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
2
Q
What releases histamines?
A
mast cells or basophils in response to an antigen in the blood
3
Q
What are the properties of antihistamines?
A
- antihistaminic
- anticholinergic
- sedative (main ingredient in OTC sleep aids)
4
Q
What are some traditional antihistamines?
A
- diphenhydramine
- dimenhydrinate
- promethazine
- brompheniramine
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
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
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)
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
9
Q
Can you use antihistamines during an acute asthma attack?
A
Yes, but NOT to be used as the sole drug therapy
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)
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
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)
13
Q
How is diphenhydramine administered?
A
Route: PO
Onset: 15-30 mins
Duration: 4 hours
(Benadryl)
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)
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
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
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
18
Q
What are some non-sedating antihistamines?
A
- Loratadine
- Fexofenadine
- Cetirizine
19
Q
What are non-sedating antihistamines used for?
A
- Nasal allergies
- Seasonal allergic rhinitis (hay fever)
- Urticaria (hives)
20
Q
What is an adverse effect of non-sedating antihistamine?
A
- GI: Dry mouth, GI upset
- Cetirizine:
– Neuro: dizziness, drowsiness, fatigue
21
Q
What does Loratadine react with? What happens?
A
- Erythromycin
- Ketoconazole
- Inhibits metabolism –> Increased Loratadine levels
22
Q
What does Fexofenadine interact with? What happens?
A
- Erythromycin
- other CYP450 inhibitors
Inhibits metabolism –> Increased Fexofenadine levels
23
Q
What does Cetirizine interact with? What happens?
A
- Alcohol
- MAOIs
- CNS depressants
Additive effects –> Increased CNS depression
24
Q
How is Loratadine administered?
A
Route: PO
Onset: 1-3 hours
Duration: 24 hours
Daily dosing (at night)
(Claritin)
25
How is nasal congestion presented? What causes it?
- Excessive nasal secretions
- Inflamed and swollen nasal mucosa
- Primary causes of congestion: allergies & URIs
26
What are some decongestants?
- Adrenergics (largest group)
- Corticosteroids
27
What are some adrenergic decongestants?
- Pseudoephedrine (PO)
- Oxymetazoline (nasally inhaled)
28
How is Pseudoephedrine administered?
Route: PO
Onset: 15-30 min (ER 60 min)
Duration: 4-6 hours (ER 12 hr)
29
What is Pseudoephedrine used for?
Symptomatic management of nasal congestion associated with acute URI
30
What are some adverse effects of Pseudoephedrine?
- Neuro: nervousness, excitability, anxiety, insomnia, restlessness
- CV: palpitations
- GI: anorexia
31
What does Pseudoephedrine interact with?
- Additive adrenergic effects w/ other adrenergic drugs
- Concurrent use w/ beta blockers (may result in hypotension and bradycardia)
32
What are some nursing implications of Pseudoephedrine?
- 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
33
What to educate patients on Pseudoephedrine?
- 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
34
How should Oxymetazoline be administered?
Route: Intranasal
Onset: 10 mins
Duration: 12 hours
(Afrin)
35
What is Oxymetazoline used for?
- 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
36
What are some adverse effects of Oxymetazoline?
EENT
- burning
- stinging
- dryness of nasal mucosa
- sneezing
- **rebound nasal congestion**
37
What are some nursing implications for Oxymetazoline?
- 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
38
What to educate patients on Oxymetazoline?
- do NOT take this medication longer than 3 days because it can cause rebound congestion
39
What are some corticosteroid decongestants?
- fluticasone
- beclomethasone dipropionate
- budesonide
- triamcinolone
40
What are corticosteroid decongestants used for?
- Acute, chronic, or seasonal rhinitis
- Used prophylactically to prevent nasal congestion in patients with chronic UR symptoms
- Does not cause rebound congestion
41
When to seek caution when using corticosteroid decongestants?
- Active untreated nasal infections
- Recent nasal trauma or surgery
- Underlying immunosuppression
42
What are some adverse effects of corticosteroid decongestants?
EENT
- Localized to where it was applied
- Mucosal irritation and dryness
43
How is Fluticasone administered?
Route: Intranasal
Onset: Few days
Duration: Unknown
44
What is Fluticasone used for?
To prevent nasal congestion in patients with chronic URT symptoms
(not associated with rebound congestion)
45
How are inhaled intranasal corticosteroid decongestants administered?
- 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
46
What to educate patients on corticosteroid decongestants?
- gently blow nose before using
- shake medication well before use
- before first-time use, prime unit by spraying 6-7x
47
What does cough reflex do?
- naturally removes respiratory secretions and foreign objects
~ Induces coughing and expectoration
~ Initiation by irritation of sensory receptors in the respiratory tract
48
What are two types of coughs?
- **Productive**: “wet” d/t excessive secretions
- **Nonproductive**: "dry" cough
49
What are Antitussives?
Drugs used to stop or reduce coughing
50
What are antitussives used for?
- enhance comfort; reduce respiratory distress
- only for nonproductive "dry" coughs
- in cases when coughing is harmful (ex: after abdomen surgery)
51
What are two types of antitussives?
- **Opioid**
- **Nonopioid**
52
What are two types of opioid antitussives?
- Codeine
- Hydrocodone
53
What do opioid antitussives do?
Stop the cough reflex when the cough is non-productive and/or harmful
54
What are some adverse effects of opioid antitussives?
- CV: hypotension
- GI: N/V, constipation
- Neuro: Sedation, confusion
- Resp: respiratory depression (including sleep apnea and sleep-related hypoxemia)
55
What do opioid antitussives react with?
- Opioids
- General anesthetics
- Tranquilizers
- Sedatives & Hypnotics
- Tricyclic antidepressants
- Alcohol
56
How is codeine administered?
Route: PO (Liquid solutions, Tablets, Capsules, Suspensions)
Onset: 15-30 mins
Duration: 4-6 hours
57
What are some nursing implications for codeine?
- 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
What are some nonopioid antitussives?
- Benzonatate
- Dextromethorphan
59
How is benzonatate administered?
capsules only
60
When is benzonatate used?
Relief of non-productive cough d/t minor throat or bronchial irritation from colds
61
How is dextromethorphan administered?
Route: PO
Onset: 15-30 mins
Duration: 3-6 hours
62
When is dextromethorphan used?
Symptomatic relief of cough caused by minor viral UR tract infection
63
What are some adverse effects of dextromethorphan?
GI: Nausea
**In high doses- dizziness and sedation**
64
What are expectorants?
- 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
Drug profile of guaifenesin?
- 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
Guaifenesin indication?
Productive cough associated w/ viral UR tract infections
67
Guaifenesin adverse effects?
GI: N/V, gastric irritation
68
Guaifenesin nursing implications?
- 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
Guaifenesin patient education?
- 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
What is an example of a herbal supplement?
- Echinacea
~ Shown in clinical trials to reduce cold symptoms and recovery time when taken early
~ Immunostimulant effects
71
What are some common uses of echinacea?
- Stimulate the immune system
- antisepsis
- tx of viral infections and influenza-like respiratory tract infections
- promotes wound healing
72
Echinacea adverse effects?
- dermatitis
- GI upset
- dizziness
- headache
- unpleasant taste
73
Describe pediatric concerns regarding OTC cough and cold products.
- 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
Describe what happens when someone has asthma.
- 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
What are the four types of asthma?
- Intrinsic (no hx of allergies)
- Extrinsic (clients with known allergy exposed to the allergen)
- Exercise induced
- Drug induced
76
What is status asthmaticus?
- Prolonged asthma attack that does not respond to typical drug therapy
- May last several minutes to hours
- MEDICAL EMERGENCY
77
What are some quick relief drugs for asthma?
- Short-acting inhaled beta2 agonists (rescue agents)- SABAs
- Anticholinergic agents
- IV systemic corticosteroids
78
What are some long-term control/maintenance drugs for asthma?
- Long acting beta2 agonists (LABAs)
~ LABAs combined with inhaled corticosteroids
- Inhaled corticosteroids
- Leukotriene receptor agonists
- Anticholinergic agents
- Mast cell stabilizers
79
Describe the two drugs used to treat the lower respiratory tract (LRT).
- SABAs: Used during acute phase of asthmatic attacks
~ Quickly reduce airway constriction and restore normal airflow
- LABAs: Used w/ maintenance/Long-term therapy
80
Describe other drugs used to treat the lower respiratory tract (LRT).
- albuterol
- levalbuterol
- metaproterenol
- pirbuterol
81
What is the drug profile of albuterol?
- 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
Albuterol indication?
Prevention or relief of acute bronchospasm r/t bronchial asthma, bronchitis, or any other pulmonary diseases like COPD
83
Albuterol adverse effects?
CV: chest pain, heart palpitations, HTN
Neuro: nervousness, restlessness, tremor
84
Albuterol drug interactions?
- 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
SABA nursing implications?
- 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
SABA patient education?
- Space doses at regular intervals
- Avoid triggers (if known)
- Provide instruction on proper use and care of devices (MDIs and dry powder inhalers)
87
What are some other examples of LABAs?
- Salmeterol
- Formoterol
- Arformoterol
- Vilanterol
88
What is the drug profile of salmeterol?
- 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
Salmeterol indication?
- 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
Salmeterol adverse effects?
Neuro: headache
91
Salmeterol drug interactions?
- **Beta-blockers may negate therapeutic effect**
- Use with caffeine-containing herbs (cola nut, guarana, mate, tea, coffee) can increase stimulant effect
92
Salmeterol nursing implications?
- These drugs should be used alongside an inhaled corticosteroid, not as monotherapy
- Assess lung sounds, HR before administration and periodically throughout therapy
93
Salmeterol patient education?
- **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
What is the drug profile of ipratropium?
- 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
Ipratropium indication?
- maintenance therapy of reversible airway obstruction d/t COPD
- unlabeled use = adjunctive management of bronchospasm caused by asthma
96
Ipratropium adverse effects?
EENT: increased intraocular pressure, dry mouth, dry throat, nasal congestion
CV: heart palpitations
GU: Urinary retention
97
Ipratropium drug interactions?
Additive effects w/ other anticholinergics
98
Ipratropium nursing implications?
- 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
Ipratropium patient education?
- 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
Describe the xanthine drugs used to treat the LRT.
- Natural xanthines:
~ theophylline
~ caffeine
- Synthetic xanthines:
~ aminophylline
101
What is the drug profile of theophylline?
- 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
Xanthine derivatives indications?
- Dilation of airways in asthma, chronic bronchitis, and emphysema
- Mild to moderate cases of acute asthma
- Adjunct drug in the management of COPD
103
Xanthine derivatives adverse effects?
CV: sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias
104
Xanthine derivatives interactions?
- 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
Xanthine derivatives nursing implications?
- If giving via IV, use infusion pump
~ Infused too fast = hypotension w/ possible syncope, tachycardia, seizures and cardiac arrest
106
Xanthine derivatives patient education?
- 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
List some leukotriene receptor antagonists.
- Montelukast
- Zafirlukast
- Zileuton
108
What is the drug profile of montelukast?
- Can be used in children 1 year old and older
- Can cause suicidal thoughts/behaviors
109
Montelukast indication?
- prevention and chronic treatment of asthma
- prevention of exercise induced asthma
110
Montelukast adverse effects?
GI: Nausea
Neuro: Headache, dizziness, insomnia, anxiety, worsening depression, suicidal thoughts/ideation
111
Montelukast nursing implications?
- 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
Montelukast patient education?
- Emphasize that this medication is for the prevention not treatment of an acute attack
- Take medication at night and even if symptoms improve
113
List the types of corticosteroids (glucocorticoids) used to treat the LRT.
- Inhaled
~ Fluticasone
~ Beclomethasone
~ Budesonide
- Intravenous
~ Methylprednisolone
114
What is the route of administration of fluticasone propionate?
Route: inhalation
115
Fluticasone propionate indication?
Primary tx of bronchospastic disorders to control the inflammatory responses that are believed to be the cause of these disorders; Persistent asthma
116
Fluticasone propionate adverse effects?
EENT: Pharyngeal irritation, dry mouth, oral fungal infection (thrush- thick white coating on tongue)
117
Fluticasone propionate nursing implications?
- 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
Fluticasone propionate patient education?
- **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
What is the route of administration of methylprednisolone?
Route: IV
120
Methylprednisolone indication?
Used systemically to decrease inflammation; **acute exacerbation of asthma or COPD**
121
Methylprednisolone adverse effects?
CV: HTN
Neuro: depression or euphoria
122
Methylprednisolone drug interactions?
**May increase requirement for insulins or oral hypoglycemic agents**
123
Methylprednisolone nursing implications?
**Monitor serum glucose levels**
124
Methylprednisolone patient education?
- Stopping the medication suddenly may result in adrenal insufficiency
- Avoid live vaccines
125
What is the drug profile of roflumilast?
- PDE4 inhibitor
- Route: PO
126
Roflumilast indication?
To decrease the risk of severe exacerbations in severe COPD patients that have a hx of COPD
127
Roflumilast adverse effects?
Neuro: headache, insomnia, anxiety, depression, suicidal thoughts/behavior
Metabolic: weight loss
128
Roflumilast nursing implications?
- Assess respiratory status periodically during therapy
- Monitor client’s weight regularly
- Assess for suicidal tendencies
129
Roflumilast patient education?
- 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
