Test 2 (hemoc/URI) Flashcards
Causes the majority of the symptoms associated with allergic reactions.
Histamine
Inflammation and swelling of mucous membrane of nose.
Rhinitis
(Eyes, ears, sinuses and throat can also be involved).
Inflammation of the palate, tonsils and uvula (back of the throat).
Pharyngitis
(get a Strep test)
Inflammation of the vocal cords.
Laryngitis
“barking cough”
MOA of Antihistamines:
Bind to H1 receptors and block histamine release.
Have mild anticholinergic effects.
Contraindications for Antihistamines:
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.
Sedating Antihistamines: 1st generation:
diphenhydramine (Benadryl)
Indications for diphenhydramine:
mild allergic reactions, motion sickness, insomnia.
-Can also be given with severe anaphylactic reactions.
Route of diphenhydramine:
PO or IV
diphenhydramine SE:
drowsiness, dizziness, dry mouth, urinary retention, constipation=DRY.
diphenhydramine NSG implications:
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.
Non-sedating Antihistamines:
loratadine (Claritin)
fexofenadine (Allegra)
cetirizine (Zyrtec)
Bronchodilator Classes
- Beta-Adrenergic Agonist
- Anti-cholinergic
- Xanthine Derivatives
Beta-Adrenergic Agonist:
SABA: Albuterol & Levalbuterol
LABA: Salmeterol & Formoterol
MOA of Beta-Adrenergic Agonist:
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!
SE of Beta-Adrenergic Agonists:
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.
Contraindications of Beta-Adrenergic Agonist:
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.
Fun Facts about Albuterol!
-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.
Fun Facts about Salmeterol:
-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.
Anti-Cholinergic Drug:
Ipratroprium
Facts about Anti-Cholinergic drugs:
-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.
MOA of ipratropium:
Blocks action of acetylcholine= creates bronchodilation (by preventing bronchoconstriction).
ipratropium use:
PROPHYLAXIS (given every day) & maintenance therapy. NOT for rescue!
-Often given in combo w/Albuterol.
SE of ipratropium:
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.
Xanthine Derivative (Methylxanthines) drugs:
theophylline & aminophylline
theophylline & aminophylline MOA:
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.
theophylline & aminophylline Use:
2nd line treatment d/t risk of toxicity & drug-drug interactions.
-Not a rescue drug.
-Preventative tx of asthma attacks & COPD exacerbation.
SE of theophylline & aminophylline:
TOXICITY–> N/V/D, insomnia, h/a, tachy, dysrhythmias, seizures (more common in elderly).
Interactions of theophylline & aminophylline:
Caffeine may increase SE; smoking: decreases absorption.
-Has narrow therapeutic index–> monitor serum levels & watch for toxicity–> REVERSE with activated charcoal.
Contraindications of theophylline & aminophylline:
-uncontrolled cardiac dysrhythmias, seizure disorders, hyperthyroid, peptic ulcers.
-LOTS of drug interactions: macrolide ABX, allopurinol, cimetidine, quinolones, flu vaccine, oral contraceptives.
H1 Blockers AKA…
Antihistamines
H1 Blockers: Antihistamines: subclasses:
Sedating Antihistamines (1st generation)
Non-Sedating Antihistamines (2nd generation)
MOA of Diphenhydramine (sedating), Loratadine, Fexodenadine & Cetirizine (nonsedating)…
(ALL H1 blockers/Antihistamines):
Bind to H1 receptors & block histamine release.
-Have mild anticholinergic effects.
Contraindications of Diphenhydramine (sedating), Loratadine, Fexofenadine & Cetirizine (nonsedating)…
(ALL H1 blockers/Antihistamines):
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).
Use of Diphenhydramine (Sedating-Antihistamine):
mild allergic reaction, motion sickness, insomnia.
-Can be given with severe anaphylaxis.
-DRY YOU UP!
Route of Diphenhydramine:
IV or PO
Nursing implications for Diphenhydramine:
monitor for dizziness with ambulation, urinary retention, constipation, AVOID driving/activities that rquire alertness.
SE of Diphenhydramine:
drowsy, dry-mouth, urinary retention, constipation, CNS depression OR can also have opposite effect–>Hyperactive!
Use of loratadine, fexofenadine & cetirizine (Non-Sedating Antihistamines):
Allergic rhinitis, chronic idiopathic urticaria.
-ALL given PO
SE of loratadine, fexofenadine & cetirizine:
Less drowsiness & fatigue… you can take it in the AM.
Antitussive (cough suppressants):
- Dextromethorphan (OTC)
- Codeine (Rx)
- Benzonatate (Rx)
MOA of dextromethorphan, codeine, benzonatate:
Directly suppress the cough reflex in the brain!
Route of dextromethorphan, codeine, benzonatate:
P.O., syrups, lozenges, sprays.
USE and SE of dextromethorphan, codeine, benzonatate:
Use: acute/chronic cough.
SE: CNS depressant–>Do NOT take with other CNS depressants. Sleepy/drowsy. Potential for abuse!
Expectorant drug:
Guaifenesin (Mucinex)
Guaifenesin MOA:
Reduction in surface tension of secretion- helping thin mucus so easier to expectorate!
Guaifenesin USE:
to decrease mucus in colds, bronchitis.
SE of Guaifenesin:
Few–> mild GI distress.
Nursing implications for Guaifenesin:
-Increase hydration/fluid to help thin secretions as well.
-Be careful in patients with chronic cough/asthma.
Mucolytics:
Acetylcysteine
MOA of Acetylcysteine:
Decrease viscosity of mucus making it easier to cough.
Acetylcysteine Use:
bronchopulmonary disease, CF
SE of Acetylcysteine:
FEW: BRONCHOSPASM (monitor lungs sounds)
They smell awful–rotten eggs.
Route of Mucolytics: Acetylcysteine:
Inhaled: via nebulizer or through tracheostomy.
Sympathomimetics: decongestants:
Phenylephrine & Pseudoephedrine
MOA of Phenylephrine & Pseudoephedrine (sympathomimetics)
Mimics the action of SNS, activates, alpha1-adrenergic recptors–> causes vasoconstriction of blood vessels–> causing nasal turbinates to shrink & open nasal passages.
Phenylephrine & Pseudoephedrine Uses:
Reduce nasal congestion, allergic rhinitis, sinusitis & the common cold.
- OPEN YOU UP & DRY YOU OUT!
SE of Phenylephrine & Pseudoephedrine:
All related to CNS stimulation–>agitation, insomnia, anxiety, tachy, heart palpations.
PSEDOEPHEDRINE Facts:
-potential for abuse
-active ingredient in meth
-OTC , but get from the pharmacy counter- limit of the amount you can buy/age.
Phenylephrine & Pseudoephedrine EDU:
Do not use >4 days–> rebound nasal congestion occurs if drug is abruptly stopped after prolonged use (taper off if taken 2-3 days).
Anti-inflammatory sub-classes:
- Leukotriene Receptor Antagonists
- Inhaled Corticosteroids
- Mast Cell Stabilizer
Anti-inflammatory: Leukotriene Receptor Antagonists:
Montelukast & Zafirlukast
MOA of Montelukast & Zafirlukast:
LTRAs prevent leukotrienes from attaching to receptors located on immune cells & w/in lungs–> prevents inflammation.
-Leukotrienes cause inflammation, bronchoconstriction & mucus production.
USE & Route of Montelukast & Zafirlukast:
Given P.O.
Oral prophylaxis & chronic tx of asthma in adults & children (also for allergies). NOT for acute asthma attacks.
Age info for Montelukast & Zafirlukast:
-Montelukast: kids >12 mos (fewer drug interactions).
-Zafirlukast: Kids >5 years
SE of Montelukast & Zafirlukast:
h/a, nausea, dizzy, insomnia, diarrhea.
Anti-inflammatory: Inhaled Corticosteroids:
Beclomethasone Dipropionate
Budesonide
Fluticasone
MOA of Beclomethasone Dipropionate,
Budesonide & Fluticasone (inhaled corticosteroids):
Decrease inflammation & enhance activity of beta agonists & bronchodilation.
Route and NSG implications of Beclomethasone Dipropionate, Budesonide & Fluticasone (inhaled corticosteroids):
-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).
SE of Beclomethasone Dipropionate,
Budesonide & Fluticasone (inhaled corticosteroids):
pharyngeal irritation, cough, dry mouth, oral fungal infection.
Anti-inflammatory: Mast Cell Stabilizer:
Cromolyn
MOA of Cromolyn:
Stabilize membranes of mast cells & prevent release of broncho-constrictive inflammatory substances:
Use & NSG implications of Cromolyn:
-To prevent acute asthma attacks.
-Take 15-20 minutes prior to known trigger (sports, pumpkin patch..).
-NOT a rescue drug.
COMBO: Inhaled Glucocorticoid & Bronchodilator:
Budesonide & Formoterol (works in min)
Fluticasone & Salmeterol (takes longer)
USE of COMBO: Inhaled Glucocorticoid & Bronchodilator: BF & FS:
& KEY teaching:
-Moderate to severe asthma
-Both have really long 1/2 life.
-Never used for acute Asthma Attacks- even though they have bronchodilator in them!
Monoclonal Antibody Anti-Asthmatic:
Omalizumab
MOA of Omalizumab:
Monoclonal antibody which selectively binds to immunoglobulin IgE–> limits the release of mediators of allergic response (decreased hyper response).
NSG implications for Omalizumab:
-Must be monitored closely for hyper-sensitivity reactions (anaphylaxis= BIG risk).
-Never give by itself.
-Route: injection
-Asthma Specific!
Selective PDE-4 Inhibitor Roflumilast MOA
Selectively inhibits PDE-4 enzyme in the lung cells.
-inhibit PDE-4= decreased inflammation
-Potent anti-inflammatory effect in lungs
USE of Selective PDE-4 Inhibitor Roflumilast:
-COPD (long-term) to prevent exacerbations–> No acute/immediate use.
-Given PO
SE of Selective PDE-4 Inhibitor Roflumilast:
N/V/D, h/a, muscle spasm, decrease appetite, uncontrollable tremors.
Anti-Tubercular Drugs
- Isoniazid (INH)
- Ethambutol
- Rifampin
- Pyrazinamide
- Streptomycin
Isoniazid MOA:
Disrupts cells wall synthesis essential functions of mycobacteria.
-First line/most widely used drug for TB.
SE of Isoniazid:
peripheral neuropathy, hyperglycemia, hepatotoxicity, optic neuritis/visual def.
NSG implications for Isoniazid:
-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)).
Ethambutol MOA:
Diffusing into mycobacteria & suppress RNA synthesis, which inhibits protein synthesis.
-1st line bacteriostatic
SE of Ethambutol:
retrobulbar neuritis, blindness.
NSG implications for Ethambutol:
-P.O.
-Usually given in combo with INH & Rifampin (1 pill with all 3 in it).
-NO children <13 yo.
MOA of Rifampin:
-Inhibits protein synthesis via attacking hydrocarbon ring structure.
-1st line
SE of Rifampin:
Hepatitis, homologic disorder, red-brown urine/tears/sweat.
NSG implications for Rifampin:
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
Pyrazinamide MOA:
Unknown- may inhibit lipid & nucleic acid synthesis.
-bacteriostatic/bactericidal.
SE of Pyrazinamide:
hepatotoxicity, hyperuricemia.
NSG implications for Pyrazinamide:
-P.O.–>always in combo with other meds.
-Not for patients with ACUTE gout or severe hepatic.
-No pregnant women (in US).
Streptomycin MOA:
aminoglycoside–>interfering with normal protein synthesis causing production of faulty proteins w/in bacteria.
SE of streptomycin:
ototoxicity, nephrotoxicity, blood dyscrasias (bleeding times)
NSG implications for Streptomycin:
-IM injection daily.
-Careful with pts on anticoags- can increase bleeding.
MOA of Erythropoietin stimulating agents: EPOETIN alfa:
stimulates erythropoiesis: increases Hgb & reticulocyte counts.
NSG implications for EPOETIN alfa:
-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.
SE of Epoetin alfa:
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.
USE of Epoetin alfa:
anemia d/t chronic kidney disease, HIV pts on Zidovudine, people on certain chemo, autoimmune hemolytic anemia.
B12 replacement:
Cyanocobalamin
Facts about Cyanocobalamin:
-Give IM weekly until levels normalize, then monthly.
-Indicated for patients with severe B12 deficits & neuro symptoms.
-Well tolerated- may have pain at site.
Diet for B12 def:
increase meat, fish, eggs, milk and other dairy products.
(oral supplement 1-2mg/day).
B12 Anemia RBCs:
MACROCYTIC & NORMOCHROMIC: large abnormal shape and normal color.
Pernicious Anemia facts:
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.
S/S of B12 anemia:
NEUROPATHY, low hct/hgb, ataxia, glossitis, dementia/psychosis, jaundice, irritability, fatigue
Folate Anemia RBCs:
MACROCYTIC & NORMOCHROMIC: large abnormal shape and normal color.
Folate anemia facts:
-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.
Increased FOLATE diet:
fortified gains, fresh fruits and vegetables.
Meds for FOLATE anemia:
Prescription strength folic acid: 1-5mg/daily.
OTC folic acid: 400 mcg/daily
-Well tolerated- no SE.
Iron deficient Anemia RBCs:
MICROCYTIC & HYPERCHROMIC: small abnormally shaped and pale in color.
We CANT make hemoglobin without ____?
IRON
s/s of Iron anemia:
PICA, koilonychia (spoon shaped nails), glossitis (tongue), tired, pale, in childhood=cog deficits; murmur/angina, pagophagia (ice), restless leg syndrome.
Iron def Anemia is seen most in:
toddler, adolescent girls, pregnant women.
Treatment for Iron def anemia:
Ferrous Sulfate; Ferrous Gluconate or Iron Dextran
Ferrous Sulfate & Ferrous Gluconate facts:
-Iron def meds
-give on empty stomach; do not crush/chew.
-Only 20% is absorbed.
-use a straw if liquid (stains teeth).
Iron Dextran facts:
-IM (1/5” needle) with z-track (stains skin).
-Have EPI available (allergic reaction)
-1st time dose: test IM/IV first.
SE of IRON drugs:
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.
Allergic Rhinitis… and most common cause:
“Runny nose”/common cold
-Pet dander
- DILATE BRONCHIALS:
- DECREASE BRONCHIAL INFLAMMATION:
- Beta2adrenergics
Inhaled anticholinergics
Xanthine derivatives - Glucocorticoids
Mast cell stabilizer
Leukotriene receptor antagonists
Key words: “Persistent productive cough”
Bronchitis
(“Goblet cells”)
Emphysema
Loss of elastic recoil in alveoli- essentially collapse on themselves–> no gas exchange.
Key words: “Infectious mucus…” what condition?
PNA
Key words: “Hyper-secretion and inflammation…” what condition
Asthma
