Respiratory Flashcards
Beta 2 adrenergic agonists - mechanism and example
relieve bronchospasms and to prevent exercise-induced bronchospasm (EIB) by inducing brochodilation
(albuterol)
Beta 2 adrenergic agonist - adverse effects
- tachycardia, heart palpitations, and tremors
- angina (when cardiac vessels are compromised)
Beta 2 adrenergic agonists - intervention
- monitor for wheezing or shortness of breath
- monitor and immediately report chest pain
- inhale 30 minutes before exercise
Anticholinergics - mechanism and example
provide relief of bronchoconstriction and reduce secretions in clients who have COPD by inhibiting the action of acetylcholine at the muscarine receptor and inducing bronchodilation
(ipratropium)
Anticholinergics - adverse effects
- dry mouth
- pharyngeal irritation
- intraoccular pressure
- urinary retention, tachycardia, headache, dizziness, blurred vision, epistaxis, bronchospasms, and hypotension
Anticholinergics - intervention
- monitor for glaucoma
- wait at least 5 minutes after administering anticholinergics to administer other inhalants
Glucocorticoids - mechanism and example
long-term management of chronic asthma and COPD and short-term management of post-exacerbation manifestations by suppressing inflammation
(fluticasone)
Glucocorticoids - adverse reactions
- oral candidiasis
- suppressed adrenal function
- muscle wasting
- osteoporosis
- hyperglycemia
- peptic ulcers
- fluid and electrolyte imbalances
- suppressed immune system
Glucocorticoids - intervention
- use of a spacer can minimize some side effects
- administer on schedule, not as needed
- caution when giving glucocorticoids to clients who have peptic ulcer disease, diabetes mellitus, hypertension, renal dysfunction, or are taking NSAIDs regularly
Mast cell stabilizers - mechanism and example
reduce bronchial inflammation prophylactically in mild to moderate asthma by preventing the release of leukotrienes and histamine to moderate inflammation
(cromolyn)
Mast cell stabilizers - adverse effects
Minimal
Mast cell stabilizers - intervention
- assess for allergies before administering
Leukotriene modifiers - mechanism and example
treatment of allergic rhinitis, asthma, and exercise-induced bronchospasm by suppressing the effect of leukotrienes
(montelukast)
Leukotriene modifiers - adverse effects
- liver damage
- slight risk of adverse neuropsychiatric manifestations such as suicidal thoughts or behaviors
Leukotrienes modifiers - interventions
- report abdominal pain or tenderness, nausea, or anorexia immediately to their provider
- use over-the-counter analgesics as needed
- be aware of any behavioral changes such as anxiety, agitation, insomnia, or irritability
First-gen antihistamines - mechanism and example
bind to H1 receptors, effectively blocking the release of histamine
(diphenhydramine)
First-gen antihistamines - adverse reactions
- drowsiness and dizziness
- dry mouth
- urinary hesitancy
- constipation
first-gen antihistamines - intervention
- monitor patient when ambulating
- advise not to drive or operate heavy machinery
- take with food to reduce GI discomfort
- sip water/hard candy for dry mouth, fiber for constipation
Difference between first- and second-gen antihistamines
First-gen antihistamines are sedating, second-gen aren’t
Second-gen antihistamines - mechanism and example
antagonize histamine effects at H1 receptor sites, without binding to or inactivating histamine
(cetrazine)
Second-gen antihistamines - adverse effects
- mild drowsiness possible
- some anticholinergic effects
Second-gen antihistamines - intervention
- monitor when ambulating (esp. doses over 10 mg)
- provide water/hard candy
- do not administer with other OTC antihistamines
- theophylline can reduce the excretion of second-gen antihistamines and lead to toxicity
Sympathomimetics - mechanism and example
activate alpha 1 adrenergic receptors in the nose to induce vasoconstriction of the blood vessels, which then causes the nasal turbinates to shrink, opening the nasal passages and relieving nasal congestion
(phenylephedrine)
Sympathomimetics - adverse effects
- CNS stimulation (anxiety, insomnia, agitation)
- systemic vasoconstriction can cause hypertension, arrhythmias, and heart palpitations
Sympathomimetics - interventions
- administer only when necessary
- monitor for CNS disturbances
- patients may need sleep aids
Antitussives - mechanism and example
Both opioid and nonopioid antitussives work by suppressing the cough reflex in the brain
(codeine, dextromethorphan)
Antitussives - adverse effects
- drowsiness (opiates)
- dizziness, lightheadedness (opiates)
- GI distress (opiates)
Antitussives - interventions
- monitor patients when they ambulate
- administer with food or milk
- administer short-term only
Expectorants - mechanism and example
Reduce surface tension of secretions to thin mucous
(guaifenesin)
Expectorants - adverse effects
Uncommon
dizziness, drowsiness, headache, gastrointestinal distress in the form of nausea and diarrhea
Expectorants - interventions
- monitor patients when the ambulate
- administer with food or 8 oz of water to minimize GI distress
- combination medications may contain guifenesin
Mucolytics - mechanism and example
work by breaking the disulfide linkages of proteins in mucus, subsequently decreasing the viscosity of mucus
(acetylcysteine)
Mucolytics - adverse reactions
- bronchospasm
- GI distress
Mucolytics - interventions
- monitor lung sounds for indications that fluid is still trapped in lungs - patients may need bronchodilator to help remove
- advise patient to report worsening cough or difficulty breathing
