with ____ in the outpatient setting may be equally effective.

A

SELECTIVE BETA-2 RECEPTORS: Inhaled Short-Acting Beta 2 Agonists
* SABAs are taken PRN to abort an ongoing attack. In patients with EIB, they are taken before exercise to prevent an attack from occurring.
* For hospitalized patients undergoing a severe acute attack, a nebulized SABA is the traditional treatment of choice.
* However, delivery with an MDI in the outpatient setting may be equally effective.

39
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

SELECTIVE BETA-2 RECEPTORS
Short-Acting Beta 2 Agonists
* There are often ____
* If they are taken in excess, however, overdose can lead to dangerous adverse effects, such as ____, ____, and ____. Cardiac arrest and death may occur.

Long-Acting Inhaled Beta 2 Agonists
* Patients who experience ____ may be prescribed an LABA for long-term control.
* Dosing is done on a ____. LABAs are preferred over SABAs for patients with ____.
* In patients with asthma, however, LABAs are not first-line therapy, and they must always be combined with a ____. In fact, their use alone in asthma is contraindicated because LABA monotherapy has been associated with ____

A

SELECTIVE BETA-2 RECEPTORS
Short-Acting Beta 2 Agonists
* There are often lifesaving medications.
* If they are taken in excess, however, overdose can lead to dangerous adverse effects, such as tachydysrhythmias, angina, and seizures. Cardiac arrest and death may occur.

Long-Acting Inhaled Beta 2 Agonists
* Patients who experience frequent attacks may be prescribed an LABA for long-term control.
* Dosing is done on a fixed schedule, not PRN. LABAs are preferred over SABAs for patients with stable COPD.
* In patients with asthma, however, LABAs are not first-line therapy, and they must always be combined with a glucocorticoid. In fact, their use alone in asthma is contraindicated because LABA monotherapy has been associated with increased incidence of asthma-associated death

40
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

SELECTIVE BETA-2 RECEPTORS: Contraindications
- Cardiac disease
- Vascular disease
- ____
- Arrhythmias
- Diabetes
- ____
- Lactation
- Watch out for: ____, Tachyarrythmias, ____, urinary retention, and hypertension.

A

SELECTIVE BETA-2 RECEPTORS: Contraindications
- Cardiac disease
- Vascular disease
- Hyperthyroidism
- Arrhythmias
- Diabetes
- Pregnancy
- Lactation
- Watch out for: Hyperglycemia, Tachyarrythmias, bronchospasm, urinary retention, and hypertension.

41
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

SELECTIVE BETA-2 RECEPTORS
A/R:
* ____
* Tachycardia
* Palpitations
* ____
* Dry mouth
* Hypertension

Nursing Considerations:
* Take the drugs ____ before exercise
* Inform the physician if the medication no longer provides sufficient relief
* Take the missed dose ____ unless it’s almost time for the next dose.

A

SELECTIVE BETA-2 RECEPTORS
A/R:
* Paradoxical bronchospasm
* Tachycardia
* Palpitations
* Tremors
* Dry mouth
* Hypertension

Nursing Considerations:
* Take the drugs 30 to 60 mins before exercise
* Inform the physician if the medication no longer provides sufficient relief
* Take the missed dose as soon as he/she remembers unless it’s almost time for the next dose.

42
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

ANTICHOLINERGIC DRUGS
* Anticholinergic drugs improve lung function by ____ in the bronchi, reducing bronchoconstriction.
* Two agents are available: ____ and ____. These drugs are approved only for COPD but are used off-label for asthma. Both drugs are administered by inhalation. The principal difference between the two is pharmacokinetic: Tiotropium has a much ____ and thus can be dosed less often. With both drugs, systemic effects are minimal.
* The most common side effects are ____ and ____. Ipratropium does not readily cross membranes hence systemic effects are absent.

A

ANTICHOLINERGIC DRUGS
* Anticholinergic drugs improve lung function by blocking muscarinic receptors in the bronchi, reducing bronchoconstriction.
* Two agents are available: ipratropium and tiotropium. These drugs are approved only for COPD but are used off-label for asthma. Both drugs are administered by inhalation. The principal difference between the two is pharmacokinetic: Tiotropium has a much longer duration of action and thus can be dosed less often. With both drugs, systemic effects are minimal.
* The most common side effects are nasal drying and irritation. Ipratropium does not readily cross membranes hence systemic effects are absent.

43
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

ANTICHOLINERGICS: Ipratropium
* Inhibit ____ secretions and dilating bronchial smooth muscle; relax the air passages to the lungs
* Ipratropium [Atrovent HFA] is an ____ administered by inhalation to relieve bronchospasm.
* Like atropine, Ipratropium is a ____, therapeutic effects begin within ____, reach 50% of their maximum in ____, and persist about ____.
* Ipratropium is effective against ____ and ____, but is less effective than the Beta 2 agonists.
* However, because Ipratropium and the Beta 2-Adrenergic agonists promote bronchodilation by different mechanisms, their beneficial effects are additive.

A

ANTICHOLINERGICS: Ipratropium
* Inhibit salivatory and mucous glands secretions and dilating bronchial smooth muscle; relax the air passages to the lungs
* Ipratropium [Atrovent HFA] is an atropine derivative administered by inhalation to relieve bronchospasm.
* Like atropine, Ipratropium is a muscarinic antagonists, therapeutic effects begin within 30 seconds, reach 50% of their maximum in 3 minutes, and persist about 6 hours.
* Ipratropium is effective against allergen-induced asthma and exercise-induced bronchospasm, but is less effective than the Beta 2 agonists.
* However, because Ipratropium and the Beta 2-Adrenergic agonists promote bronchodilation by different mechanisms, their beneficial effects are additive.

44
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

ANTICHOLINERGIC DRUGS: Nursing Considerations
* ____
* Fluid intake
* No swallowing of capsule
* C/I: ____, BPH, ____

A

ANTICHOLINERGIC DRUGS: Nursing Considerations
* Candies
* Fluid intake
* No swallowing of capsule
* C/I: Glaucoma, BPH, Intestinal Obstruction

45
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

METHYXANTHINE DERIVATIVES
* Inhibit the ____ thus increasing the cAMP; relaxing the bronchial smooth muscle
* ____, including ____ and ____, come from a variety of naturally occurring sources. There were once main choice for treatment of asthma and bronchospasm.
* The most prominent actions of these drugs are (1) ____ and (2) ____. Other actions include cardiac stimulation, vasodilation, and diuresis.

A

METHYXANTHINE DERIVATIVES
* Inhibit the phosphodiesterase thus increasing the cAMP; relaxing the bronchial smooth muscle
* Xanthines, including caffeine and theophylline, come from a variety of naturally occurring sources. There were once main choice for treatment of asthma and bronchospasm.
* The most prominent actions of these drugs are (1) central nervous system (CNS) excitation and (2) bronchodilation. Other actions include cardiac stimulation, vasodilation, and diuresis.

46
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

METHYXANTHINE DERIVATIVES: Drug Action
* Have direct effect on smooth-muscles of the respiratory tract, both those on the bronchi and the blood vessels.
* Stimulates the ____
* Relieves ____ and reversal of ____ associated with COPD.
* Stimulation of respiration in ____
* Treatment of ____ and ____ in premature infants.

A

METHYXANTHINE DERIVATIVES: Drug Action
* Have direct effect on smooth-muscles of the respiratory tract, both those on the bronchi and the blood vessels.
* Stimulates the CNS
* Relieves bronchial asthma and reversal of bronchospasm associated with COPD.
* Stimulation of respiration in Cheyne-Stokes respiration
* Treatment of apnea and bradycardia in premature infants.

47
Q

DRUGS FOR LOWER RESPIRATORY DISORDER

AMINOPHYLLINE
* Aminophylline is a ____ that is considerably more soluble than theophylline itself.
* Aminophylline is available in formulations for ____ and ____ dosing, with ____ administration employed most often.

A

AMINOPHYLLINE
* Aminophylline is a theophylline salt that is considerably more soluble than theophylline itself.
* Aminophylline is available in formulations for oral and IV dosing, with intravenous administration employed most often.

48
Q

AMINOPHYLLINE: A/R
* ____
* Epigastric pain
* ____
* Diarrhea
* Headache
* Restlessness/Irritability
* ____
* Dizziness
* ____
* Tachycardia/Palpitations/Arrhythmias

A

AMINOPHYLLINE: A/R
* Abdominal cramping
* Epigastric pain
* Anorexia
* Diarrhea
* Headache
* Restlessness/Irritability
* Insomia
* Dizziness
* Seizure
* Tachycardia/Palpitations/Arrhythmias

49
Q

AMINOPHYLLINE
3 T’s

2 Drugs

A

AMINOPHYLLINE
3 T’s
* Toxic Range (20 mgc/mL)
* Tonic-Clonic Seizure
* Tachycardia

2 Drugs
* Cimetidine
* Ciprofloxacin

50
Q

AMINOPHYLLINE
* The maintenance infusion rate should be adjusted to provide plasma levels of theophylline that are within the therapeutic range ( ____ ).
* Aminophylline solutions are ____ with many other drugs.

Therapeutic Level: ____
- Monitored frequently to avoid severe side effects
- ____ can cause Increased level
- GI Upset, anorexia, vomiting, gastric pain, nausea, irritability, and tachycardia to seizures, brain damage, and even death.
- ____ administration of AMINOPHYLLINE -> causes dizziness, flushing, severe, hypotension, bradycardia, and palpitations.

A

AMINOPHYLLINE
* The maintenance infusion rate should be adjusted to provide plasma levels of theophylline that are within the therapeutic range (10 to 20 mcg/mL).
* Aminophylline solutions are incompatible with many other drugs.

Therapeutic Level: 10-20 ug/mL
- Monitored frequently to avoid severe side effects
- CIMETIDINE can cause Increased level
- GI Upset, anorexia, vomiting, gastric pain, nausea, irritability, and tachycardia to seizures, brain damage, and even death.
- RAPID IV administration of AMINOPHYLLINE -> causes dizziness, flushing, severe, hypotension, bradycardia, and palpitations.

51
Q

AMINOPHYLLINE
Nursing Consideration
* Take the medicine in ____
* Avoid caffeine
* Avoid stimulants
* Stop before ____

Implementations:
- Monitor VS and note for BP and HR -> hypotension and tachycardia
- Administer with food or milk
- Monitor patient response to the drug: relief of respiratory difficulty and improved airflow.
- Determine the effective of the drug dosage and to adjust dosage as needed.
- ____ enteric coated and sustained release tablets
- Encourage to refrain from smoking
- Follow up including blood tests to monitor theophylline levels.

Provide comfort measures:
* Rest period
* Quiet environment
* ____
* ____
* Adequate hydration

A

AMINOPHYLLINE
Nursing Consideration
* Take the medicine in AM
* Avoid caffeine
* Avoid stimulants
* Stop before Cardiac Stress Test Procedure

Implementations:
- Monitor VS and note for BP and HR -> hypotension and tachycardia
- Administer with food or milk
- Monitor patient response to the drug: relief of respiratory difficulty and improved airflow.
- Determine the effective of the drug dosage and to adjust dosage as needed.
- Don’t crush enteric coated and sustained release tablets
- Encourage to refrain from smoking
- Follow up including blood tests to monitor theophylline levels.

Provide comfort measures:
* Rest period
* Quiet environment
* Diet (caffeine control)
* Headache therapy
* Adequate hydration

52
Q

ANTI-INFLAMMATORY AGENTS (4)

A

ANTI-INFLAMMATORY AGENTS (4)
* Steroids
* Leukotriene
* Mast Cells Stabilizer
* Cromalyn

53
Q

STEROIDS
* Decrease the inflammatory response in airway and decrease airway edema
* Beclomethasone, Fluticasone, Methylprednisone
* Glucocorticoids (e.g., budesonide, fluticasone) are the ____ available for long-term control of airway inflammation.
* Administration is usually by ____, but may also be IV or oral. Adverse reactions to inhaled glucocorticoids are generally minor, as are reactions to systemic glucocorticoids taken acutely. However, when systemic glucocorticoids are used long term, severe adverse effects are likely.
* Contraindicated: Not for ____

A

STEROIDS
* Decrease the inflammatory response in airway and decrease airway edema
* Beclomethasone, Fluticasone, Methylprednisone
* Glucocorticoids (e.g., budesonide, fluticasone) are the most effective drugs available for long-term control of airway inflammation.
* Administration is usually by inhalation, but may also be IV or oral. Adverse reactions to inhaled glucocorticoids are generally minor, as are reactions to systemic glucocorticoids taken acutely. However, when systemic glucocorticoids are used long term, severe adverse effects are likely.
* Contraindicated: Not for acute asthma attack or status asthmaticus

54
Q

STEROIDS: 4 S

A

STEROIDS: 4 S
* S – Swelling
* S – Slow onset
* S – Sugar Increase
* S – Sore in the mouth (Suppress Immune System)

55
Q

STEROIDS
S/E:
* ____
* Gastric irritation
* ____

Nursing Considerations:
* Drug doses must not be missed and must be tappered off over a ____
* DO NOT stop abruptly must be given with foods or right after meal
* ____ after using the inhaler to decrease systemic absorption and decrease GI upset and nausea.
* Monitor signs of respiratory infections due to steroids.

A

STEROIDS
S/E:
* Hypoglycemia
* Gastric irritation
* Impaired immune

Nursing Considerations:
* Drug doses must not be missed and must be tappered off over a 4-5 days periods
* DO NOT stop abruptly must be given with foods or right after meal
* Rinse mouth after using the inhaler to decrease systemic absorption and decrease GI upset and nausea.
* Monitor signs of respiratory infections due to steroids.

56
Q

LEUKOTRENE RECEPTOR AGONIST
Leukotriene
* Chemical mediator that causes inflammatory changes in the lungs

Leukotriene Receptor Antagonist
* Reducing inflammatory symptoms of asthma
* Zafirlukast, Zilueton, ____ (Singulair)

A

LEUKOTRENE RECEPTOR AGONIST
Leukotriene
* Chemical mediator that causes inflammatory changes in the lungs

Leukotriene Receptor Antagonist
* Reducing inflammatory symptoms of asthma
* Zafirlukast, Zilueton, Montelukast Sodium (Singulair)

57
Q

LEUKOTRENE RECEPTOR AGONIST
* Leukotriene modifiers suppress the effects of leukotrienes, which are compounds that promote ____, blood vessel permeability, and ____ through direct action as well as through ____ and other inflammatory cells.
* In patients with asthma, these drugs can ____ such as edema and mucus secretion.
* Current guidelines recommend using these agents as ____ (if an inhaled glucocorticoid cannot be used) and as add-on therapy when an inhaled glucocorticoid alone is inadequate.
* Although generally well tolerated, all the leukotriene modifiers can cause adverse ____, including depression, suicidal thinking, and suicidal behavior

A

LEUKOTRENE RECEPTOR AGONIST
* Leukotriene modifiers suppress the effects of leukotrienes, which are compounds that promote smooth muscle constriction, blood vessel permeability, and inflammatory responses through direct action as well as through recruitment of eosinophils and other inflammatory cells.
* In patients with asthma, these drugs can decrease bronchoconstriction and inflammatory responses such as edema and mucus secretion.
* Current guidelines recommend using these agents as second-line therapy (if an inhaled glucocorticoid cannot be used) and as add-on therapy when an inhaled glucocorticoid alone is inadequate.
* Although generally well tolerated, all the leukotriene modifiers can cause adverse neuropsychiatric effects, including depression, suicidal thinking, and suicidal behavior

58
Q

LEUKOTRENE RECEPTOR AGONIST
Uses of Leukotrienes
* ____ management of asthma
* Long onset (____ weeks therapeutic range)

A/R
* Headache
* Dizziness
* ____
* ____
* C/I for patient with ____.

A

LEUKOTRENE RECEPTOR AGONIST
Uses of Leukotrienes
* Long term management of asthma
* Long onset (1-2 weeks therapeutic range)

A/R
* Headache
* Dizziness
* N/V
* Myalgia
* C/I for patient with active liver disease.

59
Q

MAST CELL STABILIZERS
* ____
* Blocks ____
* Prevents ____
* Cromolyn is an inhalational agent that suppresses bronchial inflammation. The drug is used for ____—not quick relief—in patients with mild to moderate asthma.
* Anti-inflammatory effects are less than with glucocorticoids; therefore, cromolyn is ____ for asthma therapy. When glucocorticoids create problems, however, cromolyn may be prescribed as ____.

A

MAST CELL STABILIZERS
* Cromolyn
* Blocks histamine response
* Prevents activity-induced asthma (sports/activity)
* Cromolyn is an inhalational agent that suppresses bronchial inflammation. The drug is used for prophylaxis—not quick relief—in patients with mild to moderate asthma.
* Anti-inflammatory effects are less than with glucocorticoids; therefore, cromolyn is not a preferred drug for asthma therapy. When glucocorticoids create problems, however, cromolyn may be prescribed as alternative therapy.

60
Q

MAST CELL STABILIZERS
Cromolyn Therapeutic Uses
* ____. Cromolyn is an alternative to inhaled glucocorticoids for prophylactic therapy of mild persistent asthma
* ____. Cromolyn can prevent bronchospasm in patients at risk for EIB. For best results, cromolyn should be administered ____ anticipated exertion but ____ exercise.
* ____. Intranasal cromolyn [NasalCrom] can relieve symptoms of allergic rhinitis

A

MAST CELL STABILIZERS
Cromolyn Therapeutic Uses
* Chronic Asthma. Cromolyn is an alternative to inhaled glucocorticoids for prophylactic therapy of mild persistent asthma
* Exercise-Induced Bronchospasm. Cromolyn can prevent bronchospasm in patients at risk for EIB. For best results, cromolyn should be administered 10 to 15 minutes before anticipated exertion but no longer than 1 hour before exercise.
* Allergic Rhinitis. Intranasal cromolyn [NasalCrom] can relieve symptoms of allergic rhinitis

NR-NUR124 | Pharmacology (10 decks)

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