- Orange discoloration of urine & other secretions - Hepatitis - febrile reaction - increases metabolism of oral contraceptives, corticosteroids, Coumadin, digoxin & oral hypoglycemic - monitor liver enzymes

1. acetylcysteine (Mucomyst) 2. Dornase Alfa (pulmozyme) : used for thick bronchial secretions e.g. Cystic Fibrosis Considerations : can trigger bronchospasm or sulfur odor

Omalizumab (Xolair) - Decreases Immune response by interfering with cytokines & immune cells - long term control & prevention for allergic asthma S/E : allergic reactions & infection

Antagonizes action of histamine (H1RA) 1. Benadryl (diphenhydramine) 2. Zyrtec (cetirizine) 3. Allegra (fexofenadine) 4. Claritin (loratidine) Implications: - CI with acute asthma episode, impaired GI motility or obstruction, UT obstruction & heart disease - may cause excitation of the CNS

Respiratory Flashcards by Priscilla Kim

First line TB Agents

Isoniazid (INH)
Rifampin
Pyrazinamide
Ethambutol
Streptomycin

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Isoniazid (INH)
S/E & Considerations

Abx for TB
Hepatotoxicity/Hepatitis, flulike syndrome, neuropathy, hypersensitivity

Considerations: Pyridoxine (Vit B) to prevent/decrease neuropathy
Monitor liver enzymes

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Rifampin

Orange discoloration of urine & other secretions
Hepatitis
febrile reaction
increases metabolism of oral contraceptives, corticosteroids, Coumadin, digoxin & oral hypoglycemic
monitor liver enzymes

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Pyrazinamide

Abx

hepatotoxic

Hyperuricemia

arthralgia

skin rash

GI irritation

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Ethambutol

Abx
* optic neuritis
- decreased visual acuity
- impaired red/green color distinguishing
- blindness
- skin rash

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Streptomycin

Abx
- Ototoxicity
- Nephrotoxicity
- Hypokalemia

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Mucolytics

acetylcysteine (Mucomyst)
Dornase Alfa (pulmozyme) : used for thick bronchial secretions e.g. Cystic Fibrosis

Considerations : can trigger bronchospasm or sulfur odor

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Expectorants

Guaifenesin

liquifies resp secretions
S/E : headaches, drowsiness, GI upset

Nursing Implications : instruct to cough effectively & avoid driving after ingesting

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Antitussives

Suppresses cough reflex. Opioid doses are about 1/10 than those used for analgesia

Two groups :
1. Opioid
- Hydrocodone + homatropine (Hycodan)
- Codeine

Non opioid
- Dextromethorphan (Benylin)

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Decongestants

Pseudoephedrine (Sudafed)
Phenylephrine (Afrin)
Neosynephrine (oxymetazolline)
Ephedrine (pretz-d)

Sympathomimetics — Relieves stuffiness

S/E :
- vasoconstriction (tachy, difficulty voiding)
- CNS agitation (restlessness)
- rebound congestion due to chronic use

Implications :
CI for arrhythmias, HTN, CAD
Highly monitored for abuse

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Immunomodulators

Omalizumab (Xolair)

Decreases Immune response by interfering with cytokines & immune cells
long term control & prevention for allergic asthma

S/E : allergic reactions & infection

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Antihistamines

Antagonizes action of histamine (H1RA)

Benadryl (diphenhydramine)
Zyrtec (cetirizine)
Allegra (fexofenadine)
Claritin (loratidine)

Implications:
- CI with acute asthma episode, impaired GI motility or obstruction, UT obstruction & heart disease
- may cause excitation of the CNS

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Benadryl

diphenhydramine

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Eupnea

Normal breathing at 14-20 breaths per min

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Bradypnea

Slower than normal <10 breaths per min
With regular rhythm & normal depth
Can be due to increased ICP, a brain injury or drug overdose

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Tachypnea

Rapid, shallow breathing
>24 breaths per min
Assc with pneumonia, pulmonary edema, metabolic acidosis, septicemia, severe pain or a rib fracture

Hypoventilation

Irregular, shallow breathing

Hyperpnea

Increased depth of respirations

Hyperventilation

Increased rate & depth that result in decreased PaCO2 level
Assc with exertion, anxiety & metabolic acidosis or DKA/renal disease (the hyperventilating would be called Kussmaul’s)

Apnea

Period of cessation of breathing

Cheyne-Stokes

Regular cycle where the rate & depth of breathing increase then decrease until apnea for abt 20s

The duration of apnea varies, therefore, it is timed & recorded
Assc with heart failure & damage to the resp system (drug induced, tumor, trauma)

Biot’s Respirations

Periods of normal breathing (3-4 breaths) followed by a varying prd of apnea (10-60s) aka ataxic breathing

Resp depression assc with drug overdose & brain injury

Obstructive

Airway narrowing as seen in asthma, COPD & bronchitis
Prolonged phase of expiratory resp

Albuterol Sulfate brand names

AccuNeb
Proventil HFA
Ventolin HFA
ProAir RespiClick

Albuterol Sulfate

Go-to for acute symptoms May cause transient hypokalemia with nebulization (check potassium levels) Advise pt to use before using other inhalation medication

Racepinephrine

SABA Given via nebulizer Onset: one minute Affects both beta 1 and beta 2 adrenergic receptor sites Can result in peripheral vasoconstriction Mostly used in children

Levalbuterol Tartrate brand name

Xopenex HFA

Levalbuterol Tartrate

SABA Selected for beta (pulmonary) receptors Causes less cardiac effects Onset: 10-17 mins

What do mast cell stabilizers do?

Act as an inflammation anti-inflammatory Stabilizes mast cell membranes & inhibits the activation & release of histamine from cells Preventive tx before exposure to allergen or to exercise Blocks reaction to allergen

Therapeutic timing for Mast cell stabilizers

Several weeks Used as ppx & maintenance

Therapeutic timing for Mast cell stabilizers

Several weeks Used as ppx & maintenance

What do methylxanathines do?

Bronchodilator

What do methylxanathines do?

Bronchodilator

Nursing Considerations for Methylxanathines

Narrow therapeutic safety margin Must swallow enteric coated pill as whole Caffeine will intensify its affects, avoid CI for pts with untreated seizure disorders or PUD

What do anticholinergics do?

Blocks parasympathetic nervous system, causing bronchial smooth muscle relaxation, however, does not block exercise induced bronchospasm Therapy for maintenance of reversible airway obstruction due to COPD

Nursing considerations for Anticholinergics

Onset of action is longer than albuterol not a rescue medication Combining with beta 2 agonists is more efficient than by itself CI in pts with glaucoma, prostatic hypertrophy, bladder obstructions, allergies in peanut & soy Avoid getting it in eyes

What do Leukotriene Modifiers do?

Blocks the inflammatory process in the airways by antagonizing the effects of leukotriene, a potent bronchoconstrictor

Nursing Considerations for Leukotriene modifiers

Long-term therapy for asthma, maintenance