Module 5 Flashcards
1
Q
Histamines are mediated through at least _____ receptors; __________
A
Two; H1 and H2
2
Q
H1 receptors
A
Intestinal and bronchial smooth muscles
3
Q
H2 receptors
A
Gastric secretion
4
Q
H1 receptor antagonists
A
First generation antihistamines; Diphenhydramine, Hydroxyzine, Meclizine, promethazine
5
Q
First Generation antihistamines treat
A
Allergic rhinitis, motion sickness, induce sleep, runny nose
6
Q
How do first generation antihistamines work?
A
Competes with histamine for receptor sites preventing histamine response
7
Q
Contraindications for first generation antihistamines
A
Narrow angle glaucoma, BPH, older adults(BEERS criteria)
8
Q
Precautions for first generation antihistamines
A
Urinary retention
9
Q
Side/adverse effects of first generation H1 blockers
A
Sedation and anticholinergic effects (can’t see, can’t pee, can’t spit, can’t poop), crosses the blood brain barrier
10
Q
Interactions for first generation H1 blockers
A
Alcohol and other CNS depressants
11
Q
Nursing interventions for first generation H1 blockers
A
List of allergies(recent foods, stressors, drugs)
Give with food-dec GI distress
Avoid driving and operating heavy machinery
Avoid alcohol and CNS depressants
Sugarless candy, gum , ice-dry mouth
Increase fluids
Avoid heat/sun
12
Q
H1 receptor antagonists second generation
A
Don’t cause sedation, fewer anticholinergic effects, can be taken with alcohol but not recommended
13
Q
Second generation H1 receptor antagonists
A
Cetirizine (Zyrtec)
Fexofenadine
Loratadine(Claritin)
Azelastine
14
Q
Second-generation antihistamines
A
Doesn’t cross blood-brain barrier (decrease sedation)
First line therapy for allergic rhinitis
15
Q
A/e for second-generation antihistamines
A
Anticholinergic and anti pruritic
16
Q
Teaching interventions for second-generation antihistamines
A
No sedation, avoid apple, orange, and grapefruit juices (decreases effectiveness)
Increase fluid intake
Take with food
Avoid CNS depressants
Avoid heat/ sun
17
Q
Antitussives used to….
A
Suppress cough reflex
18
Q
Antitussives
A
Dextromethorphan
Codeine (opioid)
Benzonatate (Tessalon Perles)
19
Q
Antitussives are contraindicated in
A
Those with asthma, COPD, and emphysema bc it causes secretion retention
20
Q
Antitussives are only used for a
A
Dry, nonproductive cough
21
Q
What does dextromethorphan require?
A
A drivers license, OTC
22
Q
T/F, codeine and benzonatate are OTC
A
False, prescriptions needed
23
Q
Codeine
A
Antitussives, narcotic (opioid)
24
Q
S/e of codeine
A
Drowsiness, dizziness, irritability, constitution, restlessness
25
A/e for codeine
Respiratory depression and dependence
26
Nursing interventions for codeine
Monitor VS, avoid activities that require alertness, change positions slowly, fall risk precautions, increase fluid, fiber, exercise
Avoid alcohol naloxone order needed
Report cough greater than one week or if rash/fever
27
Dextromethorphan
Antitussive; cough suppression- read the labels!
PO, OTC, requires drivers license to purchase
S/e= dizziness, nausea, sedation
28
Nasal congestion
Dilation of nasal blood vessels due to infection, allergy, or inflammation, causes transudation of fluid into surrounding tissue spaces leading to swelling of the nasal cavities
29
What do nasal decongestants do
Stimulate alpha-adrenergic receptors (agonist)
30
What do nasal decongestants do s/s wise
Nasovascular vasoconstriction
Shrinks nasal mucosa
Reduces nasal secretions
31
systemic Decongestants
Pseudoephedrine, phenylephrine=PO
32
Topical decongestants
Naphazoline, oxymetazoline, tetrahydrozoline, zylometazoline
33
All decongestants are ______
OTC, used to temporarily relieve nasal congestion, causing vasoconstriction
34
If it is an oral decongestant, what is a possible a/e?
Hypertension
35
S/e for decongestants
related to sympathomimetic effects on CNS and cardio systems
Tachycardia, nervousness, restlessness, dry mucous membranes,weakness, anxiety, tremors
36
A/e for decongestants
Allergic rxns, HTN, arrhythmias, palpitations,delusions, hallucinations, convulsions, report to provider
37
Nasal spray (Afrin) decongestant teaching
Overuse of topical decongestants- dependence, use no more than 3 days consecutively
38
Contraindications for decongestants
Glaucoma, preexisting hypertension, cardiac disease, hyperthyroidism
39
Those with ________ should talk to their provider first Before taking decongestants
Diabetes
40
Rebound congestion tx
Tapering decongestant spray using one nostril at a time, if really bad- steroid for inflammation
41
Intranasal glucocorticoids
Anti-inflammatory; 1st line tx for nasal congestion
Tx for allergic rhinitis
May be used alone or with combo with H1 antihistamines
42
Intranasal glucocorticoids examples
Fluticasone, traimcinolone, dexamethasone, beclomethason
43
How should intranasal glucocorticoids be taken?
Daily, regardless of S/S bc it needs to build up in body to work ; blow nose first them spray and SMALL sniff; can cause nasal dryness
44
Evaluation for intranasal glucocorticoids
Decreased runny nose (rhinorrhea), congestion, and sneezing
45
Expectorants
Reduces adhesiveness and surface tension mucus
46
Guaifenesin brand name
Mucinex
47
Guaifenesin
PO OTC, use cautiously in those with asthma(causes bronchospasm)
Reduces adhesiveness and surface tension mucus
48
Side and adverse effects for Guaifenesin
Minimal, GI s/s, HA, dizziness
49
Teaching for Guaifenesin
Coughing, deep breathing, and increasing fluids. Take with a full glass of water(8 glasses a day), not an antitussive -wont work if fluids aren’t increased.
50
Evaluation for Guaifenesin
Productive cough (sputum and mucous breaks up and comes out of lungs) and decreased chest congestion
51
Lower Respiratory drugs
Beta-agonists(bronchodilation)
Corticosteroids (inflammation tx)
Leukotriene modifiers(oral prophylaxis, chronic asthma tx)
Methylxanthines(second-line for asthma and bronchospasm)
Cholinergic antagonists(block bronchoconstriction) Cromolyn and omalizumab(prophylactic tx asthma- not attack)
Mucolytics(liquefy thick secretions)
52
Processes result in respiratory compromise
Bronchoconstriction, inflammation, and loss of lung elasticity
53
Albuterol
Beta 2 adrenergic agonist- bronchodilates to prevent asthma attack and acute attack tx or pneumonia
54
What do you need with an MDI?
Spacer
55
Pt teaching for MDI
Push canister and Inhale medication with a deep breath and hold for 5-10 sec (or as long as able)
56
Short acting bronchodilators
Albuterol, Levalbuterol, Pirbuterol
57
What are the rescue drugs?
Albuterol and levalbuterol
58
Long acting bronchodilators
Arformoterol, formoterol+, indacaterol, olodaterol, salmeterol+
+=most common
59
Beta agonists
Used to tx bronchospasm and prevent exercise-induced asthma and COPD
60
Which Beta agonists are preferred for a respiratory drugs and why?
Beta 2 selective agents because it avoids Beta 1 cardiac effects
61
Emergent bronchconstriction medication
Epinephrine
62
When should a pt’s asthma regimen be reevaluated
Should not be using short-acting more than 2-3 times per week
63
Long-acting beta ________ are used for ________ of asthma s/s (and can be used with a ________ __________)
Agonists ;prevention; inhaled ; corticosteroid
64
Asthma teaching
Follow instructions on MDI, DPI, or nebulizer. Use Beta 2 agonist FIRST and then glucocorticoid (open airway and steroid can get further down in lungs)
Short acting beta 2=rescue drug
Long-acting beta drugs q 12 hrs for long term control
Glucocorticoids=long-term tx on a fixed schedule
Oral hygiene after glucosteroid inhaler
65
Side/adverse effects of inhaled beta agonists
Throat irritation, anxiety, nervousness, tremor, dizziness, palpitations, angina, hyperglycemia, bronchospasm, urticaria, angioedema, tachycardia, HTN
66
Albuterol can be used to prevent
Exercise induced asthma, must be given 15-30 min before exercise
67
Assess _____ intake for beta agonists bc______
Caffeine ; worsens s/s and s/a effects—-> stimulant
68
Beta 2 adrenergic agonists teaching
Bronchodilator first before corticosteroid
Use as ordered (rescue=2-3 x per week)
Spacer
Tolerance can occur
Side effects diminish over time
Limit/avoid caffeine
69
inhaled corticosteroids
Reduce inflammation in the bronchial tree, prophylactic and Management for asthma and COPD- maintenance drugs
Use bronchodilator first
70
Inhaled corticosteroids examples
Beclomethasone, budesonide, flunisolide, mometasone, tramicinolone, ciclesonide
71
Corticosteroids have a ____ effect on the ___________ __________
Negative; immune system
72
Contraindications for corticosteroids
Active fungal infection, live virus vaccines (bc immunosuppressant= high infection risk)
73
Precautions should be taken with corticosteroids in those
With a current infection, herpes, altered immune system
74
Side/adverse effects of corticosteroids
Sore throat, hoarseness, coughing , dry mouth, fungal infections (candidiasis if mouth isnt rinsed after inhaled)
75
Additional A/E in children (systemic)
Long-term use= decreased adrenal function, growth, bone mass. May delay growth
76
Corticosteroids teaching
Use every day, can take up to 4 weeks for therapeutic effect
77
Steroids can be used
Nasally for rhinitis
78
COPD tx
Inhaled corticosteroid for maintance and oral for exacerbations
79
Corticosteroid examples
Methylprednisolone (IV)
Prednisone
80
What do you need to monitor for a pt that is diabetic and on methylprednisolone
BG
81
Prednisone nursing considerations
Need to obtain height and weight in children weekly, stunts growth
82
Prednisone nursing interventions
Bone density screenings (osteoporosis), ophthalmologist (cataracts, glaucoma), BG, delayed wound healing , edema and weight gain, buffalo hump(cushing’s syndrome), infections, CBC, CMP, dehydration, serum cortisol levels, and ACTH levels
83
Pt teaching glucocorticoids
Rinse mouth to prevent candida infection , monitor BG level-> s/e=hyperglycemia, avoid large crowds and perform hand hygiene(immunosuppressive), taper off (adrenal issues and asthma exacerbations if not), takes 4 weeks for an effect
84
Who are contraindicated for glucocorticoids?
Fungal infections, live virus vaccines
85
Leukotriene modifiers
Oral prophylaxis and chronic tx for asthma
Zarfirlukast and montelukast
86
S/e for Leukotriene modifiers
HA, pharyngitis, rhinitis
87
A/E for Leukotriene modifiers
Depression, SI, bleeding, seizures, can affect liver (report to provider)
88
How should Leukotriene modifiers be taken?
Daily, regardless of S/S
89
Evaluation for Leukotriene modifiers
Decreased asthma s/s and frequency / severity
90
Methylxanthines
Second-Lind drug for asthma and broncospasms
Theophylline and aminophylline
91
A/e for Theyphylline and Aminophylline
GI symptoms (N/V/D)- 20-25mcg serum levels
CNS effects (HA, insomnia, irritability)- >30mcg serum levels
Hyperglycemia, arrhythmias, sezirures, brain damage, or death
92
Pt teaching for Methylxanthines
Avoid smoking and caffeine (coffee, tea, chocolate)= decreases serum levels of drug
Report N/V/D and restlessness(toxicity)
93
Nursing interventions for Methylxanthines
Monitor for toxicity (N/V/D, restlessness)
Educate to avoid smoking and caffeine
Monitor serum levels (should be 5-15mcg/mL)
94
Cholinergic antagonists
Another name=
Anticholinergics
95
Anticholinergics
Block bronchoconstriction caused by activation of parasympathetic nervous system
96
Cholinergic antagonists are used to treat
Asthma, bronchitis, and pulmonary emphysema
97
Short acting anticholinergic respiratory drug
Ipratropium
98
Long acting Cholinergic antagonist respiratory drug
Tiotropium
99
Side and adverse effects for anticholinergics respiratory drugs
Paradoxic acute bronchospasm(right after taking), anaphylactic rxn, cough, hoarseness, throat irritation, dysguesia(indigestion)
Anticholinergics effects(not as much because it is inhaled)
100
Dysguesia
Indigestion
101
Contraindications for anticholinergics respiratory drugs
Allergy to peanuts and should be used cautiously in those with narrow-angle glaucoma and BPH
102
Pt teaching for respiratory anticholinergics
Avoid smoking and take medication every day regardless of s/s
103
What is not neccessary when a pt is using a DPI (dry power inhaler)
Spacer
104
Cromolyn and Oxalixumab
Prophylactic tx of asthma, not useful tx for acute attack
Use 15-20 in before exercise
105
What is oxalizumab
Monoclonal antibody specific for IgE (allergic rxn)
106
Side and adverse effects for Cromolyn and Oxalizumab
Bronchospasm, throat irration, cough
107
Pt teaching for Cromolyn and oxalizumab
How to use a flow meter
108
Mucolytics
Liquefy thick secretions
Given via nebulizer
109
Acetylcysteine
Mucolytic and acetaminophen overdose antidote
110
Side and adverse effects of acetylcysteine (mucolytic use)
Bronchospasm, bronchoconstriction, chest tightness, burning in upper airway, rinorrhea
IV: angioedema, chest tightness, rash, hypotension, tachycardia
111
What are the two major thyroid hormones?
T3 and T4
112
What is the most active form of thyroid hormone?
T3
113
T3 is
Triiodothyronine
114
T4 is
Thyroxine
115
Levothyroxine
Increases metabolism, cardiac output, renal perfusion, body temp, growth
Tx for hypothyroidism, increases T3 and T4 levels, treats goiter
116
drug/lab interactions for levothyroxine
Warfarin and digoxin , some vitamins/supplements
117
What drug is the standard of care for thyroid hormone replacement
Levothyroxine
118
Drug of choice for hypothyroidism
Levothyroxine
119
Adverse effects of levothyroxine
Overmedication, chronic over treatment
120
TSH levels range______ and should be ___________ at least _______ a year
(0.5-4.2) monitored, once
121
Levothyroxine is contraindicated in those with:
Thyrotoxicosis, adrenal insufficiency, and post MI
122
Nursing interventions for Levothyroxine
Monitor VS, HR >100?, monitor weight, s/s hyperthyroidism, med reconciliations, TSH, T3 T4, take on empty stomach, water only, if crushing tab-mix with water
123
Client education with levothyroxine
Medic alert bracelet
List of meds bring
Take before breakfast
Report s/s hyperthyroidism
Check med labels
Lifelong replacement therapy
Do not abruptly stop
124
Evaluation for Levothyroxine
S/s hypothyroidism
TSH in normal range
125
Propylthiouracil and methimazole function
Inhibit thyroid hormone synthesis
126
what drugs are used to treat Grave’s disease, emergency management of thyrotoxicosis
Propylthiouracil and methimazole
