Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology Exam 2 > Drugs Affecting the Respiratory System > Flashcards

Drugs Affecting the Respiratory System Flashcards

1
Q

Common Cold

A

Two types: Rhinovirus, Adenovirus
Virus invades tissues (mucosa) of upper respiratory tract, causing upper respiratory infection (URI)
Excessive mucus production results from the inflammatory response to this invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Understanding the Common Cold

A

Fluid drips down the pharynx into the esophagus and lower respiratory tract, causing cold symptoms: sore throat, coughing, upset stomach
Irritation of nasal mucosa often triggers the sneeze reflex
Mucosal irritation also causes release of several inflammatory and vasoactive substances, dilating small blood vessels in the nasal sinuses and causing nasal congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treatment of the Common Cold

A

Involves combined use of antihistamines, nasal decongestants, antitussives, and expectorants
Treatment is symptomatic only, not curative
Symptomatic treatment does not eliminate the causative pathogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Histamines

A

It is involved in nerve impulse transmission, dilation of capillaries, contraction of smooth muscles, stimulation of gastric secretion, and acceleration of heart rate

Two types of histamine receptors
H1 (histamine1): mediate smooth muscle contractions (bronchoconstriction) and dilation of capillaries (causes vasodilation)

H2 (histamine2): mediates gastric acid secretion, smooth muscle relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

H2 Blockers/Antagonists

A

H2 blockers/antagonists
These are antihistamines that compete with histamine for the H2 receptors
Used to reduce gastric acid in peptic ulcer disease

H1 antagonists/Blockers are commonly referred to as antihistamines. Have several properties:
Anticholinergic: inhibits Parasympathetic system
Sedative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Antihistamines

A

Block action of histamine at the H1 receptor sites
Competes with histamine receptors for binding at unoccupied sites
More effective in preventing the actions of histamine rather than reversing it
Should be given early in treatment, before all the histamine binds to the receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Histamine Stimulation

A 
Vasodilation				
Increased GI and 
respiratory secretions
Increased capillary 
permeability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cardiovascular Effects of Histamine vs. Antihistamine

A

Histamine effects
Dilation and increased permeability
(allowing substances to leak into tissues/edema)

Antihistamine effects
Reduce dilation of blood vessels
Reduce increased permeability of blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Smooth Muscle Effects of Histamine vs. Antihistamine

A

Histamine effects
Stimulate salivary, gastric, lacrimal, and bronchial secretions

Antihistamine effects
Reduce salivary, gastric, lacrimal, and bronchial secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Immune System Effects of Histamine vs. Antihistamine

A

Histamine effects
Mast cells release histamine and other substances, resulting in allergic reactions

Antihistamine effect
Binds to histamine receptors, thus preventing histamine from causing a response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Antihistamines: Other Effects

A

Skin
Reduce capillary permeability, wheal-and-flare formation, & itching

Anticholinergic
Drying effect that reduces nasal, salivary, and lacrimal gland secretions (runny nose, tearing, and itching eyes)

Sedative
Some antihistamines cause drowsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

fexofenadine (Allegra)

Antihistamine

A

Management of:

Nasal allergies
Seasonal or perennial allergic rhinitis 
Allergic conjunctivitis
Uncomplicated urticaria (skin rash)
Angioedema (edema in airways)

Also, may be used to relieve symptoms
associated with the common cold
Sneezing, runny nose
Palliative treatment, not curative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Adverse effects of Antihistamines

A 
Anticholinergic drying effects:
Dry mouth
Difficulty urinating
Constipation
Changes in vision
Drowsiness
Mild drowsiness to deep sleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Traditional antihistamines

A

Older
Work both peripherally and centrally
Have anticholinergic effects, making them more effective than non-sedating drugs in some cases

Examples: diphenhydramine (Benadryl); chlorpheniramine (Chlor-Trimeton)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Non-sedating antihistamines

A

Developed to eliminate unwanted adverse effects, mainly sedation
Work peripherally to block the actions of histamine; thus, fewer CNS adverse effects
Longer duration of action (increases compliance)

Examples: fexofenadine (Allegra), loratadine (Claritin), cetirizine (Zyrtec)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nursing Implications: Antihistamines

A

Gather data about the condition or allergic reaction that required treatment; also assess for drug allergies
Obtain baseline respiratory pattern and rate
Contraindicated if hypersensitivity reaction to drug & children <12 y.o.
Caution in pregnancy, lactation, renal impairment
For older generation antihistamines: use with caution in increased intraocular pressure (glaucoma because of the anticholinergic effects), cardiac or renal disease, asthma, COPD, or pregnancy

Best tolerated when taken with meals—reduces GI upset
Avoid taking w/ apple, grapefruit, & orange juices
If dry mouth occurs, teach patient to perform frequent mouth care, chew gum, or suck on hard sugarless candy to ease discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Decongestants:

Types

A

Adrenergics:
Largest group
Sympathomimetics (mimicking the effects of the Sympathetic NS, they vasoconstrict)

Corticosteroids:
Topical, intranasal steroids

Two dosage forms
Oral
Inhaled/topically applied to the nasal membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Oral Decongestants

A

Prolonged decongestant effects, but delayed onset when compared to topical

Exclusively adrenergics
i.e. pseudoephedrine, phenylephrine

Absorbed systemically…higher chance of adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Topical Nasal Decongestants

A

Topical adrenergics
Prompt onset of action
Potent effect
Sustained use over several days causes rebound congestion, making the condition worse

Adrenergics
phenylephrine (Neo- Synephrine)
oxymetazoline (Afrin)
naphazoline (Privine, VasoClear, others…)

Intranasal steroids
 budesonide (Rhinocort)
 flunisolide (Nasalide)
 fluticasone (Flonase)
 Triamcinolone (Nasacort)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Nasal Decongestants:

Mechanism of Action

A

Site of action: blood vessels surrounding nasal sinuses

Adrenergics
Constrict small blood vessels that supply
upper respiratory tract structures
As a result these tissues shrink, and nasal secretions in the swollen mucous membranes are better able to drain
Nasal stuffiness is relieved

Site of action: blood vessels surrounding nasal sinuses

Nasal steroids
Anti-inflammatory effect for allergies and nasal congestion
Work to turn off the immune system cells involved in the inflammatory response
Decreased inflammation results in decreased congestion
Nasal stuffiness is relieved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Nasal Decongestants:

Drug Effects

A

Most commonly used for their ability to shrink engorged nasal mucous membranes
Relieve nasal stuffiness
Are aimed at the inflammatory response elicited by invading organisms (virus and bacteria) or other antigens (allergens)
Steroids exert their anti-inflammatory effect by causing these cells to be turned off or rendered unresponsive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Nasal Decongestants:

Adverse Effects

A 
Adrenergics	                Steroids
Nervousness	                Local mucosal dryness
Insomnia 	                &amp; irritation
Palpitations
Tremors
(systemic effects due to
adrenergic stimulation of the 
heart, blood vessels, and CNS)
Tachycardia, HTN, arrhythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Nasal Decongestants:

Nursing Implications

A

Decongestants may cause hypertension, palpitations, and CNS stimulation—avoid in patients with these conditions
Patients on medication therapy for hypertension should check with their physician before taking OTC decongestants
Assess for drug allergies
Patients should avoid caffeine and caffeine-containing products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Antitussives

A

Drugs used to stop or reduce coughing
Opioid and nonopioid

Used only for nonproductive coughs!
May be used in cases where coughing is harmful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Antitussives: Mechanisms of Action

A

Opioids
Suppress the cough reflex by direct action on the cough center in the medulla

Examples:
codeine (Robitussin A-C, Dimetane-DC), hydrocodone is used in the hospital (Hycodan)

Non-opioids
Suppress the cough reflex by directly affecting the cough center in the medulla. Chemically related to opioid agonists.

Examples:
dextromethorphan (Vicks Formula 44,Robitussin-DM), benzonatate (Tessalon Perles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Antitussive Indications

A

Used to stop the cough reflex when the cough is nonproductive and/or harmful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Adverse Effects of Antitussives

A

Benzonatate
Dizziness, headache, sedation, nausea, and others

Dextromethorphan
Dizziness, drowsiness, nausea

Opioids
Sedation, dry mouth, nausea, vomiting, constipation

28
Q

Expectorants: Mechanisms of Action

A

Loosening and thinning of respiratory tract secretions occurs by drawing in water
Example: Guaifenesin

The secretory glands are stimulated directly to increase their production of respiratory tract fluids

29
Q

Expectorants: Indications

A

Used for the relief of dry, non-productive coughs associated with:
Common cold
Acute Bronchitis
Influenza

30
Q

Expectorants:

Common Adverse Effects

A

Guaifenesin
Nausea, vomiting, anorexia

Iodinated preparations
GI irritation, enlarged thyroid gland, bitter taste. Pregnancy category X

31
Q

Expectorants: Nursing Implications

A

Expectorants should be used with caution in the elderly or those with asthma or respiratory insufficiency.
Check allergies
Patients taking expectorants should receive more fluids, if permitted, to help loosen and liquefy secretions
Report a fever, cough, or other symptoms lasting longer than a week
Monitor for intended therapeutic effects

32
Q

Mucolytics:

Actetylcysteine (Mucomyst)

A 
Indications
Cystic fibrosis 
Pneumonia (PNA)
TB
Atelectasis
Acetaminophen O.D. 
Prevention of contrast-induced nephropathy (CT scan, injected iodine is toxic to kidneys. Drug helps as an antioxidant)
33
Q

Actetylcysteine (Mucomyst): Mechanisms of Action

A

Splits disulfide bonds responsible for holding mucous together
Liquefies thick, tenacious secretions
Binds with reactive hepatotoxic metabolites of acetaminophen
Acts as an antioxidant by binding to free radicals in the prevention of contrast-induced nephrotoxicity

34
Q

Actetylcysteine (Mucomyst) Adverse Reactions:

A

Most serious: brochospasms & bronchoconstriction, anaphylaxis
Most common: N/V, rhinorrhea

35
Q

Mucolytics:

Nursing Implications

A

Monitor for anaphylactic reactions
Caution in patients with asthma
Warn patient of med’s foul odor
May induce vomiting. Caution in pts w/ esophageal varices or peptic ulcer disease
Monitor lung sounds
Administer inhaled beta agonist prior (if ordered)
Encourage fluids, pulmonary hygiene

36
Q

Drugs Used to Treat Asthma

A

Long-term control
Long-term control medicines are taken daily over a long period of time.

Antileukotrienes - improve symptoms and pulmonary function and reduce the need for quick-relief medications
Cromolyn – prevents the release of histamine
Inhaled steroids - most effective to reduce inflammation of the airways
Long-acting β2-agonists - relaxes the smooth muscles of the airways for long-term prevention of symptoms, especially at night

Quick relief
Quick-relief medications are used to help counter the effects of an acute asthma episode.

Intravenous systemic corticosteroids
Short-acting inhaled β2-agonists (Xopenex)

37
Q

Bronchodilators and

Respiratory Drugs

A

Bronchodilators
β2-adrenergic agonists
Anticholinergics
Xanthine derivatives

Anti-inflammatories
Antileukotrienes
Corticosteroids
Mast cell stabilizers

38
Q

Bronchodilators: β-Agonists

A

Large group, sympathomimetics (stimulate SNS, dilates the lungs)
Stimulate β2-adrenergic receptors throughout the lungs
Used during acute phase of asthmatic attacks
Quickly reduce airway constriction and restores normal airflow through bronchodilation

39
Q

Three times of Bronchodilators

A

1.) Nonselective adrenergic agonist
Stimulate α (vasoconstriction), β1 (cardiac), and β2 (respiratory) receptors
Example: epinephrine. Tachycardia, vasoconstriction

2.) Nonselective β-agonist
Stimulate both β1 and β2 receptors
Example: metaproterenol (Alupent)

3.) Selective β2 agonist
Stimulate only β2 receptors
Short-acting example: albuterol (Proventil, can cause some mild B1 palpitations), levalbuterol (Xopenex), terbutaline (Brethine)
Long-acting example: salmeterol (Serevent Diskus), formoterol (Brovana)

40
Q

P Albuterol/B Agonists

A

P Albuterol: drug of choice for an acute exacerbation. Can be used for prevention

Binds to β-2 receptors in lungs, causing relaxation of bronchial smooth muscles
Result: relieves bronchoconstriction, reduces airway resistance, facilitates mucus drainage, increased VC
Relief of bronchospasm related to asthma, bronchitis, and other pulmonary diseases
Useful in treatment of acute attacks as well as prevention
Used to produce uterine relaxation to prevent premature labor (terbutaline)

41
Q

P Albuterol : Sympathomimetic Component

A 
Hypertension, tachycardia, palpitations
Anxiety, tremors
Headache
Insomnia
GI: Dyspepsia, N/V
Rarely: Bronchospasms , urticaria, angioedema
42
Q

β-Agonists: Adverse Effects

α-β (epinephrine)

A 
Tachycardia
Hypertension
Palpitation
Anxiety
Tremors
43
Q

Nursing Implications: B Agonists

A

Avoid exposure to conditions that precipitate bronchospasms (allergens, smoking, stress, air pollutants)
Adequate fluid intake
Compliance with medical treatment
Avoid excessive fatigue, heat, extremes in temperature, caffeine
Always have a rescue inhaler available (albuterol, short acting B2 agonist)
Encourage patients to get prompt treatment for flu or other illnesses, and to get vaccinated against pneumonia or flu

44
Q

Anticholinergics:

Mechanism of Action

A

Acetylcholine (ACh)
Neurotransmitter of parasympathetic nervous system
Causes bronchoconstriction and narrowing of the airways
Anticholinergics bind to cholinergic (muscarinic) receptors, preventing ACh from binding
Result: decreased contractility of smooth muscle which reduces bronchospasm

45
Q

Anticholinergics

A

Meds:
Ipratropium bromide (Atrovent) P
Tiotropium (Spiriva)

Slow and prolonged action
Used to prevent bronchoconstriction
NOT used for acute asthma exacerbations!

46
Q

Anticholinergics Adverse Effects

A

Common: Cough, hoarseness, throat irritation
Classic anticholinergic adverse effects: dry mouth, constipation, urinary retention, blurred vision. Less likely than with systemic anticholinergics
If inadvertently sprayed into eyes: ocular irritation & pain, mydriasis, blurred vision

47
Q

Bronchodilators:

Xanthine Derivatives

A

Plant alkaloids: theophylline, caffeine theobromine
Only theophylline is used as a bronchodilator

Synthetic xanthines:
*****theophylline P
aminophylline

48
Q

Xanthine Derivatives:

Drug Effects

A

Causes bronchodilation by relaxing smooth muscles of the airways
Result: relief of bronchospasm and greater airflow into and out of the lungs

Inhibits phosphodiesterase:
Increases force of contraction of diaphragmatic muscles
Bronchodilation
CNS stimulation
+ inotropic effects (contractility of the heart/can cause tachycardia. Bradycardia could also occur)

49
Q

Xanthine Derivatives:

Indications

A

Dilation of airways in asthma, chronic bronchitis, and emphysema
Mild to moderate cases of acute asthma
Adjunct drug in the management of COPD
Used for LONG-TERM control
Due to its numerous side-effects, these drugs are now rarely administered for clinical use.

50
Q

Xanthine Derivatives:

Adverse Effects

A

GI: Nausea, vomiting, anorexia, gastroesophageal reflux
CV: Tachycardia, palpitations, arrhythmias
GU: Transient diuresis
CNS: Irrritability, restelessness, muscle twitching
Respiratory: Tachypnea

**signs of toxicity include tremor, seizures, tachycardia, ventricular arrhythmias.
51
Q

Xanthine Derivatives:

Nursing Implications

A

Contraindications: status asthmaticus, history of PUD or GI disorders
Cautious use: cardiac disease

Report to physician:
Palpitations, weakness, convulsions, nausea, dizziness, vomiting, chest pain

MANY interactions!
Excessive intake of xanthine-containing food or drinks increase the risk of CV & CNS side effects
Smoking decreases drug levels

52
Q

ANTI-INFLAMMATORY

AGENTS

A

Leukotriene receptor antagonists
Inhaled corticosteroids (ICS)
Mast cell stabilizers

53
Q

Antileukotrienes

A 
Also called leukotriene receptor antagonists (LRTAs)
Newer class of asthma medications
Currently available drugs
montelukast (Singulair)
zafirlukast (Accolate)  P
zileuton (Zyflo)
54
Q

How anti-leukotrienes work

A

Leukotrienes are powerful inflammatory mediators released when a trigger, such as cat hair or dust, starts a series of chemical reactions in the body
Leukotrienes cause inflammation, bronchoconstriction, and mucus production
Result: coughing, wheezing, dyspnea

zileutron (Zyflo) actually inhibits lipoxygenase therefore preventing formation of leukotrienes

55
Q

Antileukotrienes: Drug Effects

A

By blocking leukotrienes:
Prevent smooth muscle contraction of the
bronchial airways
Decrease mucus secretion
Prevent vascular permeability
Decrease neutrophil and leukocyte infiltration to the lungs, preventing inflammation

56
Q

Antileukotrienes: Indications

A

Prophylaxis and chronic treatment of asthma in adults and children older than age 12
NOT meant for management of acute asthmatic attacks

Montelukast (Singulair) is approved for use in children ages 2 and older, and for treatment of allergic rhinitis

57
Q

Antileukotrienes:

Adverse Effects

A 
zafirlukast (Accolate)
	Headache
	Gastritis
	Pharyngitis
	Rhinitis
        Liver dysfunction

montelukast (Singulair) has fewer adverse effects

58
Q

Antileukotrienes:

Nursing Implications

A

Ensure that the drug is being used for chronic management of asthma, not acute asthma
Teach the patient the purpose of the therapy
Improvement should be seen in about
1 week
Medications should be taken every night on a continuous schedule, even if symptoms improve

59
Q

Inhaled Corticosteroids

A

Most effective anti-inflammatory drugs for respiratory conditions
Used for chronic asthma
Do not relieve symptoms of acute
asthmatic attacks

Oral, inhaled, or parenteral forms

60
Q

Inhaled Corticosteroids:

Indications

A

Treatment of bronchospastic disorders
that are not controlled by conventional bronchodilators
NOT considered first-line drugs for management of acute asthmatic attacks or status asthmaticus
Tx of allergic rhinitis- intranasal flunisolide

Examples:
Flunisolide (Aerobid)
Beclomethasone (Beclovent, Qvar)
fluticasone (Flovent)
triamcinolone acetonide (Azmacort)
61
Q

Inhaled Corticosteroids:

Adverse Effects

A 
Pharyngeal irritation
Coughing
Sore throat, hoarsness
Dry mouth
Oral fungal infections: RINSE MOUTH
Systemic effects are rare because of the low doses used for inhalation therapy
62
Q

Inhaled Corticosteroids:

Nursing Implications

A

Contraindicated in patients with active fungal infections, AIDS, TB, or other bacterial or viral infections

Teach patients to gargle and rinse the mouth with lukewarm water afterward to prevent the development of oral fungal infections

If a β-agonist bronchodilator and corticosteroid inhaler are both ordered, the bronchodilator should be used several minutes before the corticosteroid to provide bronchodilation before administration of the corticosteroid

63
Q

Mast Cell Stabilizers

A

contain histamine, serotonin, bradykinin, and leukotrienes
When ruptured, substances are released and cause an inflammatory response
Mast cell stabilizers inhibit mast cell rupture and degranulation

Examples: 
Cromolyn sodium (Intal) or intranasl: (NasalCrom)
64
Q

Mast Cell Stabilizers:

Adverse Effects

A 
Oral inhalation form
Bronchospasms
Throat irritation
Cough
If lactose intolerant, GI discomfort

Intranasal form
Nasal irritation, sneezing

Ophthalmic drops
Ocular irritation

65
Q

Mast Cell Stabilizers:

Nursing Implications

A

Emphasize that this drug is for prophylaxis only. NOT to be used in an acute asthma attack.
Must be taken daily as maintenance drug
For exercise-induced bronchospasm, pt should take 15-20 min prior to starting exercise.

Pharmacology Exam 2 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions