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Pharmacology Exam 1 > Upper Respiratory Tract Agents > Flashcards

Upper Respiratory Tract Agents Flashcards

Pharmacology Exam 1

1
Q

What is the purpose of taking Upper Respiratory Tract Agents?

A

To keep airways open and to keep gasses like O2 and CO2 moving.

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2
Q

What are the 7 different types of Upper Respiratory Tract Agents that we need to know for Exam 1?

A

Antitussives
Topical Nasal Decongestants
Oral Decongestants
Steroid Nasal Decongestants
Antihistamines
Expectorants
Mucolytics

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3
Q

What are the 3 generic drugs of Antitussives that we need to know?

A

Benzonatate
Codeine & Hydrocodone
Dextromethorphan

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4
Q

What is the suffix for the Topical Nasal Decongestant agents and the name of the outlier?

A

“zoline”
Oxymetazoline
Tetrahydrozoline
Xylometazoline

Penylephrine

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5
Q

What are the names of the two Oral Decongestants that we need to remember?

A

Pseudoephedrine
Phenylephrine

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6
Q

What are the suffixes of the Steroid Nasal Decongestant

A

“one” and “ide”

Beclomethasone
Fluticasone
Triamcinolone (topical - slow acting)

Budesonide
Flunisolide

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7
Q

What are the suffixes for Antihistamines?

A

“amine” “ine”

Diphenhydramine
Promethazine

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8
Q

What is the drug that we need to remember for Expectorants?

A

Guaifenesin

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9
Q

What are the 2 drugs we need to remember for Mucolytics?

A

Acetylcysteine

Dornase Alfa

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10
Q

How does Antitussives work?

A

They act directly on the medullary cough center in the brain to depress the cough reflex. Used when the cough is unproductive.
Benzonatate is also a local anesthetic on the respiratory tract.

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11
Q

How does Topical Nasal Decongestants work?

A

They vasoconstrict the sinus canal which decrease edema and inflammation. It also limits the effect of the sympathetic nervous system.

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12
Q

How does Oral Decongestants work?

A

They stimulate the alpha-adrenergic receptors in the nasal mucus membrane to shrink the membrane which helps drain the mucus from the nasal cavity.

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13
Q

How does Steroid Nasal Decongestants work?

A

By blocking the inflammatory response to relieve inflammation. This drug class have minimal systemic absorption, but it does take 1-3 weeks to work since its inhaled. Steroids that are inhaled work slow.

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14
Q

How does Antihistamines work?

A

By blocking the action of histamines at the histamine receptor sites. Opens airways, decreases allergy response. Anticholinergic and antipruritic effect.

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15
Q

What are 1st generation antihistamines?

A

They have greater anticholinergic effect

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16
Q

What are 2nd generation antihistamines?

A

They are less sedating.

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17
Q

How does Expectorants work?

A

They liquify mucus and makes it easier to cough up. They do so by reducing the adhesiveness and surface tension of the fluid making them easier to cough out. These medications are used when cough is productive.

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18
Q

Hoe does Mucolytics work?

A

By breaking down/liquifying mucus in order to aid in high risk respiration patients to cough up think tenacious secretions.

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19
Q

Why would you give a patient Codeine?

A

To control non productive cough.

Codeine is an Antitussive

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20
Q

Why would you give a patient Fluticasone?

A

For seasonal allergy symptoms such as allergic rhinitis. Can also be given for nasal congestion inflammation and inflammation after removal of the nasal polyps.

Fluticasone is a steroid nasal contestant.

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21
Q

Why would you give a patient Dornase Alfa?

A

You would give Dornase Alfa to a patient who have difficulties in coughing up secretions. Patients who have developed atelectasis which is the collapse of alveoli.
Patients who are undergoing diagnostic bronchoscopy.
Postoperative patients that need to be able to cough .
Patients with tracheostomies (a surgical procedure that creates an opening in the neck into the windpipe to help people breathe)
COPD, Cystic fibrosis, pneumonia, TB.

Dornase Alfa particularly for cystic fibrosis symptoms to treat palliatively.

Dornase Alpha is a Mucolytics

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22
Q

What is a non respiratory treatment that you can use Acetylcysteine for?

A

Treatment of Acetaminophen OD

Acetylcysteine is a Mycolytics.

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23
Q

Why would you give Pseudoephedrine to a patient?

A

To decrease nasal congestion caused by a common cold, sinusitis, allergic rhinitis.
It also can relieve pressure in the middle ear and treat pain associated with ear infection.

Pseudoephedrine is a Oral decongestant

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24
Q

why would you give a patient Phenylephrine?

A

To relive discomfort of nasal congestion related to cold, sinusitis, runny nose from allergy, Relieve ear pressure and to dilate the nares during nasal examination

Phenylephrine is a topical decongestant

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25
Q

What is an absolute contraindication to Benzonatate?

A

Because Benzonatate is an antitussive, it should not be used by patients that need to cough to maintain airways.

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26
Q

What is a relative contraindication to Dextromethorphan?

A

Dextromethorphan is an antitussive and it should be avoided in patients with head injury or impaired CNS as it dcould worsen these conditions. It also should be avoided by patients suffering from Asthma or Emphysema as they need to be able to cough up phlegm.
Antitussives does not treat the cause of cough, they just prevent coughing from happening.

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27
Q

What is a relative contraindication to Flunisolide?

A

Flunisolide is a steroid decongestant which depresses the immune system. So Steroid decongestants should not be taken if you are trying to fight off an active infection or if you’ve had recent nasal surgery as healing process may take longer as the inflammatory system is blocked. Should be avoided in patients with an active infection.

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28
Q

What cautions are important to consider when prescribing a patient Hydrocodone?

A

Hydrocodone is a Antitussive and should be used with caution in patients that have suffered from addiction due to increased risk of addiction or relapse.
It should also not be taken in patents that need to stay alert due to the adverse affect of causing drowsiness.

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29
Q

What cautions are important to consider when prescribing a patient Diphenhydramine?

A

Caution should be taken for patients with renal or hepatic impairment because this can alter the metabolism and excretion of the drug.

There should also be increased caution with patients who has a history of arrythmias or prolonged QT intervals.1st generation antihistamines increases the risk of fatal arrythmias.

Diphenhydramine is a antihistamine

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30
Q

What are some considerations/cautions to take into account when a patient is taking Guaifenesin?

A

Persistent cough could be and underlying issue.
Guaifenesin is a Expectorant.

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31
Q

What kind of patients need to be careful/cautious of using Acetylcysteine?

A

Patients with asthma should be cautious due to the potential risk of bronchospasms which could block off the airflow.
Acetylcysteine is a Mucolytic.

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32
Q

What are some unwanted/adverse reactions to Fluticasone?

A

Fluticasone is a Steroid Nasal Contestant and adverse effect may result in stinging, burning and drying of the mucosae.
Headache and suppression of healing due to being a steroid.

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33
Q

What are some side effects/unwanted/adverse reactions to Guaifenesin?

A

Guaifenesin is a Expectorant and so it will may cause adverse effects such as GI upset, Stomatitis (inflammation of the mouth)
Rhinorrhea (running of the nose) due to the liquifying effect. Bronchospasm (shuts of bronchi and block airflow)
Rash
Anorexia

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34
Q

What are some adverse reactions to Codeine?

A

Drying affect on mucous membrane.
GI upset from drying effect
CNS effect: drowsiness and respiratory depression.

Codeine is an Antitussive

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35
Q

What are some adverse reactions to Tetrahydrozoline?

A

Tetrahydrozoline is a Topical Nasal Decongestant. So adverse effects may consist of local stinging and burning. If the local stinging doesn’t go away after a little while it may indicate that there may be open lesions in the sinus canal.
It may also have a sympathomimetic effect which could increase the heart and and cause urinary retention.

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36
Q

What are some adverse reactions to Dornase Alfa?

A

Dornase Alfa is a Mucolytic and adverse effects may result in GI issues, Headache, Dizziness and mild rash.
Prolonged use may also mask underlying health issues.

37
Q

What are some adverse reactions to Promethazine?

A

Promethazine is an antihistamine and adverse reactions could manifest themselves on the CNS in the form of drowsiness and sedation.
It may also have an anticholinergic effect such as a drying effect in the skin and also and adverse effect on the respiratory system and GI & GU tract

38
Q

What physical assessment(s) should be done before administering Benzonatate to a patient?

A

Benzonatate is a Antitussive and lung sound and respiratory rate should be assessed. Temperature should also be checked for any possible underlying illnesses.

39
Q

What physical assessment(s) should be done before administering Phenylephrine to a patient?

A

Phenylephrine is a decongestant so mucouc membrane should be checked, and caridac and urinary status.

40
Q

What physical assessment(s) should be done before administering Fluticasone to a patient?

A

Should check for active/acute infections due to the steroids effect on the immune system. Any nasal trauma or surgery due to slower healing time due to the steroid. CNs and temperature to check for any underlying illnesses.

41
Q

What physical assessment(s) should be done before administering Diphenhydramine to a patient?

A

A patient should be checked to see if they have a history of prolonged QT intervals, arrythmia. Listen to heart and lung sound due to CNS effect. Temperature, Urinary status and reflexes and affect.

Diphenhydramine is a Antihistamine

42
Q

What physical assessment(s) should be done before administering Dornase Alfa to a patient?

A

Should assess the patient for history of allergies and asthma. Should be checked for respiration, skin, abdomen and vital signs

Dornase Alfa is a Mucolytic

43
Q

What physical assessment(s) should be done before administering Guaifenesin to a patient?

A

Should assess for persistent cough, respiratory system, skin, CNS, vital sign of abdomen.

Guaifenesin is a Expectorant.

44
Q

how long of a timeframe should a patient take Dextromethorphan?

A

Drugs should never be taken longer than needed due to risk of addiction. Patient should consult provider if symptoms worsen - should stop taking when coughing stops.

Dextromethorphan is a Antitussive.

45
Q

What implementations should be made for a patient taking Oxymetazoline?

A

Patient should be shown how to administer the drug. Patient should blow their nose prior to administration and should no blow their nose immediately after because they would just blow the medications out of the nose. Drug should not be taken more than a week.

Oxymetazoline is a Topical nasal decongestant.

46
Q

What implementations should be made for a patient taking Pseudoepinephrine?

A

No more than a week due to rebound congestion. Overdose prevention due to many OTC drugs contain the same “ingredients” and treat the same illness.

Pseudoepinephrine is a Oral decongestant

47
Q

What implementations should be made for a patient taking Diphenhydramine?

A

Drug should be taken on an empty stomach to increase absorption. Sugar free candy may be used for dry mouth, skin care due to risk of dry skin, void before administration due to possible urinary retention. Most effective before onset of symptoms. Avoid alcohol due to risk of sedation.

Diphenhydramine is a antihistamine

48
Q

What implementations should be made for a patient taking Guaifenesin?

A

Patient should eat small frequent meals due to possible stomach upset.

Guaifenesin is an Expectorant

49
Q

What must a patient remember when taking Acetylcysteine?

A

Acetylcysteine is a Mucolytic. It should not be combined with other drugs in a nebulizer because it could clump and prevent precipitation. Patient should wipe their face and mouth with water after to prevent skin breakdown. Mask should also be wiped down.
Dornase Alfa should be refrigerated.

50
Q

What Lifespan considerations should be taken when an Upper Respiratory tract agent is prescribed to a child?

A

Show caution due to adverse effects such as sedation, confusion and dizzyness.

Should not be given to children under 4 y/o and be cautious with giving them to children between 4-6 y/o

Non drug meassures should be attempted first such as oral fluid and cool humidification.
Control exposure to smoke, allergens & irritants and wash hands to prevent infection.

51
Q

What Lifespan considerations should be taken when an Upper Respiratory tract agent is prescribed to an adult?

A

Potential accidental overdose caused by using multiple OTC drugs containing same “ingredients”. encourage non-drug methods for treatment. No safety established for pregnancy.

52
Q

What Lifespan considerations should be taken when an Upper Respiratory tract agent is prescribed to older adults?

A

Older adults are more likely to develop adverse effects such as sedation, confusion and dizziness which may effect their mobility.
Renal and hepatic impairment is more common in older adults and this may effect metabolism and excretion of the drug. Initial dose should be low and and increased slowly if needed.

53
Q

What non-medical measures can parents also use to help children with upper respiratory issues?

A

Cool humidification of the air, oral fluid, controlling exposure to allergens, dust and smoke and to wash hands to prevent infection.

54
Q

Why should adults take extra precautions to avoid an potential accidental overdose of these drugs?

A

Because many of these drugs are in multi-symptom over the counter medication and taking several medications for different symptoms could lead to an accidental overdose.

55
Q

Which upper respiratory medication depressed the cough reflex in the cough center of the brain?

A

Antitussives

Benzonatate, Codeine and Hydrocodone and Dextromethorphan.

56
Q

Which Antitussive is also a local anesthetic on the respiratory tract?

A

Benzonatate

57
Q

Why should someone who has had a brain injury or impaired CNS not take Dextromethorphan?

A

Dextromethorphan is an Antitussive that depressed the cough center in the brain. Antitussives should be avoided in people with these conditions because centrally active drugs can worse these conditions.

58
Q

Why should someone with Asthma avoid taking codeine?

A

Because Codeine is an antitussive and sometimes people with Asthma or emphysema have secretions that needs to be coughed up. Antitussives would prevent the coughing.

59
Q

Why should we not give Hydrocodone to a patient experiencing cough if we do not know the reason behind the cough?

A

Because it could suppress underlying conditions.

Hydrocodone is an Antitussive that depresses the cough center in the brain.

60
Q

What drug-drug interaction with Dextromethorphan could result in myoclonic seizures, extreme hypertension, coma, fever and nausea?

A

MAOI’s

Dextromethorphan is an Antitussive and none of these drugs should be mixed with MAOI’s which are a type of antidepressants.

61
Q

What substances mixed with Antitussives could result in opioid overdose?

A

Opioids, CNS suppressants including alcohol.
This could result in hypotension, respiratory depression and potentially death.

62
Q

When should a patient stop taking Benzonatate?

A

When the patient is no longer coughing since Antitussives are used to treat unproductive coughing.

63
Q

What is Phenylephrine?

A

A Topical nasal decongestant AND and Oral decongestant.

64
Q

What drug category ends in “xoline”?

A

Topical nasal decongestants

65
Q

Which upper respiratory drugs are sympathomimetics? What do they do?

A

Topical nasal decongestant.

Imitate the effect of the sympathetic nervous system. Cause vasoconstriction resulting in decreased edema and inflammation.

66
Q

If a patient have open lesions or wounds in their nasal cavity and have and have glaucoma or hypertension, why should we be careful with giving them Topical Nasal decongestants?

A

Because open wounds could lead to a systemic effect of the drug and could worsen existing conditions that may be worsened by adrenergic properties

67
Q

What is the recommended duration for a patient to take Oxymetazoline?

A

3-5 days to prevent rebound congestion.

Oxymetazoline is a topical nasal decongestant.

68
Q

What drug category does Phenylephrine and Pseudoepenephrine belong to?

A

Oral decongestants.

69
Q

what does the Alpha-adrenergic receptors do?

A

They stimulate the sympathetic nervous system.

70
Q

Which one has a systemic effect on the body? Oral decongestants or Topical Nasal decongestants?

A

Oral decongestants

71
Q

Why should you do a neurological assessment when giving a patient Pseudoepenephrine?

A

Because oral decongestants are absorbed systemically and they can trigger the adrenergic receptors which again may trigger the sympathetic nervous system. So if the patient already have anxiety, restlessness, hypertension, this may worsen with these drugs?

72
Q

What’s the longest you should take Pseudoepenephrine?

A

No longer than a week. If symptoms persist, the patient should talk to their provider.

73
Q

Why should we teach patients to read OTC drug labels?

A

To prevent accidental overdose.

74
Q

Which drug category have drug classes ending in “one” and “ide”

A

Steroid Nasal Decongestants

75
Q

Which upper respiratory drug classes take 1-3 weeks to be effective?

A

Steroid decongestants

76
Q

Which steroids are slow acting?

Oral
Inhaled
Intra muscular
IV

A

Inhaled.

77
Q

Why should you not treat a patient with an acute or long term infection with Budesonide?

A

Budesonide is a steroid decongestant and have the potential to suppress the immune response.

78
Q

Why should we implement precautions to avoid areas of infection risk to a patient that is taking Beclomethasone?

A

Because Beclomethasone is a steroid decongestant, it may suppress the immune system and make a patient more likely to get infected with a disease.

79
Q

What category of drug classes end in “amine” and “ine”

A

Antihistamines.

ex
Diphenhydramine
Promethazine
Loratadine

80
Q

What is a Histamine?

A

A chemical released during inflammation which increases secretions and narrow airways.

So an ANTIhistamine would decrease secretions and open airways.

81
Q

What is Antiherpetic?

A

Anti itching effect

82
Q

What is uricardia?

A

Its hives - red itchy welts on the skin.

83
Q

What is angioedema?

A

Swelling of the mucous membrane or swelling right under the skin.

84
Q

Can first or second generation of antihistamines have an effect on the QT duration of the heart rhythm which could lead to fatal arrythmias?

A

1st generation.

85
Q

Which drug category does Guaifenesin belong to?

A

Expectorants

86
Q

Why should a patient avoid driving until they know how Guaifenesin affects them?

A

Because drowsiness and dizziness are some of the adverse effects on Guaifenesin.

87
Q

Which drug category does Dornase Alfa and Acetylcysteine belong to?

A

Mucolytics

88
Q

What drug enhances the output of respiratory tract fluid by reducing the adhesiveness and surface tension of the fluid, which facilitates the removal of viscous mucus?

A

Guaifenesin

An Expectorant

89
Q

Which drug works to break down mucous in order to assist the high risk respiratory patient in order to cough up thick secretions?

A

Dornase Alfa

A mucolytic

Pharmacology Exam 1 (9 decks)

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