Med chart 4 Flashcards
1
Q
Antihistamine 1st Generations H1 Antagonist
A
Diphenhydramine (Benadryl)
2
Q
Diphenhydramine (Benadryl) Indications
A
- Seasonal Allergies
- Rhinitis (Stuffy nose)
- Vertigo/motion sickness
- Parkinsons
- Insomnia: take less than two weeks
- Urticaria (Hives/Rash)
3
Q
Diphenhydramine (Benadryl) MOA
A
- Acts centrally and peripherally to bind to H1 receptors
- Crosses Blood-Brain Barrier
4
Q
Diphenhydramine (Benadryl) Adverse Effects
A
- Benadryl acts on histamine and the acetylcholine neurotransmitter so their effects overlap
- CENTRAL Effects: drowsiness & sedation
- Anticholinergic effects: dry mouth & urine hesitancy
5
Q
Antihistamine; 2nd Gen H1 Antagonist
A
Loratadine (Claritin)
Certirizine (Zyrtec)
Fexofenadine (Allegra)
6
Q
Loratadine (Claritin)
Certirizine (Zyrtec)
Fexofenadine (Allegra)
Indications:
A
- Urticaria/Rahses
- Seasonal Allergies
- Rhinitis (Stuffy nose)
7
Q
Loratadine (Claritin)
Certirizine (Zyrtec)
Fexofenadine (Allegra)
MOA:
A
- Act peripherally to bind to H1 Receptor
- DO NOT cross Blood-Brain Barrier
8
Q
Loratadine (Claritin)
Certirizine (Zyrtec)
Fexofenadine (Allegra)
Adverse Effects:
A
↓ Significant central & anticholinergic effects
9
Q
Antihistamine Nursing Concerns!!
A
- Tolerance develops after a few doses- limit to less than 2 weeks
- Allergies to 1st and 2nd Generation Histamines are common
- DO NOT take during Pregnancy/Lactation
- Renal Impairment: Can cause further damage
- Avoid OTC cold/allergy meds unless approved
- NO Alcohol
- DO NOT use with other CNS acting drugs
- NO grapefruit, apple or orange juice w/in 1 hour of taking
- Stop taking 4 days before skin allergy test
10
Q
Decongestants
A
Pseudoephedrine (Sudafed)
11
Q
Pseudoephedrine (Sudafed)
Indication:
A
Nasal Congestion in common cold.
12
Q
Pseudoephedrine (Sudafed) MOA:
A
- Activate alpha 1 adrenergic receptors which causes vasoconstriction in nasal mucosa→ reduces swelling
- Stimulates beta 2 adrenergic receptors of respiratory tract→ bronchodilation
13
Q
Pseudoephedrine (Sudafed) Adverse Effects:
A
- Headache
- Nervousness/ Tremors→ CNS probs related to alpha and beta receptors
- Tachycardia/ Palpitations/ Hypertension
- DO NOT USE w/ preexisting cardiac problems
- Rebound Effects (worsened symptoms when drug is discontinued as a result of tissue dependence; often occurs after taking too long)
14
Q
Decongestant : Pseudoephedrine (Sudafed) Nursing Concerns:
A
Rebound Effects
- Use no longer than 3-5 days
- If you have dependence switch to intranasal corticosteroids
- Oral drugs eliminate rebounds effects, BUT they have a slower onset and are less effective because they don’t work directly on the target area
15
Q
Antitussives “Anti Cough”
A
Opiod- Centrally Acting “Codeine”
Nonopiod- Peripherally Acting “Dextromethorphan”
16
Q
Antitussives “Anti Cough”
Codeine MOA:
A
Suppress cough reflex in the medulla
17
Q
Antitussives “Anti Cough”
Dextromethorphan MOA:
A
Inhibit cough reflexes in throat, trachea, or lungs
18
Q
Antitussives “Anti Cough”
-Codeine
-Dextromethorphan
Indication:
A
to suppress cough reflexes
19
Q
Antitussives “Anti Cough”
-Codeine
-Dextromethorphan
Adverse Effects:
A
- Dizziness & sedation
- Abuse —> CNS toxicity: limit use < 1 week
20
Q
Antitussives “Anti Cough”
-Codeine
-Dextromethorphan
Nursing Concerns:
A
Interactions:
- Alcohol
- Other CNS drugs
- Precautions: don’t give if you have these bc you want to get rid of sputum/fever
- Fever
- Productive cough
- Pre-existing pulmonary disease: don’t need to suppress it/need to get it out
21
Q
Expectorants
Not antitussive, Reduces frequency and thin secretions, so its EASIER to Cough UP
A
Guaifenesin (Robitussin, Mucinex)
22
Q
Expectorants:
Guaifenesin (Robitussin, Mucinex)
Indication:
A
Congestion: thins mucous
23
Q
Expectorants:
Guaifenesin (Robitussin, Mucinex)
MOA:
A
Reduce thickness/ viscosity of bronchial secretions
24
Q
Expectorants:
Guaifenesin (Robitussin, Mucinex)
Nursing Considerations:
A
- Commonly used OTC drug
- NO smoking or 2nd hand smoke
25
Bronchodilators Indication:
COPD (Chronic obstructive pulmonary disease) : Emphysema, Chronic Bronchitis, Asthma
26
Bronchodilators Nursing Concerns:
- Need to get w full resp. history before administering drug
- Assessment for: Dyspnea; Orthopnea; Cyanosis; Nasal Flaring; Wheezing
- Assess Vital Signs
- Pulse Oximetry (90%-100%) (MOST IMPORTANT)
- Peak Flow (usually ˃= 6yr)→ Checks Lung Function
- Hemoglobin: Men(14-18)/Females(12-16)
- RED: EMERGENCY→ Rescuer
- YELLOW: treat with rescuer
- GREEN: ok; no treatment required
- ABG (Emergency Situations)
- Pulmonary Function Test (PFT)
27
Bronchodilators
| Beta 2 Adrenergic Agonists:
-Albuterol (Proventil)
-Levalbuterol (Xopenex): Expensive; Isomer of Albuterol; less cardiac effects
(give if Albuterol is giving bad side effect)
28
```
Bronchodilators
Beta 2 Adrenergic Agonists:
Albuterol (Proventil)
-Levalbuterol (Xopenex):
Indications:
```
Rescue for asthma attack or chronic breathing problems
29
```
Bronchodilators
Beta 2 Adrenergic Agonists:
Albuterol (Proventil)
-Levalbuterol (Xopenex):
MOA:
```
- Activate selective beta 2 adrenergic agonists in bronchus resulting in bronchodilation
- Suppress airway responsiveness to stimuli that promote bronchospasms
30
```
Bronchodilators
Beta 2 Adrenergic Agonists:
Albuterol (Proventil)
-Levalbuterol (Xopenex):
Adverse Effects:
```
- Tachypnea (abnormal rapid breathing)
- Angina (chest pain)
- Tremors (involuntary, rhythmic muscle contractions)
31
```
Bronchodilators
Beta 2 Adrenergic Agonists:
Albuterol (Proventil)
-Levalbuterol (Xopenex):
Nursing Concerns:
```
Available in
1. Inhalation- Short Acting as an inhaler
2. Oral- long Acting
32
Bronchodilators
| Methylxanthines
- Theophylline (Theolair)
| - Aminophylline
33
```
Bronchodilators
Methylxanthines:
-Theophylline (Theolair)
-Aminophylline
MOA:
```
- Increases cyclic adenosine monophosphate (cAMP) to dilate bronchial smooth muscle
- Suppress airway responsiveness to stimuli that promote bronchospasm (so they won’t spams so much)
34
```
Bronchodilators
Methylxanthines:
-Theophylline (Theolair)
-Aminophylline
ADVERSE EFFECTS: narrow therapeutic window
```
- Risk of toxicity (monitor drug level)
- ↑ cAMP
- Cerebral Stimulation (restlessness, insomnia, dizziness)
- Skeletal muscle stimulation (restlessness)
- Bronchodilation
- Pulmonary vasodilation
- Cardiac stimulation (palpation, tachycardia)
- Diuretics (urinary frequency)
- Multiple Drug-Drug interactions & contradictions
35
```
Bronchodilators
Methylxanthines:
-Theophylline (Theolair)
-Aminophylline
NURSING CONCERNS:
```
(MOSTLY oral); NOT available for inhalation: long term management
36
Bronchodilators
| Anticholinergics:
-Ipratropium (Atrovent)
37
Bronchodilators
Anticholinergics:
-Ipratropium (Atrovent)
INDICATION:
- Bronchospasm associated with COPD
| - Used for allergen OR exercise induced asthma
38
Bronchodilators
Anticholinergics:
-Ipratropium (Atrovent)
MOA:
- Block cholinergic receptors in bronchial smooth muscle
| - Intranasal administration reduces nasal hypersecretion
39
Bronchodilators
Anticholinergics:
-Ipratropium (Atrovent)
NURSING CONCERNS
Available for inhalation or nasal spray
40
```
Anti-inflammatory Drugs
Inhaled Corticosteriods (as controller/maintenance)
```
- Fluticasone (Flovent): Cost effective; Most prescribed
- Budesonide (Pulmicort): Expensive with Nebulizer
- Beclomethasone (Qvar)
41
Inhaled Corticosteriods
-Fluticasone (Flovent):
-Budesonide (Pulmicort):
-Beclomethasone (Qvar)
MOA:
Reduces inflammation & Immune Response→ Reduces frequency of asthma attacks
42
Anti-Inflammatory Drugs
| Mast Cell Stabilizer
Cromolyn (Intal)
43
Mast Cell Stabilizer
Cromolyn (Intal)
MOA:
Stabilizes Mast cells→ Prevents inflammatory response (Controler)
44
Anti-inflammatory
| Leukotriene Modifier
Montelukast (Singulair)
45
Leukotriene Modifier
Montelukast (Singulair)
MOA:
Blocks Leukotriene receptors in airways→ Prevents airway edema & inflammation (Controler)
46
Anti-TB agents
| Nursing Concerns for ALL TB drugs
-Gather history: TB exposure, living conditions, HIV status, past medical history, recent travel
- Medication Compliance
- NO Alcohol
-Medication taken WITH food→ Reduce stomach irritation
-Infection control→
Sneezing/Coughing
-Routine Assessment of Liver Function for Adverse Effects
47
Anti-TB agent
Isonizid (INH)
Indication
Prophylaxis & Treatment
48
Anti-TB agent
Isonizid (INH)
Nursing Concerns:
-Most Effective & safest (1st line Anti-TB drugs)
-Monitor Therapeutic Effectiveness in 1st 2-3 weeks
-Monitor Hepatic (Liver) Function
-Administer Vitamin B6→ Prevent neuropathy
-Avoid Alcohol→ R/T Liver Impairment
-Avoid foods w/ Tyramine→ Prevents Flushing, Palpitations, & ↑BP
Aged cheese; smoked/pickled fish; beer; chocolate; red wine
49
Anti-TB agent
Rifampin
MOA:
- BacterioCIDAL by inhibiting RNA synthesis
- Flu-like Hypersensitivity4
- Potent CYP450 Inducer→ R/T drug metabolism
50
Anti-TB agent
Pyrazinamide (PZA)
MOA:
Inhibits synthesis of mycolic acid
51
Anti-TB agent
Pyrazinamide (PZA)
Nursing Concerns:
OLD drug; easy to develop resistance when used alone (Gout OR Arthralgia)
52
Anti-TB agent
Ethambutol (Myambutol)
MOA:
"Unclear”; BacterioSTATIC by inhibiting cell wall/RNA synthesis
53
Anti-TB agent
Ethambutol (Myambutol)
Adverse Effects:
Neuritis → Affects visual Acuity for distinguishing btwn Red and Green
54
Anti-TB agent
Ethambutol (Myambutol)
Nursing Concerns:
- Active against TB resistance
| - Short Half Life
