Respiratory system meds - exam 3 Flashcards by Ellie Restrepo

Methylxanthines Prototype

theophylline (Theolair)

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methylxanthines EPA

relaxes the bronchial smooth muscle, promoting bronchodilation

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methylxanthines therapeutic use

second line treatment for chronic lung disorders that cause bronchoconstriction (COPD) EBP no longer recommends to use to treat COPD

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methylxanthines administration

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methylxanthines ADRs

tachycardia, agitation and seizures. Toxicity - ventricular dysrhythmias and convulsions

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methylxanthines contraindications and interactions

heart disease, liver dysfunction, and use with caution with seizure disorders

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methylxanthines RN intervention and client education

Need to monitor serum blood levels - narrow therapeutic range

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inhaled glucocorticoids prototype

beclomethasone (QVAR)

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inhaled glucocorticoids EPA

suppress the release of inflammatory mediators and decrease the recruitment of airway eosinophils. Increases the number and sensitivity of beta 2 adrenergic bronchodilators

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inhaled glucocorticoids therapeutic use

prophylactic management of asthma with inhaled steroids. Acute asthma flare-ups, systemic corticosteroids used

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inhaled glucocorticoids administration

inhaled orally or nasally

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inhaled glucocorticoids ADRs

pharyngitis, cough, dry mouth, and candidiasis (thrush)

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inhaled glucocorticoids contraindications and interactions

recent live virus immunization and oral candidiasis

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inhaled glucocorticoids RN intervention and client education

Rinse mouth and throat with water after using inhaler
Use with a spacer
Educate client on how to administer inhaler

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glucocorticoids prototype and other drug names

prednisone
Other: methylprednisone -IV

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glucocorticoids EPA

multiple mechanisms of action and each one varies depending on the cell tissue. All affect the inflammatory process to reduce inflammation

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Glucocorticoids therapeutic use

decreases inflammatory symptoms and alters the immune response produced by nonendocrine disorders. Used to treat:
Asthma
COPD
Arthritis
Rhinitis
Cancer
Inflammatory bowel disease
Spinal cord injury
Prevention of acute adrenocortical insufficiency

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glucocorticoids administration

PO, IM, IV

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glucocorticoids ADRs

if take 5 mg of glucocorticoids daily could result in the following AE:
CNS stimulant (jittery inside) - Insomnia
Adrenocortical insufficiency - Fainting, Weakness, Hypotension
Adrenocortical excess
Cardiovascular symptoms - Heart failure, Shock, Cardiac dysrhythmias
Increase appetite (weight gain)
Hyperglycemia… need to monitor patient with diabetes very carefully
Immunosuppressive - delayed wound healing more susceptible to infection
Bone disease
Very fragile skin… paper thin

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glucocorticoids Contraindications and interactions

immunosuppression, live vaccines, systemic fungal infections, antibiotic resistant infections

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glucocorticoids RN intervention and client education

Treats symptoms, does not cure underlying disease
Take as directed, DO NOT stop taking abruptly
Tapered off
Take with food
Educate on numerous ADRs

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anti-inflammatory/leukotriene modifiers prototype

montelukast (Singulair)

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leukotriene modifiers EPA

prevents leukotrines from binding to its receptors therefore reducing bonchoconstriction, inflammation, and mucus production

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leukotriene modifiers therapeutic use

used in patient with asthma that do not respond to other treatments. Used as a long-acting antiasthmatic med. Only tablet approved for exercise-induced asthma. Can also treat allergies.

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leukotriene modifiers administration

leukotriene modifiers ADRs

behavioral changes BLACK BOX WARNING: neuropsychiatric events have been reported in pts that take this drug (aggressive behavior, hallucinations, insomnia, and suicidal ideation)

leukotriene modifiers contraindications and interactions

liver disease

leukotriene modifiers RN interventions and client education

Not used to manage acute asthma attack Take 2 hours before exercise to prevent exercise-induced asthma Take in evening daily to treat allergies

First generation/sedating antihistamines prototype

diphenhydramine (Benadryl)

first gen antihistamine therapeutic use

treat allergic reactions, anaphylaxis, motion sickness, and insomnia

first gen antihistamines EPA

structurally like histamine and occupy the same receptor sites preventing histamine acting on target tissues and thus preventing histamine response. Binds to central H1 receptors

first gen antihistamines administration

PO (tablet and liquid), topical ointment, IV and IM

first gen antihistamines ADRs

CNS depression = drowsiness and sedation, paradoxical effect causing CNS stimulation and anticholinergic effects

first gen antihistamines contraindications and interactions

Newborns and children <2 years Breastfeeding women Do not take with ETOH or other CNS depressants

first gen antihistamines RN intervention and client education

Do not take with ETOH or other CNS depressants Use with caution in older adults Assess LOC Advise against driving and operating machinery requiring mental alertness Can cause: Dry mouth, Urinary retention, Constipation, Blurred vision

second generation/nonsedating antihistamines prototype and other drug names

cetirizine (Zyrtec) Others: loratadine (Claritin) and fexofenadine (Allegra)

second gen antihistamines therapeutic use

treats seasonal allergies, and urticaria

second gen antihistamines EPA

binds to histamine receptors to prevent histamine response, but binds to peripheral, not central H1 receptors. Therefore, does not cause drowsiness like the first-generation agents

second gen antihistamines administration

PO, nasal

second gen antihistamines ADRs

drowsiness and fatigue (higher doses and anticholinergic effects)

second gen antihistamines contraindications and interaction

Breastfeeding women Impaired kidney or liver function

second gen antihistamines RN intervention and client education

Take once a day Take with water

sympathomimetics (nasal decongestants) prototype and other drug names

phenylephrine (neo-synephrine) Other: pseudoephedrine (Sudafed)

sympathomimetics therapeutic use

relieves pressure, swelling and congestion of the nasal mucosa

sympathomimetics EPA

alpha 1 adrenergic agonist, causes vasoconsrtiction of the blood vessels… causing the nasal turbinates in the nares to shrink, in turn opening nasal passages and relieving nasal congestion

sympathomimetics administration

PO (regular and XR tablets), topical and nasal sprays

sympathomimetics ADRs

CNS excitation = tachycardia, insomnia, dizziness, palpitations, urinary retention

sympathomimetics contraindications and interations

Uncontrolled heart disease Dysrhythmias HTN Narrow angle glaucoma Older adults Caffeine may increase effects

sympathomimetics RN intervention and client education

Do not use for more than 3 to 5 days Assess for cardiac symptoms Educate about rebound effect Rebound congestion Multiple drug interactions

antitussives - nonnarcotic prototype and other drug names

dextromethorphan (Delsym) Other drugs: benzonatate (Tessalon)

antitussives - nonnarcotic therapeutic use

to suppress nonproductive cough

antitussives - nonnarcotic EPA

depresses the cough reflex in the brain

antitussives - nonnarcotic administration

PO liquid, lozenge, syrup

antitussives - nonnarcotic ADRs

CNS depression - drowsiness and sedation

antitussives - nonnarcotic contraindications and interactions

MAOIs SSRIs ETOH use

antitussives RN intervention and client education

Medication interactions Avoid alcohol

antitussives - narcotic prototype

codeine

antitussives - narcotic therapeutic use

relief of cough

antitussives - narcotic EPA

depresses the cough reflex in the brain

antitussives - narcotic administration

PO, usually combined with acetaminophen in liquid form (tylenol #3)

antitussives - narcotic ADRs

nausea, vomiting, respiratory sedation, constipation and dizziness

antitussives - narcotic contraindications and interactions

Any respiratory impairments Head injuries Seizure disorders ETOH

antitussives - narcotic RN intervention and client education

Assess GI and respiratory status Avoid in patient with asthma or head injury

expectorants prototype

guaifenesin (Mucinex)

expectorants therapeutic use

loosens mucus from respiratory tract in a productive cough

expectorants EPA

reduces viscosity of secretions

expectorants administration

expectorants ADRs

dizziness, drowsinessm HA, and skin rash

expectorants contraindications and interactions

Inability to expectorate

expectorants RN intervention and client education

Give med with food and water Hydration Swallow tablets whole Change positions carefully

mucolytics prototype

acetylcystine (Acetadote)

mucolytics therapeutic use

to liquify mucus in the respiratory tract

mucolytics EPA

attacks protein bonds in the mucus, reducing viscosity

mucolytics administration

Nebulizer, PO, and IV

mucolytics ADRs

bronchospsm, GI distress (due to rotten egg smell and ingestion of secretions)

mucolytics contraindications and interactions

Inability to expel secretions asthma

mucolytics RN intervention and client education

Assess respiratory status Difficulty breathing? Bronchospasm?Inability to expel secretions Hydration Report difficulty breathing or worsening cough