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NURS 1064 - Pharm > Chapter 35 & 48 (Learning Outcomes) > Flashcards

Chapter 35 & 48 (Learning Outcomes) Flashcards

1
Q

What are some examples of respiratory conditions that affect the patient’s ability to move air into and out of the lungs?

A
  • Pneumonia
  • Bronchitis
  • Chronic obstructive pulmonary disease
  • Cystic fibrosis
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2
Q

Why is the lower respiratory tract basically sterile?

A

Because of the various defense mechanisms of the upper respiratory systems

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3
Q

What are the three layers of the bronchial tubes?

A
  1. Cartilage
  2. Muscle
  3. Epithelial cells
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4
Q

What do all of the tubes in the lower airway produce?

A

Mucus

- to entrap any particles that may have escaped the upper airway protective mechanisms

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5
Q

What is perfusion?

A

Blood delivery to the alveoli

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6
Q

What is respiration?

A

Exchange of gases at the alveolar level

- oxygen and carbon dioxide

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7
Q

What is ventilation?

A

The act of breathing

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8
Q

What does stimulation of the sympathetic nervous system do to breathing?

A

Increases rate and depth of respiration

- dilates the bronchi to allow freer airflow through the system

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9
Q

What is CAL (chronic airway limitation)?

A

An umbrella term that describes gradually progressive, degenerative diseases
(Chronic bronchitis, emphysema, repeated asthma attacks)

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10
Q

What happens to the airways during chronic bronchitits?

A

Continuous inflammation of the bronchial tree

  • destroyed the cells
  • cilia are absent
  • defense mechanism against invading foreign material is lost
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11
Q

What happens to the airways during emphysema?

A

Abnormal distention of the lungs with air

  • loss or degeneration of elastic tissue
  • breakdown of alveolar walls
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12
Q

What is the role of mucolytic drugs?

A

Break down mucus and help the high-risk respiratory patients cough up thick, tenacious secretions

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13
Q

What is the prototype drug for mucolytics?

A

Acetylcysteine (Mucomyst)

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14
Q

What drug is used for patients that have developed atelectasis (b/c of thick mucus secretions)?

A

Acetylcysteine

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15
Q

Describe the pharmacodynamics of Acetylcysteine

A

Affects the mucoproteins in the respiratory secretions

- splits disulfide bonds that are responsible for holding the mucous material together

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16
Q

What is the result of using Acetylcysteine (Mucolytics) on secretions?

A

Decrease in the tenacity and viscosity of the secretions

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17
Q

What are the benefits of using acetylcysteine on the liver?

A

Protects against episodes of Tylenol toxicity

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18
Q

How does Acetylcysteine prevent Tylenol toxicity?

A

Binds with the reactive hepatotoxic metabolite of acetaminophen

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19
Q

In order to maximize the effects of acetylcysteine, what should you administer first?

A

Inhaled beta agonist

- to dilate the bronchial tree and enable the drug to permeate the entire tree

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20
Q

What are bronchodilators used to facilitate?

A

Respiration

- by dilating the airways

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21
Q

What is the bronchodilator (selective beta-2 agonist) used in managing CAL and asthma?

A

Albuterol (Ventolin)

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22
Q

What dietary component increases the risk of adverse effects of albuterol?

A

Caffeine

- tea, soda, cocoa, candy and chocolate should also be moderated

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23
Q

What drug is the drugs of choice for patients in the ER that are experiencing an acute asthma attack?

A

Albuterol

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24
Q

What is a common adverse effect of inhaled and oral albuterol (Ventolin)?

A

Palpitations

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25
Q

What is an indication that a patient may need to use an aerochamber (spacer) with their MDI (metered dose inhaler)?

A

If the patient has difficulty synchronizing the MDI with their inspiration

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26
Q

What drugs are considered first-line treatment for patients with CAL whose symptoms have become persistent (chronic)?

A

Inhaled anticholinergic drugs

- Ipratropium bromide (Atrovent)

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27
Q

What are the contraindications for Ipratropium Bromide (Atrovent) (4)?

A
  1. Sensitivity to ipratropium and atropine
  2. Bladder obstruction
  3. Prostatic hypertrophy
  4. Closed-angle glaucoma
    - could precipitate urinary retention and increase intraocular pressure
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28
Q

What are the classic adverse effects of Ipratropium bromide (Atrovent) (4)?

A
  • Dry mouth
  • Constipation
  • Urinary retention
  • Blurred vision
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29
Q

What is important to know for patient education regarding Ipratropium Bromide?

A

It will NOT abort an acute asthma attack

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30
Q

What is the therapeutic response expected from the theophylline drugs (Xanthine derivative?

A

Symptomatic relief or prevention of bronchial asthma and reversal of bronchospasm assoicated with CAL

  • excellent bronchodilators
  • don’t work as fast as beta-adrenergic agonist drugs (Albuterol)
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31
Q

What are the most common adverse effects of Theophylline?

A

Nausea, vomiting, headache and insomnia

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32
Q

What is the most effective anti-inflammatory drug available for managing respiratory disorders?

A

Glucocorticoid steroids

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33
Q

What is the prototype drug for inhaled corticosteroid (ICS) agents?

A

Flunisolide (AeroBid)

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34
Q

What is a technique patients can use to know when their inhaler canister is empty?

A

Count their uses and keep track

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35
Q

What does Flunisolide inhibit?

A

Production of leukotrienes and prostaglandins

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36
Q

In what circumstance is Flunisolide contraindicated?

A

In patients with an active infection

- b/c it suppresses the immune response

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37
Q

What is a common adverse effect of Flunisolide?

A

Candida albicans infections

- associated with daily use

38
Q

What should be done after administering Flunisolide?

A

Rinsing the mouth

  • prevents thrush
  • decreases amount of drug swallowed
39
Q

What are some things that we should education our patients on regarding Flunisolide (5)?

A
  • Oral hygiene
  • Proper use of MDI
  • S/S oropharyngeal candidiasis (white spots and painful swallowing)
  • Rinsing mouth after
  • Daily use (regardless of absence of symptoms)
40
Q

What happens when mast cells rupture?

A

Release histamine, serotonin, bradykinin, and leukotrienes

  • cause an inflammatory response
  • such as bronchial constriction
41
Q

What is the prototype drug for mast cell stabilizers?

A

Cromolyn Sodium

42
Q

What is Cromolyn Sodium used for?

A

Prophylactically in treating mild to moderate asthma and acute bronchospasm
- induced by exercise, environmental pollutants and known antigens

43
Q

Describe the pharmacodynamics of Cromolyn Sodium

A

Works at the surface of mast cells to inhibit rupturing and degranulation after contact with an antigen

44
Q

What is an absolute contraindication for Cromolyn Sodium?

A

Patients that have a demonstrated hypersensitivity

- anaphylaxis can occur

45
Q

Other than hypersensitivity to Cromolyn Sodium, what are other contraindicators?

A
  • For treating acute bronchospasm or status asthmasticus
  • In patients with CAD or cardiac dysrhythmias
  • Patients that have a lactose intolerance
46
Q

What is the prototype drug for Leukotriene receptor antagonsits?

A

Zafirlukast (Accolate)

47
Q

What is Zafirlukast used for?

A

Treating chronic asthma

48
Q

How can you maximize the effects of Zafirlukast?

A

Take 1 hour before or 2 hours after a meal to increase the bio-availability of the drug

49
Q

When should Zafirlukast not be used?

A

During an acute asthma attack

50
Q

What should the patient report if using Zafirlukast and hepatic injury is suscepted?

A
  • abdominal pain
  • jaundice
  • nausea
  • vomiting
  • dark urine
51
Q

A patient prescribed an inhaled corticosteriod (ICS) for daily use need to be monitored for …?

A

Dysphonia and oropharyngeal Candida Albicans infection

52
Q

What is acteylcysteine (Mucomyst) used to treat?

A

Cystic fibrosis

53
Q

What are the two main categories of drugs used to manage CAL?

A
  1. Bronchodilators

2. Anti-inflammatories

54
Q

What is the only type of drug used to treat acute asthma attacks?

A

Short-acting beta-agonist drugs

55
Q

What is the adrenal cortex primarily involved in?

A

Synthesis and secretion of glucocorticoids and mineralcorticoids

56
Q

What do the metabolic effects of glucocorticoids result in?

A
  • increase in circulating amino acids
  • overall depletion of muscle proteins
  • mobilization of fatty acids for energy
57
Q

What are three factors that are important in regulating ACTH secretion?

A
  • circulating cortisol levels
  • stress levels
  • circadian rhythms
58
Q

What is the most prevalent naturally occuring mineralcorticoid in the body?

A

Aldosterone

59
Q

What are the two forms of adrenal insufficiency?

A
  1. Primary

2. Secondary

60
Q

What is an example of a disease that is a primary adrenal insufficiency?

A

Addison’s disease

- destruction of adrenal cortex by infection or hemorrhage

61
Q

What happens if there is a sudden withdrawal from long-term therapy of a glucocorticoid drug?

A

Secondary adrenal insufficiency

62
Q

What adrenal cortex disorder is associated with hirsutism?

A

Cushing’s Syndrome

- increased adrenocortical secretion of cortisol

63
Q

What are the two primary endogenous glucocorticoids produced by the adrenal gland?

A
  1. Cortisol (Hydrocortisone)

2. Cortisone

64
Q

What are cortisol and cortisone used for?

A

Replacement therapy in patients with adrenal insufficiency

- no role in anti-inflammatory regimen

65
Q

What is the prototype drug for glucocorticoids?

A

Prednisone

66
Q

How do you prevent secondary adrenal insufficiency if you stop taking glucocorticoids?

A

Wean patients off of them

67
Q

What is prednisone used for?

A

Anti-inflammatory effects and immunosuppressive effects

68
Q

Specifically, which clinical manifestations is prednisone used to treat?

A
  • asthma
  • allergies
  • RA
  • ulcerative colitis
  • skin disorders
  • leukemia
  • acute gout
  • prevents organ transplant rejection
69
Q

What are the two kinds of therapy that can be used with Prednisone?

A
  • Short-term (acute allergic reactions)

- Long-term (COPD, asthma, ulcerative colitis)

70
Q

How does Prednisone cause edema and hypertension?

A

It can cause salt and water retention leading to edema and hypertension

71
Q

What are the immunosuppressant effects of prednisone attributable to?

A
  • Suppression of phagocytosis
  • Decrease in # of circulating eosinophils and lymphocytes
  • Decrease in antigen-antibody tissue reactions
  • Decrease in plasma immunoglobulins
72
Q

If you have a patient that is on a long-term prednisone therapy, what should they be aware of?

A

That they should wear medical indentification so that any emergency medical personnel will know about the drug therapy

73
Q

What should you recommend to your patient if they forgot to take his daily dose (5 mg) of prednisone - what would you instruct him to do?

A

Take the missed dose as soon as possible then resume the regular schedule

74
Q

Name 4 physical characteristics of Cushingoid that occur above the shoulders

A
  1. Moon face
  2. Glaucoma and cataract formation
  3. Hirsutism and masculinization
  4. Cervicodorsal fat (buffalo hump)
75
Q

Name 4 physical characteristics of Cushingoid that occur at the trunk region

A
  1. Abdominal striae (purple)
  2. Protuberant abdomen
  3. Truncal obesity
  4. Extremity thinning and atrophy (arms)
76
Q

Name 2 physcial characteristics of Cushingoid that occur below the waist (legs)?

A
  1. Swelling (fluid retention and edema)

2. Brittle bones (osteoporosis)

77
Q

State the pharmacologic classification of the glucocorticoid Prednisone.

A

A synthetic analogue of cortisone

- the prototype glucocorticoid

78
Q

What are the long-term or high-dose effects of prednisone therapy on the musculoskeletal system?

A

Osteroporosis

  • due to its association with increased bone mineral density loss
  • putting the patient at a higher risk for fracture
  • enhances calcium loss
79
Q

True or False:

There is a direct correlation between the extent of bone loss and the duration of prednisone therapy

A

True

80
Q

An older adult patient on long-term prednisone therapy should be instructed to …?

A

Take measures to minimize the risk of falls

- there is an increased risk of bone fractures on long-term prednisone therapy

81
Q

What is the naturally occurring mineralocorticoid in the body?

A

Aldosterone

82
Q

What is the prototype drug for mineralocorticoids?

A

Fludrocortisone (Florinef Acetate)

83
Q

True or False:

Fludrocortisone is 20x more potent than hydrocortisone

A

False

- only 15x more potent

84
Q

What is Fludrocortisone used for?

A
  • partial replacement therapy for primary and secondary adrenocortical insufficiency in Addison’s disease
  • for treating salt-losing adrenogenital syndrome
85
Q

What are the adverse effects of Fludrocortisone in small doses (3)?

A
  • *sodium retention
  • *increased urinary potassium excretion
  • rise in blood pressure
86
Q

What are the adverse effects of Fludrocortisone in larger doses?

A
  • inhibits endogenous adrenal cortical secretion and pituitary corticotropin excretion
  • promotes deposition of liver glycogen
87
Q

What are corticosteroids used for?

A
  • anti-inflammatory properties
  • reduce inflammation and swelling
  • anti-allergenic
  • immuno-suppressive
88
Q

What are short-term glucocorticoid therapies used for?

A

Treating acute allergic reactions

89
Q

What are long-term glucocorticoid therapies used for?

A

Acute exacerbation of chronic diseases (COPD, asthma, ulcerative colitis)

90
Q

Describe the pharmacodynamics of Fludrocortisone

A

Acts on the distal tubule to enhance the reabsorption of sodium and to increase the urinary excretion of both potassium and hydrogen ions
(increases sodium = water retention)

NURS 1064 - Pharm (9 decks)

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