Ch. 40 & 41 - Upper & Lower Respiratory

Question 1

Antihistamines - Action:

Answer 1

blocks action of histamine at H1 histamine receptor site

Tx: Allergic Rhinitis

Question 2

1st Generation Antihistamines:

Answer 2

Cause anticholinergic symptoms:

1. ) Dry mouth
2. ) Constipation
3. ) Blurred vision
4. ) Urinary retention

Ex: diphenhydramine (Benadryl)

Question 3

diphenhydramine (Benadryl):

Answer 3

1. ) PO, IM, IV
2. ) Allergic rhinitis
3. ) Prevents motion sickness
4. ) Active ingredient in OTC sleep aids

Question 4

diphenhydramine (Benadryl) - SE (anticholingeric effects):

Answer 4

• *1.) Drowsiness
  2. ) dizziness, fatigue, urinary retention, constipation
  3. ) dry mouth, blurred vision

*Should NOT take with alcohol or other CNS depressants

Question 5

diphenhydramine (Benadryl): contraindications (1):

Answer 5

Acute asthma:

-Drying effect on resp tract = may thicken secretions = more difficulty breathing

Question 6

diphenhydramine (Benadryl): contraindications (2):

Answer 6

1. ) Narrow-angle glaucoma
2. ) BPH, urinary retention
3. ) Pregnant/Nursing mothers

Question 7

2nd Generation Antihistamines:

Answer 7

1. ) Little to no effect on sedation
2. ) More specific to H1 histamine receptor
3. ) Fewer anticholingeric symptoms

Question 8

2nd Generation Antihistamines - Examples:

Answer 8

1. ) cetirizine (Zyrtec)
2. ) fexofenadine (Allegra)
3. ) loratadine (Claritin)

**Tolerance may develop over time

Question 9

Nursing Diagnoses (1):

Answer 9

1. ) Ineffective airway clearance r/t nasal congestion

2. )Sleep deprivation r/t frequent coughing

Question 10

Nasal Decongestants (sympathomimetic amines):

Answer 10

Stimulate alpha-adrenergic receptors =vasoconstriction in nasal mucosa

Nasal mucous membranes shrink=decrease fluid secretion

Question 11

Nasal Decongestants:

Answer 11

Adm:

-Nasal spray/drops

Question 12

Nasal Decongestants With Frequent Use:

Answer 12

1.) Tolerance

2. ) Rebound congestion
   - Nasal vasodilation instead of vasoconstriction

3.) Shouldn’t use more than 3-5 days

Question 13

Examples (sprays/drops):

Answer 13

oxymetazoline HCl (Afrin)

Question 14

Systemic Decongestants (alpha-adrenergic agonists):

Answer 14

1.) Po

2. ) Tx: allergic rhinitis 
   - Hay fever
   - Acute coryza

Question 15

Examples (systemic):

Answer 15

ephedrine (Ephedrine)
phenylephrine (Neo-synephrine)
pseudoephedrine (Sudafed)

Question 16

Systemic Decongestants SE:

Answer 16

Jittery, nervous
-Disappear as tolerance develops

Alpha-adrenergic drug 

- Increase BP
- Increase glucose levels

Question 17

Systemic Decongestants - Contraindications:

Answer 17

Hypertension
Cardiac disease
Hyperthyroidism
DM

Question 18

Nasal / Systemic Decongestants –>

Answer 18

Not for:

• Infants
• Young children (

Question 19

Drug Interactions (2):

Answer 19

Decongestants with MAO inhibitors: 

-Increased chance of hypertension & cardiac dysrhythmias

Question 20

Avoid:

Answer 20

Large amts coffee / tea (caffeine) = increase restlessness & palpitations

Question 21

Intranasal Glucocorticoids (steroids):

Answer 21

Antiinflammatory action decreases symptoms of:

 1. ) Rhinorrea
 2. ) Sneezing 
 3. ) Congestion

Question 22

Intranasal Glucocorticoids (steroids) - Ex:

Answer 22

dexamethasone (Decadron)

Question 23

Intranasal Glucocorticoids - SE:

Answer 23

1. ) Continuous use = dryness of nasal mucosa
2. ) Usually no systemic side effects
3. ) Should not use for > 30 days

Question 24

Antitussives (1):

Answer 24

Act on cough control center in medulla =suppresses cough reflex

Question 25

Antitussives (2):

Answer 25

Cough: - Physiological mechanism - Productive or nonproductive

Question 26

Antitussives (3):

Answer 26

Involuntary cough should not be suppressed unless: - Resp discomfort - Cant sleep

Question 27

3 Types of Antitussives:

Answer 27

1. ) Narcotic 2. ) Nonnarcotic 3. ) Combination

Question 28

Narcotic Antitussives:

Answer 28

codeine hydrocodone -Direct action on cough center in medulla

Question 29

Major Problems With Narcotic Cough Suppressants:

Answer 29

1. ) Risk for dependence 2. ) Resp depression 3. ) Bronchial constriction 4. ) CNS depression 5. ) Constipation

Question 30

Nonnarcotic Antitussives:

Answer 30

Dextromethorphan HBr: 1. ) Most common nonnarcotic cough suppressant 2. )Chemical derivative of opiates 3. ) Acts on cough center

Question 31

Dextromethorphan HBr (1):

Answer 31

* DOES NOT cause: :) - Dependence - Resp depression - Analgesia PO , IV

Question 32

Dextromethorphan (DM) HBr -- Ex:

Answer 32

Robitussin DM | Benylin DM

Question 33

Dextromethorphan -- Side Effects:

Answer 33

CNS depression = | -Nausea, dizziness, drowsiness, sedation

Question 34

Expectorants:

Answer 34

1.) Stimulate flow of secretions in resp tract -->  2.) Decrease viscosity of secretions & phlegm --> 3.) Easier to remove by coughing

Question 35

Guaifenesin:

Answer 35

* *Most popular expectorant - Well tolerated May cause : -Stomach upset / nausea

Question 36

Goal:

Answer 36

1. ) Client will be free of nonproductive cough | 2. ) Client will be free of a secondary infection

Question 37

Seek Medical Attention:

Answer 37

Cough > 1 week High fever, rash HA

Question 38

Nursing Interventions (1):

Answer 38

Assess cough: - Frequency - Productivity

Question 39

Nursing Interventions (2):

Answer 39

-Cough syrups = local, soothing effect --Do not give water, food, after admin. ---If giving several meds = give cough syrup last

Question 40

Nursing Interventions (3):

Answer 40

Should not suppress: - Productive cough - Post-op clients

Question 41

Nursing Interventions (4):

Answer 41

Teach to cough effectively: - Upright - Deep breaths before coughing - Dispose of secretions

Question 42

Nursing Interventions (5):

Answer 42

Encourage fluids Humidify dry air -clean regularly

Question 43

Sympathomimetics -- epinephrine (Adrenalin):

Answer 43

Nonselective sympathomimetic Tx: -Acute bronchospasm d/t anaphylaxis from allergic reaction = bronchodilation, increases BP (bee sting or peanut allergy)

Question 44

epinephrine (Adrenalin) SE:

Answer 44

1. ) Tremors, dizziness 2. ) Increase BP, tachycardia, heart palpitations 3. ) Cardiac dysrhythmias

Question 45

Sympathomimetics (1):

Answer 45

Beta2 adrenergic receptors = control bronchiol smooth muscle tone

Question 46

Sympathomimetics (2):

Answer 46

**Stimulate Beta2 adrenergic receptors = increase formation of cyclic adenosine monophosphate (cAMP)

Question 47

cAMP:

Answer 47

Causes: | -Smooth muscle relaxation & bronchodilation

Question 48

Drugs Affecting Both Beta1 & Beta2 Receptors:

Answer 48

Will also have cardiac SE: - Tachycardia - Increase BP

Question 49

Sympathomimetics (3):

Answer 49

Other Side Effects: 1. ) CNS stimulation 2. ) Insomnia 3. ) Nervousness, anxiety, tremor 4. ) GI distress

Question 50

Sympathomimetics (4):

Answer 50

Po Inhalation Parenteral (some)

Question 51

Extender device (spacer):

Answer 51

are long tubes that slow the delivery of medication from pressurized MDIs should always be used with MDIs that deliver inhaled corticosteroids make it easier for medication to reach the lungs, and also mean less medication gets deposited in the mouth and throat INHALE very SLOWLY --- if whistle heard, inhale slower!

Question 52

Theophylline:

Answer 52

1. ) Therapeutic range: - 10-20mcg/mL 2. ) Above 20 = toxicity 3. ) Peak / trough levels

Question 53

Theophylline -- Monitor for toxicity:

Answer 53

1. ) N/V, GI distress 2. ) Restless 3. ) Convulsions 4. ) Irregular heartbeat

Question 54

Theophylline --- Avoid:

Answer 54

Xanthine-containing beverages or foods: | -Caffeine

Question 55

Theophylline --- Smoking:

Answer 55

Increases metabolism of drug | -May need to increase dosage

Question 56

Examples: -----

Answer 56

Aminophylline – IV Theophylline (Theo-Dur, Theobid Duracaps) – time-released capsules Oral, rectal, IV

Question 57

Aminophylline:

Answer 57

controls symptoms of asthma and other lung diseases but does not cure them usually is taken every 6, 8, or 12 hours take with a full glass of water on an empty stomach, at least 1 hour before or 2 hours after a meal. Do not chew or crush the long-acting tablets; swallow them whole.

Question 58

Meter Dose Inhaler (MDI) inhaler:

Answer 58

Not for severe attack | May take 1-4 weeks for full effect

Question 59

MDI inhaler:

Answer 59

MORE EFFECTIVE for controlling symptoms than Beta-2 agonists Beclomethasone (Vanceril, Beclovent)

Question 60

MDI inhaler --Side Effects: with long term use

Answer 60

1. ) GI irritation 2. ) HA, confusion 3. ) Sweating 4. ) Insomnia

Question 61

Orally Inhaled SE:

Answer 61

Throat irritation, hoarseness, dry mouth Oral, laryngeal, pharyngeal fungal infections may occur Spacer may help

Question 62

Cromolyn Sodium (Intal):

Answer 62

1. ) Prophylactic tx 2. ) Taken daily 3. ) NOT for tx: - Acute asthma attacks - Status asthmaticus 4.) Antiinflammatory drug

Question 63

Cromolyn Sodium (Intal) cont....

Answer 63

5. ) No bronchodilator activity 6. ) Inhibits release of histamine 7. ) Inhalation ONLY (not well absorbed in GI tract) --- (Spinhaler)

Question 64

Cromolyn Sodium (Intal) ==Serious Side Effect

Answer 64

Rebound bronchospasm = do not discontinue abruptly

Question 65

acetylcysteine (Mucomyst) (1):

Answer 65

Breaks apart muco-proteins contained in respiratory mucous secretions

Question 66

acetylcysteine (Mucomyst) (2):

Answer 66

Nebulization Directly into intratracheal catheter Do not mix with any other drugs

Question 67

Acetylcysteine (Mucomyst) cont...

Answer 67

May lead to = large amt of liquefied secretions Able to cough or have suction available

Question 68

montelukast (Singulair):

Answer 68

in a class of medications called leukotriene receptor antagonists (LTRAs) works by blocking the action of substances in the body that cause the symptoms of asthma and allergic rhinitis PO & w/o food if used to treat asthma, take in evening used to prevent breathing difficulties during exercise, it should be taken at least 2 hours before exercise

Question 69

Nebulizer:

Answer 69

a drug delivery device used to administer medication in the form of a mist inhaled into the lungs commonly used for the treatment of cystic fibrosis, asthma, COPD and other respiratory diseases