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NRSG 106: Pharmacology > [Exam 1] ATI: Module 4: Lower Respiratory Disorders > Flashcards

[Exam 1] ATI: Module 4: Lower Respiratory Disorders Flashcards

1
Q

What are the two classifications of drugs to help treat asthma and chronic obstructive pulmonary diseases

A

Bronchodilators and Anti-inflammatory

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2
Q

Sub specific groups of drugs include

A

Beta2-Adrenergic Agonists

Anticholinergics

Methylxanthines

Glucocorticoids

Mast Cell Stabilizers

Leukotrine Modifiers

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3
Q

Remember that Beta-2 Adrenergic agonists stimulate

A

BEta2 cells of the adrenergic or sympathetic nervous sytem

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4
Q

Beta2-Adrenergic Agonists: Therapeutic use are

A

in the relief of acute bronchospasm and prevention of exercise induced bronchospasm (EIB)

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5
Q

Beta2-Adrenergic Agonists: Drug selection depends on intended effect such as

A

Fast relief ( used as rescue inhalers) or long term management

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6
Q

Beta2-Adrenergic Agonists - Prototype and Other Drugs: Short acting Beta2 Adrenergic Agonist is

A

Albuterol (Proventil HFA and Ventolin HFA)

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7
Q

Beta2-Adrenergic Agonists - Prototype and Other Drugs: Long Acting beta2 - adrenergic agonists include

A

Formoterol (Foradil Aerolizer)
Salmeterol (Serevent)

Terebutaline only in generic form

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8
Q

Beta2-Adrenergic Agonists - Expectd Pharmacologic

Action: Therapeutic Effect

A

Stimulate Beta2- Adrenergic receptors of sympathetic resulting in bronchdilation.

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9
Q

Beta2-Adrenergic Agonists - Expected Pharmacologic Action, the primary one

A

Relieve bronchospasm of the bronchi and bronchioles of the lungs.

Play minor role in increasing ciliary motility.

Airways stay open and used on those with COPD

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10
Q

Beta2-Adrenergic Agonists - Adverse Drug Reactions : Side Effects?

A

Tachycardia, Heart Palpitations and Tremors. Angina as well.

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11
Q

Beta2-Adrenergic Agonists - Adverse Drug Reactions : Be cautioned against overusing

A

short-acting rescue inhalers more than twice a week

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12
Q

Beta2-Adrenergic Agonists - Interventions : Monitor for

A

Tachycardia, heart palpitations and any chest pain

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13
Q

Beta2-Adrenergic Agonists - Administration: You can give this

A

Orally or by Inhalation

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14
Q

Beta2-Adrenergic Agonists - Administration: Give Shor and Long Acting Preps for what?

A

Short-acting preparations for acute exacerbations

Long-acting preparations for long-term control

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15
Q

Beta2-Adrenergic Agonists - Administration: IF taking glucocorticoid, what must you do?

A

Take Beta2 drug before glucocorticoid. Allows airway to dilate first.

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16
Q

Beta2-Adrenergic Agonists - Client Instructions: Tell client to avoid

A

Caffeine

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17
Q

Beta2-Adrenergic Agonists - Client Instructions: Let provider know if

A

they experience tremors that interefere with ADL. Watch for impending exacerbations of asthma.

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18
Q

Beta2-Adrenergic Agonists - Contraindications and Precautions: Dont give what to clients

A

Albuterol or Levabuterol to those who are allergic.

For allergy to Beta2, give caution when giving albuterol with history of side effects

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19
Q

Beta2-Adrenergic Agonists - Contraindications and Precautions: For those with diabetes, hyperthyroidism, CVD, or hypertension they make take…. but …

A

Albuterol, but make sure you monitor them incase of increase in sympathetic stimulation

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20
Q

Beta2-Adrenergic Agonists - Interations: Beta-Adrenergic Blockers do what?

A

Reduce effectiveness

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21
Q

Beta2-Adrenergic Agonists - Interations: MAOIs and Tricyclic Antidepressants do what?

A

Increase risk of hypertension, tachycardia, and Angina.

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22
Q

Beta2-Adrenergic Agonists - Interations: HYpoglyemic or Antidiabetics do what?

A

REquire increased dosing because of hyperglycemic effect of drug

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23
Q

Beta2-Adrenergic Agonists - Interations: What drugs to watch out for

A

BEta-Adrenergic Blocker

MAOIs

Tricyclic Antidepressants

Hypoglycemia ./ Antidiabetic Drugs

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24
Q

Anticholinergics: Why are these used?

A

Provide relief of bronchoconstriction and reduction of secretions in clients who have COPD

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25
Q

Anticholinergics - Prototype and Other Drugs: Drugs included are

A

Ipatropium (Atrovent , Atrovent HFA)

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26
Q

Anticholinergics - Expected Pharmacologic Action: Inhaled anticholinergics work by

A

inhibiting the action of acetylcholine.

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27
Q

Anticholinergics - Expected Pharmacologic Action: What does Acetylcholine causes

A

vasoconstriction of the bronchi and bronchioles, blocking stimulation of fparasympathetic receptors.

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28
Q

Anticholinergics - Adverse Drug Reactions: Confined to local reactions like

A

dry mouth and pharyngeal iritation.

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29
Q

Anticholinergics - Adverse Drug Reactions: For someone who has history of narrow-angle glaucoma, what can occur

A

Increased intraocular pressure

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30
Q

Anticholinergics - Adverse Drug Reactions: Other adverse reactions include

A

headache, dizziness, blurred vision, epistaxis, bronchospasms and hypotension

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31
Q

Anticholinergics - Interventions: WIth dry mouth, provide

Also monitor for

A

Water to sip on and hard candy to ease discomfort.

Get routine eye exams

Monitor urinary eleimation patterns for unirary retention.

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32
Q

Anticholinergics - Administration: Can admister via

A

inhaler or nebulizer

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33
Q

Anticholinergics - Administration: If you have to admiister otoher inhalants at same time, how long should you wait?

A

Five minutes .

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34
Q

Anticholinergics - Administration: Drugs and the aftertase

A

Drugs have unpleasant aftertase, so make sure to have water to rinse mouth

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35
Q

Anticholinergics - Administration (Safety Alert): Make sure client knows what?

A

Ensure clients know that inhaled anticholinergics are not meant for acute asthma exacerbation.

Labeled bronchodilators for COPD

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36
Q

Anticholinergics - Client Insttructions: Instruct client to

A

suck on hard candy and sip water frequently for dry mouth

Regular eye exams

Report any changes in urinary

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37
Q

Anticholinergics - Contraindications and Precautions: Take caution in giving what to clients who have glaucoma, prostatic hyperplasia, bladder neck obstruction, or urinary retention?

A

Ipratropium

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38
Q

Anticholinergics - Contraindications and Precautions (Safety Alert): Clients sensitive to what need to avoid Combivent (Ipratropium/Albuterol Combination) MDI due to allergic reaction risk

A

Those sensitive to soy or peanuts

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39
Q

Anticholinergics - Interactions: What should you do if taking Beta2-Adrenergic Agonists?

A

They enhance bronchodilation, so make sure dosage adjusted if taking both

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40
Q

Methylxanthines: What is this used for?

A

Drug used in long-term management of chronic stable asthma, though not idely used. No longer recommended for COPD

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41
Q

Methylxanthines - Prototype and Other Drugs: Prototype is

A

Theophylline (Theolair, Theochron, and Theo-24)

Aminophylline (generic only) us preferred for IV Administration

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42
Q

Methylxanthines - Prototype and Other Drugs: Theo-24 is what?

A

Extended-release form that provides 24-hour coverage in clients who metabolize theophylline at expected rate. Those who smoke would not be apporpriate candiates. Check blood levels

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43
Q

Methylxanthines - Expected Pharmacologic ACtion:

A

Relax smooth muscles of bronchi

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44
Q

Methylxanthines - Adverse Drug Reactions: When blood level exceeds the therapeutic level, wha thappens?

A

Restlessness and Insomnia.

Might also experience N/V, Diarrhea.

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45
Q

Methylxanthines - Adverse Drug Reactions: When blood at toxic levels signs are

A

Seizures and Dysrhythmias

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46
Q

Methylxanthines - Interventions: You should do what?

A

Monitor blood level, making sure it doesnt rise from delayed metabolism

Give activated charcoal to decrease additional absorption

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47
Q

Methylxanthines - Interventions (Safety Alert): What is administered if life-threatening cardiac dysrhythmias occur?

A

Antidysrhythmics to restore heart rate and rhythm

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48
Q

Methylxanthines - Interventions (Safety Alert): If client experiences a seizure ..

A

initiate anticonvulsant therapy

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49
Q

Methylxanthines - Administration: How is this administered?

A

Orally. Base dose based on childs age, weight, and other factors.

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50
Q

Methylxanthines - Administration: insructions to follow?

A

Give at prescribed intervals, to maintain therapeutic blood level.

Do not double dose if missed.

If chewable, chew throughouly.

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51
Q

Methylxanthines - Administration: IV Administration is set aside for

A

emergencies and care must be taken to infuse drug slowly

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52
Q

Methylxanthines - Client Instructions: What shhoudl they do?

A

Reduce caffeine intake.

Periodic lab testing of drug levels.

List side effects of if blood level too high to notify provider

Stop taking of toxic effects occur

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53
Q

Methylxanthines - Contraindications and Precuations: Use cautiosly in those who

A

smoke tobacco or marijuana.

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54
Q

Methylxanthines - Contraindications and Precuations: Need to be aware of what disease and their medications drug-to-drug interaction?

A

Seizure, TB Peptic Ulcer, or Bacteria

55
Q

Methylxanthines - Interactions: What can increase clients risk of toxicity?

A

Cimetidine (Tagamet) as well with some FLuroquinolones

56
Q

Methylxanthines - Interactions: Caffeine should be minimized because?

A

Caffeine is a Methyxanthines, and would increase dosage.

57
Q

Methylxanthines - Interactions: What causes increases in metabolism of theophylline causing a decrease in blood level?

A

Nicotine, Phenobarbitl, and Phenytoin

58
Q

Methylxanthines - Interactions (Safety Alert), Taking what for indigestion of GERD increases risk for methyxanthine toxicity?

A

Cimetidine

59
Q

Glucocorticoids: Why are they important?

A

Because of their significant ability to suppress the immune system and decrease inflamtion.

60
Q

Glucocorticoids: Inhaled Glucococorticoids are for what?

A

Long-term management of chronic asthma

61
Q

Glucocorticoids: What are oral glucocorticoids are for

A

short-term management of post-exacerbation symptoms

62
Q

Glucocorticoids - Prototype and Other Drugs: What are theey

A

Beclomethasone Dipropionate (QVAR) - Inhalant

Prednisone (Orally)

Gluticasone (Flonase) Intranasally or orally known as FLovent

63
Q

Glucocorticoids - Expected Pharmacologic Action: These prevent the release of

A

leukotrienes, prostaglandins and histamine. PRevents action of WBC too.

Decreases actions of these cells decrease inflammation and subsequently, decreases edema of airways.

64
Q

Glucocorticoids - Adverse Drug Reactions: Inhaled glucocorticoids can cause

A

oral candidiasis, which is a yeast infection.

Includes hoarseness and difficulty speaking.

Muscle wasting and bone demineralization

65
Q

Glucocorticoids - Adverse Drug Reactions: Oral glucocorticoids can cause suppression of

A

Adrenal function

66
Q

Glucocorticoids - Adverse Drug Reactions: Additional side-effects of short- and long term oral glucocorticoid are

A

hyperglycemia (elevated blood sugaR)

Peptic ulcer Disease

Increased susceptibility and fluid and electrolyte imbalance

67
Q

Glucocorticoids - Adverse Drug Reactions: Nasal glucoccorticoids can cause

A

dry mucous membranes , epistaxis (bleedfing from the nose) , sore throat, and headache

68
Q

Glucocorticoids - Interventions - Inhaled: Side effects can be minimized by

A

attaching a spacer to the inhaler. Decreases amount of drug that comes in contact with the tissues of the mouth and oropharynx

69
Q

Glucocorticoids - Interventions - Inhaled: What to do if oral candidiasis occurs?

A

Timely initiation of antifungal therapy

70
Q

Glucocorticoids - Interventions - Oral: Monitor what?

A

Plasma drug levels to deteramint amount of adrenal function.

Recommend lowest possible effective dose

71
Q

Glucocorticoids - Interventions - Oral: Take with what?

A

FOod or meals and recommending an analgesic substitiue such as acetaminophen if NSAID needed

72
Q

Glucocorticoids - Interventions - Oral: Closely monitor

A

blood glucose levels for hyperglycemia.

Look for infections.

Monitor sodium retention or hypernatremia or potassium losss so initiate approrpriate replacement therapy

73
Q

Glucocorticoids - Interventions - Nasal: What to do if taken nasaly?

A

Because of dry mucous membranes or sore throat, provide comfort measures such as fluids.

Adminiter non-NSAID analgeic like acetaminophen for headaches

74
Q

Glucocorticoids - Administration - Inhaled: How to give it?

A

Give on schedule.

75
Q

Glucocorticoids - Administration - Inhaled: Useful in asthma attack?

A

Not as useful as a rescue drug.

76
Q

Glucocorticoids - Administration - Inhaled: What happened if given when Beta2 Adrenergic Agonist?

A

Use Beta2 first to dilate airways.

77
Q

Glucocorticoids - Administration - Oral: Short-term oral glucocorticoid therapy gigven for

A

5-10 days.

78
Q

Glucocorticoids - Administration - Oral: Long term use is used for how long

A

10 or more days

79
Q

Glucocorticoids - Administration - Oral: Administering orally cna decrease

A

incidence of Adverse Drug REactions.

80
Q

Glucocorticoids - Administration - Oral: What can occur if dose is withdrawaled too quickly?

A

Adrenal crisis

81
Q

Glucocorticoids - Administration - Oral: What may be needed in time of stress such as illness or surgery because adrenal gland may not be functioning at optimum.

A

Supplemental Doses

82
Q

Glucocorticoids - Administration - Nasal: Use giving a

A

nasal-metered dose spray device

83
Q

Glucocorticoids - Administration - Nasal: Initial dose is when

A

a client takes is usually higher than the maintenance dose you give on long term basis.

84
Q

Glucocorticoids - Administration - Nasal: If nares are blocked, use

A

a nasal decongestant first to open the nasal passages

85
Q

Glucocorticoids - Client Instructions - Inhaled: Encourge them to use

A

spacer during administration.

Also rinse their mouth and gargle after using inhaler to prevent candidiasis

86
Q

Glucocorticoids - Client Instructions - Oral: Because glucocorticoids suppresses adrenal function, ensure client understands that

A

drugs can never be stopped abruptly. Dose must be tapered off to prevent adrenal crisis

87
Q

Glucocorticoids - Client Instructions - Oral: To prevent osteoporosis, instruct clients to

A

increase intake of calcium and vitamin D and perform weight bearing exercises.

88
Q

Glucocorticoids - Client Instructions - Oral: Bc glucocorticoids affect blood sugar, instruct clients to report

A

the incidience of polyphagia.

89
Q

Glucocorticoids - Client Instructions - Oral (Safety Alert): How to prevent ulcers?

A

Take gastric-protective measures.

Avoid taking NSAIDS and use acetaminophen instead.

90
Q

Glucocorticoids - Client Instructions - Oral (Safety Alert): Take Glucocorticoid with

And report if

A

a snack or meal.

Report immediately if they vomit blood or produce black tarry stools

91
Q

Glucocorticoids - Client Instructions - Oral (Safety Alert): Because glucocorticoids suppress the immune system, clients should

A

notify their provider at first sign of infection.

92
Q

Glucocorticoids - Client Instructions - Nasal: Bc clients experience dry mucous membranes, epistaxis and sore throat, instruct them to

A

use a humidifier when sleeping, increase their fluid intake, or suck on hard candies .

93
Q

Glucocorticoids - Client Instructions - Nasal: If headaches accompany use of an intranasal glucocorticoid, client can take

A

non-NSAID analgesics such as acetaminophen

94
Q

Glucocorticoids - Contraindications and Precautions: Be cautious on giving this to someone with

A

peptic ulcer disease, diabetes, hypertension, renal dysfunction or taking NSAIDs

95
Q

Glucocorticoids - Contraindications and Precautions: If client has systemic fungal infecition or recently received a live virus immunization, what should you do

A

avoid giving oral glucocorticoids . Reduces body ability to produe antibodies.

96
Q

Glucocorticoids - Interactions: Don’t give with

A

potassium-depleting diurects (furosemide, Lasix), because will increase risk of hypokalemia .

97
Q

Glucocorticoids - Interactions: Use of NSAIDS increases risk of

A

GI Bleeding

98
Q

Glucocorticoids - Interactions: What effect is decreased when clients are on glucococorticoid therapy?

A

Insulin and Oral Hypoglycemics

99
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers: What are these?

A

Type of anti-inflammatory inhalant-type of drug used to reduce bronchial inflammation prophylactically in mild to moderate asthma.

100
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers: They treat

A

long-term allergy-related asthma.

101
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers: They are used to prevent

A

exercise-induced bronchospasm and seasonal allergy symptoms and management of allergic rhinitis

102
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers: In case of allergic rhinitis, what is required?

A

Intranasal Instillation of Cromolyn (NasalCrom)

103
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Prototype and OTher Drugs:

A

Cromolyn (NasalCrom)

104
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Expected Pharmacologic Action: Mast cell stabilizers suppress

A

inflammation in manner similar to corticosteroids

105
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Expected Pharmacologic Action: Prevent the release of

A

leukotrienes and histamine , which mediate inflammation.

106
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Expected Pharmacologic Action: This keeps WBC like leukocytes and eosinophils form stimulating

A

inflammatory response by attacking foreign cells

107
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Expected Pharmacologic Action: Minimizing the actions of these cells decrease

A

inflammation and edema of the airways. They do not have bronchodilation effects

108
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Adverse Drug Reactions: Why is this drug useful?

A

Safest drugs. Cough and bronchospasm may occur in fewer than 1 out of 10000

109
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Interventions : Contraindicated in clients who have demonstrated

A

a previous allergic response to the drug

110
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Administration: Mast Cell Stabilizers given with

A

a power-driven nebulizer

111
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Administration: Initial dosage of

A

20mg four times daily, clients should be maintained on lowest dosage

112
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Administration: To prevent EIB, administer

A

10-15 minutes prior to activity and no sooner than 1 hour prior

113
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Administration: When using prophylactically to avoid seasonal allergies, take

A

cromolyn prior to exposure.

114
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Client Instructions: Not effective against

A

an acute asthma attack

115
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Client Instructions: How long to achieve therapeutic effects?

A

Several weeks

116
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Contraindications and Precautions: Use of mast cell stabilizers is contraindicated in clients who are

A

allergic to cromolyn

117
Q

Additional Anti-Inflammatory Drugs - Mast Cell Stabilizers - Interactions:

A

No known drug or food interactions

118
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers: What are these?

A

Oral drugs that are normally prescribed as adjunctive therapy to assist in decreasing bronchoconstriction and inflammation

119
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers: Used in treatment of

A

allergic rhinitis, asthma, and exercise induced bronchospasm

120
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Prototype and Other Drugs: Drug is

A

Montelukast (Singulair)

121
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Expected Pharmacologic Action: Modifiers work to supress

A

effect of leukotrines

122
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Expected Pharmacologic Action: What does Montelukast do?

A

Leukotriene antagonists that decrease inflammation by preventing the activation of leukotrienes

123
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Adverse Drug Reactions: What may cause liver damage?

A

Zileuton (Zyflo) and Zafirlukas (Accolate)

Montelukast does not cause any untoward side effect

124
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Adverse Drug Reactions: All leukotriene modifiers do not carry

A

the slight risk of adverse neuropsychiartic symptoms such as suicidal thoughts or behaviors

125
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Interventions: If taking Zileuton and Zafirlukast, you must m onitor for

A

Liver damage and provide liver function tests.

126
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Administration: When is this given?

A

Once daily in the evening.

127
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Administration: Available as what?

A

Oral or chewable tablets and oral granules

128
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Administration: ADvice for when using oral granules?

A

Clients can mix them with applesauce, carrots, rice, or ice cream or place directly on tingue

129
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Administration: If using drug to prevent EIB…

A

make sure its at least 2 hours before exercising . And don’t take again for 24 hours

130
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Client Instructions: For clients reporting headaches after administration, encourage them to use

A

OTC analgesics as needed.

131
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Client Instructions: Educate clients and family to be aware of

A

any behavioral changes such as anxiety, agitiation, insomnia or irritability

132
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Contraindications and Precautions: Don’t give leukotrieve modifiers for

A

acute asthma exacerbations or status asthmaticus because of the time it takes for the drug to take effect

133
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Contraindications and Precautions: Use leukotriene modifiers with cautions in clients who have

A

severe asthma because of the higher level of efficacy of other drug options

134
Q

Anti-Inflammatory Drugs / Leukotriene Modifiers - Interactions: Clients may need higher doses of Montelukast for

A

Clients taking Phenobarbital, Rifampin, or Phenytoin

NRSG 106: Pharmacology (14 decks)

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