Drugs Affecting Respiratory System Flashcards
Oral Antihistamines
Most tested:
Fexofenadine
Diphenhydramine
Loratadine
Other:
Chlorpheniramine
Cetrizine
Levocetrizine
Deslooratadine
Fexofenadine (brand: Allegra)
Upper respiratory Drugs
Antihistamine “allergy meds”
indication: Allergies, sinusitis, hives
Safe for asthma and nasal polyps
NOT for glaucoma patients due to anticholinergic effect that increases intraocular pressure
Diphenhydramine (Brand: Benadryl)
Upper respiratory Drugs
Antihistamine “allergy meds”
Commonly used for major anaphylaxis reactions
Blocks Histamines which create mucus and secretions as well as inflammation
Diphenhydramine (Brand: Benadryl) Side effects
Side effect: sedation and sleepiness
No driving in this med
Contraindicated for Diphenhydramine
Contraindicated:
Closed angle glaucoma
Urinary retention
Peptic ulcer
Small bowel obstruction
Anaphylaxis from a Bee sting
1st Epinephrine IM
2nd Diphenhydramine IV
3rd Albuterol or steroids
Intra-nasal Antihistamines
Azelastine
Olopatadine
Non-sedating Antihistamines
Loratadine
Cetirizine
Fexofenadine
Loratadine (brand: Claritin)
Upper respiratory Drugs
Antihistamine “allergy meds”
Fewer side affects than Benadryl so patients commonly switch between Benadryl and Claritin
Decongestants
3 Groups
Adrenergic (sympathomimetics)
Antichollergics (parasympathomimetics)
Topical Corticosteroids combined with antihistamine
Adrenergics (sympathomimetics)
Ephedrine
Phenylephrine, Pseudoephedrine
Naphazoline, Oxymetazoline
Terahydrozoline
Xylometazoline
Antichollergics (parasympathomimetics)
Bronchodilators
End in “Tro-pium”
Ipratropium
Tiotropium
Topical Corticosteroids combined with antihistamine
Azelastine/fluticasone propionate
Antitussives
Codeine
Hydrocodone
Dextromethorphan
Diphenhydramine
Benzonatate
Codeine
Cough Suppressant Antitussive
Most affective antitussive
Opioid analgesic also called a narcotic/pain med
Given for mild to moderate pain to suppress the cough
Codeine doesn’t not affect
Photosensitivity
Heart Palpations
insomnia or Anxiety
Codeine Side effects:
slows down central nervous system making the vital signs low and slow
Codeine Key Points
Slow position changes, low BP can result in orthostatic hypotension - dizziness/fainting upon standing = Big fall risk
Do not give to COPD patients because lungs are low and slow
GI is also low and slow = constipation and nausea
Take with food
Increase fluid intake
8 full glasses of water (minimum)
2 categories of Antitussives
2 categories
1.Opioid—all have antitussive effects, but only codeine and hydrocodone are used for this purpose
2.Non-opiod—less effective: dextromethorphan
Inhaled Corticosteroids
Most commonly tested: Beclomethasone
Fluticasone
Other:
Budesonide
Ciclesonide
Flunisolide
Mometasone
Corticosteroids that reduce swelling and inflammation in the respiratory system
Beclomethasone
Fluticasone
Methylprednisolone (solu mederol)
Corticosteroids SONE Key points
Use spacers to prevent oral thrush (candida)
Rinse mouth after each use
Do not swallow water
Clean inhaler daily
Beclomethasone
Antinflamatory agents
Ends in “SONE”
Reduces swelling and inflammation iim the resp system - decreases bronchi
Slow onset: not a rescue drug, do not use as first sign of asthma attack
Sugar increase = Expected finding
Sores in mouth (infection)
Who is MOST at risk for infection
The patient on SONE steroids
Sone steroids suppress the immune system
What kind of onset do steroids have
SLOW
Oral Corticosteriods
Methylprednisolone: Steroid, acts slow
Prednisolone
Prednisone
Beta 2 Adrenergic Agonists
Inhaled short acting
Albuterol
Levalbuterol
End in buterol
Brutal Asthma attacks
1st drug used in asthma attacks
Fasted acting bronchodilator
The only ‘rescue inhaler”
Use BEFORE steroid inhaler
Albuterol Side effects:
Tachycardia and palpitations
Tremor
Toss and Turning at Night (insomnia and Difficulty sleeping)
Drugs too Avoid for Asthmatic patients
Beta blockers: Atenolol, can cause bronchospasm NSAIDS: Ibuprofen, can worsen asthma
Beta 2 Agonist
Activate Beta 2 in the lungs which dilates the bronchi which results in increased airflow but it also activities beta 1 (heart) makes the heart go crazy fast
Side affect: rapid heart rate
Beta 2 Adrenergic Agonists
Inhaled Long Acting
Arformoterol
Formoterol
Indacaterol
*Salmeterol
Ends in “Terol not Buterol”
Slower acting, not rescue inhalers, not used during acute asthma attacks
Used with a combination of steroids for long term control of moderate to severe asthma
Drugs for acute asthma attacks
“AIM” for acute asthma attack
A: Albuterol 1st (to bronchodialate the lungs, steroids 2nd to get all the powder deep into the lungs)
I: Ipratropium 2nd
M: Methyl-prednisolone (brand: Solu mederol)
Do not use fluticasone or salmeterol for first sign of acute asthma attack - always take steroids even if albuterol provides relief
2-4 puffs every 20minutes for 3 rounds
If it doesn’t work after 3 doses then notify HCP
Effective:
Decrease iim RR
Oxygen sat at least 90%
Albuterol Nebulizer expected findings after treatment
Increase productive cough
Reports off decreased anxiety
Mild bilateral hand temors
Albuterol Administration
Shake it before you take it
Shake it well
breath all the way out, push inhaler, inhale and hold for a few seconds then exhale
Clean 2 times per week with warm water not after every use. Steroids should be washed after every use
Patient with severe asthma
Vital signs:
tachycardia
Tachypnea
O2 less than 90%
Peak exp. flow <40% predicted or best <150l/min
What medication would you give?
Albuterol inhaler
Nebulizer Ipratropium
IV methylprednisolone
Beta 2 Adrenergic Agonists
Oral
Albuterol
Terbutaline
Anticholinergics
Ipratropium
Tiotropium
Ipratropium
Anticholinergic - Bronchodilators
Dries the body out
Used for moderate to severe asthma and COPD
Longer acting brochodialator that reduces secretions and commonly given in combination with albuterol
Used 2nd in an asthma attack
Blocks secretions: Cannot see, pee, spit or poop
Side effects: Dry mouth, horsiness
Treat the dry mouth and throat for all anticholinergics: use gum/candy and drink fluids
Key point: No swallowing tiotropium capsules, put the capsule in the inhaler device and then inhale
Contraindication to all anticholinergics:
Never give to patients who are already dry. Example:
Glaucoma
Urinary mention and BPH
Bowel obstructions
Cough Expectorants
Guaifenesin
inIodinated glycerol
Potassium iodide
Guaifenesin (brand mucinex)
Cough Expectorant
Given for cough and mucus, helps clear out excess mucus
Thins mucus - teach patients to drink fluids to help thin muscus
Drink at least 2L per day
Asthma safe
Acetylcystine (brand: mucomyst)
Cough Expectorant
Helps loosen and thin serious mucus like inn cystic fibrosis
Antidote for Tylenol (acetaminophen) overdose
Blocks Acetaminophen
Also given before the cath lab to protect kidneys from contrast dye
Caution with asthmatic patients
NOT SAFE: cause or worsen bronchospasm always clarify prescriptions given for asthmatic patients
Lower Respiratory Drugs
Bronchodilators
Beta 2 Agonist: Albuterol
Anticholinergics: Ipratropium
Methylxanthines: Theophylline
Anti-inflammatory Agents
Steroids: Beclomethasone
Leukotriene Inhibitor: Montelukast
Mast Cell Stabilizers: Cromolyn
Methylxanthines
Brochodialators
Ends in “phylline”
*Theophylline
Aminophylline
Rapid heart rate and can be toxic
Toxic! over 20
Theophylline Therapeutic Valus
Therapeutic index 10-20 = frequent blood draws
Tonic colonic seizures
#1 Sign of Severe toxicity 1st priority as the nurse report signs such as restlessness, nausea/vomiting, anorexia, insomnia
tachycardia and dysrhythmias
Methylxanthines (Theophylline) Key points
Teach patients to avoid beta blockers that lower the heart rate while on Theophylline - Beta blockers can also block the affect of theophylline
Alert HCP of tachycardia before giving next dose
Take in AM
Avoid Caffeine
Stop Before Cardiac stress test
Drugs that Increase toxicity risk Theophylline
Cimetidine (H2 blocker)
Ciprofloxacine (ABX)
Which of the following prescriptions should the nurse question?
Naproxen for an Asthmatic Patient
Ipratropium for a patient with glaucoma
Theophylline for a patient taking cimetidine
atenolol for a patient with asthma
What patient teaching should be included with a new prescription of albuterol, ibuprofen, tiotropium and beclomethasone?
Tachycardia is expected after albuterol
Report dark stool to the provider
Drink fluids to prevent dry mouth and throat
Which medication prescribed for asthma causes of tachycardia and dysrhythmias?
Aminophylline
Leukotriene Inhibitors
Montelukast (brand: singular)
Opens airway
Long term management of of inflammation, commonly given in combination with albuterol and steroids
Long onset (1-2 weeks to reach therapeutic range)
Leukotriene Inhibitors Key Points
Given for prevention of asthma attacks - not during acute attacks
Not a rescue drug
This med will prevent inflammation that causes asthma attacks
Patient has been conn Montelukast for 5 days and states the medication iim not working, best response by the nurse?
Advice 102 weeks for drug to reach the therapeutic affect
Mast Cell stabilizers
Anti-inflam agents
Cromolyn
Blocks massive swelling
Prevents activity induced asthma
Take 15 minutes before exertion for maximum affects
A client is receiving discharge instructions for a inhale corticosteroid metered dose inhaler. What teaching should the nurse include?
Do not swallow the water as you wash your mouth after use
Which statement by the patient requires further teaching
I will take cromolyn 45 minutes before physical activity
- take 10-15min before
