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Drugs Affecting Respiratory System Flashcards

(54 cards)

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1
Q

Oral Antihistamines

A

Most tested:
Fexofenadine
Diphenhydramine
Loratadine

Other:
Chlorpheniramine
Cetrizine
Levocetrizine
Deslooratadine

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2
Q

Fexofenadine (brand: Allegra)

A

Upper respiratory Drugs
Antihistamine “allergy meds”
indication: Allergies, sinusitis, hives
Safe for asthma and nasal polyps
NOT for glaucoma patients due to anticholinergic effect that increases intraocular pressure

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3
Q

Diphenhydramine (Brand: Benadryl)

A

Upper respiratory Drugs
Antihistamine “allergy meds”
Commonly used for major anaphylaxis reactions
Blocks Histamines which create mucus and secretions as well as inflammation

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4
Q

Diphenhydramine (Brand: Benadryl) Side effects

A

Side effect: sedation and sleepiness
No driving in this med

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5
Q

Contraindicated for Diphenhydramine

A

Contraindicated:
Closed angle glaucoma
Urinary retention
Peptic ulcer
Small bowel obstruction

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6
Q

Anaphylaxis from a Bee sting

A

1st Epinephrine IM
2nd Diphenhydramine IV
3rd Albuterol or steroids

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7
Q

Intra-nasal Antihistamines

A

Azelastine
Olopatadine

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8
Q

Non-sedating Antihistamines

A

Loratadine
Cetirizine
Fexofenadine

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9
Q

Loratadine (brand: Claritin)

A

Upper respiratory Drugs
Antihistamine “allergy meds”

Fewer side affects than Benadryl so patients commonly switch between Benadryl and Claritin

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10
Q

Decongestants

A

3 Groups
Adrenergic (sympathomimetics)

Antichollergics (parasympathomimetics)

Topical Corticosteroids combined with antihistamine

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11
Q

Adrenergics (sympathomimetics)

A

Ephedrine
Phenylephrine, Pseudoephedrine
Naphazoline, Oxymetazoline
Terahydrozoline
Xylometazoline

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12
Q

Antichollergics (parasympathomimetics)

A

Bronchodilators
End in “Tro-pium”
Ipratropium
Tiotropium

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13
Q

Topical Corticosteroids combined with antihistamine

A

Azelastine/fluticasone propionate

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14
Q

Antitussives

A

Codeine
Hydrocodone
Dextromethorphan
Diphenhydramine
Benzonatate

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15
Q

Codeine

A

Cough Suppressant Antitussive
Most affective antitussive
Opioid analgesic also called a narcotic/pain med

Given for mild to moderate pain to suppress the cough

Codeine doesn’t not affect
Photosensitivity
Heart Palpations
insomnia or Anxiety

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16
Q

Codeine Side effects:

A

slows down central nervous system making the vital signs low and slow

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17
Q

Codeine Key Points

A

Slow position changes, low BP can result in orthostatic hypotension - dizziness/fainting upon standing = Big fall risk
Do not give to COPD patients because lungs are low and slow
GI is also low and slow = constipation and nausea
Take with food
Increase fluid intake
8 full glasses of water (minimum)

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18
Q

2 categories of Antitussives

A

2 categories
1.Opioid—all have antitussive effects, but only codeine and hydrocodone are used for this purpose

2.Non-opiod—less effective: dextromethorphan

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19
Q

Inhaled Corticosteroids

A

Most commonly tested: Beclomethasone
Fluticasone

Other:
Budesonide
Ciclesonide
Flunisolide
Mometasone

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20
Q

Corticosteroids that reduce swelling and inflammation in the respiratory system

A

Beclomethasone
Fluticasone
Methylprednisolone (solu mederol)

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21
Q

Corticosteroids SONE Key points

A

Use spacers to prevent oral thrush (candida)
Rinse mouth after each use
Do not swallow water
Clean inhaler daily

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22
Q

Beclomethasone

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A

Antinflamatory agents
Ends in “SONE”
Reduces swelling and inflammation iim the resp system - decreases bronchi

Slow onset: not a rescue drug, do not use as first sign of asthma attack

Sugar increase = Expected finding

Sores in mouth (infection)

23
Q

Who is MOST at risk for infection

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A

The patient on SONE steroids
Sone steroids suppress the immune system

24
Q

What kind of onset do steroids have

25
Oral Corticosteriods
Methylprednisolone: Steroid, acts slow Prednisolone Prednisone
26
Beta 2 Adrenergic Agonists Inhaled short acting
Albuterol Levalbuterol End in buterol Brutal Asthma attacks 1st drug used in asthma attacks Fasted acting bronchodilator The only ‘rescue inhaler” Use BEFORE steroid inhaler
27
Albuterol Side effects:
Tachycardia and palpitations Tremor Toss and Turning at Night (insomnia and Difficulty sleeping)
28
Drugs too Avoid for Asthmatic patients
Beta blockers: Atenolol, can cause bronchospasm NSAIDS: Ibuprofen, can worsen asthma
29
Beta 2 Agonist
Activate Beta 2 in the lungs which dilates the bronchi which results in increased airflow but it also activities beta 1 (heart) makes the heart go crazy fast Side affect: rapid heart rate
30
Beta 2 Adrenergic Agonists Inhaled Long Acting
Arformoterol Formoterol Indacaterol *Salmeterol Ends in "Terol not Buterol” Slower acting, not rescue inhalers, not used during acute asthma attacks Used with a combination of steroids for long term control of moderate to severe asthma
31
Drugs for acute asthma attacks
“AIM” for acute asthma attack A: Albuterol 1st (to bronchodialate the lungs, steroids 2nd to get all the powder deep into the lungs) I: Ipratropium 2nd M: Methyl-prednisolone (brand: Solu mederol) Do not use fluticasone or salmeterol for first sign of acute asthma attack - always take steroids even if albuterol provides relief 2-4 puffs every 20minutes for 3 rounds If it doesn’t work after 3 doses then notify HCP Effective: Decrease iim RR Oxygen sat at least 90%
32
Albuterol Nebulizer expected findings after treatment
Increase productive cough Reports off decreased anxiety Mild bilateral hand temors
33
Albuterol Administration
Shake it before you take it Shake it well breath all the way out, push inhaler, inhale and hold for a few seconds then exhale Clean 2 times per week with warm water not after every use. Steroids should be washed after every use
34
Patient with severe asthma Vital signs: tachycardia Tachypnea O2 less than 90% Peak exp. flow <40% predicted or best <150l/min What medication would you give?
Albuterol inhaler Nebulizer Ipratropium IV methylprednisolone
35
Beta 2 Adrenergic Agonists Oral
Albuterol Terbutaline
36
Anticholinergics
Ipratropium Tiotropium
37
Ipratropium
Anticholinergic - Bronchodilators Dries the body out Used for moderate to severe asthma and COPD Longer acting brochodialator that reduces secretions and commonly given in combination with albuterol Used 2nd in an asthma attack Blocks secretions: Cannot see, pee, spit or poop Side effects: Dry mouth, horsiness Treat the dry mouth and throat for all anticholinergics: use gum/candy and drink fluids Key point: No swallowing tiotropium capsules, put the capsule in the inhaler device and then inhale Contraindication to all anticholinergics: Never give to patients who are already dry. Example: Glaucoma Urinary mention and BPH Bowel obstructions
38
Cough Expectorants
Guaifenesin inIodinated glycerol Potassium iodide
39
Guaifenesin (brand mucinex)
Cough Expectorant Given for cough and mucus, helps clear out excess mucus Thins mucus - teach patients to drink fluids to help thin muscus Drink at least 2L per day Asthma safe
40
Acetylcystine (brand: mucomyst)
Cough Expectorant Helps loosen and thin serious mucus like inn cystic fibrosis Antidote for Tylenol (acetaminophen) overdose Blocks Acetaminophen Also given before the cath lab to protect kidneys from contrast dye Caution with asthmatic patients NOT SAFE: cause or worsen bronchospasm always clarify prescriptions given for asthmatic patients
41
Lower Respiratory Drugs
Bronchodilators Beta 2 Agonist: Albuterol Anticholinergics: Ipratropium Methylxanthines: Theophylline Anti-inflammatory Agents Steroids: Beclomethasone Leukotriene Inhibitor: Montelukast Mast Cell Stabilizers: Cromolyn
42
Methylxanthines
Brochodialators Ends in “phylline” *Theophylline Aminophylline Rapid heart rate and can be toxic Toxic! over 20
43
Theophylline Therapeutic Valus
Therapeutic index 10-20 = frequent blood draws Tonic colonic seizures #1 Sign of Severe toxicity 1st priority as the nurse report signs such as restlessness, nausea/vomiting, anorexia, insomnia tachycardia and dysrhythmias
44
Methylxanthines (Theophylline) Key points
Teach patients to avoid beta blockers that lower the heart rate while on Theophylline - Beta blockers can also block the affect of theophylline Alert HCP of tachycardia before giving next dose Take in AM Avoid Caffeine Stop Before Cardiac stress test
45
Drugs that Increase toxicity risk Theophylline
Cimetidine (H2 blocker) Ciprofloxacine (ABX)
46
Which of the following prescriptions should the nurse question?
Naproxen for an Asthmatic Patient Ipratropium for a patient with glaucoma Theophylline for a patient taking cimetidine atenolol for a patient with asthma
47
What patient teaching should be included with a new prescription of albuterol, ibuprofen, tiotropium and beclomethasone?
Tachycardia is expected after albuterol Report dark stool to the provider Drink fluids to prevent dry mouth and throat
48
Which medication prescribed for asthma causes of tachycardia and dysrhythmias?
Aminophylline
49
Leukotriene Inhibitors
Montelukast (brand: singular) Opens airway Long term management of of inflammation, commonly given in combination with albuterol and steroids Long onset (1-2 weeks to reach therapeutic range)
50
Leukotriene Inhibitors Key Points
Given for prevention of asthma attacks - not during acute attacks Not a rescue drug This med will prevent inflammation that causes asthma attacks
51
Patient has been conn Montelukast for 5 days and states the medication iim not working, best response by the nurse?
Advice 102 weeks for drug to reach the therapeutic affect
52
Mast Cell stabilizers
Anti-inflam agents Cromolyn Blocks massive swelling Prevents activity induced asthma Take 15 minutes before exertion for maximum affects
53
A client is receiving discharge instructions for a inhale corticosteroid metered dose inhaler. What teaching should the nurse include?
Do not swallow the water as you wash your mouth after use
54
Which statement by the patient requires further teaching
I will take cromolyn 45 minutes before physical activity * take 10-15min before

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