Ch. 40 & 41 - Upper & Lower Respiratory Flashcards Preview

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Flashcards in Ch. 40 & 41 - Upper & Lower Respiratory Deck (69):
1

Antihistamines - Action:

blocks action of histamine at H1 histamine receptor site

Tx: Allergic Rhinitis

2

1st Generation Antihistamines:

Cause anticholinergic symptoms:
1.) Dry mouth
2.) Constipation
3.) Blurred vision
4.) Urinary retention

Ex: diphenhydramine (Benadryl)

3

diphenhydramine (Benadryl):

1.) PO, IM, IV

2.) Allergic rhinitis

3.) Prevents motion sickness

4.) Active ingredient in OTC sleep aids

4

diphenhydramine (Benadryl) - SE (anticholingeric effects):

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

*Should NOT take with alcohol or other CNS depressants

5

diphenhydramine (Benadryl): contraindications (1):

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

6

diphenhydramine (Benadryl): contraindications (2):

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

7

2nd Generation Antihistamines:

1.) Little to no effect on sedation

2.) More specific to H1 histamine receptor

3.) Fewer anticholingeric symptoms

8

2nd Generation Antihistamines - Examples:

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

**Tolerance may develop over time

9

Nursing Diagnoses (1):

1.) Ineffective airway clearance r/t nasal congestion

2.)Sleep deprivation r/t frequent coughing

10

Nasal Decongestants (sympathomimetic amines):

Stimulate alpha-adrenergic receptors =vasoconstriction in nasal mucosa

Nasal mucous membranes shrink=decrease fluid secretion

11

Nasal Decongestants:

Adm:
-Nasal spray/drops

12

Nasal Decongestants With Frequent Use:

1.) Tolerance

2.) Rebound congestion
-Nasal vasodilation instead of vasoconstriction

3.) Shouldn't use more than 3-5 days

13

Examples (sprays/drops):

oxymetazoline HCl (Afrin)

14

Systemic Decongestants (alpha-adrenergic agonists):

1.) Po

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

15

Examples (systemic):

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

16

Systemic Decongestants SE:

Jittery, nervous
-Disappear as tolerance develops

Alpha-adrenergic drug 
-Increase BP
-Increase glucose levels

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Systemic Decongestants - Contraindications:

Hypertension
Cardiac disease
Hyperthyroidism
DM

18

Nasal / Systemic Decongestants -->

Not for:
-Infants
-Young children (

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Drug Interactions (2):

Decongestants with MAO inhibitors: 
-Increased chance of hypertension & cardiac dysrhythmias

20

Avoid:

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

21

Intranasal Glucocorticoids (steroids):

Antiinflammatory action decreases symptoms of:
1.) Rhinorrea
2.) Sneezing
3.) Congestion

22

Intranasal Glucocorticoids (steroids) - Ex:

dexamethasone (Decadron)

23

Intranasal Glucocorticoids - SE:

1.) Continuous use = dryness of nasal mucosa

2.) Usually no systemic side effects

3.) Should not use for > 30 days

24

Antitussives (1):

Act on cough control center in medulla =suppresses cough reflex

25

Antitussives (2):

Cough:
-Physiological mechanism
-Productive or nonproductive

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Antitussives (3):

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

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3 Types of Antitussives:

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

28

Narcotic Antitussives:

codeine
hydrocodone
-Direct action on cough center in medulla

29

Major Problems With Narcotic Cough Suppressants:

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

30

Nonnarcotic Antitussives:

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

31

Dextromethorphan HBr (1):

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

PO , IV

32

Dextromethorphan (DM) HBr -- Ex:

Robitussin DM
Benylin DM

33

Dextromethorphan -- Side Effects:

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

34

Expectorants:

1.) Stimulate flow of secretions in resp tract -->

2.) Decrease viscosity of secretions & phlegm -->

3.) Easier to remove by coughing

35

Guaifenesin:

**Most popular expectorant
-Well tolerated

May cause :
-Stomach upset / nausea

36

Goal:

1.) Client will be free of nonproductive cough

2.) Client will be free of a secondary infection

37

Seek Medical Attention:

Cough > 1 week
High fever, rash
HA

38

Nursing Interventions (1):

Assess cough:
-Frequency
-Productivity

39

Nursing Interventions (2):

-Cough syrups = local, soothing effect

--Do not give water, food, after admin.

---If giving several meds = give cough syrup last

40

Nursing Interventions (3):

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

41

Nursing Interventions (4):

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

42

Nursing Interventions (5):

Encourage fluids
Humidify dry air
-clean regularly

43

Sympathomimetics -- epinephrine (Adrenalin):

Nonselective sympathomimetic

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

44

epinephrine (Adrenalin) SE:

1.) Tremors, dizziness

2.) Increase BP, tachycardia, heart palpitations

3.) Cardiac dysrhythmias

45

Sympathomimetics (1):

Beta2 adrenergic receptors = control bronchiol smooth muscle tone

46

Sympathomimetics (2):

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

47

cAMP:

Causes:
-Smooth muscle relaxation & bronchodilation

48

Drugs Affecting Both Beta1 & Beta2 Receptors:

Will also have cardiac SE:
-Tachycardia
-Increase BP

49

Sympathomimetics (3):

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

50

Sympathomimetics (4):

Po
Inhalation
Parenteral (some)

51

Extender device (spacer):

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!

52

Theophylline:

1.) Therapeutic range:
-10-20mcg/mL

2.) Above 20 = toxicity

3.) Peak / trough levels

53

Theophylline -- Monitor for toxicity:

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

54

Theophylline --- Avoid:

Xanthine-containing beverages or foods:
-Caffeine

55

Theophylline --- Smoking:

Increases metabolism of drug
-May need to increase dosage

56

Examples: -----

Aminophylline – IV

Theophylline (Theo-Dur, Theobid Duracaps) – time-released capsules

Oral, rectal, IV

57

Aminophylline:

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.

58

Meter Dose Inhaler (MDI) inhaler:

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

59

MDI inhaler:

MORE EFFECTIVE for controlling symptoms than Beta-2 agonists

Beclomethasone (Vanceril, Beclovent)

60

MDI inhaler --Side Effects: with long term use

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

61

Orally Inhaled SE:

Throat irritation, hoarseness, dry mouth

Oral, laryngeal, pharyngeal fungal infections may occur

Spacer may help

62

Cromolyn Sodium (Intal):

1.) Prophylactic tx
2.) Taken daily

3.) NOT for tx:
-Acute asthma attacks
-Status asthmaticus

4.) Antiinflammatory drug

63

Cromolyn Sodium (Intal) cont....

5.) No bronchodilator activity

6.) Inhibits release of histamine

7.) Inhalation ONLY (not well absorbed in GI tract) --- (Spinhaler)

64

Cromolyn Sodium (Intal) ==Serious Side Effect

Rebound bronchospasm = do not discontinue abruptly

65

acetylcysteine (Mucomyst) (1):

Breaks apart muco-proteins contained in respiratory mucous secretions

66

acetylcysteine (Mucomyst) (2):

Nebulization

Directly into intratracheal catheter

Do not mix with any other drugs

67

Acetylcysteine (Mucomyst) cont...

May lead to = large amt of liquefied secretions


Able to cough or have suction available

68

montelukast (Singulair):

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

69

Nebulizer:

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