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RESPIRATORY MEDICATIONS Flashcards

1
Q

METERED-DOSE INHALER (MDI)

A
  • Chemical propellant pushes medication out of inhaler
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2
Q

DRY POWDER INHALER (DPI)

A
  • Delivers WITHOUT CHEMICAL PROPELLANTS

- REQUIRES STRONG/FAST INHALATION

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3
Q

NEBULIZER

A
  • DELIVERS FINE LIQUID MISTS OF MEDICATION
  • DELIVERED THROUGH MASK OR TUBE THAT FITS OVER NOSE OR MOUTH
  • USES AIR OR OXYGEN UNDER PRESSURE
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4
Q

If two different inhaled medications are prescribed and one of the medications is a glucocorticoid (corticosteroid)what will you give first ?

A
  • ADMINISTER THE BRONCHODILATOR FIRST BEFORE THE STEROID
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5
Q

Sympatho/mimetic bronchodilator

A
  • 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
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6
Q

Methylxanthine bronchodilator

A
  • STIMULATE CNS AND RESPIRATION
  • RELAX SMOOTH MUSCLE
  • DILATE coronary and pulmonary vessels
  • CAUSE DIURESIS
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7
Q

What are bronchodilators used for ?

A
  • TREAT ALLERGIC RHINITIS AND SINUSITIS
  • ACUTE BRONCHOSPASM
  • ACUTE/CHRONIC ASTHMA
  • BRONCHITIS
  • COPD
  • EMPHYSEMA
  • OTHER RESTRICTIVE AIRWAY DISEASES
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8
Q

What are BRONCHODILATORS CONTRAINDICATED IN ?

A
  • HYPERSENSITIVITY
  • PEPTIC ULCER DISEASE
  • SEVERE CARDIAC DISEASE
  • CARDIAC DYSRHYTHMIAS
  • HYPERthyroidism
  • UNCONTROLLED SEIZURE DISORDERS
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9
Q

Bronchodilators are used with caution in patients with ?

A
  • HYPERTENSION
  • NARROW- ANGLED GLAUCOMA
  • DIABETES MELLITUS
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10
Q

Which bronchodilator increases the toxicity level of digoxin and decreases the effects of lithium and phenytoin ?

A

Theophylline

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11
Q

If Theophylline and Beta2 adrenergic agonist are taken together what will it cause ?

A

Cardiac dysrhythmias

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12
Q

Do B-blockers, Cimetidine (Tagamet), and erythromycin increase or decrease the effects of Theophylline ?

A

Increase

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13
Q

Do Barbiturates and Carbamazepine (Tegretol) decrease or increase the effects of Theophylline ?

A

Decrease

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14
Q

Side effects of bronchodilators

A
  • 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
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15
Q

Interventions for bronchodilators

A
  • MONITOR FOR RESTLESSNESS AND CONFUSION
  • MONITOR VITAL SIGNS AND LUNG SOUNDS
  • MONITOR CARDIAC DYSRHYTHMIAS
  • CHECK
    Cough
    Wheezing
    Decreased breath sounds
    Sputum production
  • HYDRATION
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16
Q

When/How is bronchodilators administered ?

A

ADMINISTERED AT REGULAR INTERVALS AROUND THE CLOCK TO MAINTAIN A SUSTAINED THERAPEUTIC LEVEL

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17
Q

Are oral meds administered before/after meals ?

A

Oral meds are administered WITH or AFTER MEAL to DECREASE GI IRRITATION

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18
Q

What is the therapeutic serum level for Theophylline ?

A

10 - 20 mcg/mL

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19
Q

IV administered Aminophylline or Theophylline slow or fast ?

A
  • SLOW

- VIA INFUSION PUMP (ALWAYS)

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20
Q

Client education (bronchodilators)

A
  • 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)
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21
Q

What is the level of toxicity for Theophylline ? And what are the early signs ?

A
  • HIGHER THAN 20 mcg/mL
  • Early signs are
    RESTLESSNESS
    TREMORS
    NERVOUSNESS
    PALPITATIONS
    TACHYCARDIA
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22
Q

What drugs are inhaled ?

A
  • B-Andrenergic bronchodilators
  • Cromolyn sodium
  • Aerosol glucocorticoids
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23
Q

How are metered dose inhalers used ?

A
  • NOT IN MOUTH

- HELD ABOUT 2 FINGER WIDTHS (1 1/2 inches) in front of mouth

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24
Q

How are inhalers with spacers used ?

A

Spacers can be put in the mouth

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25
Q

BRONCHODILATORS ( B- ADRENERGIC AGONISTS ) INHALED

A
  • AlbuteROL ( Proventil, AccuNeb, ProAir, Ventolin )
  • ArformoteROL ( Brovana )
  • LevalbuteROL ( Xopenex )
  • PirbuteROL ( Maxair Autohaler )
  • SalmeteROL ( Serevent Diskus )
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26
Q

How are AlbuteROL ( VoSpire, Proventil ) and Terbutaline Sulfate administered ?

A
  • Via PO

- SubQ

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27
Q

Methylxanthine ( Bronchodilator)

A
  • Theophylline, Oral ( Theo-24, Theochron, Uniphyl, Elixophyllin )
  • Aminophylline ( SlowBid, Theo- Dur )
    If IV drip for Aminophylline must have heart monitor
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28
Q

AntiCholinergics ( Bronchodilator )

A
  • IpratroPIUM (inhaled) ( Atrovent HFA, Combivent )

- TiotroPIUM (inhaled) ( Spiriva )

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29
Q

Glucocorticoids (corticosteroids) Inhaled

A
  • BeclomethaSONE Dipropionate (Qvar, Beclovent)
  • BudesoNIDE (PulmiCORT Turbuhaler, PulmiCORT Respules, PulmiCORT Flexhaler)
  • CiclesoNIDE (Alvescol)
  • FlunisolIDE (AeroBid)
  • FluticaSONE Propionate (FLOVENT HFA, FLOVENT DISKUS)
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30
Q

Glucocorticoids (Oral)

A
  • PredniSONE

- PrednisoLONE

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31
Q

Leukotriene Modifiers (oral)

A
  • MonteluKAST ( Singular )
  • ZafirluKAST ( Accolate )
  • Zileuton ( Zyflo, Zyflo CR )
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32
Q

Inhaled NONsteroidal Anti-Allergy Agent

A
  • Cromolyn sodium
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33
Q

Monoclonal Antibody

A
  • Omalizumab (Xolair)
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34
Q

What are ANTICHOLINERGICS ?

A
  • INHALED MEDS
  • IMPROVE LUNG FUNCTION
  • RESULT IN BRONCHODILATION
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35
Q

AntiCholinergic meds are effective for treating what ?

A
  • COPD
  • ALLERGY-INDUCED ASTHMA
  • EXERCISE INDUCED BRONCHOSPASM
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36
Q

S/E OF ANTICHOLINERGICS

A
  • DRY MOUTH
  • IRRITATION OF PHARYNX
  • SUCKING ON SUGARLESS CANDY WILL HELP RELIEVE SYMPTOMS
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37
Q

What can systemic anticholinergic cause ? (Rarely occur)

A
  • Increased intraocular pressure
  • Blurred vision
  • Tachycardia
  • Cardiovascular events
  • Urinary Retention
  • Constipation
38
Q

Why should clients with peanut butter allergies not take IpratroPIUM ( Atrovent HFA and Combivent) ?

A

CONTAIN SOY LECITHIN ( Same plant family as peanuts )

39
Q

Glucocorticoids ( Corticosteroids )

A
  • Glucocorticoids act as ANTI- INFLAMMATORY AGENTS
  • REDUCE EDEMA OF AIRWAYS
  • TREAT ASTHMA/ OTHER INFLAMMATORY RESPIRATORY CONDITIONS
40
Q

Leukotriene Modifiers

A
  • 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
41
Q

Side/Adverse effects of Leukotriene Modifiers

A
  • Headache
  • Nausea/Vomiting
  • Dyspepsia ( Indigestion )
  • Diarrhea
  • Generalized pain, myalgia
  • Fever
  • Dizziness
42
Q

Interventions ( Leukotriene Modifiers )/ Client education

A
  • 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
43
Q

Inhaled Non-Steroidal Anti Allergy Agent

A
  • AntiAsthmatic, AntiAllergic
  • Mast Cell stabilizer
  • Inhibits mast cell release after exposure to antigens
44
Q

What are inhaled nonsteroidal antiallergy agents treat ?

A
  • Allergic Rhinitis
  • Bronchial Asthma
  • Exercise induced bronchospasm
  • CONTRAINDICATED IN PTs with KNOWN HYPERSENSITIVITY
45
Q

Orally administered cromolyn sodium is used in CAUTION with Pts with ?

A

Impaired hepatic or renal function

46
Q

Side Effects of NONsteroidal AntiAllergy Agent/ Interventions

A
  • Cough
  • Sneezing
  • Nasal Sting
  • Bronchospasm after inhalation
  • Unpleasant taste in the mouth

Interventions

  • Monitor Vital Signs
  • Monitor Respirations and check lungs for adventitious sounds
47
Q

Client education for NONsteroidal Anti Allergy Agent

A
  • 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
48
Q

What is given to the patient before and after an inhaled medication ?

A

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

49
Q

Antihistamines

A
  • 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
50
Q

Side effects/adverse

A
  • DROWSINESS
  • FATIGUE
  • DRY MOUTH
  • BLURRED VISION
  • WHEEZING
  • Constipation
  • GI irritation
  • Hearing disturbances
  • Photosensitivity
  • Nervousness and irritably
51
Q

Antihistamine interventions

A
  • Monitor vital signs
  • Monitor for signs of urinary dysfunction
  • Administer with food or milk
52
Q

What administration is avoid in antihistamines ?

A
  • AVOID SUB Q INJECTIONS

- INTRAMUSCULAR INJECTIONS IN LARGE MUSCLES ( IF PRESCRIBED)

53
Q

Antihistamine ( MEDs )

A
  • CetiriZINE ( Zyrtec)
  • ChlopheniraMINE (Chlo-Trimeton, Chlorphen, Allen- Chlor)
  • Dimenhydrinate ( Dramamin )
  • DyphenhydraMINE ( Benadryl )
  • FexofenadINE ( Allegra )
  • LorataDINE ( Claritin , Alavert )
54
Q

Nasal Decongestants

A

(SHRINK) NASAL MUCOSAL MEMBRANES/ REDUCE FLUID SECRETIONS

  • Adrenergic
  • Anticholinergic
  • Corticosteroid
55
Q

What are nasal decongestants contraindicated in ? What are the side effects ?

A
  • Hypertension
  • Cardiac Disease
  • Hyperthyroidism
  • Diabetes Mellitus

S/E

  • Nervousness
  • Restlessness, insomnia
  • Hypertension
  • HYPERglycemia
56
Q

Interventions/ Client Education for Nasal decongestants

A
  • 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 )
57
Q

What MUST you educate the Pt about NASAL DECONGESTANTS preferably NASAL SPRAYS AND DROPS

A
  • THEY CAN CAUSE TOLERANCE AND REBOUND NASAL CONGESTION ( Vasodilation )
  • IRRITATION
  • THESE SHOULD NOT BE TAKEN LONGER THAN 48 HRS
58
Q

Expectorants

A
  • LOOSEN BRONCHIAL SECRETIONS
  • Help in ELIMINATING WITH COUGHING, DRY/NONPRODUCTIVE COUGH
  • STIMULATE BRONCHIAL SECRETIONS
59
Q

Expectorant ( MEDs)

A
  • Guaifensin ( Humibid, Mucinex, Robitussin )
60
Q

Mucolytic Agents

A
  • THINS mucous secretions to help make cough more productive
61
Q

Side/adverse effects with Expectorants and Mucolytic Agents

A
  • GI Irritation
  • Skin Rash
  • Oropharyngeal irritation
62
Q

Expectorant/ Mucolytic Agents Interventions

A
  • 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
63
Q

What are side effects of acetylcysteine ?

A
  • NAUSEA
  • VOMITING
  • stomatitis
  • RUNNY NOSE
64
Q

Education for Expectorants/Mucolytic Agents

A
  • TAKE FULL GLASS OF WATER ( Helps loosen secretions )
  • Maintain adequate fluid intake
  • Take deep breaths periodically and cough
65
Q

Antitussives

A
  • Act on cough control center in medulla to SUPPRESS COUGH REFLEX
  • For cough that is NONproductive cough and irritating
66
Q

Side/Adverse Effects of Antitussives

A
  • DIZZINESS
  • DROWSINESS
  • SEDATION
  • GI IRRITATION
  • NAUSEA
  • DRY MOUTH
  • CONSTIPATION
  • RESPIRATORY DEPRESSION
67
Q

Nursing Interventions for Antitussives

A
  • 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 )
68
Q

Client education on antitussives

A
  • Cough that lasts LONGER THAN 1 WEEK AND FEVER OR RASH NOTIFY HCP
  • AVOID HAZARDOUS ACTIVITIES
  • AVOID USE OF ALCOHOL
69
Q

Opioid Antagonists

A
  • 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
70
Q

Side/Adverse effects of opioid antagonists

A
  • Nausea, Vomiting
  • Tremors
  • Sweating
  • Increased blood pressure
  • Tachycardia
71
Q

Nursing Interventions for Opioid Antagonists

A
  • 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
72
Q

OPIOD ANTAGONISTS

A
  • Alvimopan (Entereg)
  • Methyltrexone ( Relistor)
  • NALOXONE (NARCAN)
  • NALTREXONE (VIVITROL)
73
Q

Tuberculosis Meds

A
  • 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
74
Q

How long are individuals with tuberculosis treated ?

A

6 - 9 months

75
Q

Are clients with HIV treated for a longer period ?

A

Yes

76
Q

After an individual has received medications for 2 - 3 weeks is the risk for transmission reduced ?

A

Yes

77
Q

How long does it take for sputum cultures to come out negative ?

A

3 MONTHS OF COMPLIANCE WITH MEDICATION THERAPY

78
Q

What are individuals with active TB treated with ? How long are they on treatment ?

A

They are treated with PREVENTATIVE ISONIAZID FOR 9-12 MONTHS

79
Q

First or second line medications are more effective ?

A

FIRST LINE MEDICATIONS ARE MOST EFFECTIVE ANTITUBERCULOSIS ACTIVITY

SECOND LINE ARE USED TO COMBINE WITH FIRST LINE MEDS BUT ARE MORE TOXIC

80
Q

First Line Medications

A
  • Ethambutol (Myambutol)
  • ISONIAZID
  • PYRAZINAMIDE
  • RIFAMBUTIN (MYCOBUTIN)
  • RIFAMPIN (PRIFTIN)
81
Q

Second Line Agents

A
  • AmikaCIN (Amikin)
  • CapreomCIN Sulfate (Capastat Sulfate)
  • CiprofloxaCIN (Cipro)
  • Cycloserine (SeromyCIN)
  • EthionaMIDE (Trecator)
  • KanamyCIN (Kantrex)
  • LevoflxaCIN (Levaquin)
  • MoxifloxaCIN (Avelox)
  • p- Aminosalicylic Acid (Pacer)
  • StreptomyCIN
82
Q

Isoniazid

A
  • ACT TO KILL ACTIVELY GROWING ORGANISMS IN EXTRACELLULAR ENVIRONMENT
  • ACTIVE ONLY DURING CELL DIVISION
  • USED IN COMBINATION WITH OTHER ANTITUBERCULAR MEDS
83
Q

Contraindications for Isoniazid

A
  • HYPERSENSITIVITY
  • ACUTE LIVER DISEASE
  • CAUTION WITH PATIENTS WHO HAVE
    CHRONIC LIVER DISEASE
    ALCOHOLISM
    RENAL IMPAIRMENT
84
Q

What are some medications that may increase toxicity if taken with Isoniazid ?

A
  • CarbamazePINE ( Tegretol )

- Phenytoin ( Dilantin )

85
Q

What are some side/adverse effects of Isoniazid

A
  • 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 )
86
Q

Nursing Interventions for Isoniazid

A
  • 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
87
Q

How long before or after a meal would you administer Isoniazid ?

A
  • 1 HOUR BEFORE MEAL
  • 2 HOURS AFTER MEAL
    FOOD MAY DELAY ABSORPTION
88
Q

When to administer Isoniazid when taking antacids

A
  • Administer at least 1 hour before taking antacids, especially those that contain aluminum
89
Q

Why is Pyridoxine administered as prescribed with Isoniazid ?

A

REDUCE RISK OF NEUROTOXICITY

90
Q

What are toxic effects that tuberculosis medications cause ?

A
  • HEPATOTOXICITY
  • NEUROTOXICITY
  • OPTIC NEURITIS
  • OTOTOXICITY
91
Q

Client education on Isoniazid

A
  • 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

Respiratory (6 decks)

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