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Respiratory Flashcards

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1
Q

How does a metered-dose inhaler work?

A

Uses a chemical propellant to push the medication out of the inhaler

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2
Q

How does a dry powder inhaler work?

A

Delivers medication without using chemical propellants but requires strong and fast inhalation

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3
Q

How does a nebulizer work?

A

Delivers fine liquid mists of medication using air or oxygen under pressure

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4
Q

What order do we need to administer multiple nebs/inhalers?

- How long do we wait between them?

A

We always give the bronchodilator first (opens passages to allow second med to enter farther)
- We need to wait 5 mins between meds

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5
Q

What are Sympathomimetic bronchidilators?

A

Meds that relax the smooth muscle of the bronchi and dilate the airways of the respiratory tree

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6
Q

What are Methylxanthine bronchodilators?

A

Meds that stimulate the CNS and respiration, dilate coronary and pulmonary vessels, cause diuresis and relax smooth muscle

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7
Q

What are bronchodilators used to treat?

A

Acute bronchospasm, acute and chronic asthma, bronchitis, and restrictive airway disease

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8
Q

Contraindications of bronchodilators

A

Peptic ulcer disease, severe cardiac disease, cardiac dysrhythmias, hyperthyroidism, and uncontrolled seizure disorders

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9
Q

What does Theophylline increase or decrease the effectiveness of?

A

Increases the risk of digoxin toxicity.

Decreases the effects of lithium and phenytoin

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10
Q

What medications increase the effect of Theophylline?

A

Beta-blockers, cimetidine and erythromycin

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11
Q

What medications decrease the effect of Theophylline?

A

Barbituates and Carbamezapine

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12
Q

Side effects of bronchodilators?

A

Palpitations, tachycardia, dysrhythmias, restlessnes, nervousness, tremors, anorexia, N+V, headaches, dizziness, hyperglycemia, mouth dryness, tolerance and paradoxical bronchoconstriction.

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13
Q

What is the therapeutic level for serum Theophylline?

A

10-20mcg/mL (55.5-111mcmol/L)

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14
Q

What are the early signs of Theophylline toxicity?

A

Restlessness, nervousness, tremors, palpitations, and tachycardia

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15
Q

Name the (5) beta-adrenergic agonist bronchodilator inhalers

A

Albuterol, Arformoterol, Formoterol, Levalbuterol, and Salmeterol

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16
Q

Name the (2) beta-adrenergic agonist bronchodilator orals

A

Albuterol and Terbutaline

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17
Q

Name the (2) Methylxanthines bronchodilators

A

Theophylline (oral) and Aminophylline

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18
Q

Name the (2) Anticholinergic bronchodilators

A

Ipratropium (inhaled) and Tiotropium (inhaled)

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19
Q

Name the (6) glucocorticoid bronchodilator inhalers

A

Beclomethasone dipropionate, Budesonide, Ciclesonide, Fluticasone proprionate, Mometasone Furoate, Triamcinolone acetonide

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20
Q

Name the (2) glucocorticoid bronchodilator orals

A

Prednisone and Prednisolone

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21
Q

Name the (2) Leukotriene modifier bronchodilators

A

Montelukast (oral) and Zafirlukast (oral)

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22
Q

Name the Inhaled Nonsteroidal Antiallergy Agent bronchodilators

A

Cromolyn sodium (inhaled)

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23
Q

Name the Monoclonal Antibody bronchodilator

A

Omalizumab

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24
Q

What are Anticholinergic inhaled medications?

- Uses

A

Meds that improve lung function by blocking muscarinic receptors in the bronchi, which causes bronchodilation.
- Treats COPD, asthma, exercise-induced bronchospasm

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25
Q

Adverse effects of anticholinergic inhaled meds

A

Dry mouth, irritation of the pharynx, increased intraocular pressure, blurred vision, tachycardia, urinary retention, constipation.

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26
Q

What kind of allergy is contraindicated with Ipatropium products?

A

People with peanut allergies shouldnt take certain Ipatroprium products as they are made from soy lecithin, which is the same plant family as peanuts.

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27
Q

What are inhalabe glucocorticoids?

- Uses

A

Meds that act as antiinflammatory agents and reduce edema of the airways.
- Treat asthma, and other inflammatory respiratory conditions

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28
Q

What are Leukotriene Modifiers?

- Uses

A

Meds that inhibit bronchoconstriction caused by specific antigens and reduce airway edema and smooth muscle constriction.
- Treatment and prophylaxis of chronic bronchial asthma

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29
Q

Contraindications of Leukotriene Modifiers

A

Breast-feeding mothers and impaired hepatic function

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30
Q

Adverse effects of Leukotriene modifiers

A

Headache, N+V, dyspepsia, diarrhea, generalized pain, fever, dizziness

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31
Q

When should we admin Leukotriene modifiers?

A

Either 1 hour before or 2 hours after meals

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32
Q

What are Inhaled NonSteroidal Antiallergy Agents?

- Uses

A

Antiasthmatic, antiallergic, and mast cell stabilizers inhibit mast cell release after exposure to antigens
- Used to treat allergic rhinitis, bronchial asthma, and exercise induced bronchospasm

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33
Q

Contraindications of Cromolyn sodium

A

Impaired hepatic and renal function

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34
Q

Adverse effects of inhaled Nonsteroidal Antiallergy agents

A

Cough, sneezing, nasal sting, bronchospasm, unpleasant taste

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35
Q

When should Nonsteroidal antiallergy agents be admined?

A

At least 30 mins before meals

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36
Q

What are Monoclonal antibodies?

- Uses

A

A recombinant DNA-derived humanized Immunoglobulin G murine monoclonal antibodies that selectively bind to Immunoglobulin E to limit the release of mediators in the allergic response.
- Used to treat allergy-related asthma

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37
Q

How is Omalizumab administered?

A

Subcutaneously every 2-4 weeks. With the dose being titrated on the basis of serum IgE and pt’s weight.

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38
Q

Adverse effects of Omalizumab

A

Viral infections, upper respiratory infections, sinusitis, headache, pharyngitis, anaphylaxis, malignancies

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39
Q

What are antihistamines? (also called histamine antagonists or H1 blockers)
- Uses

A

Meds that compete with histamine for receptor sites, thus preventing a histamine response. When the histamine receptor is stimulated, the extravascular smooth muscles are constricted.
- Used to treat common cold, rhinitis, N+V, motion sickness, and urticaria

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40
Q

Contraindications of antihistamines

A

Co-administration with alcohol, hypnotics or barbituates. Cautiously used with COPD due to their drying effects.

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41
Q

Who shouldnt take diphenhydramine?

A

Pts with narrow angle glaucoma

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42
Q

Adverse effects of anthistamines

A

Drowsiness, fatigue, dizziness, urinary retention, blurred vision, wheezing, constipation, dry mouth, GI irritation, hypotension, hearing disturbances, confusion

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43
Q

How should antihistamines be administered?

A

Avoid subcutaneous injections in favour of IM injections.

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44
Q

How should antihistamines be taken for motion sickness?

A

Should be taken 30 mins before the event and before meals and at bedtime during the event.

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45
Q

Name the (12) antihistamines

A

Brompheniramine, Cetrizine, Chlorpheniramine, Clemastine, Cyproheptadine, Desloratadine, Dimenhydrinate, Diphenhydramine, Fexofenadine, Levocetirizine, Loratadine, Olopatadone

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46
Q

What are nasal decongestants?

- Uses

A

Meds that shrink nasal mucosal membranes and reduce fluid secretions
- Allergic rhinitis, hay fever, and acute nasal discharge

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47
Q

What are the 3 categories of nasal decongestants?

A

Adrenergic, anticholinergic and corticosteroids

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48
Q

Name the (3) non-glucocorticoids (adrenergic and anticholinergic) nasal decongestants

A

Oxymetazoline, Phenylphrine hydrochloride, Pseudoephedrine hydrochloride

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49
Q

Name the (8) Glucocorticoid nasal decongestants

A

Beclamethasone, Budesonide, Ciclesonide, Flunisolide, Fluticasone proprionate, Fluticasone furoate, Mometasone, Triamcinolone

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50
Q

Contraindications of nasal decongestants

A

Cardiac disease, hyperthyroidism, diabetes mellitus

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51
Q

Side effects of nasal decongestants

A

Nervousness, restlessness, insomnia, HTN, hyperglycemia

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52
Q

What should the client taking nasal decongestants avoid in their diet?

A

Avoid caffeine in large amount as this increases the risk of restlessness and palpitations.

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53
Q

What are expectorants?

- Uses

A

Meds that loosen bronchial secretions so that they can be eliminated with coughing.
- Used for dry unproductive coughs

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54
Q

What are mucolytic agents?

A

Meds that thin mucuous secretions to help make the cough more productive

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55
Q

Contraindications of Dextromethorpan

A

Not for clients with COPD because it suppresses the cough reflex

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56
Q

Contraindications of Acetylcysteine

A

Should not be used by clients with asthma as it increases the airway resistance

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57
Q

Side effects of expectorants and mucolytics

A

GI irritation, rash, oropharyngeal irritation

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58
Q

What are the ‘need to knows’ about giving Acetylcysteine nebs?

A

Cannot mix it with another medication.
Give any prescribed bronchodilator 5 mins before.
Take the medications with a full glass of water

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59
Q

What are antitussives?

- Uses

A

Meds that act on the cough control centre in the medulla to suppress the cough reflex.
- Used for nonproductive cough

60
Q

Side effects of antitussives

A

Dizziness, drowsiness, sedation, GI irritation, nausea, dry mouth, constipation, respiratory depression

61
Q

Contraindications of antitussives

A

Head injury, postoperative cranial surgery, opioids, sedatives, barbituates, antidepressants

62
Q

Name an expectorant and a mucolytic agent

A

Expectorant: Guaifensen
Mucolytic: Acetylcysteine

63
Q

Name the (2) opioid antitussives

A

Codeine phosphatel and hydrocodone

64
Q

Name the (3) non-opioid antitussives

A

Benzonatate, Dextromethorphan, Diphenhydramine hydrochloride

65
Q

What are opioid antagonists?

A

Reverses respiratory depression in opioid overdose

66
Q

Side effects of opioid antagonists

A

N+V, tremors, sweating, HTN, tachycardia

67
Q

What do we monitor for IV opioid antagonists?

A

VS (especially resps), the dose is titrated to pt status every 2-5 mins

68
Q

Name the (4) opioid antagonists

A

Alvimopan, Methylnaltrexone, Naloxone, Naltrexone

69
Q

How long do people with active TB get treated?

A

6-9 months (longer if the person also has HIV)

70
Q

How long does it take to get negative sputum cultures after the beggining of treatment?

A

3 months

71
Q

How long to people take prophylacix treatment if exposed?

A

9-12 months

72
Q

What is Isoniazid?

A

First line TB treatment
Inhibits the synthesis of mycolic acids and acts to kill actively growing organsism in the extracellular environment.
Inhibits the growth of dormant organsisms in the macrophages and caseating granulomas.
Is active only during cell division and is used in combination with other antitubercular meds.

73
Q

Contraindications of Isoniazid

A

Acute liver disease, alcoholism, renal impairment, clients taking nicotinic acid, clients taking hepatotoxic meds,

74
Q

Adverse effects of Isoniazid

A

Peripheral neuritis, neurotoxicity, hepatotoxicity, pyridoxine deficiency, N+V, dry mouth, dizziness, hyperglycemia, vision changes

75
Q

Monitoring for Isoniazid

A

LFTs (hepatic function), signs of hepatitis (anorexia, nausea, vomiting, weakness, fatigue, dark urine, jaundice), assess LOC,

76
Q

When do we admin Isoniazid?

A

1 hour before or 2 hours after meals. And 1 hour before antacids

77
Q

What med is given with Isoniazid to reduce neurotoxicity

A

Pyridoxine

78
Q

What is Rifampin?

A

First line TB treatment
Inhibits bacterial RNA synthesis. Binds to DNA-dependent RNA polymerase and blocks RNA transcription.
Used in combination with atleast one other TB med.

79
Q

Contraindications of Rifampin

A

Hepatic dysfunction, alcoholism, use of hepatotoxic meds

80
Q

What meds does Rifampin decrease the effects of?

A

Oral anticoagulants, oral hypoglycemics, chloramphenicol, digoxin, disopyramide phosphates, mexiletine, quinidine polygalacturonate, fluconazole, methadone hydrochloride, phenytoin, verapamil hydrochloride

81
Q

Adverse effects of Rifampin

A

Heartburn, N+V, diarrhea, red-orange coloured body secretions, vision changes, hepatotoxicity, hepatitis, inc. uric acid levels, blood dyscrasias, colitis,

82
Q

Monitoring for Rifampin

A

CBC, uric acid levels, LFTs,

83
Q

What is Ethambutol?

A

First-line TB treatment
Interferes with cell metabolism and multiplication by inhibiting 1 or more metabolites in susceptible organisms.
Inhibits bacterial RNA synthesis and is active only during cell division.
Slow-acting and must be used with other meds

84
Q

Contraindications of Ethambutol

A

Children under 13, Optic neuritis, renal dysfunction, gout, ocular defects, diabetic retinopathy, cataracts, pt’s taking other neurotoxic medications

85
Q

Side effects of Ethambutol

A

Anorexia, N+V, dizziness, malaise, mental confusion, joint pain, dermatitis, optic neuritis, peripheral neuritis, thrombocytopenia, inc. uric acid levels,

86
Q

Monitoring for Ethambutol

A

CBC, uric acid level, renal and liver function tests

87
Q

When is Ethambutol administered?

A

Once every 24 hours and with food to decrease GI upset

88
Q

What is Pyrazinamide?

A

First line TB treatment
Exact mechanism unknown.
Used with at least one other antitubercular med

89
Q

Contraindications of Pyrazinamide

A

Diabetes mellitus, renal impairment, gout, not for use in children

90
Q

What meds does Pyrazinamide decrease the effect of?>

A

Allopurinol, colchicine and probenecid

91
Q

Side effects of Pyrazinamide

A

Increased LFTs, inc uric acid levels, arthralgia, myalgia, photosensitivity, hepatotoxicity, thrombocytopenia,

92
Q

Monitoring for Pyrazinamide

A

CBC, LFTs, uric acid levels, painful or swollen joints, blood glucose

93
Q

When is Pyrazinamide administered?

A

Taken with food

94
Q

What is Rifabutin?

A

Second-line TB medication
Inhibits mycobacterial DNA-dependent RNA polymerase and suppress protein synthesis.
Used to treat Mycobacterium avium complex (MAC) disease in pt’s with HIV

95
Q

Cautions for Rifabutin

A

Can affect blood levels of medications (hormonal contraceptives and HIV meds)

96
Q

Side effects of Rifabutin

A

Rash, GI irritation, neutropenia, red-orange coloured secretions, uveitis, myositis, arthralgia, hepatitis, chest pain,

97
Q

Assessments for Rifabutin

A

Painful or swollen joints, ocular pain or blurred vision, hepatotoxic signs

98
Q

What is Rifapentine?

A

Second-line TB medication

Used only to treat pulmonary TB

99
Q

Cautions of Rifapentine

A

Can affet blood levels of some medications (oral contraceptives, warfarin, HIV meds)

100
Q

Side effects of Rifapentine

A

Red-orange coloured secretions, hepatotoxicity

101
Q

What is Capreomycin sulfate?

A

Second-line TB medication
Mechanism of action is unknown.
Given via IM injection.

102
Q

Contraindications of Capreomycin sulfate

A

Renal insuficiency, acoustic nerve impairment, hepatic impairment, myasthenia gravis, parkinsons

103
Q

Side effects of Capreomycin sulfate

A

Nephrotoxicity, Ototoxicity, Neuromuscular blockade

104
Q

Monitoring for Capreomycin sulfate

A

Audioetric testing, renal, hepatic and electrolyte levels

105
Q

What are Aminoglycoside antibiotics or Fluoroquinolones?

A

These are antibiotics used to treat TB.

Works because receptor-binding action interfering with protein synthesis in susceptible organisms.

106
Q

Contraindications of fluoroquinolones

A

Not recommended for used in children, neuromuscular disorders and eighth cranial nerve damage. Caution with renal insufficiency.

107
Q

Adverse effects of TB antibiotics

A

Pain at injection site, nephrotoxicity, ototoxicity, neurotoxicity, superinfections

108
Q

What are the signs of nephrotoxicity?

A

Increased BUN and serum creatinine

109
Q

What are the signs of ototoxicity?

A

Tinnitus, dizziness, ringing or roaring in the ears, reduced hearing

110
Q

What are the signs of neurotoxicity?

A

Headache, dizziness, lethargy, tremors, and visual disturbances

111
Q

What is Ethionamide?

A

Second-line TB medication.

Used to treat multi-drug resistant (MDR) TB

112
Q

Contraindication of Ethionamide

A

Diabetes Mellitus or renal dysfunction

113
Q

Adverse effects of Ethionamide

A

Anorexia, N+V, metallic taste in mouth, orthostatic hypotension, jaundice, mental changes, peripheral neuritis, rash

114
Q

What can be administered concurrently with Ethionamide to reduce neurotoxicity

A

Pyridoxine

115
Q

When should Ethionamide be administered?

A

With food or meals

116
Q

What is Aminosalicylic acid?

A

Second-line TB medication.

Inhibits folic acid metabolism. Used to treat MDR-TB.

117
Q

What blocks the absoprtion of Aminosalicylate sodium?

A

Aminobenzoates

118
Q

Side effects of Aminosalicylic acid

A

Bitter taste in the mouth, GI irritation, exfoliative dermatitis, blood dyscrasias, crytalluria, changes in thyroid function

119
Q

When should Aminosalicylic acid be administered?

A

With food

120
Q

What are signs of blood dyscrasia?

A

Sore throat or mouth, malaise, fatigue, bruising, and bleeding

121
Q

What is Cycloserine?

A

Second-line TB medication.
Interferes with cell wall biosynthesis.
Used to treat MDR-TB.

122
Q

Contraindications of Cycloserine

A

Alcohol or Ethionamide use, seizures, depression, severe anxiety, psychosis, renal insufficiency,

123
Q

Side effects of Cycloserine

A

CNS reactions, neurotoxicity, seizures, heart failure, headache, vertigo, altered LOC, confusion,

124
Q

Monitoring for Cycloserine

A

LOC, changes in mental status, renal and hepatic function, serum level

125
Q

What is the peak concentration of Cycloserine be?

A

25-35mcg/mL (140-195mcmol/L)

- Peak concentration should be taken 2hrs after dosing

126
Q

When should Cycloserine be administered?

A

Take the medication after meals to avoid GI upset

127
Q

What is Streptomycin?

A

Second-line TB medication.
Aminoglycoside antibiotic, that works because of receptor-binding action that interferes with protein synthesis in susceptible organisms

128
Q

Contraindications of Streptomycin

A

Myasthenia gravis, parkinsonism, eighth cranial nerve damage. Caution with young infants.

129
Q

Adverse effects of Streptomycin

A

Dec urine output, N+V, numbness, seizures, tingling, clumsiness, dizziness, hearing loss or ringing in ears

130
Q

Monitoring for Streptomycin

A

Liver and kindey function, monitoring for ototoxic, neurotoxic, and nephrotoxic reactions

131
Q

Name the (7) inactivated influenza vaccines

A

Afluria, Fluarix, FluLaval, Flucelvax, Flublok, Fluvirin, Fluzone

132
Q

Name the live attenuated infuenza vaccine

A

FluMist

133
Q

Who is approved to take the live nasal spray vaccine?

- Who cant take this?

A

Healthy people aged 2-49 years of age

- Should not be taken by pregnant people

134
Q

Who is approved to take the inactivated flu shot?

A

Children as young as 6 months, as well as pregnant people

135
Q

What is the advantage and disadvantage of the nasal spray vaccine?

A

Advantage: stronger immune response for those who have never had the flu or vaccine (think kids)
Disadvantage: May not be as protective for those who have already had the flu or other vaccines

136
Q

Which individuals are high priority for receiving the flu vaccine?

A

Pregnant people, caregivers of children under 6 months old, people ages 6 months -24yrs, healthcare workers, adults aged 25-63 with a chronic medical condition

137
Q

Contraindications of the inactive flu vaccine

A

Active infection, Guillain-barre syndrome, active fever, children under 6 months old

138
Q

Contraindications of the live flu vaccine

A

Younger than 2, older than 50, pregnant people, people on long-term aspirin therapy, people with chronic medical conditions or organ disease

139
Q

Side effects of flu vaccine

A

Genera aches and pains, malaise, fever, runny nose, cough, headache, sore throat

140
Q

How long after getting the live vaccine is virus shed?

A

Up to 2 days

141
Q

What are antiviral medications?

A

Medications used during outbreaks in influenz

142
Q

Name the (4) antiviral medications

A

Amantadine, Oseltamivir, Rimantadine, Zanamivir

143
Q

Side effects of antivirals

A

As per Saunders pg. 748. Literally anthing

144
Q

Within how long of symptoms do antivirals need to be given?

A

Within 2 days of onset of symptoms

145
Q

What is the pneumococcal conjugate vaccine?

- Given to who

A

Used for the prevention of invasive pneumococcal disease in infants and children
- Given to adults and high-risk children older than 2 yrs

146
Q

Side effects of pneumococcal vaccine

A

Erythema, swelling, pain at injection site, fever, irritability, drowsiness, reduced appetite

NCLEX Pharm (7 decks)

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