Respiratory Flashcards
albuterol: class
Beta2 -Adrenergic Agonist
albuterol: EPA
Stimulates beta2-adrenergic receptors in the smooth muscle of the bronchi and bronchioles, resulting in bronchodilation.
albuterol: use
Rescue medication used to treat or prevent bronchospasm in people with asthma or other obstructive airways diseases.
albuterol: administration
inhaled via MDI or nebulizer
albuterol: ADRs
MDI-fewer systemic effects
higher doses can cause more systemic effects Chest pain, palpitations, nervousness, restlessness, tremors and agitation.
albuterol: contraindications
Cardiac tachydysrhythmias
Severe CAD
MAOIs & tricyclic antidepressants increase risk of HTN, tachycardia, & angina
albuterol: RN intervention
Prevention is key
Get the flu shot!
Asthma attack - short acting bronchodilators
Inhale short acting inhaler first and then long-acting steroid inhaler (glucocorticoid)
Common cause of asthma attack is not taking medications correctly
Keep rescue inhaler with you at all times
Drink 2 to 3 quarts of fluids to help thin secretions
Use MDI and spacer correctly
Avoid caffeine
Report chest pain and heart palpitations
Beta2 - Adrenergic Agonist: medications
albuterol (Proventil, Ventolin) - short acting
form
formoterol (Foradil Areolizer) & salmeterol (Serevent) - long acting
Proper way to use a Meter Dose Inhaler (MDI)
Shake well immediately before each use
Exhale to the end of a normal breath
While pressing down on the inhaler, take a slow, deep breath for 3 to 5 seconds, hold the breath for approximately 10 seconds, and exhale slowly
Wait 5 minutes before taking a second inhalation of the drug
Rinse mouth with water after each use
Rinse the mouth piece and store the inhaler away from heat
Use a spacer if having difficulty using inhaler
ipratropium (Atrovent): class
inhaled anticholinergic
ipratropium (Atrovent): EPA
Blocks the muscarinic Ach receptors in the smooth muscles of the bronchi in the lungs, inhibiting bronchoconstriction and mucus secretion (very similar to atropine)
ipratropium (Atrovent): Use
Long-term management of asthma or other conditions (COPD)that cause bronchoconstriction and increase in secretions.
ipratropium: ADR
Dry mouth, increased intraocular pressure & urinary retention
ipratropium: contraindications
Glaucoma, BPH, and bladder neck obstruction
ipratropium: RN interventions
Dry mouth-encourage water and hard candy to treat
Monitor urinary elimination patterns
Schedule regular eye examinations-monitor for glaucoma
Educate client on how to administer inhaler (slide 9&10)
ipratropium: administration
inhaled vis MDI or nebulizer
theophylline (Theolair): Class
Methylxanthines
theophylline (Theolair): EPA
Relaxes the bronchial smooth muscle, promoting bronchodilation.
theophylline (Theolair): Use
Second line treatment for chronic lung disorders that cause bronchoconstriction (COPD) *EBP no longer recommends to use to treat COPD
theophylline (Theolair): ADRs
Tachycardia, agitation and seizures. Toxicity-Ventricular dysrhythmias or convulsions
theophylline (Theolair): contraindications
heart disease, liver dysfunction and use with caution with seizure disorders
theophylline (Theolair): RN Interventions
need to monitor serum blood levels because there is a narrow therapeutic range
beclomethasone (QVAR): class
inhaled glucocorticoid, long-term control for asthma
beclomethasone (QVAR): EPA
Suppress the release of inflammatory mediators and decrease the recruitment of airway eosinophils. Increases the number and sensitivity of beta2-adrenergic bronchodilators.
beclomethasone (QVAR): Use
Prophylactic management of asthma with inhaled steroids. Acute asthma flare-ups, systemic corticosteroids used
beclomethasone (QVAR): administration
inhaled orally or nasally
beclomethasone (QVAR): ADRs
Pharyngitis, cough, dry mouth, and candidiasis (thrush)
beclomethasone (QVAR): contraindications
recent live virus immunization and oral candidiasis
beclomethasone (QVAR): RN Interventions
Rinse the mouth and throat with water after using inhaler
Use a spacer
Educate client on how to administer inhaler
prednisone: class
glucocorticoids
prednisone: other medications
methylprednisone-IV
prednisone: EPA
Multiple mechanisms of action and each one varies depending on the cell tissue. All affect the inflammatory process to reduce inflammation.
prednisone: Use
Decreases inflammatory symptoms and alters the immune response produced by nonendocrine disorders. Used to treat:
Asthma
COPD
Arthritis
Rhinitis
Cancer
Inflammatory bowel disease
Spinal cord injury
Prevention of acute adrenocortical insufficiency
prednisone: ADRs
- CNS stimulant (jittery inside)
- Insomnia
- Adrenocortical insufficiency: Fainting, Weakness, Hypotension
- Adrenocortical excess
- Cardiovascular symptoms: Heart failure, Shock, Cardiac dysrhythmias
- Increase appetite (weight gain)
- Hyperglycemia - monitor diabetes patients
- Immunosuppressive-delayed wound healing more susceptible to infection.
- Bone disease
- Very fragile skin…paper thin
prednisone: Contraindication
Immunosuppression, live vaccines, systemic fungal infections, and antibiotic-resistant infections
prednisone: RN Intervention
Treats symptoms, does not cure underlying disease
Take as directed, DO NOT stop taking abruptly
Tapered off
Take with food
Educate on numerous ADRs
montelukast (Singulair): Class
anti-inflammatory/ Leukotriene Modifiers
montelukast (Singulair): EPA
Prevents leukotrienes from binding to its receptors - reducing bronchoconstriction, inflammation, and mucus production
montelukast (Singulair): Use
Used in patients with asthma that do not respond to other treatments. Used as a long acting antiasthmatic med. Only tablet approved for exercise-induced asthma. Can also treat allergies.
montelukast (Singulair): ADR
behavioral changes, Black Box Warning (Neuropsychiatric events)
montelukast (Singulair): BLACK BOX WARNING
Neuropsychiatric events have been reported in patients that take this drug (aggressive behavior, hallucinations, insomnia and suicidal ideation).
montelukast (Singulair): contraindications
liver disease
montelukast (Singulair): RN interventions
Not used to manage acute asthma attacks
Take 2 hours before exercise to prevent exercise induced bronchoconstriction
Take in evening daily to treat allergies
diphenhydramine (Benadryl): Class
first generation/ sedating antihistamines
diphenhydramine (Benadryl): use
treat allergic reactions, anaphylaxis, motion sickness, insomnia
diphenhydramine (Benadryl): EPA
Structurally like histamine and occupy the same receptor sites preventing histamine acting on target tissues and thus preventing histamine response. Binds to central H1 receptors.
diphenhydramine (Benadryl): ADR
CNS depression=drowsiness & sedation, paradoxical effect causing CNS stimulation and anticholinergic effects, Can cause: Dry mouth, Urinary retention, Constipation, Blurred vision
diphenhydramine (Benadryl): Contraindications
Newborns and children < 2 years old
Breastfeeding women
Do not take with ETOH or other CNS depressants
diphenhydramine (Benadryl): RN interventions
Do not take with ETOH or other CNS depressants
Use with caution in older adults
Assess LOC
Advise against driving and operating machinery requiring mental alertness
cetirizine (Zyrtec): class
second generation/ non-sedating antihistamines
cetirizine (Zyrtec): other medications
loratadine (Claritin)
fexofenadine (Allegra)
cetirizine (Zyrtec): Use
seasonal allergies, minor allergies, and urticaria
cetirizine (Zyrtec): EPA
Binds to histamine receptors to prevent histamine response, but binds to peripheral, not central H1 receptors. Therefore, does not cause drowsiness like the first-generation agents
cetirizine (Zyrtec): ADR
Drowsiness & fatigue (higher doses), and anticholinergic effects
cetirizine (Zyrtec): contraindications
breastfeeding, impaired kidney or liver function
cetirizine (Zyrtec): RN Interventions
take once a day, take with water
phenylephrine (Neo-Synephrine): class
sympathomimetics - nasal decongestants
phenylephrine (Neo-Synephrine): other medications
pseudoephedrine (Sudafed)
phenylephrine (Neo-Synephrine): Use
relieved pressure, swelling and congestion of the nasal mucosa
phenylephrine (Neo-Synephrine): EPA
Alpha1-adrenergic agonist, causes vasoconstriction of the blood vessels… causing the nasal turbinates’ in the nares to shrink, in turn opening nasal passages and relieving nasal congestion.
phenylephrine (Neo-Synephrine): ADRs
CNS excitation=tachycardia, insomnia, dizziness, palpitations, urinary retention
phenylephrine (Neo-Synephrine): Contraindications
Uncontrolled heart disease
Dysrhythmia
HTN
Narrow angle glaucoma
Older adults
Caffeine may increase effect
phenylephrine (Neo-Synephrine): RN Interventions
Do not use for more than 3 to 5 days
Assess for cardiac symptoms
Educate about rebound effect
Multiple drug interactions
What is pseudoephedrine misuse?
it is an ingredient in methamphetamine production and has high risks of hypertension and dysthymias
dextromethorphan (Delsym): Class
antitussives - nonnarcotic
dextromethorphan (Delsym): other medications
benzonatate (Tessalon)
dextromethorphan (Delsym): Use
to suppress nonproductive cough
dextromethorphan (Delsym): EPA
depress the cough reflex in the brain
dextromethorphan (Delsym): ADRs
CNS depression - drowsiness and sedation
dextromethorphan (Delsym): contraindications
MAOIs, SSRIs, ETOH use
dextromethorphan (Delsym): RN Interventions
look out for medication interactions and avoid alcohol
codeine: class
antitussives - narcotic
codeine: use
relief of cough
codeine: EPA
depresses the cough reflex in the brain
codeine: Administration
PO, usually combined with acetaminophen in liquid form (Tylenol #3)
codeine: ADRs
N/V, respiratory sedation, constipation, dizziness
codeine: Contraindications
Any respiratory impairments
Head injuries
Seizure disorders
ETOH
codeine: RN Interventions
assess GI and respiratory status, avoid in patients with asthma or head injuries
guaifenesin (Mucinex): Class
expectorants - loosening mucus
guaifenesin (Mucinex): use
loosens mucus from respiratory tract in a productive cough
guaifenesin (Mucinex): EPA
reduced viscosity of secretions
guaifenesin (Mucinex): ADRs
dizziness, drowsiness, headache, skin rash
guaifenesin (Mucinex): contraindications
inability to expectorate
guaifenesin (Mucinex): RN Interventions
Give med with food and water
Hydration
Swallow tablets whole
Change positions carefully
acetylcysteine (Acetadote): Class
Mucolytic - liquifying mucus
acetylcysteine (Acetadote): Use
liquify mucus in the respiratory tract
acetylcysteine (Acetadote): EPA
attacks protein bonds in the mucus reducing viscosity
acetylcysteine (Acetadote): ADRs
Bronchospasm, GI distress (due to rotten egg smell and ingestion of secretions)
acetylcysteine (Acetadote): contraindications
inability to expect secretions, asthma
acetylcysteine (Acetadote): RN Interventions
Assess respiratory status: Difficulty breathing? Bronchospasm? Inability to expel secretions
Hydration
Report difficulty breathing or worsening cough
