respiratory drugs Flashcards
a substance found in various parts of the body (liver, lungs, intestines, skin)
-Produced in response to injury
histamine
effect of histamines
- Dilation of arterioles = localized redness
- Increased permeability of capillaries and veins = localized swelling
Mast cells release ____ in allergic reactions such as anaphylactic shock
histamine
first generation antihistamines
benadryl
second generation antihistamines
allegra, zyrtec
Drugs to counteract the effects of histamine. Also referred to as H1 Blockers.
antihistamines
examples of antihistamines
- diphenhydramine (Benadryl)
- desloratadine (Claritin)
- fexofenadine (Allegra)
- cetirizine (Zyrtec)
- Relief of symptoms of seasonal allergies
- Allergic rhinitis
- Allergic conjunctivitis
- Relief of allergic reactions to medications or blood products
- Relief of coughs associated with allergies
- Relief of uncomplicated urticaria
- Treatment of Parkinsonism
- Relief of nausea and vomiting
uses of antihistamines
adverse reactions of antihistamines
- Drowsiness and sedation common
- May have anti-cholinergic effect =
- –Dryness of mouth, change in vision, difficulty urinating, and constipation
- –Thickening of bronchial secretions
- Possible photosensitivity
- Caution in use with patients with bronchial asthma, CV disease, hypertension, urinary retention, impaired kidney function
- Increase in anti-cholinergic effects when given with an MAO inhibitor (MAOI)
- Additive sedative effect with other CNS depressants or alcohol
- Do not consume antihistamines with apple, grapefruit, or orange juice. This can make the anticholinergic effects worse.
precautions of antihistamines
- Do not drive
- Avoid use of alcohol
- Inform about mouth dryness (frequent water). If fluids are contraindicated, then use hard candy.
- 30 min to 1 hour prior to travel if used for motion sickness
- Possible photosensitivity so use sunscreen and sun barrier devices.
pt teaching for antihistamines
A drug that decreases swelling of the nasal passages = opens clogged nasal passages and enhances drainage of the sinuses
decongestants
Three main groups of decongestants
adrenergic (sympathomimetic), nasal steroids, and anticholinergics
examples of decongestants
- oxymetazoline (Afrin)- nasal spray
- pseudoephedrene (Sudafed)
- Fluticasone furoate (Flonase)- nasal steroid
OPF
actions of decongestants: Sympathomimetic (mimics the SNS) =
produce localized vasoconstriction of the small blood vessels of the nasal membranes (reduces swelling)
actions of decongestants: Nasal steroids
work on the inflammatory response by eliciting a strong anti-inflammatory action which in turn reduces swelling in the nasal passage.
- Treat congestion associated with rhinitis, hay fever, allergic rhinitis, sinusitis and common cold.
- Caution = OVERUSE = can result in rebound congestion = congestion becomes worse than it originally was.
uses of decongestants
adverse reactions of decongestants
- Tachycardia
- Cardiac arrhythmias
- Nervousness, restlessness, insomnia
- Can increase blood pressure
- Mucosal irritation and dryness
Drug used to relieve coughing
–Productive cough = secretions from lower respiratory tract are expelled
–Non productive cough = dry, hacking cough with no secretions
(May be combined with other drugs to combine actions and effects)
antitussives
- Depress cough center located in medulla
- Anesthetize stretch receptors in respiratory passages = decrease coughing
Actions of Antitussives
uses of antitussives
- To relieve non productive cough
- To relieve a cough when it can be harmful
- When the patient has a productive cough, physical exam may indicate whether to suppress cough or allow expectoration
Codeine may result in respiratory depression, nausea, vomiting, sedation, lightheadedness, and constipation
benzonatate (Tessalon) may result in dizziness, headache, sedation, constipation, nausea, and nasal congestion.
ADVERSE REACTIONS OF ANTITUSSIVES
- Caution with persistent cough, productive cough, fever. Depression of cough reflex can result in pooling of secretions in the lungs.
- Additive CNS effects when combined with other CNS depressants or alcohol.
special precautions of antitussives
Mucolytic
- loosens respiratory secretions
- –Reduces viscosity (thickness)
- –Example = Mucomyst
Expectorant
- Aids in raising thick mucus from the respiratory passages
- -Increases production of secretions
- -Example = Guaifenesin
actions of expectorants
- reflex stimulation
2. direct stimulation of secretory gland in the respiratory tract
where loosing and thinning of secretions in the respiratory tract occur due to response to an irritation of the GI tract produced by the drug.
Reflex stimulation
uses of expectorants
- Relief of productive cough
- Thinning and loosening sputum and bronchial secretions
- Indirectly work on suppression of cough
nursing process for expectorants
Antitussives may be given to suppress non productive cough that may cause problems with the increased strain of coughing
For productive coughs = note the color and amount of expectorant
Assess for effect of medication
Bronchodilators
- Short-acting beta-2 adrenergic (SABA)
- Long-acting beta-2 adrenergic (LABA)
- Xanthine derivative
- Cholinergic blocking (anticholinergic)
antiasthma
- Inhaled corticosteroids
- Mast cell stabilizer
- Leukotriene modifier & Immunomodulator
Respiratory condition characterized by recurrent attacks of dyspnea and wheezing caused by spasmodic constriction of the bronchi
asthma
what happens with asthma?
- Body responds with inflammatory response
- Histamine released from mast cells
- Increased mucous production
- Edema of airway = = bronchospasm and inflammation
- To decrease inflammatory process
- Increase sensitivity of the B2 receptors
corticosteroids (asthma meds)
–Example = beclomethasone (QVAR); fluticasone (Flovent)
- Leukotriene (Bronchoconstrictive substance)
- Inhibiting results in bronchodilation
leukotriene inhibitors (asthma meds) --Example = montelukast sodium (Singular); zafirlukast (Accolate)
-Prevent release of substances causing bronchoconstriction and inflammation from mast cells
Mast cell stabilizers (asthma meds)
(Mast cells contain histamine)
–Examples = cromolyn (Gastrocrom)
Drug used to relieve bronchospasm associated with:
Asthma
Bronchitis
Emphysema
bronchodilators
Decrease in lumen of bronchi
Decrease in amount of air into the lungs
Results in respiratory distress
Bronchospasm
Open the airway
Allows more air to enter the lungs
Relieves respiratory distress
Bronchodilators
two types of bronchodilators
- Sympathomimetic bronchodilator
2. Xanthine derivatives
ex of Sympathomimetic bronchodilator
- epinephrine (Adrenalin)
- albuterol (Proventil)
- levalbuterol (Xopenex)
ex of Xanthine derivatives
- theophylline (Theolair)
- aminophylline
(anti asthma) manage inflammation
corticosteroids
(anti asthma) can be used in prevention of exercise induced asthma
Mast Cell Stabilizers
_____ to treat reversible airway obstruction caused by bronchospasm with a asthma, bronchitis, emphysema
Bronchodilators
adverse reactions of bronchodilators
- Restlessness, anxiety
- Increased in blood pressure
- Palpitations, arrhythmias
- Dry mouth and throat
- Headache
- Insomnia, tremors
- Potent drugs
- Act quickly and work well during acute asthma attacks
- Epinephrine, albuterol, alupent
Sympathomimetics (beta-agonist)
- Theophyllinizaton
- They are used to dilate the airways in patients with asthma
- Discourage caffeine type drugs
- Monitor for tachycardia
Xanthine Derivatives
give loading doses and monitor blood level
Theophyllinixation (xanthine derivatives)
- They help with bronchial dilation and prevent bronchial constriction or spasms.
- They are used in Chronic Obstructive Pulmonary Disease (COPD)
Anticholinergic
example of anticholinergic meds
Ipratropium (Atrovent)
When receiving sympathomimetic bronchodilator and corticosteroid by inhalation, give the ______ first, then after several minutes give the ________.
bronchodilator, corticosteroid.
anticholinergic side effects
- Hot as a hare
- Dry as a bone
- Blind as a bat
- Red as a beet
- Mad as a hatter
asthma s&s
- cough
- increased mucus
- SOB
- wheezing/prolonged expiration
- increased CO2 retention
- chest tightness
- retractions
triggers of asthma:
- hypersensitivity
- URI
- Exercise
- Air pollutants
- Respiratory infections
- GERD
Nursing process for bronchodilators
- Observation and documentation of vital signs
- Assess lung fields (note wheezing, cough, dyspnea)
- Describe sputum if present
- Any symptoms of hypoxia ( restless, confusion, cyanosis)
- monitor respiratory status every four hours
special considerations of bronchodilators
- -Caution in use of sympathomimetics with patients with hypertension, cardiac dysfunction, hyperthyroidism
- -Additive effect when used with other sympathomimetics
- Do not increase dose of med unless instructed by primary provider
- If GI Upset, take med with food or milk
- 6-8 glasses of water (helps loosen secretions)
- Instruct on med side effects
- Avoid colas, coffee when on Xanthines
- Use of medication inhalers
pt teaching for bronchodilators
s&s TB
- Progressive fatigue
- Malaise
- Anorexia
- Weight loss
- Chronic cough (productive)
- Night sweats
- Hemoptysis
- Pleuritic chest pain
- Low grade temp
tuberculosis
Infectious disease caused by Mycobacterium tuberculosis
- Characterized by granulomas in the lung fields
- Easily spread from person to person
- Spread by droplets from coughing or sneezing
- Primarily affects lungs but can spread via lymphatic system to other areas of the body
TB
The drugs used to treat infections caused by Mycobacterium are called ________.
antitubercular drugs.
two main categories of anti tubercular drugs:
- first line (primary)
- second line (secondary)
First line
used as a primary drug to fight off the infection (foundation).
Second line
used as secondary drugs when a patient is resistant to the first line drugs or have a more complicated case of TB (more toxic than first line).
__ responds well to ____ treatment with a combination of ___ or more ____ drugs.
TB, long term, two, anti tubercular drugs.
anti tubercular drug uses
- Used to treat active cases of TB
- Used as prophylaxis to prevent spread of TB
Common treatment for pulmonary TB is combination of any of the following:
-Isoniazid (INH)
-Rifampin
-Pyrazinamide (PZA)
-Ethambutol or Streptomycin
-With combination the treatment is 95% effective at treating the infection and reducing resistance.
(single-dose daily for 12 months)
anti tubercular drugs are _____ = they slow or retard growth of M. tuberculosis bacillus. Only Isoniazid (INH) is bactericidal.
bacteriostatic
(anti tubercular drugs) The drugs do not “cure”, they-
render the patient noninfectious to others.
Only anti TB drug that can be used alone, but it can be used in combination with other drugs as well.
Isoniazid
- Most common = peripheral neuropathy
- Possible severe hepatitis
- Increased risk of hepatotoxicity when used in combination with rifampin
- Can cause depletion of the B-vitamins
- Can turn bodily secretions an orange-red color, increased when used in combination with Rifampin (explain to patient that this is a normal finding).
adverse reactions of Isoniazid
nursing process for isoniazid
- With Diagnosis of TB, provider goal is to make patient noninfectious to others
- Observe patient for signs of adverse reactions (hepatotoxicity, nephrotoxicity, and ototoxicity)
- Meds given PO on empty stomach
- Meds taken for a long period of time (12 months)
- Most common problem is patient non-compliance due to side effects and the growing number of TB cases that are resistant to common drug therapies.
- Take meds on empty stomach
- Periodic lab and clinic visits
- Alcohol needs to be avoided to prevent liver failure.
- Imperative that patient/family take as directed, and know that they will need to take the meds for long period of time
- May need to use Direct
- Observation for patients that are non-compliant with the treatment regimen.
pt teaching for isoniazid
