Pharm #7 Flashcards
Upper Respiratory Disorders
Common cold, Acute rhinitis, Allergic rhinitis, Sinusitis, Acute pharyngitis
Common cold Etiology:
rhinovirus
Common cold Affects
nasopharyngeal tract
Acute rhinitis
Inflammation of nasal mucous membranes
Allergic rhinitis
Hay fever due to pollen or foreign substance
Sinusitis
Inflammation of mucous membranes of sinuses
Acute Pharyngitis
Inflammation of the throat
1-4 days before onset of symptoms during first 3 days of cold is
transmitted
Common Cold Contagious period
1-4 days before onset of symptoms
During first 3 days of cold
Common Cold Transmission
Contaminated surfaces more common than
Inhaling Droplets from sneezing
Symptoms of common cold
Nasal congestion
Nasal discharge
Cough
Increased mucosal secretions
Antihistamines Action
Compete with histamine for receptor sites (blocks histamine receptors to activate receptor sites)
most antihistamines (inhibit h1 not h2)
H1 receptors-
Affects (decreases) nasopharyngeal secretions & itching
H1 receptors-
Reducing/Affect gastric acid secretion
H2 receptors-
To treat cold
Antihistamines
First-generation antihistamines-
more side effects than 2nd generation. (first developed- first). Causes significant anticholinergic effects.
First-generation antihistamines Examples:
Diphenhydramine (Benadryl) & Chlor-Trimeton
First-generation antihistamines s/e:
Drowsiness, dry mouth
Dizziness, fatigue, blurred vision
Disturbed coordination, urine retention
Second-generation antihistamines-
refined drugs, less side effects
Second-generation antihistamines Examples:
Cetirizine (Zyrtec), Loratadine (Claritin) & Azelastine
Second-generation antihistamines cause
Less drowsiness
Less anticholinergic symptoms
Used safer in clients with glaucoma.
Diphenhydramine-Benadryl
Antihistamines
first generation
mild allergic reactions. Common ingredient in sleep meds.
Diphenhydramine
Diphenhydramine Use
Allergic rhinitis, pruritus, urticaria
Common cold, sneezing, cough
Prevent motion sickness
Sleep aid
Diphenhydramine Contraindications/cautions (high in anticholinergic effects)
Narrow-angle glaucoma
Urinary retention- use with caution and monitor urinary output
Severe liver disease
Diphenhydramine Interactions
Alcohol and other CNS depressants
Educate with alcohol or other CNS depressants do not take
Diphenhydramine
Diphenhydramine Assessment-
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?
Diphenhydramine Nursing Interventions-
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.
Diphenhydramine Education-
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
Nasal Congestion Nasal Congestion
Dilation of nasal blood vessels and swelling of nasal cavity
Stimulate alpha 1-adrenergic receptors located on the blood vessels
Nasal decongestants
Produces nasal vascular constriction (decreases swelling)
Nasal decongestants
Shrinks nasal mucous membranes
Reduces nasal secretion
Nasal decongestants
Nasal decongestant use
Allergic rhinitis, hay fever, acute coryza-inflammation of mucous membranes in the nose
Fluid passes through tissue causes swelling
Nasal Congestion
Nasal Decongestants
Oxymetazoline, Phenylephrine, Pseudoephedrine
Oxymetazoline
nasal spray
Phenylephrine
Po and Nasal
Pseudoephedrine-
PO
Nasal Decongestants Administration
Nasal spray, nasal drops, tablet, capsule, liquid
Nasal Decongestants Side effects/adverse reactions
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.
Nasal Decongestants Interactions
Caffeine- causes palpitations, increased restlessness
MAOIs- causes increase risk of hypertension and dysrhythmias.
Beta blockers- Pseudoephedrine decreases effects of beta blockers
Can be used to make meth-
phenylephrine
Works faster and provide a less systemic effect-
nasal route
Oral route-
more systemic side effect
Intranasal Glucocorticoids
Fluticasone (Flonase) & Mometasone (Nasonex)
Intranasal Glucocorticoids Action
Antiinflammatory
Decrease rhinorrhea, sneezing, and congestion
Intranasal Glucocorticoids Use
Allergic rhinitis (runny nose, sneezing, congestion)
Intranasal Glucocorticoids Side effects
Dizziness, blurred vision
Hoarseness, nausea, vomiting
Decrease nasal inflammation by directly acting in the inflamed area.
Intranasal Glucocorticoids
No systemic effect
Can be used by themselves and with antihistamine
Intranasal Glucocorticoids
Antitussives Action
Act on the cough-control center in the medulla to suppress the cough reflex
Antitussives Types
Nonopioid, opioid and combinations
Antitussives Nonopioid –
Dextromethorphan (Robitussin) & Benzonatate (Tessalon perles)-prescription
Antitussives Opioid –
Codeine. Combination effective to suppress cough reflex
Antitussives Combination preparations
Phenergan(promethazine with Codeine)- monitor respirations. Used at night to get rid of dry hacking cough.
Less cns symptoms and drowsiness
Antitussives
Expectorants
Guaifenesin (Mucinex)
Expectorants Action
Loosens bronchial secretions by reducing surface tension of secretions
Allows elimination by coughing
Expectorants Use
Common cold
Expectorants Side effects
Drowsiness, dizziness, headache, nausea
GI symptoms most common bc of secretions ingested
Thinned mucous and excreted
Can have antitussive effects
Expectorants
Nasal Decongestants Assessment-
Obtain thorough history on hypertension. Baseline vital signs. Monitor bp at home.
Nasal Decongestants Nursing Interventions-
monitor and document and watch for color characteristics of nose secretions and sputum. Green/yellow- bacterial infection
Nasal Decongestants Education-
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
Inflammation of mucous membranes of sinuses
Sinusitis
Sinusitis Treatment
Fluids, rest, saline nasal spray, Neti pot
Decongestants, acetaminophen, antibiotics
Inflammation of throat
Acute pharyngitis
Acute pharyngitis tx
Saline gargle
Cool fluids
Lozenges, acetaminophen
Antibiotics (Strep)
Educate and encourage- no active infection= not antibiotics
Sinusitis and Pharyngitis
A patient is receiving an expectorant. The nurse knows the drug is exerting its therapeutic effect when the patient experiences
loosening of bronchial secretions.
The nurse is teaching an older adult patient about guaifenesin. Which information is appropriate to include in this teaching? (Select all that apply.)
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.
A patient has been diagnosed with the common cold. The nurse should question if which drug is ordered to treat this patient?
Antibiotics
Which medication is a first-generation antihistamine?
Diphenhydramine
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?
7 days
Before administering diphenhydramine to a patient, it is most important for the nurse to assess the patient for a history of
narrow-angle glaucoma.
Which statement about benzonatate does the nurse identify as being true?
It suppresses the cough center of the medulla.
Chronic Obstructive Pulmonary Disease (COPD) Pathophysiologic changes
Airway obstruction with increased airway resistance of airflow to lung tissues
Cause permanent damage to lungs.
COPD
Tissue associated with asthma attack is reversible.
COPD
If continual asthma can cause long term effects to lung tissue
COPD
Major causes COPD
Chronic bronchitis
Bronchiectasis
Emphysema
Asthma
Can be restrictive or obstructive- causes increased airway resistance
COPD
Restrictive Lung Disease Pathophysiologic changes
Decrease in total lung capacity due to fluid accumulation and loss of elasticity of lung tissues
Pulmonary edema-fluid building up in the lungs due to LFHF, pneumonia or heart trauma.
Restrictive Lung Disease Etiology
Pulmonary fibrosis- lung tissue is thickened, damaged, and scarred(binding and no elasticity)
Restrictive Lung Disease Etiology
Pneumonitis- infamation of the lung tissue
Restrictive Lung Disease Etiology
Lung tumors- mass that is obstructing the lung itself decreasing lung cpaity
Restrictive Lung Disease Etiology
Thoracic deformities (scoliosis or kyphosis)- decrease lung capacity.
Restrictive Lung Disease Etiology
Thoracic muscular disorders (myasthenia gravis)- weaken muscles. Causes decreasd respiratory function due to decreased muscle contraction.
Restrictive Lung Disease Etiology
Due to fluid accumulation in lungs or loss of elasticity in lung tissue
Restrictive Lung Disease
Inflammatory disorder of the airway walls associated with airway obstruction
Asthma
Asthma Triggers
Stress
Allergens- cats, dogs, ragweed
Pollutants- dust, smoke, chemical, smells in air
Changes in temp or air pressure
Ibprophen or aspirin. Blocking of cox 1 causes over production of leukotrienes that increase inflammation and bronchoconstriction.
Asthma trigger
Asthma Signs/symptoms
Bronchospasm, dyspnea, mucus secretions
Audible Wheezing, coughing, tightness in the chest
Airways become sensitive to stimuli or trigger that causes a reaction
Asthma
Chronic Bronchitis Pathophysiologic changes
Bronchial inflammation and excessive mucus secretions lead to airway obstruction.
Chronic Bronchitis Causes
Smoking
Chronic lung infections
Chronic Bronchitis Signs/symptoms
Productive cough, rhonchi-like snoring
Hypoxemia- not enough o2, hypercapnia- too much co2, respiratory acidosis- compensate for both
Symptoms for 3 months out of the year for 2 consecutive years.
Chronic Bronchitis dx
Abnormal dilation and stretched of bronchi and bronchioles
Bronchiectasis Pathophysiologic changes
Bronchioles become obstructed by the breakdown of epithelium of bronchial mucosa.
Bronchiectasis Pathophysiologic changes
Tissue fibrosis (scarring, not elastic) may result.
Bronchiectasis Pathophysiologic changes
Bronchiectasis Lung tissue damaged cause by
Frequent infection (pneumonia, bronchitis)
Inflammation
Cilia are damaged and cannot remove dirt, germs , mucous, properly from the airway
Bronchiectasis
Proteolytic enzymes released in the lung by bacteria or phagocytic cells.
Emphysema Pathophysiologic changes
Terminal bronchioles become plugged with mucus leading to a loss in fiber and elastin network in alveoli.
Emphysema Pathophysiologic changes
Alveolar walls are destroyed.
Emphysema Pathophysiologic changes
Air trapped in enlarged, overexpanded alveoli. (retains CO2)
Emphysema Pathophysiologic changes
Resulting in an inadequate gas exchange.
Emphysema Pathophysiologic changes
Ineffective gas exchange
Emphysema
Cigarette smoking (and 2nd hand smoke)
Emphysema Commonly Caused
Air pollution
Emphysema Commonly Caused
Lack of the alpha1 -antitrypsin protein- at risk for em in a nonenvironmental way. (Effects normal tissue in lungs)
Emphysema Commonly Caused
Chronic cough – may have sputum production
Emphysema Signs/symptoms
Dyspnea on exertion- labored breathing
Emphysema Signs/symptoms
Diminished breath sounds
Emphysema Signs/symptoms
Others- barrel chest, clubbing, poor capillary refills, coarse crackles, high co2 level and cant breathe can cause anxiety
Emphysema Signs/symptoms
alpha1-antitrypsin protein- block WBCs from damaging normal tissue in lungs
Emphysema
Bronchodilators: Sympathomimetics
Epinephrine
Epinephrine Action
Increases cAMP in lung tissue causing bronchodilation
Restores circulation and increases airway patency
Epinephrine Use
Acute bronchospasm, asthma, anaphylaxis, angioedema, nasal congestion, status asthmaticus
Epinephrine Side effects (SNS)
Dizziness, nervousness, tremors, hypertension, angina
Palpitations, tachycardia, dysrhythmias, restlessness
Mimetics sympathetic system –acts on
alpha 1
beta 1 and 2 (nonselective)
Stimulates the receptors cause vasoconstriction and bronchodilation
Epinephrine
Epinephrine- vitals
signs monitoring
Bronchodilators: Selective Beta-Adrenergics
Albuterol (Proventil, Ventolin), Metaproterenol
selective beta 2 agonist-lungs, if too much can cause spasm and cause tachycardia
Albuterol (Proventil, Ventolin)
beta 2 but can stimulate beta 1 too without overuse
Metaproterenol
Albuterol (Proventil, Ventolin), Metaproterenol action
Cause bronchodilation (asthma attack)
Rapid onset of action
Albuterol (Proventil, Ventolin), Metaproterenol Use
Acute bronchospasm in asthma & emphysema
Bronchospasm prophylaxis
Albuterol (Proventil, Ventolin), Metaproterenol S/E
Headache, rhinitis, excitability, tremors
Hyperglycemia.
Bronchospasm, palpitations, tachycardia
decrease as more use of the drug. Bronchodilation effect can decrease.
Albuterol (Proventil, Ventolin), Metaproterenol
Given for prophylactic for exercise
Bronchodilators: Selective Beta-Adrenergics
Administered- inhalation via inhaler (quickest onset, decreased systemic effects) and oral form for meta
Bronchodilators: Selective Beta-Adrenergics
Needed in lower dose in inhalation bc it is not broken down and dissolved in the GI tract
Bronchodilators: Selective Beta-Adrenergics
All beta 2 agonist will stimulate glycogenolysis. BGL will go up
Bronchodilators: Selective Beta-Adrenergics
Bronchodilators: Anticholinergics
Tiotropium (Spiriva) & Ipratropium (Atrovent)
Tiotropium (Spiriva) & Ipratropium (Atrovent)
Use
Maintenance treatment of bronchospasms associated with COPD
Administered by inhalation only with the HandiHaler device (dry-powder capsule inhaler)
Tiotropium (Spiriva) & Ipratropium (Atrovent) Side effects- anticholinergic S/E
Dry mouth, constipation, dyspepsia, abdominal pain
Depression, insomnia, headache
Pharyngitis, sinusitis, infection
Arthralgia, peripheral edema
Ipratropium
maintainence
albuterol
quick bronchodilator, Combivent)- Last longer and work better.
Decrease secretions
Bronchodilators: Anticholinergics
Blocker cholinergic system and same stimulating effcts of the adrenergic system
Bronchodilators: Anticholinergics
Not rescue tx.
Bronchodilators: Anticholinergics
Dry inhalation of powder
Bronchodilators: Anticholinergics
Bronchodilators: Methylxanthines
Theophylline & Aminophylline
Theophylline & Aminophylline Action
Relaxes smooth muscle of bronchi and bronchioles increasing cAMP promoting bronchodilation
Theophylline & Aminophylline Use
Asthma & emphysema
Therapeutic range (Theophylline)
5-15 mcg/mL narrow
Theophylline Signs of toxicity
> 20 mcg/mL
Derivative of Theophylline & Aminophylline
and caffeine
Xanthine derivatives
Can cause diuresis due to caffeine intake
Bronchodilators: Methylxanthines
monitored carefully, similar to drinking too much caffeine)
Bronchodilators: Methylxanthines S/E
Dizziness, headache, irritability, nervousness, restlessness
Bronchodilators: Methylxanthines S/E
GI distress, seizure, insomnia
Tachycardia, palpitations, hypotension, dysrhythmias
Bronchodilators: Methylxanthines S/E
Hyperglycemia, decreased clotting
Bronchodilators: Methylxanthines S/E
Smoking increases metabolism which decreases half-life and in children need- higher dose or more frequent dosing required
Bronchodilators: Methylxanthines Interactions
High-protein, low carb diet increases elimination of Methyl
Bronchodilators: Methylxanthines Interactions
Beta blockers, cimetidine, erythromycin, & ephedra (psuedohedrine)- decrease metaboliz of methyl which will increase half life which puts at risk for toxicity.
Bronchodilators: Methylxanthines Interactions
Other xanthine derivatives & caffeine- at the same time bc it will increase stimulation and diuresis effect.
Bronchodilators: Methylxanthines Interactions
Headache and nausea- cardinal signs of toxicity
Bronchodilators: Methylxanthines
