RESPIRATORY-pharma Flashcards
What are two types of Histamines?
- H1 receptors mediate smooth muscle contraction(allergic symptoms) and dilate capillaries
- H2 accelerate HR and gastric acid secretion
What is allergic reactions?
- both H1 and H2 dilate vessels
- causes fluid to move out of vessels and into tissue causing BP to drop
- allergies are due to molds, mold spores, dust that causes hay, fever, itchy eyes, uticaria, sneezing, cough
How do allergens produce allergic reactions?
- Histamine are released by mast cells, basophils due to reaction to circulating antigens in blood
- binds and activates specific receptors in eyes, nose, skin, resp tract
- histamine bind to receptors causing pruritis
- H1 Blockers block histamine if receptors are not taken yet
What are non-sedating anti-histamine?
- Fexofenadine ( allegra and Seldane)
- Claritin
- EES and Ketoconazole(antifungal) can lead to seldane buildup and cause cardiac dysrythmias
- Allegra for seasonal allergic rhinitis-OTC and safe for 12 years old
CLARITIN
- not used in lower resp tract diseases
-
DIPHENDRAMINE
- Diphenhydramine-Benadryl
- used for allergies and motion sickness and sleep aid( safety)
- very safe -few S/E
- anticholinergic effects
- not used in neonates and nursing mothers
- combo with calamine and camphor
MECLIZINE
- for tx of vertigo
for dizziness
-use for motion sickness
PROMETHAZINE- phenergan
- antihistamine for antiemetics
- Rx only-Po,IV, IM, rectal
- usually ordered q4-6 hrs prn for nausea
- give in conjunction with DEMEROL
ASTELIN
- only nasal
- for adults and over 12 years old
- rebound effects
ZYRTEC
- used year round allergy med
- for chronic uticaria also
CHLOR-TRIMETON
- OTC
DRAMAMINE
- motion sickness
- age 6 and over
- causes sleepiness
Unisom
- OTC for sleep aid
- take with full glass of water
ATARAX/VISTARIL
- has sedative and mild antianxiety effects
ANTIVERT
- for treating vertigo
What are adverse reactions of antihistamines?
-dysrhythmia/palpitations
-hypotension, syncope
-dizziness, blurred vision
-sedation
-paradoxical excitement, insomnia
-nervousness, HA
seizure
-N/V/D
- rarely-Leukopenia, pancytopenia
What are 3 types of decongestant?
- adrenergics
- anticholinergics
- corticosteroids
NEO-SYNEPHRINE/ SUDAFED
- longest effect b/c systemic
- onset is delayed
- caution with sudafed. WHY?
How do topical adrenergics work?
-ephedrine, afrin, neo-senephrine
- vasoconstrict
- shrink engorged M. mem
- if it entered blood stream: causes: HTN, palpitations, HA, dizziness
Antitussive
-cough reflex
-stimulated in medulla
-
Non-opioid antitussives
- less effective
- no analgesic effects
- safe for short term
Benzonate
- non-opioid but anesthesize cough reflex by numbing of stretch receptors
- tesselon perle’s
Codiene/hydrocodone
- directly suppresses cough reflex
- cause dizzy, drowsy, dry mouth, nausea and constipation
- addictive properties( opioid)
- in combo with cough med-robitussin AC
- depress RR and CNS
- controlled subs
- not for severe resp DO, seizures, ICP
expectorants
- robitussin, guifenesin, guiatuss
- thins secretions
- can worsen hyperkalemia with K sparing diuretics
Nursing process for all H1 blockers
- assess s/s, allergic rxn
- URI symptoms-many safe
- LRI- not so safe
- ICP, IOP{, asthma, cardiac problems, HTN
- renal/liver
Implementation for H1
- take with food to avoid GI upset
-makes mouth dry- gum/hard candy
-frequent oral care
-not other meds with antihistaminer. WHY?
-increase PO flids
-If liquid- no food/drink 30 min after
-safety-drowsiness
-avoid coffee
-
HISTAMINE 2 BLOCKERS
- ACTS more on GI
-reduce acid likke GERD
-examples are tagamet, pepcid, zantac
-
Emphysema
- enlarged air spaces in the lungs
- destroyed alveolar walls
- O2 and CO2 exchange becomes impaired
- smoke and irritants exacerbate
Types of bronchodilators
- Xanthine deriv
- Beta-agonists
Xanthine derivatives
- plant alkaloids
-caffeine
-theophylline.. LEVELS? 10-20
-theobromine - used primarily for asthma attacks
- increase cardiac contractility increasing HR
-Bioavailability? meaning
-
Side effects of Xanthine deriv?
- N/V/anorexia
- GI reflux during sleep
- Tachy, palpitations, V dysrrhytmia
- increased urination
- hyperglycemia
- nervousness/ tremors
Interactions of XD?
- oral contraceptives
- EES-
- allipurinol
- flu vaccine
- cimetadine
THEOPHYLLINE
- 10-20 mcg/ml is the safe levels
- slo-bid, theodur, uniphyl
- for chronic resp. disorders
- monitor level
Toxicity of theophylline?
- increased restlessness, irritability, N/V, tremors
- restlessness and anxiety
- dont omit or double-up doses
BETA AGONISTS?
- smooth muscle relaxants for acute asthma attack - stimulate SNS( beta and alpha adrenergic) -imitate effects of epi/norepi -dilate smooth m and airway -vasoconstrict
terbutaline(brethine)
-relaxes uterus in preterm labor
Beta agonists drugs?
- albuterol, adrenalin, bronchaid
- causes bronchodilation
- causes tachy
- Epi is used for first line drug in CODE
COMBO drugs?
-albuterol and atrovent(combivent)
- COPD management
- not for acute attacks
SIDE -EFFECTS:anticholinergic, cough, HA, anxiety
- not use with hypersensitive to atrophine
What is leukotreine agents
- subs in body causing inflamm, bronchial constriction and mucous
- ## causes wheeze, cough, SOB
Anti-leukotreine drugs?
- Singulair ( safe for 2 years and older and few S/E
ACCOLADE- asthma prophlaxis for 12 years and older, interacts with ASA, EES, dilantin, theophylline
ZYFLO- 12 years and older, not with LIVER disease and interacts with inderal, coumadin, theophylline
contraindication of antileukotreine?
Cause N/V, dyspepsia, insomnia, dizziness. ACCOLADE can cause liver dysfunction
CORTICOSTEROIDS?
Commonly used for chronic asthma, potent anti-inlamm, not for acute asthma attacks, prophylaxis for asthma prevention,, systemic can cause fluid and elect imbalance, nervous, and dermatology. can cause pharyngeal irritation, cough, dry mouth, oral fungal , not for candida already, can exacerbate phycosis
Assessment for corticosteroids
baseline VS and lung sounds, skin color and cap refill, cough, dyspnea, SOB, orthopnea, distress, cardiac signs, restlessness, O2 sat,
EDUCATION for corticosteroids
stop smoking, avoid kwn allergies, OTC, ID band, wean most drugs over 1-2 weeks, cause cushinoid symptoms, weight gain, 3-5 /week mean trouble, oral care,
PREDNISONE
immunosuppresant can be used for inflamm diseases, lupus, arthritis, chron’s disease,
hydrocortisone
skin conditions
bexamethasone
skin conditions
dexamethasone
bacterial meningitis
Mast cells stabilizers
chromolyn and tilade
-for COPD
chromylyn used for rhinitic and allergic eye disordres, chron’s and ulcerative colitis
Chromolyn
less potent than tilade
takes 4 weeks to start working
PEDI and resp drugs
one spray per nostrils, no more than 6 doses/24 hours
clean tubing, mouth pieces with H20 and vinegar soln
scopalamine
anticholinergic works on inner ear for balance NOT USED with glaucoma 72 hour patch behind the ear 4 hours to start working not with antidepressant
Meclazine/antivert
H1 blockers
inhibits Ach
for motion sickness or vertigo
safe antiemetic
Compazine
dopamine blocking
neuroleptic drug NOT FOR bone marrow suppression
NOT FOR parkinson’s
not for seizure/ encepalopathy
Zofran
serotonin blockers
safe for adults
increase chemo tolerance
THC/Marinol (marijuana)
cause hypotensive effects
n/v for how long?
alters mood and relieves anxiety
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