Test 5 Flashcards
Antihistamine receptors, side effects, patient teaching
H1 receptor blocker
SE: Drowsiness, dry mouth, urinary retention, hypotension, tachycardia, constipation, often stimulatory in children
Pt Teaching: Avoid alcohol and opioids, fall risk in older adults, take before s/s of allergies,not for children because of idiosyncratic effects
guaifenesin (Mucinex) therapeutic indication, mechanism of action
I: dry non-productive cough
MOA: Increase expelling of bronchial secretions by thinning Mucus
Inhalation therapy patient teaching, rationale for using this route
pt: ○ Prime spray
○ Clear nasal passage
○ Insert the tip aiming high in the nasal cavity and toward the back of head
○ Close the opposite nostril, breathe in slowly and spray
○ Spit out any excess liquid.
Inhalation offers rapid and efficient bronchodilation directly to the site of action in the lungs, dramatically decreasing the onset of action *can also use lower dose
The enormous surface area of the bronchioles and alveoli and the rich blood supply to these areas results in an almost instantaneous onset of action with little systemic toxicity
oxymetazoline (Afrin) teaching, complications
pt: *if coronary artery disease-get doc approval, don’t use for longer than 3-5 days! to avoid rebound congestion. if using a corticosteroid use sympathomimetic first then wait a minute for cortico.
C: htn, rebound congestion (hypersecretion of mucous/swelling), dries mucous membranes.
Oral and intranasal route differences in general
Most oral decongestants are sympathomimetics (adrenergic drugs) nnm
○ Many combination drugs, but single dose is safer
○ Oral have a longer onset of action
○ Intranasal drugs are deliverd via sprays directly to their site of action which offers
rapid and efficient relief.
○ Oral more likely for systemic effects
Pseudoephedrine (Sudafed) patient teaching
pt: monitor hr-tachycardia, bp-htn, palpitation, dysthymias-cardiac disease pts
tracked betweeen pharmacies
possible s/e hypertension, cns stim (anxiety, insomnia, urinary retention-if pre existing issues. )
Asthma medication treatment goals
*asthma drugs
moa
where it works (mucus membrane, bronchioles, etc.)
route of administration
Goal: Terminate acute bronchospasms and to reduce the frequency of asthma attacks
Dry powder inhalation (DPI) mechanism
○ Offers rapid and efficient bronchodilation directly to the site of action in the lungs,
dramatically decreasing the onset of action
○ Large surface area and rich blood supply of bronchioles and alveoli mean almost
instantaneous onset of action with little systemic toxicity
○ Activated by inhalation
○ Have longer duration of action
○ Easier to use- less complex for pts
albuterol (Proventil) indication, side effects, mechanism of action, patient teaching
I: acute bronchospasm - most effective
SE: tachycardia, dysrhythmias, tremors, anxiety, headache, throat irritation, hyperglycemia
MOA: activate B2 receptors which causes bronchodilation, Stimulates SNS, Widens airways
Pt teaching: use correct technique, use at first sign of asthma attack, label as rescue inhaler
Glucocorticoid inhalation side effects
Hoarseness, dry mouth, thrush, long term use: cataracts
Leukotriene modifiers [zafirlukast (Accolate)] indication
I: Prophylaxis of persistent chronic asthma. Decrease inflammation in lungs
ipratropium (Atrovent) contraindication, patient teaching
C: *no use in children under 12
propellent is may of soy lecithin (no use if soy or peanut allergy),
Assess for history of narrow-angleglaucoma, benign prostatic hyperplasia, renal disorders, urinary bladder neck obstruction
◦ Contraindicated in clients with history of these and in elderly
Pt: keep away from eyes, s/e *few systemic. Headache, bitter taste (rinse), dry cough, dry mouth, irritate mucous membranes in throat (airway irritation)
Note: more effective when used in combination with beta agonists, specifically LABA’S ) *results in longer duration of action.
GERD treatment goal
G: reduce gastric acid secretion
H2-receptor antagonist indication, mechanism or action
I: peptic ulcer disease and GERD
MOA: acid reduction via Decrease of acid secretion from parietal cells
ranitidine (Zantac) patient teaching
pt: ○ H2 receptor antagonist
○ Don’t take at same time as PPIs and antacids
○ Take c meal or at bedtime, best c food
bismuth (Pepto-Bismol) indication, mechanism of action
I: peptic ulcer disease, diarrhea
MOA: stimulates mucosal bicarbonate and prostaglandin productions which prevents H. pylori from adhering to intestinal mucosa, absorbs toxins, can also destroy H. pylori cell wall
misoprostol (Cytotec) indications
I: Peptic ulcer disease and sometimes labor
Inhibits gastric acid secretion and stimulates production of protective mucosa
Also used for labor induction Pregnancy Category X (ripens cervix) do not use in pregnancy
omeprazole (Prilosec) classification
Class: PPI (acid reducer)
○ Binds to the enzyme that is responsible for secreting hydrochloric acid
○ Monitor for osteoporosis (less acid less calcium absorption)
○ Monitor liver function- PPIs can cause liver disease and problems
○ Several drug/drug interactions: cumedin (Warfarin), antivirals, anti-depressants
○ Administration: 20-30 min before meal on empty stomach (1-2 times a day) best
c food
○ Most PPIs end in “prazole”
sucralfate (Carafate) administration
sucralfate (Carafate)-Protective coating *mostly liquid, protects stomach allowing to heal.
Take on epty stomach
diphenoxylate with atropine (Lomotil) mechanism of action
Used to treat diarrhea
Diphenoxylate is a synthetic opioid receptor agonist and acts on opioid receptors in the GI tract and reduces GI motility and slows down movement of contents in intestines.
Atropine is anticholinergic and blocks the action of acetylcholine
Laxatives general patient teaching, mechanism of action
Teaching: Follow dosing instructions from the provider, hydrate well, explain that it may take time to work so do not give up if it doesn’t work immediately, get more dietary fiber, encourage regular physical activity, and avoid excessive use. Inform side effects may include abdominal cramping, diarrhea, nausea, or bowel habit changes. Do not abuse.
MOA:
- Bulk-forming laxatives: contain fiber or other substances that absorb water in intestines, softening stool and adding bulk, which stimulates peristalsis
- Stool-softeners/emollient laxatives: increase water content of stool which makes it softer and easier to pass.
- Lubricant laxatives: coat the surface of stool and intestines, making it easier for stool to move through digestive tract. Also prevents water absorption from the stool
- Osmotic laxatives: draws water into intestines, which softens stool and increases stool volume
- Saline laxatives: contains salts and mineral ions that draw water into the intestines which softens stool
- Stimulant laxatives: irritates intestinal lining, which stimulates peristalsis and secretion of fluids into the intestines to soften stool.
- Prokinetic agents: enhance muscular contractions of intestines
Treatment standards for inflammatory bowel disease
Ulcerative Colitis large intestine -ulcers in mucoss
Chron’s Disease small intestine- fat wrapping, muscle hypertrophy, fissues, cobblestone
Mild to acute flare ups
Remissions and exacerbation
Treatment- with immunosuppressants and anti-inflammatory drugs
First step 5-aminosalicylic acid drugs *rapid releif, antiinflammatory properties
Examples: sulfasalazine (Azulfidine), mesalamine (Asacol)-more common
2nd stepc corticosteroids
Example: budesonide (Entocort EC) usually given liquide
3rd step immunosupressents
Example: azathioprine (Imuran)
Biologic therapy binds with and prevents activity of Tumor Necrotic Factor which is involved in producing inflammation. Name 2 examples:
infliximab (remicade)
adalimumab (humira)
prochlorperazine (Compazine) side effects
Antipsychotic medication used to manage schizophrenia and nausea/vomiting from surgery or chemo.
S/E: Drowsiness, sedation, dry mouth, blurred vision, dizziness or lightheadedness, constipation, weight gain, difficulty urinating, EPS, NMS, hypotension, elevated prolactin
B12 deficiency causes and complications
Causes: Inadequate dietary intake, impaired digestive absorption, GI disorders (Crohns, celiac, atrophic gastritis), aging, GI surgery, parasites, alcoholism
Complications: Pernicious anemia (B12 helps create blood cells), neurological/cognitive issues, neuropathy, optic nerve damage, heart problems, psychiatric issues
