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Pharm Exam 3 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Asthma in Pregnancy increases the risk for:

A

preterm birth, intrauterine growth restriction, pregnancy-induced hypertension, preeclampsia, congenital malformations of nervous, respiratory and digestive systems at birth and respiratory disease later

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2
Q

Treatment Goal for COPD

A

Improve the patients health status and exercise tolerance

Reduce risks and mortality by preventing progression of COPD and preventing and managing exacerbations

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3
Q

Seasonal allergic rhinitis

A

Usually in the fall and spring

Reaction to outdoor allergens

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4
Q

Perennial allergic rhinitis

A

Non seasonal

Reaction to indoor allergens

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5
Q

Other Meds/ Combos for allergic rhinitis

A 
Antihistamine/Sympathomimetic 
Antihistamine/Glucocorticoid 
Ipratropium 
Montelukast 
Omalizumab
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6
Q

Cold remedies Combo of:

A 
Nasal decongestant 
Antitussive
Analgesic
Antihistamine 
Caffeine
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7
Q

Cold remedies in Children

A

FDA does not recommend OTC cold remedies in children under 2
Measure carefully
Do not use to sedate children
Use only products labeled for pediatric use

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8
Q

Antihistamines Therapeutic effects

A

Prevents vasodilation → decreasing flushing
Decrease capillary permeability → decreases edema
Increased drowsiness
Decreased bronchoconstriction
Decreased itching, burning
Decreased mucus secretion

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9
Q

Antihistamine Use

A

Mild allergy/ season allergic rhinitis
Motion sickness
Insomnia
Common cold (sx management)

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10
Q

Severe allergy DOC

A

Epinephrine

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11
Q

Antihistamine Drug interactions

A 
ETOH
Barbiturates 
Benzo
Opioid
Sedatives
CNS depressants 
TCA
MAOI
Other ototoxic drugs
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12
Q

Antihistamine A/E

A 
Sedation
Dizziness
Confusion
Incoordination 
Fatigue
GI upset
Drying of mucous membranes 
Urinary retention (careful with BPH)
Constipation 
Palpitations
HTN 
Tachycardia
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13
Q

Promethazine A/E

A

Respiratory depression

Local tissue injury (IV, Give slowly)

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14
Q

Antihistamine Contraindication

A 
Pregnancy 
-fetal malformation 
-Benefit v risk
-XX 3rd trimester 
Lactation 
Acute toxicity
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15
Q

Antihistamine Acute toxicity

A 
Dilated pupils 
Flushed face
Hyperpyrexia
Tachycardia
Dry mouth 
Urinary retention 
In kids: CNS excitation (can progress to coma, cardiovascular collapse and death)
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16
Q

Antihistamine BEERS criteria

A

Highly anticholinergic
Clearance reduced with advanced age, and tolerance develops when used as hypnotic
Risk of confusion, dry mouth, constipation, and other anticholinergic effects or toxicity
Use of diphenhydramine in situations such as acute treatment of severe allergic reaction maybe appropriate

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17
Q

Antihistamine 1st generation

A

Sedation is common
Significant anticholinergic effects
Generally less expensive

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18
Q

Antihistamine 2nd Generation

A

Less sedating
Fewer anticholinergic effects
Usually more expensive

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19
Q

2nd Generation Antihistamine Drugs

A 
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Loratadine (Claritin)
Levocetirizine (Xyzal)
Desloratadine (Carinex) 
Azelastine (IN)
Olopatadine (IN)
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20
Q

Diphenhydramine

A

1st gen
Avoid as a sedative in children
Use lowest possible dose

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21
Q

Fexofenadine

A

OTC
Decrease dose in renal failure
Avoid fruit juice 4 hr before and 2 hr after
Good in combo and safe among other 2nd generations
Reduce dose in renal and hepatic impairment

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22
Q

Azelastine

A

IN 2nd generation

Causes drowsiness, nose bleeds, HA, and an unpleasant taste

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23
Q

Astelin Use

A

Not approved for children <12

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24
Q

Astepro Use

A

Approved for children 5-11

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25
Glucocorticoids Therapeutic action
Anti-inflammatory Usually inhaled Fixed schedule Usually prophylaxis
26
Glucocorticoids Use
Most effective drug for long term control of airway inflammation Suppresses inflammation Reduced bronchial hyperreactivity Decreased airway mucus production
27
Glucocorticoid Inhaled Use
1st line therapy for asthma Use daily w/persistent asthma More effective and safer than PO
28
Glucocorticoid Oral Use
Moderate to severe persistent asthma Management of acute exacerbations in asthma and COPD Treatment should be as brief as possible Must taper off slowly
29
Glucocorticoid Contraindication
D/C long term therapy slowly Will not abort an acute asthma attack Inhaled is preferred over oral
30
Glucocorticoid A/E Inhaled
Adrenal suppression Oropharyngeal candidiasis Dysphonia May slow growth in children but not height Bone loss with long term use Glaucoma and cataracts with continuous use of high doses
31
Glucocorticoid A/E Oral
``` No significant A/E with doses less than 10 days Adrenal suppression Osteoporosis Hyperglycemia PUD Growth suppression in children ```
32
Glucocorticoid Pt edu
MDI: know how to use inhaler, and have hand/mouth coordination, if not use a spacer Respimat: rinse mouth after use DPI: must have lung capacity Nebulizer: can be used at home
33
Fluticasone Propionate Inhaled
Glucocorticoid Flovent HFA is a MDI Flovent Diskus is a DPI Administered on a fixed schedule
34
Montelukast MOA
Leukotriene modifier | Leukotriene receptor blocker in the airway and proinflammatory cells such as eosinophils
35
Montelukast Use
Prophylaxis/Maintenance for asthma in patients at least 1 yr old Prevention of exercise induced bronchospasm in patients at least 15 y/o Relief of allergic rhinitis
36
Montelukast Drug interactions
``` CYP3A4 inhibitors (no effect on warfarin or theophylline) Phenytoin decreased effect of montelukast ```
37
Montelukast A/E
Neuropsychiatric effects Mood changes Suicidality Depression
38
Montelukast Nursing considerations
Decrease asthma related nocturnal awakening Improved morning lung function Decreased need for SABA
39
Bronchodilators
Beta 2 adrenergic agonist
40
SABA Drugs
Albuterol | Levalbuterol
41
LABA Drugs
Salmeterol
42
Bronchodilators MOA
Sympathomimetic drugs that activate beta 2 adrenergic receptors -activate the smooth muscle of the lung, promoting bronchodilation thus relieving bronchospasm
43
SABA Use
Abort asthma attack Prevention of exercise induced bronchospasm Long term/short term control (albuterol) Take before exercise induced bronchospasm (levalbuterol) Works for 2-4 hr
44
LABA Use
Long term control for pt who have frequent asthma attacks Must be combo therapy in asthma with glucocorticoids Stable COPD Works for about 24 hr
45
SABA Route/Dose
Nebulizer, MDI, DPI | Can be used 3-4 x a day
46
LABA Route/Dose
Inhaled, PO | Fixed schedule
47
SABA A/E
``` Tachycardia Angina Tremor Insomnia (albuterol) Less effects on the heart (Levalbuterol) ```
48
LABA A/E Inhaled
Increased risk for death in asthma if monotherapy
49
LABA A/E PO
Angina Tachydysrhythmias Tremor
50
SABA Contraindication
Stable COPD -- use LABA
51
LABA Contraindication
Avoid monotherapy use
52
SABA Nursing implementation
Step up therapy if using >2x/wk
53
LABA Nursing implementations
Cannot stop acute attack | May need to increase frequency of dosing with continuous use
54
Bronchodilators Nursing considerations
Symptomatic relief of asthma and COPD Do not alter the underlying inflammation Usually adjunct therapy Monotherapy in mild asthma with infrequent attacks Includes beta 2 adrenergic agonist, methylxanthines, and anticholinergic drugs
55
Methylxanthines Drug
Theophylline
56
Theophylline MOA
CNS excitation, bronchoconstriction | Relaxes smooth muscle in bronchi
57
Theophylline Use
Prevents attacks (at night) and stable asthma Chronic stable asthma COPD
58
Theophylline Drug interactions
Caffeine Tobacco Mj smoke
59
Theophylline A/E
``` Mild: -N/V/D -Insomnia -Restlessness Severe: -Dysrhythmias -Convulsions -Cardiopulmonary collapse → DEATH ```
60
Theophylline Contraindications
Untreated seizure disorders or PUD
61
Theophylline Caution
Heart disease Liver/ Kidney dysfunction Severe hypertension
62
Theophylline Monitoring
Drug levels | LFT
63
Anticholinergic Drug
Ipratropium
64
Ipratropium MOA
Relieve bronchospasm | Muscarinic antagonist: blocks muscarinic cholinergic receptors in the bronchi
65
Ipratropium Use
Approved for COPD Off label use for Asthma (allergy induced, exercise induced) Can be used with albuterol due to different MOA to help with severe asthma attack
66
Ipratropium A/E
Dry mouth Pharynx irritation Increase intraocular pressure Cardiovascular (heart attack, stroke, death)
67
Fluticasone Use
Most effective drug for prevention and treatment of allergic rhinitis Congestion
68
Fluticasone Dose
Daily not PRN | IN
69
Fluticasone A/E
``` Nasal mucosal drying Burning/itching sensation Sore throat Epistaxis HA Systemic effects are rare -adrenal suppression -decreased growth in children like with glucocorticoids ```
70
Sympathomimetics Drugs
Phenylephrine | Pseudoephedrine
71
Sympathomimetic IN/Topical MOA
Causes rapid and intense vasoconstriction which leads to reduced swelling of membranes and decreased nasal congestion
72
Sympathomimetic Oral MOA
Causes prolonged and moderate vasoconstriction which leads to reduced swelling of membranes and leads to decreased nasal congestion
73
Sympathomimetic MOA
Act on alpha 1 adrenergic receptors on nasal blood vessels
74
Sympathomimetic Use
Decongestant | only relieve stuffiness
75
Sympathomimetics IN/Topical Dosing
3-5 days only (rebound congestion) Drops for Kids Sprays are less effective than drops
76
Sympathomimetics IN/Topical A/E
Rebound congestion
77
Sympathomimetics Oral A/E
``` Restlessness Irritability Anxiety Insomnia Generalized vasoconstriction ```
78
Sympathomimetics Oral Contraindications
HTN
79
Phenylephrine Route
IN PO Fast /effective: topical IV for hypotension
80
Phenylephrine A/E
No abuse | First pass effect
81
Pseudoephedrine Route
PO
82
Pseudoephedrine A/E
Abuse | CNS stimulation is lower
83
Pseudoephedrine Nursing considerations
Can be converted to meth Restriction on purchase More effective than phenylephrine
84
Antitussives Drugs
Opioid: Codeine Non Opioid: Diphenhydramine, Benzonatate Dextromethorphan (DM): Most effective OTC
85
DM MOA
Derivative from opioid | Blocks NMDA in the brain and spinal cord
86
Benzonatate MOA
Decrease sensitivity of respiratory tract and decreasing cough
87
Antitussives Use
Cough suppression for dry, non productive cough
88
Antitussive Opioid A/E
Abuse | Respiratory depression
89
Antitussive DM A/E
Increase doses can cause opioid like reaction | dont give with opioids
90
Antitussive Benzonatate A/E
``` Mild sedation Dizziness Constipation Seizure Dizziness Death ```
91
Antitussive Benzonatate Contraindications
<10yr | COPD
92
Antitussive Benzonatate Pt edu
Swallow whole: can cause laryngeal spasm
93
Expectorant Drug
Guaifenesin
94
Guaifenesin MOA
Stimulates respiratory secretion making coughs more productive
95
Guaifenesin Use
Thins mucus to make it easier to get out
96
Guaifenesin A/E
``` HA N/V Dizziness Rash Drowsiness ```
97
Guaifenesin Drug interactions
Often combo with DM to help decrease irritation of cough
98
Levalbuterol Use
Better for those with cardiac problems because it has less effects on the heart
99
Omalizumab
2nd line treatment Sub Q Black box for anaphylaxis For allergy induced asthma

Pharm Exam 3 (4 decks)

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