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Patho Fall 2023 Block 1 > Test 2 (hemoc/URI) > Flashcards

Test 2 (hemoc/URI) Flashcards

1
Q

Causes the majority of the symptoms associated with allergic reactions.

A

Histamine

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2
Q

Inflammation and swelling of mucous membrane of nose.

A

Rhinitis

(Eyes, ears, sinuses and throat can also be involved).

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3
Q

Inflammation of the palate, tonsils and uvula (back of the throat).

A

Pharyngitis

(get a Strep test)

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4
Q

Inflammation of the vocal cords.

A

Laryngitis
“barking cough”

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5
Q

MOA of Antihistamines:

A

Bind to H1 receptors and block histamine release.
Have mild anticholinergic effects.

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6
Q

Contraindications for Antihistamines:

A

For all H1: closed angle glaucoma, cardiac disease, kidney disease, HTN, bronchial asthma, COPD, PUD, seizures, BHP and pregnancy.

-Do not take if you have uncontrolled HTN as they can raise BP.

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7
Q

Sedating Antihistamines: 1st generation:

A

diphenhydramine (Benadryl)

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8
Q

Indications for diphenhydramine:

A

mild allergic reactions, motion sickness, insomnia.
-Can also be given with severe anaphylactic reactions.

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9
Q

Route of diphenhydramine:

A

PO or IV

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10
Q

diphenhydramine SE:

A

drowsiness, dizziness, dry mouth, urinary retention, constipation=DRY.

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11
Q

diphenhydramine NSG implications:

A

monitor closely for dizziness when ambulating, monitor for urinary retention and constipation.
-AVOID driving and activities that require mental alertness!
-Some people will have the opposite affect: hyperactive.

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12
Q

Non-sedating Antihistamines:

A

loratadine (Claritin)
fexofenadine (Allegra)
cetirizine (Zyrtec)

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13
Q

Bronchodilator Classes

A
  1. Beta-Adrenergic Agonist
  2. Anti-cholinergic
  3. Xanthine Derivatives
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14
Q

Beta-Adrenergic Agonist:

A

SABA: Albuterol & Levalbuterol
LABA: Salmeterol & Formoterol

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15
Q

MOA of Beta-Adrenergic Agonist:

A

Mimic action of SNS–> FIGHT OR FLIGHT!
Relax & dilate the airways by stimulating beta2-adrenergic receptors throughout the lungs.
Bronchial dilation & increase airflow in & out of the lungs is the GOAL!

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16
Q

SE of Beta-Adrenergic Agonists:

A

Beta2 drugs can cause: HTN/hypotension, insomnia, restless, anorexia, cardiac stimulation, hyperglycemia, tremor, vascular h/a.

-NON-Selective have the most.

-Short 1/2 life so effects so away quick.

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17
Q

Contraindications of Beta-Adrenergic Agonist:

A

Uncontrolled HTN, cardiac dysrhythmias, high risk for stroke.
Can be given with beta blockers, but may diminish the effects –> watch for bronchospasm.
Avoid use of: MAOIs, sympathomimetics bc of HTN risk, DM patients may need to increase dose as they raise blood sugar.

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18
Q

Fun Facts about Albuterol!

A

-SABA; RESCUE DRUG
-Onset: minutes; inhaled q4-6h
-MDI/ned: 1st line treatment for asthma attacks, bronchitis & emphysema–> ACUTE wheezing , chest tightness & SOA!
- >1 cannister/month= indication of poor asthma control.
-Although can be used at prevention of EIA.

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19
Q

Fun Facts about Salmeterol:

A

-LABA
-NOT for acute tx–> this is a maintenance drug.
-Inhaled (powder) q12-24h or 2x/day.
-USE: worsening COPD, mod-severe asthma.
-ALWAYS given w/an inhaled corticosteroid- NOT indicated for monotherapy.

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20
Q

Anti-Cholinergic Drug:

A

Ipratroprium

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21
Q

Facts about Anti-Cholinergic drugs:

A

-Still a type of bronchodilator, BUT works on acetylcholine receptors, not adrenergic receptors.

-Give Anti-Cholinergic agents–>Turns OFF cholinergic response (PNS) & Turns ON SNS…SNS dominates = BRONCHODILATION –> increased perfusion to heart , lungs & brain.

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22
Q

MOA of ipratropium:

A

Blocks action of acetylcholine= creates bronchodilation (by preventing bronchoconstriction).

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23
Q

ipratropium use:

A

PROPHYLAXIS (given every day) & maintenance therapy. NOT for rescue!
-Often given in combo w/Albuterol.

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24
Q

SE of ipratropium:

A

Dry as a bone, hot a hare, blind as a bat, Red as a beet, mad as a hatter:
urinary retention, dry throat/dry mouth, constipation, feel hot/decreased sweating, tachy, blurred vision, confused/ hallucinations, sedation, dizzy.

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25
Q

Xanthine Derivative (Methylxanthines) drugs:

A

theophylline & aminophylline

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26
Q

theophylline & aminophylline MOA:

A

Increasing levels of the cAMP enzyme by inhibiting phosphodiesterase. Stimulates CNS & CVD system.
-Increased cAMP enzyme= increased relaxation of smooth muscle & inhibit IgE allergic reaction.

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27
Q

theophylline & aminophylline Use:

A

2nd line treatment d/t risk of toxicity & drug-drug interactions.
-Not a rescue drug.
-Preventative tx of asthma attacks & COPD exacerbation.

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28
Q

SE of theophylline & aminophylline:

A

TOXICITY–> N/V/D, insomnia, h/a, tachy, dysrhythmias, seizures (more common in elderly).

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29
Q

Interactions of theophylline & aminophylline:

A

Caffeine may increase SE; smoking: decreases absorption.
-Has narrow therapeutic index–> monitor serum levels & watch for toxicity–> REVERSE with activated charcoal.

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30
Q

Contraindications of theophylline & aminophylline:

A

-uncontrolled cardiac dysrhythmias, seizure disorders, hyperthyroid, peptic ulcers.

-LOTS of drug interactions: macrolide ABX, allopurinol, cimetidine, quinolones, flu vaccine, oral contraceptives.

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31
Q

H1 Blockers AKA…

A

Antihistamines

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32
Q

H1 Blockers: Antihistamines: subclasses:

A

Sedating Antihistamines (1st generation)
Non-Sedating Antihistamines (2nd generation)

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33
Q

MOA of Diphenhydramine (sedating), Loratadine, Fexodenadine & Cetirizine (nonsedating)…
(ALL H1 blockers/Antihistamines):

A

Bind to H1 receptors & block histamine release.
-Have mild anticholinergic effects.

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34
Q

Contraindications of Diphenhydramine (sedating), Loratadine, Fexofenadine & Cetirizine (nonsedating)…
(ALL H1 blockers/Antihistamines):

A

For ALL H1 blockers: closed angle glaucoma, cardiac disease, kidney disease, HTN, bronchial asthma, COPD, PUD, seizures, BPH & pregnancy.
-Uncontrolled HTN–> NOT good to take! (raises BP).

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35
Q

Use of Diphenhydramine (Sedating-Antihistamine):

A

mild allergic reaction, motion sickness, insomnia.
-Can be given with severe anaphylaxis.
-DRY YOU UP!

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36
Q

Route of Diphenhydramine:

A

IV or PO

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37
Q

Nursing implications for Diphenhydramine:

A

monitor for dizziness with ambulation, urinary retention, constipation, AVOID driving/activities that rquire alertness.

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38
Q

SE of Diphenhydramine:

A

drowsy, dry-mouth, urinary retention, constipation, CNS depression OR can also have opposite effect–>Hyperactive!

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39
Q

Use of loratadine, fexofenadine & cetirizine (Non-Sedating Antihistamines):

A

Allergic rhinitis, chronic idiopathic urticaria.

-ALL given PO

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40
Q

SE of loratadine, fexofenadine & cetirizine:

A

Less drowsiness & fatigue… you can take it in the AM.

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41
Q

Antitussive (cough suppressants):

A
  1. Dextromethorphan (OTC)
  2. Codeine (Rx)
  3. Benzonatate (Rx)
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42
Q

MOA of dextromethorphan, codeine, benzonatate:

A

Directly suppress the cough reflex in the brain!

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43
Q

Route of dextromethorphan, codeine, benzonatate:

A

P.O., syrups, lozenges, sprays.

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44
Q

USE and SE of dextromethorphan, codeine, benzonatate:

A

Use: acute/chronic cough.
SE: CNS depressant–>Do NOT take with other CNS depressants. Sleepy/drowsy. Potential for abuse!

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45
Q

Expectorant drug:

A

Guaifenesin (Mucinex)

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46
Q

Guaifenesin MOA:

A

Reduction in surface tension of secretion- helping thin mucus so easier to expectorate!

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47
Q

Guaifenesin USE:

A

to decrease mucus in colds, bronchitis.

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48
Q

SE of Guaifenesin:

A

Few–> mild GI distress.

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49
Q

Nursing implications for Guaifenesin:

A

-Increase hydration/fluid to help thin secretions as well.
-Be careful in patients with chronic cough/asthma.

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50
Q

Mucolytics:

A

Acetylcysteine

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51
Q

MOA of Acetylcysteine:

A

Decrease viscosity of mucus making it easier to cough.

52
Q

Acetylcysteine Use:

A

bronchopulmonary disease, CF

53
Q

SE of Acetylcysteine:

A

FEW: BRONCHOSPASM (monitor lungs sounds)
They smell awful–rotten eggs.

54
Q

Route of Mucolytics: Acetylcysteine:

A

Inhaled: via nebulizer or through tracheostomy.

55
Q

Sympathomimetics: decongestants:

A

Phenylephrine & Pseudoephedrine

56
Q

MOA of Phenylephrine & Pseudoephedrine (sympathomimetics)

A

Mimics the action of SNS, activates, alpha1-adrenergic recptors–> causes vasoconstriction of blood vessels–> causing nasal turbinates to shrink & open nasal passages.

57
Q

Phenylephrine & Pseudoephedrine Uses:

A

Reduce nasal congestion, allergic rhinitis, sinusitis & the common cold.
- OPEN YOU UP & DRY YOU OUT!

58
Q

SE of Phenylephrine & Pseudoephedrine:

A

All related to CNS stimulation–>agitation, insomnia, anxiety, tachy, heart palpations.

59
Q

PSEDOEPHEDRINE Facts:

A

-potential for abuse
-active ingredient in meth
-OTC , but get from the pharmacy counter- limit of the amount you can buy/age.

60
Q

Phenylephrine & Pseudoephedrine EDU:

A

Do not use >4 days–> rebound nasal congestion occurs if drug is abruptly stopped after prolonged use (taper off if taken 2-3 days).

61
Q

Anti-inflammatory sub-classes:

A
  1. Leukotriene Receptor Antagonists
  2. Inhaled Corticosteroids
  3. Mast Cell Stabilizer
62
Q

Anti-inflammatory: Leukotriene Receptor Antagonists:

A

Montelukast & Zafirlukast

63
Q

MOA of Montelukast & Zafirlukast:

A

LTRAs prevent leukotrienes from attaching to receptors located on immune cells & w/in lungs–> prevents inflammation.

-Leukotrienes cause inflammation, bronchoconstriction & mucus production.

64
Q

USE & Route of Montelukast & Zafirlukast:

A

Given P.O.
Oral prophylaxis & chronic tx of asthma in adults & children (also for allergies). NOT for acute asthma attacks.

65
Q

Age info for Montelukast & Zafirlukast:

A

-Montelukast: kids >12 mos (fewer drug interactions).
-Zafirlukast: Kids >5 years

66
Q

SE of Montelukast & Zafirlukast:

A

h/a, nausea, dizzy, insomnia, diarrhea.

67
Q

Anti-inflammatory: Inhaled Corticosteroids:

A

Beclomethasone Dipropionate
Budesonide
Fluticasone

68
Q

MOA of Beclomethasone Dipropionate,
Budesonide & Fluticasone (inhaled corticosteroids):

A

Decrease inflammation & enhance activity of beta agonists & bronchodilation.

69
Q

Route and NSG implications of Beclomethasone Dipropionate, Budesonide & Fluticasone (inhaled corticosteroids):

A

-Inhaled: Neb or MDI
-Can take several weeks before full effect,
-NOT A RESCUE DRUG.
-Give bronchodilator (B2) FIRST to open up airways for better absorption of drug.
-RINSE mouth after use (thrush).

70
Q

SE of Beclomethasone Dipropionate,
Budesonide & Fluticasone (inhaled corticosteroids):

A

pharyngeal irritation, cough, dry mouth, oral fungal infection.

71
Q

Anti-inflammatory: Mast Cell Stabilizer:

A

Cromolyn

72
Q

MOA of Cromolyn:

A

Stabilize membranes of mast cells & prevent release of broncho-constrictive inflammatory substances:

73
Q

Use & NSG implications of Cromolyn:

A

-To prevent acute asthma attacks.
-Take 15-20 minutes prior to known trigger (sports, pumpkin patch..).
-NOT a rescue drug.

74
Q

COMBO: Inhaled Glucocorticoid & Bronchodilator:

A

Budesonide & Formoterol (works in min)
Fluticasone & Salmeterol (takes longer)

75
Q

USE of COMBO: Inhaled Glucocorticoid & Bronchodilator: BF & FS:
& KEY teaching:

A

-Moderate to severe asthma
-Both have really long 1/2 life.
-Never used for acute Asthma Attacks- even though they have bronchodilator in them!

76
Q

Monoclonal Antibody Anti-Asthmatic:

A

Omalizumab

77
Q

MOA of Omalizumab:

A

Monoclonal antibody which selectively binds to immunoglobulin IgE–> limits the release of mediators of allergic response (decreased hyper response).

78
Q

NSG implications for Omalizumab:

A

-Must be monitored closely for hyper-sensitivity reactions (anaphylaxis= BIG risk).
-Never give by itself.
-Route: injection
-Asthma Specific!

79
Q

Selective PDE-4 Inhibitor Roflumilast MOA

A

Selectively inhibits PDE-4 enzyme in the lung cells.
-inhibit PDE-4= decreased inflammation
-Potent anti-inflammatory effect in lungs

80
Q

USE of Selective PDE-4 Inhibitor Roflumilast:

A

-COPD (long-term) to prevent exacerbations–> No acute/immediate use.
-Given PO

81
Q

SE of Selective PDE-4 Inhibitor Roflumilast:

A

N/V/D, h/a, muscle spasm, decrease appetite, uncontrollable tremors.

82
Q

Anti-Tubercular Drugs

A
  1. Isoniazid (INH)
  2. Ethambutol
  3. Rifampin
  4. Pyrazinamide
  5. Streptomycin
83
Q

Isoniazid MOA:

A

Disrupts cells wall synthesis essential functions of mycobacteria.
-First line/most widely used drug for TB.

84
Q

SE of Isoniazid:

A

peripheral neuropathy, hyperglycemia, hepatotoxicity, optic neuritis/visual def.

85
Q

NSG implications for Isoniazid:

A

-AVOID antacids.
-When given w/Phenytoin–> increased the effects of phenytoin (swollen gums, h/a, slurred speech, light-headed).
-When given with Rifampin–> increased CNS & hepatotoxicity.
-BLACK BOX: increased risk of hepatitis (give with pyridoxine (b6)).

86
Q

Ethambutol MOA:

A

Diffusing into mycobacteria & suppress RNA synthesis, which inhibits protein synthesis.
-1st line bacteriostatic

87
Q

SE of Ethambutol:

A

retrobulbar neuritis, blindness.

88
Q

NSG implications for Ethambutol:

A

-P.O.
-Usually given in combo with INH & Rifampin (1 pill with all 3 in it).
-NO children <13 yo.

89
Q

MOA of Rifampin:

A

-Inhibits protein synthesis via attacking hydrocarbon ring structure.
-1st line

90
Q

SE of Rifampin:

A

Hepatitis, homologic disorder, red-brown urine/tears/sweat.

91
Q

NSG implications for Rifampin:

A

Decreases effect of beta blockers, benzos, cyclosporin, anticoags, antidiabetic, phenytoin, theophylline—> may need to increase dose of these meds.
-Watch LIVER function.
-P.O. or IV

92
Q

Pyrazinamide MOA:

A

Unknown- may inhibit lipid & nucleic acid synthesis.
-bacteriostatic/bactericidal.

93
Q

SE of Pyrazinamide:

A

hepatotoxicity, hyperuricemia.

94
Q

NSG implications for Pyrazinamide:

A

-P.O.–>always in combo with other meds.
-Not for patients with ACUTE gout or severe hepatic.
-No pregnant women (in US).

95
Q

Streptomycin MOA:

A

aminoglycoside–>interfering with normal protein synthesis causing production of faulty proteins w/in bacteria.

96
Q

SE of streptomycin:

A

ototoxicity, nephrotoxicity, blood dyscrasias (bleeding times)

97
Q

NSG implications for Streptomycin:

A

-IM injection daily.
-Careful with pts on anticoags- can increase bleeding.

98
Q

MOA of Erythropoietin stimulating agents: EPOETIN alfa:

A

stimulates erythropoiesis: increases Hgb & reticulocyte counts.

99
Q

NSG implications for EPOETIN alfa:

A

-ONLY give is Hgb is <10g/dL (unless on dialysis).
-Monitor blood tests weekly–>hgb goal >11.
-Contraindicated for pts with HTN.
-Do NOT give if: shaken, frozen, protects from light and do not dilute or mix w/ other drugs.
-Route: IV or subcut (may also be given IV push).
-MUST have adequate bone marrow function & iron levels for this to work.

100
Q

SE of Epoetin alfa:

A

HTN, serious CV events (related to polycythemia state), Increased HCT=Increased risk; progression of cancer, injection site pain, bone pain, h/a.
-Black box: stroke & heart attack.

101
Q

USE of Epoetin alfa:

A

anemia d/t chronic kidney disease, HIV pts on Zidovudine, people on certain chemo, autoimmune hemolytic anemia.

102
Q

B12 replacement:

A

Cyanocobalamin

103
Q

Facts about Cyanocobalamin:

A

-Give IM weekly until levels normalize, then monthly.
-Indicated for patients with severe B12 deficits & neuro symptoms.
-Well tolerated- may have pain at site.

104
Q

Diet for B12 def:

A

increase meat, fish, eggs, milk and other dairy products.

(oral supplement 1-2mg/day).

105
Q

B12 Anemia RBCs:

A

MACROCYTIC & NORMOCHROMIC: large abnormal shape and normal color.

106
Q

Pernicious Anemia facts:

A

Autoimmune system disorder–>pernicious anemia–> parietal cells are destroyed–> decrease in intrinsic factor–>intrinsic factor is needed for stomach to absorb B12, so therefore B12 deficient.

-Atrophic-gastritis, by-pass surgery and Crohn’s also contribute to B12 def.

107
Q

S/S of B12 anemia:

A

NEUROPATHY, low hct/hgb, ataxia, glossitis, dementia/psychosis, jaundice, irritability, fatigue

108
Q

Folate Anemia RBCs:

A

MACROCYTIC & NORMOCHROMIC: large abnormal shape and normal color.

109
Q

Folate anemia facts:

A

-Not a problem with absorption–> decreased intake and increased need.
-Alcoholism, pregnancy, cirrhosis, diet and pregnancy.
-S/S are the same as B12 BUT NO NEURO deficits.

110
Q

Increased FOLATE diet:

A

fortified gains, fresh fruits and vegetables.

111
Q

Meds for FOLATE anemia:

A

Prescription strength folic acid: 1-5mg/daily.
OTC folic acid: 400 mcg/daily
-Well tolerated- no SE.

112
Q

Iron deficient Anemia RBCs:

A

MICROCYTIC & HYPERCHROMIC: small abnormally shaped and pale in color.

113
Q

We CANT make hemoglobin without ____?

A

IRON

114
Q

s/s of Iron anemia:

A

PICA, koilonychia (spoon shaped nails), glossitis (tongue), tired, pale, in childhood=cog deficits; murmur/angina, pagophagia (ice), restless leg syndrome.

115
Q

Iron def Anemia is seen most in:

A

toddler, adolescent girls, pregnant women.

116
Q

Treatment for Iron def anemia:

A

Ferrous Sulfate; Ferrous Gluconate or Iron Dextran

117
Q

Ferrous Sulfate & Ferrous Gluconate facts:

A

-Iron def meds
-give on empty stomach; do not crush/chew.
-Only 20% is absorbed.
-use a straw if liquid (stains teeth).

118
Q

Iron Dextran facts:

A

-IM (1/5” needle) with z-track (stains skin).
-Have EPI available (allergic reaction)
-1st time dose: test IM/IV first.

119
Q

SE of IRON drugs:

A

GI: nausea, heartburn, constipation, metallic taste, stains skin/teeth.
-POISONING in children!!!! BIG EDU for safety!
-antedote: deferoxamine= “chelating” iron so secreted in stool.
-DARK stool is an expected finding

-Decreased absorption with antacids; increased absorption with VIT C.

120
Q

Allergic Rhinitis… and most common cause:

A

“Runny nose”/common cold
-Pet dander

121
Q
  1. DILATE BRONCHIALS:
  2. DECREASE BRONCHIAL INFLAMMATION:
A
  1. Beta2adrenergics
    Inhaled anticholinergics
    Xanthine derivatives
  2. Glucocorticoids
    Mast cell stabilizer
    Leukotriene receptor antagonists
122
Q

Key words: “Persistent productive cough”

A

Bronchitis
(“Goblet cells”)

123
Q

Emphysema

A

Loss of elastic recoil in alveoli- essentially collapse on themselves–> no gas exchange.

124
Q
A
125
Q

Key words: “Infectious mucus…” what condition?

A

PNA

126
Q

Key words: “Hyper-secretion and inflammation…” what condition

A

Asthma

Patho Fall 2023 Block 1 (3 decks)

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