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Pharmacology > Exam 5 Ch 38 and 39 > Flashcards

Exam 5 Ch 38 and 39 Flashcards

1
Q

What does the H1 histamine receptor do?

A

intestinal and bronchial smooth musclesW

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2
Q

What does the H2 histamine receptor do?

A

gastric section

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3
Q

What are the first generation antihistamines?

A

diphenhydramine, hydroxyzine , meclizine, promethazine

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4
Q

First generation H1 receptor agonists are more likely to cause?

A

sedation and anticholinergic effects

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5
Q

What are the indications for first generation antihistamines?

A

allergic rhinitis, motion sickness, induce sleep, runny nose

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6
Q

What are the side effects of first gen H1 receptor antagonists?

A

can’t pee, can’t see, can’t spit, can’t poop, can’t sweat, sedation, drowsiness, tachycardia

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7
Q

Adverse effects of first gen H1 receptor agonists?

A

sedation (do not drive)

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8
Q

What time should we take first generation receptor agonists?

A

in evening before bed

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9
Q

Contraindications of first gen antihistamines?

A

BPH, glaucoma, older adult (beers criteria)

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10
Q

first generation antihistamines can cause _______ in older adults

A

confusion

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11
Q

What should we avoid while on first generation antihistamines?

A

alcohol, opioids/cns depressatns

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12
Q

What causes the first generation antihistamines to cause sedation?

A

they cross the blood brain barrier

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13
Q

What drugs are in the second generation antihistamines?

A

cetirizine, fexofenadine, loratadine, azelastine

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14
Q

Indications for second generation antihistamines

A

first line therapy for allergic rhinitis

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15
Q

Nursing interventions/ patient teaching for second generation antihistamines

A

obtain information about allergies, give with food, alcohol is not recommended, use candy/gum/ice chips for dry mouth, increase fiber, increase fluids, avoid heat/sun

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16
Q

Those on second generation antihistamines should avoid?

A

apple, grapefruit, and orange juice ; being out in heat

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17
Q

What are the oral decongestants

A

pseudoephedrine and phenylephrine

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18
Q

You must have an ID to purchase which oral decongestant?

A

pseudoephedrine

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19
Q

Oral decongestants have a systemic or local effect?

A

systemic

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20
Q

What is nasal congestion?

A

when nasal blood vessels dilate and fills into tissue spaces –> leads to swelling in nasal cavity

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21
Q

What is the indication for decongestants?

A

temporarily relieve nasal congestion

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22
Q

Mechanism of action for decongestants?

A

Stimulate alpha adrenergic receptors causing vasoconstriction. this shrinks the nasal mucus membranes and reduces secretions

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23
Q

Side effects of decongestants?

A

sympathomimetic effects: tachycardia, nervousness, anxiety, weakness, tremors, dry mucous membranes

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24
Q

Adverse effects of decongestants?

A

palpitations, HTN, arrhythmias, hallucinations, delusions, convulsions

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25
Q

What are the contraindications of decongestants?

A

preexisting hypertension, glaucoma, cardiac disease, hyperthyroidism

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26
Q

Should those with hypertension take oral decongestants?

A

NO ; decongestants will have systemic effect and cause HTN to become worse

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27
Q

If you have diabetes and want to take decongestants you should?

A

talk to provider first

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28
Q

We should instruct patients taking decongestants to read medication labels closely because?

A

phenylephrine can be found in many medications ; they may take too much

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29
Q

What are the topical decongestants?

A

oxymetazoline, tetrahydrozoline, xylometazoline, naphazoline

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30
Q

Topical decongestants will have systemic or local effects?

A

local

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31
Q

What are the indications for topical decongestants?

A

nasal congestion

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32
Q

Will systemic or topical nasal decongestants work faster?

A

topical

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33
Q

We should make sure our clients taking topical decongestants do not?

A

swallow the medication

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34
Q

We should teach our patients that topical decongestants can cause?

A

tolerance to develop–> leads to dependence

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35
Q

How long can our patients use topical decongestants ?

A

no more than 3 days

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36
Q

Topical decongestant tolerance can cause what to occur?

A

rebound congestion

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37
Q

How should our clients taper off of topical decongestants ?

A

one nostril at a time

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38
Q

Side effects of topical decongestants?

A

tachycardia, nervousness, anxiety, restlessness, tremors, weakness, dry mucous membranes

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39
Q

Adverse effects of decongestants?

A

tolerance , palpitations, HTN, arrhythmias, hallucinations, delusions, convulsions

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40
Q

What do expectorants do?

A

relieve chest congestion of those with dry nonproductive cough

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41
Q

what is the expectorant drug?

A

guaifenesin

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42
Q

Expectorants can cause ______ so we must use cautiously in those with?

A

bronchoconstriction ; asthma

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43
Q

We should teach our patients on expectorants to?

A

Increase fluids, deep breathing, and cough. Take with a full glass of water.

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44
Q

How much fluid should those on expectorants consume a day?

A

8 8oz glasses of water

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45
Q

Why do those on expectorants need to increase fluid?

A

relieves surface tension of mucous so we can cough it up

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46
Q

What is the difference between expectorants and antitussives?

A

expectorants will not reduce coughing…. with expectorants we want them to cough so it will come up

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47
Q

the goal of expectorant therapy is to?

A

produce productive cough

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48
Q

What drugs are antitussives?

A

dextromethorphan, codeine, benzonatate

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49
Q

What is the indication for antitussives?

A

suppress the cough reflex for dry, nonproductive cough

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50
Q

Antitussives are contraindicated in what conditions?

A

asthma and emphysema

51
Q

What ae the side effects of dextromethorphan?

A

dizziness, nausea, sedation

52
Q

When buying dextromethorphan, we must have?

A

and ID present

53
Q

side effects of antitussive codeine?

A

drowsiness, dizziness, irritability, constipation, restlessness, hypotension

54
Q

patient teaching for antitussive codeine?

A

avoid activities requiring alertness, change positions slowly, hard candy, increase fiber/fluid/exercise, avoid alcohol and other depressants

55
Q

While on codeine, we should instruct our patient to report?

A

cough > 1 week , cough with a fever

56
Q

antitussives act on the?

A

cough control center in the medulla

57
Q

what is the difference between inhaled and systemic corticosteroids?

A

inhaled have fewer side effects and can be given long term ; systemic goes into bloodstream and have more side effects with longterm use

58
Q

What are inhaled corticosteroids used for?

A

reducing inflammation in the bronchial tree

59
Q

Beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone, and ciclesonide are what drug class?

A

inhaled corticosteroids

60
Q

Inhaled corticosteroids are used prophylactically in what conditions?

A

asthma and COPD

61
Q

Inhaled corticosteroids for COPD are used for ________ , while oral (systemic) corticosteroids are used for?

A

maintenance ; exacerbations

62
Q

are inhaled corticosteroids rescue drugs?

A

NO

63
Q

Side and adverse effects of inhaled corticosteroids?

A

sore throat, hoarseness, coughing, dry mouth, fungal infections

64
Q

We should teach our patients taking inhaled corticosteroids to use a?

A

spacer with their pMDI

65
Q

How can we use the teach back method when explaining inhaled corticosteroids?

A

have the patient explain they should use bronchodilator (albuterol) first

66
Q

Our clients taking inhaled corticosteroids should do what to prevent thrush?

A

rinse mouth after with water and spit ; clean inhaler

67
Q

We should teach our patients it can take how long for inhaled corticosteroids to work?

A

four weeks, they should use every day regardless of symptoms

68
Q

Corticosteroids can cause ______ , so they’re contraindicated in?

A

immunosuppression ; fungal infections and live virus vaccines

69
Q

What are the systemic corticosteroids?

A

methylprednisolone (IV) and prednisone

70
Q

Systemic corticosteroids are indicated for?

A

COPD/ Asthma exacerbations and antiinflammatories

71
Q

Children taking systemic corticosteroids have an increased risk for?

A

decreased adrenal function, growth, and bone mass

72
Q

those taking systemic corticosteroids have a risk of immunosuppression, we should teach them to?

A

avoid large crowds, follow hand hygiene guidelines

73
Q

Why should we monitor blood glucose in those taking corticosteroids?

A

causes hyperglycemia

74
Q

Contraindications for systemic corticosteroids?

A

active fungal infections, live virus vaccines

75
Q

Should our patients abruptly stop taking their corticosteroids?

A

no

76
Q

What can happen if our patient does not taper off corticosteroids?

A

symptoms similar to adrenal insufficiency

77
Q

What are leukotriene modifiers used for?

A

prophylaxis and chronic treatment of asthma

78
Q

Are leukotriene modifiers taken orally or inhaled?

A

oral tablets

79
Q

What drugs are leukotriene modifiers?

A

zafirlukast, montelukast

80
Q

Are leukotriene modifiers recommended for acute attacks?

A

no

81
Q

Adverse effects of leukotriene modifiers?

A

depression, SI, bleeding, seizures, liver dysfunction

82
Q

Anticholinergics are used to block?

A

bronchoconstriction

83
Q

What drugs are anticholinergics?

A

ipratropium, tiotropium

84
Q

What are anticholinergics used to treat?

A

asthma, bronchitis, and pulmonary emphysema

85
Q

Contraindications of anticholinergics?

A

allergy to peanuts

86
Q

Anticholinergics should be used cautiously in patient with?

A

glaucoma and BPH

87
Q

Patients on cholinergic antagonists should avoid?

A

smoking

88
Q

theophylline and aminophylline are what type of drugs?

A

methylxanthines

89
Q

methylxanthines are used to treat?

A

asthma and bronchospasms

90
Q

A serum drug level of 5-15 mcg with methylxanthines indicates?

A

normal levels

91
Q

A methylxanthine serum drug level of 20-25 mcg will produce what symptoms

A

N/V/D , HA(headache), insomnia, irritability

92
Q

A methylxanthine serum drug level of >30 MCG will produce what symptoms?

A

hypotension, hyperglycemia, arrhythmias, seizures, brain damage, death

93
Q

Why should those taking theophylline and aminophylline avoid smoking?

A

will decrease serum drug levels

94
Q

Those on theophylline and aminophylline should avoid caffeine such as?

A

coffee, tea, soda, chocolate

95
Q

Patients taking theophylline and aminophylline should report symptoms of toxicity such as?

A

N/V/D and restlessness

96
Q

Why should caffeine be avoided in theophylline

A

increases side effects

97
Q

Beta 2 agonists come in two forms. What are they

A

short acting (rescue drugs), long acting

98
Q

What are the short acting bronchodilators?

A

albuterol, levalbuterol, pirbuterol

99
Q

What are the long acting bronchodilators?

A

arformoterol, formoterol, indacaterol, olodaterol, salmaterol

100
Q

Albuterol is used to prevent?

A

prevent asthma attack, resolve acute asthma attacks

101
Q

Beta 2 agonists are used to treat?

A

acute bronchospasm and prevent exercise induced asthma

102
Q

Long acting beta agonists are used for?

A

prevention/prophylacticaly of asthma symptoms

103
Q

short acting bronchodilators should not be used more than?

A

2-3 times a week

104
Q

How long before exercise should albuterol be given?

A

15-30 minute

105
Q

We should teach our patients to hold their breath ______ after hitting their inhaler

A

5-10 seconds (as long as possible)

106
Q

If our patient is prescribed a bronchodilator and corticosteroid, which do we take first?

A

bronchodilator to open lungs, then corticosteroid to reduce inflammation

107
Q

What are side effects of beta agonists?

A

throat irritation, anxiety, nervousness, tremor, dizziness

108
Q

What are adverse effects of beta agonists?

A

sinus tachycardia, hypertension, palpitations, angina, hyperglycemia

109
Q

What are rare and life threatening adverse effects of beta 2 agonists?

A

bronchospasm, urticaria, angioedema

110
Q

For our patients on beta agonists, we should assess their?

A

caffeine intake (can make side effects worse)

111
Q

patient teaching for beta 2 bronchodilators?

A

use only as ordered, use a spacer, side effects diminish over time, tolerance can occur, limit caffeine

112
Q

Why should our patients use a spacer?

A

allows more medication to get into the lungs

113
Q

what kind of drug class is epinephrine?

A

alpha adrenergic agonist

114
Q

If we are having emergent bronchoconstriction, should we use albuterol or epinephrine

A

epinephrine

115
Q

If we swallow intranasal glucocorticoids, what could happen?

A

can cause systemic anti-inflammatory effects

116
Q

What are manifestations of hyperthyroidism

A

tachycardia, nervousness, sweating tremors, excess heat production, insomnia, weight loss

117
Q

What are manifestations of hypothyroidism

A

low HR, depression, fatigue, weight gain, cold interolerance

118
Q

What manifestations can children have if they have hypothyroidism

A

intellectual disability and short stature

119
Q

What drug is used for thyroid hormone replacement?

A

levothyroxine

120
Q

What drugs affect levothyroxine

A

warfarin, digoxin, some vitamins and supplements

121
Q

How does warfarin affect levothyroxine? What labs do we monitor

A

increases effect ; monitor PT/INR (s/s of bleeding)

122
Q

How does digoxin affect levothyroxine? What labs do we monitor

A

decreases effect ; monitor for CHF (edema, fluid retention, crackles in lungs, SOB)

123
Q
A

Pharmacology (12 decks)

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