Exam 5 Ch 38 and 39 Flashcards
1
Q
What does the H1 histamine receptor do?
A
intestinal and bronchial smooth musclesW
2
Q
What does the H2 histamine receptor do?
A
gastric section
3
Q
What are the first generation antihistamines?
A
diphenhydramine, hydroxyzine , meclizine, promethazine
4
Q
First generation H1 receptor agonists are more likely to cause?
A
sedation and anticholinergic effects
5
Q
What are the indications for first generation antihistamines?
A
allergic rhinitis, motion sickness, induce sleep, runny nose
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
7
Q
Adverse effects of first gen H1 receptor agonists?
A
sedation (do not drive)
8
Q
What time should we take first generation receptor agonists?
A
in evening before bed
9
Q
Contraindications of first gen antihistamines?
A
BPH, glaucoma, older adult (beers criteria)
10
Q
first generation antihistamines can cause _______ in older adults
A
confusion
11
Q
What should we avoid while on first generation antihistamines?
A
alcohol, opioids/cns depressatns
12
Q
What causes the first generation antihistamines to cause sedation?
A
they cross the blood brain barrier
13
Q
What drugs are in the second generation antihistamines?
A
cetirizine, fexofenadine, loratadine, azelastine
14
Q
Indications for second generation antihistamines
A
first line therapy for allergic rhinitis
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
16
Q
Those on second generation antihistamines should avoid?
A
apple, grapefruit, and orange juice ; being out in heat
17
Q
What are the oral decongestants
A
pseudoephedrine and phenylephrine
18
Q
You must have an ID to purchase which oral decongestant?
A
pseudoephedrine
19
Q
Oral decongestants have a systemic or local effect?
A
systemic
20
Q
What is nasal congestion?
A
when nasal blood vessels dilate and fills into tissue spaces –> leads to swelling in nasal cavity
21
Q
What is the indication for decongestants?
A
temporarily relieve nasal congestion
22
Q
Mechanism of action for decongestants?
A
Stimulate alpha adrenergic receptors causing vasoconstriction. this shrinks the nasal mucus membranes and reduces secretions
23
Q
Side effects of decongestants?
A
sympathomimetic effects: tachycardia, nervousness, anxiety, weakness, tremors, dry mucous membranes
24
Q
Adverse effects of decongestants?
A
palpitations, HTN, arrhythmias, hallucinations, delusions, convulsions
25
What are the contraindications of decongestants?
preexisting hypertension, glaucoma, cardiac disease, hyperthyroidism
26
Should those with hypertension take oral decongestants?
NO ; decongestants will have systemic effect and cause HTN to become worse
27
If you have diabetes and want to take decongestants you should?
talk to provider first
28
We should instruct patients taking decongestants to read medication labels closely because?
phenylephrine can be found in many medications ; they may take too much
29
What are the topical decongestants?
oxymetazoline, tetrahydrozoline, xylometazoline, naphazoline
30
Topical decongestants will have systemic or local effects?
local
31
What are the indications for topical decongestants?
nasal congestion
32
Will systemic or topical nasal decongestants work faster?
topical
33
We should make sure our clients taking topical decongestants do not?
swallow the medication
34
We should teach our patients that topical decongestants can cause?
tolerance to develop--> leads to dependence
35
How long can our patients use topical decongestants ?
no more than 3 days
36
Topical decongestant tolerance can cause what to occur?
rebound congestion
37
How should our clients taper off of topical decongestants ?
one nostril at a time
38
Side effects of topical decongestants?
tachycardia, nervousness, anxiety, restlessness, tremors, weakness, dry mucous membranes
39
Adverse effects of decongestants?
tolerance , palpitations, HTN, arrhythmias, hallucinations, delusions, convulsions
40
What do expectorants do?
relieve chest congestion of those with dry nonproductive cough
41
what is the expectorant drug?
guaifenesin
42
Expectorants can cause ______ so we must use cautiously in those with?
bronchoconstriction ; asthma
43
We should teach our patients on expectorants to?
Increase fluids, deep breathing, and cough. Take with a full glass of water.
44
How much fluid should those on expectorants consume a day?
8 8oz glasses of water
45
Why do those on expectorants need to increase fluid?
relieves surface tension of mucous so we can cough it up
46
What is the difference between expectorants and antitussives?
expectorants will not reduce coughing.... with expectorants we want them to cough so it will come up
47
the goal of expectorant therapy is to?
produce productive cough
48
What drugs are antitussives?
dextromethorphan, codeine, benzonatate
49
What is the indication for antitussives?
suppress the cough reflex for dry, nonproductive cough
50
Antitussives are contraindicated in what conditions?
asthma and emphysema
51
What ae the side effects of dextromethorphan?
dizziness, nausea, sedation
52
When buying dextromethorphan, we must have?
and ID present
53
side effects of antitussive codeine?
drowsiness, dizziness, irritability, constipation, restlessness, hypotension
54
patient teaching for antitussive codeine?
avoid activities requiring alertness, change positions slowly, hard candy, increase fiber/fluid/exercise, avoid alcohol and other depressants
55
While on codeine, we should instruct our patient to report?
cough > 1 week , cough with a fever
56
antitussives act on the?
cough control center in the medulla
57
what is the difference between inhaled and systemic corticosteroids?
inhaled have fewer side effects and can be given long term ; systemic goes into bloodstream and have more side effects with longterm use
58
What are inhaled corticosteroids used for?
reducing inflammation in the bronchial tree
59
Beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone, and ciclesonide are what drug class?
inhaled corticosteroids
60
Inhaled corticosteroids are used prophylactically in what conditions?
asthma and COPD
61
Inhaled corticosteroids for COPD are used for ________ , while oral (systemic) corticosteroids are used for?
maintenance ; exacerbations
62
are inhaled corticosteroids rescue drugs?
NO
63
Side and adverse effects of inhaled corticosteroids?
sore throat, hoarseness, coughing, dry mouth, fungal infections
64
We should teach our patients taking inhaled corticosteroids to use a?
spacer with their pMDI
65
How can we use the teach back method when explaining inhaled corticosteroids?
have the patient explain they should use bronchodilator (albuterol) first
66
Our clients taking inhaled corticosteroids should do what to prevent thrush?
rinse mouth after with water and spit ; clean inhaler
67
We should teach our patients it can take how long for inhaled corticosteroids to work?
four weeks, they should use every day regardless of symptoms
68
Corticosteroids can cause ______ , so they're contraindicated in?
immunosuppression ; fungal infections and live virus vaccines
69
What are the systemic corticosteroids?
methylprednisolone (IV) and prednisone
70
Systemic corticosteroids are indicated for?
COPD/ Asthma exacerbations and antiinflammatories
71
Children taking systemic corticosteroids have an increased risk for?
decreased adrenal function, growth, and bone mass
72
those taking systemic corticosteroids have a risk of immunosuppression, we should teach them to?
avoid large crowds, follow hand hygiene guidelines
73
Why should we monitor blood glucose in those taking corticosteroids?
causes hyperglycemia
74
Contraindications for systemic corticosteroids?
active fungal infections, live virus vaccines
75
Should our patients abruptly stop taking their corticosteroids?
no
76
What can happen if our patient does not taper off corticosteroids?
symptoms similar to adrenal insufficiency
77
What are leukotriene modifiers used for?
prophylaxis and chronic treatment of asthma
78
Are leukotriene modifiers taken orally or inhaled?
oral tablets
79
What drugs are leukotriene modifiers?
zafirlukast, montelukast
80
Are leukotriene modifiers recommended for acute attacks?
no
81
Adverse effects of leukotriene modifiers?
depression, SI, bleeding, seizures, liver dysfunction
82
Anticholinergics are used to block?
bronchoconstriction
83
What drugs are anticholinergics?
ipratropium, tiotropium
84
What are anticholinergics used to treat?
asthma, bronchitis, and pulmonary emphysema
85
Contraindications of anticholinergics?
allergy to peanuts
86
Anticholinergics should be used cautiously in patient with?
glaucoma and BPH
87
Patients on cholinergic antagonists should avoid?
smoking
88
theophylline and aminophylline are what type of drugs?
methylxanthines
89
methylxanthines are used to treat?
asthma and bronchospasms
90
A serum drug level of 5-15 mcg with methylxanthines indicates?
normal levels
91
A methylxanthine serum drug level of 20-25 mcg will produce what symptoms
N/V/D , HA(headache), insomnia, irritability
92
A methylxanthine serum drug level of >30 MCG will produce what symptoms?
hypotension, hyperglycemia, arrhythmias, seizures, brain damage, death
93
Why should those taking theophylline and aminophylline avoid smoking?
will decrease serum drug levels
94
Those on theophylline and aminophylline should avoid caffeine such as?
coffee, tea, soda, chocolate
95
Patients taking theophylline and aminophylline should report symptoms of toxicity such as?
N/V/D and restlessness
96
Why should caffeine be avoided in theophylline
increases side effects
97
Beta 2 agonists come in two forms. What are they
short acting (rescue drugs), long acting
98
What are the short acting bronchodilators?
albuterol, levalbuterol, pirbuterol
99
What are the long acting bronchodilators?
arformoterol, formoterol, indacaterol, olodaterol, salmaterol
100
Albuterol is used to prevent?
prevent asthma attack, resolve acute asthma attacks
101
Beta 2 agonists are used to treat?
acute bronchospasm and prevent exercise induced asthma
102
Long acting beta agonists are used for?
prevention/prophylacticaly of asthma symptoms
103
short acting bronchodilators should not be used more than?
2-3 times a week
104
How long before exercise should albuterol be given?
15-30 minute
105
We should teach our patients to hold their breath ______ after hitting their inhaler
5-10 seconds (as long as possible)
106
If our patient is prescribed a bronchodilator and corticosteroid, which do we take first?
bronchodilator to open lungs, then corticosteroid to reduce inflammation
107
What are side effects of beta agonists?
throat irritation, anxiety, nervousness, tremor, dizziness
108
What are adverse effects of beta agonists?
sinus tachycardia, hypertension, palpitations, angina, hyperglycemia
109
What are rare and life threatening adverse effects of beta 2 agonists?
bronchospasm, urticaria, angioedema
110
For our patients on beta agonists, we should assess their?
caffeine intake (can make side effects worse)
111
patient teaching for beta 2 bronchodilators?
use only as ordered, use a spacer, side effects diminish over time, tolerance can occur, limit caffeine
112
Why should our patients use a spacer?
allows more medication to get into the lungs
113
what kind of drug class is epinephrine?
alpha adrenergic agonist
114
If we are having emergent bronchoconstriction, should we use albuterol or epinephrine
epinephrine
115
If we swallow intranasal glucocorticoids, what could happen?
can cause systemic anti-inflammatory effects
116
What are manifestations of hyperthyroidism
tachycardia, nervousness, sweating tremors, excess heat production, insomnia, weight loss
117
What are manifestations of hypothyroidism
low HR, depression, fatigue, weight gain, cold interolerance
118
What manifestations can children have if they have hypothyroidism
intellectual disability and short stature
119
What drug is used for thyroid hormone replacement?
levothyroxine
120
What drugs affect levothyroxine
warfarin, digoxin, some vitamins and supplements
121
How does warfarin affect levothyroxine? What labs do we monitor
increases effect ; monitor PT/INR (s/s of bleeding)
122
How does digoxin affect levothyroxine? What labs do we monitor
decreases effect ; monitor for CHF (edema, fluid retention, crackles in lungs, SOB)
123
