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Pharm > Upper respiratory > Flashcards

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
Q

diphenhydramine & promethazine contraindications due to

A

anticholinergic effects:

urinary retention

BPH

glaucoma

HTN

26
Q

diphenhydramine & promethazine

OTHER CONSIDERATIONS

A

warn against:
combination medications
- decongestant alpha 1 agonist

Vesicant: ensure for IV patency
= blister agent

27
Q

promethazine

A

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
Q 
decongestants 
non-specific a agonist 
smpathomimetic 
OTC 
PRN
A

ephedrine
pseudoephedrine

PRN

29
Q

ephedrine & pseudoephedrine

MOA:

A

non-specific - a & b agonist

- when PO or large intranasal doses

30
Q

ephedrine & pseudoephedrine

MOA continued:

A 
a - peripheral vasoconstriction 
- decongestant effects
- decreases:
swelling 
stuffiness
rhinorrhea

a & b - worsening HTN , BPH , tachycardia

CNS effect: 
restlessness
jitteriness
nervousness 
- avoid stimulants
31
Q

decongestants

ROUTES

A

nasal spray

inh mist

ophthalmic

im

sub q

iv

po

32
Q

ephedrine & pseudoephedrine –

ROUTES

A

ephedrine
PO
inh mist

pseudoephedrine
PO
limited scale with ID

33
Q

naphazoline

A

Eye drop for redness

34
Q

ephedrine NOTES

A

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
Q

Decongestants
non- specific a agonists sympathomimetic
OTH
PRN
ephedrine & pseudoephedrine considerations:

A 
1. Nasal spray/ drop: 
apply while sitting/lateral NOT SUPINE
tilt head forward  
sniff gently 
- to avoid swallowing and systemic effect
  1. avoid frequent use of nasal spray / drop
    multiple doses may cause:
    paradoxical congestion by irritation on nasal mucosa NOT IN THE PO FORM
  2. causes tolerance
    must always TAPER OFF and avoid
    rebound congestion
    (only 3
36
Q

Antitussive
“cough suppressant”
PRN

A
  1. cough lozenges

menthol : local anesthetic obtained from mint

  1. Non opioid

benzonatate : RX (po, soft gel)

dextromethropan : (OTC syrup, lozenges)

  1. opioid

codine

37
Q

Antitussive indication

A

dry cough

to avoid further throat irritation

38
Q

Cough lozenges

A

menthol

local anesthetic obtained from mint
- call doctor before use not given out of purse

39
Q

non opioid antitussive

A

benzonatate

dextromethropan

40
Q

benzonatate
dextromethropan
MOA

A

benzonatate
RX
PO soft gel

dextromethropan
OTC syrup, lozenges

41
Q

benzonatate
dextromethropan
MOA

A

suppress the cough center in the MEDULLA

related to opoids structurally but has no analgesic properties

42
Q

benzonatate
dextromethropan
SIDE EFFECTS:

A

drowsiness
dizziness

euphoria with high doses —- risk of abuse

43
Q

opioid antitussives

A

codine

often in cobination with
antihistamine
decongestant
expectorant

44
Q

codine
opioid antitussives
MOA:

A

suppress cough by increasing cough threshold in CNS -PRODRUG= usually not abuse have to drink take it to become active

45
Q

codine
opioid antitussives
SIDE EFFECTS

A 
drowsiness 
respiratory depression 
dizziness - fall, driving
nausea 
constipation 
hypotension 
- relax bowels- falls asleep
46
Q

codine
opioid antitussives
RISK OF ABUSE

A

risk of abuse–
short term only

reversed by naloxone - for respiratory depression

47
Q

codine
opioid antitussives
REVERSAL AGENT

A

naloxone

respiratory depression

48
Q

codine
opioid antitussives
CONTRAINDICATIONS

A

respriatory disease

alcohol

head trauma

49
Q

expectorant

A

guaifenesin

guaifenesin/dextromethorphan

50
Q

guaifenesin
guaifenesin/dextromethorphan
MOA

A

increasing respiratory tract fluid

  • adds water to mucus -> no more dry cough - more productive
51
Q

guaifenesin

ROUTE

A

PO
tab
capsule
syrup

52
Q

guaifenesin

NURSING

A

increase hydration to promote drug action

53
Q

guaifenesin

CONTRAINDICATIONS

A

never to children

< 4 YO

54
Q

guaifenesin

COMBOS

A 
various combinations with 
analgesic
antihistamines
decongestants
antitussive (OTC cold drugs)

PATIENTS ARE AT HIGH RISK OF OD

55
Q

guaifenesin/dextromethorphan

ROUTE

A

OTC

56
Q

guaifenesin/dextromethorphan

CAUTIONS

A

drowsiness

dizziness

57
Q

intranasal glucocorticoid

steroid- corticosteroids

A

budesonide

fluticasone

NASAL SPRAYSSS

58
Q

budesonide
fluticasone
NURSING

A

SCHEDULED not prn

maintenance drug - not rescue - not designed to rescue

it takes 7-21 days for peak effect

59
Q

budesonide
fluticasone
SIDE EFFECTS

A

dryness of nasal mucosa
epistaxis
manage dryness by saline nasal spray

60
Q

budesonide
fluticasone
CONTRAINDICATIONS:

A

pregnancy (c)

URI - upper respiratory infections

61
Q

budesonide
fluticasone
OTHER CONSIDERATIONS

A

must shorten the length of use TO PREVENT OPPORTUNISTIC INFECTION- CANDIDIASIS

Pharm (7 decks)

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