Exam 2 Study Guide- Respiratory Flashcards
Alergic Rhinitis
- what is it
- causes the release of what
- relieved by what medications
- “Allergies”
- causes histamine release
- relieved by oral/intranasal congestants and anti-histamines
Histamine 1 (H1)
- locations
- causes what
- found in smooth muscle
- causes many of symptoms of allergic rhinitis
Histamine 2 (H2)
- location
- responsible for
- found in the stomach
- responsible for peptic ulcers
What is the prototype for antihistamines (H1 antagonists)?
diphenhydramine (Benadryl)
diphenhydramine (Benadryl)
- use
- mechanism of action
- adverse effects
- use: allergic reactions
- moa: histamine (h1) receptor blocker
- adverse effects: drowsiness, photosensitivity
- slow IV push (no more than 25 mg/min)- can send pt into shock if pushed too fast
- anticholinergic- dries up secretions; can cause urinary retention
What are the 2 prototypes for intranasal corticosteroids?
- fluticasone (Flonase)
- beclomethasone (Beconase)
Intranasal Corticosteroids
- use
- major complaints
- time frame
- # 1 in treating allergic rhinitis
- major complaints: nose bleeds and burning during administration
- must be administered 2-3 weeks prior to allergen exposure
*reduces tissue edema (in turbenence)
fluticasone (Flonase) & beclomethasone (Beconase)
- route
- mechanism of action
- adverse effects
- topical steroid that is safe for patients
- moa: decreases local inflammation in nasal passages, thus reducing nasal stuffiness
- adverse effects: nasal irritation, epistaxis
What is the prototype for intranasal sympathomimetics?
oxymetazoline (Afrine)
Intranasal & Oral Sympathomimetics
- use
- mechanism of action
- used as decongestants
- moa: constrict blood vessels (potential issue with patients with HTN)
oxymetazoline (Afrin)
- time frame
- potential adverse effect
- mechanism of action
- can only be used for 3-5 days (if used longer can cause rebound congestion)
- can cause blurred vision if you don’t wash your hands after administering
- moa: causes arterioles in nasal passages to constrict; dries mucous membrane
What is the prototype for oral sympathomimetics?
pseudoephedrine (Sudafed)
*often combined with antihistamine preparation (examples: Zyrtec-D and Allegra-D)
What medications are used to inhibit a severe cough?
Opiods
Antitussives inhibit _________ and expectorants inhibit __________ ____________.
Cough; mucous production
What are the prototype drugs for antitussives?
dextromethorphan (Benylin) & Delsym
dextromethorphan (Benylin) & Delsym
- mechanism of action
- adverse effects
- effects of large amounts
- moa: acts in the medulla to inhibit cough reflex
- adverse effects: dizziness, drowsiness, GI upset
- very large amounts can cause euphoria type effect
Aerosol Therapy
- provides immediate relief of what
- possible side effects
- provides immediate relief of bronchospasm by loosening thick mucous
- side effects can occur if pt swallows drug or doesn’t rinse mouth after inhalation
What are the 3 devices used for aerosol therapy?
- Nebulizer
- Metered-dose inhaler (always shake and expel first air)
- Dry powder inhaler (activated by inhalation; long lasting so should last for 12 hours)
Characteristics of Asthma (2)
- inflammation coupled with mucous production
- bronchospasm (spasms in the lungs, making it difficult to breath)
Status asthmaticus
-definition
- prolonged asthma attack
* pt typically admitted to the ICU for close monitoring; can be life-threatening
What are the 4 medications used for asthma?
- Beta-adrenergic agonists (Albuterol)
- Bronchodilators (Atrovent)
- Methylxanthines (Theophylline)
- Corticosteroids (Prednisone)
Beta-adrenergic agonist
- prototype
- most effective against what
- moa
- adverse effects
- teaching
- normal adult dose
- Proto: Albuterol
- most effective for relieving acute broncho spasm
- moa: activate beta2 receptors in bronchial smooth muscle to cause bronchodilation
- adverse effects: tachycardia, increased BP
- teaching: normal breathing, deep breath every 5th breath, shake well, expel first air
- norm. adult dose: 2puffs/4hours as needed
Bronchodilators-antocholinergic
- prototype
- moa
- adverse effects
- Proto: Atrovent
- moa: dries up secretions
- adverse effects: cough, drying of nasal mucosa, bitter taste
**used a lot with COPD patent because of the increased mucous production
Methylxanthines
- prototype
- use
- Prototype: Theophylline
- use: primarily for long-term prophylaxis of asthma that it unresponsive to beta agonists or corticosteroids
*narrow margin of safety (8-20 mcg/mL)
Corticosteroids
- prototype
- use
- adverse effects
- Proto: Prednisone
- used to decrease frequency of asthma attacks
- adverse effects: orpharyngeal candidiasis, weight gain, adrenal insufficient, hyperglycemia
Leukotriene Modifiers
- prototype
- use
- mechanism of action
- adverse effects
- Proto: Accolate
- use: persistent, chronic asthma
- moa: prevented airway edema and inflammation by blocking leukotriene receptors in airways
- adverse effects: headache, nausea, diarrhea
- Liver issues- use caution due to reported cases of liver failure
- Warfarin- increases PT l
- Erthromycin- decreases serum levels
- Aspirin- increases levels of meds
Contraindications in the treatment of asthma
- Beta2 agonist (Albuterol)
- Methylxanthines (Theophylline)
- Beta2 agonist: beta blockers; shouldn’t be used if pt has hx of dysrhythmias or MI
- Methylxanthines: CAD, angina pectoris, severe renal or liver disorders (this medication is cleared by the kidneys and liver- 50% in levels of medication), peptic ulcer, BPH, diabetes mellitus
