Exam 3 (Respiratory) Flashcards
Indoor allergens can trigger allergic rhinitis. allergens will bind to _______. What is rhinitis?
IgE, stuffy nose (irritation and swelling of the mucus membrane in the nose)
What is the most prevalent mineralocorticoid and what does it do? The most prevalent glucocorticoid?
mineral corticoid: Aldosterone (retains sodium and regulates water balance)
glucocorticoid: Cortisol (regulation of blood glucose, anti-inflammatory, immunosuppressant)
what would hyper-aldosteronism do to a patients blood pressure? what would it do to the patients potassium levels?
increase blood pressure, decrease potassium levels in the blood (b/c it promotes potassium secretion in the distal tubes) *hypokalemia
What is the suffix for glucocorticoids?
-sone
ex) prednisone, dexamethasone, hydrocortisone, beclomethasone
on glucocorticoid therapy, what is the danger with patients blood sugar levels?
hyperglycemia
A patient with Adrenal Insufficiency is diagnosed with Addisons Disease, what will they be prescribed?
PO Prednisone, administer with low dosing
What is Cushing’s Syndrome?
Long term glucocorticoid therapy can cause this.
Manifestation: thin, wrinkled skin, purpura
cardiac hypertrophy (b/c HT)
fat pads
emotional disturbance
destruction of bone proteins and alterations in calcium metabolism
cortisol increases gastric acid secretion, which may provoke gastric ulceration and bleeding
cardiac renal,,, na+ and h20 retention
endocrine vs non endocrine doses
*low doses for endocrine disorder
ex) adrenal insufficiency, modulation of flucose metabolism
*higher doses when treating a non endocrine disorder
why might someone with pain associated with rheumatoid arthritis be prescribed glucocorticoid therapy?
as an anti-inflammatory
a patient is recovering from a lung transplant and is prescribed 30mg of prednisone each day. what will happen with future dosing if there are no signs of organ rejection?
dosing will be tapered down each day
The parents ask the nurse about how to limit the effects of glucocorticoid therapy on the child’s growth.
-growth delay can be minimized with alternate day dosing of glucocorticoids
The patient taking glucocorticoid for several months and comes in with swollen cheeks and fat
What labs do you check?
blood glucose, and electrolytes
do Glucocorticoids have fever side effects than NSAIDS?
no they dont have fewer side effects
a pt who enjoys running has been diagnosed with RA in both knees. for a new prescription of glucocorticoids, what information would the nurse share?
glucocorticoids are used as adjunctive therapy during acute flare-ups
a patient with COPD is prescribed 20mg of hydrocortisone taken orally once each day. What time would the nurse make sure the drug is administered?
at 8am (morning)
A patient is about to begin long term glucocorticoid therapy. What is a way to minimize the risk of osteoporosis?
weight bearing exercise 5x a week, to keep the bones strong
A patient taking high doses of glucocorticoids develops weakness in the muscles of the upper arms and legs. why does this occur?
protein breakdown, will breakdown the muscle
osteoporosis is happening because of hypocalcemia
What is the first line therapy for persistent asthma and COPD?
glucocorticoids
patient with persistent asthma asks:
“is it smart to save my inhaled Fluticasone medication and use only when my wheezing starts?
no, this medication should be taken on a fixed schedule
what are the three main problems in asthma? What are the two types of drugs you need to use?
broncho constriction, inflammation, and hyper reactivity
you need anti-inflammatory and broncho dilators
a pt is on prolonged systemic glucocorticoid therapy. what will happen to the patients endogenous production of glucocortidoids?
what does it mean to the pt in times of extreme stress?
the patient will have decreased production of glucocorticoids from the adrenal glands
(the body will stop making it)
extra dosing will be necessary because the body will not produce the extra stress hormones
what are routes of ingestion for systemic?
oral, iv, IM
match the ADR to inhaled or systemic
hyperglycemia
voice changes
mood changes
risk for infection
oral candidiasis
what are some things to assess for in a patient on prolonged systemic glucocorticoid therapy?
adrenal insufficiency
osteoporosis
hyperglycemia
electrolyte disorders (hypokalemia)
cataracts
peptic ulcer
stress marks (Striae)
fractures
what is a way to minimize the risk of oral candidiasis?
use a spacer on the inhaler device
rinse the mouth after use
what are three classes of drugs that are anti-inflammatory?
mast cell stabilizer, leukotriene modifier, glucocorticoids
MOA:
albterol
cromolyn
montekulast
albuterol -> activate beta 2 receptor on bronchial smooth muscles
cromolyn -> changes release of inflammatory mediators by mast cell
montekulast ->blocks leukotriene receptor
MOA:
fluticasone
olizumad
iprotropium
fluticasone : anti-inflammatory and immunosuppressant action
olizumad :IgE antagonist
iprotropium :blocks muscarinic receptors
for asthma, what do you use first? then second?
broncho dilator, then anti-inflammatory
what is the most effective medication for exercise induced bronchospams?
inhaled albuterol (bronchodilator)
T/F: overuse of BETA 2 Agonist can result in BETA 1 effects
true
what can result from excessive dosing of beta 2 agonist? who would most be at risk?
tachycardia, angina, and tremor
people with cardiac dysrhythmias or heart failure, or hypertension
What medication has proven to decrease the number of exacerbations of COPD?
Roflumilast (PDE4 inhibitor)
An asthma patient is taking theophylline. What types of items will the nurse warn him to avoid?
Why is this medication highly monitored when used?
How will Iprotropium help this patient ? what are the common ADRs when using this medication?
narrow therapeutic window, avoid smoking, caffeine, energy drinks
iprotropium-> will block the muscarinic receptors so that they don’t constrict and keep the airway open
common ADRs are cardiac dysrhythmias,
what will the nurse recommend for a patient taking isoniazid for active TB?
supplemental vitamin B (because of the B6 deficiency leading and peripheral neuropathy), avoid drinking alcohol, report any new medications for providers
what are the for primary drugs for TB
P pyrazinamide
I isoniazid
E ethambutol
R Rifampin
what are examples of hepatotoxicity?
anorexia, malaise, fatigue, nausea, jaundice
check liver enzymes
a patient with atrial fibrillation is taking warfarin. the patient will begin to take rifampin for TB. what is the most important thing for the nurse to asses for?
A) abdominal pain
B) easily bruising
C) change in mental status
D) oliguria
change in mental status (bleed in their head)
what will the nurse teach the patient about taking Rifampin?
-wear eye glasses instead of contact lenses
-be aware that your urine and tears will be orange
what will the nurse teach the patient about taking ethambutol?
change in vision- optive neuritis
what will the nurse teach the patient about taking pyrazinamide?
non gouty joint paint
what is the most effective OT cough suppressant? what is the most effective prescription cough suppressant?
dextromethorpan-OTC
codeine - RX
what are the two major differences between 1st and 2nd anti-histamines ?
-increased sedation with 1st generation
-increased anticholinergic effect (tachycardia, dry mouth, dry eyes, constipation, urinary retention,)
what type of medication is oxymetazoline nasal spray? What happens if they use this many times a day?
A) sympathomimetic
B) sympatholytic
C) antihistamine
D) glucocorticoid
sympathomimetic
- rebound congestion
can decongestant medications treat all signs of allergic rhinitis?
only treats nasal congestion
Glucocorticoids are contraindicated in the treatment of a patient with________ or in ________. Glucocorticoids should be used with caution in patients with ______, ______, and ________.
diabetes mellitus, myasthenia gravis, and glaucoma.
Guaifenesin (robitussin)
prototype expectorant: Stimulates flow of secretions, reduces viscosity (thickness) of secretions
action: decrease mucus viscosity and decrease surface tension. changes a non productive cough into a productive cough
indication: cough cold, sinusitis, bronchitis
Dextromethorphan
most effective non-opiod antitussive
*acts on the CNS - cough center in the medulla
*lessens irritation of the respiratory tract
synergistic effect when combined with Morphine (better pain relief)
if taken in high doses, can produce euphoria and may be abused
ADR: slight inebriation, mild dizziness, and drowsiness
Codeine
opioid antitussive (need prx)
-most effective cough suppressant availiable
-decreases the frequency and intensity of cough
-codeine for cough has a low abuse potential, but there is a higher does for pain relief and it is a schedule 2 drug
acetylcysteine
prototype mucolytic drug
changes the molecular composition of mucus, and decrease viscosity
indication: thick mucus, chronic bronchitis, cystic fibrosis
administration: nebulizer inhalation
ADR: foul odor
what is the ending for first generation ORAL anti histamines and the prototype drug?
prototype: Diphenhydramine
ending -ramine
ADRS are mild (sedation and anticholinergic effects)
nursing consideration: use with caution in patients with glaucoma, hyperthyroidism , HTN, or urinary retention
what is the ending for second gen ORAL anti-histamine drugs? and the prototype
ending is -zine and -dine
prototype is Ioratidine (claritin)
Sympathomimetic Decongestant , what is a prototype?
prototype is Phenylephrine and Psudoephedrine
MOA: activates alpha 1 adrenergic receptors in the blood vessels causing vasoconstriction
indication: treat nasal congestion
ADR: rebound congestion
caution: those with CV disorders like HTN, arythmias
hgh abuse potential esp with pseudoephedrine
for the CNS stimulation effect that is similar to amphetamines
