(Pharmacology) Upper and Lower Respiratory Study Guide

Question 1

What is the purpose of antitussive medication? (Pg 488)

Answer 1

• Antitussives act by suppressing the cough center in the brain.
• They are used when the patient has a dry, hacking, nonproductive cough.
• These agents will not stop the cough completely but should decrease the frequency and suppress the severe spasms that prevent adequate rest at night.
• Under normal circumstances, it is not appropriate to suppress a productive cough, so antitussives should not be used in patients with a productive cough.

Question 2

What is Patient education/ nursing interventions during antihistamine therapy?

Answer 2

• Nursing Interventions(475)
  
  • Review the patient’s history for evidence of glaucoma, prostatic hyperplasia, or asthma. If any one of these is present, consult the healthcare provider before initiating therapy.
  • Inquire about urinary pattern, particularly in male patients older than age 55 who may be developing prostatic hyperplasia.
  • Assess the patient’s work environment and consider whether drowsiness will affect safety and work performance.
  • Because antihistamines are prescribed for a variety of symptoms (e.g., hay fever, dermatologic reactions, drug hypersensitivity, rhinitis, transfusion reactions), it is necessary to individualize the patient assessments with regard to the underlying pathologic condition.
• Patient Education (477 under Common adverse effects)
  
  • Neurologic
    
    • Sedative effects
      
      • The types of antihistamines ordered can produce varying degrees of sedation.
      • Tolerance may be produced over time, thus diminishing the effect.
      • Operating machinery or motor vehicles may be hazardous.
      • Warn the patient to be cautious.
    • Cognitive impairment
      
      • Although newer antihistamines are less sedating, patients should still be cautioned about the possibility of impaired memory, coordination, and psychomotor performance.
      • In many states it is a crime to operate a motor vehicle while under the influence of medicines (in addition to alcohol).
      • Operating machinery or motor vehicles may be hazardous.
      • Caution patients to watch closely for signs of impairment (e.g., forgetfulness, poor coordination) in these situations.
  • Respiratory
    
    • Drying effects
      
      • Monitor the patient’s cough and degree of sputum production when antihistamines are used.
      • Because of their drying effects, antihistamines may impair expectoration.
      • Give adequate fluids concurrently with the use of antihistamines.
      • Maintain fluid intake at 8 to 10 eight-ounce glasses daily.
  • Anticholinergic
    
    • Blurred vision; constipation; urinary retention; dryness of mouth, throat, and nose mucosa
      
      • These symptoms are the anticholinergic effects produced by antihistamines.
      • Patients taking these medications should be monitored for these effects.
      • Mucosa dryness may be alleviated by sucking hard candy or ice chips or by chewing gum.
      • Caution the patient that blurred vision may occur, and make appropriate suggestions for the personal safety of the individual.
  • Genitourinary
    
    • Urinary retention
      
      • Some patients, particularly men with prostatic hyperplasia, may develop urinary partial obstruction—difficulty with starting a stream of urine—when taking oral antihistamines, particularly with first-generation antihistamines (e.g., diphenhydramine).
      • The obstruction is dose related and will resolve with metabolism of the drug.
      • This adverse effect can be eliminated by using only topical antihistamines (e.g., azelastine) or second-generation antihistamines (e.g., loratadine, desloratadine, fexofenadine) rather than first-generation antihistamines.
  • Drug interactions
    
    • Central nervous system depressants
      
      • Central nervous system depressants—including sleep aids, analgesics, tranquilizers, and alcohol—will potentiate the sedative effects of antihistamines.
      • People who work around machinery, operate motor vehicles, or perform other duties that require constant mental alertness should be particularly cautious until they know how the medication affects them and should not take these medications while working.

Question 3

What is the Treatment for Tylenol (acetaminophen) overdose?

Answer 3

• Acetylcysteine is used to dissolve abnormally viscous mucus that may occur in chronic emphysema, emphysema with bronchitis, asthmatic bronchitis, and pneumonia.
• The reduced viscosity allows easier removal of secretions by coughing, percussion, and postural drainage.

Question 4

What are nursing interventions and patient education for administration of promethazine(Phenergan)?

Answer 4

• Nursing Interventions (475 under pre-medication assessment)
  
  • Review the patient’s history for evidence of glaucoma, prostatic hyperplasia, or asthma.
    
    • If any one of these is present, consult the healthcare provider before initiating therapy.
  • Inquire about urinary pattern, particularly in male patients older than age 55 who may be developing prostatic hyperplasia.
  • Assess the patient’s work environment and consider whether drowsiness will affect safety and work performance.
  • Because antihistamines are prescribed for a variety of symptoms (e.g., hay fever, dermatologic reactions, drug hypersensitivity, rhinitis, transfusion reactions), it is necessary to individualize the patient assessments regarding the underlying pathologic condition.
• Patient Education (477 under Common adverse effects)
  
  • Neurologic
    
    • Sedative effects
      
      • The types of antihistamines ordered can produce varying degrees of sedation.
      • Tolerance may be produced over time, thus diminishing the effect.
      • Operating machinery or motor vehicles may be hazardous.
      • Warn the patient to be cautious.
    • Cognitive impairment
      
      • Although newer antihistamines are less sedating, patients should still be cautioned about the possibility of impaired memory, coordination, and psychomotor performance.
      • In many states it is a crime to operate a motor vehicle while under the influence of medicines (in addition to alcohol).
      • Operating machinery or motor vehicles may be hazardous.
      • Caution patients to watch closely for signs of impairment (e.g., forgetfulness, poor coordination) in these situations.
  • Respiratory
    
    • Drying effects
      
      • Monitor the patient’s cough and degree of sputum production when antihistamines are used.
      • Because of their drying effects, antihistamines may impair expectoration.
      • Give adequate fluids concurrently with the use of antihistamines.
      • Maintain fluid intake at 8 to 10 eight-ounce glasses daily.
  • Anticholinergic
    
    • Blurred vision; constipation; urinary retention; dryness of mouth, throat, and nose mucosa
      
      • These symptoms are the anticholinergic effects produced by antihistamines.
      • Patients taking these medications should be monitored for these effects.
      • Mucosa dryness may be alleviated by sucking hard candy or ice chips or by chewing gum.
      • Caution the patient that blurred vision may occur, and make appropriate suggestions for the personal safety of the individual.
  • Genitourinary
    
    • Urinary retention
      
      • Some patients, particularly men with prostatic hyperplasia, may develop urinary partial obstruction—difficulty with starting a stream of urine—when taking oral antihistamines, particularly with first-generation antihistamines (e.g., diphenhydramine).
      • The obstruction is dose related and will resolve with metabolism of the drug.
      • This adverse effect can be eliminated by using only topical antihistamines (e.g., azelastine) or second-generation antihistamines (e.g., loratadine, desloratadine, fexofenadine) rather than first-generation antihistamines.
  • Drug interactions
    
    • Central nervous system depressants
      
      • Central nervous system depressants—including sleep aids, analgesics, tranquilizers, and alcohol—will potentiate the sedative effects of antihistamines.

People who work around machinery, operate motor vehicles, or perform other duties that require constant mental alertness should be particularly cautious until they know how the medication affects them and should not take these medications while working

Question 5

What are laboratory finding before administration of omalizumab (Xolair)?

Answer 5

• Before administering the first dose of omalizumab, ensure that serum IgE levels have been measured; this helps determine the dose of the omalizumab to be administered.

Question 6

How do you Convert of lbs. to kg?

Answer 6

2.2Ibs=1kg

Question 7

How to do you properly use Benadryl and what are the adverse reactions and contraindications?

Answer 7

• Drug class: Antihistamines //Benadryl (brand name) // Diphenhydramine (generic name)
• Action of antihistamine: Do not prevent histamine release, but they reduce the symptoms of an allergic reaction. Antihistamines are more effective if they are taken before histamine is released or when symptoms first appear.

Adverse reactions:

• Sedative effect (sleepy)
• Cognitive impairment (forgetfulness, poor coordination)
• Drying effects (expectoration impairment, dry mouth)
• Anticholinergic (blurred vision, constipation, urinary retention, dryness of mouth, throat, and nose mucosa)
• Genitourinary (urinary retention)

Contraindications:

• CNS depressants (sleeping aids, analgesics, tranquilizers, and alcohol)
• When operating heavy machinery
• Work that requires mental alertness

Question 8

What is the Patient education for COPD and the usage of ipratropium?

Answer 8

• Patients in all groups should be taught to avoid risk factors that cause their COPD to flare up and should receive vaccinations for influenza yearly and pneumococcal disease when appropriate.
• Patients in Group A may start therapy with a short- or long-acting bronchodilator.
• Patients in Group B initiate therapy with either a long-acting beta or anticholinergic bronchodilator.
• Patients in Group C initiate a long-acting bronchodilator, preferably an anticholinergic agent.
• Patients in Group D can generally also start with a long-acting anticholinergic agent.
• Patients with more severe symptoms can start both a long-acting beta agonist and a long-acting anticholinergic agent, either as single products or combination products.
• Some patients with an eosinophil count equal or greater than 300 μL should begin therapy with both a long-acting beta agonist and an inhaled corticosteroid.
• Some patients with severe symptoms, moderate to severe airflow obstruction, and a history of frequent or severe exacerbations may need triple therapy with a long-acting beta agonist, a long-acting anticholinergic agent, and an inhaled corticosteroid.

Usage of Ipratropium (Pg. 498)

• Ipratropium is a short-acting bronchodilating agent, whereas aclidinium, glycopyrrolate, revefenacin, tiotropium, and umeclidinium are long-acting bronchodilators.
• Ipratropium is administered every 6 hours, aclidinium and glycopyrrolate every 12 hours, and revefenacin, tiotropium, and umeclidinium every 24 hours.
• All the anticholinergic bronchodilating agents are used in long-term treatment of reversible bronchospasm associated with COPD, including bronchitis and emphysema.

Ipratropium, in combination with a short-acting beta agonist such as albuterol, is also used in the management of patients with asthma exacerbations.

Question 9

What are the medical treatments and medical management of emphysema?

Answer 9

• Medical Management
  
  • Utilizes the Classification of Airway Limitation Severity, Classification of Group, and Therapy
• Medical Treatment
  
  • Depending on the group classification different therapy is recommended/ required

Question 10

Medical management for persistent coughing causing insomnia (sleeping difficulty)?

Answer 10

• Antitussive agents (cough suppressants) will not stop the cough completely but should decrease its frequency and suppress the severe spams that prevent adequate rest at night.
• Diphenhydramine has both antihistaminic and antitussive properties as well.
  
  • Examples include: Codeine, Benzonatate, Dextromethorphan.

Question 11

What are nursing interventions, patient education and adverse reactions, with the administration of nasal cromolyn sodium?

Answer 11

• Nursing intervention
  
  • Cromolyn must be taken before exposure to the stimulus that initiates an allergic response.
  • Check to see if the concurrent use of antihistamines or nasal decongestants has been ordered by the healthcare provider, especially during the initiation of cromolyn therapy.
  • Have the patient blow their nose before the nasal instillation of this drug.
• Patient Education
  
  • The therapeutic effects of these drugs, unlike those of sympathomimetic amines, are not immediate.
  • This should be explained to the patient in advance to ensure cooperation and continuation of treatment with the prescribed dosage regimen.
  • The full therapeutic benefit requires regular use, and it is usually evident within 2 to 4 weeks.
  • Therapy must be continued even when the patient is free of symptoms.
• Nasal spray
  
  • Adult patients with blocked nasal passages should be encouraged to use a decongestant just before intranasal cromolyn administration to ensure adequate penetration.
  • Patients should also be advised to clear their nasal passages of secretions and then inhale through the nose during administration.
  • One spray is placed in each nostril three or four times daily at regular intervals.
  • The maximum dosage is six sprays in each nostril daily.
• Adverse reactions
  
  • Respiratory Nasal irritation
    
    • The most common adverse effect is irritation manifested by sneezing, nasal itching, burning, and stuffiness.
    • Patients usually develop a tolerance to the irritation, but this is rarely a cause for discontinuing intranasal therapy.
• Serious Adverse Reaction
  
  • Bronchospasm and coughing
    
    • Notify the healthcare provider if inhalation causes bronchospasm or coughing.
  • Drug interactions
    
    • No significant drug interactions have been reported.

Question 12

What is the Nursing intervention and Patient education with patients that are taking mucomyst (acetylcysteine)?

Answer 12

Nursing Interventions: Before starting therapy:

• Record characteristics of cough and secretions produced prior to starting the therapy.
• Obtain and record vital signs to establish a baseline. Respiratory assessment, pulse oximetry, and pulmonary function tests may also be ordered, performed, and reviewed. Check for GI symptoms and obtain baseline mental status.

Adverse Effects and Patient Education:

• Common: Nausea and vomiting (medication smells like rotten eggs that triggers this response in patents)
• Serious: Bronchospasm (patient should be aware of side effects and be knowledgeable about when to contact their healthcare provider or 911 and/or when to seek emergency care)

Note: antibiotics should be scheduled for administration one hour after the aerosol inhalation, as Acetylcysteine inactivates most antibiotics

Question 13

What are the examples of antitussive having a combination of antihistamine and antitussive properties?

Answer 13

• Diphenhydramine is an anticholinergic agent with both antihistaminic and antitussive properties.
• As with most other antihistamines, diphenhydramine has significant sedative properties.
• This is often detrimental during the day, especially if the person must be mentally alert, but it is an excellent agent to suppress cough during sleep.
• Like other anticholinergic agents, diphenhydramine should not be taken by patients with closed-angle glaucoma or those with prostatic hyperplasia.
• It also may cause mucus to dry, making it thickened and more viscous, especially if the patient is not well hydrated.
• In addition, it should be used cautiously with other central nervous system depressants, such as sedatives, hypnotics, alcohol, or antidepressants.

Question 14

What are the nursing instructions for intranasal corticosteroids?

Answer 14

• Blocked nasal passages should be treated with a topical decongestant just before beginning intranasal corticosteroids.
• Ask the patient to blow the nose thoroughly before administering intranasal therapy.
• Patients with blocked nasal passages should be encouraged to use a nasal decongestant 15 to 30 minutes before intranasal corticosteroid administration to ensure adequate penetration.
• Patients should also be advised to clear their nasal passages of secretions before use.
• Instruct patients about proper positioning and administration of intranasal corticosteroid away from the septum within each side of the nose.
• Although rare, nasal septal perforation can occur but may be avoided with proper administration techniques, pointing away from the septum.

Question 15

What patient education must be given to patients that are on both Spiriva and advair inhalers?

Answer 15

• Ensure that the patient understands how to use the inhaler that accompanies the medication.
• Read the manufacturer’s instructions for administration for the various types of inhalers available.
• Not a rescue medicine with acute episodes
• One capsule daily, administered with HandiHaler inhaler
• Capsule placed in center chamber, press piercing button in and release
• Close lips tightly around mouthpiece and inhale slowly and deeply to cause capsule vibration; inhale and hold breath as long as comfortable
• Keep mouthpiece clean

Question 16

Order to infuse 1500ml of iv solution via electronic pump for 150min(2.5hr). The pump will be set at _________ml/hr

Answer 16

• 1500 / 2.5 = 600 mL/hr

Question 17

What drugs are used for upper respiratory disorders?

Answer 17

• Antihistamines, or H1-receptor antagonists
  
  • are used for treating Allergic Rhinitis.
  • Antihistamines reduce the symptoms of nasal itching, sneezing, rhinorrhea, lacrimation, and conjunctival itching; however, antihistamines do not reduce nasal congestion.
  • Decongestants
    
    • are alpha-adrenergic stimulants that cause vasoconstriction of the nasal mucosa, which significantly reduces nasal congestion.
    • When treating AR, decongestants are often administered in conjunction with antihistamines to reduce nasal congestion.
  • Anti-inflammatory agents
    
    • administered intranasally are used to treat nasal symptoms resulting from mild to severe AR depending on the anti-inflammatory agent.
    • In general, anti-inflammatory agents are not used to treat symptoms associated with a cold because the symptoms start to resolve before the anti-inflammatory agents can become effective.
    • The anti-inflammatory agents used to treat AR are corticosteroids and cromolyn sodium.

Question 18

What drugs are used for lower respiratory disorders?

Answer 18

• Lower Respiratory Drugs
  
  • Expectorants
    
    • liquefy mucus by stimulating the secretion of natural lubricant fluids from the serous glands.
    • The flow of serous fluids helps liquefy thick mucus masses that may plug the narrow bronchioles.
    • A combination of ciliary action and coughing will then expel the phlegm from the pulmonary system.
    • Expectorants are used to treat nonproductive cough, bronchitis, and pneumonia, in which mucous plugs inhibit the expulsion of irritants and bacteria that cause bronchitis or pneumonia.
  • Antitussives
    
    • act by suppressing the cough center in the brain.
    • They are used when the patient has a dry, hacking, nonproductive cough.
    • These agents will not stop the cough completely but should decrease the frequency and suppress the severe spasms that prevent adequate rest at night.
    • Under normal circumstances, it is not appropriate to suppress a productive cough, so antitussives should not be used in patients with a productive cough.
  • Mucolytic agents
    
    • reduce the stickiness and viscosity of pulmonary secretions by acting directly on the mucous plugs to cause dissolution.
    • This eases the removal of the secretions by suction, postural drainage, and coughing.
    • Mucolytic agents are most effective in removing mucous plugs obstructing the tracheobronchial airway.
    • They are used in treating patients with acute and chronic pulmonary disorders, before and after bronchoscopy, after chest surgery, and as part of the treatment of tracheostomy care.
  • Bronchodilators
    
    • relax the smooth muscle of the tracheobronchial tree.
    • This allows an increase in the opening of the bronchioles and alveolar ducts, which decreases the resistance to airflow into the alveolar sacs.
    • Asthma and bronchitis cause reversible obstruction of the airways. The airway constriction associated with emphysema is somewhat reversible, depending on the severity and duration of the disease.
    • The primary bronchodilators used in the treatment of airway obstructive diseases include beta-adrenergic agonists and anticholinergic aerosols.
    • Combining bronchodilators that have different mechanisms of action (e.g., combining a long-acting anticholinergic agent with a long-acting beta agonist) and duration of action may increase the degree of bronchodilation and lung function.
  • Anti-inflammatory agents
    
    • play an important role in the treatment of asthma to reduce inflammation.
    • Corticosteroids are the most effective agents and the mainstay of all asthma therapy.
    • Most commonly used are those administered by inhalation, often in combination with beta-adrenergic agonists.
    • Inhalation places the medicine at the site of inflammation with minimal systemic adverse effects.
    • Depending on the frequency and severity of acute attacks, some patients with asthma will require short “bursts” of systemic steroids, usually prednisone, for 1 to 2 weeks of therapy.
    • Occasionally a patient with asthma may require alternate-day or daily steroid administration to control symptoms.
    • All efforts must be made to optimize other forms of treatment before resorting to regular systemic steroid administration because of the potential serious adverse effects that accompany this.
    • Another anti-inflammatory agent used is roflumilast.
      
      • Roflumilast is the first of a class of agents, the selective PDE-4 inhibitors. This agent inhibits the release of inflammatory mediators and inhibits immune cell activation.
      • It does not have broncho dilating properties.
  • Immunomodulators
    
    • omalizumab, benralizumab, dupilumab, reslizumab, or mepolizumab—may be prescribed for patients who have been diagnosed with subtypes of asthma.
    • Benralizumab, dupilumab, reslizumab, and mepolizumab are used to treat eosinophilic asthma, and omalizumab is used to treat airborne allergenic asthma.
    • The immunomodulators are used in addition to other maintenance treatment (corticosteroids, bronchodilators) to reduce the frequency of asthma exacerbations.