NP3- Respiratory & TB Medications Flashcards
What is the difference between an antitussive and a cough expectorant?
An antitussive is a cough suppressant while a cough expectorant thins/loosens mucus in the respiratory tract so that it is easier to cough up and expel
What type of cough should antitussives be used for?
Chronic, non-productive cough
What type of cough should an expectorant be used for
Acute, productive cough
What are the two categories of cough suppressants (antitussives)?
Opioid (ex: codeine phosphate, codeine sulfate, hydrocodone)
Non-opioid (Benzonatate, Dextromethorphan)
What are contraindications to administering antitussives (cough suppressants)?
Avoid giving to patients with head injuries or postop cranial surgeries
Avoid giving to patients using opioids, sedative-hypnotics, barbiturates, or antidepressants due to CNS depression
What are the nursing considerations for codeine?
Slow position changes, do not use for COPD, take with food, increase fluid intake, medication dependency may occur
Give two examples of cough expectorants - medical name and brand name
Guaifenesin (Mucinex) and Acetylcysteine (Mucomyst)
Describe the nursing considerations for Guaifenesin (Musinex)
Expectorant
Increase fluids to at least 2L/day
Asthma safe
Describe the nursing considerations for Acetylcysteine (Mucomyst)
Not asthma safe (can worsen/cause bronchospasm)
Do not use with COPD (suppresses cough)
Used as antidote to acetaminophen poisoning
What are some of the side effects of antitussives (cough suppressants)?
Dizziness, respiratory depression (opioid), lightheadedness, N/V, constipation (opioid)
Name some of the nursing considerations associated with antitussives?
Do not take with ETOH or CNS depressants, avoid driving if dizziness occurs, teach the patient how to cough and deep breathe, notify HCP if fever, rash, CP or persistent HA occur
What are the common S/E of expectorants?
Dizziness, drowsiness, rash, GI upset
What are some of the nursing considerations for expectorants?
Assist with coughing/deep breathing, document onset of cough relief, do not take for chronic cough, report to HCP if cough lasts longer than 7 days, report fever, rash, sore throat, HA, increase fluid intake
What is the brand name for Benzonatate and what drug classification is it?
Tessalon Perles - non-opioid antitussive
What is a common term for antihistamines?
Allergy meds
What are the 3 main antihistamines used?
Diphenhydramine, Loratadine, Fexofenadine
What is the commercial brand name for diphenhydramine and what are its contraindications?
Benadryl (used for anaphylaxis) - contraindicated for closed angle glaucoma, urinary retention, peptic ulcer, small bowel obstruction
What is commercial brand name for Loratadine, and what advantage does it have to other antihistamines?
Claritin - it has fewer sedation effects
What is the MOA of antihistamines (h1 blockers)?
They block histamine (which creates inflammation)
What is the commercial brand name for Fexofenadine and what are its nursing considerations?
Allegra - it should not be used for glaucoma because its anticholinergic effects increase IOP (intraocular pressure)
What are first generation antihistamines used for?
Allergic rhinitis, anaphylactic reactions, acute urticaria, motion sickness
What are S/E of 1st generation antihistamines?
Depression, drowsiness, dry mouth, GI upset, bronchospasm, thickening of secretions, anticholinergic effects, arrythmias
What are the nursing considerations/education assoc. w/ first generation antihistamines?
Take with food, drink at least 8 glasses of water/day, frequent oral care, avoid ETOH, do not drive or operate heavy machinery, notify HCP if confusion occurs
What is another name for second generation antihistamines?
Non-sedating antihistamines
What is unique about second generation antihistamines when compared to first generation?
They cause less drowsiness and fewer anticholinergic symptoms
Name 3 examples of first generation antihistamines
Diphenhydramine (Benadryl)
Brompheniramine (Dimetapp)
Chlorpheniramine (Chlortrimeton)
Clemastine fumurate (Tavist)
Cyproheptadine (Periactin)
Levocetrizine (Xyzal)
Meclizine (Antivert, Bonine)
Hydroxyzine (Atarax, Vistaril)
Name 3 examples of second generation antihistamines
Loratadine (Claritin)
Azelastine (Optivar)
Desloratadine (Clarinex)
Fexofenadine (Allegra)
Cetrizine (Zyrtec)
What do nasal decongestants do?
Shrink nasal mucosal membranes and reduce fluid secretion
What are the nursing considerations for nasal decongestants?
Use with caution in patients with HTN, cardiac disease, hyperthyroidism, DM, hepatic & renal disease, monitor for cardiac arrythmias and monitor blood glucose levels
Give 3 uses of nasal and systemic decongestants
Allergic rhinitis, hay fever, acute coryza
What are some S/E of nasal and systemic decongestants
S/E: Anxiety, insomnia, nervousness, dizziness, drowsiness, excitability, hypertension, palpitations, tachycardia, anorexia, N/V, transient burning, headache, rebound nasal congestion (if used >72 hrs.)
What can be administered to decrease insomnia in patients taking nasal/systemic decongestants?
Pseudoephedrine (Sudafed)
Why should patients avoid using nasal/systemic decongestants for more than 3-5 days?
Rebound congestion can occur
True or false: Nasal and systemic decongestant extended release capsules and tablets should be crushed, broken, or chewed?
FALSE
How soon should a patient take a missed dose of nasal/systemic decongestant?
Within one hour of the missed dose
Name the 4 main nasal decongestants
Oxymetazoline Afrin)
Phenylephrine (Neo-Synephrine)
Pseudoephedrine (Sudafed, Unifed)
Tetrahydrozoline (Tyzine)
Bronchodilators are a group of medications that help breathing. What are the 3 main categories of bronchodilators typically used in obstructive lung diseases like asthma and COPD?
B2-agonists, anticholinergics, methylxanthines
What are the 3 desired therapeutic effects of bronchodilators?
Decreased dyspnea, improved wheezing, improved airway exchange
Why should bronchodilators be administered first if being given with another inhaler?
The bronchodilator will open the airway making the second inhaled medication more effective
How are bronchodilators commonly administered
As inhaled medications
B2-agonists can be classified as one of 2 things:
Long-acting (LABA) or short-acting (SABA)
How are B2-agonists commonly administered
With metered dose inhalers (MDIs) or nebulizers
Albuterol is what type of B2-agonist?
Short acting B2-agonist (SABA)
Salmeterol is what type of B2-agonist?
LABA
What are SABAs used for?
They are B2-agoinists used for quick symptom relief in acute asthmatic attacks
What are LABAs used for?
They are used with an inhaled corticosteroid as prophylactic or maintenance treatment for asthma or COPD
What is the onset and duration of SABAS?
Onset within minutes; duration 4-8 hours
True or false, SABAs are used as first line therapy in acute attacks
FALSE, they are used as an alternate medication when low-dose inhaled corticosteroids (ICS) are ineffective
What are some side effects of using SABAs too frequently?
Tremors, anxiety, tachycardia, palpitations, nausea, reduced drug effectiveness
Using SABAs too frequently indicates:
Poor asthma control
True or false: SABAS should be used alone as primary treatment?
FALSE
Give two examples of LABAS
Salmeterol (Serevent) and Formoterol (Foradil)
True or false, LABAS are used only as an adjunct to treatment
TRUE, they should not be used alone as primary treatment
True or false: LABAS are used for acute symptoms and quick relief from bronchospasms
FALSE
How often should LABAS be used, and how long are they effective for?
They are used 1 every 12 hours and effective for 12 hours
Use caution using B2-agonists in patients with:
Concurrent hear or renal disease, hyperthyroidism, diabetes mellitus, pregnancy
Name 2 anticholinergics used as bronchodilators?
Ipratropium and Tiotropium
How are anticholinergics administered when used as bronchodilators?
Via inhaler or nebulizer, often in combination with LABAS
True or false, anticholinergics are less effective for asthma but more effective for COPD
TRUE
What are some of the common side effects of anticholinergics?
Pupil dilation, dry mouth, tachycardia, restlessness
In which patients is the use of anticholinergics contraindicated
Those with previous hypersensitivity and allergic reaction
With which patients should anticholinergics be used with caution
Narrow angle glaucoma, heart disease, hyperthyroidism
The anticholinergic Ipratropium should be avoided in patients with that type of allergy?
Peanut allergy - certain Ipratropium products contain soy lecithin, which is in the same family as peanuts
Give an example of a bronchodilator that is classified as a methylxanthine
Theophylline
True or false: Methylxanthines can be used in both asthma and COPD
TRUE
What type of foods should be limited in patients taking methylxanthines?
Foods that contain xanthine like coffee, tea, cocoa beans, kola nuts
What are the common side effects of methylxanthine (theophylline)?
Insomnia, N/V
What type of patients should not use methylxanthines?
Those with seizure disorders, heart, renal, or liver disease
Why is it easy to overdose on methylxanthines?
It has a very narrow therapeutic window (toxicity can occur at levels >20 mcg/ml)
Methyxanthine has multiple drug interactions, such as:
Beta blockers, phenytoin, beta adrenergic agonists, antidepressants, and certain antibiotics (like cipro)
Cardiac dysrhythmias occur when theophylline is taken in conjunction with what type of of bronchodilators?
beta adrenergic agonists
How does methylxanthine interact with digoxin, lithium, and phenytoin
It increases the risk of digoxin toxicity, and decreases the effects of lithium and phenytoin
Name the 3 main categories of anti-inflammatory agents
Steroids, Leukotriene inhibitors, Mast cell stabilizers
What are the top 3 side effects for steroids that end in -SONE
Sore in the mouth (oral candida -thrush)
Sepsis/Sickness (increased infection risk)
Sugar increased
What are the uses of intranasal glucocorticoids?
Allergic rhinitis and non-allergic rhinitis
What are the side effects associated with intranasal glucosteroids?
Dizziness, headache, epistaxis, nasal burning, rhinorrhea, tearing eyes, dry moth, N/V, cough, bronchospasm, nasal congestion/irritation
What are the nursing considerations for intranasal glucocorticoids?
For short term use, assess degree of nasal stuffiness, color/amount of discharge, monitor growth rate in children, and decrease dose to lowest amount after desired clinical effect has been obtained
What education should be provided about intranasal glucocorticoids?
Shake well before use.
Administer decongestant 5-15 minutes before spraying
Keep head upright, blow nose gently, and breathe through nose
Notify HCP if no improvement in 1 month
Temporary nasal stinging may occur
Give 3 examples of glucocorticoids
Beclomethasone (Qvar)
Budesonide (Pulmicort)
Flunisolide (Nasalide)
Fluticasone (Flovent, Flonase)
Mometasone furote (Elocon)
Triamcinolone (Nasacort)
Ciclesonide (Alvesco)
Glucocorticoids typically end in -ide or -one
True or false: Leukotriene modifiers are used in acute asthma episodes
FALSE
How do leukotriene modifiers help patients with allergic rhinitis?
They decrease nasal congestion and inflammation
How do leukotriene modifiers help patients with obstructive lung diseases like asthma?
They decrease the narrowing and obstruction of airways
Leukotriene modifiers should be used in caution in patients with that type of impaired functioning
impaired liver function
True or false: Leukotriene modifiers are only used as adjunct therapy when there is no response to ICS
TRUE
True or false: Leukotriene modifiers are less effective than corticosteroids
TRUE
How do leukotrienes work?
Leukotrienes are inflammatory molecules. When leukotriene receptors are inhibited, there is a reduction in airway edema, bronchoconstriction, and inflammation
What is an easy way to identify drugs in the leukotrienes calss
They have the work Luk/Leuk in them
Ex: Montelukast, Zileuton, Zafirlukast
At what time of the say should Montelukast be administered for asthma?
In the evening with with an inhaled corticosteroid
When should Montelukast be administered to counteract exercise-induced bronchoconstriction?
2-3 hours before exercise
When should Montelukast be administered to combat allergic rhinitis
In the morning or evening
Mast Cell Stabilizers help reduce inflammation in patients with:
Allergic conjunctivitis, allergic rhinitis, asthma
What are side effects of mast cell stabilizers?
Bronchospasm, cough, nasal congestion, throat irritation, wheezing
What side effects may occur if mast cell stabilizers are administered orall
Pruritis, nausea, diarrhea, myalgia
What may happen if mast cell stabilization medication is discontinued abruptly?
Rebound asthma attack
What are the first line agents in acute attacks and the first step in acute asthma management
ICS - Inhaled corticosteroids
How should a MDI (metered dose inhaler) be used?
Slow, steady 4-5 second inhalation
Sync breathing with the release of medication
How should a MDI (metered dose inhaler) + spacer be used?
Slow, steady 4-5 second inhalation or slow, steady breathing in/out mouth
No need to sync breathing
Preferred for preschoolers, those with poor inspiratory flow, pt with dementia
How should a DPI (dry powder inhaler) be used
Quick, deep inhalation of 2-3 sec
No need to sync breathing
Uses a dose counter
Preferred for school aged kids
Larger than MDI
How long should a patient wait before administering a second dose with an MDI?
1 minute
What should a patient do after using an inhaler?
Rinse out their mouth to avoid thrush/candida
What is the purpose of using a spacer with an inhaler?
The spacer promotes maximal delivery of medication to the lungs
Which 2 categories of drugs exacerbate COPD
Opioids and Benzos
Which category of antiviral medication prevent influenza?
Neuraminidase inhibitors
Give 3 examples of neuraminidase inhibitors
Oseltamivir, Peramivir, Zanamivir
Which category of antiviral medications are used in the acute treatment of the influenza virus
Endonuclease inhibitors
Give an example of an endonuclease inhibitor
Baloxavir Marboxil
Which category of antivirals are not recommended for combatting the influenza virus?
Adamantanes (Amantadine and Rimantadine)
True or false: Antivirals prevent the spread of the influenza virus
FALSE
How many negative TB cultures indicate that the patient is no longer infected?
3 negative cultures on 3 different days
How often are sputum samples taken or TB positive patients?
Every 2 to 4 weeks
True or false: Family members and people who spend time in close proximity to a person with TB should be tested?
TRUE
What type of mask should be worn at all times when working with TB patients?
N-95
What can combat the peripheral neuritis caused by certain TB meds?
Administering pyridoxine (Vitamin B6)
What type of foods should a person taking Isoniazid avoid?
Those containing tyramine like: aged cheeses, pickled foods, smoked meats, fermented foods and beverages, red/white wine, and chocolate
Isoniazid is contraindicated in which patients?
Those with acute or chronic liver disease, alcoholism or renal impairment
How is peripheral neuritis manifested?
By numbness, tingling, parethesia in extremities
What is a common but non-harmful side effect of the TB medication Rifampicin/Rifampin?
Reddish-orange tinged urine, stool, saliva, sweat or tears, sputum
Which medication is used as first line therapy for TB and also treats Hansen’s disease (Leprosy)?
Rifampin/Rifampicin
What are the side effects associated with Rifampin/Rifampicin?
Hepatitis, febrile reaction, hypersensitivity, peripheral neuropathy, GI disturbance, orange-red tinged fluids
What effects do Rifampin/Rifampicin have on warfarin, digoxin, and oral hypoglycemics
It decreases the effect of warfarin and increases metabolism of digoxin and oral hypoglycemics
What is the relationship between Rifampin/Rifampicin and oral contraceptives?
Rifampin/Rifampicin makes oral oral contraceptives ineffective. Patients should use a second method
Which medication is a first line therapy for TB and is used most frequently to prevent disease in people exposed to organism (prophylaxis)?
Isoniazid
What are side effects associated with Isoniazid?
Hyperglycemia, N/V/ fever, rash, gynecomastia, lupus syndrome, peripheral neuropathy, neurotoxicity, optic neuritis, hepatotoxicity with ETOH
How do antacids affect the effectiveness of Isoniazid?
They make the drug less effective
How is peripheral neuropathy due to Isoniazid decreased?
Vitamin B6 (pyridoxine)
Name a TB medication used as a first line therapy that includes the side effects of retrobulbar optic neuritis, blindness, and peripheral neuritis/
Ethambutol
True or false, the side effects of Ethambutol are reversible with the discontinuation of the drug
TRUE
Ethambutol is most commonly used as a substitute when toxicity occurs with what drugs?
Isoniazid or rifampin
Which first line TB drug has the following side effects: hepatotoxicity, hyperuricemia, anemia, anorexia
Pyrazinamide
What can help the problem of excess uric acid in patients taking pyrazinamide, and why is it important?
Increasing fluids can help flush out the excess uric acid, which will help with the symptoms of gout
What symptom may occur with pyrazinamide due to lack of biliruin?
Clay-colored stools, symptoms of hepatitis: malaise, anorexia, N/V, yellowish discoloration of the skin
