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Med chart 4 Flashcards

1
Q

Antihistamine 1st Generations H1 Antagonist

A

Diphenhydramine (Benadryl)

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2
Q

Diphenhydramine (Benadryl) Indications

A
  • Seasonal Allergies
  • Rhinitis (Stuffy nose)
  • Vertigo/motion sickness
  • Parkinsons
  • Insomnia: take less than two weeks
  • Urticaria (Hives/Rash)
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3
Q

Diphenhydramine (Benadryl) MOA

A
  • Acts centrally and peripherally to bind to H1 receptors

- Crosses Blood-Brain Barrier

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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
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5
Q

Antihistamine; 2nd Gen H1 Antagonist

A

Loratadine (Claritin)

Certirizine (Zyrtec)

Fexofenadine (Allegra)

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6
Q

Loratadine (Claritin)
Certirizine (Zyrtec)
Fexofenadine (Allegra)
Indications:

A
  • Urticaria/Rahses
  • Seasonal Allergies
  • Rhinitis (Stuffy nose)
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7
Q

Loratadine (Claritin)
Certirizine (Zyrtec)
Fexofenadine (Allegra)
MOA:

A
  • Act peripherally to bind to H1 Receptor

- DO NOT cross Blood-Brain Barrier

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8
Q

Loratadine (Claritin)
Certirizine (Zyrtec)
Fexofenadine (Allegra)
Adverse Effects:

A

↓ Significant central & anticholinergic effects

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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
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10
Q

Decongestants

A

Pseudoephedrine (Sudafed)

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11
Q

Pseudoephedrine (Sudafed)

Indication:

A

Nasal Congestion in common cold.

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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
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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)
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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
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15
Q

Antitussives “Anti Cough”

A

Opiod- Centrally Acting “Codeine”

Nonopiod- Peripherally Acting “Dextromethorphan”

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16
Q

Antitussives “Anti Cough”

Codeine MOA:

A

Suppress cough reflex in the medulla

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17
Q

Antitussives “Anti Cough”

Dextromethorphan MOA:

A

Inhibit cough reflexes in throat, trachea, or lungs

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18
Q

Antitussives “Anti Cough”
-Codeine
-Dextromethorphan
Indication:

A

to suppress cough reflexes

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19
Q

Antitussives “Anti Cough”
-Codeine
-Dextromethorphan
Adverse Effects:

A
  • Dizziness & sedation

- Abuse —> CNS toxicity: limit use < 1 week

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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
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21
Q

Expectorants

Not antitussive, Reduces frequency and thin secretions, so its EASIER to Cough UP

A

Guaifenesin (Robitussin, Mucinex)

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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
Q

Bronchodilators Indication:

A

COPD (Chronic obstructive pulmonary disease) : Emphysema, Chronic Bronchitis, Asthma

26
Q

Bronchodilators Nursing Concerns:

A
  • 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
Q

Bronchodilators

Beta 2 Adrenergic Agonists:

A

-Albuterol (Proventil)
-Levalbuterol (Xopenex): Expensive; Isomer of Albuterol; less cardiac effects
(give if Albuterol is giving bad side effect)

28
Q 
Bronchodilators
Beta 2 Adrenergic Agonists: 
Albuterol (Proventil)
-Levalbuterol (Xopenex): 
Indications:
A

Rescue for asthma attack or chronic breathing problems

29
Q 
Bronchodilators
Beta 2 Adrenergic Agonists: 
Albuterol (Proventil)
-Levalbuterol (Xopenex): 
MOA:
A
  • Activate selective beta 2 adrenergic agonists in bronchus resulting in bronchodilation
  • Suppress airway responsiveness to stimuli that promote bronchospasms
30
Q 
Bronchodilators
Beta 2 Adrenergic Agonists: 
Albuterol (Proventil)
-Levalbuterol (Xopenex): 
Adverse Effects:
A
  • Tachypnea (abnormal rapid breathing)
  • Angina (chest pain)
  • Tremors (involuntary, rhythmic muscle contractions)
31
Q 
Bronchodilators
Beta 2 Adrenergic Agonists: 
Albuterol (Proventil)
-Levalbuterol (Xopenex): 
Nursing Concerns:
A

Available in

  1. Inhalation- Short Acting as an inhaler
  2. Oral- long Acting
32
Q

Bronchodilators

Methylxanthines

A
  • Theophylline (Theolair)

- Aminophylline

33
Q 
Bronchodilators
Methylxanthines:
-Theophylline (Theolair) 
-Aminophylline 
MOA:
A
  • 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
Q 
Bronchodilators
Methylxanthines:
-Theophylline (Theolair) 
-Aminophylline 
ADVERSE EFFECTS: narrow therapeutic window
A
  • 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
Q 
Bronchodilators
Methylxanthines:
-Theophylline (Theolair) 
-Aminophylline 
NURSING CONCERNS:
A

(MOSTLY oral); NOT available for inhalation: long term management

36
Q

Bronchodilators

Anticholinergics:

A

-Ipratropium (Atrovent)

37
Q

Bronchodilators
Anticholinergics:
-Ipratropium (Atrovent)
INDICATION:

A
  • Bronchospasm associated with COPD

- Used for allergen OR exercise induced asthma

38
Q

Bronchodilators
Anticholinergics:
-Ipratropium (Atrovent)
MOA:

A
  • Block cholinergic receptors in bronchial smooth muscle

- Intranasal administration reduces nasal hypersecretion

39
Q

Bronchodilators
Anticholinergics:
-Ipratropium (Atrovent)
NURSING CONCERNS

A

Available for inhalation or nasal spray

40
Q 
Anti-inflammatory Drugs
Inhaled Corticosteriods (as controller/maintenance)
A
  • Fluticasone (Flovent): Cost effective; Most prescribed
  • Budesonide (Pulmicort): Expensive with Nebulizer
  • Beclomethasone (Qvar)
41
Q

Inhaled Corticosteriods

-Fluticasone (Flovent):
-Budesonide (Pulmicort):
-Beclomethasone (Qvar)
MOA:

A

Reduces inflammation & Immune Response→ Reduces frequency of asthma attacks

42
Q

Anti-Inflammatory Drugs

Mast Cell Stabilizer

A

Cromolyn (Intal)

43
Q

Mast Cell Stabilizer
Cromolyn (Intal)
MOA:

A

Stabilizes Mast cells→ Prevents inflammatory response (Controler)

44
Q

Anti-inflammatory

Leukotriene Modifier

A

Montelukast (Singulair)

45
Q

Leukotriene Modifier
Montelukast (Singulair)
MOA:

A

Blocks Leukotriene receptors in airways→ Prevents airway edema & inflammation (Controler)

46
Q

Anti-TB agents

Nursing Concerns for ALL TB drugs

A

-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
Q

Anti-TB agent
Isonizid (INH)
Indication

A

Prophylaxis & Treatment

48
Q

Anti-TB agent
Isonizid (INH)
Nursing Concerns:

A

-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
Q

Anti-TB agent
Rifampin
MOA:

A
  • BacterioCIDAL by inhibiting RNA synthesis
  • Flu-like Hypersensitivity4
  • Potent CYP450 Inducer→ R/T drug metabolism
50
Q

Anti-TB agent
Pyrazinamide (PZA)
MOA:

A

Inhibits synthesis of mycolic acid

51
Q

Anti-TB agent
Pyrazinamide (PZA)
Nursing Concerns:

A

OLD drug; easy to develop resistance when used alone (Gout OR Arthralgia)

52
Q

Anti-TB agent
Ethambutol (Myambutol)
MOA:

A

“Unclear”; BacterioSTATIC by inhibiting cell wall/RNA synthesis

53
Q

Anti-TB agent
Ethambutol (Myambutol)
Adverse Effects:

A

Neuritis → Affects visual Acuity for distinguishing btwn Red and Green

54
Q

Anti-TB agent
Ethambutol (Myambutol)
Nursing Concerns:

A
  • Active against TB resistance

- Short Half Life

Pharmocology (28 decks)

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