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Pharmacology Final > respiratory drugs > Flashcards

respiratory drugs Flashcards

1
Q

what medications are used for upper respiratory disorders?

A

antihistamines
medications to control bronchial secretions:
antitussives
expectorants
mucolytics
decongestants

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2
Q

what are the medication classes to control bronchial secretions?

A

antitussives
expectorants
mucolytics
decongestants

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3
Q

What is the method of action of antihistamines?

A

compete with histamine at receptor sites

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4
Q

What are the effects of antihistamines?

A

Bronchial smooth muscle relaxation
Prevent or alleviate pruritis (itching)
Reduce secretions (runny nose, scratchy throat, watery eyes…)

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5
Q

antihistamines work best when?

A

early in response cycle

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6
Q

What are the first generation antihistamines?

A

Diphenhydramine
Promethazine
Dimenhydrinate

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7
Q

what are the second generation antihistamines?

A

Loratadine
Cetirizine

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8
Q

are great at treating nasal allergies- hay fever and helping with the symptoms of a common cold

A

first and second generation antihistamines

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9
Q

Which drug class causes CNS depression?

A

1st generation antihistamines

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10
Q

which drugs have anticholinergic effects?

A

promethazine
dimenhydrinate

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11
Q

are antihistamines useful in extreme anaphylaxis?

A

no

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12
Q

are antihistamines useful as monotherapy in asthma attacks?

A

no

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13
Q

Blocking acetylcholine can cause?
which drugs do this?

A

temporary drowsiness, confusion, and memory loss
first generation antihistamines

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14
Q

this drug is used to prevent N/V and motion sickness

A

promethazine -bc of its anticholinergic effects

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15
Q

______ may be used for an allergic reaction causing itching, hives, but in a true anaphylactic emergency reaction, epinephrine (epi pen) needs to be used.

A

diphenhydramine

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16
Q

Airway: SOB, wheezing, chest pain or tightness, tightening of throat, difficulty swallowing

Skin: hives, swelling, itchiness, widespread redness, warmth

brain: anxiety, confusion, headache, feeling that something is about to happen

heart: faint, pale or blue color, dizziness, weak pulse, shock, loss of consciousness,

Stomach: N/V, diarrhea, stomach pain or cramps

A

S/S of anaphylaxis

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17
Q

What are the anticholinergic antihistamine drugs?
What are negative side effects of the drugs?

A

dimenhydrinate
promethazine

Cants: see, spit, piss, shit

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18
Q

Nasal allergies
hay fever
hives
mild blood transfusion reactions

A

What are the primary uses for antihistamines? (4)

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19
Q

What are the secondary uses for antihistamines? (5)

A

motion sickness
vertigo
Parkinson’s
anaphylactic reactions (with other drugs)
sleep aid

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20
Q

which drug is used to treat motion sickness and vertigo?

A

dimenhydrinate

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21
Q

_______ and _______ are often used before a blood transfusion to prevent possible reactions.

A

Benadryl and acetaminophen

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22
Q

_____ and _____ are first gen antihistamines that are not going to be used for nasal allergies.

A

promethazine and dimenhydrinate

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23
Q

When are maximal plasma concentrations reached for antihistamines?
epinephrine?

A

1-3 hours for antihistamines
<10 minutes for epi

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24
Q

Has both CNS depressant and Anticholinergic properties

A

diphenhydramine

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25
Q

does diphenhydramine cross the placenta and go into breast milk?

A

yes

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26
Q

Appears on BEERS list- geriatric more susceptible to drug reactions- dose should be decreased or other antihistamine recommended

A

diphenhydramine

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27
Q

what is diphenhydramine used for?

A

anaphylaxis
allergic rhinitis
parkinson’s symptoms
insomnia
pruritis

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28
Q

Decreases skin response to allergy testing. Stop 4 days before testing.
Can be given PO, IV, or topically.
Avoid use of alcohol with ______

A

diphenhydramine

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29
Q

Avoid when breast feeding.
CNS depressant- avoid driving or things that require alertness
antiCholinergic- sugarless gum, frequent liquids, good oral hygiene

A

education for diphenhydramine

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30
Q

what can diphenhydramine cause in young children?

A

paradoxical excitation

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31
Q

how long should you avoid diphenhydramine before an allergy test?

A

four days

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32
Q

how is promethazine administered?

A

PO
IM
IV (caution)
suppository
ointment

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33
Q

Used for nausea, vomiting, often used as an adjuvant with pain med postop. In some cough syrups

A

promethazine

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34
Q

is promethazine a BEERS drug?

A

yes

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35
Q

because promethazine is a high alert drug, what can happen if it is given incorectly or in the wrong dose? what age should it not be administered to?

A

respiratory depression
dont use under 2 years old

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36
Q

what happens if promethazine is not diluted or given too rapidly?

A

tissue damage and fall of BP
must be given slowly

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37
Q

is promethazine given subcutaneously?

A

no, can cause tissue necrosis

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38
Q

IV- Assess for pain and burning at IV site. Avoid IV administration if possible.
Risk of CNS depression/respiratory depression with other CNS depressants.

A

promethazine cautions and assessments

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39
Q

IV –if not properly diluted or given too fast it can actually be dangerous –resp depression, pain and burning at IV site. has to be diluted well and given slowly
not usually given when pregnant

A

promethazine

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40
Q

can alcohol be taken with promethazine?

A

no

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41
Q

Life threatening reaction to some medications
Altered Mental Status
Muscle rigidity
Fever (102-104)
Irregular, rapid pulse
May have high or low blood pressure

A

adverse effects of promethazine (6)
(Promethazine & some antipsychotics)

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42
Q

Anticholinergic Antihistamine (antiemetic)
PO/IM

A

dimenhydrinate

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43
Q

Used for nausea, vomiting, dizziness accompanying motion sickness
Decreased vestibular (inner ear) stimulation, which may prevent motion sickness
BEERS Drug
Causes CNS depression: drowsiness, dizziness
Can cause paradoxical excitation in children
Increased CNS depression with other CNS depressants
Pregnancy Risk B
dry mouth (anticholinergic)

A

dimenhydrinate

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44
Q

CNS depression- teach to avoid driving or other activities requiring alertness. Avoid use of other CNS depressants- alcohol, sedative/hypnotics, other antihistamines, opoids. pregnancy risk B

used for motion sickness, anticholinergic antihistamine

A

dimenhydrinate

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45
Q

do second generation antihistamines cause as much sedationas the first generation?

A

no, they do not

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46
Q

because second generation antihistamines do not cross the blood brain barrier, they do not cause which adverse effect as much?

A

respiratory depression

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47
Q

are the second generation antihistamines or the first generation histamines longer acting?

A

second generation are longer acting

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48
Q

these are often given more often daily because they can be taken during the day and don’t cause the drowsiness.

A

second generation antihistamines

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49
Q

which antihistamines typically have to be given every four hours?

A

promethazine
diphenhydramine

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50
Q

taken once a day and decrease symptom of allergies

A

second generation antihistamines

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51
Q

Decreased symptoms of allergic symptoms (nasal stuffiness, red swollen eyes, itching)
Daily dosing
Cautious use in children under 2.
Geri- Increased risk of adverse reactions
Dry mouth..
Avoid CNS depressants

A

loratadine

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52
Q

can cause photosensitivity, pregnancy risk B, and available in rapidly disintegrating tablet

A

loratadine

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53
Q

what is the only contraindication to the OTC drug loratadine?

A

allergy to the drug

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54
Q

PO/IV- most PO
Given for allergic/seasonal rhinitis and urticaria (hives)
Children: Contraindicated in children under 6 with renal/hepatic impairment
Geri: Lower dose
Caution in renal/hepatic impairment
Mouth dryness..
Pregnancy B; risk vs benefit (also breastfeeding)
Avoid CNS depressants with medication
Side effect of dizziness/drowsiness although not as significant as 1st generation

A

cetirizine

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55
Q

what do you need to assess for with first generation antihistamines?

A

drowsiness/dizziness
symptom resolution
toxicity

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56
Q

what do you need to increase you fluid intake to when taking a 1st generation antihistamine?

A

2-3 liters per day

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57
Q

t/f: you should administer an antihistamine prior to contact with allergens if possible?

A

true

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58
Q

t/f: antihistamines may cause a false negative on an allergy test?

A

true

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59
Q

what are the four drug classes used to control bronachial secretions?

A

anti-tussives
expectorants
mucolytics
decongestants

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60
Q

these medication shrink swollen nasal mucosa

A

nasal decongestants

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61
Q

what are decongestants used to treat?

A

rhinitis
common cold
sinusitis
hay fever
allergies

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62
Q

these medications are used for visualization of membranes prior to procedures

A

nasal decongestants

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63
Q

what are the three primary nasal decongestants?

A

phenylephrine
ephedrine
pseudoephedrine

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64
Q

Decrease the swollen nasal mucosa and decrease stuffiness

A

nasal decongestant

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65
Q

this drug is used to make meth and is controlled by pharmacists

A

pseudoephedrine

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66
Q

how do adrenergics or (sympathomimetic) nasal decongestants work?

A

constrict small blood vessels in the nasal passage and sinuses

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67
Q

constrict small blood vessels in the nasal passage and sinuses

A

adrenergics

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68
Q

how do anticholinergic nasal decongestants work?

A

decrease secretions

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69
Q

these nasal decongestants decrease secretions

A

anticholinergics

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70
Q

how do corticosteroid nasal decongestants work?

A

reduce inflammatory response in nasal passage

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71
Q

reduce inflammatory response in nasal passage

A

corticosteroid nasal decongestants

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72
Q

oxymetazoline is an example

A

adrenergic decongestants

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73
Q

______ nasal decongestants are addictive and can cause ______ ______ if used over 3-5 days

A

adrenergic, rebound congestion

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74
Q

fluticasone propionate is a ?

A

corticosteroid nasal decongestant

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75
Q

takes longer to receive full benefit and can be used for longer periods of time without rebound congestion.

A

corticosteroid decongestant

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76
Q

is the only intranasal anticholinergic

A

ipatropium bromide

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77
Q

Most decongestants are OTC while many ______ are by prescription

A

corticosteroids

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78
Q

Causes dilated arterioles in the nose to constrict
Reduces congestion

A

adrenergic decongestants (oxymetazoline)

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79
Q

Use these drugs no more than 3 days at a time to prevent?

A

adrenergic (oxymetazoline)
rebound congestion

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80
Q

is an alpha adrenergic agonist

A

oxymetazoline

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81
Q

causes vasoconstriction of dilated arterioles and reduces blood flow.

A

oxymetazoline

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82
Q

Sympathomimetic drug
(Increase heart rate/blood pressure)

A

oxymetazoline

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83
Q

During a cold, the blood vessels that surround the nasal sinus are dilated and engorged with plasma, white blood cells, mast cells, histamines, and many other blood components that are involved in fighting infections of the respiratory tract. This swelling, or dilation, blocks the nasal passages, which results in nasal congestion. When these drugs are administered intranasally, they cause dilated arterioles to constrict, which reduces nasal blood flow and congestion. ______ should be used for no more than 3 days at a time.

A

Oxymetazoline

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84
Q

can cause you to be nervous –high heart rate, high bp,
(IMPORTANT)

A

oxymetazoline

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85
Q

this decongestant decreases secretions and must be primed y spraying before first use? what class is it in as well?

A

ipratropium, anticholinergic decongestant

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86
Q

good for treating runny nose in patients with both allergic and nonallergic rhinitis

A

ipratropium (anticholinergic decongestant)

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87
Q

These work by blocking acetylcholine which decreases secretions from the glands in the nasal passage. Common reactions include dry mouth and bad taste. It doesn’t have to be stopped after 3 days although there are differing opinions on length of time)

A

anticholinergics, ipratropium

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88
Q

what are the side effects of ipratropium ?

A

sore throat
nasal dryness/irritation

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89
Q

does not have to be stopped after three days, does not cause rebound congestion

A

anticholinergic decongestants
Corticosteroids

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90
Q

fluticasone propionate is a ?

A

corticosteroid nasal spray

91
Q

treat allergic rhinitis caused by airborne allergens
Children: Less than 4 years safety not established
OB: Safety not established
Lactation: Risks vs benefits

A

corticosteroid nasal sprays (fluticasone propionate)

92
Q

side effect of these drugs are decreased growth in long term use by children

A

corticosteroid nasal spray

93
Q

what are some of the side effects of cortiocosteroid nasal sprays?

A

nasal burning and irritation

94
Q

) takes longer to receive full benefit and can be used for longer periods of time without rebound congestion

A

Corticosteriod- (fluticasone propionate)

95
Q

It works in your nose to block the effects of substances that cause allergies (such as pollen, pet dander, dust mites, mold) and to reduce swelling

A

Corticosteriod- (fluticasone propionate)

96
Q

Don’t use adrenergic nasal sprays longer than ___ days

A

3

97
Q

Avoid with
Hypertension; uncontrolled cardiovascular disease; dysrhythmias
Narrow angle glaucoma
Stroke

A

adrenergic

98
Q

Increase fluids if not contraindicated
Report fever over 100.4 F or any other symptoms (indicate infection)
lasting longer than 3-4 days
Caution with caffeine (adrenergic)
Smoking = vasoconstriction
Adrenergic: longer than 3 days, take oral preparation
If rebound congestion, taper use
Drops preferred for children (rather than nasal spray)

A

nursing notes for nasal decongestants

99
Q

usually use a saline drop rather than a nasal decongestant in?

A

children

100
Q

need to avoid caffeine with ___ meds (fast heart beat, restlessness or fidgeting)

A

adrenergic

101
Q

what are the two types of anti tussives?

A

opioids, non-opioids

102
Q

Suppress cough reflex
Analgesic and drying effect

A

opioids

103
Q

non-opoid medication that suppresses cough reflex?

A

dextromethorphan

104
Q

non-opioid medication that numbs receptor cells that cause cough?

A

benzonatate

105
Q

can you drive while taking an opioid cough medicine?

A

no

106
Q

what opioid antitussive is used?

A

codeine

107
Q

what are the nonopiod antitussives?

A

dextromethorphan
benzonatate
[diphenhydramine]

108
Q

when is the ONLY time you want to use an antitussive to suppress a cough?

A

when it is NON productive that interferes with sleep health or healing

109
Q

t/f: May give cough medicine after surgery if the patient has a major cough to prevent them from coughing and busting open those sutures.

A

true

110
Q

what are antitussives contraindicated in?

A

individuals at high risk for respiratory depression/sedation
trail elderly
those on other CNS depressants
opoid antitussives, concern with opioid dependency

111
Q

Mild nausea, dizziness, and sedation
Euphoria in high doses

A

nonopioid antitussive adverse effects

112
Q

CNS effects (Sedation, dizzy, lightheaded, respiratory depression)
GI effects (N/V, constipation)
Abuse potential

A

opioid adverse effects

113
Q

Avoid drinking liquids within half hour of taking _____ of this form of antitussive

A

lozenge

114
Q

t/f: avoid smoking with antitissives?

A

true

115
Q

take oral codeine with?

A

food

116
Q

how much water should you drink in a day with antitussives?

A

2-3 liters (helps with dry mouth and nose)

117
Q

how do expectorants work?

A

Stimulate glands in respiratory tract
Breakdown and thin secretions in respiratory tract

118
Q

are used for secretions in the bronchi and NOT in the nose

A

expectorants

119
Q

what is the prototype expectorant?

A

guaifenesin

120
Q

what are the adverse effects of expectorants?

A

GI upset
drowsy/dizzy
rash

121
Q

used for thick secretions that need to be thinned

A

expectorant

122
Q

what are drugs that interact with guaifenesin ?

A

none are known

123
Q

Minimal adverse effects (Yay!)
Fluid intake of 2-3 liters a day if not contraindicated
Check OTC expectorants for ingredients and combinations
Report fever or cough that lasts more than a week
Short half life; repeat dosing

A

nursing notes for expectorants

124
Q

Sometimes acetaminophen may be mixed in with ______ and we want to make sure they aren’t taking a mixed medication and separate acetaminophen.
If they are coughing longer than a week then we need to check for a different dx.

A

expectorants

125
Q

used for babies and little kids to help them absorb inhalant

A

spacer

126
Q

s/s: inflammation
bronchoconstriction
mucosal edema
viscous mucus

A

asthma

127
Q

constriction of airway, mucus becomes thick, drying of the mucosa

A

symptoms of asthma

128
Q

is destruction of the respiratory wall characterized by one or both: chronic bronchitis and emphysema

A

COPD -chronic obstructive pulmonary disease

129
Q

what are the two indications that someone has COPD?

A

chronic bronchitis
emphesema

130
Q

what are three indications for acetylcstine?

A

Acute and/or chronic pulmonary disorders with large amounts of secretions (cystic fibrosis/COPD)
Acetylcysteine (Mucomyst) is antidote for acetaminophen (Tylenol) poisoning
Prevent renal dysfunction due to administration of radiocontrast

131
Q

acetylcystine is a ?

A

mucolytic

132
Q

what are the mucolytics?

A

acetylcystine
hypertonic saline (3-7%)

133
Q

How does it work?
Thin and liquefy mucus
Uses enzymes to break down mucus (some)
Muscle relaxant properties for easier expectoration (some)
Enhance flow of secretions in respiratory tract

A

how mucolytics work

134
Q

crackles in the lungs- thins and liquifies the mucous so they are able to cough up the mucous.

A

mucolytics

135
Q

this mucolytic smells like rotten eggs

A

acetylcysteine

136
Q

Hx of hypothyroidism, CNS depression, renal or liver disease, seizure disorders, asthma

A

caution with mucolytics

137
Q

Bronchospasm and possible aspiration of the liquid, sore throat, cough, dizziness, drowsiness, hypotension, tachycardia, hepatoxicity

A

adverse effects associated with acetylcysteine

138
Q

Increased coughing, sore throat, chest tightness are adverse effects associated with?

A

hypertonic saline

139
Q

If they already have severe asthma- acetylcysteine could cause a _______

A

bronchospasm (airway goes into spasm)

140
Q

Fluid intake 2-3L per day unless contraindicated
Mix with fruit juices, sodas, water
Usual dosage: q 4 hours for 3 days
Monitor Labs
Liver function tests, PT, BUN, creatinine, glucose, electrolytes and acetaminophen levels

A

administration and education for mucolytics

141
Q

prothrombin (PT) is an enzyme produced by?

A

the liver

142
Q

what are the kidney function labs?

A

BUN, creatinine

143
Q

What are the three different classes of bronchodilators?

A

beta adrenergic agonists
anticholinergics
xanthines

144
Q

what are the beta2 adrenergic agonists?

A

albuterol
levabuterol
formoterol
salmeterol
terbutaline

145
Q

these drugs work by relaxing smooth muscle in the airway

A

beta2 adrenergic agonists

146
Q

these drugs imitate norepinephrine and quickly open airway

A

beta 2 adrenergic agonists

147
Q

t/f: beta 2 adrenergic agonists can be short or long acting?

A

true

148
Q

beta-adrenergic agonists work by ______ beta 2 adrenergic receptors in lungs

A

stimulating

149
Q

which drug type and specific drug should a patient take when they immediately need help breathing?

A

short acting beta 2 agonist bronchodilators , albulterol

150
Q

Contraindicated
Client with tachydysrhythmia/severe artery disease
High risk for stroke
Using MAOIs
Other sympathomimetics (epinephrine, norepinephrine, and dopamine or cocaine and methamphetamines)

A

contraindications with beta 2 agonist bronchodilators

151
Q

______ is the most commonly used short acting beta specific beta agonist

A

Albuterol

152
Q

alternative for patient with tachycardia
Less Beta 1 (cardiac) effects
More expensive

A

levabuterol

153
Q

Frequent, large doses
Increase in cardiac side effects
Palpitations, increased HR
Anxiety, tremors, nausea

A

albuterol

154
Q

Assess for chest, jaw, or arm pain or palpitations and notify the provider if they occur (cardiovascular problem?)
Check pulse, report an increase of greater than 20-30 beats/min
Teach patient how to use inhalers, spacers, etc. and which medication is “rescue” and which one is “prevention”

A

nursing notes for albuterol

155
Q

Albuterol inhaler works in _______ minute(s). Inhale as they push the button. Hold breath and then slowly let it out slowly.

A

1 minute

156
Q

acetycholine causes broncho______

A

chronchoconstriction

157
Q

_________ block acetylcholine receptors = indirect bronchodilation

A

Anticholinergics

158
Q

t/f: inhaled anticholinergics reduce secretions in respiratory tract

A

true

159
Q

Prevents bronchospasm
Not for acute symptom management

A

inhaled anticholinergics

160
Q

Airway relaxation and dilation. Can indirectly reduce secretions.. Dry them up.

A

inhaled anticholinergics

161
Q

what are the two inhaled anticholinergics?

A

ipratropium
tiotropium

162
Q

Used for the prevention of bronchospasm and not for management of acute symptoms

A

anticholinergic bronchodilators

163
Q

Peanuts, soy allergy (this would only be because of an inactive ingredient- shouldn’t be in new formulations)

A

contraindications for anticholinergic bronchodilators

164
Q

Narrow-angle glaucoma and benign prostatic hypertrophy
Taking other _______

A

anticholinergic bronchodilators

165
Q

Rinse mouth after administration due to unpleasant taste and to prevent oral yeast infection
Manage ______ effects
Wait____minutes between puffs for same inhaler
Wait _____ minutes between different types of inhaler
Not a rescue inhaler

A

anticholinergic
1-2
2-5

166
Q

Increases cyclic adenosine monophosphate (cAMP) levels
Smooth muscle relaxation (bronchial dilation)
Decreases allergic reaction
Enhances respiratory drive

A

how xanthines work

167
Q

Higher levels of ______ _____ _____ contribute to smooth muscle relaxation

A

cyclic adenosine monophosphate

168
Q

relax smooth muscle and dilates bronchi, decreases allergic reaction, and enhances respiratory drive (opens up the airways)

A

xanthines

169
Q

What are the two xanthine examples?

A

methylxanthines
theophylline

170
Q

Increases the ease of breathing. These decrease seizure threshold so they can cause seizures should not be used in someone who already has seizures

A

xanthines

171
Q

May be used for asthma (often allergy related) or COPD. Slow onset medication.

A

xanthines

172
Q

what are the indications for xanthines?

A

mild to moderate asthma
COPD adjunct

173
Q

are xanthines a rescue drug?

A

no, they are not

174
Q

Contraindications
History of uncontrolled cardiac dysrhythmias
History of peptic ulcer disease or seizure disorders
History of hyperthyroidism

A

contraindications with xanthines

175
Q

what is the therapeutic blood level of theophylline?

A

5-15 mcg/mL

176
Q

adverse effects associated with theophylline occur with drug levels of ?

A

20-25 mc/mL

177
Q

adverse cardiac effects are more frequent with levels above ______ with theophylline

A

30mcg/mL

178
Q

______ can be seen with theophylline levels above 40 mcg/mL

A

seizures

179
Q

what do you do with an overdose of theophylline?

A

stop med
administer activated charcoal
monitor vitals
seizure precautions

180
Q

______ are now deemphasized because of their potential for drug interactions and the interpatient variability in therapeutic drug levels in the blood.

A

Xanthines

181
Q

CNS - confusion, tremors, dizziness, hallucinations, restlessness, agitation, headache, insomnia
GI - N/V, anorexia, stomach cramps, diarrhea, increased urination
CV - palpitations, tachycardia, arrhythmias, chest pain, flushing

A

toxicity/overdose to theophylline

182
Q

GI
N/V, anorexia, gastroesophageal reflux during sleep
Cardiovascular
Tachycardia, palpitations, dysrhythmias
Others
Temporary hyperglycemia and increase in urination

A

side effects of theophylline

183
Q

Dosages usually started low and titrated up to relieve symptoms
Aminophylline IV occasionally used for Status Asthmaticus
If used with oral contraceptives or some antibiotics can increase blood levels

A

xanthines

184
Q

Aminophylline IV occasionally used for ______ _____

A

Status Asthmaticus

185
Q

Drink 2-3 liters to decrease viscosity of secretions
Minimize intake of xanthine containing foods (colas, coffee, chocolate).
Notify prescriber of any signs/symptoms of toxicity

A

patient education for xanthines

186
Q

what are the non broncho dilating respiratory medication classes?

A

leukotriene receptor antagonists
mast cell stabilizers
corticosteroids/glucocorticosteroids

187
Q

are leukotriene modifiers bronchodilators?

A

no

188
Q

what are the three leukotriene modifiers?

A

montelukast
zafirlukast
zileuton

189
Q

Allergen -> _________ are released - >inflammation + bronchoconstriction + mucus production = ->Coughing, sneezing, wheezing, and shortness of breath!

Inhibits an enzyme or blocks receptor sites

Also prevents migration of neutrophils and lymphocytes (keep from going to lungs)

A

how leukotriene modifiers work

190
Q

Prevent asthma attacks, NOT for current acute attacks
Chronic treatment of asthma in adults and teens
Drug effects primarily limited to lungs:
Prevent smooth muscle contraction of bronchial airways
Decrease mucus secretions
Reduce vascular permeability = decreases edema
improvement is usually seen in ~a week

A

leukotriene modifier indication

191
Q

Allergy to povidone, lactose, titanium dioxide, cellulose derivatives (inactive ingredients in drug)

A

contraindications for leukotriene modifiers

192
Q

Liver injury with use of zileuton (zyflo) and zafirlukast (accolate)
Normal AST is 0-45 IU/liter, Normal ALT is 0-40 IU/liter
Hold the medication if AST/ALT levels 3x higher
Check PT/INR

A

contraindications for leukotriene modifiers

193
Q

IT IS MAINLY _______ THAT CAUSES LIVER INJURY WHEN GIVEN WITH a leukotriene
WATCH LIVER ENZYMES

A

ZILEUTON

194
Q

PT/INR

A

measures how long it take your blood to clot

195
Q

Liver Dysfunction is associated with which leukoriene modifier?

A

zafirlukast

196
Q

this leukotriene modfier causes dizzines, insomnia, liver dysfunction

A

zileuton

197
Q

this leukotriene modfier causes heartburn

A

montelukast

198
Q

what are adverse side effects of all leukotriene modifiers?

A

headache, nausea, eiarrhea, sucicdal ideation, depression

199
Q

Zileuton 1 hr before or after a meal
Avoid taking Zafirlukast with food
Take Montelukast once daily at bedtime
For exercise‑induced bronchospasm, take 2 hr before exercise
Monitor liver function tests, PT, and INR
DARK URINE, ITCHING, JAUNDICE, ABDOMINAL PAIN & SWELLING, CLOTTING ISSUES,
Monitor for signs of liver damage
How would you know?

A

leukotriene modifier nursingg notes

200
Q

what are s/s of liver damage?

A

Yellow skin and eyes
Itching
Dark urine
Abdominal pain and swelling
Elevated liver enzymes (AST and ALT)
Prolonged PT and increased INR (time required to form a clot)

201
Q

Yellow skin and eyes
Itching
Dark urine
Abdominal pain and swelling
Elevated liver enzymes (AST and ALT)
Prolonged PT and increased INR (time required to form a clot)

A

signs of liver damage

202
Q

do inhaled corticosteroids bronchodilate?

A

no, they do not

203
Q

Anti-inflammatory effects
Stabilizes cell membranes that release bronchoconstricting substances
Less inflammatory mediators released from Leukocytes
Restores responsiveness of bronchial smooth muscle to beta adrenergic receptor stimulation
Better stimulation of Beta 2 receptors by Beta agonist drugs

A

how inhaled corticosteroids work

204
Q

what are the inhaled glucocorticoid steroids?

A

fluticaseone and salmeterol
methyl prednisone IV

205
Q

what are oral glucocorticoid steroids?

A

prednisone
prednisolone

206
Q

what are IV glucocorticoid drugs?

A

hydrocortisone
methylprednisolone

207
Q

how is methylprednisolone usually administered?

A

it is usually given IV

208
Q

what are the indications for inhaled corticosteroids?

A

status asthmaticus
long term prophylaxis of asthma
bronchitis
COPD
Cystic fibrosis
severe asthma

209
Q

It may take several ______ of inhaled corticosteroid for real effects to be seen.

A

weeks

210
Q

contraindicated in client with infections or suppressed immune systems:
Systemic fungal infections, AIDS, tuberculosis (TB)
Positive sputum test for Candida organisms
Those who have received a live virus vaccine

A

contraindications for corticosteroids

211
Q

Common Inhaled Effects:
Pharyngeal irritation/sore throat
Coughing
Dry mouth
Oral fungal infections such as thrush (candidiasis)

A

common INHALED corticosteroid effects

212
Q

Suppression of adrenal gland function
Bone loss FOR CHILDREN
Hyperglycemia and glycosuria
Infection

A

adverse effects associated with corticosteroids

213
Q

Oral doses may need to be increased during times of stress (long term treatment)
Oral ________ are used short‑term, 3 to 10 days
Rinse mouth after using inhaled ________
Take bronchodilator inhaler 2-5 minutes before ________ inhaler
Use as a maintenance drug, not a rescue drug

A

corticosteroid

214
Q

stabilize ______ cell membranes to prevent release of inflammatory mediators such as histamine

A

mast

215
Q

are mast cell stabilizers rescue ihalers or for long term control?

A

for long term control

216
Q

3-5 minutes after rescue inhaler
OB/breastfeeding: Safety not established
Pedi- Children under 2: safety not established
More often used for mild persistent asthma
medication is not used a lot anymore
do not work as well as inhaled corticosteroids

A

mast cell stabilizers

217
Q

Desired effect is Improved airflow in the air passages
Increased oxygen supply
Perform a thorough assessment of respiratory status-
Skin color, temperature
Respiratory rate, depth, rhythm
Breath sounds
Blood pressure, pulse
Signs and symptoms of respiratory distress
Pulse ox

A

assessment with any respiratory drugs

218
Q

______ REACTS WITH MANY MEDS AND CAN CAUSE VASO CONSTRICTION AND EXASERBATES RESPIRATORY ISSUES

A

NICOTINE

219
Q

May take longer to deliver than MDI
May be more effective in some patients

A

nebulizer

220
Q

Less portable
Can be easier to get doses for small children (under 8) who are unable to use inhaler correctly.
More expensive (DME)
They require more cleaning.

A

nebulizer

221
Q

Used to monitor a patient’s ability to breathe out air

A

peak flow meter

222
Q

red zone for peak flow meter

A

50% or less

223
Q

yellow zone for peak flow meter

A

50-80%

224
Q

green zone for peak flow meter

A

> 80%

Pharmacology Final (12 decks)

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