Test #8 Flashcards
1
Q
What uses a cycle balance maintain homeostasis?
A
female reproductive system
2
Q
What are the groups of drugs in women’s health?
A
estrogens, progestins, fertility drugs, oxytocics drugs, and tocolytics
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
4
Q
Why are estrogens given?
A
- prevent/treat menopause. (ERT) protects cardiac & bone
- stimulate ovulation (hypogonadism): maintain menstrual cycle
- combined with progestins for oral contraceptives
5
Q
What is the action of estrogen?
A
bind with receptors to produce the same effect as natural estrogen
6
Q
What are the uses of estrogen?
A
hormone replacement therapy
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
8
Q
Estrogens fight menopausal symptoms. What are the symptoms?
A
hot flashes, night sweats, fatigue, headaches and nervousness
9
Q
What can cause the early onset of menopause (before the age of 45)?
A
smoking
10
Q
How does estrogen help bone health?
A
reduces the risk of osteoporosis
11
Q
Estrogen helps with menstrual disturbances described as what?
A
abnormal bleeding, PMS, and dysmenorrhea
12
Q
What is estrogen used for in men?
A
prostate cancer
13
Q
What cancer is estrogen used for in women?
A
breast cancer
14
Q
What teenage problem can estrogen be used for?
A
severe acne
15
Q
What are the major side effects of estrogen?
A
- Nausea (most common)
- Na+ and H2O retention (weight gain & HTN)
- Breast tenderness
- Increased risk of blood clots (smokers & over the age of 35)
- Break-through menstrual bleeding
- Photosensitivity (cholasma: brownish macular spots on face and neck)
16
Q
What should the nurse monitor for in women taking estrogen?
A
blood pressure, liver function, and weight gain
17
Q
What should patients report on estrogen?
A
break-through bleeding
18
Q
What should nurses tell male patients taking estrogen?
A
female characteristics disappear when drug therapy is complete and drug is discontinued
19
Q
What should nurses warn against when taking estrogen?
A
smoking
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
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
22
Q
What is the drug brand name for estrogen?
A
Premarin
23
Q
What is the goal for Premarin?
A
low dose possible for the shortest duration to alleviate pre- or peri- menopausal symptoms
24
Q
What has Women’s Health Institutes of Health studies determined about estrogen?
A
- decreased rate of hip fractures
- no effect on rates of CAD or breast cancer
- increased risk of CVA & Endometrial cancer
25
What is the goal of progestins?
replace missing progesterone by modifying the progesterone molecule so that the liver cannot inactivate it.
26
Why is progesterone needed?
1. uterine prep for pregnancy
2. development of breasts for lactation
3. decreased risk of spontaneous abortion (miscarriage)
27
What are progestins?
synthetic derivative of progesterone; inhibit the LH surge and ovulation
28
What are the uses of progestins?
1. dysfunctional uterine bleeding (amenorrhea, endometriosis, menorrhagia, break-through bleeding, PMS, postmenopausal bleeding, endometrial cancer)
2. prevent miscarriage
29
What are the side effects of progestins?
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)
30
What are the contraindications for progestin use?
- 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
31
What is the drug brand name for progestin?
Provera
32
What herbal drug is similar to progestin?
Black Cohosh
33
What are contraceptive drugs?
used to prevent pregnancy, teratogenic, pregnancy risk category X
34
Contraceptive drugs are a combination of:
estrogen & progestin
35
What is the action of contraceptive drugs?
block FSH and LH which prevent the release of the ovum (ovulation prevented)
36
What do contraceptive drugs promote?
the formation of thick cervical mucous that slows sperm transport & inhibit the process of sperm penetration into the ovum.
37
How do contraceptive drugs decrease the likelihood of implantation?
makes uterine endometrium less favorable to receive an embryo
38
How do contraceptive drugs act on the menstrual cycle?
improves menstrual cycle regularity & decreases the incidence of dysmenorrhea
39
Contraceptive drugs can be taken as a morning after pill, which does what?
- prevents fertilized implantation
- taken within 72 hrs of unprotected intercourse
- take follow-up dose 12 hrs later
40
What is the emergency contraceptive pill called?
Plan B
41
When do you begin taking a contraceptive drug?
on day 7 of the menstrual cycle and continue for 14 days
42
During the other 7 days of the month, what does the woman take?
a placebo pill
43
What do some BCP contain?
Iron; replaces iron lost during bleeding
44
What do extended cycle products do?
decrease the frequency of menstrual bleeding; seasonal; women will have period every 3 months
45
What is the common problem of contraceptive drugs?
forget to take it
46
If a patient misses one dose, how should you instruct them?
take 2 pills the following day
47
What happens if two consecutive doses are missed?
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
48
What are the side effects of contraceptive drugs?
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
49
What are the interactions of contraceptive drugs?
Many: antibiotics, anticonvulsants, anticoagulants, antihypertensives, caffeine, corticosteroids, analgesics
50
What should be taught to the pt taking contraceptive drugs?
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
51
What is Yasmin?
OC; may have no periods at all or up to 4/yr
52
What is Depo-Provera?
single deep IM injections provides 3 months of contraceptive protection and cannot be reversed once injected
53
What are the SE of Depo-Provera?
bloating, headache, depression, decreased libidoi
54
What is NuvaRing?
- 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
55
What is Ortho-Evra?
- topical patch
- time released hormones
- changed every 7 days for 1st 3 weeks, no patch for the 4th week
56
When can Ortho-Evra be worn?
bathing and swimming
57
After Ortho-Evra patch is removed, hormone levels return to normal in how many days?
3 days
58
Why are drugs given for osteoporosis?
prevent low bone mass to avoid increased risk of fractures
59
What was the original plan to treat osteoporosis?
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
60
What are the three drug classifications for osteoporosis?
Bisphosphonates, selective estrogen receptor modules (SERM), and calcitonin
61
What is the osteoporosis drug of choice?
Bisphosphonates
62
What is an example of a bisphosphonate?
Boniva and Fosamax
63
What does Boniva or Fosamax do?
prevent or reverse lost bone mass
64
What do Boniva/Fosamax do?
inhibits osteoclast bone damage
65
What are osteoclasts?
cells that break down bone
66
How do you evaluate the effectiveness of Boniva/Fosamax?
increased bone density and no fractures
67
How should you take Boniva/Fosamax?
with 8 oz of water and remain upright for 30 min
68
What are the side effects of Boniva/Fosamax?
headaches, GI upset, and joint pain
69
What is an example of SERM?
Evista
70
How does Evista work?
increases bone density by stimulating estrogen receptors on the bone
71
What does Evista do?
prevents osteoporosis and has positive effects at lowering cholesterol levels
72
What are SE of Evista?
hot flashes, leg cramps, and increased risk of DVT
73
What do calcitonin drugs do?
treat post-menopausal osteoporosis or hypercalcemia and prevents osteoclasts bone breakdown
74
What is an example of a calcitonin drug?
Calcimar (fish protein) or Miacalcin
75
What form does Calcimar or Miacalcin come in?
nasal spray
76
What are SE of Calcimar or Miacalcin?
flushing of face and nausea
77
What allows fertility drugs to work?
- ovaries must be functional
- no ovarian cysts present
- functioning thyroid
78
What do fertility drugs do?
- 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
79
What can fertility drugs be used with?
invetro fertilization
80
What is invetro fertilization?
egg is fertilized with sperm in the lab and then surgically implanted into the uterus
81
What are the SE of fertility drugs?
- multiple births
- hot flashes and blurred vision
- ovarian cysts
- breast tenderness and weight gain
- depression
82
What is the implication of fertility drugs?
1. carful monitoring & follow-up visits required--expensive and self-pay
2. take PO 5 days and repeat with next cycle
83
What is an example of a fertility drug?
Clomid
84
What are oxytoxics?
stimulate contraction of the uterus, especially in a gravid (full-term) uterus
85
What are the uses of oxytoxics?
induce labor in post-term pregnancy, prevent hemorrhage after delivery, and abortions
86
What are the SE of oxytoxics?
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)
87
What are the implications of oxytoxic drugs?
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
88
What is Cervidil?
a vaginal gel or suppository; ripen cervix for labor induction
89
What is Methergine?
given IM; prevent hemorrhage after delivery
90
What is Mifepristone RU-486?
given PO; induce abortion in the 1st trimester (12-14 weeks)
91
What are tocolytic drugs?
relax uterine smooth muscle to stop preterm labor (between 20 to 39 weeks of gestation)
92
What are the SE of tocolytic drugs?
1. Headaches
2. tachycardia and HTN (mom)
3. pulmonary edema
93
What is an example of a tocolytic drug?
magnesium sulfate (Brethine)
94
What is the new rx?
give a high dose NSAID (Indocin) to inhibit prostaglandins or CCV: (nifedipine) to block Ca+ (uterine muscles need prostaglandins and Ca+ to contract)
95
What are the nursing implications of magnesium sulfate?
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
96
What are androgens?
male sex hormones responsible for the normal development and maintenance of male sex characteristics
97
What is the most common androgen?
testosterone
98
What is Danocrine?
a synthetic androgen derivative
99
How is Danocrine administered?
injection or topical patch
100
How is Androderm and Testoderm administered?
topical patch
101
Why is Androderm and Testoderm administered?
given for hypogonadism, oligospermia, & breast cancer
102
What does Androderm and Testoderm do?
mimic the normal release of testosterone--maximum levels occur in the morning and minimum levels occur in the evening
103
Where is Testoderm applied?
scrotal area and changed every 24 hours
104
Where is Androderm applied?
clean, dry, shaved skin of back, abdomen, upper arms or thighs and changed every 7 days
105
Where should testosterone be given?
given IM in the deep UOQ of the gluteal muscle
106
How long will it take for therapeutic benefit to occur?
3-4 months
107
How should you DC Androderm and Testoderm?
gradually
108
What is may be a problem of Androderm and Testoderm use?
edema
109
What should be assessed before using Androderm and Testoderm?
cardiac disease
110
What is banned from professional sports?
anabolic steroids
111
What do anabolic steroids do?
responsible for bone and muscle development and decreased protein breakdown
112
How are anabolic steroids classified?
Schedule III controlled substance
113
What are anabolic steroids approved for?
FDA approval required for anemia, metastatic cancer of breasts
114
Why are anabolic steroids misused by athletes?
muscle building properties
115
What are SE of misusing anabolic steroids?
- sterility
- MI
- liver cancer
- personality changes
- cardiomyopathy
- sudden cardiac death
- impotency
- decreased sperm count
- amenorrhea
116
What is the benefit of anabolic steroids?
retention of nitrogen, potassium, & phosphorus needed for protein building; prevents breakdown of amino acids
117
What are the results of anabolic steroids?
weight gain and increased muscle bulk & strength
118
What are androgen inhibitors?
blocks the effects of naturally occurring androgens
119
What do 5-alpha reductase inhibitors?
block the enzyme needed to form testosterone
120
What is an example of an androgen inhibitor?
Proscar
121
What is Proscar?
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
What does Proscar do?
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
What are the SE of Proscar?
- loss of libido
- gynecomastia (increased breast tissue)
- myopathy
124
What is a herbal drug that works like an androgen inhibitor?
Saw Palmetto and it inhibits 5-alpha reductase in order to treat BPH
125
What is erectile dysfunction (ED)?
penile erection does not occur because the corpus cavernosum does not fill with blood
126
What are the drugs used to treat ED?
PDE5 Inhibitors: Viagra, Cialis, and Levitra
127
How does Viagra work?
inhibits phosphodiasterase to permit inflow of blood into penis
128
What are the SE of ED medications?
headache, flushing, dyspepsia, UTI, diarrhea, dizziness, blurred vision, blue tinged vision, MI, sudden death
129
What should you teach your patient about using ED medications?
- taken PO
- peak time is 60 min
- avoid taking with high-fat meal
- only effective in the presence of sexual stimulation
130
What are the contraindications for ED medications?
- don't use if on vasodilators
- severe hypotension effect
- don't drink grapefruit juice
131
What drugs are used to treat upper respiratory infection (URI) or rhinovirus (cold)?
antihistamines
132
What is the action of antihistamines?
compete with histamine for receptor sites; when histamine is blocked, this prevents vasodilation, decrease GI & respiratory secretions, and increased capillary permeability.
133
What do antihistamines do?
- treat seasonal allergies, -decrease the effect of lacrimal, salivary, and respiratory mucosal glands
- prevent and treat allergy S/Sx
134
What do antihistamines produce?
- relaxation of the bronchus
- prevention or alleviation of itching
- drying effect (anti-cholinergic)
- relief from hay fever and common cold symptoms
135
What are adverse effects of antihistamines?
1. sleep; take at HS
2. dry mouth, urine retention, and constipation
3. blurred vision and vertigo
136
What are drug examples of non-sedating antihistamines?
Allegra, Claritin, and Zyrtec
137
What is a drug example of a tradition antihistamine?
Benedryl
138
What are the uses of Benedryl?
allergic disorders, nighttime sleeping aid, and motion sickness
139
What are nursing considerations for antihistamines?
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
What drug categories are considered cold medications?
decongestants, antitussives, and expectorants
141
What are cold medications used for?
treat/relieve (not cure) the symptoms of rhinovirus (influenza) and URI.
142
What is a herbal product used for cold medications?
Echinacea
143
What are decongestants used for?
relieve congestion, rhinitis, and Eustachian tube occlusion associated with sinusitis, the common cold, hay fever, and other allergies
144
What is the action of decongestants?
sympathomimetic action--on alpha-adrenergic receptors to promote vasoconstriction of the nasal mucosa
145
How do decongestants decrease the nasal mucosa vasoconstriction?
- 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
What are the 2 routes of administration for decongestants?
systemic (PO) and topically (drop & nasal spray)
147
What is an example of a decongestant given by mouth?
Sudafed
148
What is an example of a decongestant given topically?
Afrin
149
How should Afrin be administered?
1-2 drops in each nare q6h prn for only 3-5 days
150
What is an example of a decongestant that is an inhaled steroid?
Rhinocort and Flonase
151
What are SE of decongestants?
- rebound nasal congestion
- transient burning, stinging of nasal mucosa on application
- sneezing d/t mucosal drying
- restlessness or insomnia
152
What does Rebound Nasal Congestion look like?
hyperemia of nasal mucosa, red, boggy, and swollen; occurs with sustained use of topical sprays for several days
153
What do you do if rebound congestion occurs?
hold the drug and notify the doctor; may need a NS spray.
154
True or False: Transient burning and stinging will occur.
True
155
What should you use if dryness and nasal mucosa occurs?
a humidifier
156
How long should you use a decongestant?
3-5 days
157
How do you minimize CNS stimulation?
- 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
Why are antitussives given?
given to suppress cough that is exhausting and interrupting ADLs or sleep
159
What is a cough?
a protective mechanism to remove mucous and irritants, and should not be inhibited unless necessary
160
What are examples of antitussives?
- dextromethorphan: Vicks Formula 44, Robitussin-DM, and Tessalong
- Codeine
161
What is the onset of an antitussive?
15-30 minutes
162
What is the duration of an antitussive?
4-6 hours
163
What are the pharmacodynamics of opioid antitussives?
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
What are the pharmacodynamics of dextromethorphan?
Vicks-Formula 44 and Robitussin-DM--works the same way without providing analgesia, CNS depression, or addiction.
165
What is the treatment of a cough?
1. irritant removal
2. treat postnasal drip
3. bronchospasms
4. give antitussives
166
What are the SE of Robitussin-DM?
drowsiness and stupor
167
What are the S/Sx of an overdose of Robitussin-DM?
euphoria, hyperactivity, and staggering gait
168
What is Codeine typically reserved for?
intractable cough, usually associated with lung cancer
169
What are the SE of Codeine?
- Nausea and Vomiting
- Constipation
- Sedation
- Agitation
- Potential Drug Addiction
170
Is Codeine a controlled substance?
yes
171
What should be monitored when Codeine is given?
respiratory depression
172
When should an antitussive not be given?
to a patient with a productive cough or one who needs to cough (post-op)
173
What is the best way to ensure safety in a pt taking an antitussive?
monitor for dizziness, sedation, and agitation
174
What should be taught to a pt taking an antitussive?
- 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
What is an expectorant?
used to help raise respiratory secretions; found in prescription and OTC cough medications
176
What do expectorants do?
liquefy thick secretions and aid in movement and removal
177
How can the process to liquefy thick secretions and aid in movement and removal be aided?
- encourage fluids--2 L/day
- deep breathing exercises
- frequent position changes
- humidifier = moist air
178
What is the mechanism of action for expectorants?
loosen/thin respiratory tract secretions in response to GI tract irritation by the drug, Mucinex (guaifenesin)
179
What is an example of a drug for an expectorant
guaifenesin--Humibid, Robitussin, Mucinex
180
What are the uses for guaifenesin?
- bronchitis
- persistent coughs
- mucous plugs
- influenza
- common cold
181
What are the SE of guaifenesin?
GI irritation and nausea and vomiting
182
What should be assessed when taking guaifenesin?
lung sounds and secretions (color, amount, and character)
183
What should be given to clients before and after expectorant agents?
water
184
What should be administered with SSKI?
fruit juice to cover taste
185
What drug is a mucolytic?
Mucomyst (acetylcysteine)
186
What does a mucolytic do?
decreases the viscosity of secretions
187
How is a mucolytic given?
down ET tube or give PO
188
What is Mucomyst the antidote for?
acetaminophen overdose
189
What does Mucomyst smell like?
rotten eggs
190
What are the diseases of the respiratory tract?
asthma, emphysema, and COPD
191
What is obstruction related to?
inflammation that results in narrowing of the interior of the airway and muscle constriction that results in a narrowing of the bronchus
192
What happens with chronic inflammation?
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
What happens with COPD?
- air is trapped in the lower respiratory tract
- the alveoli degenerate and fuse together
- alveoli collapse and gas exchange is impaired
194
What are bronchodilators given to treat?
asthma, chronic bronchitis, and emphysema
195
How do bronchodilators work?
dilate the bronchus and bronchioles that are narrowed
196
What do bronchodilators do?
relax bronchial smooth muscle band to dilate the bronchus and bronchioles
197
What are the three classes of bronchodilators?
- beta-adrenergic agonists
- anticholinergics
- xanthine derivatives
198
How are beta-agonists used?
commonly during the acute phase of an asthma attack to quickly dilate airway constriction and restore airflow to normal
199
What is another name for beta-agonists?
sympathomimetic bronchodilators
200
How do sympathomimetic bronchodilators work?
stimulate the SNS by imitating the effects of norepinephrine by dilating the bronchus and increasing the rate & depth of respirations
201
What is the action of beta-agonists?
stimulate the beta-2 adrenergic receptors throughout the lungs to allow the constricted airways to relax
202
What are the uses for beta-agonists?
- bronchospasms
- COPD
- asthma
- airway obstruction
203
What are the two drugs for beta-agonists?
albuterol and Serevent
204
What are the drug brand names for albuterol?
Proventil and Xoponex
205
What is albuterol?
short-acting inhaler
206
What is Serevent?
long-acting inhaler to maintain control of asthma and COPD
207
What can Serevent come in?
diskus, which is a powder that is inhaled
208
What may Serevent be combined with?
Advair--a corticosteroid
209
What are the major SE of beta-agonists?
anxiety, restlessness or insomnia, and palpations, HTN, or dysrhythmias
210
What are the contraindications of beta-agonists?
HTN and dysrhythmias
211
What should be assessed when giving a beta-agonist?
respiratory status and blood gases (ABG)
212
How should a patient use an inhaler?
-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
What should be monitored in a pt taking a beta-agonist?
cardiac status
214
What is an anticholinergic?
block the acetylcholine receptors to prevent bronchoconstriction, resulting in a dilated airway
215
What are two drug examples of an anticholinergic?
Atrovent and Spiriva
216
What is the generic name for Atrovent?
ipratropium
217
What is Atrovent used for?
treat COPD or asthma
218
How should Atrovent be administered?
given by inhalation (MDI, liquid aerosol, or nebulizer treatment) to produce bronchodilation twice a day
219
What is an anticholinergic used for?
to prevent allergy induced or exercise induced asthma
220
What are the SE of an anticholinergic?
dry mouth and headache
221
What is the typical dose of an anticholinergic?
1-2 inhalations as ordered
222
When should an anticholinergic be held?
if a pt is allergic to peanuts, legumes, or soy beans
223
What do xanthine derivatives do?
- 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
What are the uses of xanthine derivatives ?
asthma (dyspnea, increased respiratory rate, and SOB), wheezing, and COPD
225
What are two drug examples of xanthine derivatives?
aminophylline and theophylline
226
What is aminophylline used for?
treat acute asthma (IV) that do no respond to initial therapy (status asthmaticus)
227
What is Theophylline?
has slow onset and best used to prevent asthma attacks vs. treating them (PO)
228
What is the action of xanthine derivatives?
inhibits phosphodiesterase, an enzyme responsible for breaking down cAMP, which make it more available for bronchodilation
229
What happens when large doses of xanthine derivatives are given?
stimulate cardiac muscle and CNS--tachycardia and dieresis
230
What are the SE of xanthine derivatives?
-CNS stimulation: tremors, nervousness, insomnia
231
How are xanthine derivatives administered?
oral, rectal, parenteral, and topical
232
What are the nursing implications of xanthine derivatives?
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
What are other types of non-bronchodilating respiratory drugs?
antileukotrine agents and corticosteroids
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What do antileukotrine agents do?
- 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)
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What is the newest drug whose researcher won a Nobel Prize?
antileukotrine agents
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How is Singulair given?
oral use (chewable) and administered @ night before HS
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What is the effect of antileukotrine agents?
works to prevent smooth muscle from constricting and decrease mucus secretion (less inflammation)
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Who are antileukotrine agents given to?
adults and children over 12 years
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When is improvement seen?
1 week
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What are antileukotrine agents used for?
to prevent an acute asthma attack
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What are the SE of antileukotrine agents?
headache, nausea, and liver toxicity
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What are corticosteroids?
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
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What conditions are possible from corticosteroid use?
Cushing's syndrome and Addison's crisis
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What is the route used in corticosteroids?
inhalation, oral, and IV; best given inhaled as the effects are topical and confined to just the lungs
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What are drug examples of corticosteroids?
Azmacort (pulmicort), AeroBid, Advair, Flovent, and Solu-Medrol (given IVP)
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What is the action of corticosteroids?
stabilize the cells that release histamine to prevent inflammation
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What are corticosteroids used for?
to treat bronchospasms
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What are the SE of corticosteroids?
sore throat, cough, dry mouth
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What should be done after using a corticosteroid?
rinse mouth to avoid thrush (an oral fungal infection)
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How long does it take for corticosteroids to have a full therapeutic benefit?
several weeks
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How should corticosteroids be DC?
slow tapering dose; gradually DC otherwise death may occur
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What should be done with children who use corticosteroids?
track bone growth
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How should patients be assessed on non-bronchodilating respiratory drugs?
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
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What is a nursing diagnosis for Pts on non-bronchodilating respiratory drugs?
impaired gas exchange or fatigue or anxiety
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How should Pts with a headache be treated?
given analgesia
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What should be done in Pts started on PO therapy?
DC the IV infusion
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What should be done for Pts with drug induced insomnia?
encourage relaxation techniques and dose and timing may need to be adjusted
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What serum concentrations should be monitored for toxicity?
theophylline levels of >20 mEq/dL
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How does fluid help with secretions?
decreases thickness and helps to expectorate sputum
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What is the purpose of a spacer device?
increase the amount of drug delivered
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How should someone care for a spacer device?
wash and dry after each use
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What is nebulizer therapy?
the most effective way to deliver these drugs by administering small amounts of misted droplets of drug will reach lower airspaces
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How is nebulizer therapy delivered?
through a mouth-piece or mask
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What should be taught to a patient when administering a bronchodilator and a steroid MDI?
administer the bronchodilator first and wait 5 minutes to follow with the steroid
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What criteria should be evaluated in a patient with on respiratory drugs?
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
