Respiratory Meds Flashcards
Beta-2 Adrenergic Agonists prototype
Albuterol
Beta-2 Adrenergic Agonists action
activate beta-2 receptors in the bronchial smooth muscle which results in bronchodilation relieving bronchospasm, inhibiting histamine release, and increasing ciliary motility
Beta-2 Adrenergic Agonists therapeutic uses
- prevention of exercise induced asthma episode
- inhaled short acting form used for prevention of asthma
- treatment of bronchospasm
- long term control of asthma
Beta-2 Adrenergic Agonists complications
TACHYCARDIA, ANGINA due to activation of alpha- 1 receptors in the heart (client should report pain or increase of HR 20-30 bpm, avoid caffeine, consider reduction of dose)
TREMORS due to activation of beta- 2 receptors in skeletal muscles (usually resolves with continued medication use, consider dose reduction)
Beta-2 Adrenergic Agonists contraindications/ precautions
pregnancy risk category C, clients with tachydysrhythmias, or clients with DM, hyperthyroid, heart disease, HTN, and angina
Beta-2 Adrenergic Agonists nursing administration
follow instructions for administration, use beta- 2 before glucocorticoid if prescribed both b/c will allow for bronchodilation and increased absorption, do not exceed prescribed dose, know dosage schedule, log asthma exacerbations and inform provider of change in frequency
Methylxanthines prototype
Theophylline
Methylxanthines action
relaxation of bronchial smooth muscle, resulting in bronchodilation (used less frequently because newer meds are safer)
administered oral or IV (emergency use)
Methylxanthines therapeutic uses
long-term control of chronic asthma or COPD
Methylxanthines complications
MILD TOXICITY REACTION CAN INCLUDE GI DISTRESS AND RESTLESSNESS and more severe reactions can occur with higher therapeutic levels and can include DYSRHYTHMIAS and SEIZURES (monitor serum levels, if symptoms occur stop treatment - activated charcoal decreases absorption, lidocaine treats dysrhythmias, and diazepam controls seizures, periodic blood monitoring required, report - nausea, diarrhea, or restlessness)
Methylxanthines contraindications/ precautions
pregnancy risk category C
use cautiously with heart disease, hypertension, liver & kidney dysfunction, diabetes mellitus, in children, and older adults
Methylxanthines nursing administration
do not double dose if dose missed, do not crush or chew sustained- release preparations
Inhaled Anticholinergics prototype
Ipratropium
Inhaled Anticholinergics action
block muscarinic receptors of bronchi resulting in bronchodilation
Inhaled Anticholinergics therapeutic uses
relieve bronchospasm associated with COPD
allergen-induced and exercise induced bronchospasm
Inhaled Anticholinergics complications
DRY MOUTH and HOARSENESS considered local anticholinergic effects (advise client to sip fluid and suck on sugar free hard candy to control dry mouth)
Inhaled Anticholinergics contraindications/ precautions
pregnancy risk category b
allergy to peanuts
used cautiously when narrow-angle glaucoma and benign prostatic hyperplasia
Inhaled Anticholinergics nursing administration
rinse mouth after inhalation to decrease unpleasant taste, adult dose is usually 2 puffs, wait directed length of time between puffs, if two meds are prescribed wait at least 5 minutes between medications
Glucocorticoids prototype
Prednisone (oral form)
Beclomethasone (inhaled form)
Glucocorticoids action
prevent inflammation, suppress airway mucus production, promote responsiveness of beta2 receptors in bronchial tree
reduction in airway mucosa edema
use is not to provide immediate effects, but rather promote decreased frequency and severity of exacerbations and acute attacks
Glucocorticoids therapeutic use
short term IV agents for status asthmaticus, inhaled for long-term prophylaxis of asthma, short-term oral therapy following acute asthma episode, long-term oral therapy for chronic, severe asthma, promote lung maturity and decrease respiratory distress in fetuses at risk for preterm birth
Glucocorticoids complications
BECLOMETHASONE
DIFFICULTY SPEAKING, HOARSENESS, and CANDIDIASIS (rinse mouth or gargle with water after use, monitor for redness, sores, or white patches - treat candidiasis with nystatin oral suspension)
PREDNISONE with greater than 10 day use
SUPPRESSION OF ADRENAL FUNCTION due to decrease in ability of adrenal cortex to produce glucocorticoids secondary to inhaled or oral agents (administer oral med on alternate day dosing schedule, monitor blood glucose levels, taper dose and do not stop abruptly)
BONE LOSS with inhaled or oral agents (perform weight bearing exercises, consume diet with sufficient calcium and vitamin D, use lowest possible does, oral med should be given on alternate day schedule)
HYPERGLYCEMIA and GLYCOSURIA (monitor blood glucose, clients with DM may need increase in insulin dosage)
MYOPATHY as evidenced by muscle weakness (report signs of weakness, med dosage should be decreased)
PEPTIC ULCER DISEASE (avoid NSAIDs, report black tarry stools, check stool for occult blood periodically, administer with food or meals)
INFECTION (report early signs of infection including sore throat, weakness, malaise)
DISTURBANCES OF FLUID AND ELECTROLYTES fluid retention as evidenced by weight gain and edema and hypokalemia as evidenced by muscle weakness (observe for manifestations and report to provider)
Glucocorticoids contraindications/ precations
pregnancy risk category C
contraindicated in clients who have received a live virus vaccine and those who have systemic fungal infections
use cautiously with children, pts with DM, HTN, heart failure, PUD, osteoporosis, and/or kidney dysfunction
Glucocorticoids nursing administrations
use on a fixed schedule not for acute episodes
administer using MDI, DPI, or nebulizer
devices with HFA do not require spacer
inhale beta-2 agonist before glucocorticoid
oral glucocorticoids are used short term, 3-10 days after acute episode
if on long term therapy, may require additional doses in times of stress
Leukotriene Modifiers prototype
Montelukast
Leukotriene Modifiers action
suppress the effects of leukotrienes, thereby reducing inflammation, bronchoconstriction, airway edema, and mucous production
Leukotriene Modifiers therapeutic use
long-term therapy of asthma in adults and children, and to prevent exercise-induced bronchospasm
Leukotriene Modifiers complications
DEPRESSION and SUICIDAL IDEATIONS (monitor for behavior changes)
Leukotriene Modifiers contraindications/ precautions
pregnancy category B, use cautiously in patients with liver dysfunction
Leukotriene Modifiers nursing administration
monitor for behavior changes, obtain baseline liver function tests, monitor for liver damage (nausea, anorexia, abdominal pain), take montelukast once daily at bedtime, or take 2hr before exercise if exercise-induced bronchospasm (but dont take additional dose)
Antitussives - opioids prototype
Codeine
Antitussives - opioids action
suppresses cough by acting on CNS to increase cough threshold
Antitussives - opioids therapeutic use
chronic nonproductive cough to decrease frequency and intensity
Antitussives - opioids complications
CNS - DIZZINESS, LIGHTHEADNESS, DROWSINESS, RESPIRATORY DEPRESSION (obtain baseline vitals, monitor ambulation, change positions slowly, lay down if light headed, monitor for respiratory depression - antidote: Naloxone, avoid activities that require alertness)
GI - NAUSEA, VOMITING, CONSTIPATION (take with food, increase fluids and dietary fiber)
OPIOID USE DISORDER (alert client of potential abuse, use for short duration)
Antitussives - opioids contraindications/ precautions
pregnancy class C, contraindicated in clients with respiratory depression, acute asthma, head trauma, liver and renal dysfunction and alcohol disorder, use cautiously with children, older adults and those with a history of substance abuse
Antitussives - opioids nursing administration
avoid activities that require alertness, change positions slowly, lay down if feeling dizzy, avoid alcohol and other CNS depressants
Antitussives - non-opioids prototype
Dextromethorphan
Antitussives - non-opioids action
acts on CNS to depress cough, although it is not an opioid it is derived from opioids
Antitussives - non-opioids therapeutic use
cough suppression, reduce pain when combined with an opoid
Antitussives - non-opioids complications
med has few adverse effects but may cause nausea, dizziness, sedation
potential for abuse as the medication can instill euphoria in high doses
Antitussives - non-opioids contraindications/ precautions
pregnancy risk category C
Antitussives - non-opioids nursing administration
cause fever if given within 2 weeks of a MAOI, risk of abuse, some formulas can contain alcohol and/or sucrose
Expectorants prototype
Guaifenesin
Expectorants action
increased cough production by increasing and thinning mucus secretion. This decreases chest congestion by coughing out secretions
Expectorants therapeutic use
combined with antitussives or decongestant to treat cold, allergic or non allergic rhinitis or cough caused by lower respiratory disorders
Expectorants complications
GI UPSET (take with food if upset occurs) DROWSINESS/ DIZZINESS (do not do activities that require alertness) ALLERGIC RXN - RASH (stop med and call doctor if this occurs)
Expectorants contraindications/ precautions
pregnancy risk class C, breastfeeding, might be contraindicated in children
Expectorants nursing administration
take with food, increase fluid, do not take prior to driving, tablets should not be crushed, read label - this is often used in combination with other medications, report a cough lasting longer than 1 week
Mucolytics prototype
Acetylcysteine
Mucolytics action
thin and enhance flow of secretion in the respiratory passages
Mucolytics therapeutic use
acute or chronic pulmonary disorders exacerbated by large amounts of secretions, cystic fibrosis, antidote for acetaminophen poisoning
Mucolytics complications
ASPIRATION and BRONCHOSPASM when administered orally (monitor for conditions, if indicated stop med immediately and notify provider)
DIZZINESS, DROWSINESS, HYPOTENSION, TACHYCARDIA (monitor vital signs, change positions slowly, avoid activities that require alertness)
HEPATOTOXICITY (monitor liver function tests)
Mucolytics contraindications/ precautions
pregnancy risk category B, clients hypersensitive to acetylcysteine, use cautiously in clients with hypothyroidism, CNS depression, renal, liver disease, seizure disorders, and asthma (potential for bronchospasm)
Mucolytics nursing administration
monitor vitals, change position slowly, assess for manifestations of aspiration, monitor liver function tests, tell patient the medication smells like rotten eggs (ew!), be prepared to suction
Decongestants prototype
Phenylephrine
Decongestants action
sympathomimetic decongestant that stimulates alpha 1-adrenergic receptors causing reduced inflammation of the nasal membranes
Decongestants therapeutic use
allergic/non-allergic rhinitis, relieves nasal stuffiness, decongestant for sinusitis and common cold
Decongestants complications
REBOUND CONGESTION secondary to prolonged use of topical agents (only used for short term therapy - 3 to 5 days, taper use and discontinue medication using one nostril at a time)
CNS stimulation AGITATION, NERVOUSNESS, UNEASINESS (rare with topical agent, report symptoms, stop medication if symptoms occur)
VASOCONSTRICTION (advise clients who have HTN, cerebrovascular disease, dysrhythmias, and coronary artery disease to avoid these meds)
Decongestants contraindications/ precautions
cardiac patients (CAD, HTN, cerebrovascular disease and dysrhythmias), closed-angle glaucoma
Decongestants nursing administration
when administering drops be in lateral, head- low position to increase desired effects and to prevent swallowing meds
if using topical agent do not use for more than 3-5 days to avoid rebound congestion (no concern for rebound with oral)
taper use and discontinue one nostril at a time
do not exceed recommended dose
Antihistamines prototype
1st generation H1 Antagonists–Diphenhydramine
2nd Generation H1 Antagonists– Cetirzine & Fexofenadine
Antihistamines action
action on the H1 receptors, which results in the blocking of histamine release in the sm blood vessels, capillaries, and nerves during allergic reactions. These medications relieve itching, sneezing, and rhinorrhea, but do not relieve nasal congestion. 1st generation produce cholinergic effects and drowsiness
Antihistamines therapeutic use
mild allergic reactions (seasonal allergic rhinitis, urticaria, mild transfusion reaction), anaphylaxis (hypotension, acute laryngeal edema, bronchospasm), motion sickness, insomnia, used in combination with sympathomimetics to provide nasal decongestant effect
Antihistamines complications
SEDATION common with 1st generation H1 antagonists (take at night, avoid activities that require alertness)
anticholinergic effects DRY MOUTH, CONSTIPATION most common with 1st generation agents (sugar free gum or hard candy to avoid dryness with 2-3L water per day)
GI discomfort NAUSEA, VOMITING, CONSTIPATION (take with meals)
ACUTE TOXICITY, EXCITATION, HALLUCINATIONS, INCOORDINATION, SEIZURES in children, FLUSHED FACE, HIGH FEVER, TACHYCARDIA, DRY MOUTH, URINARY RETENTION, PUPIL DILATION (notify provider if effects occur, activated charcoal and cathartic decrease absorption, acetometophin for high fever, apply ice packs or sponge baths)
Antihistamines contraindications/ precautions
3rd trimester of pregnancy, breastfeeding mothers (it can dry up their milk supply!), and for newborns (sedation effect), pregnancy risk category C, use cautiously in children and adults (respiratory depression), contraindicated in clients who have cardiac dysrhythmias, hepatic diseases, and those on MAOI therapy, caution in clients with asthma, seizure disorder, cardiac disease, renal disease, urinary retention, open-angle glaucoma, hypertension, and prostate hypertrophy
Antihistamines nursing administration
avoid alcohol and meds causing CNS depression
Nasal Glucocorticoids prototype
Mometasone
Nasal Glucocorticoids action
decrease inflammation associated with allergic rhinitis, first line treatment for nasal congestion
Nasal Glucocorticoids therapeutic use
reduce the effects of allergic rhinitis including sneezing, nasal itching, runny nose
Nasal Glucocorticoids complications
SORE THROAT, NOSEBLEED, HA, BURNING IN NOSE (contact provider if adverse effects occur)
Nasal Glucocorticoids contraindications/ precautions
Pregnancy risk category C
Nasal Glucocorticoids nursing administration
use metered-dose spray device, dose daily, may take 7 days or more for maximum relief, if perennial allergic rhinitis may take as long as 21 days for relief, clear blocked nasal passages with a topical decongestant prior to administering
