Respiratory Flashcards
What do adrenergic drugs stimulate?
beta 2- adrenergic receptors of the sympathetic nervous system
What are some side effects of beta 2- adrenergic drugs?
tachycardia, heart palpitations, tremors, and angina with those with compromised cardiac blood vessels.
What disorders are inhaled anticholinergics used for?
those with COPD
What are the expected actions of anticholinergics?
inhibit acetylcholine, which causes vasoconstriction of the bronchioles and blocks the stimulation of parasympathetic receptors.
How do glucocorticoids help chronic asthma?
They suppress the immune system including decreasing inflammation in the airway by preventing the release of leukotrienes, prostaglandins, and histamine, which mediate inflammation.
What can mast cell stabilizers be used for?
Allergic rhinitis and chronic allergies.
Which generation antihistamines caused sedation?
First gen, the older of two types
What can first gen antihistamines be used for?
insomnia, allergic and anaphylactic reactions
What receptors do antihistamines bind to?
H1 receptors to block the release of histamine
What are second-gen antihistamines used for?
chronic and/or idiopathic urticaria
Why don’t second-gen antihistamines cause drowsiness?
they antagonize histamine effects without binding to or inactivating histamine like first-gen do
What are sympathomimetics for?
allergic rhinitis, sinusitis, and common cold.
What happens if a drug like sympathomimetics bind to alpha one-adrenergic receptors?
causes vasoconstriction
therefore nasal turbinates shrink, and relieves nasal congestion
What are antitussives used for?
Chronic nonproductive coughing related to allergies and other upper respiratory conditions
What is the pharmacologic action of opioid and nonopioid antitussives?
Suppress the cough reflex in the brain
What are expectorants used to treat?
Colds, other respiratory infections, and bronchitis to remove expectorants.
How does expectorants work?
reduces surface tension of secretions making it easy to cough out of the lungs and drain
Beta2 agonists and methylxanthines cause what in the airway?
cause bronchodilation by relaxing bronchial smooth muscle
A client says, “My doctor told me that I have COPD and might develop emphysema. I always thought I had chronic bronchitis.” How should the nurse respond to this statement?
“COPD is a combination of either asthma, chronic bronchitis, or emphysema.”
An 8-year-old child was just diagnosed with asthma. Which question is not pertinent for the nurse ask the child and parents during the admission assessment
1. “Have you eaten any new foods?”
2. “Were you exposed to anyone who smokes?”
3. “Have you had your carpet cleaned lately?”
4. “Have you grown taller since last year?”
5. “Has there been a change in laundry products recently?”
“Have you grown taller since last year?”
What symptoms should the nurse expect when a patient comes in with allergies?
Characterized by sneezing, watery eyes, and nasal congestion
What are some common suspects of allergic reactions?
Pollens from weeds, grasses, and trees
Mold spores; dust mites; certain foods
Animal dander
Genetic predisposition
What are some primary interventions and actions to take when someone has allergies?
Assess heart rate, respiratory rate, and lung sound
What are things that should the nurse look for if the patient has allergies?
Determine - patient is developing an allergic reaction
What are some things that you might tell the parent about adverse effects of H1 receptor agonists?
paradoxical CNS stimulation (opposite effect) and excitability/agitation in some children
What are some alternatives to H1 receptor antagonists?
You might need to give a second generation
What is the prototype drugs of H1 Receptor Antagonists?
diphenhydramine (Benadryl)
What are some adverse effects that people might face with diphenhydramine?
Significant drowsiness
Urinary retention/hesitancy?
What would you tell a patient who need to take Diphenhydramine long-term about their sleepiness?
Usually diminishes with long-term use and lessens within a few doses
What are four things you can’t do from anticholinergic effects?
No Seeing (blurred vision/ dizziness)
No Spitting (dry mouth)
No Peeing
No Pooping
What are some ADR from Diphenhydramine that you should report to the provider?
May experience anuria or oliguria
What is a physical assessment you would do for a patient on diphenhydramine?
Evaluate the bladder to check for distension for anuria
What are some things you would tell a patient on diphenhydramine to lessen their most urgent symptom?
Encourage patient to drink more fluids or ask if you can put in an IV for fluids
What are some ADR’s you should look for for with Sudafed P E Sinus and Allergy tablets?
Dysrhythmias- Normal rate with an irregular pattern 90 and irregular
How long should you give nasal decongestants to see results?
3-5 days
What may happen if a patient takes a nasal decongestant for too long?
Rebound nasal congestion if use is prolonged
Why should a patient stop using a nasal decongestant after a while?
congestion will clear up after stopping the spray.
What are some ADR’s that might happen if you take Oral Preparation Decongestants?
Can cause hypertension
What are the differences in the effects of taking an oral prep vs an intranasal decongestant?
The oral prep has more systemic effects
What is the prototype drug for intranasal corticosteroids?
fluticasone (Flonase)
What are some things that you should ask before someone takes Veramyst?
Are you pregnant?
What are some MOA of Benzonatate HCl ?
Suppresses the cough center in the medulla
Does not depress respiration.
Does not cause sedation, physical dependence, nor tolerance.
How does guaifenesin (Mucinex) work?
Loosen thick bronchial secretions - bronchial passages
Less thick and sticky and easier to cough up phlegm from the lungs
If a patient is taking Mucinex for a cold, what other teaching should you give?
Drink 8 glasses of water minimum a day
Drowsiness, dizziness, irritability and nausea can occur
What are some ADR of expectorants or mucolytics?
Drowsiness, dizziness, irritability and nausea can occur
What should you ask a patient before they take Dextromethorphan?
Ask them if they smoke or drink
How can you tell a patient is taking dextromethorphan and alcohol?
They report hallucinations and have slurred speech.
What are some patient teachings for Dextromethorphan?
Do not drink grapefruit juice while taking this medication, smoke, or drink
What kind of behavior should you report when someone is taking Dextromethorphan?
Slurred speech
What are some questions to figure out the triggers to asthma?
Have you eaten any new foods?
Are you exposed to anyone who smokes?
Have you had your carpet cleaned lately?
Has there been a change in laundry products recently?
What are the three goals of asthma drug therapy?
To terminate acute bronchospasms in progress (quick-relief/rescue medications)
To reduce the frequency of asthma attacks (long-acting medications)
Prevent asthmatic attacks
What are some lab assessment to monitor when a patient has albuterol?
serum electrolyte (Potassium)
serum glucose level
What are some types of albuterol?
ProAir H F A, Proventil, H F A, Ventolin H F A, VoSpire E R
What are some ADRs from overuse of albuterol?
Overdose results in an exaggerated sympathetic activation, causing dysrhythmias, hypokalemia, and hyperglycemia.
What must you inform the patient to get rid of bitter taste after ipratropium (Atrovent) use?
Rinse the mouth
What four drugs are used consistently and long term for asthma?
Corticosteroids
Mast cell stabilizers- Cromolyn (Intal)
Leukotriene modfiers
Anticholinergics
What is the most effective long-term anti-inflammatory medications for asthma?
Inhaled corticosteroids
What are some benefits of Inhaled corticosteroids over oral corticosteroids to deal with asthma?
fewer side effects than oral corticosteroids and most potent and consistently effective
What are inhaled corticosteroids used for?
Used for management of persistent asthma at all levels of severity to improve symptoms and pulmonary function.
What is a type of Mast Cell Stabilizers?
Cromolyn (Intal)
What type of Leukotriene modifier should you use for infants?
montelukast (Singulair)
What type of Leukotriene modifier should you use for those older than 7 y.o.?
zafirlukast (Accolate)
What is a type of anticholinergic for long-term management of asthma?
Spiriva® Respimat (tiotropium bromide)
What is the MOA for Spiriva® Respimat (tiotropium bromide)?
relaxes and dilates the bronchioles.
What would you assess for fungal infection of Beclomethasone?
Sore on tongue
White spots on tongue and oral mucous membranes
What are some signs of Candida albicans oropharyngeal) ?
Sore on tongue
White spots on tongue and oral mucous membranes
What are some questions to ask a patient on Beclomethasone for asthma?
Assess if the client has blown his nose prior to administration of nasal spray.
Assess if the client has had a change in taste.
Assess the client for any hoarseness or change in voice.
Tachycardia
What type of patient should you avoid giving Beclomethasone to? Why?
Do not give clients with an infection because corticosteroids can mask s/s of infection and are contraindicated if an active infection is present
What is a contraindication of Beclomethasone? Why?
Don’t give clients with an infection because corticosteroids can mask s/s of infection
What are some lab assessment for Montelukast?
CBC, liver levels, ALT
How would you teach the patient to take Montelukast?
Do not use ibuprofen or aspirin
Take in the evening preferably
What vitals should be monitored for Montelukast?
Respiratory and pulse rates, respiratory effort, lung sounds, Skin color and oxygen saturation level
What should you give for pain if a patient is taking Montelukast?
Tylenol because NSAIDS can be toxic
What is a reason you would tell an alcoholic not to drink when on Montelukast?
Chronic users of alcohol may not tolerate the medication because it is metabolized by the liver
What are two types of patients who should not take Leukotriene Therapy for Asthma?
Alcoholics and those with hepatic dysfunction
When should Montelukast be used?
Consistently, but not for acute attacks
Why should a person taking Methylxanthine Therapy for Asthma get decaf?
The medication is a a xanthine derivative, which can cause increased risk of toxicity and severe adverse effects
What are somethings a person should avoid when taking Methylxanthine Therapy for Asthma?
Avoid caffeine and smoking
Why should a person taking Methylxanthine Therapy for Asthma not smoke?
It increases the metabolism of theophylline so they Require a higher dose for therapeutic effects.
What is a side effect of increasing the dose of Methylxanthine Therapy for Asthma?
Headache and nausea
What should you inform the patient about the dose of taking Methylxanthine Therapy for Asthma?
It has a narrow therapeutic range - must be dosed carefully by the provider
What are some administration reminders to tell the patient taking Methylxanthine Therapy for Asthma?
GI symptoms are common side effects.
Take on empty stomach because food slows absorption
What are contraindicated with Methylxanthine Therapy for Asthma?
Stimulants – caffeine–causes toxicity and severe ADRs
Ephedra – potentiates theophylline–may increase SEs
What is some possible prescription for chronic bronchitis?
ipratropium bromide (Atrovent), albuterol (Proventil), and an inhaled glucocorticoid medication (steroid)
What is the order in which meds for chronic bronchitis are administered?
1st Beta agonist first
2nd ipratropium bromide
3rd Glucocorticoid steroi
Why is the order important when administering meds for chronic bronchitis
1st Beta agonist first- helps bronchioles dialate
2nd ipratropium bromide - Subsequent medications can be deposited in the bronchioles for improved effect.
3rd Glucocorticoid steroid
What are some types of Beta agonist?
Albuterol (Proventil, Ventolin)
What are some types of Glucocorticoid Steroids?
beclomethasone (Q V A R)
What are some types of Bronchodilators?
ipratropium bromide (Atrovent)
How do we know a COPD combo therapy is making the COPD better?
combined increase the forced expiratory volume in 1 second (FEV1)
What are two types of COPD drugs for the phlegm?
Mucolytics and expectorants
What is the combo therapy for COPD?
ipratropium bromide/albuterol sulfate (Combivent)
What is the prototype drug for anti-inflammatory drug for asthma and allergic rhinitis?
Beclomethasone (Q V A R)
What are some treatments for coughing and how would you teach them to the patient?
Antitussives (suppressant) inhibit cough by suppressing the cough center in the medulla
Opioids used to inhibit severe cough with sedation
Expectorants inhibit mucus production
If a patient has thick secretions in her cough, what should they take?
Expecorants or mucolytics
What are some opioids to give to a Severely coughing patient?
Codeine – causes sedation
hydrocodone combined with homatropine (Hycodan, others)Codeine – causes sedation
hydrocodone combined with homatropine (Hycodan, others)
What are some types of methylxanthine therapy for asmatics?
Theo 24, Theochron, Elixophyllin, aminophylline, and Uniphyl
What are some vital signs to monitor with methylxanthine?
HR, BP, RR, O2
What is the role of bronchodilators?
ipratropium bromide (Atrovent) gives epinephrine to dilate the bronchioles
What is the prototype drug for diphenhydramine?
Benadryl
What do antihistamines do?
Prevent the onset of allergies by blocking the H1 histamine receptor blocker
What are some nursing assessment on people taking diphenhydramine?
Evaluate the bladder to check for dissension for Anura
What are som ADR’s for diphenhydramine?
Anticholinergic: dry mouth, tachycardia, mild hypotension, drowsiness occasionally
What are some ADR’s in children for diphenhydramine?
Paradoxical CNS stimulation and excitability/agitation in some children
What might happen if someone takes Benadryl for too long?
The sleepiness symptoms go away or diminishes
How do intranasal corticosteroid medications work?
Decreases local inflammation in the nasal passages, thus, reducing nasal stuffiness
What is a question to answer before someone takes intranasal corticosteroids?
Ask if they are pregnant
What are some ADR’s of Fluticasone?
Nasal irritation and epistaxis
What is the prototype drug of Benzonatate HCI?
Thessalon Perles
What is an advantage of Thessalon Perles?
It does not depress respiration and only suppresses the cough center in the medulla. Also does not cause sedation, physical dependence, nor tolerance
What are two ways that guaifenesin works to help someone with a cold?
Inhibits mucus production so it is less thick and sticky and easier to cough up phlegm
Loosens thick bronchial secretions
What are some ADR’s of Mucinex?
Drowsiness, dizziness, irritability, and nausea
What are some type of nonopioid cough meds?
Delysm
Robitussin, Vicks, DayQuil
Buckly’s
What should patients not drink with Dextromethorphan?
Alcohol and grapefruit juice
How do you know if someone is drinking while on Mucinex?
Visual hallucinations and slurred speech
How do Beta 2 adrenergic agonists work?
The medication binds to beta two adrenergic receptors in the bronchial smooth muscles to cause bronchodilation
What medication stimulates the fight or flight response of the nervous system?
Beta 2 adrenergic agonist aka Albuterol
The patient is says that the nurse measures serum potassium and glucose levels. What medication are they most likely taking for their asthma?
albuterol or ProAir HFA or VoSpire ER
If a patient asks why they shouldn’t drink caffeine while on Albuterol, what is the reason the nurse should give?
Caffeine can cause nervousness, tremors, or palpitations
What happens if a patient takes too many puffs of their Albuterol?
Palpations and airway narrowing and bronchospasm
Also, exaggerated sympathetic activation such as Dysrhythmias, hypokalemia, and hyperglycemia
How do anticholinergic bronchodilators work?
They relax the bronchioles
Which bronchodilator can cause a reaction to soy?
Anticholinergics such as ipratroprium and Spiriva
Why should people rinse out their mouths after using anticholinergic inhalants?
To prevent or reduce the bitter taste and hoarseness
What symptoms should people using Atrovent and Tiotropium bromide report to the doctor?
Dyspnea, odd urinary pattern, and consistent something
What is the prototype drug for beclomethasone?
QVAR
What is the prototype drug for cromolyn aka?
Intal
What should you tell people to do while taking mast cell stabilizers?
Drink lots of water
What type of leukotriene modifier should an infant take?
Montelukast (Singulair)
What type of leukotriene modifier should a patient older than seven take?
Zafirlukast (Accolate)
What thinks should you assess for if someone is taking leukotriene modifiers?
Vitals: RR, effort, lung sounds, CBC, and ALT
If someone is on ibuprofen and/or aspirin, what should they not take?
Leukotriene modifiers
If a patient is unresponsive to beta agonists or corticosteroids, what might be recommended to them?
Methylxanthine Therapy for Asthma
What are some things a patient should do to take Methylxanthine: theyophylline (Theo 24, theochron, Elixophyllin
Without caffeine on empty stomach
What should a patient on ephedra and stimulants not be given? (prototypes)
Elixophyllin, aminophylline, and Uniphyl
Why must a person on Methylxanthine: theyophylline (Theo 24, theochron, Elixophyllin) not self administer any dose?
It has a narrow therapeutic range and must be dosed carefully
What are some ADR’s of Methylxanthine: theyophylline (Theo 24, theochron, Elixophyllin)?
GI symptoms, nausea, vomiting, CNS simulation, palpitations and jitteriness
