Respiratory Flashcards
First line TB Agents
Isoniazid (INH)
Rifampin
Pyrazinamide
Ethambutol
Streptomycin
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
Rifampin
- Orange discoloration of urine & other secretions
- Hepatitis
- febrile reaction
- increases metabolism of oral contraceptives, corticosteroids, Coumadin, digoxin & oral hypoglycemic
- monitor liver enzymes
Pyrazinamide
Abx
hepatotoxic
Hyperuricemia
arthralgia
skin rash
GI irritation
Ethambutol
Abx
* optic neuritis
- decreased visual acuity
- impaired red/green color distinguishing
- blindness
- skin rash
Streptomycin
Abx
- Ototoxicity
- Nephrotoxicity
- Hypokalemia
Mucolytics
- acetylcysteine (Mucomyst)
- Dornase Alfa (pulmozyme) : used for thick bronchial secretions e.g. Cystic Fibrosis
Considerations : can trigger bronchospasm or sulfur odor
Expectorants
Guaifenesin
liquifies resp secretions
S/E : headaches, drowsiness, GI upset
Nursing Implications : instruct to cough effectively & avoid driving after ingesting
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)
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
Immunomodulators
Omalizumab (Xolair)
- Decreases Immune response by interfering with cytokines & immune cells
- long term control & prevention for allergic asthma
S/E : allergic reactions & infection
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
Benadryl
diphenhydramine
Eupnea
Normal breathing at 14-20 breaths per min
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
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
