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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
Q

Glucocorticoids Therapeutic action

A

Anti-inflammatory
Usually inhaled
Fixed schedule
Usually prophylaxis

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26
Q

Glucocorticoids Use

A

Most effective drug for long term control of airway inflammation
Suppresses inflammation
Reduced bronchial hyperreactivity
Decreased airway mucus production

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27
Q

Glucocorticoid Inhaled Use

A

1st line therapy for asthma
Use daily w/persistent asthma
More effective and safer than PO

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28
Q

Glucocorticoid Oral Use

A

Moderate to severe persistent asthma
Management of acute exacerbations in asthma and COPD
Treatment should be as brief as possible
Must taper off slowly

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29
Q

Glucocorticoid Contraindication

A

D/C long term therapy slowly
Will not abort an acute asthma attack
Inhaled is preferred over oral

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30
Q

Glucocorticoid A/E Inhaled

A

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

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31
Q

Glucocorticoid A/E Oral

A 
No significant A/E with doses less than 10 days
Adrenal suppression
Osteoporosis 
Hyperglycemia 
PUD
Growth suppression in children
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32
Q

Glucocorticoid Pt edu

A

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

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33
Q

Fluticasone Propionate Inhaled

A

Glucocorticoid
Flovent HFA is a MDI
Flovent Diskus is a DPI
Administered on a fixed schedule

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34
Q

Montelukast MOA

A

Leukotriene modifier

Leukotriene receptor blocker in the airway and proinflammatory cells such as eosinophils

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35
Q

Montelukast Use

A

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

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36
Q

Montelukast Drug interactions

A 
CYP3A4 inhibitors (no effect on warfarin or theophylline)
Phenytoin decreased effect of montelukast
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37
Q

Montelukast A/E

A

Neuropsychiatric effects
Mood changes
Suicidality
Depression

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38
Q

Montelukast Nursing considerations

A

Decrease asthma related nocturnal awakening
Improved morning lung function
Decreased need for SABA

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39
Q

Bronchodilators

A

Beta 2 adrenergic agonist

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40
Q

SABA Drugs

A

Albuterol

Levalbuterol

41
Q

LABA Drugs

A

Salmeterol

42
Q

Bronchodilators MOA

A

Sympathomimetic drugs that activate beta 2 adrenergic receptors
-activate the smooth muscle of the lung, promoting bronchodilation thus relieving bronchospasm

43
Q

SABA Use

A

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
Q

LABA Use

A

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
Q

SABA Route/Dose

A

Nebulizer, MDI, DPI

Can be used 3-4 x a day

46
Q

LABA Route/Dose

A

Inhaled, PO

Fixed schedule

47
Q

SABA A/E

A 
Tachycardia
Angina
Tremor 
Insomnia (albuterol) 
Less effects on the heart (Levalbuterol)
48
Q

LABA A/E Inhaled

A

Increased risk for death in asthma if monotherapy

49
Q

LABA A/E PO

A

Angina
Tachydysrhythmias
Tremor

50
Q

SABA Contraindication

A

Stable COPD – use LABA

51
Q

LABA Contraindication

A

Avoid monotherapy use

52
Q

SABA Nursing implementation

A

Step up therapy if using >2x/wk

53
Q

LABA Nursing implementations

A

Cannot stop acute attack

May need to increase frequency of dosing with continuous use

54
Q

Bronchodilators Nursing considerations

A

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
Q

Methylxanthines Drug

A

Theophylline

56
Q

Theophylline MOA

A

CNS excitation, bronchoconstriction

Relaxes smooth muscle in bronchi

57
Q

Theophylline Use

A

Prevents attacks (at night) and stable asthma
Chronic stable asthma
COPD

58
Q

Theophylline Drug interactions

A

Caffeine
Tobacco
Mj smoke

59
Q

Theophylline A/E

A 
Mild:
-N/V/D
-Insomnia
-Restlessness 
Severe: 
-Dysrhythmias 
-Convulsions
-Cardiopulmonary collapse → DEATH
60
Q

Theophylline Contraindications

A

Untreated seizure disorders or PUD

61
Q

Theophylline Caution

A

Heart disease
Liver/ Kidney dysfunction
Severe hypertension

62
Q

Theophylline Monitoring

A

Drug levels

LFT

63
Q

Anticholinergic Drug

A

Ipratropium

64
Q

Ipratropium MOA

A

Relieve bronchospasm

Muscarinic antagonist: blocks muscarinic cholinergic receptors in the bronchi

65
Q

Ipratropium Use

A

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
Q

Ipratropium A/E

A

Dry mouth
Pharynx irritation
Increase intraocular pressure
Cardiovascular (heart attack, stroke, death)

67
Q

Fluticasone Use

A

Most effective drug for prevention and treatment of allergic rhinitis
Congestion

68
Q

Fluticasone Dose

A

Daily not PRN

IN

69
Q

Fluticasone A/E

A 
Nasal mucosal drying
Burning/itching sensation 
Sore throat 
Epistaxis 
HA
Systemic effects are rare 
-adrenal suppression 
-decreased growth in children like with glucocorticoids
70
Q

Sympathomimetics Drugs

A

Phenylephrine

Pseudoephedrine

71
Q

Sympathomimetic IN/Topical MOA

A

Causes rapid and intense vasoconstriction which leads to reduced swelling of membranes and decreased nasal congestion

72
Q

Sympathomimetic Oral MOA

A

Causes prolonged and moderate vasoconstriction which leads to reduced swelling of membranes and leads to decreased nasal congestion

73
Q

Sympathomimetic MOA

A

Act on alpha 1 adrenergic receptors on nasal blood vessels

74
Q

Sympathomimetic Use

A

Decongestant

only relieve stuffiness

75
Q

Sympathomimetics IN/Topical Dosing

A

3-5 days only (rebound congestion)
Drops for Kids
Sprays are less effective than drops

76
Q

Sympathomimetics IN/Topical A/E

A

Rebound congestion

77
Q

Sympathomimetics Oral A/E

A 
Restlessness
Irritability 
Anxiety
Insomnia
Generalized vasoconstriction
78
Q

Sympathomimetics Oral Contraindications

A

HTN

79
Q

Phenylephrine Route

A

IN
PO
Fast /effective: topical
IV for hypotension

80
Q

Phenylephrine A/E

A

No abuse

First pass effect

81
Q

Pseudoephedrine Route

A

PO

82
Q

Pseudoephedrine A/E

A

Abuse

CNS stimulation is lower

83
Q

Pseudoephedrine Nursing considerations

A

Can be converted to meth
Restriction on purchase
More effective than phenylephrine

84
Q

Antitussives Drugs

A

Opioid: Codeine
Non Opioid: Diphenhydramine, Benzonatate
Dextromethorphan (DM): Most effective OTC

85
Q

DM MOA

A

Derivative from opioid

Blocks NMDA in the brain and spinal cord

86
Q

Benzonatate MOA

A

Decrease sensitivity of respiratory tract and decreasing cough

87
Q

Antitussives Use

A

Cough suppression for dry, non productive cough

88
Q

Antitussive Opioid A/E

A

Abuse

Respiratory depression

89
Q

Antitussive DM A/E

A

Increase doses can cause opioid like reaction

dont give with opioids

90
Q

Antitussive Benzonatate A/E

A 
Mild sedation 
Dizziness
Constipation
Seizure 
Dizziness
Death
91
Q

Antitussive Benzonatate Contraindications

A

<10yr

COPD

92
Q

Antitussive Benzonatate Pt edu

A

Swallow whole: can cause laryngeal spasm

93
Q

Expectorant Drug

A

Guaifenesin

94
Q

Guaifenesin MOA

A

Stimulates respiratory secretion making coughs more productive

95
Q

Guaifenesin Use

A

Thins mucus to make it easier to get out

96
Q

Guaifenesin A/E

A 
HA
N/V
Dizziness
Rash
Drowsiness
97
Q

Guaifenesin Drug interactions

A

Often combo with DM to help decrease irritation of cough

98
Q

Levalbuterol Use

A

Better for those with cardiac problems because it has less effects on the heart

99
Q

Omalizumab

A

2nd line treatment
Sub Q
Black box for anaphylaxis
For allergy induced asthma

Pharm Exam 3 (4 decks)

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