RESPIRATORY MEDICATIONS Flashcards
METERED-DOSE INHALER (MDI)
- Chemical propellant pushes medication out of inhaler
DRY POWDER INHALER (DPI)
- Delivers WITHOUT CHEMICAL PROPELLANTS
- REQUIRES STRONG/FAST INHALATION
NEBULIZER
- DELIVERS FINE LIQUID MISTS OF MEDICATION
- DELIVERED THROUGH MASK OR TUBE THAT FITS OVER NOSE OR MOUTH
- USES AIR OR OXYGEN UNDER PRESSURE
If two different inhaled medications are prescribed and one of the medications is a glucocorticoid (corticosteroid)what will you give first ?
- ADMINISTER THE BRONCHODILATOR FIRST BEFORE THE STEROID
Sympatho/mimetic bronchodilator
- MIMICS SYMPATHETIC NERVOUS SYSTEM IN RELAXING SMOOTH MUSCLE
- RELAX THE SMOOTH MUSCLE OF THE BRONCHI AND DILATE AIRWAYS OF RESPIRATORY TREE
- AIDS IN MAKING RESPIRATION AND AIR EXCHANGE EASIER
Methylxanthine bronchodilator
- STIMULATE CNS AND RESPIRATION
- RELAX SMOOTH MUSCLE
- DILATE coronary and pulmonary vessels
- CAUSE DIURESIS
What are bronchodilators used for ?
- TREAT ALLERGIC RHINITIS AND SINUSITIS
- ACUTE BRONCHOSPASM
- ACUTE/CHRONIC ASTHMA
- BRONCHITIS
- COPD
- EMPHYSEMA
- OTHER RESTRICTIVE AIRWAY DISEASES
What are BRONCHODILATORS CONTRAINDICATED IN ?
- HYPERSENSITIVITY
- PEPTIC ULCER DISEASE
- SEVERE CARDIAC DISEASE
- CARDIAC DYSRHYTHMIAS
- HYPERthyroidism
- UNCONTROLLED SEIZURE DISORDERS
Bronchodilators are used with caution in patients with ?
- HYPERTENSION
- NARROW- ANGLED GLAUCOMA
- DIABETES MELLITUS
Which bronchodilator increases the toxicity level of digoxin and decreases the effects of lithium and phenytoin ?
Theophylline
If Theophylline and Beta2 adrenergic agonist are taken together what will it cause ?
Cardiac dysrhythmias
Do B-blockers, Cimetidine (Tagamet), and erythromycin increase or decrease the effects of Theophylline ?
Increase
Do Barbiturates and Carbamazepine (Tegretol) decrease or increase the effects of Theophylline ?
Decrease
Side effects of bronchodilators
- PALPITATIONS/TACHYCARDIA
- DYSRHYTHMIAS
- RESTLESSNESS/NERVOUSNESS/TREMORS
- Anorexia, nausea, vomiting
- Headache/dizziness
- HYPERglycemia
- Mouth dryness and throat irritation with inhalers
- Tolerance and paradoxical bronchoconstriction with inhalers
Interventions for bronchodilators
- MONITOR FOR RESTLESSNESS AND CONFUSION
- MONITOR VITAL SIGNS AND LUNG SOUNDS
- MONITOR CARDIAC DYSRHYTHMIAS
- CHECK
Cough
Wheezing
Decreased breath sounds
Sputum production - HYDRATION
When/How is bronchodilators administered ?
ADMINISTERED AT REGULAR INTERVALS AROUND THE CLOCK TO MAINTAIN A SUSTAINED THERAPEUTIC LEVEL
Are oral meds administered before/after meals ?
Oral meds are administered WITH or AFTER MEAL to DECREASE GI IRRITATION
What is the therapeutic serum level for Theophylline ?
10 - 20 mcg/mL
IV administered Aminophylline or Theophylline slow or fast ?
- SLOW
- VIA INFUSION PUMP (ALWAYS)
Client education (bronchodilators)
- DO NOT CRUSH ENTERIC COATED OR SUSTAINED RELEASE TABLETS OR CAPSULES
- AVOID CAFFEINE, PRODUCTS THAT CONTAIN IT
- OTC MEDS
- HOW TO MONITOR THE PULSE
- REPORT ANY ABNORMALITIES TO THE HCP
- HOW TO USE AN INHALER/SPACER/NEBULIZER (MONITOR AMOUNT OF MEDICATION IN INHALERS)
- CEASE SMOKING
- MONITOR BLOOD GLUCOSE IN DIABETIC MELLITUS PTs
- MEDIC- BRACELET TO BE WORN (PARTICULARLY IN ASTHMATICS)
What is the level of toxicity for Theophylline ? And what are the early signs ?
- HIGHER THAN 20 mcg/mL
- Early signs are
RESTLESSNESS
TREMORS
NERVOUSNESS
PALPITATIONS
TACHYCARDIA
What drugs are inhaled ?
- B-Andrenergic bronchodilators
- Cromolyn sodium
- Aerosol glucocorticoids
How are metered dose inhalers used ?
- NOT IN MOUTH
- HELD ABOUT 2 FINGER WIDTHS (1 1/2 inches) in front of mouth
How are inhalers with spacers used ?
Spacers can be put in the mouth
BRONCHODILATORS ( B- ADRENERGIC AGONISTS ) INHALED
- AlbuteROL ( Proventil, AccuNeb, ProAir, Ventolin )
- ArformoteROL ( Brovana )
- LevalbuteROL ( Xopenex )
- PirbuteROL ( Maxair Autohaler )
- SalmeteROL ( Serevent Diskus )
How are AlbuteROL ( VoSpire, Proventil ) and Terbutaline Sulfate administered ?
- Via PO
- SubQ
Methylxanthine ( Bronchodilator)
- Theophylline, Oral ( Theo-24, Theochron, Uniphyl, Elixophyllin )
- Aminophylline ( SlowBid, Theo- Dur )
If IV drip for Aminophylline must have heart monitor
AntiCholinergics ( Bronchodilator )
- IpratroPIUM (inhaled) ( Atrovent HFA, Combivent )
- TiotroPIUM (inhaled) ( Spiriva )
Glucocorticoids (corticosteroids) Inhaled
- BeclomethaSONE Dipropionate (Qvar, Beclovent)
- BudesoNIDE (PulmiCORT Turbuhaler, PulmiCORT Respules, PulmiCORT Flexhaler)
- CiclesoNIDE (Alvescol)
- FlunisolIDE (AeroBid)
- FluticaSONE Propionate (FLOVENT HFA, FLOVENT DISKUS)
Glucocorticoids (Oral)
- PredniSONE
- PrednisoLONE
Leukotriene Modifiers (oral)
- MonteluKAST ( Singular )
- ZafirluKAST ( Accolate )
- Zileuton ( Zyflo, Zyflo CR )
Inhaled NONsteroidal Anti-Allergy Agent
- Cromolyn sodium
Monoclonal Antibody
- Omalizumab (Xolair)
What are ANTICHOLINERGICS ?
- INHALED MEDS
- IMPROVE LUNG FUNCTION
- RESULT IN BRONCHODILATION
AntiCholinergic meds are effective for treating what ?
- COPD
- ALLERGY-INDUCED ASTHMA
- EXERCISE INDUCED BRONCHOSPASM
S/E OF ANTICHOLINERGICS
- DRY MOUTH
- IRRITATION OF PHARYNX
- SUCKING ON SUGARLESS CANDY WILL HELP RELIEVE SYMPTOMS
What can systemic anticholinergic cause ? (Rarely occur)
- Increased intraocular pressure
- Blurred vision
- Tachycardia
- Cardiovascular events
- Urinary Retention
- Constipation
Why should clients with peanut butter allergies not take IpratroPIUM ( Atrovent HFA and Combivent) ?
CONTAIN SOY LECITHIN ( Same plant family as peanuts )
Glucocorticoids ( Corticosteroids )
- Glucocorticoids act as ANTI- INFLAMMATORY AGENTS
- REDUCE EDEMA OF AIRWAYS
- TREAT ASTHMA/ OTHER INFLAMMATORY RESPIRATORY CONDITIONS
Leukotriene Modifiers
- Used in prophylaxis and treatment of CHRONIC BRONCHIAL ASTHMA( NOT ACUTE EPISODES )
- Inhibits bronchoconstriction caused by specific antigens and reduce airway edema and smooth muscle constriction
- CONTRAINDICATED IN HYPERSENSITIVITY AND BREASTFEEDING MOTHERS
- CAUTION IN PATIENTS WITH IMPAIRED HEPATIC FUNCTION
- Coadministration of inhaled glucocorticoids increase the risk if upper respiratory infection
Side/Adverse effects of Leukotriene Modifiers
- Headache
- Nausea/Vomiting
- Dyspepsia ( Indigestion )
- Diarrhea
- Generalized pain, myalgia
- Fever
- Dizziness
Interventions ( Leukotriene Modifiers )/ Client education
- Monitor VS
- Check lung sounds for adventitious breath sounds
- Monitor liver function lab values
- Monitor for cyanosis
Education
- Take medication 1 hour before or 2 hours after meals
- Increase fluid intake
- Not discontinue the medication and to take as prescribed, EVEN DURING SYMPTOM- FREE PERIODS
Inhaled Non-Steroidal Anti Allergy Agent
- AntiAsthmatic, AntiAllergic
- Mast Cell stabilizer
- Inhibits mast cell release after exposure to antigens
What are inhaled nonsteroidal antiallergy agents treat ?
- Allergic Rhinitis
- Bronchial Asthma
- Exercise induced bronchospasm
- CONTRAINDICATED IN PTs with KNOWN HYPERSENSITIVITY
Orally administered cromolyn sodium is used in CAUTION with Pts with ?
Impaired hepatic or renal function
Side Effects of NONsteroidal AntiAllergy Agent/ Interventions
- Cough
- Sneezing
- Nasal Sting
- Bronchospasm after inhalation
- Unpleasant taste in the mouth
Interventions
- Monitor Vital Signs
- Monitor Respirations and check lungs for adventitious sounds
Client education for NONsteroidal Anti Allergy Agent
- Administer oral capsules at least 30 min before meals
- Not to discontinue the medication abruptly because a rebound asthmatic attack can occur
- Medication needs to be taken as prescribed
What is given to the patient before and after an inhaled medication ?
Pt is given water and told to take a few sips before and after inhalation to prevent a cough and unpleasant taste in the mouth
Antihistamines
- Histamine Antagonists or H1 blockers
- COMPETE WITH HISTAMINE FOR RECEPTOR SITES, PREVENTING A HISTAMINE RESPONSE
- WHEN H1 IS STIMULATED EXTRAVASCULAR SMOOTH MUSCLES, INCLUDING THOSE LINING THE NASAL CAVITY ARE CONSTRICTED
- DECREASE NASOPHARYNGEAL, GASTROINTESTINAL, AND BRONCHIAL SECRETIONS BY BLOCKING H1 RECEPTOR
- USED FOR COMMON COLD, RHINITIS, NAUSEA/VOMITING, MOTION SICKNESS, SLEEP AID
- CAUTION WITH PTs WHO HAVE COPD BECAUSE OF DRYING EFFECT
- DYPHENHYDRAMINE (BENADRYL) HAS ANTICHOLINERIC EFFECT AND SHOULD BE AVOIDED IN CLIENTS WITH NARROW ANGLED GLAUCOMA
- CAUSE CNS DEPRESSION IF TAKEN WITH ALCOHOL, OPIODS, HYPNOTICS, BARBITURATES
Side effects/adverse
- DROWSINESS
- FATIGUE
- DRY MOUTH
- BLURRED VISION
- WHEEZING
- Constipation
- GI irritation
- Hearing disturbances
- Photosensitivity
- Nervousness and irritably
Antihistamine interventions
- Monitor vital signs
- Monitor for signs of urinary dysfunction
- Administer with food or milk
What administration is avoid in antihistamines ?
- AVOID SUB Q INJECTIONS
- INTRAMUSCULAR INJECTIONS IN LARGE MUSCLES ( IF PRESCRIBED)
Antihistamine ( MEDs )
- CetiriZINE ( Zyrtec)
- ChlopheniraMINE (Chlo-Trimeton, Chlorphen, Allen- Chlor)
- Dimenhydrinate ( Dramamin )
- DyphenhydraMINE ( Benadryl )
- FexofenadINE ( Allegra )
- LorataDINE ( Claritin , Alavert )
Nasal Decongestants
(SHRINK) NASAL MUCOSAL MEMBRANES/ REDUCE FLUID SECRETIONS
- Adrenergic
- Anticholinergic
- Corticosteroid
What are nasal decongestants contraindicated in ? What are the side effects ?
- Hypertension
- Cardiac Disease
- Hyperthyroidism
- Diabetes Mellitus
S/E
- Nervousness
- Restlessness, insomnia
- Hypertension
- HYPERglycemia
Interventions/ Client Education for Nasal decongestants
- Assessed for existing medical disorders
- MONITOR CARDIAC DYSRHYTHMIAS
- BLOOD GLUCOSE LEVELS
- AVOID CAFFEINE ( Cause restlessness and palpitations )
- LIMITING USE OF NASAL SPRAYS AND DROPS ( MAY CAUSE REBOUND NASAL CONGESTION )
What MUST you educate the Pt about NASAL DECONGESTANTS preferably NASAL SPRAYS AND DROPS
- THEY CAN CAUSE TOLERANCE AND REBOUND NASAL CONGESTION ( Vasodilation )
- IRRITATION
- THESE SHOULD NOT BE TAKEN LONGER THAN 48 HRS
Expectorants
- LOOSEN BRONCHIAL SECRETIONS
- Help in ELIMINATING WITH COUGHING, DRY/NONPRODUCTIVE COUGH
- STIMULATE BRONCHIAL SECRETIONS
Expectorant ( MEDs)
- Guaifensin ( Humibid, Mucinex, Robitussin )
Mucolytic Agents
- THINS mucous secretions to help make cough more productive
Side/adverse effects with Expectorants and Mucolytic Agents
- GI Irritation
- Skin Rash
- Oropharyngeal irritation
Expectorant/ Mucolytic Agents Interventions
- Acetylcysteine ( Mucomyst )
Administered by NEBULIZATION
SHOULD NOT be mixed with another medication - If Acetylcysteine is administered with a BRONCHODILATOR, MUST wait 5 min before administering it
What are side effects of acetylcysteine ?
- NAUSEA
- VOMITING
- stomatitis
- RUNNY NOSE
Education for Expectorants/Mucolytic Agents
- TAKE FULL GLASS OF WATER ( Helps loosen secretions )
- Maintain adequate fluid intake
- Take deep breaths periodically and cough
Antitussives
- Act on cough control center in medulla to SUPPRESS COUGH REFLEX
- For cough that is NONproductive cough and irritating
Side/Adverse Effects of Antitussives
- DIZZINESS
- DROWSINESS
- SEDATION
- GI IRRITATION
- NAUSEA
- DRY MOUTH
- CONSTIPATION
- RESPIRATORY DEPRESSION
Nursing Interventions for Antitussives
- Take adequate fluids with medication
- Sleep with the head of bed elevated
- Drug dependency can occur
- DO NOT GIVE TO PATIENTS WHO HAD A CRANIAL SURGERY or HEAD INJURY
- IF USING OPIODS, SEDATIVE HYPNOTICS, BARBITURATES, ANTIDEPRESSANTS IS AVOIDED ( CNS DEPRESSION CAN OCCUR )
Client education on antitussives
- Cough that lasts LONGER THAN 1 WEEK AND FEVER OR RASH NOTIFY HCP
- AVOID HAZARDOUS ACTIVITIES
- AVOID USE OF ALCOHOL
Opioid Antagonists
- REVERSES RESPIRATORY DEPRESSION IN OPIOD OVERDOSE IN OPIOD OVERDOSE
- AVOID USE IN ( NONOPIOID RESPIRATORY DEPRESSION )
- REOCCURRENCE OF RESPIRATORY DEPRESSION CAN OCCUR IF DURATION OF OPIATE EXCEEDS DURATION OF OPIOD ANTAGONIST
Side/Adverse effects of opioid antagonists
- Nausea, Vomiting
- Tremors
- Sweating
- Increased blood pressure
- Tachycardia
Nursing Interventions for Opioid Antagonists
- Monitor vital signs
- RESPIRATIONS
- RN RESPONSIBLE FOR IV administration and for titrating the dose administered every 2 - 5 min as prescribed
- HAVE OXYGEN AND RESUSCITATIVE EQUIPMENT AVAILABLE DURING ADMINISTRATION
OPIOD ANTAGONISTS
- Alvimopan (Entereg)
- Methyltrexone ( Relistor)
- NALOXONE (NARCAN)
- NALTREXONE (VIVITROL)
Tuberculosis Meds
- MOST EFFECTIVE METHOD FOR TREATING DISEASE AND PREVENTING TRANSMISSION
- Treatment depends on weather pt has active disease or has been exposed to disease
- Use of multi drug regimen DESTROYS ORGANISMS AS QUICKLY AS POSSIBLE AND MINIMIZES THE EMERGENCE OF DRUG- RESISTANT ORGANISMS
- ACTIVE TB IS TREATED WITH A COMBINATION OF MEDS TO WHICH THE ORGANISM IS SUSCEPTIBLE
How long are individuals with tuberculosis treated ?
6 - 9 months
Are clients with HIV treated for a longer period ?
Yes
After an individual has received medications for 2 - 3 weeks is the risk for transmission reduced ?
Yes
How long does it take for sputum cultures to come out negative ?
3 MONTHS OF COMPLIANCE WITH MEDICATION THERAPY
What are individuals with active TB treated with ? How long are they on treatment ?
They are treated with PREVENTATIVE ISONIAZID FOR 9-12 MONTHS
First or second line medications are more effective ?
FIRST LINE MEDICATIONS ARE MOST EFFECTIVE ANTITUBERCULOSIS ACTIVITY
SECOND LINE ARE USED TO COMBINE WITH FIRST LINE MEDS BUT ARE MORE TOXIC
First Line Medications
- Ethambutol (Myambutol)
- ISONIAZID
- PYRAZINAMIDE
- RIFAMBUTIN (MYCOBUTIN)
- RIFAMPIN (PRIFTIN)
Second Line Agents
- AmikaCIN (Amikin)
- CapreomCIN Sulfate (Capastat Sulfate)
- CiprofloxaCIN (Cipro)
- Cycloserine (SeromyCIN)
- EthionaMIDE (Trecator)
- KanamyCIN (Kantrex)
- LevoflxaCIN (Levaquin)
- MoxifloxaCIN (Avelox)
- p- Aminosalicylic Acid (Pacer)
- StreptomyCIN
Isoniazid
- ACT TO KILL ACTIVELY GROWING ORGANISMS IN EXTRACELLULAR ENVIRONMENT
- ACTIVE ONLY DURING CELL DIVISION
- USED IN COMBINATION WITH OTHER ANTITUBERCULAR MEDS
Contraindications for Isoniazid
- HYPERSENSITIVITY
- ACUTE LIVER DISEASE
- CAUTION WITH PATIENTS WHO HAVE
CHRONIC LIVER DISEASE
ALCOHOLISM
RENAL IMPAIRMENT
What are some medications that may increase toxicity if taken with Isoniazid ?
- CarbamazePINE ( Tegretol )
- Phenytoin ( Dilantin )
What are some side/adverse effects of Isoniazid
- HYPERSENSITIVITY REACTIONS
- PERIPHERAL NEURITIS
- NEUROTOXICITY
- HEPATOTOXICITY AND HEPATITIS
- INCREASED LIVER FUNCTION TEST LEVELS
- PYRIDOXINE (VIT B6) DEFICIENCY
- irritation at injection site ( intramuscular administration )
- nausea/vomiting
- dizziness ( Safety precautions )
- hyperglycemia
- VISION CHANGES ( NOTIFY RN )
Nursing Interventions for Isoniazid
- MONITOR HYPERSENSITIVITY
- MONITOR HEPATIC DYSFUNCTION
- MONITOR FOR SENSITIVITY TO NICOTINIC ACID (NIACIN)
- MONITOR LIVER FUNCTION TEST RESULTS
- MONITOR SIGNS OF HEPATITIS:
NAUSEA
VOMITING
WEAKNESS
FATIGUE
DARK URINE
JAUNDICE ( HOLD MEDS IF THESE OCCUR TELL RN )
MONITOR TINGLING/NUMBING OR BURNING OF EXTREMITIES - MONITOR CBC & BLOOD GLUCOSE LEVELS
How long before or after a meal would you administer Isoniazid ?
- 1 HOUR BEFORE MEAL
- 2 HOURS AFTER MEAL
FOOD MAY DELAY ABSORPTION
When to administer Isoniazid when taking antacids
- Administer at least 1 hour before taking antacids, especially those that contain aluminum
Why is Pyridoxine administered as prescribed with Isoniazid ?
REDUCE RISK OF NEUROTOXICITY
What are toxic effects that tuberculosis medications cause ?
- HEPATOTOXICITY
- NEUROTOXICITY
- OPTIC NEURITIS
- OTOTOXICITY
Client education on Isoniazid
- NOT TO SKIP DOSES/ TAKE MEDICATION FOR THE FULL LENGTH
- NOT TAKE ANY OTHER MEDICATIONS WITHOUT CONSULTING THE DOCTOR
- IMPORTANCE OF FOLLOWING UP WITH THE DOCTOR ( VISION TESTS )
- NO ALCOHOL
- TAKE MEDICATION ON EMPTY STOMACH WITH 8 oz OF WATER 1 HR BEFORE OR 2 AFTER MEALS
- AVOID ANTACIDS
- RECOGNIZE NEUROTOXICITY, HEPATITIS, HEPATOTOXICITY, VISUAL CHANGES
