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Nursing > Drug Therapy for the Respiratory System > Flashcards

Drug Therapy for the Respiratory System Flashcards

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1
Q

Common Cold

A

affects the upper respiratory tract (clavicles up)
Occurs when viruses or bacteria invade our system and get past our general defense mechanisms

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2
Q

Viral Cold

A

2-4 occurrences every year typical in adults; up to 10 occurrences a year for children.
Viruses invade via mucous membranes
Can survive for several horse on skin and hard surfaces

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3
Q

Sinusitis

A

When the sinus cavities become inflamed or infected and it blocks the fluid that drains out of the sinuses

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4
Q

Rhinitis

A

(running nose) is the most common cause of sinusitis because your nose is running and you are blowing it constantly and it gets swollen which blocks off the sinuses

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5
Q

Signs and Symptoms of colds and sinusitis

A

Nasal congestion
Cough: protective defense
Productive vs. non-productive

Increased secretions: they run down your throat and into your bronchi. You can get these from irritations like allergies, smoking, or surgery

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6
Q

Nasal Decongestants Example

A

pseudoephedrine
Oxymetazoline
Phenylephrine

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7
Q

Nasal Decongestants Action

A

relieve nasal obstruction and discharge by producing vasoconstriction. Decreases nasal blood vessels and increase blood flow for breathing.

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8
Q

Nasal Decongestants Contraindications

A

Anything that is dangerous with SNS/vasoconstriction
Severe HTN, CAD, narrow angle glaucoma, antidepressants

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9
Q

Nasal Decongestants Patient teaching

A

Encourage adequate fluid intake (thin secretions)
Humidification (moisture is good for GI tract and respiratory tract)
Do not take longer than package recommendation (3-5d. Could cause rebound congestion. It is going to overpower the medication)
Avoid caffeine (increased vasoconstriction)
Avoid accidental OD (be careful when taking with other cold medicine)
Avoid HTN
Proper use of nasal spray
Take with or without food

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10
Q

Antitussive Examples

A

Cough Medicine
Dextromethorphan

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11
Q

Antitussive Action

A

Suppresses dry, hacking, non-productive cough

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12
Q

Centrally Acting Antitussive

A

Narcotic and non-narcotic
Taken orally
Acts on whole body
Cough syrup (DM)

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13
Q

Locally Acting Antitussive

A

Throat lozenges
Cough drops

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14
Q

Nursing considerations for Antitussives:

A

Don’t eat or drink after a syrup (30 min)
Drug-to-drug interactions with antidepressants
Fluid intake and humidification

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15
Q

Expectorant Examples

A

Guaifenesin (mucinex)

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16
Q

Expectorant Action

A

Liquify respiratory secretions and allow for easier removal.
Used in a productive cough (tenacious sputum)

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17
Q

Expectorant Considerations

A

Do not crush or chew (extending release)
Adequate hydration and fluid intake.
Don’t take longer than 1 week w/o seeing a doctor.
Avoid accidental OD
Encourage coughing and deep breathing

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18
Q

Mucolytic Examples

A

Acetylcysteine

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19
Q

Mucolytic Action

A

highest power expectorant
Used with chronic respiratory issues
Used in the event of an acetaminophen overdose
Liquifies the mucous in the respiratory tract and is given via inhalation

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20
Q

Nursing considerations for Mucolytic

A

Given inhalation so monitor airways because the are going to cough out their secretions
Encourage coughing and deep breathing
Don’t leave the acetylcysteine on the person’s face (it smells like rotting eggs)

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21
Q

Pseudoephedrine

A

Vasoconstrictor that was used in meth so it is no longer OTC. Phenylephrine replaced it. Good for people with cardiac issues. It is in all of the cold medicine that you can buy in the OTC aisle.

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22
Q

OTC Cold Medicine

A

Vicks NyQuil
Pseudoephedrine
Phenylephrine

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23
Q

Histamine

A

the 1st chemical mediator released in an allergic reaction. Found in mast cells and basophils.

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24
Q

What happens when Histamine is released

A

Constriction of smooth muscle in R tract
Bronchoconstriction
Stimulation of the Vagus nerve
Increased permeability of veins and capillaries
Increased secretion from mucus glands
Stimulation of peripheral nerve endings
Dilation of capillaries in the skin
Increase secretion of gastric acid
Increased heart rate and force of contraction

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25
Q

Hypersensitivity Reactions

A

Memory B cells (antibodies) in the immune system mark something as harmful that isn’t actually harmful and whenever it sees it, it attacks it like crazy

Involves an exaggerated allergic response

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26
Q

Type 1 Hypersensitivity

A

Immediate hypersensitivity
Occurs within minutes

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27
Q

Type 1 Hypersensitivity enzyme and cell activation

A

IgE induced Mast cells activation. Usually after 2nd or later exposure
Mast Cells and Basophils

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28
Q

Type 2 Hypersensitivity

A

Much less common
Cytotoxic
Generates direct damage to cell surface
Blood transfusion reactions
Hemolytic disease of newborns, hemolytic anemia
Seen as reactions to penicillin and heparin

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29
Q

Type 2 Hypersensitivity Enzyme

A

Mediated by IgG or IgM

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30
Q

Type 3 hypersensitivity

A

Immune Complex
Serum sickness
Rare: seen in an antibody transfusion or in a response to some medications

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31
Q

Type 3 hypersensitivity Enzyme and action

A

Mediated by IgG or IgM
Forms antigen(badguy)-antibody(goodguy) complexes and causes acute inflammatory reaction in tissue

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32
Q

Type 4: Delayed hypersensitivity

A

Happens after exposure to an antigen
We don’t have the antibodies already looking for it, so it is a delayed response.
Tuberculin test
Contact Dermatitis
Graft rejection, poison ivy

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33
Q

Type 4: Delayed hypersensitivity
Cells activated

A

T cells reacts and causes a reaction
Sensitized T lymphocytes react with antigen to cause inflammation

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34
Q

Allergic Rhinitis

A

Inflammation of nasal mucosa caused by type 1 reaction to inhaled allergens

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35
Q

Allergic Rhinitis Symptoms

A

Nasal congestion
Itching, sneezing
Watery drainage
Itching or throat, eyes, and ears.

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36
Q

Seasonal Disease

A

Response to airborne pollens (spring, or fall)

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37
Q

Perennial Disease:

A

Response to nonseasonal allergies (happen all year round)
Dust Mites, molds
Animal dander

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38
Q

Allergic food reactions

A

Immune response to ingestion of a protein
Higher risk of triggering anaphylaxis

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39
Q

Common Food Allergies

A

Shellfish, fish, corn, seeds, bananas, eggs, milk, soy, peanuts

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40
Q

Contact Dermatitis

A

(Type 4–delayed reaction)
Poison Ivy, cosmetics, metals, tattoo dye
Affected skin: Inflamed, warm, swollen, itchy Blisters may form, drain, and become infected

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41
Q

Allergic Reactions from medications

A

Symptoms vary but may include:
Skin rash, fever, itching, hematologic reaction
May be from a preservative or a dye or a coating and NOT from the drug
May occur 7-10 days after starting the medication

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42
Q

Antihistamines

A

Stop the allergic cascade from the histamine. Stops histamine from binding.
Relieve symptoms but do not relieve hypersensitivity

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43
Q

Antihistamine Indication

A

Allergic Rhinitis
Anaphylaxis
Allergic conjunctivitis
Drug allergies, pseudoallergies
Blood/blood product transfusion
Dermatologic conditions

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44
Q

First Generation H1 Receptor Antagonists Example

A

Diphenhydramine

45
Q

First Generation H1 Receptor Antagonists Action

A

Prevents/reduces most physiologic effects that histamine produces at receptor sites
Decreases capillary permeability
Decreases salivation and tear formation

46
Q

First Generation H1 Receptor Antagonists Adverse Effects

A

CNS depression
Anticholinergic effects
(avoid giving to glaucoma, BPH, or constipation)
Make old adults confused.
Thickens secretions
Take med before exposure to the allergen.
Makes people TIRED

47
Q

First Generation H1 Receptor Antagonists Indication for Use

A

Treats allergic reactions, motion sickness, and insomnia
**Children may experience paradoxical effect and might be very energetic

48
Q

Second Generation H2 Receptor Antagonists Example

A

Fexofenadine, Loratadine, Cetirizine

49
Q

Second Generation H2 Receptor Antagonists Action

A

occupy the same receptors as histamine which prevents histamine from reaching the target receptor sites. Bind preferentially to peripheral rather than central H1 receptors

50
Q

Second Generation H2 Receptor Antagonists Considerations

A

Safer for older adults because it does not mess with CNS
Does not readily enter the brain from the blood
Be careful in patients with renal failure because they are at a higher risk of overdosing on this medication

51
Q

Lower respiratory system

A

bronchia, lungs, and trachea

52
Q

Common symptoms of Lower tract

A

excessive mucus production
Airway hyperresponsiveness
Swelling

53
Q

Common Conditions with the Lower Tract

A

Asthma, emphysema and chronic bronchitis

54
Q

Asthma

A

Caused by an IgE hypersensitivity reaction (type 1 sensitivity)
Can occur at any age

55
Q

Asthma is Stimulated by

A

Viral infections
Environmental irritants
stress/emotion
Strenuous activity
temperature/weather changes
***This is why it is different than an allergy

56
Q

Asthma Pathophysiology

A

Muscle constriction narrows airways
Inflammatory response
Mast cells release Cytokines which increase inflammation

57
Q

Mild to moderate asthma

A

Recurrent and reversible

58
Q

Advanced to severe Asthma

A

Less reversible, chronic inflammation, structural changes
Can lead to structural changes and long term structural changes known as remodeling

59
Q

Manifestations of Asthma

A

dyspnea, wheezing, chronic cough, peak expiratory flow rate decrease (how much air you are able to breathe out), vary moderate to severe symptoms

60
Q

Status Asthmaticus

A

Acute severe asthma, does not respond to usual treatments, severe respiratory distress, life threatening

61
Q

Air Trapping

A

Hard to EXHALE

62
Q

Chronic Bronchitis

A

Frequent productive cough more than 3 months/year x2 years
Increased mucus leads to airway narrowing. Chronic changes

63
Q

Bronchitis s/sx

A

Blue Bloater:
Airway flow problems
Cyanosis
Hypoxia
Increased Hgb

64
Q

Emphysema

A

Enlargement and destruction of Alveoli r/t long term lung damage
Loss of elasticity and surface area
Carbon dioxide trapping

65
Q

Emphysema s/sx

A

Pink Puffer:
Increased CO2 retention
Pink
Pursed lips
Barrel Chested

66
Q

Chronic Obstructive Pulmonary Disease

A

Chronic bronchitis and Emphysema together
Usually develops with long standing exposure to airway irritants

67
Q

COPD S/sx

A

Symptoms are more consistent and less reversible
Dyspnea
Activity intolerance
Air trapping

68
Q

Goal for Broncocogestive disorders

A

prevent airway inflammation
Minimize the use of “rescue drugs”
Maintenance drug: everyday prevention of congestion

69
Q

Bronchodilators

A

Andrenergics
Anticholinergics
Xanthines

70
Q

Anti-Inflammatories

A

Corticosteroids
Leukotriene modifiers
Mast cell stabilizers
Immunosuppressants

71
Q

first choice to relieve acute asthma

A

Administering bronchodilators by inhalation is most effective and the treatment of first choice to relieve acute asthma

72
Q

Two general types of inhaled B2 adrenergic agonists

A

Rescue inhalant
Maintenance inhalant:

73
Q

Maintenance inhalant:

A

long term control drugs used to achieve and maintain prophylactic control of persistent asthma

Salmeterol

74
Q

Rescue inhalant

A

quick relief short acting drugs used during periods of acute symptoms and exacerbations

Albuterol

75
Q

Beta 2 Adrenergic Agonists

A

beta 2 receptors in the smooth muscle of bronchi and bronchioles and open up the bronchioles
The receptors, in turn, stimulate the production of cyclic AMP
The increased cyclic AMP produces bronchodilation

76
Q

Beta 2 Adrenergic Agonists Considerations

A

Can be used in children and older adults
Large doses used in critical care short term
Available as nebulizer, MDI, or oral

77
Q

Beta 2 Adrenergic Agonists Adverse Effects

A

Muscle Tremor
Cardiac stimulation
CNS stimulation

78
Q

Beta 2 Adrenergic Agonists Contraindications

A

Dysrhythmias
CAD
HTN
With Beta Blockers, it may cause bronchospasm
Thyroid hormones, theophylline, cold med, caffeine increase stimulatory effects

79
Q

Beta 2 Adrenergic Agonist Patient Teaching

A

Use bronchodilator inhaler first
Wati 5 minutes between inhalers
Use steroid inhaler second
Do not overuse the rescue inhaler or it will not work as well when you really need it!
Do not skip or overuse maintenance inhalers
Proper use of a MDI

80
Q

Anticholinergics Examples

A

Ipratropium

81
Q

Anticholinergic Action

A

blocks the action of acetylcholine in the bronchial smooth muscle, inhibiting bronchoconstriction and mucus secretion
Maintenance therapy for bronchoconstriction r/t asthma, chronic bronchitis, and emphysema

82
Q

Anticholinergic Uses

A

Available in nebulizer or MDI
Usually used in combination with other bronchodilators
Prevent bronchoconstriction.
Maintenance
Don’t skip a dose
These do NOT have cardiac stimulation like B2

83
Q

Anticholinergics Adverse Effects

A

Cough, Dry Mouth, GI upset

84
Q

Anticholinergic Contraindications

A

Narrow angle glaucoma
BPH

85
Q

Xanthines Examples

A

Theophylline

86
Q

Xanthines Action

A

Works by relaxing the smooth muscle, which promotes bronchodilation.
Suppresses airway responsiveness

87
Q

Xanthines Uses

A

Used as second line treatment in SEVERE cases of chronic bronchoconstriction

88
Q

Xanthine Considerations

A

Monitor lab values for dosing because it can be very toxic (which is why it is only used in emergencies)

**Smoking Cigarettes can increase metabolism. Call dc. if quitting smoking

89
Q

s/sx of Xanthine overdose

A

anorexia, N+V, tachycardia, convulsions

90
Q

Xanthine Contraindications

A

Gastritis
PUD
Seizure disorder

91
Q

Corticosteroid Examples

A

Beclomethasone

92
Q

Corticosteroid Action

A

Suppress airway inflammation by blocking the cytokines
Results in
Blocks mucus secretion
Blocks airway mucosal edema
Repaired epithelium damage
Reduced airway reactivity

93
Q

Corticosteroid Use

A

Prevention (low dose) and treatment (high dose) of asthma and COPD
Long term can be used in combination
Inhaled for local effect to lungs only

94
Q

Corticosteroid Adverse effects

A

HA
Dry mouth, cough
Fungal infection (candidiasis/thrush)

95
Q

Corticosteroid Contraindications

A

Recent nasal/oral surgery because it slows down the healing process

96
Q

Leukotriene Modifier Example

A

Montelukast

97
Q

Leukotriene Modifier Action

A

Prevents leukotrienes from binding to receptors reducing bronchoconstriction and inflammation

98
Q

Leukotriene Modifier Use

A

Long term treatment of asthma
Not effective in relieving acute attacks
PO
Maintenance
prevent acute asthma attack from allergens, exercise, cold air, irritants, hyperventilation

99
Q

Leukotriene Modifier BLACK BOX

A

Neuropsychiatric events (vivid dreams)

100
Q

Mast Cell Stabilizer Example

A

Cromolyn

101
Q

Mast Cell Stabilizer Action

A

Prevent release of bronchoconstrictive and inflammatory substances from mast cells

102
Q

Mast Cell Stabilizer Use

A

Second line treatment option
Used in prophylaxis of acute asthma in mild, persistent asthma
Not effective in acute bronchospasm or status asthmaticus

103
Q

Monoclonal Antibodies Example

A

Omalizumab

104
Q

Monoclonal Antibodies Action

A

Binds with IgE blocking receptors so there is less IgE available to start allergic reactions
Adjunct therapy for severe allergic asthma not well controlled

105
Q

BLACK BOX WARNING Monoclonal Antibodies

A

only give this drug under medical supervision risk of life-threatening anaphylaxis

106
Q

Relievers

A

acute problems: albuterol

107
Q

Controller

A

Maintenance: salmeterol, Ipratropium

108
Q

Preventers

A

Prevent the problems: Theophylline, Beclomethasone, Montelukast, Cromolyn, and Omalizumab

Nursing (17 decks)

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