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Upper respiratory Flashcards

1
Q

Rhinitis

A

Inflammation of nasal mucous membrane

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2
Q

allergic rhinitis

A

(hay fever)
may occur alone or
along with lower respiratory disorders (asthma)

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3
Q

infectious rhinitis

A

may occur alone or
with sinusitis
(viral, bacterial)

  • common cold - caused by rhinovirus - is a type of viral rhinitis
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4
Q

viral rhinitis

A

common cold- caused by rhinovirus is a type of viral rhinitis

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5
Q

signs and symptoms of rhinitis

A
  1. rinorrhea
  2. water eyes - epiphora
    epiphora= abnormal secretory system - often due to inflammation- normal tear secretion
  3. nasal congestion
  4. cough
  5. sneezing
    lacrimation: excessive tear production, normal excretory system
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6
Q

types of drugs for upper resp - rhinitis

A

antihistamines

decongestants

mast cell stabilizers ~

antitussives

expectorants

intranasal corticosteroids - never during infection

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7
Q

inflammatory mediator

A

Histamine 1

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8
Q

histamine 1

A

vasodilation

increase vascular permeability

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9
Q

histamine side effects

A

swelling - congestion of airway

erythema

rinorrhea

epiphora

irratation of nerve endings–

cough

sneezing

itching

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10
Q

antihistamines MOA

A

Prevent histamine 1 release in small blood vessels and nerves - allergies

relieving:
1. itching
2. sneezing
3. rhinorrhea
4. allergic reaction
5. anaphylaxis
6. motion sickness
7. insomnia

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11
Q

drugs that work against histamine 1

A

antihistamine

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12
Q

Antihistamines

A

PRN

FIRST GEN
SECOND GEN

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13
Q

antihistamines first gen

ROUTES

A

PO, IV, IM

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14
Q

FIRST GEN Antihistamines

A

diphenhydramine

promethazine

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15
Q

diphenhydramine and promethazine side effects

A 
Crossing BBB
CNS depressant 
1. drowsiness 
2. dizziness
3. fatigue
4. disturbed coordination 
FALL
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16
Q

Secondary use of diphenhydramine and promethazine

A

insomnia

motion sickness

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17
Q

SIDE EFFECTS of diphenhydramine and promethazine under secondary use

A

toxicity=
excitation
hallucination
seizure

ANTICHOLINERGIC EFFECTS
PNS

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18
Q

PNS effects of diphenhydramine and promethazine

A

anti cholinergic effects

pns

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19
Q

SECOND GEN route

A

PO

nasal spray

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20
Q

SECOND GEN antihistamines

A

cetirizine

fexofenadine

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21
Q

cetirizine and fexofenadine

EFFECTS

A

little to no sedative effect

little to no anti cholinergic effect

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22
Q

Antihistamines first Gen effects:

diphenhydramine & promethazine

A

breathing
- CNS depressant = respiratory depression –> shallow diminished breathing

VS 
- for anticholinergic effects 
increase BP
increase HR
increase RESPIRATION

I/Os
for anticholinergic urinary retention–> shunting from kidney

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23
Q

First gen antihistamine CNS depression: diphenhydramine & promethazine

A

avoid driving or operating dangerous machinery FALL

hangover effect– residual drowsiness effect

Avoid other CNS depressants - ETOH & codeine

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24
Q

diphenhydramine & promethazine CONTRAINDICATIONS

A

pregnancy

lactation

newborns

children

older adults

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25
diphenhydramine & promethazine contraindications due to
anticholinergic effects: urinary retention BPH glaucoma HTN
26
diphenhydramine & promethazine | OTHER CONSIDERATIONS
warn against: combination medications - decongestant alpha 1 agonist Vesicant: ensure for IV patency = blister agent
27
promethazine
is a vesicant- causes: blistering tissue injury damage to intima layer of veins - dilute IV form in a large-bore IV and very slow IV push, deep IM if you have to give
28
``` decongestants non-specific a agonist smpathomimetic OTC PRN ```
ephedrine pseudoephedrine PRN
29
ephedrine & pseudoephedrine | MOA:
non-specific - a & b agonist | - when PO or large intranasal doses
30
ephedrine & pseudoephedrine | MOA continued:
``` a - peripheral vasoconstriction - decongestant effects - decreases: swelling stuffiness rhinorrhea ``` a & b - worsening HTN , BPH , tachycardia ``` CNS effect: restlessness jitteriness nervousness - avoid stimulants ```
31
decongestants | ROUTES
nasal spray inh mist ophthalmic im sub q iv po
32
ephedrine & pseudoephedrine -- | ROUTES
ephedrine PO inh mist pseudoephedrine PO limited scale with ID
33
naphazoline
Eye drop for redness
34
ephedrine NOTES
IV is used to treat low BP POST ANESTHESIA dietary supplements containing ephedrine alkalosis is used as weight management drugs are banned for impurity side effects such as HTN, tachycardia 1005 comprehensive system of controls regarding pseudoephedrine, ephedrine, and phenylpropanolamine distribution and sale of drugs that can be sued in the illicit production of meth
35
Decongestants non- specific a agonists sympathomimetic OTH PRN ephedrine & pseudoephedrine considerations:
``` 1. Nasal spray/ drop: apply while sitting/lateral NOT SUPINE tilt head forward sniff gently - to avoid swallowing and systemic effect ``` 2. avoid frequent use of nasal spray / drop multiple doses may cause: paradoxical congestion by irritation on nasal mucosa NOT IN THE PO FORM 3. causes tolerance must always TAPER OFF and avoid rebound congestion (only 3
36
Antitussive "cough suppressant" PRN
1. cough lozenges menthol : local anesthetic obtained from mint 2. Non opioid benzonatate : RX (po, soft gel) dextromethropan : (OTC syrup, lozenges) 3. opioid codine
37
Antitussive indication
dry cough to avoid further throat irritation
38
Cough lozenges
menthol local anesthetic obtained from mint - call doctor before use not given out of purse
39
non opioid antitussive
benzonatate | dextromethropan
40
benzonatate dextromethropan MOA
benzonatate RX PO soft gel dextromethropan OTC syrup, lozenges
41
benzonatate dextromethropan MOA
suppress the cough center in the MEDULLA related to opoids structurally but has no analgesic properties
42
benzonatate dextromethropan SIDE EFFECTS:
drowsiness dizziness euphoria with high doses ---- risk of abuse
43
opioid antitussives
codine often in cobination with antihistamine decongestant expectorant
44
codine opioid antitussives MOA:
suppress cough by increasing cough threshold in CNS -PRODRUG= usually not abuse have to drink take it to become active
45
codine opioid antitussives SIDE EFFECTS
``` drowsiness respiratory depression dizziness - fall, driving nausea constipation hypotension - relax bowels- falls asleep ```
46
codine opioid antitussives RISK OF ABUSE
risk of abuse-- short term only reversed by naloxone - for respiratory depression
47
codine opioid antitussives REVERSAL AGENT
naloxone respiratory depression
48
codine opioid antitussives CONTRAINDICATIONS
respriatory disease alcohol head trauma
49
expectorant
guaifenesin guaifenesin/dextromethorphan
50
guaifenesin guaifenesin/dextromethorphan MOA
increasing respiratory tract fluid - adds water to mucus -> no more dry cough - more productive
51
guaifenesin | ROUTE
PO tab capsule syrup
52
guaifenesin | NURSING
increase hydration to promote drug action
53
guaifenesin | CONTRAINDICATIONS
never to children | < 4 YO
54
guaifenesin | COMBOS
``` various combinations with analgesic antihistamines decongestants antitussive (OTC cold drugs) ``` PATIENTS ARE AT HIGH RISK OF OD
55
guaifenesin/dextromethorphan | ROUTE
OTC
56
guaifenesin/dextromethorphan | CAUTIONS
drowsiness | dizziness
57
intranasal glucocorticoid | steroid- corticosteroids
budesonide fluticasone NASAL SPRAYSSS
58
budesonide fluticasone NURSING
SCHEDULED not prn maintenance drug - not rescue - not designed to rescue it takes 7-21 days for peak effect
59
budesonide fluticasone SIDE EFFECTS
dryness of nasal mucosa epistaxis manage dryness by saline nasal spray
60
budesonide fluticasone CONTRAINDICATIONS:
pregnancy (c) URI - upper respiratory infections
61
budesonide fluticasone OTHER CONSIDERATIONS
must shorten the length of use TO PREVENT OPPORTUNISTIC INFECTION- CANDIDIASIS

Pharm (7 decks)

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