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Pharm week 1 Flashcards

1
Q

types of asthma (asthma is persistent)

A

Mild intermittent
 Mild persistent
 Moderate persistent
 Severe persistent

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2
Q

asthma

A

Recurrent and reversible shortness of breath
 Occurs when the airways of the lungs become
narrow as a result of:
 Bronchospasms
 Inflammation of the bronchial mucosa
 Edema of the bronchial mucosa
 Production of viscid mucus

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3
Q

asthma - status asthmaticus - does it respond to meds? How long does it last?

A

Status asthmaticus
 Prolonged asthma attack that
does not respond to typical
drug therapy
 May last several minutes to hours
 Medical emergency

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4
Q

asthma - Alveolar ducts - open or closed?

A

Alveolar ducts/alveoli remain open, but airflow
to them is obstructed
 Symptoms
 Wheezing
 Difficulty breathing
SOB

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5
Q

emphysema

A

 Air spaces enlarge as a result of the destruction
of alveolar walls
 The surface area where gas exchange takes place
is reduced
 Effective respiration is impaired
pink puffers or blue bloaters

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6
Q

chronic bronchitis

A

Continuous inflammation of the bronchi and
bronchioles
 Often occurs as a result of prolonged exposure to
bronchial irritants

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7
Q

causes chronic bronchitis

A

 Continuous inflammation of the bronchi and
bronchioles
 Often occurs as a result of prolonged exposure to
bronchial irritants
 SMOKING!!

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8
Q

Mucokinetic drugs

A

Promote elimination of excessive respiratory secretions

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9
Q

asthma long-term control (luke and long beta on steroids for the long-haul)

A

 Leukotriene receptor antagonists
 Inhaled steroids
 Long-acting beta2
-agonists

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10
Q

asthma - quick relief - don’t forget IV

A

Quick relief
 Intravenous systemic corticosteroids
 Short-acting inhaled beta2
-agonists

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11
Q

bronciodilators - beta agonists - mimic what body system, and are they short or long term?

A

Large group, sympathomimetics (mimic sympathetic nervous system)
 Used during acute and chronic phases of asthma

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12
Q

beta agonist - 3 types (A BB is beta)

A

Three types
 1) Nonselective (both beta 1 - heart and 2 - lungs) adrenergics
 2) Nonselective beta-adrenergics
3) Selective beta2 drugs (just respiratory beta cells)

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13
Q

beta agonist - MOA -dont need to know such detail for MOA (just know they relax smooth muscle)

A

Begins at the specific receptor stimulated
 Ends with dilation of the airways
 Activation of beta2
receptors activates cyclic adenosine
monophosphate (cAMP), which relaxes smooth muscle in
the airway and results in bronchial dilation and
increased airflow

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14
Q

beta-agonists indications (Im shocked betta is used for labor)

A

Relief of bronchospasm related to asthma,
bronchitis, and other pulmonary diseases
 Used in treatment and prevention of acute attacks
 Used in hypotension and shock
 Used to produce uterine relaxation to prevent
premature labor

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15
Q

beta-agonists - side effects - Alpha and beta (epinephrine) (Betta is amped with high sugar)

A

 Insomnia
 Restlessness
 Anorexia
 Vascular headache
 Hyperglycemia
 Tremor
 Cardiac stimulation

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16
Q

Beta-Agonists: metaproterenol - side effects (angina and headache at the met)

A

 Cardiac stimulation
 Tremor
 Anginal pain
 Vascular headache
 Hypotension

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17
Q

Beta2 (albuterol) - side effects (Al can go high or low with tension)

A

Beta2 (albuterol)
 Hypotension OR hypertension
Vascular headache
 Tremor

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18
Q

Beta-agonist derivatives

A

 Ensure that patients take medications exactly
as prescribed, with no omissions or double doses
 Inform patients to report insomnia, jitteriness,
restlessness, palpitations, chest pain, or any change in
symptoms

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19
Q

Three modalities - inhaled drugs

A

 Aerosol by metered-dose inhaler
 Aerosol by nebulizer
 Aerosol by dry powder inhaler (Never swallow dry powder - can be fatal - always put inside inhaler)

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20
Q

 Aerosol therapy promotes: - basically a humidifier

A

 Bronchodilation and pulmonary decongestion
 Loosening of secretions
 Topical application of corticosteroids and other drugs
 Moistening, cooling, or heating of inspired air

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21
Q

anticholinergics - examples (IT are anti - ACH)

A

Ipratropium bromide (Atrovent®) and tiotropium
(Spiriva®)

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22
Q

anticholinergics - MOA (achhoo opens my lungs)

A

Acetylcholine (ACh) causes bronchial constriction
and narrowing of the airways

 Anticholinergics bind to the ACh receptors,
preventing ACh from binding
 Result: bronchoconstriction is prevented, airways
dilate

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23
Q

Anticholinergics: Adverse Effects (achoo makes my mouth dry and my nose run)

A

Dry mouth or throat
 Nasal congestion
 Heart palpitations
 Gastrointestinal distress
 Headache
 Coughing
 Anxiety
 No known drug interactions

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24
Q

Leukotriene Receptor Antagonists
(LTRAs) - examples (luke loves monteLUK, aka singulair)

A

Newer class of asthma medications
 Currently available drugs
 montelukast (Singulair®)
 zafirlukast (Accolate)
 zileuton (Zyflo)

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25
LTA - MOA (anti-lukes put out the fire and dilate)
 Leukotrienes are substances released when a trigger, such as cat hair or dust, starts a series of chemical reactions in the body  Leukotrienes cause inflammation, bronchoconstriction, and mucus production  Result: coughing, wheezing, shortness of breath
26
LTRA - MOA
LRTAs prevent leukotrienes from attaching to receptors on cells in the lungs and in circulation  Inflammation in the lungs is blocked, and asthma symptoms are relieved
27
how many kids have asthma? (Selene has asthma)
8.6%
28
pink puffer
they have pursed lips trying to get more O2 in lungs. Barrel chest. thin appearance.
29
chronic bronchitis
blue bloater - difficulty breathing, blue appearance, O2 is not getting to fingers and toes.
30
inhaler question
nurse should tell pt to come to office for respiratory evaluation
31
LRTA - drug effects
 By blocking leukotrienes:  Prevent smooth muscle contraction of the bronchial airways  Decrease mucus secretion  Prevent vascular permeability  Decrease neutrophil and leukocyte infiltration to the lungs, preventing inflammation
32
LRTA - long or short term? and what age?
Prophylaxis and chronic treatment of asthma in adults and children older than age 12
33
LRTA adverse effects - which one has fewer side effects? (Monte and Luke don't have side effects)
Zileuton®  Headache, dyspepsia, nausea, dizziness, insomnia, liver dysfunction  Zafirlukast ®  Headache, nausea, diarrhea, liver dysfunction  Montelukast ® has fewer adverse effects****
34
LRTA takes how long to kick in? (Luke kicked in a week, maybe 2)
a week to kick in, up to 2 weeks. AND you have to take it every day, even if you feel better. And you will feel better.
35
LTRTA - nursing implications (Luke might hurt my liver, and comes by in one week)
Ensure that the drug is being used for chronic management of asthma, not acute asthma  Teach the patient the purpose of the therapy  Improvement should be seen in about 1 week Advise patients to check with physician before taking over-the-counter or prescribed medications—there are many drug interactions  Assess liver function before beginning therapy  Teach patient to take medications every night on a continuous schedule, even if symptoms improve
36
corticosteroids - used for acute or chronic?
Antiinflammatory properties  Used for chronic asthma  Do not relieve symptoms of acute asthmatic attacks
37
types of corticosteroids - ex. (S for steroids, S for end in sone)
beclomethasone dipropionate (Beclovent®, Vanceril®)  triamcinolone acetonide (Azmacort®)  dexamethasone sodium phosphate (Decadron Phosphate Respihaler)  fluticasone (Flovent®, Flonase®)  Others
38
inhaled corticosteroids - indications
Treatment of bronchospastic disorders that are not controlled by conventional bronchodilators  NOT considered first-line drugs for management of acute asthmatic attacks or status asthmaticus
39
inhaled corticosteroids - side effects
Pharyngeal irritation  Coughing  Dry mouth  Oral fungal infections - ***need to rinse mouth after each use and clean inhaler often  Systemic effects are rare because low doses are used for inhalation therapy
40
Inhaled Corticosteroids: Nursing Implications (steroids are not for which ppl?)
Contraindicated in patients with psychosis, fungal infections, AIDS, TB  Teach patients to gargle and rinse the mouth with lukewarm water afterward to prevent the development of oral fungal infections
41
inhaled corticosteroids - use before or after bronchodilator?
If a beta-agonist bronchodilator and corticosteroid inhaler are both ordered, the bronchodilator should be used several minutes before the corticosteroid to provide bronchodilation before administration of the corticosteroid
42
Inhaled Corticosteroids: Nursing Implications
Teach patients to monitor disease with a peak flow meter  Encourage use of a spacer (good for kids, and adults too) device to ensure successful inhalations  Teach patient how to keep inhalers and nebulizer equipment clean after uses
43
steroids for COPD patients question
true
44
Drugs That Improve Clearance of Respiratory Tract Secretions
Mucokinetic agents (guyphanize - musincex) (expectorants)  Work by thinning hyperviscous mucus  Mucolytic agents  Serve to break down mucus  Agents that suppress bronchial secretions
45
sputum and mucus
Sputum (phlegm) is an abnormal secretion originating in the lower respiratory tract.  Mucus is a normal secretion produced by surface cells in mucous membranes.
46
common cold
Most caused by viral infection (rhinovirus or influenza virus)  Virus invades tissues (mucosa) of upper respiratory tract, causing upper respiratory infection (URI)  Excessive mucus production results from the inflammatory response to this invasion  Fluid drips down the pharynx into the esophagus and lower respiratory tract, causing cold symptoms: sore throat, coughing, upset stomach
47
understanding the common cold
 Irritation of nasal mucosa often triggers the sneeze reflex  Mucosal irritation also causes release of several inflammatory and vasoactive substances, dilating small blood vessels in the nasal sinuses and causing nasal congestion
48
treatment of colds
nvolves combined use of antihistamines, nasal decongestants, antitussives, and expectorants  Treatment is symptomatic only, not curative  Symptomatic treatment does not eliminate the causative pathogen  Difficult to identify whether cause is viral or bacterial  Treatment is “empiric therapy,” treating the most likely cause  Antivirals and antibiotics may be used, but a definite viral or bacterial cause may not be easily identified
49
cold empiric means
1. the medications cure the cold. 2. the medications only treat the symptoms. 3. herbal medications are useful to eliminate symptoms. 4. it is prevented with careful use of medications.
50
antihistamine - what are the histamine receptors (just 1 and 2)
Drugs that directly compete with histamine for specific receptor sites  Two histamine receptors  H1 (histamine1)  H2 (histamine2)
51
antihistamine - H1 antagonists - ex. (1st take an antihistamine)
 H1 antagonists are commonly referred to as antihistamines  Examples: diphenhydramine (Benadryl®), loratadine (claritin®)
52
H1 is what symptom (1st take antihistamine)
runny nose
53
H2 is
GI symptoms
54
antihistamine - other effects
Skin  Reduce capillary permeability, wheal-and-flare formation, itching  Anticholinergic  Drying effect that reduces nasal, salivary, and lacrimal gland secretions (runny nose, tearing, and itching eyes)  Sedative  Some antihistamines cause drowsiness
55
antihistamine nursing contraindicated (hiss at asthma and pneumonia)
 Gather data about the condition or allergic reaction that required treatment; also assess for drug allergies  Contraindicated in the presence of acute asthma attacks and lower respiratory diseases, such as pneumonia
56
antihistamine - nursing implications
Instruct patients to report excessive sedation, confusion, or hypotension  Instruct patients to avoid driving or operating heavy machinery; advise against consuming alcohol or other CNS depressants  Instruct patients not to take these medications with other prescribed or over-the-counter medications without checking with prescriber
57
decongestants - Three main types are used (De andrean is anti-cort)
 Adrenergics  Anticholinergics  corticosteroids
58
oral decongestants - (rebound so it's oral only) ex.
Prolonged decongestant effects, but delayed onset  Effect less potent than topical  No rebound congestion  Exclusively adrenergics  Example: pseudoephedrine (Sudafed®)
59
topical decongestants
Adrenergics  phenylephrine (Neo-Synephrine®)  Others  Intranasal steroids  beclomethasone dipropionate  flunisolide (Nasalide®)  fluticasone (Flonase®)  Others
60
decongestants - rebound
will work and you stop taking and it comes back. won't happen with oral, but can happen with inhaled or topical.
61
nasal decongestants - adverse effects (think ephedrine)
Adrenergics Steroids Nervousness Local mucosal dryness Insomnia and irritation Palpitations Tremors (Systemic effects caused by adrenergic stimulation of the heart, blood vessels, and CNS)
62
Nasal Decongestants: Nursing Implications - again, think ephedrine
Decongestants may cause hypertension, palpitations, and CNS stimulation—avoid in patients with these conditions  Patients on medication therapy for hypertension should check with their physician before taking over-the-counter decongestants  Assess for drug allergies
63
Antitussives - you know this
Drugs used to stop or reduce coughing  Opioid and nonopioid  Used only for nonproductive coughs!  May be used in cases where coughing is harmful
64
Antitussives: Mechanism of Action
Opioids  Suppress the cough reflex by direct action on the cough center in the medulla  Examples:  codeine (Robitussin A-C®, Dimetane-DC®)  hydrocodone
65
Antitussives: Mechanism of Action - non- opioids (the non-opioids are a stretch)
Nonopioids  Suppress the cough reflex by numbing the stretch receptors in the respiratory tract and preventing the cough reflex from being stimulated  Examples:  benzonatate (Tessalon Perles®)  dextromethorphan (Vicks Formula 44®, Robitussin-DM®)
66
Antitussives: Benzonatate - Adverse Effects (benzos make me dizzy and headachy)
 Dizziness, headache, sedation, nausea, and others
67
antitussives - nursing implications - taking cheweables, what to do?
Perform respiratory and cough assessment, and assess for allergies  Instruct patients to avoid driving or operating heavy equipment because of possible sedation, drowsiness, or dizziness  Patients taking chewable tablets or lozenges should not drink liquids for 30 to 35 minutes afterward
68
expectorants
Drugs that aid in the expectoration (removal) of mucus  Reduce the viscosity of secretions  Disintegrate and thin secretions
69
expectorants - MOA
Direct stimulation  Reflex stimulation  Final result: thinner mucus that is easier to remove
70
expectorants - implications - caution with who? (what do you expect)
Expectorants should be used with caution in the elderly*** or those with asthma or respiratory insufficiency  Patients taking expectorants should receive more fluids, if permitted, to help loosen and liquefy secretions  Report a fever, cough, or other symptoms lasting longer than a week  Monitor for intended therapeutic effects
71
Herbal Products: Echinacea
Reduces symptoms of the common cold and recovery time  Adverse effects  Dermatitis  GI disturbance  Dizziness  Headache
72
drink water to
thin mucus
73
94 year old severe dry cough
benzonatate
74
at 58-year old
gauifensesin
75
beta agonist - non-selective adrenergics and ex - (Adrienne is an agonist)
 1) Nonselective (both beta 1 and 2) adrenergics  Stimulate alpha, beta1 (cardiac), and beta2 (respiratory) receptors  Example: epinephrine
76
beta agonist - nonselective - example (Al is nonselective at the met)
 Stimulate both beta1 and beta2 receptors  Example: metaproterenol (Alupent®),
77
beta agonist - selective beta 2 drugs - example (selective is the best)
(just respiratory beta cells)  Stimulate only beta2 receptor  Example: albuterol (Proventil®, others)
78
anti-cholernagenics - fast or slow?
 Slow and prolonged action
79
anti-cholernagenics used for what? And don't use them for what?
 Used to prevent bronchoconstriction  NOT used alone for acute asthma exacerbation!
80
LTRA - when not to use?
 NOT meant for management of acute asthmatic attacks
81
Montelukast® (luke) is used for what age and treatment of what?
 Montelukast® is approved for use in children ages 2 and older****, and for treatment of allergic rhinitis
82
beta agonists (bronchodilators) work fast or slow?
 Quickly reduce airway constriction and restore normal airflow  Stimulate beta2 -adrenergic receptors throughout the lungs
83
corticosteroids - inhaled form reduces what? How long do they take to work? (muscles don't happen overnight)
 Oral or inhaled forms  Inhaled forms reduce systemic effects  May take several weeks before full effects are see
84
antihistamine properties (anti-hist, anti-chol, and sedative)
 Antihistamines have several properties  Antihistaminic  Anticholinergic  Sedative
85
antihistamine H2 (2 dine on my stomach)
 H2 blockers or H2 antagonists  Used to reduce gastric acid in peptic ulcer disease  Examples: cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid)
86
antihistamine contraindications (antihistamines are NOT for the eyes, heart, and kidneys)
 Use with caution in increased intraocular pressure, cardiac or renal disease, hypertension, asthma, COPD, peptic ulcer disease, BPH, or pregnancy
87
decongestants - Adrenergics (Adrienne is large)
 Largest group  Sympathomimetics (mimic sympathetic system)
88
decongestants - Anticholinergics (anti-common)
 Less commonly used  Parasympatholytics
89
decongestants - Corticosteroids - two forms
 Topical, intranasal steroids  Two dosage forms  Oral  Inhaled/topically applied to the nasal membranes
90
antitussives - Dextromethorphan - adverse effects (Dex for DDN - the usual)
 Dizziness, drowsiness, nausea
91
antitussives - opioid - adverse effects
 Sedation, nausea, vomiting, lightheadedness, constipation
92
H2 - cimetidine trade name (T for tagamet)
cimetidine (Tagamet)
93
H2 , ranitidine trade name (rant about zant)
ranitidine (Zantac)
94
H2 famotidine trade name (Pepcid if fam)
famotidine (Pepcid)
95
BAM
bronchodilators
96
SLM
anti-inflammatory
97
anticcccholernegics - anti-cccccecretions
you can't pee with em tropium
98
Ipratropium bromide trade name (Peeum with atrovent)
(Atrovent®)
99
tiotropium trade name (Tito eats spira)
(Spiriva®)

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