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320 Pharmacology > Respiratory Medications > Flashcards

Respiratory Medications Flashcards

1
Q

What’s the role of histamines?

A
  • involved in nerve impulse transmission from CNS
  • dilatation of capillaries
  • contraction of smooth muscle
  • stimulation of gastric secretion
  • acceleration of the HR
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2
Q

What releases histamines?

A

mast cells or basophils in response to an antigen in the blood

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3
Q

What are the properties of antihistamines?

A
  • antihistaminic
  • anticholinergic
  • sedative (main ingredient in OTC sleep aids)
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4
Q

What are some traditional antihistamines?

A
  • diphenhydramine
  • dimenhydrinate
  • promethazine
  • brompheniramine
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5
Q

How do antihistamines compete with histamines?

A
  • cannot push histamine off the receptor if it’s already bound
  • can pass the blood-brain barrier
  • act on the central and peripheral nervous system
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6
Q

When should you use antihistamines?

A
  • Nasal allergies
  • Seasonal or perennial allergic rhinitis (hay fever)
  • Urticaria (hives)
  • Allergic rnxs
  • Motion sickness
  • Parkinson’s disease (d/t anticholinergic effects)
  • Vertigo
  • Sleep disorders
  • Symptoms r/t to the common cold
    – Sneezing, runny nose
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7
Q

What are some contraindications of antihistamines?

A
  • Known drug allergy
  • Narrow-angle glaucoma
  • Cardiac disease, HTN
  • Kidney disease
  • BPH
  • Peptic ulcer disease
  • Seizure disorders
  • Pregnancy (Category B)
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8
Q

When should you seek caution when using antihistamines?

A
  • Impaired liver function
  • Renal insufficiency
  • Lactating mothers
  • Neonates
  • Elderly (65+)
  • Lower respiratory tract symptoms
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9
Q

Can you use antihistamines during an acute asthma attack?

A

Yes, but NOT to be used as the sole drug therapy

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10
Q

What are some adverse effects of antihistamines?

A
  • EENT- blurred vision, tinnitus
  • CV- hypotension, palpitations, syncope
  • GI- anorexia, N/V, dry mouth, constipation
  • GU- urinary retention
  • Neuro- drowsiness, sedation, paradoxical excitement, restlessness, nervousness, seizures
  • Resp- chest tightness, thickened bronchial secretions (not common)
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11
Q

What to educate patients on antihistamines?

A
  • take medication at night before bed
  • perform frequent mouth care, chew gum, or suck on hard candy (sugarless) - for dry mouth
  • humidifier may be needed to liquify secretions
  • intake of fluids
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12
Q

What is diphenhydramine used for?

A
  • relief or prevention of histamine-related allergies
  • motion sickness
  • tx of Parkinson’s disease
  • promotion of sleep
  • management of anaphylaxis (alongside epinephrine)
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13
Q

How is diphenhydramine administered?

A

Route: PO
Onset: 15-30 mins
Duration: 4 hours
(Benadryl)

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14
Q

What are some nursing implications of diphenhydramine?

A
  • encourage to chew/suck on sugar-free candy and gum (dry mouth), OTC throat lozenges
  • frequent mouth care
  • don’t take with other OTC cold and/or cough medications
  • monitor older adults and children for paradoxical reactions
  • monitor BP and other VS as ordered and PRN (if in acute care setting)
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15
Q

What to educate patients on diphenhydramine?

A
  • sedating effects
    – avoid activities that require mental alertness
  • DON’T take with other traditional antihistamines
  • report any difficulty breathing, heart palpitations, or unusual adverse effects
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16
Q

What is some information about traditional antihistamines?

A
  • Older
  • Works both peripherally and centrally
  • Crosses the BBB
  • Has anticholinergic effects, making them more effective than nonsedating drugs in some cases
  • Generically available, less expensive
  • Rx and OTC
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17
Q

What is some information about non-sedating/2nd generation antihistamines?

A
  • Newer
  • Developed to eliminate unwanted adverse effects (sedation)
  • Works only peripherally to block the actions of histamine (less CNS/neuro effects)
  • Do not cross the BBB
  • Longer duration of action (daily; better adherence)
  • OTC, but more expensive
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18
Q

What are some non-sedating antihistamines?

A
  • Loratadine
  • Fexofenadine
  • Cetirizine
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19
Q

What are non-sedating antihistamines used for?

A
  • Nasal allergies
  • Seasonal allergic rhinitis (hay fever)
  • Urticaria (hives)
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20
Q

What is an adverse effect of non-sedating antihistamine?

A
  • GI: Dry mouth, GI upset
  • Cetirizine:
    – Neuro: dizziness, drowsiness, fatigue
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21
Q

What does Loratadine react with? What happens?

A
  • Erythromycin
  • Ketoconazole
  • Inhibits metabolism –> Increased Loratadine levels
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22
Q

What does Fexofenadine interact with? What happens?

A
  • Erythromycin
  • other CYP450 inhibitors
    Inhibits metabolism –> Increased Fexofenadine levels
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23
Q

What does Cetirizine interact with? What happens?

A
  • Alcohol
  • MAOIs
  • CNS depressants
    Additive effects –> Increased CNS depression
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24
Q

How is Loratadine administered?

A

Route: PO
Onset: 1-3 hours
Duration: 24 hours
Daily dosing (at night)
(Claritin)

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25
Q

How is nasal congestion presented? What causes it?

A
  • Excessive nasal secretions
  • Inflamed and swollen nasal mucosa
  • Primary causes of congestion: allergies & URIs
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26
Q

What are some decongestants?

A
  • Adrenergics (largest group)
  • Corticosteroids
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27
Q

What are some adrenergic decongestants?

A
  • Pseudoephedrine (PO)
  • Oxymetazoline (nasally inhaled)
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28
Q

How is Pseudoephedrine administered?

A

Route: PO
Onset: 15-30 min (ER 60 min)
Duration: 4-6 hours (ER 12 hr)

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29
Q

What is Pseudoephedrine used for?

A

Symptomatic management of nasal congestion associated with acute URI

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30
Q

What are some adverse effects of Pseudoephedrine?

A
  • Neuro: nervousness, excitability, anxiety, insomnia, restlessness
  • CV: palpitations
  • GI: anorexia
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31
Q

What does Pseudoephedrine interact with?

A
  • Additive adrenergic effects w/ other adrenergic drugs
  • Concurrent use w/ beta blockers (may result in hypotension and bradycardia)
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32
Q

What are some nursing implications of Pseudoephedrine?

A
  • assess congestion before and during therapy
  • assess lung sounds and bronchial secretions
  • maintain fluid intake to decrease viscosity of secretions
  • at least 2 hours before bedtime to minimize insomnia
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33
Q

What to educate patients on Pseudoephedrine?

A
  • avoid OTC cough and cold products while breastfeeding or to children younger than 4
  • notify the provider if nervousness, slow or fast HR, breathing difficulty, hallucinations, or seizures occur
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34
Q

How should Oxymetazoline be administered?

A

Route: Intranasal
Onset: 10 mins
Duration: 12 hours
(Afrin)

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35
Q

What is Oxymetazoline used for?

A
  • management of nasal congestion associated with allergic and infectious disorders of the UR tract
  • reduce swelling of the nasal passage and facilitate visualization of the nasal or pharyngeal membranes before surgery or diagnostic procedures
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36
Q

What are some adverse effects of Oxymetazoline?

A

EENT
- burning
- stinging
- dryness of nasal mucosa
- sneezing
- rebound nasal congestion

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37
Q

What are some nursing implications for Oxymetazoline?

A
  • place the spray nozzle in nostril and tilt patient’s head slightly forward
    – have patient sniff briskly during administration
  • wipe dropper with alcohol pad after each use to prevent contamination
  • administered in the morning and before bedtime
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38
Q

What to educate patients on Oxymetazoline?

A
  • do NOT take this medication longer than 3 days because it can cause rebound congestion
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39
Q

What are some corticosteroid decongestants?

A
  • fluticasone
  • beclomethasone dipropionate
  • budesonide
  • triamcinolone
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40
Q

What are corticosteroid decongestants used for?

A
  • Acute, chronic, or seasonal rhinitis
  • Used prophylactically to prevent nasal congestion in patients with chronic UR symptoms
  • Does not cause rebound congestion
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41
Q

When to seek caution when using corticosteroid decongestants?

A
  • Active untreated nasal infections
  • Recent nasal trauma or surgery
  • Underlying immunosuppression
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42
Q

What are some adverse effects of corticosteroid decongestants?

A

EENT
- Localized to where it was applied
- Mucosal irritation and dryness

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43
Q

How is Fluticasone administered?

A

Route: Intranasal
Onset: Few days
Duration: Unknown

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44
Q

What is Fluticasone used for?

A

To prevent nasal congestion in patients with chronic URT symptoms
(not associated with rebound congestion)

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45
Q

How are inhaled intranasal corticosteroid decongestants administered?

A
  • patient should clear nasal secretions
  • if nasal passages are blocked use an inhaled intranasal decongestant immediately prior to use
  • ensure patient’s head is upright
  • have patient breathe in through the nose during administration
  • have patient sniff hard for a a few minutes after administration
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46
Q

What to educate patients on corticosteroid decongestants?

A
  • gently blow nose before using
  • shake medication well before use
  • before first-time use, prime unit by spraying 6-7x
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47
Q

What does cough reflex do?

A
  • naturally removes respiratory secretions and foreign objects
    ~ Induces coughing and expectoration
    ~ Initiation by irritation of sensory receptors in the respiratory tract
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48
Q

What are two types of coughs?

A
  • Productive: “wet” d/t excessive secretions
  • Nonproductive: “dry” cough
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49
Q

What are Antitussives?

A

Drugs used to stop or reduce coughing

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50
Q

What are antitussives used for?

A
  • enhance comfort; reduce respiratory distress
  • only for nonproductive “dry” coughs
  • in cases when coughing is harmful (ex: after abdomen surgery)
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51
Q

What are two types of antitussives?

A
  • Opioid
  • Nonopioid
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52
Q

What are two types of opioid antitussives?

A
  • Codeine
  • Hydrocodone
53
Q

What do opioid antitussives do?

A

Stop the cough reflex when the cough is non-productive and/or harmful

54
Q

What are some adverse effects of opioid antitussives?

A
  • CV: hypotension
  • GI: N/V, constipation
  • Neuro: Sedation, confusion
  • Resp: respiratory depression (including sleep apnea and sleep-related hypoxemia)
55
Q

What do opioid antitussives react with?

A
  • Opioids
  • General anesthetics
  • Tranquilizers
  • Sedatives & Hypnotics
  • Tricyclic antidepressants
  • Alcohol
56
Q

How is codeine administered?

A

Route: PO (Liquid solutions, Tablets, Capsules, Suspensions)
Onset: 15-30 mins
Duration: 4-6 hours

57
Q

What are some nursing implications for codeine?

A
  • Assess BP, HR, and RR
  • Fall safety! Drowsiness or dizziness may occur
  • Assess for opioid addiction, abuse, or misuse prior to administration
  • For overdose, administer naloxone (reversal agent)
58
Q

What are some nonopioid antitussives?

A
  • Benzonatate
  • Dextromethorphan
59
Q

How is benzonatate administered?

A

capsules only

60
Q

When is benzonatate used?

A

Relief of non-productive cough d/t minor throat or bronchial irritation from colds

61
Q

How is dextromethorphan administered?

A

Route: PO
Onset: 15-30 mins
Duration: 3-6 hours

62
Q

When is dextromethorphan used?

A

Symptomatic relief of cough caused by minor viral UR tract infection

63
Q

What are some adverse effects of dextromethorphan?

A

GI: Nausea
In high doses- dizziness and sedation

64
Q

What are expectorants?

A
  • Drugs that aid in the expectoration (removal; coughing up and spitting out) of mucus
  • Reduces the viscosity of sputum
  • Disintegrate and thin secretions
  • Available in a lot of OTC cold and cough preparations and provide symptom relief for many clients
  • Most popular one is guaifenesin
65
Q

Drug profile of guaifenesin?

A
  • Beneficial b/c it thins the mucus in the respiratory tract
  • IR guaifenesin is dosed multiple times throughout the day
  • SR products are given once daily or BID
  • Many PO forms available:
    ~ Capsules
    ~ Tablets
    ~ Solutions
    ~ Granules
66
Q

Guaifenesin indication?

A

Productive cough associated w/ viral UR tract infections

67
Q

Guaifenesin adverse effects?

A

GI: N/V, gastric irritation

68
Q

Guaifenesin nursing implications?

A
  • Administer each dose followed by a full glass of water to decrease viscosity of secretions
  • Assess frequency and nature of cough, lung sounds, and amount and type of sputum produced (if any)
69
Q

Guaifenesin patient education?

A
  • Teach patient how to effectively cough
  • Notify provider is cough lasts longer than 1 week or is accompanied by fever, rash, persistent headache, or sore throat
70
Q

What is an example of a herbal supplement?

A
  • Echinacea
    ~ Shown in clinical trials to reduce cold symptoms and recovery time when taken early
    ~ Immunostimulant effects
71
Q

What are some common uses of echinacea?

A
  • Stimulate the immune system
  • antisepsis
  • tx of viral infections and influenza-like respiratory tract infections
  • promotes wound healing
72
Q

Echinacea adverse effects?

A
  • dermatitis
  • GI upset
  • dizziness
  • headache
  • unpleasant taste
73
Q

Describe pediatric concerns regarding OTC cough and cold products.

A
  • OTC cough and cold products should not be given to children younger than 2 years of age
    ~ Oversedation
    ~ Seizures
    ~ Tachycardia
    ~ Death
    ~ Evidence that they simply are not effective
74
Q

Describe what happens when someone has asthma.

A
  • Recurrent and reversible SOB that occurs when the airways of the lungs become narrow as a result from
    ~ Bronchospasms
    ~ Inflammation of the bronchial mucosa
    ~ Edema of the bronchial mucosa
    ~ Production of viscous mucus
  • Alveolar ducts & alveoli remain open, but airflow to them is obstructed
75
Q

What are the four types of asthma?

A
  • Intrinsic (no hx of allergies)
  • Extrinsic (clients with known allergy exposed to the allergen)
  • Exercise induced
  • Drug induced
76
Q

What is status asthmaticus?

A
  • Prolonged asthma attack that does not respond to typical drug therapy
  • May last several minutes to hours
  • MEDICAL EMERGENCY
77
Q

What are some quick relief drugs for asthma?

A
  • Short-acting inhaled beta2 agonists (rescue agents)- SABAs
  • Anticholinergic agents
  • IV systemic corticosteroids
78
Q

What are some long-term control/maintenance drugs for asthma?

A
  • Long acting beta2 agonists (LABAs)
    ~ LABAs combined with inhaled corticosteroids
  • Inhaled corticosteroids
  • Leukotriene receptor agonists
  • Anticholinergic agents
  • Mast cell stabilizers
79
Q

Describe the two drugs used to treat the lower respiratory tract (LRT).

A
  • SABAs: Used during acute phase of asthmatic attacks
    ~ Quickly reduce airway constriction and restore normal airflow
  • LABAs: Used w/ maintenance/Long-term therapy
80
Q

Describe other drugs used to treat the lower respiratory tract (LRT).

A
  • albuterol
  • levalbuterol
  • metaproterenol
  • pirbuterol
81
Q

What is the drug profile of albuterol?

A
  • Short-acting (beta2 specific bronchodilating) beta agonist [SABA]
  • Must not be used too frequently
  • PO and inhalational use
  • forms include metered-dose inhalers (MDIs) as well as solutions for inhalation
82
Q

Albuterol indication?

A

Prevention or relief of acute bronchospasm r/t bronchial asthma, bronchitis, or any other pulmonary diseases like COPD

83
Q

Albuterol adverse effects?

A

CV: chest pain, heart palpitations, HTN
Neuro: nervousness, restlessness, tremor

84
Q

Albuterol drug interactions?

A
  • Concurrent use w/ other adrenergic drugs will have an increased adrenergic side effects
  • Beta-blockers may negate therapeutic effect
  • Use with caffeine-containing herbs (cola nut, guarana, mate, tea, coffee) can increase stimulant effect
85
Q

SABA nursing implications?

A
  • Assess lung sounds, HR before administration
  • Administer PO medication w/ meals to minimize gastric irritation
  • For inhalers:
    ~ Shake the inhaler well
    ~ Prime the inhaler before first use by releasing 4 test sprays into the air (away from the face)
    ~ For ANY inhaler: if 2 puffs from the same inhaler, wait 1-2 minutes in between puffs; if using a 2nd inhaler wait 2-5 minutes or the Rx’d amount of time after the first inhaler
86
Q

SABA patient education?

A
  • Space doses at regular intervals
  • Avoid triggers (if known)
  • Provide instruction on proper use and care of devices (MDIs and dry powder inhalers)
87
Q

What are some other examples of LABAs?

A
  • Salmeterol
  • Formoterol
  • Arformoterol
  • Vilanterol
88
Q

What is the drug profile of salmeterol?

A
  • Long-acting beta2 agonist bronchodilator- LABA
  • Used for the maintenance and of asthma and COPD and is used in conjunction with an inhaled corticosteroid
  • Should never be given more than twice daily, nor should the maximum daily dose (one puff BID) be exceeded
89
Q

Salmeterol indication?

A
  • Co-therapy for the treatment of asthma and the prevention of bronchospasm in patients who are concurrently taking an inhaled corticosteroid
  • prevention of exercise induced bronchospasm
  • maintenance treatment to prevent bronchospasm in COPD
90
Q

Salmeterol adverse effects?

A

Neuro: headache

91
Q

Salmeterol drug interactions?

A
  • Beta-blockers may negate therapeutic effect
  • Use with caffeine-containing herbs (cola nut, guarana, mate, tea, coffee) can increase stimulant effect
92
Q

Salmeterol nursing implications?

A
  • These drugs should be used alongside an inhaled corticosteroid, not as monotherapy
  • Assess lung sounds, HR before administration and periodically throughout therapy
93
Q

Salmeterol patient education?

A
  • Caution patient NOT use a LABA to treat acute symptoms
  • Use rescue inhaler first in an acute attack
  • Educate patient on rescue vs. long-term therapy drugs
94
Q

What is the drug profile of ipratropium?

A
  • Oldest & most commonly use anticholinergic bronchodilator
  • Available both as a liquid aerosol (nebulizer) for inhalation and as a multi-dose inhaler
  • DuoNebs (albuterol + ipratropium)
  • Usually, dosed BID
95
Q

Ipratropium indication?

A
  • maintenance therapy of reversible airway obstruction d/t COPD
  • unlabeled use = adjunctive management of bronchospasm caused by asthma
96
Q

Ipratropium adverse effects?

A

EENT: increased intraocular pressure, dry mouth, dry throat, nasal congestion
CV: heart palpitations
GU: Urinary retention

97
Q

Ipratropium drug interactions?

A

Additive effects w/ other anticholinergics

98
Q

Ipratropium nursing implications?

A
  • Assess for allergies to other anticholinergics such as atropine
  • Wait 1-2 minutes (or as Rx’d) before receiving 2nd “puff” of medication
  • Rinse mouth out with water to prevent mucosal dryness and/or irritation
  • When giving this concurrently w/ other inhalers, administer adrenergic bronchodilator first, followed by ipratropium, then corticosteroid
99
Q

Ipratropium patient education?

A
  • Used prophylactically to decrease the frequency and severity of asthma and taken as Rx’d
  • Force fluids, unless contraindicated
  • Wait 2-5 minutes (or as ordered) before using additional, different inhaler
100
Q

Describe the xanthine drugs used to treat the LRT.

A
  • Natural xanthines:
    ~ theophylline
    ~ caffeine
  • Synthetic xanthines:
    ~ aminophylline
101
Q

What is the drug profile of theophylline?

A
  • Most commonly used xanthine derivative
  • Make sure you do a thorough cardiac assessment (noting BP, HR, & hx of cardiac dx)
  • Therapeutic range for theophylline blood level is 10 to 20 mcg/mL
102
Q

Xanthine derivatives indications?

A
  • Dilation of airways in asthma, chronic bronchitis, and emphysema
  • Mild to moderate cases of acute asthma
  • Adjunct drug in the management of COPD
103
Q

Xanthine derivatives adverse effects?

A

CV: sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias

104
Q

Xanthine derivatives interactions?

A
  • Cigarette smoking decreased blood concentrations of the xanthine derivative
  • Interacting foods include charcoal-broiled, high-protein, and low-carbohydrate foods
    ~ These foods may reduce serum levels of xanthines through various metabolic mechanisms
    ~ Note client’s intake of caffeine
105
Q

Xanthine derivatives nursing implications?

A
  • If giving via IV, use infusion pump
    ~ Infused too fast = hypotension w/ possible syncope, tachycardia, seizures and cardiac arrest
106
Q

Xanthine derivatives patient education?

A
  • Educate patients about foods that contain caffeine (chocolate, coffee, cola, tea) because their consumption can exacerbate CNS stimulation
  • Some patients may need to take their own pulse; Educate patients on proper demonstration and have them teach it back to you
107
Q

List some leukotriene receptor antagonists.

A
  • Montelukast
  • Zafirlukast
  • Zileuton
108
Q

What is the drug profile of montelukast?

A
  • Can be used in children 1 year old and older
  • Can cause suicidal thoughts/behaviors
109
Q

Montelukast indication?

A
  • prevention and chronic treatment of asthma
  • prevention of exercise induced asthma
110
Q

Montelukast adverse effects?

A

GI: Nausea
Neuro: Headache, dizziness, insomnia, anxiety, worsening depression, suicidal thoughts/ideation

111
Q

Montelukast nursing implications?

A
  • Montelukast chewable tablets contain aspartame, assess for allergies as some clients may need to avoid it
  • Emphasize that these drugs are indicated for the treatment of CHRONIC (not acute) asthma attacks
112
Q

Montelukast patient education?

A
  • Emphasize that this medication is for the prevention not treatment of an acute attack
  • Take medication at night and even if symptoms improve
113
Q

List the types of corticosteroids (glucocorticoids) used to treat the LRT.

A
  • Inhaled
    ~ Fluticasone
    ~ Beclomethasone
    ~ Budesonide
  • Intravenous
    ~ Methylprednisolone
114
Q

What is the route of administration of fluticasone propionate?

A

Route: inhalation

115
Q

Fluticasone propionate indication?

A

Primary tx of bronchospastic disorders to control the inflammatory responses that are believed to be the cause of these disorders; Persistent asthma

116
Q

Fluticasone propionate adverse effects?

A

EENT: Pharyngeal irritation, dry mouth, oral fungal infection (thrush- thick white coating on tongue)

117
Q

Fluticasone propionate nursing implications?

A
  • Take measures that promote a generally good state of health to prevent, relieve, or decrease symptoms of COPD
    ~ Avoid exposure to conditions that precipitate bronchospasm (allergens, smoking, stress, air pollutants)
    ~ Adequate fluid intake
    ~ Avoid excessive fatigue, heat, extremes in temperature, and caffeine
118
Q

Fluticasone propionate patient education?

A
  • Teach patients to gargle and rinse the mouth with lukewarm water afterward to prevent the development of oral fungal infections
  • If a beta agonist bronchodilator and corticosteroid inhaler are both ordered, the bronchodilator should be used several minutes before the corticosteroid to provide bronchodilation before administration of the corticosteroid
119
Q

What is the route of administration of methylprednisolone?

A

Route: IV

120
Q

Methylprednisolone indication?

A

Used systemically to decrease inflammation; acute exacerbation of asthma or COPD

121
Q

Methylprednisolone adverse effects?

A

CV: HTN
Neuro: depression or euphoria

122
Q

Methylprednisolone drug interactions?

A

May increase requirement for insulins or oral hypoglycemic agents

123
Q

Methylprednisolone nursing implications?

A

Monitor serum glucose levels

124
Q

Methylprednisolone patient education?

A
  • Stopping the medication suddenly may result in adrenal insufficiency
  • Avoid live vaccines
125
Q

What is the drug profile of roflumilast?

A
  • PDE4 inhibitor
  • Route: PO
126
Q

Roflumilast indication?

A

To decrease the risk of severe exacerbations in severe COPD patients that have a hx of COPD

127
Q

Roflumilast adverse effects?

A

Neuro: headache, insomnia, anxiety, depression, suicidal thoughts/behavior
Metabolic: weight loss

128
Q

Roflumilast nursing implications?

A
  • Assess respiratory status periodically during therapy
  • Monitor client’s weight regularly
  • Assess for suicidal tendencies
129
Q

Roflumilast patient education?

A
  • medication is NOT for a bronchodilator and should not be used to treat sudden breathing problems
  • monitor their weight regularly
  • notify provider if thoughts about suicide or dying

320 Pharmacology (36 decks)

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