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NUR-250 > Test #8 > Flashcards

Test #8 Flashcards

1
Q

What uses a cycle balance maintain homeostasis?

A

female reproductive system

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2
Q

What are the groups of drugs in women’s health?

A

estrogens, progestins, fertility drugs, oxytocics drugs, and tocolytics

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3
Q

What is estrogen?

A

the female sex hormone that develops the reproductive system and the secondary sex characteristics: full breasts, soft skin, fat distribution, and female voice

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4
Q

Why are estrogens given?

A
  1. prevent/treat menopause. (ERT) protects cardiac & bone
  2. stimulate ovulation (hypogonadism): maintain menstrual cycle
  3. combined with progestins for oral contraceptives
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5
Q

What is the action of estrogen?

A

bind with receptors to produce the same effect as natural estrogen

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6
Q

What are the uses of estrogen?

A

hormone replacement therapy

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7
Q

What are the available forms of women’s drugs?

A

oral, injection, vaginal cream, transdermal patch, implant, vaginal ring, and implanted uterine device

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8
Q

Estrogens fight menopausal symptoms. What are the symptoms?

A

hot flashes, night sweats, fatigue, headaches and nervousness

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9
Q

What can cause the early onset of menopause (before the age of 45)?

A

smoking

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10
Q

How does estrogen help bone health?

A

reduces the risk of osteoporosis

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11
Q

Estrogen helps with menstrual disturbances described as what?

A

abnormal bleeding, PMS, and dysmenorrhea

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12
Q

What is estrogen used for in men?

A

prostate cancer

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13
Q

What cancer is estrogen used for in women?

A

breast cancer

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14
Q

What teenage problem can estrogen be used for?

A

severe acne

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15
Q

What are the major side effects of estrogen?

A
  1. Nausea (most common)
  2. Na+ and H2O retention (weight gain & HTN)
  3. Breast tenderness
  4. Increased risk of blood clots (smokers & over the age of 35)
  5. Break-through menstrual bleeding
  6. Photosensitivity (cholasma: brownish macular spots on face and neck)
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16
Q

What should the nurse monitor for in women taking estrogen?

A

blood pressure, liver function, and weight gain

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17
Q

What should patients report on estrogen?

A

break-through bleeding

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18
Q

What should nurses tell male patients taking estrogen?

A

female characteristics disappear when drug therapy is complete and drug is discontinued

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19
Q

What should nurses warn against when taking estrogen?

A

smoking

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20
Q

What are the contraindications for estrogen?

A
  • estrogen-dependent tumors
  • undiagnosed vaginal bleeding
  • pregnancy
  • active thrombophlebitis (h/o CVA and blood clots)
  • Hx of breast, cervical, endometrial, and prostate cancer and hepatitis
  • can increase HDL, cholesterol, & triglyceride levels
  • Pregnancy category X
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21
Q

Women over the age of 60 on progestin/estrogen combo meds:

A
  • increase risk of MI, CVA, breast cancer, dementia, DVT
  • less reported hip fractures
  • less risk of colo-rectal cancers
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22
Q

What is the drug brand name for estrogen?

A

Premarin

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23
Q

What is the goal for Premarin?

A

low dose possible for the shortest duration to alleviate pre- or peri- menopausal symptoms

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24
Q

What has Women’s Health Institutes of Health studies determined about estrogen?

A
  1. decreased rate of hip fractures
  2. no effect on rates of CAD or breast cancer
  3. increased risk of CVA & Endometrial cancer
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25
Q

What is the goal of progestins?

A

replace missing progesterone by modifying the progesterone molecule so that the liver cannot inactivate it.

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26
Q

Why is progesterone needed?

A
  1. uterine prep for pregnancy
  2. development of breasts for lactation
  3. decreased risk of spontaneous abortion (miscarriage)
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27
Q

What are progestins?

A

synthetic derivative of progesterone; inhibit the LH surge and ovulation

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28
Q

What are the uses of progestins?

A
  1. dysfunctional uterine bleeding (amenorrhea, endometriosis, menorrhagia, break-through bleeding, PMS, postmenopausal bleeding, endometrial cancer)
  2. prevent miscarriage
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29
Q

What are the side effects of progestins?

A
  1. Nausea (most common)
  2. Na+ and H2O retention (weight gain & HTN)
  3. Breast tenderness
  4. Increased risk of blood clots (smokers & over the age of 35)
  5. Break-through menstrual bleeding
  6. Photosensitivity (cholasma: brownish macular spots on face and neck)
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30
Q

What are the contraindications for progestin use?

A
  • estrogen-dependent tumors
  • undiagnosed vaginal bleeding
  • pregnancy
  • active thrombophlebitis (h/o CVA and blood clots)
  • Hx of breast, cervical, endometrial, and prostate cancer and hepatitis
  • can increase HDL, cholesterol, & triglyceride levels
  • Pregnancy category X
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31
Q

What is the drug brand name for progestin?

A

Provera

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32
Q

What herbal drug is similar to progestin?

A

Black Cohosh

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33
Q

What are contraceptive drugs?

A

used to prevent pregnancy, teratogenic, pregnancy risk category X

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34
Q

Contraceptive drugs are a combination of:

A

estrogen & progestin

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35
Q

What is the action of contraceptive drugs?

A

block FSH and LH which prevent the release of the ovum (ovulation prevented)

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36
Q

What do contraceptive drugs promote?

A

the formation of thick cervical mucous that slows sperm transport & inhibit the process of sperm penetration into the ovum.

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37
Q

How do contraceptive drugs decrease the likelihood of implantation?

A

makes uterine endometrium less favorable to receive an embryo

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38
Q

How do contraceptive drugs act on the menstrual cycle?

A

improves menstrual cycle regularity & decreases the incidence of dysmenorrhea

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39
Q

Contraceptive drugs can be taken as a morning after pill, which does what?

A
  • prevents fertilized implantation
  • taken within 72 hrs of unprotected intercourse
  • take follow-up dose 12 hrs later
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40
Q

What is the emergency contraceptive pill called?

A

Plan B

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41
Q

When do you begin taking a contraceptive drug?

A

on day 7 of the menstrual cycle and continue for 14 days

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42
Q

During the other 7 days of the month, what does the woman take?

A

a placebo pill

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43
Q

What do some BCP contain?

A

Iron; replaces iron lost during bleeding

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44
Q

What do extended cycle products do?

A

decrease the frequency of menstrual bleeding; seasonal; women will have period every 3 months

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45
Q

What is the common problem of contraceptive drugs?

A

forget to take it

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46
Q

If a patient misses one dose, how should you instruct them?

A

take 2 pills the following day

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47
Q

What happens if two consecutive doses are missed?

A

2 pills are taken on both the day the missed doses are remembers and the following day and a backup method of contraception (condom) should be used for the next week

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48
Q

What are the side effects of contraceptive drugs?

A
  1. Signs of early pregnancy
    • nausea
    • breast tenderness
    • weight gain
    • depression w/ mood swings
  2. Irregular menstrual bleeding
  3. Thromboembolism (MI, CVA, PE)
  4. HTN
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49
Q

What are the interactions of contraceptive drugs?

A

Many: antibiotics, anticonvulsants, anticoagulants, antihypertensives, caffeine, corticosteroids, analgesics

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50
Q

What should be taught to the pt taking contraceptive drugs?

A
  1. Do monthly BSE
  2. Category X
  3. Monitor BP; report sudden weight gain, pain on dorsiflexion w/ tenderness, redness, swelling of the extremity–clot
  4. limit caffeine (estrogen decreases caffeine metabolism)
  5. wait 3 months after DC the OCs before attempting pregnancy
  6. antibiotics decrease OCs effectiveness
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51
Q

What is Yasmin?

A

OC; may have no periods at all or up to 4/yr

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52
Q

What is Depo-Provera?

A

single deep IM injections provides 3 months of contraceptive protection and cannot be reversed once injected

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53
Q

What are the SE of Depo-Provera?

A

bloating, headache, depression, decreased libidoi

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54
Q

What is NuvaRing?

A
  • inserted into vagina once a month for 3 weeks of contraceptive action
  • slowly releases hormones
  • removed at end of week 3
  • new ring inserted during the first week of the next menstrual cycle
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55
Q

What is Ortho-Evra?

A
  • topical patch
  • time released hormones
  • changed every 7 days for 1st 3 weeks, no patch for the 4th week
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56
Q

When can Ortho-Evra be worn?

A

bathing and swimming

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57
Q

After Ortho-Evra patch is removed, hormone levels return to normal in how many days?

A

3 days

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58
Q

Why are drugs given for osteoporosis?

A

prevent low bone mass to avoid increased risk of fractures

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59
Q

What was the original plan to treat osteoporosis?

A

give 1000-1500 mg of calcium daily along with vitamin D to women over 60 years; increases risk of renal stones and no prevention against colon polyps & cancer

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60
Q

What are the three drug classifications for osteoporosis?

A

Bisphosphonates, selective estrogen receptor modules (SERM), and calcitonin

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61
Q

What is the osteoporosis drug of choice?

A

Bisphosphonates

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62
Q

What is an example of a bisphosphonate?

A

Boniva and Fosamax

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63
Q

What does Boniva or Fosamax do?

A

prevent or reverse lost bone mass

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64
Q

What do Boniva/Fosamax do?

A

inhibits osteoclast bone damage

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65
Q

What are osteoclasts?

A

cells that break down bone

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66
Q

How do you evaluate the effectiveness of Boniva/Fosamax?

A

increased bone density and no fractures

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67
Q

How should you take Boniva/Fosamax?

A

with 8 oz of water and remain upright for 30 min

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68
Q

What are the side effects of Boniva/Fosamax?

A

headaches, GI upset, and joint pain

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69
Q

What is an example of SERM?

A

Evista

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70
Q

How does Evista work?

A

increases bone density by stimulating estrogen receptors on the bone

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71
Q

What does Evista do?

A

prevents osteoporosis and has positive effects at lowering cholesterol levels

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72
Q

What are SE of Evista?

A

hot flashes, leg cramps, and increased risk of DVT

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73
Q

What do calcitonin drugs do?

A

treat post-menopausal osteoporosis or hypercalcemia and prevents osteoclasts bone breakdown

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74
Q

What is an example of a calcitonin drug?

A

Calcimar (fish protein) or Miacalcin

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75
Q

What form does Calcimar or Miacalcin come in?

A

nasal spray

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76
Q

What are SE of Calcimar or Miacalcin?

A

flushing of face and nausea

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77
Q

What allows fertility drugs to work?

A
  • ovaries must be functional
  • no ovarian cysts present
  • functioning thyroid
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78
Q

What do fertility drugs do?

A
  • stimulate the growth and maturation of the ovum and increase the release of gonadotropins
  • promotes ovulation
  • given 1 year after infertility
  • blocks estrogen receptor sites in brain/uterus
  • false signal sent that decreased levels of estrogen are present
  • increased maturity of ovarian follicles
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79
Q

What can fertility drugs be used with?

A

invetro fertilization

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80
Q

What is invetro fertilization?

A

egg is fertilized with sperm in the lab and then surgically implanted into the uterus

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81
Q

What are the SE of fertility drugs?

A
  • multiple births
  • hot flashes and blurred vision
  • ovarian cysts
  • breast tenderness and weight gain
  • depression
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82
Q

What is the implication of fertility drugs?

A
  1. carful monitoring & follow-up visits required–expensive and self-pay
  2. take PO 5 days and repeat with next cycle
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83
Q

What is an example of a fertility drug?

A

Clomid

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84
Q

What are oxytoxics?

A

stimulate contraction of the uterus, especially in a gravid (full-term) uterus

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85
Q

What are the uses of oxytoxics?

A

induce labor in post-term pregnancy, prevent hemorrhage after delivery, and abortions

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86
Q

What are the SE of oxytoxics?

A
  1. Nausea and vomiting
  2. HTN (increases by 30%)
  3. Headache
  4. Excess uterine hypertonicity (strong, frequent, prolonged contractions)
  5. Risk of uterine rupture (immediately stop the IV drug administration)
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87
Q

What are the implications of oxytoxic drugs?

A
  1. Assess VS frequently (mom & baby); IV pump–stress on fetus can either increase or decrease FHR (normal is 120-150)
  2. Assess strength, frequency, and duration of uterine contractions
  3. Assess vaginal hemorrhage
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88
Q

What is Cervidil?

A

a vaginal gel or suppository; ripen cervix for labor induction

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89
Q

What is Methergine?

A

given IM; prevent hemorrhage after delivery

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90
Q

What is Mifepristone RU-486?

A

given PO; induce abortion in the 1st trimester (12-14 weeks)

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91
Q

What are tocolytic drugs?

A

relax uterine smooth muscle to stop preterm labor (between 20 to 39 weeks of gestation)

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92
Q

What are the SE of tocolytic drugs?

A
  1. Headaches
  2. tachycardia and HTN (mom)
  3. pulmonary edema
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93
Q

What is an example of a tocolytic drug?

A

magnesium sulfate (Brethine)

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94
Q

What is the new rx?

A

give a high dose NSAID (Indocin) to inhibit prostaglandins or CCV: (nifedipine) to block Ca+ (uterine muscles need prostaglandins and Ca+ to contract)

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95
Q

What are the nursing implications of magnesium sulfate?

A
  1. Bed rest; quiet
  2. Monitor pulse (>140) and respirations (>20) indicate pulmonary edema (ER)
  3. Avoid fluid overload
  4. Position mom on left lateral side to keep weight off the uterus/fetus of the aorta
  5. Evaluation–the uterine contractions should stop
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96
Q

What are androgens?

A

male sex hormones responsible for the normal development and maintenance of male sex characteristics

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97
Q

What is the most common androgen?

A

testosterone

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98
Q

What is Danocrine?

A

a synthetic androgen derivative

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99
Q

How is Danocrine administered?

A

injection or topical patch

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100
Q

How is Androderm and Testoderm administered?

A

topical patch

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101
Q

Why is Androderm and Testoderm administered?

A

given for hypogonadism, oligospermia, & breast cancer

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102
Q

What does Androderm and Testoderm do?

A

mimic the normal release of testosterone–maximum levels occur in the morning and minimum levels occur in the evening

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103
Q

Where is Testoderm applied?

A

scrotal area and changed every 24 hours

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104
Q

Where is Androderm applied?

A

clean, dry, shaved skin of back, abdomen, upper arms or thighs and changed every 7 days

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105
Q

Where should testosterone be given?

A

given IM in the deep UOQ of the gluteal muscle

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106
Q

How long will it take for therapeutic benefit to occur?

A

3-4 months

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107
Q

How should you DC Androderm and Testoderm?

A

gradually

108
Q

What is may be a problem of Androderm and Testoderm use?

A

edema

109
Q

What should be assessed before using Androderm and Testoderm?

A

cardiac disease

110
Q

What is banned from professional sports?

A

anabolic steroids

111
Q

What do anabolic steroids do?

A

responsible for bone and muscle development and decreased protein breakdown

112
Q

How are anabolic steroids classified?

A

Schedule III controlled substance

113
Q

What are anabolic steroids approved for?

A

FDA approval required for anemia, metastatic cancer of breasts

114
Q

Why are anabolic steroids misused by athletes?

A

muscle building properties

115
Q

What are SE of misusing anabolic steroids?

A
  • sterility
  • MI
  • liver cancer
  • personality changes
  • cardiomyopathy
  • sudden cardiac death
  • impotency
  • decreased sperm count
  • amenorrhea
116
Q

What is the benefit of anabolic steroids?

A

retention of nitrogen, potassium, & phosphorus needed for protein building; prevents breakdown of amino acids

117
Q

What are the results of anabolic steroids?

A

weight gain and increased muscle bulk & strength

118
Q

What are androgen inhibitors?

A

blocks the effects of naturally occurring androgens

119
Q

What do 5-alpha reductase inhibitors?

A

block the enzyme needed to form testosterone

120
Q

What is an example of an androgen inhibitor?

A

Proscar

121
Q

What is Proscar?

A

drug given to stop the growth of the prostate in men diagnosed with BPH (benign prostate hypertrophy); will have difficulty with obstructed urine outflow; PSA (prostate specific antigen) levels will increase with BPH

122
Q

What does Proscar do?

A
  1. decrease PSA levels by 50% and evaluate every 6 months–goal: 2.5-3.0 ng/mL
  2. improved urination without dysuria
  3. hair growth–may be used for male baldness
123
Q

What are the SE of Proscar?

A
  • loss of libido
  • gynecomastia (increased breast tissue)
  • myopathy
124
Q

What is a herbal drug that works like an androgen inhibitor?

A

Saw Palmetto and it inhibits 5-alpha reductase in order to treat BPH

125
Q

What is erectile dysfunction (ED)?

A

penile erection does not occur because the corpus cavernosum does not fill with blood

126
Q

What are the drugs used to treat ED?

A

PDE5 Inhibitors: Viagra, Cialis, and Levitra

127
Q

How does Viagra work?

A

inhibits phosphodiasterase to permit inflow of blood into penis

128
Q

What are the SE of ED medications?

A

headache, flushing, dyspepsia, UTI, diarrhea, dizziness, blurred vision, blue tinged vision, MI, sudden death

129
Q

What should you teach your patient about using ED medications?

A
  • taken PO
  • peak time is 60 min
  • avoid taking with high-fat meal
  • only effective in the presence of sexual stimulation
130
Q

What are the contraindications for ED medications?

A
  • don’t use if on vasodilators
  • severe hypotension effect
  • don’t drink grapefruit juice
131
Q

What drugs are used to treat upper respiratory infection (URI) or rhinovirus (cold)?

A

antihistamines

132
Q

What is the action of antihistamines?

A

compete with histamine for receptor sites; when histamine is blocked, this prevents vasodilation, decrease GI & respiratory secretions, and increased capillary permeability.

133
Q

What do antihistamines do?

A
  • treat seasonal allergies, -decrease the effect of lacrimal, salivary, and respiratory mucosal glands
  • prevent and treat allergy S/Sx
134
Q

What do antihistamines produce?

A
  • relaxation of the bronchus
  • prevention or alleviation of itching
  • drying effect (anti-cholinergic)
  • relief from hay fever and common cold symptoms
135
Q

What are adverse effects of antihistamines?

A
  1. sleep; take at HS
  2. dry mouth, urine retention, and constipation
  3. blurred vision and vertigo
136
Q

What are drug examples of non-sedating antihistamines?

A

Allegra, Claritin, and Zyrtec

137
Q

What is a drug example of a tradition antihistamine?

A

Benedryl

138
Q

What are the uses of Benedryl?

A

allergic disorders, nighttime sleeping aid, and motion sickness

139
Q

What are nursing considerations for antihistamines?

A
  1. Avoid driving or operating heavy machinery
  2. Never given to pt with hx of asthma
  3. Don’t use alcohol or other CNS depressants
140
Q

What drug categories are considered cold medications?

A

decongestants, antitussives, and expectorants

141
Q

What are cold medications used for?

A

treat/relieve (not cure) the symptoms of rhinovirus (influenza) and URI.

142
Q

What is a herbal product used for cold medications?

A

Echinacea

143
Q

What are decongestants used for?

A

relieve congestion, rhinitis, and Eustachian tube occlusion associated with sinusitis, the common cold, hay fever, and other allergies

144
Q

What is the action of decongestants?

A

sympathomimetic action–on alpha-adrenergic receptors to promote vasoconstriction of the nasal mucosa

145
Q

How do decongestants decrease the nasal mucosa vasoconstriction?

A
  • decrease blood flow to area
  • decreases inflammation
  • decreases congestion
  • decreases edema
  • allows mucous membranes to drain, which shrinks enlarged nasal mucosa membranes and relieve nasal congestion
146
Q

What are the 2 routes of administration for decongestants?

A

systemic (PO) and topically (drop & nasal spray)

147
Q

What is an example of a decongestant given by mouth?

A

Sudafed

148
Q

What is an example of a decongestant given topically?

A

Afrin

149
Q

How should Afrin be administered?

A

1-2 drops in each nare q6h prn for only 3-5 days

150
Q

What is an example of a decongestant that is an inhaled steroid?

A

Rhinocort and Flonase

151
Q

What are SE of decongestants?

A
  • rebound nasal congestion
  • transient burning, stinging of nasal mucosa on application
  • sneezing d/t mucosal drying
  • restlessness or insomnia
152
Q

What does Rebound Nasal Congestion look like?

A

hyperemia of nasal mucosa, red, boggy, and swollen; occurs with sustained use of topical sprays for several days

153
Q

What do you do if rebound congestion occurs?

A

hold the drug and notify the doctor; may need a NS spray.

154
Q

True or False: Transient burning and stinging will occur.

A

True

155
Q

What should you use if dryness and nasal mucosa occurs?

A

a humidifier

156
Q

How long should you use a decongestant?

A

3-5 days

157
Q

How do you minimize CNS stimulation?

A
  • lateral head low position for nasal drops
  • sitting position for nasal sprays
  • block Eustachian tubes: lie supine with head turned 15 degrees toward the effected ear and remain in this position for 5 minutes
  • report fever and cough lasting longer than 1 week
  • avoid caffeine
158
Q

Why are antitussives given?

A

given to suppress cough that is exhausting and interrupting ADLs or sleep

159
Q

What is a cough?

A

a protective mechanism to remove mucous and irritants, and should not be inhibited unless necessary

160
Q

What are examples of antitussives?

A
  • dextromethorphan: Vicks Formula 44, Robitussin-DM, and Tessalong
  • Codeine
161
Q

What is the onset of an antitussive?

A

15-30 minutes

162
Q

What is the duration of an antitussive?

A

4-6 hours

163
Q

What are the pharmacodynamics of opioid antitussives?

A

Codeine–suppress the cough reflex by affecting the cough center in the medulla. They also dry the respiratory tract mucous by increasing the viscosity (thickness) of the secretions. They also produce sedation and constipating effects as well.

164
Q

What are the pharmacodynamics of dextromethorphan?

A

Vicks-Formula 44 and Robitussin-DM–works the same way without providing analgesia, CNS depression, or addiction.

165
Q

What is the treatment of a cough?

A
  1. irritant removal
  2. treat postnasal drip
  3. bronchospasms
  4. give antitussives
166
Q

What are the SE of Robitussin-DM?

A

drowsiness and stupor

167
Q

What are the S/Sx of an overdose of Robitussin-DM?

A

euphoria, hyperactivity, and staggering gait

168
Q

What is Codeine typically reserved for?

A

intractable cough, usually associated with lung cancer

169
Q

What are the SE of Codeine?

A
  • Nausea and Vomiting
  • Constipation
  • Sedation
  • Agitation
  • Potential Drug Addiction
170
Q

Is Codeine a controlled substance?

A

yes

171
Q

What should be monitored when Codeine is given?

A

respiratory depression

172
Q

When should an antitussive not be given?

A

to a patient with a productive cough or one who needs to cough (post-op)

173
Q

What is the best way to ensure safety in a pt taking an antitussive?

A

monitor for dizziness, sedation, and agitation

174
Q

What should be taught to a pt taking an antitussive?

A
  • report cough that lasts longer than 7 days
  • report nonproductive cough that becomes productive
  • avoid alcohol or other sedatives
  • not to drink liquids for 30 min after taking antitussive lozenges or chewable tablets
175
Q

What is an expectorant?

A

used to help raise respiratory secretions; found in prescription and OTC cough medications

176
Q

What do expectorants do?

A

liquefy thick secretions and aid in movement and removal

177
Q

How can the process to liquefy thick secretions and aid in movement and removal be aided?

A
  • encourage fluids–2 L/day
  • deep breathing exercises
  • frequent position changes
  • humidifier = moist air
178
Q

What is the mechanism of action for expectorants?

A

loosen/thin respiratory tract secretions in response to GI tract irritation by the drug, Mucinex (guaifenesin)

179
Q

What is an example of a drug for an expectorant

A

guaifenesin–Humibid, Robitussin, Mucinex

180
Q

What are the uses for guaifenesin?

A
  • bronchitis
  • persistent coughs
  • mucous plugs
  • influenza
  • common cold
181
Q

What are the SE of guaifenesin?

A

GI irritation and nausea and vomiting

182
Q

What should be assessed when taking guaifenesin?

A

lung sounds and secretions (color, amount, and character)

183
Q

What should be given to clients before and after expectorant agents?

A

water

184
Q

What should be administered with SSKI?

A

fruit juice to cover taste

185
Q

What drug is a mucolytic?

A

Mucomyst (acetylcysteine)

186
Q

What does a mucolytic do?

A

decreases the viscosity of secretions

187
Q

How is a mucolytic given?

A

down ET tube or give PO

188
Q

What is Mucomyst the antidote for?

A

acetaminophen overdose

189
Q

What does Mucomyst smell like?

A

rotten eggs

190
Q

What are the diseases of the respiratory tract?

A

asthma, emphysema, and COPD

191
Q

What is obstruction related to?

A

inflammation that results in narrowing of the interior of the airway and muscle constriction that results in a narrowing of the bronchus

192
Q

What happens with chronic inflammation?

A

muscle and cilia action is lost and the patient is at risk for infections, pneumonia, and inhalation of foreign substances deep into the respiratory tract

193
Q

What happens with COPD?

A
  • air is trapped in the lower respiratory tract
  • the alveoli degenerate and fuse together
  • alveoli collapse and gas exchange is impaired
194
Q

What are bronchodilators given to treat?

A

asthma, chronic bronchitis, and emphysema

195
Q

How do bronchodilators work?

A

dilate the bronchus and bronchioles that are narrowed

196
Q

What do bronchodilators do?

A

relax bronchial smooth muscle band to dilate the bronchus and bronchioles

197
Q

What are the three classes of bronchodilators?

A
  • beta-adrenergic agonists
  • anticholinergics
  • xanthine derivatives
198
Q

How are beta-agonists used?

A

commonly during the acute phase of an asthma attack to quickly dilate airway constriction and restore airflow to normal

199
Q

What is another name for beta-agonists?

A

sympathomimetic bronchodilators

200
Q

How do sympathomimetic bronchodilators work?

A

stimulate the SNS by imitating the effects of norepinephrine by dilating the bronchus and increasing the rate & depth of respirations

201
Q

What is the action of beta-agonists?

A

stimulate the beta-2 adrenergic receptors throughout the lungs to allow the constricted airways to relax

202
Q

What are the uses for beta-agonists?

A
  • bronchospasms
  • COPD
  • asthma
  • airway obstruction
203
Q

What are the two drugs for beta-agonists?

A

albuterol and Serevent

204
Q

What are the drug brand names for albuterol?

A

Proventil and Xoponex

205
Q

What is albuterol?

A

short-acting inhaler

206
Q

What is Serevent?

A

long-acting inhaler to maintain control of asthma and COPD

207
Q

What can Serevent come in?

A

diskus, which is a powder that is inhaled

208
Q

What may Serevent be combined with?

A

Advair–a corticosteroid

209
Q

What are the major SE of beta-agonists?

A

anxiety, restlessness or insomnia, and palpations, HTN, or dysrhythmias

210
Q

What are the contraindications of beta-agonists?

A

HTN and dysrhythmias

211
Q

What should be assessed when giving a beta-agonist?

A

respiratory status and blood gases (ABG)

212
Q

How should a patient use an inhaler?

A

-administered after pt has exhaled
inhale deeply to count of 5 with head tipped backward to provide maximal opening of airway
-hold breath for 10 sec then exhale
-wait 1-2 min between puffs

213
Q

What should be monitored in a pt taking a beta-agonist?

A

cardiac status

214
Q

What is an anticholinergic?

A

block the acetylcholine receptors to prevent bronchoconstriction, resulting in a dilated airway

215
Q

What are two drug examples of an anticholinergic?

A

Atrovent and Spiriva

216
Q

What is the generic name for Atrovent?

A

ipratropium

217
Q

What is Atrovent used for?

A

treat COPD or asthma

218
Q

How should Atrovent be administered?

A

given by inhalation (MDI, liquid aerosol, or nebulizer treatment) to produce bronchodilation twice a day

219
Q

What is an anticholinergic used for?

A

to prevent allergy induced or exercise induced asthma

220
Q

What are the SE of an anticholinergic?

A

dry mouth and headache

221
Q

What is the typical dose of an anticholinergic?

A

1-2 inhalations as ordered

222
Q

When should an anticholinergic be held?

A

if a pt is allergic to peanuts, legumes, or soy beans

223
Q

What do xanthine derivatives do?

A
  • increase the levels of cAMP (necessary to maintain open dilated airways)
  • increasing cAMP inhibits the release of chemicals that drive allergy reactions (histamine)
  • enhance the respiratory drive in the medulla
224
Q

What are the uses of xanthine derivatives ?

A

asthma (dyspnea, increased respiratory rate, and SOB), wheezing, and COPD

225
Q

What are two drug examples of xanthine derivatives?

A

aminophylline and theophylline

226
Q

What is aminophylline used for?

A

treat acute asthma (IV) that do no respond to initial therapy (status asthmaticus)

227
Q

What is Theophylline?

A

has slow onset and best used to prevent asthma attacks vs. treating them (PO)

228
Q

What is the action of xanthine derivatives?

A

inhibits phosphodiesterase, an enzyme responsible for breaking down cAMP, which make it more available for bronchodilation

229
Q

What happens when large doses of xanthine derivatives are given?

A

stimulate cardiac muscle and CNS–tachycardia and dieresis

230
Q

What are the SE of xanthine derivatives?

A

-CNS stimulation: tremors, nervousness, insomnia

231
Q

How are xanthine derivatives administered?

A

oral, rectal, parenteral, and topical

232
Q

What are the nursing implications of xanthine derivatives?

A
  1. Be compliant–dosing, schedule, blood work
  2. Do not chew or alter dosage form
  3. Take with food to avoid GI effect
  4. Avoid smoking–increases metabolism of these drugs
  5. If tachycardia occurs, the drug is not discontinued but the dose is reduced
  6. Food interactions:
    • charcoal broiling
    • increased protein
    • decreased CHO diet to reduce serum concentration of xanthine derivatives
  7. Teach about foods/beverages that contain caffeine–avoid them
233
Q

What are other types of non-bronchodilating respiratory drugs?

A

antileukotrine agents and corticosteroids

234
Q

What do antileukotrine agents do?

A
  • prevent leukotrines from attaching to receptors in circulating immune cells
  • blocks inflammation in the lungs that occurs when the immune system is triggered by an allergen (cat hair or dust)
235
Q

What is the newest drug whose researcher won a Nobel Prize?

A

antileukotrine agents

236
Q

How is Singulair given?

A

oral use (chewable) and administered @ night before HS

237
Q

What is the effect of antileukotrine agents?

A

works to prevent smooth muscle from constricting and decrease mucus secretion (less inflammation)

238
Q

Who are antileukotrine agents given to?

A

adults and children over 12 years

239
Q

When is improvement seen?

A

1 week

240
Q

What are antileukotrine agents used for?

A

to prevent an acute asthma attack

241
Q

What are the SE of antileukotrine agents?

A

headache, nausea, and liver toxicity

242
Q

What are corticosteroids?

A

anti-inflammatory drugs used for acute asthma attacks to provide a decrease in inflammation of the airways and can be used prophylactilly–prevent and treat asthma

243
Q

What conditions are possible from corticosteroid use?

A

Cushing’s syndrome and Addison’s crisis

244
Q

What is the route used in corticosteroids?

A

inhalation, oral, and IV; best given inhaled as the effects are topical and confined to just the lungs

245
Q

What are drug examples of corticosteroids?

A

Azmacort (pulmicort), AeroBid, Advair, Flovent, and Solu-Medrol (given IVP)

246
Q

What is the action of corticosteroids?

A

stabilize the cells that release histamine to prevent inflammation

247
Q

What are corticosteroids used for?

A

to treat bronchospasms

248
Q

What are the SE of corticosteroids?

A

sore throat, cough, dry mouth

249
Q

What should be done after using a corticosteroid?

A

rinse mouth to avoid thrush (an oral fungal infection)

250
Q

How long does it take for corticosteroids to have a full therapeutic benefit?

A

several weeks

251
Q

How should corticosteroids be DC?

A

slow tapering dose; gradually DC otherwise death may occur

252
Q

What should be done with children who use corticosteroids?

A

track bone growth

253
Q

How should patients be assessed on non-bronchodilating respiratory drugs?

A
  1. Note contraindications of cardiac disease, glaucoma, and GI disease
  2. Skin color, temp, resp rate & depth, O2 sat
  3. Allergies
  4. Resp distress of SE of medications
254
Q

What is a nursing diagnosis for Pts on non-bronchodilating respiratory drugs?

A

impaired gas exchange or fatigue or anxiety

255
Q

How should Pts with a headache be treated?

A

given analgesia

256
Q

What should be done in Pts started on PO therapy?

A

DC the IV infusion

257
Q

What should be done for Pts with drug induced insomnia?

A

encourage relaxation techniques and dose and timing may need to be adjusted

258
Q

What serum concentrations should be monitored for toxicity?

A

theophylline levels of >20 mEq/dL

259
Q

How does fluid help with secretions?

A

decreases thickness and helps to expectorate sputum

260
Q

What is the purpose of a spacer device?

A

increase the amount of drug delivered

261
Q

How should someone care for a spacer device?

A

wash and dry after each use

262
Q

What is nebulizer therapy?

A

the most effective way to deliver these drugs by administering small amounts of misted droplets of drug will reach lower airspaces

263
Q

How is nebulizer therapy delivered?

A

through a mouth-piece or mask

264
Q

What should be taught to a patient when administering a bronchodilator and a steroid MDI?

A

administer the bronchodilator first and wait 5 minutes to follow with the steroid

265
Q

What criteria should be evaluated in a patient with on respiratory drugs?

A
  1. Decreased dyspnea, decreased wheezing, restlessness & anxiety
  2. Improved activity tolerance, return to normal blood gas results
  3. Bronchodilators–increase the ease of breathing, normal rate/depth of respirations
  4. presence of SE

NUR-250 (3 decks)

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