Exam 2 Material Flashcards
Allergic Rhinitis
Exposure to allergen (antigen) triggers mast cells to release histamine and several other chemical mediators, causing common allergy symptoms
Drugs for prevention of allergic rhinitis
Leukotriene modifiers Mast cell stabilizers Antihistamines: H1 receptor blockers (antagonists) Intranasal corticosteroids
Drugs for relief of allergic rhinitis
Decongestants (most are sympathomimetics)
What are anticholinergic effects?
Acetylcholine is a neurotransmitter that affects muscular contraction (including cardiac muscle) and endocrine function Anticholinergic effects (think blocking the effects of acetylcholine) include dry mouth, constipation, urinary retention, increased heart rate, dilated pupils, blurred vision, decreased sweating
Therapeutic class of diphenhydramine (Benadryl)
Antihistamine; allergy
Pharmacological class of diphenhydramine (Benadryl)
H1 receptor blocker/antagonist
Indications for diphenhydramine (Benadryl)
Allergies, motion sickness, insomnia, pruritus (itching), Parkinson’s disease
MOA of diphenhydramine (Benadryl)
H1 receptor antagonist - blocks action of histamine
Cautions for diphenhydramine (Benadryl)
Elderly more likely to experience delirium, increased heart rate Children more likely to have paradoxical excitation
Adverse effects of diphenhydramine (Benadryl)
Drowsiness (can develop tolerance to this), dry mouth, increased heart rate (anticholinergic effects)
Interactions of diphenhydramine (Benadryl)
Avoid concurrent use with other CNS depressants
Therapeutic class of fluticasone (Flonase)
Anti-inflammatory (includes skin conditions), allergic rhinitis, asthma
Pharmacological class of fluticasone (Flonase)
Corticosteroid
Indications of fluticasone (Flonase)
Allergic rhinitis
MOA of fluticasone (Flonase)
Decrease inflammation in nasal mucosa
Adverse effects/interactions of fluticasone (Flonase)
Burning sensation when spraying, epistaxis (nose bleed)
Therapeutic class of oxymetazoline (Afrin)
Decongestant
Pharmacological class of oxymetazoline (Afrin)
Sympathomimetic
Indications of oxymetazoline (Afrin)
Allergic rhinitis, nose bleeds, nasal congestion
MOA of oxymetazoline (Afrin)
Alpha1 adrenergic agonist (causes vasoconstriction of blood vessels in the nasal mucosa and drying of mucous membranes)
Caution for oxymetazoline (Afrin)
Use with caution in people with HTN, thyroid disorders, diabetes, and heart disease
Adverse effects of oxymetazoline (Afrin)
Rebound congestion, dry/stinging of nasal mucosa
Nursing implications of oxymetazoline (Afrin)
Instruct clients not use use for more than 3 days
What is the action of alpha 1 - adrenergic receptors agonists
Vasoconstriction
What is the action of alpha2 adrenergic agonists
Inhibits the release of norepinephrine (negative feedback)
What is the action of beta1 adrenergic agonists
Increased HR and contractility
What is the action of beta2 adrenergic agonists
Relaxation of smooth muscle in bronchioles, uterus, GI tract, and bladder
What causes a cough refelx
Cough center is located in the medulla; it is a symptom of an underlying condition
What are antitussives
Suppress cough by raising cough threshold or anesthetizing stretch receptors in the lungs
What are expectorants
Simulate mucous flow and decrease viscosity of secretions; make cough more productive
What are mucolytics
Break down mucus; used for COPD and cystic fibrosis
What is asthma
A chronic pulmonary disease characterized by acute bronchoconstriction and inflammation of the airways, leading to increased mucus production and airway obstruction
What are the goals to asthma therapy?
Terminate acute bronchospasm Reduce frequency of asthma attacks
Why may IV medications be necessary during a severe asthma attack?
Mucus is coating the lungs and the medication is unable to reach the site of action
What type of drugs are given during an acute bronchospasm?
Beta2 adrenergic agonists Leads to bronchodilation Has few adverse effects (increased heart rate, tremors) Short acting beta agonists (SABA) rescue inhaler: has rapid onset and effective for 2-6 hours Albuterol is an example
When are anticholinergics given in asthma?
Can be used in conjunction with beta 2 adrenergic agonists Not as quick or as effective as B2 adrenergic agonists Few adverse effects Atrovent is an example
When are systemic corticosteroids used in asthma?
IV - hospital
Maintenance therapy of asthma includes what drug types?
Long acting beta agonists (LABAs) Corticosteroids Mast cell stabilizers Leukotriene modifiers Methylxanthines Biologics/monoclonal antibodies
What do long acting beta agonists (LABAs) do
Slower onset (20-60 min) Will not help during an acute asthma attack Causes bronchodilation Examples: salmeterol (Serevent), formoterol (Foradil)
What do corticosteroids do in asthma?
Treat inflammatory component Most effective drug for prevention of acute attacks Few adverse effects when inhaled Can cause oral thrush (rinse mouth after use) Must use daily; can take 4-8 weeks for maximum effect Oral/Iv routes used in severe cases Examples: fluticasone (Flovent), budesonide (Pulmicort), beclomethasone
What do mast cell stabilizers do for asthma?
Inhibit the release of histamine from mast cells Examples: cromolyn (Intal)
What do leukotriene modifiers do for asthma?
Modify the action of leukotrienes, which are chemical mediators of inflammation Only available orally Adverse effects: headache, GI symptoms, anxiety, depression, suicidal behavior/thoughts Example: montelukast sodium (Singulair)
What do methylxanthines do for asthma?
Bronchodilator Narrow margin of safety Many drug interactions Adverse effects: N/V, CNS stimulation, dysrhythmias Examples: theophylline (Theo-dur), amnophylline
What do biologics/monoclonal antibodies do for asthma?
Target inflammation pathways involving IgE (antibodies) Examples: omalizumab (Xolair) Tend to be expensive
What is COPD?
Chronic, progressive lung disease characterized by inflammation and excess mucus (chronic bronchitis) and alveolar dilation/loss of elasticity (emphysema)
What medications are used for COPD?
LABAs Anticholinergic bronchodilators Inhaled corticosteroids Mucolytics and expectorants Several combination drugs Oxygen
What medications are avoided/used with caution in COPD??
Beta-adrenergic antagonists (causes bronchoconstriction) Respiratory depressants (opioids)
When taking more than one inhaler, which inhaler should be taken first?
Bronchodilator should be taken first to open up bronchioles and give more surface area for other medications to work
What does the autonomic nervous system control?
Involuntary responses 2 Divisions: sympathetic and parasympathetic
What are parasympathetic responses?
Constrict pupils Stimulate saliva Slow heart beat Constrict airways Stimulate activity of stomach Inhibit release of glucose; stimulate gallbladder Stimulate activity of intestines Contract bladder Promote erection of genitals
What are sympathetic responses?
Dilate pupils Inhibit salivation Increase heartbeat Relax airways Inhibit activity of stomach Stimulate release of glucose; inhibit gallbladder Inhibit activity of intestines Secrete epinephrine and norepinephrine Relax bladder (prevents urination) Promote ejaculation and vaginal contraction
What is a neurotransmitter?
A chemical substance that transmit a nerve impulse across a synapse, creating activation at a receptor site Includes: GABA AcH Dopamine Serotonine Histamine Many drugs have identical or similar chemical structures to neurotransmitters and work by enhancing or blocking the activity of the neurotransmitter
What are autonomic drugs?
Cholinergic/parasympathomimetic/cholinesterase inhibitors Cholinergic blockers/anticholinergics Adrenergics/sympathomimetics Adrenergic blockers
What do cholinergic/parasympathomimetics/cholinesterase inhibitors do?
Activation of the parasympathetic nervous system Rest and digest AcH is a neurotransmitter involved that will create a parasympathetic response Direct acting and indirect acting drugs
What do cholinergic blockers/anticholinergics do?
Inhibit parasympathetic nervous system
What do adrenergic/sympathomimetics do?
Activation of the sympathetic nervous system (fight or flight)
What do adrenergic blocker do?
Inhibit sympathetic nervous system
What are some adverse effects of cholinergic/parasympathomimetic/cholinesterase inhibitors?
Increased salivation Sweating Abdominal cramps Bradycardia Hypotension (due to slowing of the heart) Wheezing (constriction of bronchioles)
What are some direct acting cholinergics?
Bethanechol: stimulates bladder and GI tract after general anesthesia Pilocarpine: decreases intraocular pressure in acute glaucoma; treatment of dry mouth
What are some indirect acting cholinergics?
Donepezil (Aricept): increases avilability of AcH in Alzeimer’s Edrophonium (Tensilon): facilitates the diagnosis of Myasthenia Gravis (temporarily improves muscle strength)
Tensilon Test
Give Tensilon to a patient to temporarily increase AcH. Patient will get muscle strength back if they have Myasthenia Gravis. MG blocks AcH causing extreme fatigue and weakness in the arm and leg muscles, difficulty with chewing and speech.
What do cholinergic blockers (anticholinergics) do?
Block action of acetylcholine (specifically muscarinic receptors), mimicking the fight or flight response.
Therapeutic class of atropine?
Antidysrhythmic, mydriatic, antidote of anticholinesterase posisoning
Pharmacologic class of atropine
Anticholinergic
What do beta adrenergic blockers do?
Lower heart rate and blood pressure Atenolol, metoprolol
MOA of atropine
Blocks cholinergic (muscarinic) receptors, causing increased heart rate, decreased GI motility, mydriasis, bronchodilation, and decreased secretion from glands (salivation)
Adverse effects of atropine
Dry mouth, constipation, urinary retention, tachycardia, blurred vision
Contraindications of atropine
Clients with glaucoma
What do adrenergic (sympathomimetics) do?
Activation of sympathetic nervous system; fight or flight response. Norepinephrine is the neurotransmitter. Effects depends on what adrenergic receptor is stimulated (alpha1, alpha2, beta1, beta 2)
What does epinephrine stimulate?
Adrenalin stimulates alpha1 and beta receptors; used with asthma, cardiac arrest, allergic reactions
What does albuterol stimulate
Beta 2 receptors; used with asthma
What does clonidine stimulate?
Alpha 2 receptors; used with HTN Inhibits the release of the neurotransmitter
What are nursing considerations for clients taking adrenergics?
Have patients check with provider before taking OTC with the adrenergic Most significant effects relate to cardiovascular system (report chest pain, dizziness, palpitations) Monitor for urinary retention Monitor IV site for extravasation (tissue damage if it leaks into the tissue) Chewing gum/sucking hard candies can help dry mouth
What do adrenergic blockers do?
Inhibit sympathetic nervous system (similar to “rest and digest”)
What do alpha 1 adrenergic blockers do?
Relax vascular smooth muscle Doxazosin, prazosin
What do beta adrenergic blockers do?
Lower heart rate and blood pressure Atenolol, metoprolol
What is cholesterol?
A lipid that plays a key role in the development of atherosclerosis (plaque build up on the lining of the arteries). Contributes to angina, MI, and stroke (CVA)
What is atherosclerosis?
Narrowing of the arteries
What is arteriolosclerosis?
Hardening of the arteries
What is hyperlipidemia?
HPL is high lipid levels in the blood. It is a broad term Often there are other comorbidities (heart failure, diabetes, coronary artery disease)
What is hypertriglycermia?
High triglyceride levels More specific
Are triglycerides cholesterol?
NO, they are a lipid. Cholesterol is also a lipid
What is dislipidemia?
DLD is a broad term for abnormal lipid levels (can be high or low)
What are symptoms of elevated cholesterol?
typically not many symptoms arise until it develops into a disease or causes a stroke that you realize its a problem. Why lipid panels should be done annually
What are LDLs
Low-density lipoproteins; contain the most cholesterol Synthesized in the liver and transported to the tissues for building of plasma membranes and steroids Contributes to plaque deposits “BAD” cholesterol
What are HDLs?
High-density lipoprotein; transports cholesterol away from the body and back to the liver where it is used to make bile and excreted in the stool “GOOD” Cholesterol
What are VLDLs?
Very low density lipoproteins that carry triglycerides throughout the blood; reduces in size to LDL
What are lifestyle changes that can lower cholesterol?
Increase physical activity (30 min/5days/week) Maintain normal weight Reduce dietary saturated fat, trans fat, cholesterol Increase fiber (whole grains, vegetables, fruits) Eliminate tobacco use Will try lifestyle changes before medications and during if medications are indicated
Goal for cholesterol therapy?
Goals are no longer clear cut (treating the number) Now, take into account risk factors (age, smoking, family history, comorbidities)
Should those over 75 still take statins?
Insufficient evidence to recommend statin use when over 75. could cause higher risks by staying on the medication.
What are statins?
HMG-CoA Reductase Inhibitors Atrovastatin (Lipitor) Fluvastatin (Lescol) Lovastatin (Mevacor) Pravastatin (Pravachol) Simvastatin (Zocar)
What is the MOA of statins?
Limit cholesterol biosynthesis by inhibiting HMG-CoA which is needed for cholesterol production Lowers LDL; may also increase HDL and decrease triglycerides
What are the indications for statins?
First line treatment for hyperlipidemia (significant reduction in morbidity and mortality)
What are adverse effects of statins?
Myalgia (muscle aches/pains) - should ALWAYS be followed up on Diarrhea Increase glucose levels (risk increases in diabetic patients) Rhabdomyolysis (breakdown of muscle cells, will produce myalgia) Liver failure (rare) Eye lens opacities
Nursing implications for statins?
- Check fasting lipid profile and liver function tests before starting therapy
- Generally administered in the evening (hepatic cholesterol production increases at night) to make it more beneficial
- Avoid taking with grapefruit juice (leads to toxicity by slowing down metabolism of drug)
- Educate patients to report unexplained muscle pain, weakness, tenderness
- Used in conjunction with diet and exercise
- Onset 2 weeks
- Maximum effects 4-8 weeks
- Excess alcohol use increases risk for liver damage
- Pregnancy category X
Bile Acid Sequestrants
Example: cholestyramine (Questran)
- Bind bile acids (made from cholesterol) in intestine, preventing them from being recycled by the liver and re-entering circulation
- Lowers LDL
- Administered as a powder for suspension
Adverse effects of bile acid sequestrants
- GI related side effects: abdominal pain, flatulence, conspitation, N/V, dyspepsia (upset stomach), steatorrhea (fatty stool), diarrhea
- Do not take with other medications - it affects absorption
- Take 2 hours before or 4 hours after
MOA of Niacin (Vitamin B3)
- Not well understood
- Decreases VDL (very effective), LDL, and triglycerides
- Increases HDL
Implications for Niacin (Vitamin B3)
Treatment of hyperlipidemia
Usually used iwht other lipid lowering agents
Adverse effects of Niacin (Vitamin B3)
- Flushing (especially with immediate release formulation)
- GI distress (nausea, gas, diarrhea)
- Abnormal liver function
- Extended release is more toxic
Nursing implications of Niacin (Vitamin B3)
- Educate patients regarind flushing to increase compliance
- Aspirin helps to relieve this effect if taken 30 min before (only take if prescribed it anyway)
- Take with cold water to help minimize flushing
- Take on a full stomach
- Different than what comes as a vitamin supplement; typically a significantly larger dose
Examples of Fibric Acid Derivatives
- Have “fibr” in their name
- femfibrozil (Lopid)
- fenobribrate
Largely have replaced statins
MOA of fibric acid derivatives
- Not well understood
- Decrease triglycerides (very effective), VLDL
- Increases HDL
Indicatin of fibric acid derivatives
Hypertriglyceridemia to decrease risk of CAD
Adverse effects of fibric acid derivatives
- Abdominal pain
- Nausea
- Myalgia (muscle pain)
- Abnormal liver function
What do cholesterol absorption inhibitors do?
- Inhibit the absorption of cholesterol in the small intestine
- Used in combination with a statin to lower LDL, or alone for familial hypercholesterolemia
- Example: ezetimibe (Zetia)
Omega-3 fatty acids
- Dietary supplement derived from marine and plant sources
- Decrease triglycerides
- Prophylaxis to prevent MI (unlabeled use)
- No strong evidence
- High doses can increase clotting time
- Monitor, especially if they are on an anticoagulant
What are diuretics?
Something that increases urinary excretion of water
Common indication of diuretics?
- Hypertension due to high volume of blood
- Heart failure: lower volume heart needs to pump
- Renal failure: excess fluid
- Liver failure.cirrhosis: tends to collect extra fluid
- Pulmonary edema: alveoli filled with fluid
What is a common concern when taking diuretics?
There effects on serum electrolytes, in particular, potassium (and magnessium)
High or low potassium levels cause heart problems
Therapeutic class of furosemide (Lasix)
Drug for heart failure, hypertension
Pharmacologic class of furosemide (Lasix)
Loop diuretic
Indications of furosemide (Lasix)
Heart failure, renal failure, hepatic cirrhosis, pulmonary edema, edema, HTN
MOA of furosemide (Lasix)
Inhibits reabsorption of sodium and chloride in the ascending loop of Henle
Results in increased excretion of sodium, potassium, chloride, calcium, magnessium, and water
Adverse effects of furosemide (Lasix)
- Dehydration
- Hypotension (low BP)
- Dizziness
- Electrolyte depletion (especially K+ and Mg+)
- Renal impairment
- Ototoxicity (higher doses, rapid IV administration
Nursing implications of furosemide (Lasix)
- Monitor urine output, BP, creatinine, K+, Mg (may require electrolyte replacement)
- May be on potassium supplement
- Avoid taking at bedtime - fall risk
- Educate patients on importance of monitoring lab work and BP
- Rise slowly when getting up (orthostasis)
- Related to sulfonamides - watch for cross-sensitivity (will still though)
- Avoid using with other nephrotic or ototoxic (hearing) drugs
- If taking digoxin, monitor for toxicity if hypokalemic (low potassium level)
Therapeutic class of hydrochlorothiazide (Microzide)
Antihypertensive, drug for edema
Pharmacologic class of hydrochlorothiazide (Microzide)
Thiazide diuretic
Indications for hydrochlorothiazide (Microzide)
Mild to moderate HRN (first-line drug), edema
MOA of hydrochlorothiazide (Microzide)
Affects sodium reabsorption (decreases) at the distal renal tubule, causing increased excretion of sodium and chloride