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Pharmacology Exam #1 > Upper Respiratory Agents > Flashcards

Upper Respiratory Agents Flashcards

1
Q

Upper Respiratory Agents
In Children

A
  • Caution due to adverse effects: sedation, confusion, dizziness
  • DO NOT give UNDER 4 years old
  • Caution in 4-6 years old
  • Non-Drug Measures first: oral fluids, cool humidifier, control exposure to smoke, allergens, irritants
  • Wash hands to prevent infection
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2
Q

Upper Respiratory Agents
In Adults

A
  • Potential Accidental Overdose
  • Non-drug measures
  • No established safety in pregnancy and lactation
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3
Q

Upper Respiratory Agents
In Older Adults

A
  • More Likely to develop adverse effects: sedation, confusion, dizziness
  • Renal and hepatic impairment
  • START LOW, GO SLOW
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4
Q

Antitussives
Drug Names

A
  • Benzonatate
  • Codeine and Hydrocodone
  • Dextromethorphan
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5
Q

Antitussives
MOA

A

Codeine, Hydrocodone, Dextromethorphan:
* Acts directly on the medullary cough center of the brain to depress the cough reflex

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6
Q

Antitussives
Benzonatate
MOA

A

Local anesthetic on the respiratory tract

Need to know cause of cough first

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7
Q

Antitussives
Contraindications

A

Absolute:
* Allergy
* Patients who need to cough to maintain the airway

Relative:
* Head injury or impaired CNS
* Serious respiratory conditions like asthma or emphysema

Caution:
* History of narcotic addiction
* If they need to be alert

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8
Q

Antitussives
Adverse Effects

A
  • Drying effect on the mucus membranes
  • GI upset from drying effects
  • CNS effects
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9
Q

Antitussives
Drug Interactions

A

Drug:
* MAOIs - taken for depression
* Opiods/CNS depressants - including alcohol

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10
Q

Antitussives
Assessment

A

History:
* Contraindications, cautions, pregnancy, lactation

Physical:
* Lung sounds & respiratory rate
* Temperature
* Orientation and affect

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11
Q

Antitussives
Nursing Conclusions

A
  • Ineffective airway clearance
  • Altered sensory perception
  • Knowledge deficit
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12
Q

Antitussives
Implementation/Patient Teaching

A
  • Do not take longer than prescribed or needed
  • Further medical evaluation if needed
  • Comfort measures: Resting, lozenges, cool humidifier, avoiding irritants, oral fluids
  • Patient Teaching: avoid other opiods and CNS depressants
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13
Q

Topical Nasal Decongestants
MOA

A

Sympathomimetic => local vasoconstriction => decreased edema and inflammation

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14
Q

Topical Nasal Decongestants
Indications

A
  • Relieve the discomfort of nasal congestion (cold, allergies)
  • Dilate the nares (nostrils) for medical exams or to relieve middle ear pressure
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15
Q

Topical Nasal Decongestants
Drug names

A

“-zoline”
* Oxymetazoline
* Tetrahydrozoline
* Xylometazoline

Phenylephrine

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16
Q

Topical Nasal Decongestants
Contraindications

A

Absolute:
Allergy

Caution:
* Lesion or erosion in the mucus membranes (can lead to systemic absorption)
* Conditions that might be exacerbated by sympathetic activity: Glaucoma, HTN

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17
Q

Topical Nasal Decongestants
Adverse Effects

A
  • Local stinging and burning (Usually goes away after a few uses)
  • Rebound congestion (after 3-5 days)
  • Sympathomimetic effects
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18
Q

Topical Nasal Decongestants
Drug Interactions

A

Drug:
* Other sympathomimetic drugs (Toxic effect)
* Sympathomimetic blocking drugs (less effective)

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19
Q

Topical Nasal Decongestants
Assessment

A

History:
* Contraindications or cautions

Physical:
* Nasal mucus membranes
* Cardiac
* Urinary Status (elimination patterns)

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20
Q

Topical Nasal Decongestants
Nursing conclusions

A
  • Impaired comfort
  • Knowledge deficit
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21
Q

Topical Nasal Decongestants
Implementation/Patient Teaching

A
  • Administer correctly
  • Drug not taken longer than 1 week
  • Further medical evaluation for persistent symptoms
  • Comfort measures (ie. cool humidifier)
  • Patient Teaching: overdose prevention
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22
Q

Topical Nasal Decongestants
How to administer

A
  • Sit upright, close one nostril
  • Hold the bottle upright and insert the tip (about 1/2 inch) into the open nostril
  • Firmly squeeze the bottle
  • Repeat with other nostril
  • Refrain from blowing nose after administration
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23
Q

Oral Decongestants
MOA

A
  • Vasoconstricts small blood vessels of the nasal membranes
  • Stimulates the alpha-adrenergic receptors in the nasal mucus membranes to shrink them
  • Leads to promotion of drainage in the sinuses and improving air flow
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24
Q

Oral Decongestants
Indications

A

Decrease nasal congestion due to:
* common cold
* sinusitis
* allergic rhinitis

Relieves pressure in the middle ear:
* ear infections

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25
Q

Oral Decongestants
Drug Names

A
  • Pseudoephedrine
  • Phenylephrine
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26
Q

Oral Decongestants
Contraindications

A

Absolute:
* Allergy

Caution:
* Any conditions that might be exacerbated by sympathetic activity (Alpha-adrenergic receptors => sympathetic activity)

27
Q

Oral Decongestants
Adverse Effects

A
  • Rebound congestion
  • Sympathetic effects (restlessness, anxiety, sweating, etc)
28
Q

Oral Decongestants
Drug Interactions

A

Other OTC products that contain the same ingredients (Increased toxicity)

29
Q

Oral Decongestants
Interventions/Patient Teaching

A
  • Don’t take drug more than one week
  • Further medical evaluation for persistent symptoms
  • Monitor vitals (Pulse, BP) to detect adverse effects
  • Safety and comfort measures
  • Patient teaching - read drug labels to prevent overdose
30
Q

Steroid Nasal Decongestents
MOA

A
  • Blocks inflammatory response to relieve inflammation
  • Exact mechanism of action is NOT known
  • Minimal systemic absorption
  • Takes 1-3 weeks to be effective (because it is TOPICAL, not oral)
31
Q

Steroid Nasal Decongestents
Indications

A
  • Seasonal allergic rhinitis
  • Nasal congestion
  • Inflammation after the removal of nasal polyps
32
Q

Steroid Nasal Decongestents
Drug names

A

“-one”
* Beclomethasone
* Fluticasone
* Triamcinolone

“-ide”
* Budesonide
* Flunisolide

33
Q

Steroid Nasal Decongestents
Contraindications

A

Absolute:
* Allergy

Relative:
* Acute infection (because it suppresses immune function)
* Recent nasal surgery or trauma (can interfere with healing)

Caution:
* Active infection (because it suppresses immune function)

34
Q

Steroid Nasal Decongestents
Adverse Effects

A
  • Local burning, irritation, stinging, drying of the mucosa
  • Headache
  • Suppression of healing/immune function
  • Nausea
35
Q

Steroid Nasal Decongestents
Assessment

A

History:
* Allergy
* Acute/Active Infection
* Nasal trauma/surgery

Physical:
* Nasal mucosa (lesions)
* CNS (headache)
* Temperature (infection)

36
Q

Steroid Nasal Decongestents
Nursing Conclusions

A
  • Impaired comfort (r/t local effects)
  • Infection risk (r/t immune suppression)
  • Knowledge deficit
37
Q

Steroid Nasal Decongestents
Implementation/Patient Teaching

A
  • Monitor for acute infection
  • Safety measures: avoid areas with airborne infections
  • Comfort measures: cool environment, humidification, oral fluids)
  • Patient teaching: how to administer, follow up, takes 1-3 weeks to work
38
Q

Antihistamines
MOA

A
  • Blocks release or action of histamine at histamine-1 receptor sites
  • Decreases allergic response
  • Anticholinergeric and antipruritic effects
  • 1st generation: greater anticholinergic effects
  • 2nd generation: less sedating
39
Q

Antihistamines
Indications

A
  • Allergic rhinitis and conjunctivitis
  • Urticaria
  • Angioedema
40
Q

Antihistamines
Drug names

A

“-amine” or “-ine”
* Diphenhydramine
* Hydroxyzine
* Meclizine
* Promethazine
* Azelastine
* Cetirizine
* Fexofenadine
* Levocetirizine
* Loratadine

41
Q

Antihistamines
Contraindications

A

Absolute:
* Allergy

Caution:
* Renal or hepatic impairment
* History of arrhythmias or prolonged QT intervals (1st gen can result in fatal arrhythmias)

42
Q

Antihistamines
Drug Interactions

A
  • Varies based on the drug
  • CNS depressants
  • Any drug that increases QT intervals
43
Q

Antihistamines
Adverse Effects

A
  • CNS: drowsiness and sedation
  • Anticholinergic: respiratory, skin, GI/GU (urinary retention)
44
Q

Antihistamines
Assessment

A

History:
* Allergy, pregnancy/lactation, prolonged QT interval/arrhythmias
* Renal or hepatic impairement

Physical:
* heart and lung sounds
* skin
* CNS
* Urinary status, orientation, affect and reflexes

45
Q

Antihistamines
Nursing Conclusions

A
  • Impaired comfort (r/t adverse effects)
  • Altered sensory percepetion (r/t CNS effects)
  • Knowledge deficit
46
Q

Antihistamines
Implementation/Patient Teaching

A
  • Administer on an empty stomach to increase absorption
  • Sugarless candy/lozenges for dry mouth
  • Skin Care
  • Void before administration
  • Most effective before onset of symptoms
  • Comfort and safety measures
  • Patient Teaching: Read labels to avoid overdose, avoid alcohol
47
Q

Expectorants
MOA

A

Enhances the output of respiratory tract fluids by reducing the adhesiveness and surface tension of these fluids, allowing easier movement of the less viscous secretions

48
Q

Expectorants
Indications

A

Increase productive cough to expel mucus to clear the airway therby relieving respiratory congestion

49
Q

Expectorants
Drug name

A

Guaifenesin

50
Q

Expectorants
Contraindications

A

Absolute:
* Allergy

Cautions:
* Persistent cough: unknown underlying problem

51
Q

Expectorants
Drug Interaction

A

NONE/Unknown

52
Q

Mucolytics
Drug Interaction

A

NONE/Unknown

53
Q

Expectorants
Adverse Effects

A
  • GI Symptoms: nausea
  • Headache, dizziness
  • Mild rash
  • Prolonged use may mask serious underlying condition
54
Q

Expectorants
Assessment

A

History:
* Allergy, pregnancy, lactation, persistent cough

Physical:
* Respiratory
* Skin
* CNS
* Abdomen
* Vital Signs

55
Q

Expectorants
Nursing Conclusions

A
  • Impaired comfort (r/t adverse effects)
  • Altered sensory percetion (r/t CNS effects)
  • Knowledge Deficit
56
Q

Expectorants
Implementation/Patient Teaching

A
  • Small frequent meals to prevent GI effects
  • Safety
  • patient teaching
57
Q

Mucolytics
MOA

A

Works to break down mucus in order to aid the high-risk respiratory patient in cougning up thick. tenacious secretions

58
Q

Mucolytics
Drug Names

A
  • Acetylcysteine
  • Dornase alfa (for cystic fibrosis symptomatic relief)
59
Q

Mucolytics
Contraindications

A

Absolute:
* Allergy

Caution:
* asthma (potential for bronchospasm)

60
Q

Mucolytics
Adverse Effects

A
  • GI upset
  • Stomatitis (inflammation in mouth)
  • Rhinorrhea
  • Bronchospasm
  • Rash
61
Q

Mucolytics
Assessment

A

History:
* Allergy, asthma

Physical:
* Respiratory
* skin
* abdomen
* Vital signs

62
Q

Mucolytics
Nursing Conclusions

A
  • Impaired comfort (r/t adverse effects)
  • Ineffective airway clearance (r/t bronchospasm)
  • Knowledge deficit
63
Q

Mucolytics
Implementation/Patient Teaching

A
  • DO NOT COMBINE in a Nebulizer: (prevents precipitation)
  • Wipe face and mask with water after nebulizer (prevent skin breakdown)
  • Patient Teaching *(what to take, when, and why)
  • Keep Dornase alfa in fridge
64
Q

Mucolytics
Indications

A
  • Pts. with difficulty coughing up secretions
  • Pts. with atelectasis
  • Pts. undergoing diagnostic bronchoscopy
  • Postoperative pts.
  • Pts. with tracheostomies
  • Illnesses such as:
    COPD, cystic fibrosis, pneumonia, TB

Pharmacology Exam #1 (10 decks)

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