Respiratory Tract

Question 1

are medications used to facilitate respiration by dilating the airways.
* They are helpful in symptomatic relief or prevention of bronchial asthna and for bronchospasm associated with COPD.

Answer 1

Bronchodilators or antiasthmatics

Question 2

characterized by reversible bronchospasm, inflammation, and hyperactive airways.

• The hyperactivity is triggered by allergens or nonallergic inhaled irritants, or by factors such as exercise and emotions.
• The trigger causes an immediate release of histamine, which results in bronchospasm in about 10 minutes.
• The later response (3-5 hours) is cytokine-mediated inflammation, mucus production, and edema contributing to obstruction

Answer 2

Asthma

Question 3

The extreme case of asthma is called status ___ ; this is life-threatening bronchospasm that does not respond to usual treatment and occludes airflow into the lungs.

Answer 3

asthmaticus

Question 4

A theory suggests this meds work by directly affecting the mobilization of calcium

Result to “smooth muscle relaxation”, which increases the vital capacity that has been impaired by the bronchospasm or air trapping.

Answer 4

Xanthines

Question 5

• Indications
• Relief of symptoms or prevention of bronchial asthma.
• Reversal of bronchospasm associated with COPD

Answer 5

Xanthines

Question 6

bronchodilator common side effects: tachycardia (objective, palpitations (subjective)

Answer 6

bronchodilator common side effects: tachycardia (objective, palpitations (subjective)

Question 7

___ are drugs that mimic the effects of the sympathetic nervous system.
* One of the actions of the sympathetic nervous system is dilation of the bronchi with increased rate and depth of respiration. (Beta 2)

• specific to the beta-receptors found in bronchi

Other systemic effects include increased blood pressure, increased heart rate, vasoconstriction, and decreased renal and GI blood flow- all actions of the sympathetic nervous system.

Answer 7

Sympathomimetics

Question 8

_____, the prototype drug, is the drug of choice for adults and chiidren for the treatment of acute bronchospasm, including that caused by anaphylaxis; it is also available for inhalation. → first line of treatment Indications

Answer 8

Epinephrine

Question 8

• Long-term maintenance treatment of bronchoconstriction in COPD.
• Treatment of acute bronchospasm in adults and children, although epinephrine is the drug of choice.
• Treatment and prophylaxis of acute asthma attacks in children more than 6 years old.

Answer 8

Sympathomimetics

Question 9

Sympathomimetics
Adverse Effects
* CNS: Headache, restlessness.
* Cardiovascular: Palpitation, tachycardia.
* Skin: Pallor, local burning and stinging.

Answer 9

Sympathomimetics
Adverse Effects
* CNS: Headache, restlessness.
* Cardiovascular: Palpitation, tachycardia.
* Skin: Pallor, local burning and stinging.

Question 9

Patients who cannot tolerate the sympathetic effects of sympathomimetics might respond to the drug ex: ipratropium (Atrovent) and tiotropium: (Spiriva).

These drugs are not as effective as the sympathomimetics but can provide some relief to those patients who cannot tolerate the other drugs.

• used as bronchodilators because of their effect on the vagus nerve, which sis to block or antagonize the action of the neurotransmitter acetylcholine at vagal-mediated receptor sites.
• By blocking the vagal effect, relaxation of smooth muscle in the bronchi occurs, leading to bronchodilation

Answer 9

Anti-cholinergics

Question 10

Anti-cholinergics

• Adverse Effects
• CNS: Dizziness, headache.
• GI: Nausea, gastrointestinal distress.
• Cardiovascular: Palpitations.
• Respiratory: Cough.

Answer 10

Anti-cholinergics

• Adverse Effects
• CNS: Dizziness, headache.
• GI: Nausea, gastrointestinal distress.
• Cardiovascular: Palpitations.
• Respiratory: Cough.

Question 11

___ are used to decrease the inflammatory response in the airway.

Increase airflow and facilitate respiration.

Inhaling the steroid tends to decrease the numerous systemic effects that are associated with steroid use.

Answer 11

Inhaled Steroids

Question 12

oral steroid can increase hydrochloric production

Answer 12

oral steroid can increase hydrochloric production

Question 13

Nursing Considerations (Inhaled Steroids)

• Not for immediate relief. Do not administer inhaled steroids to treat an acute asthma attack or status asthmaticus because these drugs are not intended for the treatment of acute attack and will not provide the immediate reliet needed.

-Proper tapering of steroids. Taper systemic steroids carefully during the transfer to inhaled steroids; deaths have occurred from adrenaline insufficiency with sudden withdrawal.

• Use decongestant drops. Have the patient use decongestant drops before hormoned using the inhaled steroid to facilitate penetration of the drug if nasal congestion is a problem.
• Oral care. Have the patient rinse the mouth after using the inhaler because this will help to decrease systemic absorption and decrease GI upset and nausea.

Answer 13

Nursing Considerations (Inhaled Steroids)

• Not for immediate relief. Do not administer inhaled steroids to treat an acute asthma attack or status asthmaticus because these drugs are not intended for the treatment of acute attack and will not provide the immediate reliet needed.

-Proper tapering of steroids. Taper systemic steroids carefully during the transfer to inhaled steroids; deaths have occurred from adrenaline insufficiency with sudden withdrawal.

• Use decongestant drops. Have the patient use decongestant drops before hormoned using the inhaled steroid to facilitate penetration of the drug if nasal congestion is a problem.
• Oral care. Have the patient rinse the mouth after using the inhaler because this will help to decrease systemic absorption and decrease GI upset and nausea.

Question 14

do not abruptly stop taking steroid bcos it can lead o Addisonian diseases

Answer 14

do not abruptly stop taking steroid bcos it can lead o Addisonian diseases

Question 15

selectively and competitively block (zafirlukast, montelukast) or antagonize (zileuton) receptors for the production of leukotrienes D4 and E4

• As a result, these drugs/block many of the signs and symptoms of asthma, such as neutrophil and cosinophil migration, neutrophil and monocyte aggregation, leukocyte adhesion, increased capillary permeability, and smooth muscle contraction.

-They do not have immediate effects on the airways and are not indicated for treating acute asthma attacks

FOR MAINTENANCE

Answer 15

Leukotriene receptor antagonists

Question 16

prevents the release of inflammatory and bronchoconstricting substances when the mast cells are stimulated to release these substances because of irritition or the presence of an antigen.

Answer 16

mast cell stabilizer

Question 17

is the only drug still available in this class (mast cell stabilizer), only available in an over-the-counter form, and it is no longer considered part of the treatment standards because of the availability of more specific and safer drugs

Commonly used to prevent asthmatic attack

Answer 17

Cromolyn (NasalCrom)

Question 18

are naturally occurring compounds that reduce the surface tension within the alveoli, allowing expansion of the alveoli for gas exchange

-Used to replace the surfactant that is missing in the lungs of neonates with RDS.

Answer 18

Lung surfactant

Question 18

frequently seen in premature infants who are delivered before their lungs have fully developed and while surfactant levels are still very low.

Answer 18

Respiratory distress syndrome (RDS)

Question 18

Nursing Considerations (lung surfactant)

• Correct endotracheal tube placement (serves as artificial airway). Ensure proper placement of the endotracheal tube with bilateral chest movement and lung sounds to provide adequate delivery of the drug.
• Suction the infant. Suction the infant immediately after administration, but DO NOT suction for 2 hours after administration unless clinically necessary, to allow the drug time to work.

Answer 18

Nursing Considerations (lung surfactant)

• Correct endotracheal tube placement (serves as artificial airway). Ensure proper placement of the endotracheal tube with bilateral chest movement and lung sounds to provide adequate delivery of the drug.
• Suction the infant. Suction the infant immediately after administration, but DO NOT suction for 2 hours after administration unless clinically necessary, to allow the drug time to work.

Question 19

act on the cough-control center in the medulla to (suppress the cough reflex); if the cough is nonproductive and irritating, an antitussive may be taken.

• Persistent coughing can be exhausting and can cause muscle strain and further irritation of the respiratory tract.
• Many disorders of the respiratory tract are accompanied by an uncomfortable, unproductive cough.
• Coughing is a naturally protective way to clear the airway of secretions or any collected material, and antitussives prevent these actions.

Answer 19

Antitussives

Question 20

Indications
* Local anesthetic on the respiratory passages, lungs, and pleurae, blocking the effectiveness of the stretch receptors that stimulate a cough reflex.

• For the treatment of dry cough, drug withdrawal syndrome, opioid type drug dependence, and pain.

Answer 20

Antitussives

Question 20

Contraindications and Caution (Antitussives) * Asthma and emphysema. Patients with asthma and emphysema are contraindicated because cough suppression could lead to accumulation of secretions and a loss of respiratory reserve. * Addiction. Patients who are hypersensitive to or have a history of addiction to narcotics; codeine is a narcotic and has addiction potential * Sedation. Patients who need to drive or be alert should use codeine, hydrocodone, and dextromethorphan with extreme caution because these drugs can cause sedation and drowsiness.

Answer 20

Contraindications and Caution (Antitussives) * Asthma and emphysema. Patients with asthma and emphysema are contraindicated because cough suppression could lead to accumulation of secretions and a loss of respiratory reserve. * Addiction. Patients who are hypersensitive to or have a history of addiction to narcotics; codeine is a narcotic and has addiction potential * Sedation. Patients who need to drive or be alert should use codeine, hydrocodone, and dextromethorphan with extreme caution because these drugs can cause sedation and drowsiness.

Question 21

decrease the overproduction of secretions by causing local vasoconstriction to the upper respiratory tract * This vasoconstriction leads to a shrinking of swollen mucous membranes and tends to open clogged nasal passages, providing relief from the discomfort of a blocked nose and promoting drainage of secretions and improved airflow. * Topical nasal decongestants, oral decongestant, and topical steroid nasal decongestants are classifications of decongestants.

Answer 21

Decongestants

Question 22

1. Topical Nasal Decongestants * Imitate the effects of the sympathetic nervous system to cause vasoconstriction, leading to decreased edema and inflammation of the nasal membranes. Relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis. * 2. Oral Decongestants (claritin; pseudoephedrine) * Decrease nasal congestion related to the common cold, sinusitis, and allergic rhinitis * Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes. * This shrinkage results in a decrease in membrane size promoting drainage of the sinuses and improving airflow. * 3. Topical Nasa Steroid Decongestants * Their anti-inflammatory action results from their ability to produce a direct local effect that blocks many of the complex reactions responsible for the inflammatory response. Treatment of seasonal allergic rhinitis in patients who are not obtaining a response with other decongestants or preparations

Answer 22

1. Topical Nasal Decongestants * Imitate the effects of the sympathetic nervous system to cause vasoconstriction, leading to decreased edema and inflammation of the nasal membranes. Relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis. * 2. Oral Decongestants (claritin; pseudoephedrine) * Decrease nasal congestion related to the common cold, sinusitis, and allergic rhinitis * Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes. * This shrinkage results in a decrease in membrane size promoting drainage of the sinuses and improving airflow. * 3. Topical Nasa Steroid Decongestants * Their anti-inflammatory action results from their ability to produce a direct local effect that blocks many of the complex reactions responsible for the inflammatory response. Treatment of seasonal allergic rhinitis in patients who are not obtaining a response with other decongestants or preparations

Question 23

selectively block the effects of histamine at the histamine-I receptor sites, decreasing the allergic response. * block the release or action of histamine, a chemical released during inflammation that increases secretions and narrows airways. * They are found in multiple OTC preparations that are designed to relieve respiratory symptoms and treat allergies. * first-generation have greater anticholinergic effects with resultant [drowsiness], a person who needs to be alert should be given one of the second-generation, less sedating antihistamines.

Answer 23

Antihistamines

Question 24

are drugs that liquefy the lower respiratory tract secretions, reducing the viscosity of these secretions and making it easier to cough them up. They are used for the symptomatic relief of respiratory conditions characterized by [a dry, nonproductive cough.]

Answer 24

Expectorants

Question 25

increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients who are coughing up thick, tenacious secretions. * Affects the mucoproteins in the respiratory secretions by splitting apart disulfide bonds that are responsible for holding the mucus material together. * The result is a decrease in the tenacity and viscosity of the secretions. * Patients may be suffering from conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, or tuberculosis.

Answer 25

Mucolytics

Question 26

Acetylcysteine is used orally to protect the liver from acetaminophen toxicity.

Answer 26

Acetylcysteine is used orally to protect the liver from acetaminophen toxicity.