Resp System(Pharm) Flashcards
Dextromethorphan
Generic Name: Dextromethorphan
Trade Name: Romilar
-Antitussive(central acting)(non narcotic)
most commonly used for nonproductive, dry cough
-working in CNS(central acting non-narcotic)
-non narcotic
-cause hypotension, decrease resp.drowsiness(not as severe), increase risk of tolerance/abuse, euphora,misused by adolescents
-not for children under 4
-caustion 4-12
-adolescents can abuse
Guaifenesin
Generic Name: Guaifenesin
Trade Name: Robitussin
-rarely has adv reaction
-is expectorant
-10ml/2tsp q4hr
side effect:
-hypersensitvity
-gastrotoxivity
-drowsiness
nursing implication:
-give meals(after meal), do not follow by water
-position in high fowlers
-teach deep breathing cough
-humidification
-increase fluids
-temp control
-suction as neededAcetylcysteine
Generic Name: Acetylcysteine Trade Name: Mucomyst -Mucolytic -liquify thick tenacious secretion, breaks down mucous -break down mucous -antidote to tylenol -indication-emphysema,copd, -smells like rotten egg
Albuterol
Generic Name: Albuterol Trade Name: Proventil Sympathomimetics(drug) bronchodilator(anti-asthmatic drug) -short acting beta agonist(drug) PO/Inhalation-q6h
Theophylline
Generic Name: Theophylline
Trade Name: Elixophyllin/Theo-Dur/Unipyhyl
Methyl-Xanthine
Xanthinal/Xanthine Derivatives-Theophylline(Theo-Dur/Uniphyl)
-300-800mg
-start of with theophylization
-10-20mcg per ml(therapeutic level)action: act directly to relax the smooth muscle of the bronchus to increase the size and lumen of the bronchioles
-they are mild diuretics(remove fluid)
-indicated for pulmonary edema=dilate bronchi,get rid of fluid
Diphenhydramine
Generic Name: Diphenhydramine
Trade Name: Benadryl
-25-50mg 3x day, po,im
indication:
-seasonal allergy
-Hypersensitivity=from medication,blood products,seasonal allergies
-N&V,motion sickness
-Parkinsons-have anticholegerin like effect=decrease in strength/muscle tone
-adjucts to anesthesia-drying,prevent nausea
-allergy to drugs and blood products
Phenylephrine
Generic Name: Phenylephrine Trade Name: Neosynephrine -Nasal Decongestant -Sympathomimetics/Ageneric -Topical, Local
Beclomethasone
Generic Name: Beclomethasone
Trade Name: Beclovent/Vanceril
-Beconase/Vancenase
-Corticosteroid nasal decongesant
Dexamethasone
Generic Name: Dexamethasone
Trade Name: Decadron
-corticosteroid/antiinflammatory/antiasthmatic
–po, 3-5days, ac exacerbation
Ipratropium Bromide
Generic Name: Ipratropium Bromide
Trade Name: Atrovent
-Anticholinergic/Broncodilator
inhalation-short term relief of symptoms-last 4hrs
Triamcinolone
Generic Name: Triamcinolone
Trade Name: Azmacort, Nasocort
Corticosteroid nasal decongesant
Isoproterenol
Generic Name: Isoproterenol Trade Name: Isuprel -bronchodilator -sympathomimetic -short acting beta 2 agonist -subcut,inhal,iv -cause pink coloration of mucus
Loratadine
Generic Name: Loratadine Trade Name: Claritin -Anti histamine -2ng gen -10mg daily,Tab,liq,and peds dose
Zafirlukast
Generic Name: Zafirlukast
Trade Name: Accolate
-bronchodilator
-Leukotrine antagonist
Histamine
- substance found in various body tissue
- highest concentration in the mast cells and basophils
- produced in response to injury and released in allergic and hypersensitivity reaction
- forms in foundation for many cold remedies
Antihistamine/Driers
action: blocks the action of histamine at the H1 receptor site and prevent histamine from entering the receptor site
- H1 receptor blocker
- H1 receptor antagonist
- more effective in prevention
- best given at early sign and symptoms
- better at preventing than reversing effect
- pallitive treatment(makes feel better)
Antihistamine/Driers(Indication)
- seasonal allergy
- Hypersensitivity=from medication,blood products,seasonal allergies
- N&V,motion sickness
- Parkinsons-have anticholegerin like effect=decrease in strength/muscle tone
- adjucts to anesthesia-drying,prevent nausea
- allergy to drugs and blood products
Antihistamine/Driers(First Generation s/s)
- works centrally at the brain
- works periphally at the site
- have anti-cholegernic effect(drying,decrease muscle tone,decreased mobility,dilated pupils,cause drowsiness(sedation)
- fast onset(30min), short duration=taken more frequetly
- decrease muscle strength, urinary retention,constipation,dilated pupils, blurry vision, hypotension, monitor BP
Antihistamine/Driers(First Generation Drugs)
Diphenhydramine(Benadryl)
-25-50mg 3x day, po,im
Hydroxyzine(Atarax Vistaril)
-25-50mg 3x day, po,im
Antihistamine/Driers(Second Generation s/s)
- slower onset: 1hr or more
- dont have to take as often
- less effective in drying
- less sedating/drowsiness
- Anticholinergic like effect
- sedation, hypotension
- gastrotoxicity
- hypersensitivity
- photosensitivity
- paradoxical excitement-some pt may have insomnia-elderly
- tolerance-w/ prolonged use-less drowsy as continue to take medication
Antihistamine/Driers(Second generation drugs)
- Loratadine(Claritin)-10mg daily,Tab,liq,and peds dose
- Cetirizine(Zyrtec)
- Fexofenadine(Allegra)- 2x day dose, 60mg cap, BID, po, not to be used by anyone under the age of 12,pt should not be drinking fruit juice, decrease absorbtion
Antihistamine/Driers(contraindication)
- asthma,copd=b/c drying effect=mucous harde to expel
- glaucoma=b/c dilates pupil
- prostate=b/c decreae unrinary output/retention
- pregnant and lactating women
- interaction-MAOI
Antihistamine/Driers(Nursing implication)
- take with meal, parental deep IM(exception allegra(fruit juice)
- for motion sickness 30min to 1hr before traveling
- stop 4 days before allergic testing: b/c can mask allergic response
- watch for degree of drowsiness
- provide safety: decrease bp: orthostatic hypotention-watch for hot showers
- relieve drynes
- alcohol and other CNS depressants increase drowsiness
- can cause resp difficulty
Nasal Deocongestants(action/indication)
shrink engorged mucous membrane in the nose to relive stuffiness
-constrict blood vessels in the nose to decrease the formation of mucous and increase drainage to lessen swelling
indication: drain sinuses/adjunct in middle ea infectino, cold
- increase drainage
- decrease swelling
- decrease formation of mucous
- adjunct for common cold/ear infection/pre op med for balance anesthesia
- systemic last longer
- topical works faster
- locally/systemic
- topical/ by mouth
Nasal Deocongestants(Drugs)
- Sympathomimetics/Ageneric
- Phenylephrine Hcl(Neo synephrine)
Corticosteriods
- Flucticasone
- Tramcinolone
- Beclomethasone
Nasal Deocongestants(side effects)
- local-use topically
- cns stimulation
- cardiac stimulation
- gastrotoxicity
- rebound congestion-no more than 3-5days-overuse of medication, more frequently than they should
- contrainfication: MAOI(hypertensive crisis), pregancy,lactating women
- caution HTN, Heart disease,diabetes(hyperglycemia)
- systemic-cns stimulation,cardiac,gastrotoxity
- local: burning, rebound congestion
Nasal Deocongestants(Nursing implications)
- caution in htn, heart disease and diabetes
- burning or stinging discontinue
- do not giver for more than 4 days can cause rebound congestiion
- monitor bp and heart rate/apical pulse
- assess nasal mucosa
- d/c if burning/stinging occur
Antitussive
- action: suppress cough reflex center located in the medulla in the brain
- there are two types central and peripheral(affecting receptor sites) acting
- central acting directly on the cough reflex center in the medulla. There are two types of central acting(narcotics and non-narcotics)
- suppresses cough reflex center in medullar
- drowsiness
- decrease resp. decrease bp
Antitussive
1) Narcotics:
- Morphine
- Codeine-most effective antitussive
- Hydrocodone-most effective antiitussive
2) Non-Narcotics:
- Dextromethorphan(Romilar)
Dextromethorphan(Romilar)
-Antitussive
most commonly used for nonproductive, dry cough
-working in CNS(central acting non-narcotic)
-non narcotic
-cause hypotension, decrease resp.drowsiness(not as severe), increase risk of tolerance/abuse, euphora,misused by adolescents
-not for children under 4
-caution 4-12
-adolescents can abuse
Peripheral Acting
- works at receptor site
- peripheral acting act directly on the cough receptor in the trachea,pharynx,and lung for a demulcent(soothing) or local anesthetic effect(dulling irritation)
Peripheral Acting
- works at receptor site
- peripheral acting act directly on the cough receptor in the trachea,pharynx,and lung for a demulcent(soothing) or local anesthetic effect(dulling irritation)
Antitussive(indication)
-relieve dry hacking cough non productive cough
side effects:
-all antitussive can cause some drowsiness
-central active have more degree drowsiness
-opiate like
-cns depression
central side effect:
-resp depression
-euphora
-dependency
-n/v
-constipation
peripheral side effect:
-cardiovasuclar collapse
Peripheral Acting(Drug)
Benzonatete(Tessalon):
- has cain substance,
- anesthetic like effect,
- must swallow whole,
- can cause arrhythmia,
- spasm in bronchi
- cardiovascular collapse,
- allergy to cain products,
- teach pt to swallow whole(gel like substance)
Diphenhydramine(Benylin)
- related to benadryl
- drowsiness,dizziness
Antitussive(indication)
-relieve dry hacking cough
Antitussive(indication)
-relieve dry hacking cough non productive cough
side effects:
-opiate like
-cns depression
central side effect:
-resp depression
-euphora
-dependency
-n/v
-constipation
peripheral side effect:
-cardiovasuclar collapseMucolytic(action)
- action:liquify thick tenacious secretion, breaks down mucous
indication: emhysema-copd-part of treatment for pulmonary diseases
Expectorants
- reduce the viscosity and help raise thick tenacious secretions making expulsion of the sputum easier. act directly on the bronchial glands
- loosen and thin the sputum
Expectorants(drug)
-Guaifenesin(Robitussin)
-rarely has adv reaction
-is expectorant
-10ml-2tsp q4hr
side effect:
-hypersensitvity
-gastrotoxivity
-drowsiness
nursing implication:
-give meals(after meal), do not follow by water
-position in high fowlers
-teach deep breathing cough
-humidification
-increase fluids
-temp control
-suction as needed
Mucolytic
- action:liquify thick tenacious secretion, breaks down mucous
indication: emhysema-copd-pulmonary diseases
Mucolytic(drug)
- acetylcystein(mucomyst)-antidote/tylenol
- tyloxapol(alevaire)
Mucolytic(side effect)
- N/V
- smells like rotten egg
- stomatitis,bronchospasm
- interaction: tetracycline,erythromycin H202
Mucolytic(Nurising Implication)
- given instilled or by nebulizer
- assess mucus membrane in mouth
- cough patient or suction before and after
- store in fridge discard after 96hrs
Asthma
- inflammatory respiratory condition characterized by recurrent attack of dysnea, wheezing and bronchospasm
- various combination of drugs are used to treat asthma
- the objective is to give the smallest dose and to decrease the number and frequency
Bronchodilator(Antiasthmatic drug)(indication)
-relieve bronchospasms associated with respiratory disorders such as asthma,emphysema,and chronic bronchiits Four types: -Sympathomimietics -Methyl Xanthine compounds -Anticholinergics -Leukotrience Receptors Antagonist
Sympathomimetics
- Broncodilator/Antiasthmatic drug
- dilate the bronchus by stimulating the sympathetic nervous system
- most stimulate beta 2 receptor site
- drugs divided into short acting and long acting
Sympathomimetics(drug)
bronchodilator(anti-asthmatic drug)
-short acting beta agonist(drug)
-rescue inhaler/meds
-Albuterol(Proventil)-PO/Inhalation-q6h
-Epinephrine(Adrenalin)-via inhalation-
1-1000(0.5mg-1mg)-tuberculin syringe-side effect: tremors
Sympathomimetics(drug)
bronchodilator(anti-asthmatic drug)
-long acting beta agonist
- symptom control
- Salmeterol
- Formoterol fumarate
- sustained released albuterol
Side effect(Sympathomimetic)
- CNS stimulation
- cardiac stimulation
- gastrotoxicity
- endrocrine
- prolonged used lead to tolerance
Methyl-Xanthine
Xanthinal/Xanthine Derivatives
(Action/Indication)
action: act directly to relax the smooth muscle of the bronchus to increase the size and lumen of the bronchioles
- they are mild diuretics(remove fluid)
- indicated for pulmonary edema=dilate bronchi,get rid of fluid
Methyl-Xanthine
Xanthinal/Xanthine Derivatives
(Drugs)
- Theophylline(Theo-Dur/Uniphyl)
- 300-800mg
- start of with theophylization
- 10-20mcg per ml(therapeutic level)
Methyl-Xanthine
Xanthinal/Xanthine Derivatives
(interaction)
-beta blocker,erythromycin and cimetidine: cause increase theophylline toxicity, decrease effect allupurinol, anticonvulsant, oral contraceptive
Methyl-Xanthine
Xanthinal/Xanthine Derivatives
(Nursing implication)
- Xanthine products increase toxicity like chocolate and soda
- given with food if nausea
- monitor site/peri care
- educate to protect from UV light(photosensitivity)
- monitor for theophyline toxicity: N/V, anorexia, arrthymia, seizure
Anticholinergic(action)
bronchodilator
- most useful longterm treatment with COPD
- or for asthma not able to tolerate beta 2 agonist
Methyl-Xanthine
Xanthinal/Xanthine Derivatives
(side effects)
- similar to beta 2 agonist(review A part of map)
- increase hypotension and N/V
- iv: bp drop(hyp0tension), pump mlxhr
Anticholinergic(drug)
bronchodilator
- Inpratropium Bromide(Atrovent)-inhalation-short term relief of symptoms-last 4hrs
- Tiotropium Bromide(Spiriva)-long term, last about 24hrs-maintain airway, not as drying
Anticholinergic(side effect)
- atropine like, cough, nervousness, headache, and dizziness
- dilation of pupils=glaucoma(blurry vision)
- tachycardia, N/V, headache, dizzy, cough,
- best taken when they wake in the morning
Leukotriene Antagonist(Action)
- action: antagonize leukotriene which is a bronchoconstrictor to dilate the bronchus and decrease mucus secretion
indication: prophylactic long-term - good for asthma patient,prophalatic,long term management
Leukotriene Antagonist(Drug)(Only PO routes)
Zafirlukast(Accolate)-5yrs and older
Montelukast-1yr and above, tab,chewable,granules
Zileuton-12 yrs and older
Leukotriene Antagonist(side effect)
- drowsiness, headache, dizziness, dyspepsia, abdominal pain, myalgia, hepatoxicity, and increased incidence of resp tract infection
- monitor liver enzymes and s/s of infection
- interaction-potentiate: NSAIDS, ASA, Theophyline and erythromycin decrease levels infection
- contraindicated in pregnancy and lactation and an acute asthmatic attack
- used to prevent not to treat acute attack
Bronchodilators(Nursing Implication)
- dose by number of puffs
- vital signs
- auscultate lungs
- give oral with food
- space dose at equal interval
- if symptoms increase do not increase dose
- IV rate monitor closely
- wait one min to recharge
- in more that one drug inhaled wait 5min
- rinse mouth and spit out
- check dose counter or indicator
- check empty full if no indicator
- if more than one drug inhaled wait 5 min
- avoid smoking, OTDC, caffeine and beta blockers
- increase fluids
- sympathomimetic-epinephringe drug of choice for an acute attack asthma
- isuprel and epinephrine should never be given together
- methylxanthine: bp: hypotension
- watch for theophylline toxicity
- monitor blood levels
- watch for seizures
- inhalation puffs equally spaced
- mdi wait 1 min to recharge
- hold breathe for long as possible 10 seconds
- use bronco dilator first than steroids to decrease inflammation
- avoid smoking no OTC,caffeine
- increase fluids
Anti-Inflammatory
Corticosteroids
- used prophylactic treatment of bronchial asthma
- decrease inflammatory process
- least amount of drug small dose
Anti-Inflammatory
Corticosteroids(Drugs)
Beclomethasone:
- Beclovent-inhalation
- Beconase-decongestion
- maintanece
Dexamethasone(Decadron):
-po, 3-5days, ac exacerbation
Triamcinolone(Azmacort/Nasort):
Azmacort=for asthma
Nasocort=nasal decongestion
-maintenance
Corticosteroids(side effect)
- require tappering, give body time to release own steroids
- can cause addison crisis
- throat irritation-rinse mouth/throat
- hoarsenss
- cough
- oral fungal infection
- vertigo
- headache
- steroids effect calcium levels decrease(hypocalcemia)-take calcium supplements
- increase Blood sugar
- stunt growth in child
- increase BP(hypertension)
Mast Cell Stabilizer(action)
-decrease secretion of histamine by the mast cells
Mast Cell Stabilizer(indication)
- prophylatic treatment of mild bronchial asthma especially in children when growth retardation is concern
- exercise induced bronchospasm
- need 2 to 4 weeks for optimal
Mast Cell Stabilizer(Drugs)(side effect)
-cromolyn and nedocromil side effect: -N/V/D -headache -fatigue -hypotension -joint swelling -dysuria -rash -sneezing -cough,hoarseness,burning,stinging, bad taste in mouth -rinse after use and spit out
Nursing implication:
- teach mdi
- teach spacer
- humdifier
- teach peak flow
