Respi Flashcards
Codeine (opioid) dextromethorphan (nonopioid) Class/Use
Antitussive
Suppression of cough
Anittussive Adverse effects
CNS depress, dizzy, constipation with opioids
GI disturb
Antitussive Interventions
Monitor for CNS issues - respiratory - give narcan if needed
Take with food or milk
May need stool softener - high fiber
Antitussive Admin
short term use
use only when needed
Antitussive Teaching
Change positions slowly
avoid alcohol
don’t drive
Antitussive Contraindications
MAO inibi or SSRI
HX of substance abuse
prostatic hypertrophy
Antitussive Interactions
Alcohol other opioids - Ince CNS effect
St Johns wart inc sedation
Albuterol (short acting) Salmeterol (Long acting) Class and Use
Beta 2 Adrenergic Agonist
Relief of acute bronchospasm and prevent EIB - broncholdilation
Which Beta 2 albuterol or salmeterol?
depends on on the intended effect - fast relief (rescue inhaler) like for asthma or long term management like for COPD
Beta 2 - albuterol/salmeterol Adverse reactions
Chest pain, palpitations
* Nervousness, restlessness, tremors
Beta 2 - albuterol/salmeterol Interventions
Monitor for adverse reactions - dizzy, palpitations, chest pain tremors
Beta 2 - albuterol/salmeterol Admin
Short acting: for acute exacerbation Use long-acting preparations for long-term control.
* Inhale beta2-adrenergic agonists before inhaling glucocorticoids.
* Follow dosage limits and schedules.
* Watch for signs and triggers of impending exacerbations of asthma.
* Keep a log of the frequency and intensity of exacerbations.
* Notify the provider of changes in patterns of exacerbations.
Beta 2 - albuterol/salmeterol Teaching
avoid caffeine
don’t overuse rescue inhaler
report side effects
Beta 2 - albuterol/salmeterol Precautions
DM
CVD
HTN
Angina
Beta 2 - albuterol/salmeterol Interactions
MAOI and tricyclic antidepressant = inc risk of HTN, tacky and angina
Anti-diabetic drugs - require inc dosage because of hyperglycemic effect
Guaifenesin Class/use
Expectorant - Mucinex
Coughs related to viral upper respiratory infection
Guaifenesin Adverse Reaction
Dizziness, drowsiness, headache
* Gastrointestinal distress (nausea, diarrhea)
* Allergic reaction (rash)
Guaifenesin Interventions
Monitor clients when changing positions or ambulating.
* Give drug with food and/or 8 oz of water.
* Stop drug and recommend alternative therapy.
* Encourage fluid intake of 1,500 to 2,000 mL daily
Guaifenesin Admin
use only when needed
watch for other OTC meds that contain same guaifenesin
Guaifenesin Teaching
Do not take before driving or activities requiring mental alertness.
* Sit or lie down if feeling lightheaded.
* Change positions gradually.
* Take the drug with food and/or 8 oz of water.
Guaifenesin Contraindicaitons
DM - due to sugar content
PKU
Diphenhydramine (Benadryl) Class and use
1st generation antihistamine - sedating
Management of:
* Mild allergic reactions (seasonal allergic rhinitis, cough, urticaria, mild transfusion reaction)
* Anaphylaxis (hypotension, acute laryngeal edema, bronchospasm)
* Motion sickness
Diphenhydramine (Benadryl) Adverse Drug Reaction
Drowsiness, dizziness
* Anticholinergic effects (dry mouth, constipation)
Diphenhydramine (Benadryl) Interventions
Monitor the client when ambulating - Advise against driving or operating machinery requiring mental alertness.
* Encourage sips of water or sucking on hard candy.
* Give with food.
* Encourage high intake of fluids.
- Monitor for urinary retention.
Diphenhydramine (Benadryl) Admin
Do not crush or chew enteric-coated formulations.
* Do not take with alcohol or other CNS depressants.
Diphenhydramine (Benadryl) Teaching
Take the drug before or at bedtime.
Report difficulty urinating
Diphenhydramine (Benadryl) Contraindications
Newborns and children under 2 yr
* Breastfeeding women
* Narrow-angle glaucoma
* Prostatic hypertrophy
* Acute asthma exacerbation
Diphenhydramine (Benadryl) Interactions
Alcohol and other CNS depressants increase depressant effects of antihistamines.
Cetirizine (Zyrtec) Class/Use
2nd Generation non sedating antihistamine
Management of:
* Allergic rhinitis
Cetirizine (Zyrtec) Adverse Reaction
drowsy in high doses
anticholinergic effects - not as bas as Benadryl
Cetirizine (Zyrtec) Interventions
Monitor the client when ambulating.
* Provide water and encourage frequent sips.
* Encourage intake of 1,500 to 2,000 mL daily
* Provide hard candy to suck on.
Cetirizine (Zyrtec) Teaching
Take 1 x per day
Cetirizine (Zyrtec) Interactions
Theophylline
Other sedatives/alcohol = CNS depress
beclomethasone dipropionate (QVAR)/ fluticasone (Flovent) prednisone and Fluticasone (Flonase) class/use
Inhaled Glucocorticoid - QVAR and Flovent
Oral Glucocorticoid - Prednisone
Nasal Glucocorticoid - Flonase
Long-term management of chronic asthma
* Short-term management of post-exacerbation symptoms (oral)
Glucocorticoid Adverse Reaction
Inhaled = oral candidiasis
Oral - suppression of adrenal function
Nasal - dry mucus membranes, sore throat
All - bone demineralization/muscle wasting
Fluid and electrolyte imbalance
hyperglycemia
infection
Headache
Glucocorticoid Interventions
Spacer for inhaled
Alternate day dosing for oral
give with food or meals
observe for infection
water and hard candy
Glucocorticoid Admin
Inhaled: use on reg schedule - not for acute attack
Inhaled: use after beta 2 inhaler
Oral: taper dose , long term = alternate day dosing
Nasal: nasal metered dose device, use nasal decongestant first if blocked
Glucocorticoid Teaching
Rinse mouth/gargle after inhaler
Never stop abruptly
Perform weight bearing exercise
Glucocorticoid Contraindicaitons
Recent live vaccines
fungal infections
oral candidiasis
Glucocorticoid Interactions
furosemide (Lasix) increase risk of hypokalemia.
* NSAIDs increase risk of gastrointestinal bleeding.
* Effects of insulin and oral hypoglycemics are decreased.
Ipratropium (Atrovent) Class/Use
Inhaled Anticholinergics
Relief of bronchoconstriction in clients who have COPD
* Decreases secretions in clients with COPD
Ipratropium Adverse Reactions
Dry mouth, irritation of the pharynx
* Increased intraocular pressure
* Urinary retention
Ipratropium Interventions
Provide water and hard candy to client
* Schedule routine testing for glaucoma.
* Monitor urinary elimination patterns, especially in older adults.
Ipratropium Admin
Allow the prescribed time between puffs.
* Delay use of other inhalants for 5 minutes.
* Do not use as an emergency rescue medication.
* Rinse the mouth after use to reduce unpleasant taste.
Ipratropium Precautions
Glaucoma
* Prostatic hypertrophy
* Bladder neck obstruction
Montelukast (Singular) Class/Use
Leukotriene Modifier
Adjunctive therapy in the treatment of allergic rhinitis, asthma, and exercise induced bronchospasm
Montelukast (Singular) Adverse Reaction
Neuropsychiatric effects such as suicidal ideations
Montelukast (Singular) Interventions
Observe for behavioral changes
Montelukast (Singular) Admin
Take once daily in evening
take 2 hrs before exercise for EIP - do not repeat dose for 24 hrs
Montelukast (Singular) Contraindications
Acute asthma exacerbations
* Status asthmaticus
Cromolyn Class/Use
Mast cell stabilizer
Long-term treatment of allergy-related asthma
* Prophylaxis for exercise-induced bronchospasm
* Prophylaxis for seasonal allergy symptoms
* Management of allergic rhinitis (intranasally)
Cromolyn Admin
Use with a nebulizer or metered-dose inhaler.
* Expect several weeks of use for full effects to become apparent.
* Administer four times daily on a fixed schedule.
* Use the inhaler 15 min before exercising to prevent exercise- induced bronchospasm (EIB)
* Do not use to relieve an acute asthma exacerbation.
Theophylline Class/Use
Methylxanthines
Long-term management of chronic asthma
Theophylline Adverse Drug Reaction
Rare at therapeutic levels
N/V/D and dysrhymias when levels get high
Toxic levels = seizures
Theophylline Interventions
Monitor plasma drug levels.
* Give activated charcoal to decrease absorption - toxic
* Prepare to initiate anticonvulsant therapy and institute seizure precautions.
* Monitor heart rate and rhythm.
* Give antidysrhythmics to restore heart rate and rhythm.
Theophylline Teaching
Reduce or eliminate caffeine intake.
* Have periodic laboratory testing of drug levels.
Theophylline Contraindications
Clients with impaired metabolism
* Tobacco or marijuana use
* Caffeine
Theophylline Interactions
caffeine increase the risk of toxicity.
* Phenobarbital, phenytoin (Dilantin), and nicotine increase metabolism of theophylline.
Acetylcysteine Class/Use
Mucolytic
Decrease viscosity of mucous secretions
* Reverse acetaminophen (Tylenol) overdose
Acetylcysteine Adverse Reactions
bronchospasm
* Gastrointestinal distress due to rotten-egg smell of drug and ingestion of secretions (nausea, vomiting)
Acetylcysteine Interventions
Monitor respiratory status.
Administer bronchodilator as needed.
* Have suction available.
* Administer antiemetic as needed.
Acetylcysteine Admin
Give via nebulizer that does not contain metal or rubber parts or direct instillation into tracheostomy tube.
* Clear the airway before aerosol administration-
* Assess the client’s ability to cough before administration.
* Expect a sulfur-like (rotten egg) odor.
Acetylcysteine Teaching
lots of water
Acetylcysteine Contra and precautions
gastric bleeding
asthma or hx of bronchospasm
Acetylcysteine Contra and precautions
gastric bleeding
asthma or hx of bronchospasm
Phenylephrine Class/Use
Sympathomimetics
Allergic rhinitis, sinusitis, and the common cold
Phenylephrine Adverse Reactions
CNS stimulation with oral agents (agitation, anxiety, insomnia)
* Increased blood pressure
* Tachycardia/palpitations
* Rebound congestion with prolonged use of topical agents
Phenylephrine Interventions
Monitor for agitation, anxiety, and insomnia.
* Administer a mild hypnotic or sleep aid.
* Monitor blood pressure and heart rate.
Phenylephrine Admin
Only when needed
topical - no more than 3-5 days or rebound congestion
Phenylephrine Teaching
- Report prolonged tachycardia or heart palpitations.
- Do not use for more than 3 to 5 days.
- Taper and discontinue the drug using one nostril at a time.
Phenylephrine Contraindications
Chronic rhinitis
* Narrow angle glaucoma
* Uncontrolled heart disease, dysrhythmia, or hypertension
Phenylephrine Interactions
MAOI
Beta 2 agonist/ other stimulants = inc HTN
Neuromuscular Blocking Agents Meds
What do they do?
Rocuronium
Vecuronium
Pancuronium
Nondepolarizing neuromuscular blocking agents block acetylcholine (ACh) at the neuromuscular junction, resulting in muscle relaxation and hypotension. They do not cross the blood-brain barrier, so complete paralysis is achieved without loss of consciousness or decreased pain sensation.
Neuromuscular Blocking Agents Meds used
control spontaneous respiratory movements in clients receiving mechanical ventilation.
● Neuromuscular blocking agents are used during endotracheal intubation and endoscopy.
Neuromuscular Blocking Agents Meds Complication
Resp arrest
Neuromuscular Blocking Agents for pain?
No, not anesthetics and therefore have no effect on hearing, thinking, or ability to feel pain.
