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Pharmacology > Module 5 > Flashcards

Module 5 Flashcards

1
Q

Histamines are mediated through at least _____ receptors; __________

A

Two; H1 and H2

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2
Q

H1 receptors

A

Intestinal and bronchial smooth muscles

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3
Q

H2 receptors

A

Gastric secretion

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4
Q

H1 receptor antagonists

A

First generation antihistamines; Diphenhydramine, Hydroxyzine, Meclizine, promethazine

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5
Q

First Generation antihistamines treat

A

Allergic rhinitis, motion sickness, induce sleep, runny nose

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6
Q

How do first generation antihistamines work?

A

Competes with histamine for receptor sites preventing histamine response

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7
Q

Contraindications for first generation antihistamines

A

Narrow angle glaucoma, BPH, older adults(BEERS criteria)

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8
Q

Precautions for first generation antihistamines

A

Urinary retention

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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

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10
Q

Interactions for first generation H1 blockers

A

Alcohol and other CNS depressants

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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

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12
Q

H1 receptor antagonists second generation

A

Don’t cause sedation, fewer anticholinergic effects, can be taken with alcohol but not recommended

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13
Q

Second generation H1 receptor antagonists

A

Cetirizine (Zyrtec)
Fexofenadine
Loratadine(Claritin)
Azelastine

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14
Q

Second-generation antihistamines

A

Doesn’t cross blood-brain barrier (decrease sedation)
First line therapy for allergic rhinitis

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15
Q

A/e for second-generation antihistamines

A

Anticholinergic and anti pruritic

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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

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17
Q

Antitussives used to….

A

Suppress cough reflex

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18
Q

Antitussives

A

Dextromethorphan
Codeine (opioid)
Benzonatate (Tessalon Perles)

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19
Q

Antitussives are contraindicated in

A

Those with asthma, COPD, and emphysema bc it causes secretion retention

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20
Q

Antitussives are only used for a

A

Dry, nonproductive cough

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21
Q

What does dextromethorphan require?

A

A drivers license, OTC

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22
Q

T/F, codeine and benzonatate are OTC

A

False, prescriptions needed

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23
Q

Codeine

A

Antitussives, narcotic (opioid)

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24
Q

S/e of codeine

A

Drowsiness, dizziness, irritability, constitution, restlessness

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25
Q

A/e for codeine

A

Respiratory depression and dependence

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26
Q

Nursing interventions for codeine

A

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

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27
Q

Dextromethorphan

A

Antitussive; cough suppression- read the labels!
PO, OTC, requires drivers license to purchase
S/e= dizziness, nausea, sedation

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28
Q

Nasal congestion

A

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

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29
Q

What do nasal decongestants do

A

Stimulate alpha-adrenergic receptors (agonist)

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30
Q

What do nasal decongestants do s/s wise

A

Nasovascular vasoconstriction
Shrinks nasal mucosa
Reduces nasal secretions

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31
Q

systemic Decongestants

A

Pseudoephedrine, phenylephrine=PO

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32
Q

Topical decongestants

A

Naphazoline, oxymetazoline, tetrahydrozoline, zylometazoline

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33
Q

All decongestants are ______

A

OTC, used to temporarily relieve nasal congestion, causing vasoconstriction

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34
Q

If it is an oral decongestant, what is a possible a/e?

A

Hypertension

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35
Q

S/e for decongestants

A

related to sympathomimetic effects on CNS and cardio systems
Tachycardia, nervousness, restlessness, dry mucous membranes,weakness, anxiety, tremors

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36
Q

A/e for decongestants

A

Allergic rxns, HTN, arrhythmias, palpitations,delusions, hallucinations, convulsions, report to provider

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37
Q

Nasal spray (Afrin) decongestant teaching

A

Overuse of topical decongestants- dependence, use no more than 3 days consecutively

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38
Q

Contraindications for decongestants

A

Glaucoma, preexisting hypertension, cardiac disease, hyperthyroidism

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39
Q

Those with ________ should talk to their provider first Before taking decongestants

A

Diabetes

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40
Q

Rebound congestion tx

A

Tapering decongestant spray using one nostril at a time, if really bad- steroid for inflammation

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41
Q

Intranasal glucocorticoids

A

Anti-inflammatory; 1st line tx for nasal congestion
Tx for allergic rhinitis
May be used alone or with combo with H1 antihistamines

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42
Q

Intranasal glucocorticoids examples

A

Fluticasone, traimcinolone, dexamethasone, beclomethason

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43
Q

How should intranasal glucocorticoids be taken?

A

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

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44
Q

Evaluation for intranasal glucocorticoids

A

Decreased runny nose (rhinorrhea), congestion, and sneezing

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45
Q

Expectorants

A

Reduces adhesiveness and surface tension mucus

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46
Q

Guaifenesin brand name

A

Mucinex

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47
Q

Guaifenesin

A

PO OTC, use cautiously in those with asthma(causes bronchospasm)
Reduces adhesiveness and surface tension mucus

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48
Q

Side and adverse effects for Guaifenesin

A

Minimal, GI s/s, HA, dizziness

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49
Q

Teaching for Guaifenesin

A

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.

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50
Q

Evaluation for Guaifenesin

A

Productive cough (sputum and mucous breaks up and comes out of lungs) and decreased chest congestion

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51
Q

Lower Respiratory drugs

A

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
Q

Processes result in respiratory compromise

A

Bronchoconstriction, inflammation, and loss of lung elasticity

53
Q

Albuterol

A

Beta 2 adrenergic agonist- bronchodilates to prevent asthma attack and acute attack tx or pneumonia

54
Q

What do you need with an MDI?

A

Spacer

55
Q

Pt teaching for MDI

A

Push canister and Inhale medication with a deep breath and hold for 5-10 sec (or as long as able)

56
Q

Short acting bronchodilators

A

Albuterol, Levalbuterol, Pirbuterol

57
Q

What are the rescue drugs?

A

Albuterol and levalbuterol

58
Q

Long acting bronchodilators

A

Arformoterol, formoterol+, indacaterol, olodaterol, salmeterol+
+=most common

59
Q

Beta agonists

A

Used to tx bronchospasm and prevent exercise-induced asthma and COPD

60
Q

Which Beta agonists are preferred for a respiratory drugs and why?

A

Beta 2 selective agents because it avoids Beta 1 cardiac effects

61
Q

Emergent bronchconstriction medication

A

Epinephrine

62
Q

When should a pt’s asthma regimen be reevaluated

A

Should not be using short-acting more than 2-3 times per week

63
Q

Long-acting beta ________ are used for ________ of asthma s/s (and can be used with a ________ __________)

A

Agonists ;prevention; inhaled ; corticosteroid

64
Q

Asthma teaching

A

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
Q

Side/adverse effects of inhaled beta agonists

A

Throat irritation, anxiety, nervousness, tremor, dizziness, palpitations, angina, hyperglycemia, bronchospasm, urticaria, angioedema, tachycardia, HTN

66
Q

Albuterol can be used to prevent

A

Exercise induced asthma, must be given 15-30 min before exercise

67
Q

Assess _____ intake for beta agonists bc______

A

Caffeine ; worsens s/s and s/a effects—-> stimulant

68
Q

Beta 2 adrenergic agonists teaching

A

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
Q

inhaled corticosteroids

A

Reduce inflammation in the bronchial tree, prophylactic and Management for asthma and COPD- maintenance drugs
Use bronchodilator first

70
Q

Inhaled corticosteroids examples

A

Beclomethasone, budesonide, flunisolide, mometasone, tramicinolone, ciclesonide

71
Q

Corticosteroids have a ____ effect on the ___________ __________

A

Negative; immune system

72
Q

Contraindications for corticosteroids

A

Active fungal infection, live virus vaccines (bc immunosuppressant= high infection risk)

73
Q

Precautions should be taken with corticosteroids in those

A

With a current infection, herpes, altered immune system

74
Q

Side/adverse effects of corticosteroids

A

Sore throat, hoarseness, coughing , dry mouth, fungal infections (candidiasis if mouth isnt rinsed after inhaled)

75
Q

Additional A/E in children (systemic)

A

Long-term use= decreased adrenal function, growth, bone mass. May delay growth

76
Q

Corticosteroids teaching

A

Use every day, can take up to 4 weeks for therapeutic effect

77
Q

Steroids can be used

A

Nasally for rhinitis

78
Q

COPD tx

A

Inhaled corticosteroid for maintance and oral for exacerbations

79
Q

Corticosteroid examples

A

Methylprednisolone (IV)
Prednisone

80
Q

What do you need to monitor for a pt that is diabetic and on methylprednisolone

A

BG

81
Q

Prednisone nursing considerations

A

Need to obtain height and weight in children weekly, stunts growth

82
Q

Prednisone nursing interventions

A

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
Q

Pt teaching glucocorticoids

A

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
Q

Who are contraindicated for glucocorticoids?

A

Fungal infections, live virus vaccines

85
Q

Leukotriene modifiers

A

Oral prophylaxis and chronic tx for asthma
Zarfirlukast and montelukast

86
Q

S/e for Leukotriene modifiers

A

HA, pharyngitis, rhinitis

87
Q

A/E for Leukotriene modifiers

A

Depression, SI, bleeding, seizures, can affect liver (report to provider)

88
Q

How should Leukotriene modifiers be taken?

A

Daily, regardless of S/S

89
Q

Evaluation for Leukotriene modifiers

A

Decreased asthma s/s and frequency / severity

90
Q

Methylxanthines

A

Second-Lind drug for asthma and broncospasms
Theophylline and aminophylline

91
Q

A/e for Theyphylline and Aminophylline

A

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
Q

Pt teaching for Methylxanthines

A

Avoid smoking and caffeine (coffee, tea, chocolate)= decreases serum levels of drug
Report N/V/D and restlessness(toxicity)

93
Q

Nursing interventions for Methylxanthines

A

Monitor for toxicity (N/V/D, restlessness)
Educate to avoid smoking and caffeine
Monitor serum levels (should be 5-15mcg/mL)

94
Q

Cholinergic antagonists
Another name=

A

Anticholinergics

95
Q

Anticholinergics

A

Block bronchoconstriction caused by activation of parasympathetic nervous system

96
Q

Cholinergic antagonists are used to treat

A

Asthma, bronchitis, and pulmonary emphysema

97
Q

Short acting anticholinergic respiratory drug

A

Ipratropium

98
Q

Long acting Cholinergic antagonist respiratory drug

A

Tiotropium

99
Q

Side and adverse effects for anticholinergics respiratory drugs

A

Paradoxic acute bronchospasm(right after taking), anaphylactic rxn, cough, hoarseness, throat irritation, dysguesia(indigestion)
Anticholinergics effects(not as much because it is inhaled)

100
Q

Dysguesia

A

Indigestion

101
Q

Contraindications for anticholinergics respiratory drugs

A

Allergy to peanuts and should be used cautiously in those with narrow-angle glaucoma and BPH

102
Q

Pt teaching for respiratory anticholinergics

A

Avoid smoking and take medication every day regardless of s/s

103
Q

What is not neccessary when a pt is using a DPI (dry power inhaler)

A

Spacer

104
Q

Cromolyn and Oxalixumab

A

Prophylactic tx of asthma, not useful tx for acute attack
Use 15-20 in before exercise

105
Q

What is oxalizumab

A

Monoclonal antibody specific for IgE (allergic rxn)

106
Q

Side and adverse effects for Cromolyn and Oxalizumab

A

Bronchospasm, throat irration, cough

107
Q

Pt teaching for Cromolyn and oxalizumab

A

How to use a flow meter

108
Q

Mucolytics

A

Liquefy thick secretions
Given via nebulizer

109
Q

Acetylcysteine

A

Mucolytic and acetaminophen overdose antidote

110
Q

Side and adverse effects of acetylcysteine (mucolytic use)

A

Bronchospasm, bronchoconstriction, chest tightness, burning in upper airway, rinorrhea
IV: angioedema, chest tightness, rash, hypotension, tachycardia

111
Q

What are the two major thyroid hormones?

A

T3 and T4

112
Q

What is the most active form of thyroid hormone?

A

T3

113
Q

T3 is

A

Triiodothyronine

114
Q

T4 is

A

Thyroxine

115
Q

Levothyroxine

A

Increases metabolism, cardiac output, renal perfusion, body temp, growth
Tx for hypothyroidism, increases T3 and T4 levels, treats goiter

116
Q

drug/lab interactions for levothyroxine

A

Warfarin and digoxin , some vitamins/supplements

117
Q

What drug is the standard of care for thyroid hormone replacement

A

Levothyroxine

118
Q

Drug of choice for hypothyroidism

A

Levothyroxine

119
Q

Adverse effects of levothyroxine

A

Overmedication, chronic over treatment

120
Q

TSH levels range______ and should be ___________ at least _______ a year

A

(0.5-4.2) monitored, once

121
Q

Levothyroxine is contraindicated in those with:

A

Thyrotoxicosis, adrenal insufficiency, and post MI

122
Q

Nursing interventions for Levothyroxine

A

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
Q

Client education with levothyroxine

A

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
Q

Evaluation for Levothyroxine

A

S/s hypothyroidism
TSH in normal range

125
Q

Propylthiouracil and methimazole function

A

Inhibit thyroid hormone synthesis

126
Q

what drugs are used to treat Grave’s disease, emergency management of thyrotoxicosis

A

Propylthiouracil and methimazole

Pharmacology (12 decks)

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