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XIO > Pharm week 1 > Flashcards

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
Q

LTA - MOA (anti-lukes put out the fire and dilate)

A

 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

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26
Q

LTRA - MOA

A

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

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27
Q

how many kids have asthma? (Selene has asthma)

A

8.6%

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28
Q

pink puffer

A

they have pursed lips trying to get more O2 in lungs. Barrel chest. thin appearance.

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29
Q

chronic bronchitis

A

blue bloater - difficulty breathing, blue appearance, O2 is not getting to fingers and toes.

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30
Q

inhaler question

A

nurse should tell pt to come to office for respiratory evaluation

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31
Q

LRTA - drug effects

A

 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

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32
Q

LRTA - long or short term? and what age?

A

Prophylaxis and chronic treatment of asthma in
adults and children older than age 12

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33
Q

LRTA adverse effects - which one has fewer side effects? (Monte and Luke don’t have side effects)

A

Zileuton®
 Headache, dyspepsia, nausea, dizziness, insomnia, liver
dysfunction
 Zafirlukast ®
 Headache, nausea, diarrhea, liver dysfunction
 Montelukast ® has fewer adverse effects**

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34
Q

LRTA takes how long to kick in? (Luke kicked in a week, maybe 2)

A

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.

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35
Q

LTRTA - nursing implications (Luke might hurt my liver, and comes by in one week)

A

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

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36
Q

corticosteroids - used for acute or chronic?

A

Antiinflammatory properties
 Used for chronic asthma
 Do not relieve symptoms of acute
asthmatic attacks

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37
Q

types of corticosteroids - ex. (S for steroids, S for end in sone)

A

beclomethasone dipropionate
(Beclovent®, Vanceril®)
 triamcinolone acetonide (Azmacort®)
 dexamethasone sodium phosphate (Decadron Phosphate
Respihaler)
 fluticasone (Flovent®, Flonase®)
 Others

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38
Q

inhaled corticosteroids - indications

A

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

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39
Q

inhaled corticosteroids - side effects

A

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

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40
Q

Inhaled Corticosteroids: Nursing
Implications (steroids are not for which ppl?)

A

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
Q

inhaled corticosteroids - use before or after bronchodilator?

A

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
Q

Inhaled Corticosteroids: Nursing
Implications

A

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
Q

steroids for COPD patients question

A

true

44
Q

Drugs That Improve Clearance of
Respiratory Tract Secretions

A

Mucokinetic agents (guyphanize - musincex) (expectorants)
 Work by thinning hyperviscous mucus
 Mucolytic agents
 Serve to break down mucus
 Agents that suppress bronchial secretions

45
Q

sputum and mucus

A

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
Q

common cold

A

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
Q

understanding the common cold

A

 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
Q

treatment of colds

A

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
Q

cold empiric means

A
  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
Q

antihistamine - what are the histamine receptors (just 1 and 2)

A

Drugs that directly compete with histamine for specific receptor sites
 Two histamine receptors
 H1
(histamine1)
 H2
(histamine2)

51
Q

antihistamine - H1 antagonists - ex. (1st take an antihistamine)

A

 H1 antagonists are commonly referred to as antihistamines
 Examples: diphenhydramine (Benadryl®), loratadine
(claritin®)

52
Q

H1 is what symptom (1st take antihistamine)

A

runny nose

53
Q

H2 is

A

GI symptoms

54
Q

antihistamine - other effects

A

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
Q

antihistamine nursing contraindicated (hiss at asthma and pneumonia)

A

 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
Q

antihistamine - nursing implications

A

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
Q

decongestants - Three main types are used (De andrean is anti-cort)

A

 Adrenergics
 Anticholinergics
 corticosteroids

58
Q

oral decongestants - (rebound so it’s oral only) ex.

A

Prolonged decongestant effects, but delayed
onset
 Effect less potent than topical
 No rebound congestion
 Exclusively adrenergics
 Example: pseudoephedrine (Sudafed®)

59
Q

topical decongestants

A

Adrenergics
 phenylephrine (Neo-Synephrine®)
 Others
 Intranasal steroids
 beclomethasone dipropionate
 flunisolide (Nasalide®)
 fluticasone (Flonase®)
 Others

60
Q

decongestants - rebound

A

will work and you stop taking and it comes back. won’t happen with oral, but can happen with inhaled or topical.

61
Q

nasal decongestants - adverse effects (think ephedrine)

A

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
Q

Nasal Decongestants:
Nursing Implications - again, think ephedrine

A

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
Q

Antitussives - you know this

A

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
Q

Antitussives:
Mechanism of Action

A

Opioids
 Suppress the cough reflex by direct action on the cough
center in the medulla
 Examples:
 codeine (Robitussin A-C®, Dimetane-DC®)
 hydrocodone

65
Q

Antitussives:
Mechanism of Action - non- opioids (the non-opioids are a stretch)

A

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
Q

Antitussives: Benzonatate - Adverse Effects (benzos make me dizzy and headachy)

A

 Dizziness, headache, sedation, nausea, and others

67
Q

antitussives - nursing implications - taking cheweables, what to do?

A

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
Q

expectorants

A

Drugs that aid in the expectoration (removal) of
mucus
 Reduce the viscosity of secretions
 Disintegrate and thin secretions

69
Q

expectorants - MOA

A

Direct stimulation
 Reflex stimulation
 Final result: thinner mucus that is easier to
remove

70
Q

expectorants - implications - caution with who? (what do you expect)

A

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
Q

Herbal Products: Echinacea

A

Reduces symptoms of the common cold and
recovery time
 Adverse effects
 Dermatitis
 GI disturbance
 Dizziness
 Headache

72
Q

drink water to

A

thin mucus

73
Q

94 year old severe dry cough

A

benzonatate

74
Q

at 58-year old

A

gauifensesin

75
Q

beta agonist - non-selective adrenergics and ex - (Adrienne is an agonist)

A

 1) Nonselective (both beta 1 and 2) adrenergics
 Stimulate alpha, beta1
(cardiac), and beta2
(respiratory)
receptors
 Example: epinephrine

76
Q

beta agonist - nonselective - example (Al is nonselective at the met)

A

 Stimulate both beta1 and beta2
receptors
 Example: metaproterenol (Alupent®),

77
Q

beta agonist - selective beta 2 drugs - example (selective is the best)

A

(just respiratory beta cells)
 Stimulate only beta2 receptor
 Example: albuterol (Proventil®, others)

78
Q

anti-cholernagenics - fast or slow?

A

 Slow and prolonged action

79
Q

anti-cholernagenics used for what? And don’t use them for what?

A

 Used to prevent bronchoconstriction
 NOT used alone for acute asthma exacerbation!

80
Q

LTRA - when not to use?

A

 NOT meant for management of acute asthmatic
attacks

81
Q

Montelukast® (luke) is used for what age and treatment of what?

A

 Montelukast® is approved for use in children
ages 2 and older**, and for treatment of allergic
rhinitis

82
Q

beta agonists (bronchodilators) work fast or slow?

A

 Quickly reduce airway constriction and restore normal airflow
 Stimulate beta2
-adrenergic receptors throughout
the lungs

83
Q

corticosteroids - inhaled form reduces what? How long do they take to work? (muscles don’t happen overnight)

A

 Oral or inhaled forms
 Inhaled forms reduce systemic effects
 May take several weeks before full
effects are see

84
Q

antihistamine properties (anti-hist, anti-chol, and sedative)

A

 Antihistamines have several properties
 Antihistaminic
 Anticholinergic
 Sedative

85
Q

antihistamine H2 (2 dine on my stomach)

A

 H2 blockers or H2 antagonists
 Used to reduce gastric acid in peptic ulcer disease
 Examples: cimetidine (Tagamet), ranitidine (Zantac),
famotidine (Pepcid)

86
Q

antihistamine contraindications (antihistamines are NOT for the eyes, heart, and kidneys)

A

 Use with caution in increased intraocular pressure,
cardiac or renal disease, hypertension, asthma,
COPD, peptic ulcer disease, BPH, or pregnancy

87
Q

decongestants - Adrenergics (Adrienne is large)

A

 Largest group
 Sympathomimetics (mimic sympathetic system)

88
Q

decongestants - Anticholinergics (anti-common)

A

 Less commonly used
 Parasympatholytics

89
Q

decongestants - Corticosteroids - two forms

A

 Topical, intranasal steroids
 Two dosage forms
 Oral
 Inhaled/topically applied to the nasal membranes

90
Q

antitussives - Dextromethorphan - adverse effects (Dex for DDN - the usual)

A

 Dizziness, drowsiness, nausea

91
Q

antitussives - opioid - adverse effects

A

 Sedation, nausea, vomiting, lightheadedness,
constipation

92
Q

H2 - cimetidine trade name (T for tagamet)

A

cimetidine (Tagamet)

93
Q

H2 , ranitidine trade name (rant about zant)

A

ranitidine (Zantac)

94
Q

H2 famotidine trade name (Pepcid if fam)

A

famotidine (Pepcid)

95
Q

BAM

A

bronchodilators

96
Q

SLM

A

anti-inflammatory

97
Q

anticcccholernegics - anti-cccccecretions

A

you can’t pee with em tropium

98
Q

Ipratropium bromide trade name (Peeum with atrovent)

A

(Atrovent®)

99
Q

tiotropium trade name (Tito eats spira)

A

(Spiriva®)

XIO (372 decks)

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