Resp/ Urinary Flashcards
1
Q
Adrenergics (sympathomimetics)
A
Drugs that stimulate the sympathetic nerve fines of the autonomic nervous system that use epinephrine or epinephrine-like substances as neurotransmitters
2
Q
Anticholinergics (parasympatholytics)
A
Drugs that block the action of acetylcholine and similar substances at acetylcholine receptors, resulting in the inhibition of the transmission of parasympathetic nerve impulses
3
Q
Antigens
A
Substances that, upon entering the body, can induce specific immune responses and, in turn, react with the specific products of this response, such as antibodies and specifically sensitized T lymphocytes
4
Q
Antihistamines
A
Substances capable of reducing the physiological and pharmacological effects of histamine, including a wide variety of drugs that block histamine receptors
5
Q
Antitussive
A
A drug that reduces coughing, often by inhibiting neural activity in the cough centre of the central nervous system (CNS)
6
Q
Corticosteroids
A
Any of the hormones produced by the adrenal cortex, either in natural or synthetic form
7
Q
Decongestants
A
Drugs that reduce congestion or swelling, especially of the upper or lower respiratory tract
8
Q
Empirical therapy
A
A method of treating disease on the basis of observations and experience, without an understanding of the precise cause of or mechanism responsible for the disorder or the way in which the therapeutic drug or procedure produces improvement or cure
9
Q
Expectorants
A
Drugs that increase the flow of fluid in the respiratory tract, usually by reducing the viscosity or bronchial and tracheal secretions and facilitating their removal by the cough reflex and ciliary action
10
Q
Histamine antagonists
A
Drugs that compete with histamine for binding sites on histamine receptors
11
Q
Influenza
A
A highly contagious infection of the respiratory tract caused by a myxovirus and transmitted by airborne droplets
12
Q
Non-sedating antihistamines
A
Newer medications that work peripherally to block the actions of histamine and therefore do not have the CNS effects of many of the older antihistamines; also called second-generation antihistamines or peripherally acting antihistamines
13
Q
Reflex stimulation
A
An irritation of the respiratory tract occurring in response to an irritation of the gastrointestinal tract
14
Q
Rhinovirus
A
Any of approximately 100 serologically distinct ribonucleic acid (RNA) viruses that cause approximately 40% of acute respiratory illnesses
15
Q
Sympathomimetic drugs
A
A class of drugs whose effects mimic those resulting from the stimulation of organs and structures by the sympathetic nervous system
16
Q
Upper Respiratory Tract Infection (URI)
A
Any infectious disease of the upper respiratory tract, including the common cold, laryngitis, pharyngitis, rhinitis, sinusitis, and tonsilitis
17
Q
Allergen
A
Any substance that evokes an allergic response
18
Q
Allergic asthma
A
Bronchial asthma caused by hypersensitivity to an allergen or allergens
19
Q
Alveoli
A
Microscopic sacs in the lungs where oxygen is exchanged for carbon dioxide; also called air sacs
20
Q
Antibodies
A
Immunoglobulin produced by lymphocytes in response to bacteria, viruses, or other antigenic substances
21
Q
Asthma
A
Recurrent and reversible shortness of breath that occurs when the airways of the lung (bronchi and bronchioles) become narrow as a result of bronchospasm, inflammation, and edema of the bronchial mucosa
22
Q
Asthma Attack
A
The onset of wheezing together with difficulty breathing
23
Q
Bronchial Asthma
A
General term for recurrent and reversible shortness of breath resulting from narrowing of the bronchi and bronchioles; it is often referred to simply as asthma
24
Q
Bronchodilators
A
Medications that improve airflow by relaxing bronchial smooth muscle cells
25
Chronic Bronchitis
Chronic inflammation of the bronchi
26
Emphysema
A condition of the lungs characterized by enlargement of the air spaces distal to the bronchioles
27
Immunoglobulins
Proteins belonging to any of five structurally and antigenically distinct classes of antibodies present in the serum and external secretions of the body
28
Lower Respiratory Tract (LRT)
The division of the respiratory system composed of organs located almost entirely within the chest
Trachea
All segments of bronchial tree
Lungs
29
Status asthmaticus
A prolonged asthma attack
30
Upper Respiratory Tract (URT)
```
The division of the respiratory system composed of organs located outside the chest cavity (thorax)
Nose
Nasopharynx
Oropharynx
Laryngopharynx
Larynx
```
31
Antihistamines: Mechanism of Action
Block action of histamine at the H1 receptor sites
Compete with histamine for binding at unoccupied receptors
The binding of H1 blockers to the histamine receptors prevents the adverse consequences of histamine stimulation (vasodilation, increased GI and respiratory secretions increased capillary permeability)
More effective in preventing the actions of histamine rather than reversing them
Should be given early in treatment, before all the histamine binds to the receptors
32
Histamine Effects
Dilates blood vessels
Increases permeability
Stimulates salivary, gastric, lacrimal and bronchial secretions
Is released from mast cells along with other substances, resulting in allergic reactions
33
Antihistamine Effects
Reduces dilation of blood vessels
Reduces increased permeability of blood vessels
Reduces salivary, gastric, lacrimal and bronchial secretions
Binds to histamine receptors, thus preventing histamine from causing a response
34
Antihistamines: Indications
Nasal allergies
Seasonal of perennial allergic rhinitis (hay fever)
Allergic reactions
Motion sickness
Parkinson's disease
Sleep disorders
Also used to alleviate symptoms of the common cold (sneezing, running nose)
35
Antihistamines: Contraindications
Known drug allergy
Sole drug therapy during acute asthmatic attacks
Many other disease entities (narrow-angle glaucoma, heart disease, kidney disease, hypertension)
Children (depending on product)
36
Antihistamine: Adverse Effects
```
Dry mouth
Difficulty urinating
Constipation
Changes in vision
Mild drowsiness to deep sleep
```
37
Antihistamine: Traditional
Are older
Work both peripherally and centrally
Have anticholinergic effects which makes them more effective than non-sedating drugs in some instances (diphenydramine, chlorpheniramine)
38
Antihistamine: Nonsedating (peripherally acting)
Were developed to eliminate unwanted adverse effects, mainly sedation
Work peripherally to block the actions of histamine
Have a longer duration of action (fexofenadine- Allegra, loratadine - Claritin, ceterizine - Reactine
39
Nursing implications of antihistamines?
?
40
Decongestants: Types (3)
Adrenergics- largest group (sympathomimetics)
Anticholinergics- less commonly used (parasympatholytics)
Corticosteroids- topical (intranasal steroids)
Can be PO or inhaled/ topically applied
41
Oral Decongestants
Prolonged decongestant effects but delayed onset
Effect less potent than that of topical decongestants
No rebound congestion
Exclusively adrenergics
Example: pseudoephedrine
42
Topical Nasal Decongestant
Have a prompt onset
Produces potent effect
Causes rebound congestion if used for several days
Include oxymetazoline hydrochloride (Afrin, Claritin, Dristan, Drixoral, Vicks) phenylephrine (Mydfrin) xylometazoline hydrochloride (Balminil, Otrivin)
43
Nasal Decongestants: Mechanism of Action (Adrenergics)
Acts on blood vessels surrounding nasal sinuses
Constrict small blood vessels that supply upper respiratory structures
Result: Tissues shrink and nasal secretions in the swollen mucous membranes are able to drain, nasal stuffiness is relieved
44
Nasal Decongestants: Mechanism of Action (Nasal Steroids)
Act on blood vessels surrounding nasal sinuses
Have an anti-inflammatory effect
Work to turn off the immune system cells involved in the inflammatory response
Result: Decreased inflammation results in decreased congestion, nasal stuffiness is relieved
45
Nasal Decongestants: Indications
Relief of nasal congestion associated with:
Acute or chronic rhinitis
Common cold
Sinusitis
Hay fever
Other allergies
May also be used to reduce swelling of the nasal passage and facilitate visualization of the nasal and pharyngeal membranes before surgery or diagnostic procedures
46
Nasal Decongestants: Contraindications
```
Drug allergy
Narrow - angle glaucoma
Uncontrolled cardiovascular disease
Hypertension
DM
Hyperthyroidism
Prostatitis
Use cautiously in patients with Hx of:
Stroke or TIA's
Cerebral arteriosclerosis
Long-standing asthma
BPH (Benign prostatic hyperplasia)
DM
```
47
Nursing Implications: Decongestants
?
48
Antitussives
Drugs used to stop or reduce coughing
May be opioid or nonopioid
Are used only for nonproductive coughs
May be used in cases in which coughing is harmful
49
Antitussives: Mechanism of Action (opioids)
```
Suppress the cough reflex by directly acting on the cough centre in the medulla
Include codeine (Robitussin AC) and hydrocodone
```
50
Antitussives: Mechanism of Action (nonopioids)
```
Suppress the cough reflex by numbing the stretch receptors in the respiratory tract and preventing the cough reflex from being stimulated
Include dextromethorphan (Buckleys, Robitussin DM, Vicks)
```
51
Antitussives: Contraindications
Drug allergy
Opioid dependency
High risk for respiratory depression
52
Nursing Implications of Antitussives
?
53
Expectorants
Drugs that aid in the expectoration of mucous by reducing the viscosity of secretions
54
Expectorants: Mechanism of Action (Reflex stimulation)
Drug causes irritation of the GI tract
Loosening and thinning of respiratory tract secretions occur in response to this irritation
Final result is thinner mucous that is easier to remove
Example: (guaifenesin: Balminil, Robitussin)
55
Expectorants: Mechanism of Action (Direct Stimulation)
The secretory glands are stimulated directly to increase their production of respiratory tract fluids
Example: iodine-containing products
56
Expectorants: Drug Effects
By loosening and thinning sputum and bronchial secretions, the tendency to cough is indirectly diminished
Used for the relief of productive coughs associated with:
common cold
bronchitis
laryngitis
pharyngitis
coughs caused by chronic paransal sinusitis
57
Nursing Implications of Expectorants
?
58
Drugs Used to Treat Asthma
```
Long-term control:
Inhaled or oral glucocorticosteroids
Ipatropium
Rapid-relief:
Inhaled short-acting B2 agonists
Adjunct Therapy:
Antiallergic, non steroidal drugs (sodium cromoglycate, nedocromil)
Leukotrine-receptor agonists
Long-acting B2- agonists
```
59
Bronchodilators
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Relax bronchial smooth muscle bands to dilate the bronchi and bronchioles
Bronchodilators:
B-adrenergic agonists
Xanthine derivatives
Anticholinergics
```
60
Bronchodilators: B-Agonists
Are also called sympathomimetic bronchodilators
Are used during acute phases of asthmatic attacks
Quickly reduce airway constriction and restore normal airflow
Stimulate B2-adrenergic receptors throughout the lungs
61
Bronchodilators: B-Agonists (Types)
```
Nonselective adrenergics:
Stimulate a1, B1 (cardiac) and B2 (respiratory) receptors
Include epinephrine
Nonselective B-Adrenergics:
Stimulate both B1 and B2 receptors
Include isoproterenol
Selective B2 Drugs:
Stimulate only B2 receptors
Include salbutamol (Ventolin)
```
62
B-Agonists: Mechanism of Action
Begins at the specific receptor stimulated
| Ends with the dilation of airways
63
B-Agonists: Indications
Relief of bronchospasms related to asthma, bronchitis, and other pulmonary diseases
Treatment and prevention of acute attacks
Treatment of hypotension and shock
To produce uterine relaxation and premature labour
Treatment of hyperkalemia ( stimulates potassium to shift into the cell)
64
B-Agonists: Adverse Effects (a-B epinephrine)
```
Insomnia
Restlessness
Anorexia
Vascular headache
Hyperglycemia
Tremor
Cardiac stimulation
```
65
B-Agonists: Adverse Effects (B1 + B2 isoproterenol)
```
Cardiac stimulation
Tremor
Vascular headache
Hypotension
Angina pain
```
66
B-Agonists: Adverse Effects (B2 salbutamol)
Hypo/hypertension
Vascular headache
Tremor
67
B- Agonists: Interactions
Interactions with various drugs may:
Increase risk for hypertension, cardiac toxicity
Require an adjustment to antihyperglycemic drugs
68
B-Agonist Derivatives: Nursing Implications
Encourage patients to take measures that promote a generally good state of health in order to prevent, relief, or decrease symptoms of COPD
- Avoid exposure to conditions that promote bronchospasms
- Take in adequate fluids
- Adhere to medical treatment
- Avoid excessive fatigue, heat, extremes in temperature, caffeine
Encourage patients to get prompt treatment for flu and other illnesses and to get vaccinated
Encourage patients to talk with their physician before taking any medications, including OTC
Patients should take medications exactly as prescribed, with no omissions and no double doses
Patients should report insomnia, jitteriness, restlessness, palpitations, chest pain or any change in symptoms
69
Anticholinergics: Mechanism of Action
Acetylcholine causes bronchial constriction and narrowing of the airways
Anticholinergics bind to the ACh receptors preventing them from binding
Result is that bronchoconstriction is prevented and airways dilate
70
Anticholinergics
Include ipratropium bromide (Atrovent) and and tiotropium (Spiriva)
Have a slow and prolonged action
Are used to prevent bronchoconstrition
Are not used for acute asthma exacerbations
71
Anticholinergics: Adverse Effects
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Dry mouth or throat
Nasal congestion
Heart palpitations
GI distress
Headache
Coughing
Anxiety
```
72
Bronchodilators: Xanthine Derivatives
The natural xanthines are the plant alkaloids caffeine, theobromine, and theophylline (Theolair and Uniphyl)
Only theophylline is used as a bronchodilator
73
Xanthine Derivatives: Mechanism of Action
Xanthine drugs increase levels of energy-producing cAMP by competitively inhibiting phosphodiesterase, the enzyme that breaks down cAMP
The result is decreased cAMP levels , smooth muscle relaxation, bronchodilation, and increased airflow
74
Xanthine Derivatives: Drug Effects
Stimulate cardiovascular system, increasing force of contraction and heart rate, resulting in increased cardiac output and blood flow to the kidneys (diuretic effect)
Cause bronchodilation by relaxing smooth muscle of airways
Stimulate CNS
75
Xanthine Derivatives: Indications
Dilation of airways in asthma, chronic bronchitis, and emphysema
Mild to moderate cases of acute asthma
Adjunct drug in the management of COPD
76
Xanthine Derivatives: Contraindications
```
Drug allergy
Uncontrolled cardiac dysrhythmias
Seizure disorders
Hyperthyroidism
Peptic Ulcers
```
77
Xanthine Derivatives: Adverse Effects
N/V, anorexia
GERD during sleep
Sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias
Transient increased urination
78
Xanthine Derivatives: Nursing Implications
```
Report to physician:
Palpitations
Weakness
Convulsions
N/V
Dizziness
Chest pain
```
79
Antileukotrienes
```
Also called leukotriene receptor antagonists (LRTAs)
Newer class of asthma medications
Currently available:
montelukast (Singular)
zafirlukast (Accolate)
```
80
Antileukotrienes: Mechanism of Action
Leukotrienes are substances released when a trigger starts a series of chemical reactions in the body
Leukotrienes cause inflammation, bronchoconstriction, and mucous production
The result is coughing, wheezing, and SOB
Antileukotriene drugs prevent leukotrienes from attaching to receptors on circulating immune cells and immune cells within the lungs
Inflammation in the lungs is blocked, and asthma symptoms are relieved
81
Antileukotrienes: Drug Effects
Prevent smooth muscle contraction of the bronchial airways
Decrease mucous secretion
Prevent vascular permeability
Decrease neutrophil and leukocyte infiltration to the lungs, preventing inflammation
82
Antileukotrienes: Indications
Used for prophylaxis and long term treatment of asthma in adults and children >12
Not meant for management of acute asthmatic attacks
83
Antileukotrienes: Adverse Effects
Headache
Nausea
Diarrhea
Liver dysfunction
84
Antileukotrienes: Nursing Implications
Ensure that the drug is being used for chronic management of asthma, not acute
Teach the patient the purpose of the therapy
Improvement should be seen in 1 week
Assess liver function prior to beginning therapy
Medications should be taken every night on a continuous schedule even if symptoms improve
85
Corticosteroids
Have anti-inflammatory effects
Are used for chronic asthma
Do not relieve symptoms of acute asthma attacks
Available in oral and inhaled forms
May take several weeks before effects are seen
86
Corticosteroids: Mechanism of Action
Stabilize membranes of cells (leukocytes or WBC) that release harmful bronchoconstricting substances
Increase responsiveness of bronchial smooth muscle to B-adrenergic stimulation
87
Inhaled Corticosteroids: Indications
Treatment of bronchospastic disorders that are not controlled by conventional bronchodilators
Not first line drugs for management of acute asthmatic attacks or status asthmaticus
88
Inhaled Corticosteroids: Contraindications
Hypersensitive in response to glucocorticoids
Sputum tests positive for Candida organisms
Systemic fungal infection
89
Inhaled Corticosteroids: Adverse Effects
Pharyngeal Irritation
Coughing
Dry mouth
Oral fungal infections
90
Inhaled Corticosteroids: Nursing Implications
Teach patients to gargle and rinse the mouth with lukewarm water afterward to prevent development of oral fungal infection
Bronchodilator should be used several minutes before corticosteroid to provide bronchodilation before administration of the corticosteroid
Teach patients to monitor disease with a peak flow meter
Encourage use of a spacer device to ensure successful inhalations
91
UTI: Urinalysis Results
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White and cloudy: Infection
Dark yellow to amber: dehydrated
Foul smell: Infection
Foamy or frothy: Proteins present
Casts: dehydration
```
92
S&S of UTI
Urinary Frequency
Urgency
Dysuria
Chills, fever, flank pain, and tenderness
93
Fosfomycin Antibiotics
Inhibits bacterial cell wall synthesis, reduces bacteria adherence to the urinary tract
First to be approved for as a single dose treatment for UTIs
N/D, flatulence, abdominal cramps
*Perineal burning, dysuria
94
Quinolone Antibiotics
Inhibit cell replication
Treat recurrent UTIs caused by E. coli and others
N/V, anorexia, abdominal cramps, flatulence, drowsiness, visual disturbance, photosensitivity
*Hematuria, perineal burning, urticaria, hives, headache, dizziness, photophobia, tinnitus
95
Quinolone Antibiotics
Used more commonly to treat gram negative bacteria
Should avoid direct sunlight
May enhance effects of warfarin
