Unit 11 - Oxygenation Flashcards
3 main mechanisms that contribute to bronchoconstriction
- bronchospasm
- secretion production
- edema
Prototype of the Beta2 Adrenergic Agonists (Bronchodilators) (Selective) (fast acting)
albuterol
first choice for asthma attacks
Beta2 Adrenergic Agonists (Bronchodilators) (Selective)
T/F: more is better for albuterol
FALSE! (>12xd is not healthy = decreased lung function)
route of albuterol
- inhalation (first choice)
- PO (more risk for systemic side effects)
Expected therapeutic effects for albuterol
- Beta 2 Adrenergic Agonist, fast acting bronchodilator ->improved breathing
- exercise induced asthma
- drain mucous better
- decrease inflammation
Contraindications/interactions of albuterol
- hypersensitivty
- caution: cardiovascular disorders
- beta blockers block effect
- MAOIs increase BP
- thyroid hormone increase CV effects
- CNS stimulants, caffeine, increase CNS & CV stimulation
Side effects of albuterol
*- tremors (common)
Nursing considerations/pt. teaching for albuterol
… no link slide 6
*- monitor for paridoxical syndrome
Prototype for inhaled anticholinergics (bronchodilators)
iptratropium
If a pt. had COPD and has an acute attack, what drug would they use
iptratropium, because of the COPD
Therapeutic effects of iptratropium
acute attacks in pt. c COPD
contraindications/interactions of iptratropium
*- watch out for pt. c allergies to soy beans, peanuts, atropine (allergic to ingrediant in propellent of inhalor)
side effects of iptratropium
…
- cholinergic effects (dry mouth, cough, etc.)
nursing considerations/pt. teaching of iptratropium
- do not confuse with alupent
- nebulizer (SVN): using in same nebulizer = goop it up & make it form a clumpy precipitate*- monitor for paridoxical syndrome
- teach to no use as rescue drug
- rinse mouth after use
- do not use in children under 12
T/F: you should use your bronchodilator first for asthma
T
prototype for inhaled corticosteroids (anti-inflammatory)
Beclomethasone
drug of choice for prevention & maintenance of chronic respiratory problems
inhaled corticosteroids
- decrease mucous productions
- decrease edema
- steroids have NOTHING to do with bronchodilation (don’t prevent bronchoconstriction)
T/F: steroids have everything to do with bronchodilation
FALSE! They don’t prevent bronchoconstriction
drug of choice for long-term management of asthma or COPD
Beclamethasone
Therapeutic effects of Beclamethasone
Decreased inflammation of respiratory tract alleviating the symptoms of asthma or allergic rhinitis
Contraindications/interactions of Beclamethasone
*- DO NOT USE IN AN ACUTE ATTACK (not harmful nor helpful….use bronchodilator instead!)
side effects of Beclamethasone
- osteoporosis (long-term use)
- cataracts (older adults)
nursing considerations/pt. teaching for Beclamethasone
- avoid with active infections (decrease immune response = potential danger)
- monitor for infections
- assess for oral candidiasis (mouth yeast infection)
- effects might take 1-4 wks for benefit
- rinse mouth
- monitor for osteoporosis/vision changes (cataracts)
T/F: you should perform a resp. assessment (lung auscultation) with all respiratory drugs
T!
Prototype for Leukotriene Receptor Antagonists (anti-inflammatory)
Zafirlukast
T/F: you should use Zafirlukast for acute asthma attacks
NO!
Route for Zafirlukast
only PO
Can you use Zafirlukast in children
yes :)
Therapeutic effect of Zafirlukast
Prevent the signs and symptoms of asthma – blocks leukotriene receptors and decreases inflammation
contraindications/interactions for Zafirlukast
- caution: liver dysfunction
- may increase PT when taken c warfarin
side effects for Zafirlukast
- HA
- Chura-Strauss syndrome (fever, muscles aches & pains, weight loss)
- hepatic failure
nursing considerations/pt. teaching for Zafirlukast
- dangerous to use c liver dysfunction…can cause liver failure (monitor LFTs)
- report s/s of liver dysfunction (N,V, jaundice)
- take even if not having s/s
- food decreases rate/amt. of drug absorption = take on empty stomach ( 1 hr before or 2 hr after meals)
prototype for methylxanthines
theophylline (modest bronchodilators)
- similar side effects to caffeine
T/F: we have to assess whether pt’s using methylxanthines are smokers or not
T
- smoking significantly increases metabolism = increase dosage
Therapeutic effects of theophylline
- relaxes bronchiole smooth muscle
- Relieves bronchospasm for patients with asthma, chronic bronchitis and emphysema.
- Reduces responsiveness to airway irritants
contraindications/interactions of theophylline
- IV: incompatible with many other IV drugs
* - interacts c many other drugs (antibiotics & antianxieties)
side effects of theophylline
…
nursing considerations/pt. teaching for theophylline
- monitor LFTs because of significant metabolism
- give PO = give c extra glass of water to decrease stomach upset
- give at same times every day
- Avoid charcoal broiled foods (because if increased excretion = decreased effects)
- limit caffeine = increase adverse effects
- **- therapeutic range: 10-15 mcg/mL
- **- toxic range: > 20 mcg/mL
- report s/s toxicity: anorexia, N, V, dizziness, shakiness, restlessness, irritability, hypotension, cardica arrhythmias, tachycardia
List 2 meds that prevent allergic/cold symptoms
antihystamines & steroids
List 4 meds that help relieve allergic/cold symptoms
- decongestants
- antitussives
- expectorants
- mucolytics
What type of antihistamine:
- used for allergies, insomnia, nausea/motion sickness, urticaria, Parkinson’s
- found in resp. tract
H1
What type of antihistamine:
- used for GERD & peptic ulcer disease
- found in GI tract
H2
What type of antihistamine:
- cause drowsiness
1st generation
What type of antihistamine:
- less likely to cause drowsiness (doesn’t cross BBB)
2nd generation
Classify Diphenhydramine
1st generation antihistamine
Classify Texotenadine
2nd generation antihistamine
T/F: Diphenhydramine crosses the BBB
T, so it causes drowsiness
T/F: Diphenhydramine blocks cholinergic receptors
T, so it causes anticholinergic side effects
Therapeutic effects of Diphenhydramine
…
- Has anticholinergic, antihistamine, and antiemetic effects
- Decreased N&V, sedation, decreased itching and hives
contraindications/interactions of Diphenhydramine
- MAOIs (antidepressent = hypertensive crisis potential)
side effects of Diphenhydramine
anticholinergic effects (dry mouth, etc.)
nursing considerations/pt. teaching for Diphenhydramine
- monitor for falls (drowsiness)
- avoid alcohol & other CNS depressants
- increase fluids = help c dry mucous membranes
- chew gum
Therapeutic effects of Fexofenadine
- H1 receptor antagonist
- Reduces nasal congestion, sneezing, teary eyes, urticaria
contraindications/interactions of Fexofenadine
- pregnancy
- caution: severe renal disease
- interactions: CNS depressants increase sedative effects, antacids decrease absorption, erythromycin increase serum levels, absorption decreased c apple, orange or grapefruit juice
side effects of Fexofenadine
*- HA
nursing considerations/pt. teaching for Fexofenadine
- avoid other OTC cold meds
- drowsiness = avoid driving
- avoid alcohol
- do NOT take with apple, orange, or grapefruit juice
Prototype for allergic rhinitis/cold corticosteroid
fluticasone
T/F: we like to use PO corticosteroids
FALSE! We use inhaled first because you want to avoid systemic side effects
T/F: corticosteroids are for immediate problems
F, used long-term therapy
Therapeutic effect of Fluticasone
Anti-inflammatory action that improves breathing
Contraindications/interactions for Fluticasone
contraindication: - active infection
side effects of Fluticasone
- HA
- local burning
- drying of nasal mucosa = epistaxis, irritation
Nursing considerations/pt. teaching for Fluticasone
- tell people not to share these meds: increase spread of virus (used in nose)
- use for only one illness (throw away after done using)
- rinse mouth if used in mouth, avoid swallowing
- therapeutic results take 1-3 wks
- take decongestants first before steroids
- can use a humidifier = help with nasal dryness
Prototype for Decongestants (alpha adrenergic agonists - intranasal & sympathomimetic)
Pseudoephedrine
nasal mucosa is controlled by the _____
ANS
The SNS causes arteriole vasoconstriction which causes ____ congestion
decreased
The PNS causes arteriole dilation which causes ____ congestion & ______ mucous production
increased, increased
Therapeutic effect of pseudoephedrine
Causes vasoconstriction that relieves congestion of nasal passages and eustachian tubes
contraindications/interactions of pseudoephedrine
…
- caution: HTN, cardiac disease, diabetes, glaucoma, hyperthyroidism, prostate enlargement
side effects of pseudoephedrine
- rebound congestion: when stop using it
* - insomnia
nursing considerations/pt. teaching for pseudoephedrine
- monitor for nasal irritation & bleeding
- monitor VS: HR, BP = in case of systemic effect
- encourage to not use longer than 2-5 days (especially nasal)
- discourage sharing
- DO NOT USE IN CHILDREN UNDER 2
prototype for antitussives (stop coughing = suppress cough reflex)
dextromethorphan
is dextromethorphan a narcotic antitussive?
NO. It’s non-narcotic, however there are other antitussives that are narcotics (codeine, hydrocodone)
contraindications/interactions for dextromethorphan
- pt. c a lot of secretions/mucous: we need them to be able to cough it out
- caution: immobilized pt’s
- MAOIs, SSRIs
side effects of dextromethorphan
- drowsiness
- dizziness
- N, V
- stomach pain
nursing considerations/pt. teaching for dextromethorphan
- only use on pt. who don’t need to cough/have non-productive cough
- increase liquids in order to liquify secretions
- encourage good pt. positioning (head of bed up)
- humidify room
- encourage avoidance of pulmonary irritants: smoking (discourage smoking around pt.)
- monitor pt. c lung disease
- avoid alcohol
- report s/s resp. infections
therapeutic effect of dextromethorphan
treat non-productive cough
prototype for expectorant
guaifenesin
therapeutic effects of guaifenesin
- expectorant: do NOT break down mucous, just help them thin out = more easily removed
contraindications/interactions of guaifenesin
*- caution: pregnancy/breast feeding
side effects of guaifenesin
- drowsiness
- dizziness
- N, V, D
- stomach pain
nursing considerations/pt. teaching for guaifenesin
*- increase fluids to liquify secretions (drink whole glass of water before and after the dose: trick to encourage pt. to get more fluid intake)
prototype for Mucolytic
acetylcysteine
therapeutic effect of acetylcysteine
- DOES breakdown mucous
- changes chemical structure of respiratory secretions
contraindications/interactions of acetylcysteine
…
side effects of acetylcysteine
…
nursing considerations/pt. teaching for acetylcysteine
- nausea c unpleasant odor lessons over time
- when treating acetaminophen overdose must be used within 24 hrs of ingestion - give immediately - do not wait for serum drug levels to get back
is acetylcysteine an OTC
NO! Only prescription
what medication can we use for tylenol (acetominaphen) overdose
acetylcysteine
drug used for TB
Isoniazid
- mechanism of action: breaking up the synthesis of particular acid that’s only used with microbacteria (TB)
Therapeutic effect of Isoniazid
Used for treatment and prophylaxis of tuberculosis infections
Contraindications/interactions of Isoniazid
*- caution: liver or renal disease, seizure disorders
side effects of Isoniazid
- hard on liver = elevated liver enzymes: have LFTs monitored
- CNS effects: put on perodoxine to prevent/minimize CNS effects
- rash
- fever
- parasthesias
- peripheral neuropathy
nursing considerations of Isoniazid
*- LFTs…discourage alcohol use: because of effect on liver
- report s/s liver dysfunction: excessive N,V, dark urine, light colored stools, jaundice
*- neurotoxic effects: to minimize be put on B6 or parodoxine
- report to doc. about neuro problems: numbness, tingling
-
Q: What is the drug of choice for acute respiratory distress? A. ipratropium, an anti-cholinergic B. albuterol, a beta 2 agonist C. beclomethasone, an inhaled steroid D. acetylcysteine, a mucolytic
B. albuterol, a beta 2 agonist
Q: What is an important teaching point about inhaled beclomethasone?
A. use for an acute asthma attack
B. prime the inhaler prior to every inhaled dose
C. rinse out the mouth after taking the inhaled med
D. store the inhaler in the refrigerator
C. rinse out the mouth after taking the inhaled med
Q: If a smoker uses throphylline, how will the dose need to be adjusted?
A. The dose will need to be increased above the usual dosage.
B. The dose will need to be lowered below the usual dosage.
A. The dose will need to be increased above the usual dosage.
Q: What is the advantage of 2nd generation H1 blockers over 1st generation H1 blockers?
A. 2nd generation H1 blockers are more effective
B. 2nd generation H1 blockers are less expensive
C. 2nd generation H1 blockers are less likely to cause an idiosyncratic anaphylactic reaction
D. 2nd generation H1 blockers are less likely to cause drowsiness
D. 2nd generation H1 blockers are less likely to cause drowsiness
Q: What is NOT a common adverse effect of diphenhydramine? A. dry mouth B. drowsiness C. watery eyes D. incoordination
C. watery eyes
Q: What is the main action of fluticasone that helps relieve the symptoms of seasonal allergies?
A. It stabilizes mast cells.
B. It blocks histamine from attaching to receptors on nasal mucosa.
C. It decreases inflammatory mediators.
D. It causes vasoconstriction of nasal mucosa blood vessels.
C. It decreases inflammatory mediators.
Q: When using an inhaled decongestant and an inhaled steroid together, which one should be used first?
A. the decongestant
B. the steroid
A. the decongestant
Q: What patient teaching should be included for a client using dextromethorphan, and anti-tussive.
A. decrease fluid intake to decrease secretions
B. don’t drive until its effects are known
C. keep the bedroom as dry as possible to avoid lung irritants
D. take with alcohol to increase the absorption of the med
B. don’t drive until its effects are known
Q: True or False: guaifenesin, an expectorant, breaks down the chemical structure of mucous.
A. True
B. False
B. False
Q: What disease is isoniazid used to treat? A. tuberculosis B. allergies C. asthma D. cystic fibrosis
A. tuberculosis
use of afrin nasal spray decongestant (not oral)
short term use (for asthma?)
*only use for a few days, switch over to nasal steroid for long term use
TQ: The nurse teaches a client about the use of corticosteroid nasal sprays for treating seasonal allergies. The nurse advises the client to limit the use of the spray container to one person and one episode of illness. What is the reason for this advice?
A. viruses may colonize at the tip of the container and increase the potential for spreading infection.
B. once the container is opened the medication reapidly loses its effectiveness
C. the pt. will develop a tolerance due to overuse.
D. all of the above
A. viruses may colonize at the tip of the container and increase the potential for spreading infection.
TQ: Which of the following physiologic processes does beclomethasone effect in treating the s/s of asthma? Select all that apply: A. tissue edema B. mucous production C. respiratory rate D. bronchospams
A. tissue edema
B. mucous production
TQ: Which of the following is NOT an important nursing consideration related to administration of the drug, isoniazid? A. monitor for cardiac dysrhythmias B. monitor LFTs C. monitor for peripheral neuropathy D. monitor for compliance
A. monitor for cardiac dysrhythmias
TQ: Which of the following pt. teaching points need to be included for the pt receiving isoniazid? A. avoid foods high in potassium B. avoid alcohol intake C. avoid caffeine intake D. avoid food in vitamin B6
B. avoid alcohol intake
TQ: A pt. is taking dabigatran. Which conidition is being preventing by this pt.s use of dabigatran
???
TQ: Which is NOT a first line drug for the treatment of early heart failure? A. digoxin B. furosemide C. lisinopril D. metoprolol
A. digoxin (last resort med)
TQ: A client is given a new prescription for metoprolol. Which of the following conditions could be complicated by taking metoprolol and would require additional teaching about the medication? A. arthritis pain B. diabetes C. frequent urination D. osteoporosis
B. diabetes
TQ: Which of the following symptoms are adverse effects of the corticosteroid, prednisone? A. hypertension B. increased risk for infection C. weight loss D. hypoglycemia E. moodiness
A. hypertension
B. increased risk for infection
E. moodiness
TQ: A pt. has been on long-term prednisone for the treatment of Chrone's disease. Which medications might the nurse also expect ehe pt. to be taking? A. levadopa B. alendronate C. ibuprofen D. insulin E. losarten
B. alendronate
D. insulin
E. losarten
TQ: Nursing diagnoses for pharmacotherapy are developed form what phase of the Nursing Process? A. assessment B. planning C. implementation D. evaluation
A. assessment
