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Pharmacology N322 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

beta 2 adrenergic agonists

A
  • Mimic action of SNS
  • short and long term prevention of asthma
  • treat ongoing asthma exacerbations
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2
Q

Albuterol (Proventil, Ventolin)

A

■ Promote bronchodilation
■ Relive bronchospasms
■ Histamine release is inhibited
■ Ciliary motility is increased

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3
Q

Albuterol (Proventil, Ventolin)

Nursing Considerations

A

Tachycardia, heart palpitations, tremors, angina, avoid caffeine, can cause hypoglycemia
identify triggers.

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4
Q

Albuterol (Proventil, Ventolin)

Contraindications

A 
Tachydysrhythmias
DM
hyperthyroidism
Cardio disease
hypertension
angina
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5
Q

Albuterol (Proventil, Ventolin)

Interactions

A

Reduce beta blocker effectiveness
MAOI and TCA increase hypertension, tachy, angina
Hypoglycemics need increased dose

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6
Q

If taking a corticosteroid and a Beta 2 agonist, which should you take first?

A

Beta 2 Agonist

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7
Q

Ipratropium (atrovent), triatropium (spiria)

A

Anticholinergic

Blocks muscarinic receptor causing bronchodilations.

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8
Q

Ipratropium (atrovent), triatropium (spiria)

Use

A

Bronchospasm in patients with COPD

Not for acute symptoms

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9
Q

Ipratropium (atrovent), triatropium (spiria)

NS

A 
Dry mouth
hoarseness
IIOP
urinary retention
Inhaled: delay use of other inhalants for 5 minutes and rinse mouth after.
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10
Q

Ipratropium (atrovent), triatropium (spiria)

Contraindications

A

Glaucoma
Prostatic Hypertrophy
bladder neck obstruction

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11
Q

Ipratropium (atrovent), triatropium (spiria)

interactions

A

Enhance bronchodilation of Beta 2 adrenergic agonist

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12
Q

Theophylline (thelair)

A

– Long-term management and prevention of Chronic Asthma, Chronic Bronchitis, Emphysema as an adjunct
– Relax smooth muscles in Bronchi and pulmonary blood vessels
– Anti-inflammatory effects
– Narrow therapeutic range- too low- no benefit, too high-toxicity
– Metabolized to caffeine in the body
■ Think about coffee side effects

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13
Q

Theophylline (thelair)

Nursing considerations

A
  1. ABOVE therapeutic level – CNS stimulation
  2. Restlessness and insomnia
  3. Nausea, vomiting and diarrhea
  4. TOXIC level
  5. Seizures
  6. Dysrhythmias
  7. Monitor blood level
  8. Notify provider if elevated
  9. Target range is 5-15
  10. Activated charcoal MAY decrease absorption
  11. Monitor heart rate/rhythm
  12. Initial dose based on age, weight, and factors that affect metabolism
  13. Do not double next dose if a dose is missed
  14. Reduce/eliminate caffeine – Methylxanthine
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14
Q

Theophylline (thelair)

Contraindications

A
  1. Cardiac disorders that cannot withstand myocardial stimulation
  2. Heart disease
  3. Liver/renal dysfunction
  4. Acute pulmonary edema
  5. Hyperthyroidism
  6. Diabetes mellitus
  7. Peptic ulcer disease
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15
Q

Theophylline (thelair)

interactions

A

■ Cimetidine (Tagament), fluoroquinolones, caffeine = toxicity
■ Nicotine, phenobarbital, phenytoin (Dilantin) = Decrease blood levels

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16
Q

Glucocorticoid

A

– Suppresses inflammation
■ Prevents release of inflammation mediators (leukotrienes, prostaglandins, histamine)
■ Prevents action of white blood cells (Leukocytes, eosinophils)
– These processes decrease edema of airways

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17
Q

Glucocorticoid

Routes: inhaled

A

■ Long-term management of chronic asthma
■ Fluticasone propionate (Flovent)
■ Typically local infects

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18
Q

Glucocorticoid

Routes: Oral

A

■ Short-term management of post-exacerbation symptoms

■ Methylprednisolone (IV) or prednisone (PO)

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19
Q

Glucocorticoid

Routes: Nasal

A

■ Reduce inflammation and prevent and treat rhinitis
■ Fluticasone propionate (Flonase)
■ Local side effects

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20
Q

Glucocorticoid
Nursing consideration
Inhaled

A
  1. Oral candidiasis, hoarseness, and difficulty speaking
  2. Use spacer/give on a regular schedule
  3. Rinse mouth/gargle after use
  4. Initiate antifungal therapy when indicated
  5. DO NOT use for acute attack
  6. Give Beta2 Adrenergic agonist first
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21
Q

Glucocorticoid
Nursing consideration
Oral

A
  1. Suppresses adrenal function
  2. Muscle wasting and bone demineralization
  3. Hyperglycemia, peptic ulcer disease, infection and fluid/electrolyte imbalances
  4. Recommend lowest possible effective or alternate day dosing
  5. Taper dose—never stop abruptly
  6. Take drug with food or meals
  7. Recommend acetaminophen if NSAID is prescribed
  8. Monitor blood glucose levels
  9. Report polyphagia, polydipsia, polyuria
  10. Monitor for infection
  11. Monitor for signs of electrolyte imbalance
  12. Weight gain
  13. Edema
  14. Generalized weakness
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22
Q

Glucocorticoid
Nursing consideration
Nasal

A
  1. Dry mucous membranes, epistaxis, sore throat and headache
  2. Provide comfort measures
  3. Fluids, throat lozenges, hard candy, humidified air
  4. Acetaminophen for headache
  5. Expect therapeutic effect to take 2-3 weeks
  6. Use nasal decongestant if nares are completely blocked
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23
Q

Glucocorticoid

Contraindications

A
  1. Recent live virus immunization (oral)
  2. Systemic fungal infection (oral)
  3. Oral candidiasis (inhaled)
  4. Peptic ulcer disease
  5. Diabetes mellitus
  6. Hypertension
  7. Renal dysfunction
  8. Use of NSAIDs
24
Q

Glucocorticoid

interactions

A

■ Potassium depleting diuretics (furosemide) = hypokalemia
■ NSAIDs increase risk for GI bleed
■ Insulin and oral hypoglycemic effects are decreased

25
Q

Leukotriene modifier

A

– Long-term treatment of chronic asthma
– Prophylaxis for exercise-induced bronchospasm
– Management of allergic rhinitis

26
Q

Montelukast (singulair)

A

– Suppress inflammation by inhibiting the release of leukotrienes

27
Q

Montelukast (singulair)

NC

A

Headache
daily in the evening
Take 2 hours before exercising and do not repeat dose in 24 hours.

28
Q

Montelukast (singulair)

Contraindications

A

Acute asthma exacerbation
status asthmaticus
PKU
Severe asthma

29
Q

Montelukast (singulair)

Interactions

A

■ Phenobarbital and rifampin may require higher dosage

30
Q

epinephrine (epi-pen, adrenalin)

A

– MOA: nonselective adrenergic drug that stimulates alpha, beta 1, and beta 2 receptors in heart and lung tissue
– IM administration, to be carried with client at all times
– Side effects: insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, vascular headache
– Nursing: PREVENTION!, recognize symptoms, call EMS

31
Q

H1 receptor antagonist

A

Benadryl, dramamine

32
Q

sedating antihistamines

benadryl and drammamine

A 
–	Seasonal allergic reactions
–	Mild transfusion reactions
–	Urticaria (hives)
■	Management of severe Anaphylactic reactions
–	Hypotension
–	Acute laryngeal edema
–	Bronchospasms
■	Treatment of motion sickness and insomnia
33
Q

benadryl and drammamine

NC

A
  1. Drowsiness and dizziness
  2. Anticholinergic effects
  3. Dry mouth
  4. Constipation
  5. Urinary hesitancy
  6. GI discomfort – nausea vomiting
  7. Acute toxicity
  8. Adults
  9. Flushed face
  10. High fever
  11. Tachycardia
  12. Dry mouth
  13. Urinary retention
  14. Pupil dilation
  15. Children
  16. Excitation
  17. Hallucinations
  18. Seizures
34
Q

sedating antihistamines

addressing toxicity

A

Can administer activated charcoal and cathartics (laxatives to remove remaining drug from bowels)
Administer acetaminophen
Apply ice packs/give sponge baths
Anticipate the need for phenytoin IV if patient experiences seizures

35
Q

sedating antihistamine

Contraindications

A
  1. Newborns and children under 2 years
  2. Breastfeeding women (anticholinergics can dry up milk)
  3. Narrow-angle glaucoma
  4. Sudden/painful increase in IOP that can damage the optic nerve
  5. Prostatic hypertrophy
  6. Acute asthma exacerbation
  7. Children and older adults
  8. Patients with history of:
  9. Asthma
  10. Urinary retention
  11. Open-angle glaucoma
  12. Hypertension
  13. Impair Kidney function
36
Q

sedating antiH

Interactions

A

avoid alcohol and other CNS depressants

37
Q

Non-sedating antiH

A

Loratadine (claritin)
– Binds to H1 receptors blocking the release of histamine
– Does not cross the BBB
– Longer duration of action

38
Q

Non-sedating antiH

NC

A
  1. Drowsiness and fatigue (less than with diphenhydramine)
  2. Monitor during ambulation
  3. Avoid driving/activities that require mental alertness until effects are known
  4. Mild anticholinergic effects
  5. Dry mouth, nose, throat
  6. Encourage fluids
  7. Can give with or without food
  8. DON’T give with other OTC antihistamines
  9. Lower doses for patients with renal/liver function impairment
39
Q

non-sedating antiH

Contraindications

A
  1. Newborns under 6 months
  2. Breastfeeding women
  3. Allergies to H1 receptors
  4. Impaired Kidney/liver function
40
Q

Non-sedating antiH

Interactions

A

■ Theophylline can reduce clearance and lead to toxicity of antihistamines
■ Atropine may cause anticholinergic effects
■ Oral contraceptives

41
Q

■ Sympathomimetics (AKA alpha-adrenergic drugs)

A

– Reduces nasal congestion
– Allergic rhinitis
– Sinusitis
– Common cold

42
Q

■ Oxymetazoline (Afrin)

A

– Mimic SNS by activating alpha1-adrenergic receptors in the nose  vasoconstriction of blood vessels occur
– Turbinates shrink  open nasal passages

43
Q

Oxymetazoline (Afrin)

NC

A
  1. Related to CNS stimulation
  2. Agitation, anxiety, insomnia
  3. Systemic vasoconstriction, tachycardia and heart palpitations
  4. Administer only when needed and only recommended dose
  5. Advise patient of abuse potential
  6. Rebound nasal congestion because of short action
  7. Nasal glucocorticoid may minimize symptoms
44
Q

Oxymetazoline (Afrin)

Contraindications

A
  1. Chronic rhinitis
  2. Narrow-angle glaucoma
  3. Uncontrolled heart disease
  4. Hypertension
  5. Dysrhythmia
  6. Diabetes Mellitus
  7. Coronary artery disease
  8. Hypertension
  9. Older adults
45
Q

Oxymetazoline (Afrin)

Interactions

A

■ MAOI’s potentiate effects of sympathomimetics

■ Beta2 adrenergic agonists potentiate hypertensive effects

46
Q

antitussives

A

■ Antitussives

– Suppress chronic, nonproductive cough reflex in medulla

47
Q

Opioid (codeine)

A

Opioid (Codeine)

– Suppress cough center in CNS, increases viscosity of mucus

48
Q

Non-opioids

A

dextromethorphan (Delsym, Robitussin)
– benzonatate (Tessalon Perles)
■ Anesthetizes cough receptors in respiratory tract, prevent stimulation of cough center

49
Q

Antitussive

NC

A

CNS depression (less with dextromethorphan and benzonatate)

  1. Drowsiness, sedation – monitor when ambulating
  2. Dizziness/lightheadedness
  3. GI – nausea, vomiting, constipation
  4. Administer with food/milk
  5. Encourage fluids and fiber
  6. Respiratory depression
  7. Potential for abuse
  8. Use only when needed and lowest effective dose
50
Q

non-opioid

A
  1. CNS depression can occur with large doses OR concurrent
  2. GI – nausea, vomiting,
  3. Abuse potential
51
Q

Opioid contraindications

A
  1. Acute asthma
  2. Liver/renal disease
  3. Acute alcoholism
  4. All antitussives
  5. Reduced respiratory reserve (COPD)
  6. History of substance abuse
  7. Prostatic hypertrophy
  8. Opioid antitussives
  9. Children and older adults
52
Q

antitussive interaction

A

 Opioids + CNS depressants = increased CNS depression
 Non-opioid antitussives increase analgesic effects of opioid
 Nonopioid antitussives + MAOIs = fever, hypotension
 St. John’s Wort may increase sedation
 Head trauma

53
Q

Expectorants

A

Guaifenesin (mucinex)
– Reduce the surface tension of secretions which thins out thick mucus
– Makes secretions easier to remove

54
Q

Expectorants NC

A
  1. Dizziness, drowsiness
  2. Monitor when changing positions
  3. Avoid driving or mentally alert activities until side effects known
  4. GI – nausea and diarrhea
  5. Give with food or 8 oz of water
  6. Increase fluid intake
  7. Allergic reaction - rash
  8. Stop drug and use alternate drug
  9. Notify provider if fever worsens or develops
  10. Use only when needed
  11. Don’t give with combination products for colds that also contain guaifenesin
  12. Don’t chew/crush SR tablets
55
Q

expectorant

Contraindications

A
  1. Cough due to heart failure
  2. ACE inhibitor therapy
  3. Chronic cough
  4. Asthma
56
Q

expectorant

interactions

A

■ Increased risk of hemorrhage with heparin/warfarin and guaifenesin use – inhibits platelet function

Pharmacology N322 (11 decks)

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