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Pharmacology > Drugs acting on Respiratory System > Flashcards

Drugs acting on Respiratory System Flashcards

1
Q

Enumerate the 3 parts of the Upper respiratory tract

A

Nasal Cavity
Pharynx
Larynx

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2
Q

Enumerate the 3 parts of the Lower respiratory tract

A

Trachea
Primary Bronchi
Lungs

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3
Q

The common cold is caused by what virus

A

rhinovirus

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4
Q
  • most contagious 1-4 days before the onset of symptoms, and during the first 3 days of the cold
  • Transmission: touching contaminated surfaces, then touching the nose or mouth
  • S/Sx: rhinorrhea, nasal congestion, cough, and increased mucosal secretions
A

Common Cold

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5
Q

Drugs used to treat common colds

A

antihistamines, decongestants, antitussives, and expectorants

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6
Q
  • Inflammation of the mucuous membrane that usually accompanies the common cold
  • Increased nasal secretions
A

Acute Rhinitis

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7
Q

– aka “hay fever”; caused by pollen or foreign substance

  • increased nasal secretions
A

Allergic Rhinitis

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8
Q

Identify the drug…

  • H1 blockers or H1 antagonists
  • Compete with histamine for receptore sites
  • Not useful in an emergency situation e.g. anaphylaxis
  • Rapidly absorbed in 15 minutes but not potent enough to combat anaphylaxis
A

Antihistamines

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9
Q

Which Generation of Antihistamines is being described below

  • Cause drowsiness, dry mouth, and other anticholinergic symptoms
  • Patient should be alerted not to drive or operate machinery when taking such medications
  • Decreases secretions, nasal itching and tickling that cause sneezing
A

First-Generation

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10
Q

Identify the drug…

  • 1st generation Antihistamine
  • Frequently combined with other ingredients in cold remedy preparations
  • Can be Oral, IM, IV
  • Major SE: drowsiness
A

DIPHENHYDRAMINE (Benadryl)

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11
Q

Nursing Interventions
for First-Generation Antihistamines

A
  • Give oral form with food to decrease gastric distress
  • Administer IM form in large muscle; avoid SQ injection
  • Warn pt to avoid driving and performing dangerous activities after taking drug
  • Advise pt to avoid alcohol and other CNS depressants
  • Encourage pt to take drug as prescribed
  • Teach pt on prophylaxis for motion sickness to take the drug at least 30mins before offending event, and also before meals and at bedtime during event
  • Inform breastfeeding mothers that small amounts of drug pass into breastmilk
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12
Q

Which Generation of Antihistamines is being described below

  • Fewer anticholinergic effects and lower incidence of drowsiness
  • Cetirizine, Fexofenadine, and Loratadine – t1/2: 7-15hrs
  • Azelastine - t1/2: 22hrs; nasal spray
A

Second-Generation Antihistamines

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13
Q

They…

  • Stimulate the alpha-adrenergic receptors causing vasoconstriction (nasal mucosa) causing shrinking of the nasal mucosal membranes and reduction in fluid secretion
  • Can be Nasal spray or drops, tablets, capsule, liquid
  • Frequent use can result in tolerance and rebound nasal congestion
  • Advantage: Fewer side effects that systemic decongestants
A

NASAL DECONGESTANTS

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14
Q

They…

  • Can be Tablet, capsule, liquid form
  • Used primarily for allergic rhinitis including hay fever and acute coryza
  • Ephedrine, Phenylephrine, Pseudoephedrine
  • Frequently combined with antihistamine, analgesic, or antitussive in oral cold remedies
  • Advantage: relieve nasal congestion for a longer period that nasal decongestants
A

SYSTEMIC DECONGESTANTS

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15
Q

Side Effects and Adverse Reactions of Nasal and Systemic Decongestants

A
  • Topical preparations have low incidence of side effects
  • Jittering, nervousness, or restlessness will decrease or disappear as the body adjusts to the drug
  • Nasal sprays causes rebound nasal congestion; emphasize the importance of limiting use of nasal sprays and drops
  • Decongestants will increased BP and blood glucose levels
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16
Q

Drug Interaction of Nasal and Systemic Decongestants

A
  • Pseudoephedrine may decrease the effect of beta blockers
  • Decongestants + Monoamine oxidase inhibitors (MAOIs) – hypertension and dysrhythmias; restlessness; advice to avoid large amounts of caffeine
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17
Q

They are…

  • Effective for treating allergic rhinitis
  • Antiinflammatory action – decrease sx of rhinorrhea, sneezing, and congestion
  • May be used alone or in combination with an H1 antihistamine
  • Chronic use – dryness of nasal mucosa
  • Dexamethasone – should NOT be used for >30 days
A

Intranasal Glucocorticoids

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18
Q

Examples of Intranasal Glucocorticoids

A

Beclomethasone, Budesonide, Dexamethasone, Flunisolide, Fluticasone, Triamcinolone

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19
Q

– naturally protective way to clear airway of secretions or any collected material

A

Cough

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20
Q
  • Act on the cough control center in the medulla to suppress the cough reflex
  • Indicated ONLY for nonproductive, irritating cough
  • Hard candy – may decrease the constant, irritating cough
  • There are 3 types – nonnarcotic, narcotic, or combination
A

Antitussives

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21
Q

3 types of Antitussives

A

nonnarcotic, narcotic, or combination

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22
Q

Theses Antitussives are

  • Nonnarcotic
  • OTC drug
  • Syrup or liquid form, chewable, capsules, and lozenges
  • Can cause neither physical dependence nor tolerance
  • Fast onset of action; Duration of action: 3-6hrs; t1/2: 11hours
A

Dextrometorphan (Robitussin), Butamirate Citrate (Sinecod)

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23
Q

They…

  • Loosen bronchial secretions so they can be eliminated by coughing
  • Found in many OTC cold remedies along with analgesics, antihistamines, decongestants, and antitussives
  • Must Instruct pt to increase fluid intake to at least 8 glasses per day to help loosen mucus
A

Expectorants

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24
Q

best natural expectorant

A

Hydration

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25
Q

An example of Expectorants

A

Guaifenesin

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26
Q

Common Cold: Nursing Interventions and Patient Teaching

A
  • Monitor VS. Assess for hypertension and dysrhythmias
  • Observe for color of bronchial secretions; yellowish-greenish mucus is indicative of a bronchial infection
  • Warn pt that codeine preparation for cough suppression can lead to tolerance and physical dependence
  • Tell pt that hypotension and hyperpyrexia may occur when dextromethorphan is taken with MAOIs
  • Teach pt about the proper use of nasal sprays, “puff” or squeeze products
  • Caution pt not to use >1-2 puffs, 4-6x a day, for 5-7 days (rebound congestion)
  • Advise pt to read labels on OTC drugs and to check with physician before taking cold remedies
  • Antibiotics are not helpful in treating common cold viruses
  • Encourage older patients with comorbidities to contact HCP concerning selection of drug, including OTC drugs
  • Instruct pt not to drive during initial use of a cold remedy
  • Tell pt to maintain adequate fluid intake
  • Teach pt not to take a cold remedy before or at bedtime;
  • Insomnia may occur if it contains decongestant
    Encourage pt to get adequate rest
  • Inform pt about the mode of transmission of cold and flu viruses; hand-to-hand contact or by touching contaminated surfaces
  • Advise pt to avoid environmental pollutants, fumes, smoking, and dust
  • Teach pt to perform 3 effective coughs before bedtime to promote uninterrupted sleep
  • Instruct pt to store drug out of reach of children; request childproof caps
  • Advise pt to contact HCP if cough persists for >1 week, or is accompanied by chest pain, fever, or headache
  • Teach pt how to self-administer nose drops and inhalants
  • Encourage pt to cough effectively; deep breaths before coughing in an upright position
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27
Q
  • Inflammation of the mucous membrane of one or more of the maxillary, frontal, ethmoid or sphenoid sinuses
  • Systemic or nasal decongestant may be indicated
  • Acetaminophen, fluids, and rest ma also be helpful
  • Acute or Severe may need antibiotics
A

SINUSITIS

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28
Q
  • Inflammation of the throat; “sore throat”
  • Can be caused by a virus, beta-hemolytic streptococci (strep throat), or other bacteria
  • Can occur alone or with the common cold and rhinitis or acute sinusitis
  • Sx – fever and cough
  • Throat culture – to rule out B-hemolytic streptococcal infection; if (+), a 10-day course of antibiotic is prescribed
  • Saline gargles, lozenges, and increased fluid intake are usually indicated
  • Acetaminophen – to alleviate fever
  • Antibiotics are NOT effective for viral pharyngitis
A

ACUTE PHARYNGITIS

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29
Q

Enumerate Drugs Acting on the Upper Respiratory System

A
  • Antihistamines
  • Nasal and Systemic Decongestants
  • Intranasal Glucocorticoids
  • Antitussives
  • Expectorants
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30
Q

Name 3 examples of Chronic Obstructive Pulmonary Disease (COPD)

A

Asthma | Chronic Bronchitis | Emphysema

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31
Q

Identify which COPD is being described

  • Inflammatory disorder of the airway associated with a varying amount of airway obstruction
  • Triggers: stress, allergens, and pollutants causing inflammation and edema of bronchial airways causing constriction of air passages causing wheezing, coughing, dyspnea, chest tightnes
A

Asthma

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32
Q

Identify which COPD is being described

  • Progressive lung disease caused by smoking and chronic lung infections
  • Bronchial inflammation and excessive mucus secretion causing airway obstruction causing productive coughing, expiratory rhonchi, hypercapnia, hypoxemia
A

Chronic Bronchitis

33
Q

Identify which COPD is being described

  • Progressive lung disease caused by cigarette smoking, atmospheric contaminants, or lack of a1-antitrypsin protein that inhibits proteolytic enzymes that destroy alveoli
  • Bacterial infection causing Release of proteolytic enzymes causing terminal bronchioles are plugged with mucus causing loss in the fiber and elastin network in the alveoli
A

Emphysema

34
Q

They…

Increase cAMP causing dilation of the bronchioles
Bronchospasm due to anaphylaxis – epinephrine causing dilation and inc. BP

  • Bronchospasm due to chronic asthma or COPD – selective B2 adrenergic agonists as aerosol or tablet
A

SYMPATHOMIMETICS: ALPHA- and BETA2-ADRENERGIC AGONISTS

35
Q

Examples of SYMPATHOMIMETICS: ALPHA- and BETA2-ADRENERGIC AGONISTS

A

Albuterol/Salbutamol
Isoproterenol

36
Q

Identify which SYMPATHOMIMETICS: ALPHA- and BETA2-ADRENERGIC AGONISTS is being described

  • Selective B2 drug
  • Effective for treatment and control of asthma
  • Causes bronchodilation with long duration of action
  • More rapid by inhalation (1 min) than orally (15mins)
A

Albuterol/Salbutamol

37
Q

Identify which SYMPATHOMIMETICS: ALPHA- and BETA2-ADRENERGIC AGONISTS is being described

  • First beta adrenergic agent used for bronchospasm, 1941
  • Non-selective beta agonist (B1 and B2)
  • B1 stimulation – inc. heart rate
  • B2 stimulation – bronchodilation
  • Aerosol inhaler or IV
    Short duration of action
A

Isoproterenol

38
Q

Use of an Aerosol Inhaler

A
  • Explain correct use of meter-dose inhaler or dry-powder inhaler and dosage intervals
  • Spacer may be attached to the inhaler to improve drug delivery to the lungs
  • SE and AE: mouth dryness, throat irritation, tolerance, severe paradoxical airway resistance, tremors, nervousness, and increased heart rate
39
Q

Side Effects and Adverse Reactions of Epinephrine

A
  • Tremors, dizziness, hypertension, tachycardia, heart palpitations, cardiac dysrhythmias, and angina
  • Close monitoring when administered
40
Q

Side Effects and Adverse Reactions of Beta2-adrenergic drugs

A
  • Tremors, headaches, nervousness, tachycardia, palpitations
  • Increased blood glucose levels
    DM patients should be taught to closely monitor blood glucose levels
  • SE may diminish after 1 week or longer
    Tolerance
41
Q

a class of drugs that block the action of acetylcholine, a neurotransmitter that helps you…
- Stay alert
- Maintain a steady heart rate
- Breathe
- Digest food
- Sweat
- Empty your bladder

used to treat a variety of conditions, including: Parkinson’s disease, Dystonia, especially in children, COPD, Overactive bladder, and Gastrointestinal disorders.

A

ANTICHOLINERGICS

42
Q

used to treat a variety of conditions, including: Parkinson’s disease, Dystonia, especially in children, COPD, Overactive bladder, and Gastrointestinal disorders.

A

ANTICHOLINERGICS

43
Q

Identify which ANTICHOLINERGICS is being described

  • Used to treat asthmatic conditions by dilating the bronchioles
  • Fewer systemic effects
  • Aerosol
  • Combined with albuterol sulfate to treat chronic bronchitis
  • Administer b-agonist inhalants, 5 mins before using it
  • Administer inhaled glucocorticoids or cromolyn 5 mins after using it;
    Rationale: so that bronchioles can dilate so steroid or cromolyn can be deposited in the bronchioles
A

Ipratropium bromide (Atrovent)

44
Q
  • Group of bronchodilators used to treat asthma
  • Stimulate the CNS and respiration, dilate coronary and pulmonary vessels, and cause diuresis
A

METHYLXANTHINE (XANTHINE) DERIVATIVES

45
Q

Examples of METHYLXANTHINE (XANTHINE) DERIVATIVES

A

Aminophylline, theophylline, caffeine

46
Q

first theophylline preparation produced, 1936

A

Aminophylline

47
Q

Identify which METHYLXANTHINE (XANTHINE) DERIVATIVES is being described

  • Inhibition of phosphodiesterase causing increased cAMP causing relaxation of smooth muscles of bronchi, bronchioles, and pulmonary blood vessels causing bronchodilation
  • Low therapeutic index and narrow therapeutic range (10-20mcg/mL)
  • Once used as a first-line drug for pts with chronic asthma and other COPDs
  • Serious AEs – dysrhythmias, convulsions, cardiorespiratory collapse; should NOT be prescribed in patients with seizure d/o or cardiac, renal and liver disease
A

Theophylline

48
Q

Drug Interactions of METHYLXANTHINE (XANTHINE) DERIVATIVES

A
  • Beta blockers, cimetidine, propranolol, and erythromycin – decrease the liver metabolism rate and increase the half-life and effects of theophylline
  • Barbiturates and carbamazepine – decreases the effects of theophylline
    Increased risk of digitalis toxicity; Decreases effects of lithium
  • Phenytoin – decreases theophylline levels
    Synergistic effect when given with B-adrenergic agonist
49
Q

Bronchodilators: Nursing Interventions

A
  • Monitor VS
  • Provide adequate hydration
  • Monitor drug therapy
  • Observe for side effects
  • Administer medication after meals to decrease GI distress
  • Administer at regular intervals around the clock
  • DO NOT crush enteric-coated or sustained-release tablets or capsules
  • Check serum theophylline levels (10-20mcg/mL)
50
Q

Bronchodilators: Patient Teaching

A
  • Teach pt to monitor pulse rate
  • Encourage pt to monitor amount of medication remaining in the canister
  • Advise pt not to take OTC preparations w/o checking with HCP
  • Encourage pt contemplating pregnancy to seek medical advice before taking theophylline
    Advise pt to avoid smoking
  • Discuss ways to alleviate anxiety
  • Advise pt having asthma attacks to wear an ID bracelet or MedicAlert tag
  • Inform pt that certain herbal products may interact with theophylline (Ephedra, St. John’s Wort)
  • Advise pt to notify HCP of aggressive or altered behavior and suicidal thoughts
  • Teach pt to correctly use inhaler or nebulizer
  • Advise that high-protein, low-carbohydrate diet increases theophylline elimination
51
Q
  • aka Leukotriene Modifiers
  • Effective in reducing inflammatory symptoms of asthma triggered by allergic and environmental stimuli
  • NOT RECOMMENDED for treatment of acute asthmatic attack
  • Safe for >6yo
A

LEUKOTRIENE RECEPTOR ANTAGONISTS AND SYNTHESIS INHIBITORS

52
Q

Examples of LEUKOTRIENE RECEPTOR ANTAGONISTS AND SYNTHESIS INHIBITORS

A

Zafirlukast, Montelukast sodium, Zileuton

53
Q
  • Chemical mediator that can cause inflammatory changes in the lung
  • Promote an increase in eosinophil migration, mucus production, and airway wall edema causing bronchoconstriction
A

Leukotriene

54
Q

LT Receptor Antagonists: Nursing Interventions

A
  • Monitor respirations for rate, depth, rhythm and type
  • Monitor lung sounds for rhonchi, wheezing, or rales
  • Observe lips and fingernails for cyanosis
  • Monitor drug therapy for effectiveness
  • Observe for side effects
  • Provide adequate hydration
  • Monitor liver function tests (AST and ALT)
  • Provide pulmonary therapy by chest tapping and positional drainage, as appropriate
55
Q

LT Receptor Antagonists: Patient Teaching

A
  • Advise pt to notify HCP once allergic reaction occurs
  • Monitor periodic liver function tests
  • Direct patient not to take St.
    John’s wort without first checking with HCP
  • Warm pt that black or green tea and guarana with montelukast and zafirlukast may cause increased stimulation
  • Encourage pt to stop smoking
  • Discuss ways to alleviate anxiety
  • Advise pt having frequent or severe asthmatic attacks to wear an ID bracelet or MedicAlert tag
  • Encourage pt contemplating pregnancy to seek medical advice before taking montelikast
  • Caution pt or significant other not to open oral granule packets until ready for use; Must be administered within 15mins after opening; if mixed with baby formula or approved food, do not store for future use
  • Advise pt with known aspirin sensitivity to avoid a bronchoconstrictor response by avoiding aspirin and NSAIDs while taking montelukast
  • Tell pt to take medication in the evening for maximum effectiveness
56
Q
  • Indicated if asthma is unresponsive to bronchodilator therapy or if the pt has an asthmatic attack while on maximum doses of theophylline or adrenergic drug
  • Synergistic effect with b2 agonist
  • Inhaler, tablet, IV
  • Take with food to avoid gastric irritation and ulceration
  • Combination containing fluticasone proprionate 100mcg and salmeterol 50mcg is effective in controlling asthma symptoms; 2 puffs per day
A

GLUCOCORTICOIDS (STEROIDS)

57
Q

Examples of GLUCOCORTICOIDS (STEROIDS)

A

Beclomethasone, dexamethasone, prednisone, prednisolone, methylprednisone, hydrocortisone

58
Q

Identify which type of GLUCOCORTICOIDS (STEROIDS) is being described below

  • Not helpful in treating a severe asthmatic attack; may take 1-4 weeks before reaching full effect
  • More effective for controlling sx of asthma than b2 agonist
  • Minimized risk for adrenal suppression
  • Preferred over oral preparations
A

Inhaled

59
Q

Identify which type of GLUCOCORTICOIDS (STEROIDS) is being described below

  • Acute asthma exacerbations
  • Large doses (20-50mg prednisone for 5 days; 1-2 mg/kg/day for children for 3-5 days)
  • Single dose or short-term use may be discontinued abruptly
  • Prolonged glucocorticoids therapy – weaning or tapering of dose
A

Systemic glucocorticoids

60
Q

Identify what type of commonly used drugs to treat asthma and COPD are found below

  • B2 Agonist Agents (Short acting B2 Agonist Agent) (SABA)
    *Salbulatamol
    *Terbutaline
  • Anti Muscarinic agents (Short Acting) (SAMA)
    *Ipratropium Bromide
A

Short Acting Bronchodilator

61
Q

Identify what type of commonly used drugs to treat asthma and COPD are found below

  • B2 Agonist Agents (Long Acting) (LABA)
    *Salmeterol
    *Formoterol
    *Indacaterol
  • Anti Muscarinic Agent (Long Acting) (LAMA)
    *Tioptropium
A

Long Acting Bronchodilator

62
Q

Identify what type of commonly used drugs to treat asthma and COPD are found below
- Fluticasone
- Budesonide
- Beclomethasone

A

Inhaled Corticosteroid

63
Q

GLUCOCORTICOIDS (STEROIDS) SE and AE

A
  • SE are generally local rather than systemic – throat irritation, hoarseness, dry mouth, coughing
  • Fungal infections may be prevented by using a spacer; instruct pt to rinse mouth and throat with water after each dose and wash the apparatus daily with warm water
  • Aes – usually seen within 2 weeks of therapy
  • Other SE – headache, euphoria, confusion, sweating , hyperglycemia, insomnia, nausea, vomiting, weakness, and menstrual irregularities
  • Aes – depression, peptic ulcer, loss of bone density, development of osteoporosis, psychosis
  • Prolonged oral and IV use – electrolyte imbalance, fluid retention, hypertension, thinning of skin, purpura, abnormal subcutaneous fat distribution, hyperglycemia, and impaired immune response
64
Q

4 layers of the Adrenal Gland

A

Arranged From Superficial to Deep

Zona Glomerulosa
Zona Fasciculata
Zona Reticularis
Adrenal Medulla

65
Q

Identify which layer of the Adrenal Gland produces the hormones described below

  • Mineralocorticoids
A

Zona Glomerulosa

66
Q

Identify which layer of the Adrenal Gland produces the hormones described below

  • Glucocorticoids
A

Zona Fasciculata

67
Q

Identify which layer of the Adrenal Gland produces the hormones described below

  • Androgens
A

Zona Reticularis

68
Q

Identify which layer of the Adrenal Gland produces the hormones described below

  • Catecholamines
A

Adrenal Medulla

69
Q

This is ….

  • Used for prophylactic treatment of bronchial asthma and must be taken daily
  • NOT used for asthma attacks
  • NO bronchodilator properties
  • Acts by inhibiting histamine release to prevent an asthma reaction
  • SE: cough and bad taste; instruct pt to drink water before and after using the drug
    Inhalation
  • Can be used with b-adrenergics and xanthine derivatives
  • Should NOT be discontinued abruptly
A

Cromolyn sodium

70
Q

This is…

  • Action and uses are similar to cromolyn
  • Has anti-inflammatory effects and suppress the release of histamine, LTs, and other mediators from the ,ast cells
  • More effective than cromolyn
A

Nedocromil sodium

71
Q

DRUG THERAPY FOR Young children

A
  • Cromolyn and nedocromil – inflammatory effects of asthma
  • Oral glucocorticoids – control a moderate to severe asthmatic state; 1-2 inhalations 3-4x a day or 40-80mcg 2x/day
  • Oral b2-adrenergic agonist – severe attacks
72
Q

DRUG THERAPY FOR
Older adults

A
  • B2-adrenergic agonist and methylxanthines – can cause tachycardia, nervousness, and tremors in older adults esp those with cardiac conditions
  • Frequent glucocorticoids – increased risk of developing cataracts, osteoporosis, and DM
73
Q

They Liquefy and loosen thick mucus secretions so they can be expectorated

A

MUCOLYTICS

74
Q

Examples of MUCOLYTICS

A

Acetylcysteine and Dornase alfa

75
Q

Identify which Mucolytic is being described below

-Should NOT be mixed with other drugs

  • May be an adjunct to bronchodilator (not mixed together)
  • Give bronchodilator 5 mins before acetylcysteine
  • SE: nausea, vomiting, stomatitis, and runny nose
  • Antidote for acetaminophen overdose of given within 12-24h after overdose inegestion
  • Inhaled, oral as effervescent tabs or powder (diluted in juice or softdrinks)
A

Acetylcysteine

76
Q

Identify which Mucolytic is being described below

  • Enzyme that digests DNA in thick sputum secretions of patients with cystic fibrosis
  • Hep reduce respiratory infections and improves pulmonary function
  • Improvement occur 3-7 days with its use
  • SE: chest pain, sore throat, laryngitis, hoarseness
A

Dornase alfa

77
Q

They are Used ONLY if a bacterial infection results from retained mucus secretions

A

ANTIMICROBIALS

78
Q

An ANTIMICROBIAL that…

  • aka Co-trimoxazole
  • Effective for mild to moderate acute exacerbations of chronic bronchitis from infectious causes
A

Trimethoprim-sulfamethoxazole

Pharmacology (2 decks)

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