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Pharm #7 Flashcards

1
Q

Upper Respiratory Disorders

A

Common cold, Acute rhinitis, Allergic rhinitis, Sinusitis, Acute pharyngitis

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2
Q

Common cold Etiology:

A

rhinovirus

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3
Q

Common cold Affects

A

nasopharyngeal tract

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4
Q

Acute rhinitis

A

Inflammation of nasal mucous membranes

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5
Q

Allergic rhinitis

A

Hay fever due to pollen or foreign substance

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6
Q

Sinusitis

A

Inflammation of mucous membranes of sinuses

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7
Q

Acute Pharyngitis

A

Inflammation of the throat

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8
Q

1-4 days before onset of symptoms during first 3 days of cold is

A

transmitted

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9
Q

Common Cold Contagious period

A

1-4 days before onset of symptoms
During first 3 days of cold

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10
Q

Common Cold Transmission

A

Contaminated surfaces more common than
Inhaling Droplets from sneezing

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11
Q

Symptoms of common cold

A

Nasal congestion
Nasal discharge
Cough
Increased mucosal secretions

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12
Q

Antihistamines Action

A

Compete with histamine for receptor sites (blocks histamine receptors to activate receptor sites)

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13
Q

most antihistamines (inhibit h1 not h2)

A

H1 receptors-

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14
Q

Affects (decreases) nasopharyngeal secretions & itching

A

H1 receptors-

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15
Q

Reducing/Affect gastric acid secretion

A

H2 receptors-

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16
Q

To treat cold

A

Antihistamines

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17
Q

First-generation antihistamines-

A

more side effects than 2nd generation. (first developed- first). Causes significant anticholinergic effects.

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18
Q

First-generation antihistamines Examples:

A

Diphenhydramine (Benadryl) & Chlor-Trimeton

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19
Q

First-generation antihistamines s/e:

A

Drowsiness, dry mouth
Dizziness, fatigue, blurred vision
Disturbed coordination, urine retention

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20
Q

Second-generation antihistamines-

A

refined drugs, less side effects

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21
Q

Second-generation antihistamines Examples:

A

Cetirizine (Zyrtec), Loratadine (Claritin) & Azelastine

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22
Q

Second-generation antihistamines cause

A

Less drowsiness
Less anticholinergic symptoms
Used safer in clients with glaucoma.

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23
Q

Diphenhydramine-Benadryl

A

Antihistamines
first generation

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24
Q

mild allergic reactions. Common ingredient in sleep meds.

A

Diphenhydramine

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25
Q

Diphenhydramine Use

A

Allergic rhinitis, pruritus, urticaria
Common cold, sneezing, cough
Prevent motion sickness
Sleep aid

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26
Q

Diphenhydramine Contraindications/cautions (high in anticholinergic effects)

A

Narrow-angle glaucoma
Urinary retention- use with caution and monitor urinary output
Severe liver disease

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27
Q

Diphenhydramine Interactions

A

Alcohol and other CNS depressants

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28
Q

Educate with alcohol or other CNS depressants do not take

A

Diphenhydramine

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29
Q

Diphenhydramine Assessment-

A

Health and drug history. Glaucoma and urinary retention(anticholinergic affects. S/Sx of urinary dysfunction. If using for reaction, assess the severity of the reaction and monitoring vital signs and lung sounds if it is not strong enough=epinephrine. Allergic reaction- what triggered it?

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30
Q

Diphenhydramine Nursing Interventions-

A

urine output monitor- at risk for urinary retention. Give oral form with food to decrease GI distress. IM- give large muscle. Avoid driving, operating heavy machinery, alcohol, cns depressants. If taking prophylactically for motion sickness take 30 mins before action that causes motion sickness.

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31
Q

Diphenhydramine Education-

A

breastfeeding moms can pass through breast milk, fetus can be susceptible to the side effects. Children are more sensitive to Benadryl which causes paradoxical effect (extreme opposite effect). Older adults watch for sensitivity bc hard time excreting- desired effects can be prolonged and cns depressive effect worred about become too sedated. Complaining about dry mouth- use ice chips, sugar free gum, and candy to increase saliva production

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32
Q

Nasal Congestion Nasal Congestion

A

Dilation of nasal blood vessels and swelling of nasal cavity

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33
Q

Stimulate alpha 1-adrenergic receptors located on the blood vessels

A

Nasal decongestants

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34
Q

Produces nasal vascular constriction (decreases swelling)

A

Nasal decongestants

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35
Q

Shrinks nasal mucous membranes
Reduces nasal secretion

A

Nasal decongestants

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36
Q

Nasal decongestant use

A

Allergic rhinitis, hay fever, acute coryza-inflammation of mucous membranes in the nose

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37
Q

Fluid passes through tissue causes swelling

A

Nasal Congestion

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38
Q

Nasal Decongestants

A

Oxymetazoline, Phenylephrine, Pseudoephedrine

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39
Q

Oxymetazoline

A

nasal spray

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40
Q

Phenylephrine

A

Po and Nasal

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41
Q

Pseudoephedrine-

A

PO

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42
Q

Nasal Decongestants Administration

A

Nasal spray, nasal drops, tablet, capsule, liquid

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43
Q

Nasal Decongestants Side effects/adverse reactions

A

Nervous, restless
Rebound nasal congestion if prolonged use ex: Afrine Oxymetazoline. Does diminish after stopping the med but takes time to clear from the persons system.

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44
Q

Nasal Decongestants Interactions

A

Caffeine- causes palpitations, increased restlessness
MAOIs- causes increase risk of hypertension and dysrhythmias.
Beta blockers- Pseudoephedrine decreases effects of beta blockers

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45
Q

Can be used to make meth-

A

phenylephrine

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46
Q

Works faster and provide a less systemic effect-

A

nasal route

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47
Q

Oral route-

A

more systemic side effect

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48
Q

Intranasal Glucocorticoids

A

Fluticasone (Flonase) & Mometasone (Nasonex)

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49
Q

Intranasal Glucocorticoids Action

A

Antiinflammatory
Decrease rhinorrhea, sneezing, and congestion

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50
Q

Intranasal Glucocorticoids Use

A

Allergic rhinitis (runny nose, sneezing, congestion)

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51
Q

Intranasal Glucocorticoids Side effects

A

Dizziness, blurred vision
Hoarseness, nausea, vomiting

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52
Q

Decrease nasal inflammation by directly acting in the inflamed area.

A

Intranasal Glucocorticoids

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53
Q

No systemic effect
Can be used by themselves and with antihistamine

A

Intranasal Glucocorticoids

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54
Q

Antitussives Action

A

Act on the cough-control center in the medulla to suppress the cough reflex

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55
Q

Antitussives Types

A

Nonopioid, opioid and combinations

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56
Q

Antitussives Nonopioid –

A

Dextromethorphan (Robitussin) & Benzonatate (Tessalon perles)-prescription

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57
Q

Antitussives Opioid –

A

Codeine. Combination effective to suppress cough reflex

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58
Q

Antitussives Combination preparations

A

Phenergan(promethazine with Codeine)- monitor respirations. Used at night to get rid of dry hacking cough.

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59
Q

Less cns symptoms and drowsiness

A

Antitussives

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60
Q

Expectorants

A

Guaifenesin (Mucinex)

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61
Q

Expectorants Action

A

Loosens bronchial secretions by reducing surface tension of secretions
Allows elimination by coughing

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62
Q

Expectorants Use

A

Common cold

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63
Q

Expectorants Side effects

A

Drowsiness, dizziness, headache, nausea
GI symptoms most common bc of secretions ingested

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64
Q

Thinned mucous and excreted
Can have antitussive effects

A

Expectorants

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65
Q

Nasal Decongestants Assessment-

A

Obtain thorough history on hypertension. Baseline vital signs. Monitor bp at home.

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66
Q

Nasal Decongestants Nursing Interventions-

A

monitor and document and watch for color characteristics of nose secretions and sputum. Green/yellow- bacterial infection

67
Q

Nasal Decongestants Education-

A

if MAOI taken= increased risk of HTN. Proper use of nasal med- do not use more than 7 days. Going past that there can be rebound effect. Antibiotic use proper- if drainage is still clear does not need it. Read the label of medications esp. when at pharmacy getting their own. Cold meds have more than one ingredient- acetaminophen or NSAID do not double up on meds. Take single ingredient medications to dry secretions (antihistamine). Increase fluid intake esp. with expectorant to thin mucous. Sit up right and deep breathing coughing for secretion excretion

68
Q

Inflammation of mucous membranes of sinuses

A

Sinusitis

69
Q

Sinusitis Treatment

A

Fluids, rest, saline nasal spray, Neti pot
Decongestants, acetaminophen, antibiotics

70
Q

Inflammation of throat

A

Acute pharyngitis

71
Q

Acute pharyngitis tx

A

Saline gargle
Cool fluids
Lozenges, acetaminophen
Antibiotics (Strep)

72
Q

Educate and encourage- no active infection= not antibiotics

A

Sinusitis and Pharyngitis

73
Q

A patient is receiving an expectorant. The nurse knows the drug is exerting its therapeutic effect when the patient experiences

A

loosening of bronchial secretions.

74
Q

The nurse is teaching an older adult patient about guaifenesin. Which information is appropriate to include in this teaching? (Select all that apply.)

A

Take the drug with a glass of water.
Read labels on over-the-counter drugs and check with health care provider before taking cold remedies.

75
Q

A patient has been diagnosed with the common cold. The nurse should question if which drug is ordered to treat this patient?

A

Antibiotics

76
Q

Which medication is a first-generation antihistamine?

A

Diphenhydramine

77
Q

When teaching a patient about use of nasal decongestant sprays, the nurse informs the patient that they are most effective and less likely to lead to rebound congestion when administered for how many days?

A

7 days

78
Q

Before administering diphenhydramine to a patient, it is most important for the nurse to assess the patient for a history of

A

narrow-angle glaucoma.

79
Q

Which statement about benzonatate does the nurse identify as being true?

A

It suppresses the cough center of the medulla.

80
Q

Chronic Obstructive Pulmonary Disease (COPD) Pathophysiologic changes

A

Airway obstruction with increased airway resistance of airflow to lung tissues

81
Q

Cause permanent damage to lungs.

A

COPD

82
Q

Tissue associated with asthma attack is reversible.

A

COPD

83
Q

If continual asthma can cause long term effects to lung tissue

A

COPD

84
Q

Major causes COPD

A

Chronic bronchitis
Bronchiectasis
Emphysema
Asthma

85
Q

Can be restrictive or obstructive- causes increased airway resistance

A

COPD

86
Q

Restrictive Lung Disease Pathophysiologic changes

A

Decrease in total lung capacity due to fluid accumulation and loss of elasticity of lung tissues

87
Q

Pulmonary edema-fluid building up in the lungs due to LFHF, pneumonia or heart trauma.

A

Restrictive Lung Disease Etiology

88
Q

Pulmonary fibrosis- lung tissue is thickened, damaged, and scarred(binding and no elasticity)

A

Restrictive Lung Disease Etiology

89
Q

Pneumonitis- infamation of the lung tissue

A

Restrictive Lung Disease Etiology

90
Q

Lung tumors- mass that is obstructing the lung itself decreasing lung cpaity

A

Restrictive Lung Disease Etiology

91
Q

Thoracic deformities (scoliosis or kyphosis)- decrease lung capacity.

A

Restrictive Lung Disease Etiology

92
Q

Thoracic muscular disorders (myasthenia gravis)- weaken muscles. Causes decreasd respiratory function due to decreased muscle contraction.

A

Restrictive Lung Disease Etiology

93
Q

Due to fluid accumulation in lungs or loss of elasticity in lung tissue

A

Restrictive Lung Disease

94
Q

Inflammatory disorder of the airway walls associated with airway obstruction

A

Asthma

95
Q

Asthma Triggers

A

Stress
Allergens- cats, dogs, ragweed
Pollutants- dust, smoke, chemical, smells in air
Changes in temp or air pressure

96
Q

Ibprophen or aspirin. Blocking of cox 1 causes over production of leukotrienes that increase inflammation and bronchoconstriction.

A

Asthma trigger

97
Q

Asthma Signs/symptoms

A

Bronchospasm, dyspnea, mucus secretions
Audible Wheezing, coughing, tightness in the chest

98
Q

Airways become sensitive to stimuli or trigger that causes a reaction

A

Asthma

99
Q

Chronic Bronchitis Pathophysiologic changes

A

Bronchial inflammation and excessive mucus secretions lead to airway obstruction.

100
Q

Chronic Bronchitis Causes

A

Smoking
Chronic lung infections

101
Q

Chronic Bronchitis Signs/symptoms

A

Productive cough, rhonchi-like snoring
Hypoxemia- not enough o2, hypercapnia- too much co2, respiratory acidosis- compensate for both

102
Q

Symptoms for 3 months out of the year for 2 consecutive years.

A

Chronic Bronchitis dx

103
Q

Abnormal dilation and stretched of bronchi and bronchioles

A

Bronchiectasis Pathophysiologic changes

104
Q

Bronchioles become obstructed by the breakdown of epithelium of bronchial mucosa.

A

Bronchiectasis Pathophysiologic changes

105
Q

Tissue fibrosis (scarring, not elastic) may result.

A

Bronchiectasis Pathophysiologic changes

106
Q

Bronchiectasis Lung tissue damaged cause by

A

Frequent infection (pneumonia, bronchitis)
Inflammation

107
Q

Cilia are damaged and cannot remove dirt, germs , mucous, properly from the airway

A

Bronchiectasis

108
Q

Proteolytic enzymes released in the lung by bacteria or phagocytic cells.

A

Emphysema Pathophysiologic changes

109
Q

Terminal bronchioles become plugged with mucus leading to a loss in fiber and elastin network in alveoli.

A

Emphysema Pathophysiologic changes

110
Q

Alveolar walls are destroyed.

A

Emphysema Pathophysiologic changes

111
Q

Air trapped in enlarged, overexpanded alveoli. (retains CO2)

A

Emphysema Pathophysiologic changes

112
Q

Resulting in an inadequate gas exchange.

A

Emphysema Pathophysiologic changes

113
Q

Ineffective gas exchange

A

Emphysema

114
Q

Cigarette smoking (and 2nd hand smoke)

A

Emphysema Commonly Caused

115
Q

Air pollution

A

Emphysema Commonly Caused

116
Q

Lack of the alpha1 -antitrypsin protein- at risk for em in a nonenvironmental way. (Effects normal tissue in lungs)

A

Emphysema Commonly Caused

117
Q

Chronic cough – may have sputum production

A

Emphysema Signs/symptoms

118
Q

Dyspnea on exertion- labored breathing

A

Emphysema Signs/symptoms

119
Q

Diminished breath sounds

A

Emphysema Signs/symptoms

120
Q

Others- barrel chest, clubbing, poor capillary refills, coarse crackles, high co2 level and cant breathe can cause anxiety

A

Emphysema Signs/symptoms

121
Q

alpha1-antitrypsin protein- block WBCs from damaging normal tissue in lungs

A

Emphysema

122
Q

Bronchodilators: Sympathomimetics

A

Epinephrine

123
Q

Epinephrine Action

A

Increases cAMP in lung tissue causing bronchodilation
Restores circulation and increases airway patency

124
Q

Epinephrine Use

A

Acute bronchospasm, asthma, anaphylaxis, angioedema, nasal congestion, status asthmaticus

125
Q

Epinephrine Side effects (SNS)

A

Dizziness, nervousness, tremors, hypertension, angina
Palpitations, tachycardia, dysrhythmias, restlessness

126
Q

Mimetics sympathetic system –acts on

A

alpha 1
beta 1 and 2 (nonselective)

127
Q

Stimulates the receptors cause vasoconstriction and bronchodilation

A

Epinephrine

128
Q

Epinephrine- vitals

A

signs monitoring

129
Q

Bronchodilators: Selective Beta-Adrenergics

A

Albuterol (Proventil, Ventolin), Metaproterenol

130
Q

selective beta 2 agonist-lungs, if too much can cause spasm and cause tachycardia

A

Albuterol (Proventil, Ventolin)

131
Q

beta 2 but can stimulate beta 1 too without overuse

A

Metaproterenol

132
Q

Albuterol (Proventil, Ventolin), Metaproterenol action

A

Cause bronchodilation (asthma attack)
Rapid onset of action

133
Q

Albuterol (Proventil, Ventolin), Metaproterenol Use

A

Acute bronchospasm in asthma & emphysema
Bronchospasm prophylaxis

134
Q

Albuterol (Proventil, Ventolin), Metaproterenol S/E

A

Headache, rhinitis, excitability, tremors
Hyperglycemia.
Bronchospasm, palpitations, tachycardia

135
Q

decrease as more use of the drug. Bronchodilation effect can decrease.

A

Albuterol (Proventil, Ventolin), Metaproterenol

136
Q

Given for prophylactic for exercise

A

Bronchodilators: Selective Beta-Adrenergics

137
Q

Administered- inhalation via inhaler (quickest onset, decreased systemic effects) and oral form for meta

A

Bronchodilators: Selective Beta-Adrenergics

138
Q

Needed in lower dose in inhalation bc it is not broken down and dissolved in the GI tract

A

Bronchodilators: Selective Beta-Adrenergics

139
Q

All beta 2 agonist will stimulate glycogenolysis. BGL will go up

A

Bronchodilators: Selective Beta-Adrenergics

140
Q

Bronchodilators: Anticholinergics

A

Tiotropium (Spiriva) & Ipratropium (Atrovent)

141
Q

Tiotropium (Spiriva) & Ipratropium (Atrovent)
Use

A

Maintenance treatment of bronchospasms associated with COPD
Administered by inhalation only with the HandiHaler device (dry-powder capsule inhaler)

142
Q

Tiotropium (Spiriva) & Ipratropium (Atrovent) Side effects- anticholinergic S/E

A

Dry mouth, constipation, dyspepsia, abdominal pain
Depression, insomnia, headache
Pharyngitis, sinusitis, infection
Arthralgia, peripheral edema

143
Q

Ipratropium

A

maintainence

144
Q

albuterol

A

quick bronchodilator, Combivent)- Last longer and work better.

145
Q

Decrease secretions

A

Bronchodilators: Anticholinergics

146
Q

Blocker cholinergic system and same stimulating effcts of the adrenergic system

A

Bronchodilators: Anticholinergics

147
Q

Not rescue tx.

A

Bronchodilators: Anticholinergics

148
Q

Dry inhalation of powder

A

Bronchodilators: Anticholinergics

149
Q

Bronchodilators: Methylxanthines

A

Theophylline & Aminophylline

150
Q

Theophylline & Aminophylline Action

A

Relaxes smooth muscle of bronchi and bronchioles increasing cAMP promoting bronchodilation

151
Q

Theophylline & Aminophylline Use

A

Asthma & emphysema

152
Q

Therapeutic range (Theophylline)

A

5-15 mcg/mL narrow

153
Q

Theophylline Signs of toxicity

A

> 20 mcg/mL

154
Q

Derivative of Theophylline & Aminophylline
and caffeine

A

Xanthine derivatives

155
Q

Can cause diuresis due to caffeine intake

A

Bronchodilators: Methylxanthines

156
Q

monitored carefully, similar to drinking too much caffeine)

A

Bronchodilators: Methylxanthines S/E

157
Q

Dizziness, headache, irritability, nervousness, restlessness

A

Bronchodilators: Methylxanthines S/E

158
Q

GI distress, seizure, insomnia
Tachycardia, palpitations, hypotension, dysrhythmias

A

Bronchodilators: Methylxanthines S/E

159
Q

Hyperglycemia, decreased clotting

A

Bronchodilators: Methylxanthines S/E

160
Q

Smoking increases metabolism which decreases half-life and in children need- higher dose or more frequent dosing required

A

Bronchodilators: Methylxanthines Interactions

161
Q

High-protein, low carb diet increases elimination of Methyl

A

Bronchodilators: Methylxanthines Interactions

162
Q

Beta blockers, cimetidine, erythromycin, & ephedra (psuedohedrine)- decrease metaboliz of methyl which will increase half life which puts at risk for toxicity.

A

Bronchodilators: Methylxanthines Interactions

163
Q

Other xanthine derivatives & caffeine- at the same time bc it will increase stimulation and diuresis effect.

A

Bronchodilators: Methylxanthines Interactions

164
Q

Headache and nausea- cardinal signs of toxicity

A

Bronchodilators: Methylxanthines

NSG (13 decks)

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