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Drug Therapy for the Respiratory System Flashcards

(108 cards)

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1
Q

Common Cold

A

affects the upper respiratory tract (clavicles up)
Occurs when viruses or bacteria invade our system and get past our general defense mechanisms

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2
Q

Viral Cold

A

2-4 occurrences every year typical in adults; up to 10 occurrences a year for children.
Viruses invade via mucous membranes
Can survive for several horse on skin and hard surfaces

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3
Q

Sinusitis

A

When the sinus cavities become inflamed or infected and it blocks the fluid that drains out of the sinuses

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4
Q

Rhinitis

A

(running nose) is the most common cause of sinusitis because your nose is running and you are blowing it constantly and it gets swollen which blocks off the sinuses

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5
Q

Signs and Symptoms of colds and sinusitis

A

Nasal congestion
Cough: protective defense
Productive vs. non-productive

Increased secretions: they run down your throat and into your bronchi. You can get these from irritations like allergies, smoking, or surgery

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6
Q

Nasal Decongestants Example

A

pseudoephedrine
Oxymetazoline
Phenylephrine

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7
Q

Nasal Decongestants Action

A

relieve nasal obstruction and discharge by producing vasoconstriction. Decreases nasal blood vessels and increase blood flow for breathing.

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8
Q

Nasal Decongestants Contraindications

A

Anything that is dangerous with SNS/vasoconstriction
Severe HTN, CAD, narrow angle glaucoma, antidepressants

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9
Q

Nasal Decongestants Patient teaching

A

Encourage adequate fluid intake (thin secretions)
Humidification (moisture is good for GI tract and respiratory tract)
Do not take longer than package recommendation (3-5d. Could cause rebound congestion. It is going to overpower the medication)
Avoid caffeine (increased vasoconstriction)
Avoid accidental OD (be careful when taking with other cold medicine)
Avoid HTN
Proper use of nasal spray
Take with or without food

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10
Q

Antitussive Examples

A

Cough Medicine
Dextromethorphan

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11
Q

Antitussive Action

A

Suppresses dry, hacking, non-productive cough

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12
Q

Centrally Acting Antitussive

A

Narcotic and non-narcotic
Taken orally
Acts on whole body
Cough syrup (DM)

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13
Q

Locally Acting Antitussive

A

Throat lozenges
Cough drops

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14
Q

Nursing considerations for Antitussives:

A

Don’t eat or drink after a syrup (30 min)
Drug-to-drug interactions with antidepressants
Fluid intake and humidification

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15
Q

Expectorant Examples

A

Guaifenesin (mucinex)

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16
Q

Expectorant Action

A

Liquify respiratory secretions and allow for easier removal.
Used in a productive cough (tenacious sputum)

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17
Q

Expectorant Considerations

A

Do not crush or chew (extending release)
Adequate hydration and fluid intake.
Don’t take longer than 1 week w/o seeing a doctor.
Avoid accidental OD
Encourage coughing and deep breathing

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18
Q

Mucolytic Examples

A

Acetylcysteine

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19
Q

Mucolytic Action

A

highest power expectorant
Used with chronic respiratory issues
Used in the event of an acetaminophen overdose
Liquifies the mucous in the respiratory tract and is given via inhalation

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20
Q

Nursing considerations for Mucolytic

A

Given inhalation so monitor airways because the are going to cough out their secretions
Encourage coughing and deep breathing
Don’t leave the acetylcysteine on the person’s face (it smells like rotting eggs)

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21
Q

Pseudoephedrine

A

Vasoconstrictor that was used in meth so it is no longer OTC. Phenylephrine replaced it. Good for people with cardiac issues. It is in all of the cold medicine that you can buy in the OTC aisle.

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22
Q

OTC Cold Medicine

A

Vicks NyQuil
Pseudoephedrine
Phenylephrine

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23
Q

Histamine

A

the 1st chemical mediator released in an allergic reaction. Found in mast cells and basophils.

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24
Q

What happens when Histamine is released

A

Constriction of smooth muscle in R tract
Bronchoconstriction
Stimulation of the Vagus nerve
Increased permeability of veins and capillaries
Increased secretion from mucus glands
Stimulation of peripheral nerve endings
Dilation of capillaries in the skin
Increase secretion of gastric acid
Increased heart rate and force of contraction

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25
Hypersensitivity Reactions
Memory B cells (antibodies) in the immune system mark something as harmful that isn't actually harmful and whenever it sees it, it attacks it like crazy Involves an exaggerated allergic response
26
Type 1 Hypersensitivity
Immediate hypersensitivity Occurs within minutes
27
Type 1 Hypersensitivity enzyme and cell activation
IgE induced Mast cells activation. Usually after 2nd or later exposure Mast Cells and Basophils
28
Type 2 Hypersensitivity
Much less common Cytotoxic Generates direct damage to cell surface Blood transfusion reactions Hemolytic disease of newborns, hemolytic anemia Seen as reactions to penicillin and heparin
29
Type 2 Hypersensitivity Enzyme
Mediated by IgG or IgM
30
Type 3 hypersensitivity
Immune Complex Serum sickness Rare: seen in an antibody transfusion or in a response to some medications
31
Type 3 hypersensitivity Enzyme and action
Mediated by IgG or IgM Forms antigen(badguy)-antibody(goodguy) complexes and causes acute inflammatory reaction in tissue
32
Type 4: Delayed hypersensitivity
Happens after exposure to an antigen We don't have the antibodies already looking for it, so it is a delayed response. Tuberculin test Contact Dermatitis Graft rejection, poison ivy
33
Type 4: Delayed hypersensitivity Cells activated
T cells reacts and causes a reaction Sensitized T lymphocytes react with antigen to cause inflammation
34
Allergic Rhinitis
Inflammation of nasal mucosa caused by type 1 reaction to inhaled allergens
35
Allergic Rhinitis Symptoms
Nasal congestion Itching, sneezing Watery drainage Itching or throat, eyes, and ears.
36
Seasonal Disease
Response to airborne pollens (spring, or fall)
37
Perennial Disease:
Response to nonseasonal allergies (happen all year round) Dust Mites, molds Animal dander
38
Allergic food reactions
Immune response to ingestion of a protein Higher risk of triggering anaphylaxis
39
Common Food Allergies
Shellfish, fish, corn, seeds, bananas, eggs, milk, soy, peanuts
40
Contact Dermatitis
(Type 4–delayed reaction) Poison Ivy, cosmetics, metals, tattoo dye Affected skin: Inflamed, warm, swollen, itchy Blisters may form, drain, and become infected
41
Allergic Reactions from medications
Symptoms vary but may include: Skin rash, fever, itching, hematologic reaction May be from a preservative or a dye or a coating and NOT from the drug May occur 7-10 days after starting the medication
42
Antihistamines
Stop the allergic cascade from the histamine. Stops histamine from binding. Relieve symptoms but do not relieve hypersensitivity
43
Antihistamine Indication
Allergic Rhinitis Anaphylaxis Allergic conjunctivitis Drug allergies, pseudoallergies Blood/blood product transfusion Dermatologic conditions
44
First Generation H1 Receptor Antagonists Example
Diphenhydramine
45
First Generation H1 Receptor Antagonists Action
Prevents/reduces most physiologic effects that histamine produces at receptor sites Decreases capillary permeability Decreases salivation and tear formation
46
First Generation H1 Receptor Antagonists Adverse Effects
CNS depression Anticholinergic effects (avoid giving to glaucoma, BPH, or constipation) Make old adults confused. Thickens secretions Take med before exposure to the allergen. Makes people TIRED
47
First Generation H1 Receptor Antagonists Indication for Use
Treats allergic reactions, motion sickness, and insomnia ****Children may experience paradoxical effect and might be very energetic
48
Second Generation H2 Receptor Antagonists Example
Fexofenadine, Loratadine, Cetirizine
49
Second Generation H2 Receptor Antagonists Action
occupy the same receptors as histamine which prevents histamine from reaching the target receptor sites. Bind preferentially to peripheral rather than central H1 receptors
50
Second Generation H2 Receptor Antagonists Considerations
Safer for older adults because it does not mess with CNS Does not readily enter the brain from the blood Be careful in patients with renal failure because they are at a higher risk of overdosing on this medication
51
Lower respiratory system
bronchia, lungs, and trachea
52
Common symptoms of Lower tract
excessive mucus production Airway hyperresponsiveness Swelling
53
Common Conditions with the Lower Tract
Asthma, emphysema and chronic bronchitis
54
Asthma
Caused by an IgE hypersensitivity reaction (type 1 sensitivity) Can occur at any age
55
Asthma is Stimulated by
Viral infections Environmental irritants stress/emotion Strenuous activity temperature/weather changes ***This is why it is different than an allergy
56
Asthma Pathophysiology
Muscle constriction narrows airways Inflammatory response Mast cells release Cytokines which increase inflammation
57
Mild to moderate asthma
Recurrent and reversible
58
Advanced to severe Asthma
Less reversible, chronic inflammation, structural changes Can lead to structural changes and long term structural changes known as remodeling
59
Manifestations of Asthma
dyspnea, wheezing, chronic cough, peak expiratory flow rate decrease (how much air you are able to breathe out), vary moderate to severe symptoms
60
Status Asthmaticus
Acute severe asthma, does not respond to usual treatments, severe respiratory distress, life threatening
61
Air Trapping
Hard to EXHALE
62
Chronic Bronchitis
Frequent productive cough more than 3 months/year x2 years Increased mucus leads to airway narrowing. Chronic changes
63
Bronchitis s/sx
Blue Bloater: Airway flow problems Cyanosis Hypoxia Increased Hgb
64
Emphysema
Enlargement and destruction of Alveoli r/t long term lung damage Loss of elasticity and surface area Carbon dioxide trapping
65
Emphysema s/sx
Pink Puffer: Increased CO2 retention Pink Pursed lips Barrel Chested
66
Chronic Obstructive Pulmonary Disease
Chronic bronchitis and Emphysema together Usually develops with long standing exposure to airway irritants
67
COPD S/sx
Symptoms are more consistent and less reversible Dyspnea Activity intolerance Air trapping
68
Goal for Broncocogestive disorders
prevent airway inflammation Minimize the use of “rescue drugs” Maintenance drug: everyday prevention of congestion
69
Bronchodilators
Andrenergics Anticholinergics Xanthines
70
Anti-Inflammatories
Corticosteroids Leukotriene modifiers Mast cell stabilizers Immunosuppressants
71
first choice to relieve acute asthma
Administering bronchodilators by inhalation is most effective and the treatment of first choice to relieve acute asthma
72
Two general types of inhaled B2 adrenergic agonists
Rescue inhalant Maintenance inhalant:
73
Maintenance inhalant:
long term control drugs used to achieve and maintain prophylactic control of persistent asthma Salmeterol
74
Rescue inhalant
quick relief short acting drugs used during periods of acute symptoms and exacerbations Albuterol
75
Beta 2 Adrenergic Agonists
beta 2 receptors in the smooth muscle of bronchi and bronchioles and open up the bronchioles The receptors, in turn, stimulate the production of cyclic AMP The increased cyclic AMP produces bronchodilation
76
Beta 2 Adrenergic Agonists Considerations
Can be used in children and older adults Large doses used in critical care short term Available as nebulizer, MDI, or oral
77
Beta 2 Adrenergic Agonists Adverse Effects
Muscle Tremor Cardiac stimulation CNS stimulation
78
Beta 2 Adrenergic Agonists Contraindications
Dysrhythmias CAD HTN With Beta Blockers, it may cause bronchospasm Thyroid hormones, theophylline, cold med, caffeine increase stimulatory effects
79
Beta 2 Adrenergic Agonist Patient Teaching
Use bronchodilator inhaler first Wati 5 minutes between inhalers Use steroid inhaler second Do not overuse the rescue inhaler or it will not work as well when you really need it! Do not skip or overuse maintenance inhalers Proper use of a MDI
80
Anticholinergics Examples
Ipratropium
81
Anticholinergic Action
blocks the action of acetylcholine in the bronchial smooth muscle, inhibiting bronchoconstriction and mucus secretion Maintenance therapy for bronchoconstriction r/t asthma, chronic bronchitis, and emphysema
82
Anticholinergic Uses
Available in nebulizer or MDI Usually used in combination with other bronchodilators Prevent bronchoconstriction. Maintenance Don't skip a dose These do NOT have cardiac stimulation like B2
83
Anticholinergics Adverse Effects
Cough, Dry Mouth, GI upset
84
Anticholinergic Contraindications
Narrow angle glaucoma BPH
85
Xanthines Examples
Theophylline
86
Xanthines Action
Works by relaxing the smooth muscle, which promotes bronchodilation. Suppresses airway responsiveness
87
Xanthines Uses
Used as second line treatment in SEVERE cases of chronic bronchoconstriction
88
Xanthine Considerations
Monitor lab values for dosing because it can be very toxic (which is why it is only used in emergencies) **Smoking Cigarettes can increase metabolism. Call dc. if quitting smoking
89
s/sx of Xanthine overdose
anorexia, N+V, tachycardia, convulsions
90
Xanthine Contraindications
Gastritis PUD Seizure disorder
91
Corticosteroid Examples
Beclomethasone
92
Corticosteroid Action
Suppress airway inflammation by blocking the cytokines Results in Blocks mucus secretion Blocks airway mucosal edema Repaired epithelium damage Reduced airway reactivity
93
Corticosteroid Use
Prevention (low dose) and treatment (high dose) of asthma and COPD Long term can be used in combination Inhaled for local effect to lungs only
94
Corticosteroid Adverse effects
HA Dry mouth, cough Fungal infection (candidiasis/thrush)
95
Corticosteroid Contraindications
Recent nasal/oral surgery because it slows down the healing process
96
Leukotriene Modifier Example
Montelukast
97
Leukotriene Modifier Action
Prevents leukotrienes from binding to receptors reducing bronchoconstriction and inflammation
98
Leukotriene Modifier Use
Long term treatment of asthma Not effective in relieving acute attacks PO Maintenance prevent acute asthma attack from allergens, exercise, cold air, irritants, hyperventilation
99
Leukotriene Modifier BLACK BOX
Neuropsychiatric events (vivid dreams)
100
Mast Cell Stabilizer Example
Cromolyn
101
Mast Cell Stabilizer Action
Prevent release of bronchoconstrictive and inflammatory substances from mast cells
102
Mast Cell Stabilizer Use
Second line treatment option Used in prophylaxis of acute asthma in mild, persistent asthma Not effective in acute bronchospasm or status asthmaticus
103
Monoclonal Antibodies Example
Omalizumab
104
Monoclonal Antibodies Action
Binds with IgE blocking receptors so there is less IgE available to start allergic reactions Adjunct therapy for severe allergic asthma not well controlled
105
BLACK BOX WARNING Monoclonal Antibodies
only give this drug under medical supervision risk of life-threatening anaphylaxis
106
Relievers
acute problems: albuterol
107
Controller
Maintenance: salmeterol, Ipratropium
108
Preventers
Prevent the problems: Theophylline, Beclomethasone, Montelukast, Cromolyn, and Omalizumab

Nursing (17 decks)

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