Exam 2

Question 1

What are the classes of drugs used to treat the common cold?

Answer 1

antihistamines, nasal decongestants, antitussives, and expectorants

Question 2

Why does the FDA not recommend the usage of over the counter cough and cold products for children younger than 2?

Answer 2

there’s a chance of over sedation, seizures, tachycardia, and death

Question 3

What is Echinacea? Side effects? Interactions?

Answer 3

an herbal remedy that can reduce upper respiratory infection and cold symptoms and shorten the length of infection by stimulating the immune system; dermatitis, nausea, vomiting, dizziness, headache; potential interaction with aminodraone (used to treat arrthymia), cyclosporine (immunesuppressant), phenytonin (seizures), and methotrexate (antineoplastic)

Question 4

What is Goldenseal? Usages? Side effects? Interactions?

Answer 4

an herbal remedy that have antibacterial, antifungal, and antiviral function that will promote acid excretion in the GI system and vasoconstriction; used for upper respiratory infections, allergies, and nasal congestions; GI; potential interactions with antacids, H2 blockers, antihypertensives

Question 5

What are the histamine receptors and their jobs?

Answer 5

H1: involved in smooth muscle contraction and vasodilation of capillaries
H2: increases HR and gastric acid secretion

Question 6

What is histamine involved in?

Answer 6

nerve transmission, vasodilation, smooth muscle contraction, if too much leads to anaphylaxis

Question 7

What is the function of antihistamines? Usages? Best time to give?

Answer 7

compete for histamine receptor sites; used for hay fever allergies, anaphylaxis, itching; early in reaction so that histamine does not have time to bind to receptors

Question 8

What is the function of anticholinergics? Usages? Examples? Side effects?

Answer 8

long-acting muscarinic agonists that will bind to acetylcholine receptors to prevent acetylcholine from binding; for colds: leading to a drying and sedative effect for nasal allergies, hay fever, allergic reactions, motion sickness, Parkinson’s disease, sleep disorders
for bronchodilation: mostly used for COPD ex/ ipratropium (BID), tiotropium (QD, most common), combivent (ipratropium/albuterol), side effects include:dry mouth or throat, nasal congestion, heart palpitations, GI distress

Question 9

What is the MOA for traditional antihistamines? Examples and their details? Side effects?

Answer 9

non-specific drug that blocks all of H1 receptors; diphenhydramine (Benadryl) can cross the blood brain barrier, promethazine (Phenergan) for nausea and vomiting, meclizine (Dramamine) for motion sickness, hydroxyzine (Atarax) for itching; drowsiness, additive effects with other meds, dry mouth, problems urinating

Question 10

Contraindications for antihistamines?

Answer 10

known drug allergies, cardiac and kidney disease, COPD

Question 11

What are some examples of non-sedating antihistamines?

Answer 11

fexofenadine (Allegra), loratadine (Claritin), cetirizine (Zyrtec)

Question 12

What are the nursing considerations of non-sedating antihistamine?

Answer 12

longer duration of action, careful assessment to determine if it is viral, bacterial, or allergies and why they are presenting with symptoms, stop taking them four days before allergy test

Question 13

What are the usages of decongestants? Difference between oral vs topical routes?

Answer 13

acute or chronic rhinitis, common cold, sinusitis, hay fever, other allergies; oral is more systemic effect but topical (ie. nasal spray) more localized effect

Question 14

What are the groups of decongestants? Nursing implications? Contradictions?

Answer 14

Adrenergic, anticholinergic and cortiosteroids; avoid oversue of caffeine, report fever and cough lasting over a week, monitor for intended therapeutic effect; drug allergy, narrow-angle glaucoma, uncontrolled cardiovascular disease, hypertension, long-standing asthma

Question 15

What are adrenergics? Examples and details?

Answer 15

largest group of decongestants; oxymetazoline (Afrin) topical nasal spray with few side effects but can only be used 3 days at a time due to rebound congestion, pseudoephedrine (Sudafed) PO alpha adrenergic agonist that is slower to work with more systemic side effects of increased BP, jitters/insomnia due to stimulation of CNS

Question 16

What are corticosteroids (not for respiratory)? Route? Examples? Side effects?

Answer 16

localized anti-inflammatory decongestant; topical intranasal steroid; fluticasone (Flovent), triamcinolone (Nasacort), budesonite (Rhinocort); can cause localized drying and irritation

Question 17

What are antitussives? Uses? Nursing considerations?

Answer 17

medications used to stop or reduce coughing; used only for non-productive/dry coughs; drug allergy, opioid dependency, respiratory depression

Question 18

What are opioid antitussives MOA? Usages? Example? Side effects? Contraindications?

Answer 18

work directly on cough reflex in medulla and suppress it, can dry respiratory mucosa and give pain relief; used as an additive in OTC cough syrups; codeine, hydrocodone; sedation, GI, constipation, lightheaded; other opioids or other CNS depressants

Question 19

What are example non-opioid antitussives MOA? Side effects?

Answer 19

benzonatate (Tessalon Perles) suppresses cough reflex by numbing stretch receptors in respiratory tract to prevent stimulation of cough reflex in medulla; dizzy, headache, sedation, nausea

dextromethorphan (Robatussin) drys out mucosa of respiratory tract, decreases runny nose and nasal drip; dizziness, drowsiness, nausea

Question 20

What are expectorants? Example? Nursing considerations? Side effects?

Answer 20

disintegrate and thin secretions to help relieve productive cough, guaifensin (Mucinex); increase fluid intake; GI

Question 21

What is epinephrine MOA?

Answer 21

nonselective adrenergic that will stimulate receptors and reverse symptoms of anaphylaxis by relaxing smooth muscles to improve breathing, can increase HR to improve blood flow

Question 22

What are the treatments for blood pressure categories?

Answer 22

elevated, stage 1, or stage 2 hypertension advise change in lifestyle first by increasing exercise and changing the diet, stage 1 should try lifestyle changes but if they have risk factors including age, diabetes, renal disorders they may get one diuretic, stage 2 with lifestyle changes they will receive two hypertensive drugs from different classes

Question 23

What are adrenergic drug types?

Answer 23

Alpha 2 receptor agonists and Alpha 1 receptor blockers

Question 24

What is the MOA for alpha 2 receptor agonists? Example? Side effects? Nursing considerations?

Answer 24

works on alpha 2 receptors in the brain to decrease norepinephrine production and alpha 2 receptors in the kidneys to reduce renin activity to cause vasodilation; clonidine (Catapres), methyldopa in pregnancy; due to significant side effects not typically first line drugs, orthostatic hypotension, fatigue, and dizziness; change positions slowly, need to taper off due to rebound hypertension, check BP, first dose syncope

Question 25

What is the MOA for alpha 1 receptor blockers? Example? Side effects? Nursing considerations?

Answer 25

blocks alpha 1 receptors in the vessels to prevent the release of norepinephrine to cause vasodilation; "azosin" doxazosin, prazosin, terazosin; not as profound as alpha 2 receptor agonists, dizziness, orthostatic hypotension, bradycardia; change positions slowly, need to taper off due to rebound hypertension, check BP, first dose syncope

Question 26

What is the MOA beta blockers? Examples? Side effects? Nursing considerations?

Answer 26

nonselective works on beta 1 peripherally in the heart to reduce HR and on beta 2 receptors to reduce renin secretion of kidneys and aid in vasodilation while selective works only beta 2 receptors; "olol" propranolol is a nonselective that can also be used for panic attacks and migraine preventions that should not be used with albuterol due to bronchospasm risk and metroprolol (used for heart failure to reduce HR and contractility) and atenolol are selective and will be commonly used for exercise induced angina to decrease myocardial demand of oxygen by attenuating to increased HR and BP during exercise; bradycardia, dizziness; check BP and pulse need to be tapered off due to risk of angina, MI, and death if stopped suddenly

Question 27

What are dual-action alpha 1 and beta receptor blockers? Examples? Side effects? Nursing considerations?

Answer 27

works in the peripheral blood vessels to cause vasodilation and target beta receptors in the heart to lower HR; labterlol and carvediol; erectile dysfunction; check BP and HR

Question 28

What are angiotension-conversting enzyme inhibitors? Examples? Side effects? Nursing considerations?

Answer 28

often first line drugs for heart failure and hypertension, inhibits ACE to prevent conversion of angiotensin I to angiotensin II to promote vasodilation and prevent aldosterone secretion that will then stimulate diuresis to decrease blood volume; "pril" captopril, enalapril, fosinopril, lisinopril (diuresis promoting to decrease CO and decrease preload); presistent dry cough, hyperkalema, fatigue, dizziness, angioedema, lithium toxicity; want to avoid potassium sparing diuretics and supplements

Question 29

What are angiotensin II receptor blockers? Examples? Side effects? Nursing considerations?

Answer 29

similar to ACE inibitors but will block angiotensin II from binding to receptors to prevent aldosterone secretion therefore causing a diuresis effect; "sartans" losartan, valsartan (used for heart failure and will reduce systemic vascular resistance and reduce afterload), irbesartan, candesartan; angina, fatigue, weakness, diarrhea; toxic during to fetus during pregnancy and nursing

Question 30

What are calcium channel blockers? Examples? Side effects? Nursing considerations?

Answer 30

used in hypertension and angina, will prevent calcium from binding to receptors to cause vasodilation and prevent muscle contraction of all arteries in the body thus decreasing vascular resistance and increasing oxygen supply; "dipines" amlodipine, nimodipine; hypotension, peripheral/pitting edema; no grapefruit juice as it can lead to toxicity and hypotension

Question 31

What is angina pectoris? How do we treat?

Answer 31

when oxygen supply does not meet the demand for the heart the muscle will hurt; need to either increase blood flow thus increasing oxygen supply or need to decrease oxygen demand of the heart by decreasing oxygen consumption by the heart

Question 32

What are nitrates and nitriles? Uses? Forms? Contraindications? Example? Nursing implications?

Answer 32

very potent vasodilator that effects the smooth muscle of coronary arteries to increase the amount of oxygen delivered to the heart; prophylaxis and angina (stable, unstable, and vasopastic); those that bypass the first pass effect: SL, IV, transdermal patches and sprays. those that don't bypass the first pass effect: chewable tabs, oral caps/tabs, ointments. Rapid acting used to treat acute anginal attacts include SL and IV. Long-acting used to prevent angina include tabs and topicals; known drug allergy, severe anemia, hypotension; use of erectile dysfunction drugs ("fil") including sildenafil, tadalafil, and vardenafil; isosorbide dinrate is an oral nitrate that produces a steady and therapeutic response, available in rapid-acting SL tabs, immediate-release tabs, and LA oral dosage; SL: never chew and swallow, potency lost in 3 months after bottle opened, lie down after taking. Topical and transdermal: rotate sites, remove old medication. IV: special non-PVC tubing and bags, frequent vitals

Question 33

What is tolerance of nitrates and nitriles? Prevention?

Answer 33

occurs in patients taking them around the clock or with long-acting forms; allow a regular nitrate-free period to allow enzyme pathways to replenish, ie. transdermal forms remove patches at bedtime for 8 hours and apply new patch in the morning

Question 34

What are the relative amounts of sodium and water reabsorption in the kidneys?

Answer 34

proximal tubule: most is reabsorbed, loop of Henle: some is reabsorbed, distal tubule tubule: only a little is reabsorbed

Question 35

What are diuretic drugs? Uses?

Answer 35

first line of antihypertension drugs, removes water and sodium; hypertension, heart failure, renal failure

Question 36

What are carbonic anhydrase inhibitors? Uses? Examples?

Answer 36

blocks carbonic anhydrase to prevent hydrogen ions from being exchanged; not the most common as a diuretic, seen more in usage for pancreatitis; acetazolamide (most common)

Question 37

What are loop diuretics? Uses? Examples? Side effects? Nursing considerations?

Answer 37

works at the ascending loop of Henle to inhibit reabsorption of chloride and sodium and increase prostaglandin secretion in the kidneys to promote vasodilation and reduce vascular resistance; common, potent, and effective for hypertension, heart failure, and edema; "semide" furosemide (Lasix) and torsemide (demadex) given IV or PO; hypokalemia, hypovolemia, dizziness, tinnitus; sulfonamide cross reaction, monitor electrolytes and complete blood count, timing of doses

Question 38

What are osmotic diuretics? Uses? Examples? Side effects? Nursing considerations?

Answer 38

works mainly in the proximal tubule; not typically used regularly as a diuretic due to rapid diuresis, acute renal failure to help with vasodilation, swelling of the brain to reduce intracranial pressure, and if a toxin was ingested; mannitol most commonly used, given IV; convulsions, thrombophlebitis, pulmonary congestion; given IV through filter due to quick crystallization, careful monitoring of neural, cardiac, and renal

Question 39

What are potassium sparing diuretics? Uses? Examples? Side effects? Nursing considerations?

Answer 39

works in the collecting ducts and distal tubules and interfere with sodium-potassium exchange and binds to aldosterone to block reabsorption of sodium and water; can protect heart from permanently remodeling after IM; spironolactone and amiloride; hyperkalemia (especially if used with other meds like ACE inhibitors), gynecomastia in men, and amenorrhea, irregular menses, postmenopausal bleeding in females; medical interactions with potassium supplements and lithium toxicity

Question 40

What are thiazide and thiazide-like diuretics? Uses? Examples? Side effects?

Answer 40

works in teh distal tubule to prevent reabsorption of sodium, chloride, and potassium and promote vasodilation of small blood vessels to decrease peripheral vascular resistance; common first line med for hypertension and heart failure also used for edema; thiazide diuretics: "thiazide" hydrochlorothiazide and chlorothiazide. thiazide-like diuretics: metolazone; overall safe, side effects typically seen at the start of therapy until the body adjusts, hypokalemia (considered potassium wasting), hyponatremia, decreased libido, dizziness

Question 41

What is heart failure? Manifestations?

Answer 41

when the heart cannot keep up with the demand of the body and will undergo irreversible hypertrophy in order to try and keep up; SOB, dyspnea, fatigue, retaining fluid, pulmonary edema

Question 42

What do heart failure drugs do?

Answer 42

do not cure but rather relieve the work of the heart by reducing force of contractility, increasing contractibility to increase efficiency, reduce work of heart by reducing fluid overload

Question 43

What are phosphodiesterase inhibitors? Example? Side effects? Nursing considerations?

Answer 43

inhibits phosphodiesterase; milrinone given IV only to increase heart contractability, decrease peripheral vascular resistance thereby reducing afterload; ventricular arrhythmia, headache, hypokalemia, tremor; short term use if not responding to other medications, used in ICU

Question 44

What is digoxin? Uses? Toxic symptoms? Nursing considerations?

Answer 44

a type of cardiac glycoside derived from foxglove, digitalis plant that will increase contractibility and stroke volume and reduce size of the heart during diastole to increase coronary circulation; has a very narrow therapeutic window and used for HF and Afib; visual disturbances (light have halo or flickers), bradycardia, confusion, headache, dizziness, ECG changes; check dosage forms and follow instructions for administrations, avoid high fiber foods, interactions with aminodarone and verapamil which can increase digoxin levels by 50%, monitor drug levels (0.5 to 2 ng/mL), low potassium increases toxicity

Question 45

What is digotoxin toxicity antidote? When is it given?

Answer 45

digoxin immune Fab (Digibind) therapy; significant toxicity cases including hyperkalemia in a digitalis-toxic patient, life threatening cardiac dysrhythmias, life threatening digoxin overdose

Question 46

What are antilipemic drugs?

Answer 46

very common to treat high lipids, want to try lifestyle changes first, high lipids puts us at risk for heart disease due to narrowing of arteries from inflammatory response leading to plaque formation especially in bad coronary arteries

Question 47

What are the types of lipoproteins?

Answer 47

very low density lipoproteins (VLDL) produced by liver to transport endogenous lipids to cell, low density lipoproteins (LDL) "bad", high density lipoproteins (HDL) "good" responsible for "recycling" cholesterol

Question 48

What are statins? Examples? Side effects? Nursing considerations? Interactions?

Answer 48

inhibits HMG-CoA reductase which is used by the liver to create VLDLs, first line drug that can decrease LDL by 50% and triglycerides by 10-30% but does not knowingly increase HDL; "statin" atorvastatin, simvastatin, pravastatin, rosuvastatin; upset stomach, elevated liver enzymes, rhabdomyolysis (can lead to renal failure and death but is reversible), muscle pain and soreness causing urine to become brown; should be taken usually in evening as this is when cholesterol is produced; warfarin (inhibits metabolism of warfin and increases risk of bleeding), erythromycin, azoles, grapefruit juice

Question 49

What are bile sequestrants? Example? Side effects? Nursing considerations?

Answer 49

not as popular for high lipid medications and will prevent bile acid from being reabsorbed in small intestine thereby blocking reabsorption of LDL, can lower LDL by 15-30%; cholestyramine and colesevelam; constipation, heart burn, belching, bloating over time they get better; other medications must be taken either 1 hour before or 4 to 6 hours after

Question 50

What is niacin? Uses? Side effects?

Answer 50

vitamin B3, could increase lipase activity to break down LDL, and triglycerides and increase HDLs; often used at lower dosages with other lipid lowering medications; flushing, pruritus due to histamine release

Question 51

What are fibric acid derivatives? Examples? Side effects?

Answer 51

primarily lowers triglycerides, total cholesterol, and VLDL with a slight increase in HDL but no effect on LDL. could possilby activate lipase to break down lipids and triglycerides, stop free fatty acids from being released and triglyceride synthesis in the liver; genfibrozil and fenofibrate; diarrhea, nausea, increased risk of gall stones, increased liver enzymes, enhance anticoagulants

Question 52

What are cholesterol absorption inhibitors? Example?

Answer 52

inhibits absorption in the small intestine to lower total cholesterol, LDL, and triglycerides and increase HDL, often combined with statins; ezetimibe

Question 53

What is asthma? Causes? Manifestations?

Answer 53

recurrent and reversible shortness of breath; allergy, bronchospasm, inflammation and edema of bronchial mucosa, production of viscous mucus; wheezing, dyspnea, chronic cough

Question 54

What is COPD?

Answer 54

chronic obstructive pulmonary disease is a progressive irreversible lung disease often occuring as a result of prolonged exposure to irritants that will cause remodeling of the alveoli to cause them to become dysfunctional. cilia are removed from lung making gas exchange and secretion of mucous hard leading to inefficient breathing as air gets trapped in lungs

Question 55

What are bronchodilators? Drug class examples?

Answer 55

relax smooth muscle and dilate airways; beta-adrenergic agonists, anticholinergics, and xanthine derivatives

Question 56

What are beta-adrenergic agonists? Examples? Side effects?

Answer 56

most common bronchodilator that will stimulate beta-2 adrenergic receptors to produce cAMP and cause bonchodilation; short-acting beta agonist inhalers are rescue inhalers that should be used during acute asthmatic attack examples include albuterol (side effects include tachycardia, headache, tremor, and jitters) and levalbuterol. long-acting beta agonist: can take 30-45 minutes to take effect, seen as a combination drugs examples include salmeterol, formoterol, and afromoterol

Question 57

What are xanthine derivatives? Examples? Side effects? Nursing considerations?

Answer 57

plant alkaloids that increase cAMP to cause smooth muscle relaxation and bronchodilation, stimulates CNS to increase respiration and cardiac output; theophylline (PO) and aminophylline (IV); heart palpitations, nervousness, insomnia, tremors, nausea, vomiting, anorexia; avoid other sources of caffein, good cardiac assessments

Question 58

What are drug class examples of nonbronchodilating respiratory drugs?

Answer 58

leukotriene receptor agonists, corticosteroids, phosphodiesterase-4 inhibitors

Question 59

What are leukotriene receptor agonists? Examples? Side effects? Nursing considerations?

Answer 59

binds to leukotriene receptors to prevent leukotriene binding thus reducing mucus production and inflammation; montelukast (chewable tab) and zafirlukast; nausea, headache, diarrhea; for asthma it can be given prophylactically in adults and children older than 12 but will take about a week to work, for allergic rhinitis can be given to children older than 1

Question 60

What are corticosteroid respiratory drugs? Examples? Side effects? Nursing considerations?

Answer 60

have anti-inflammatory properties that if given PO or IV is more systemic effect or inhaled for a localized effect takes a couple of weeks for full effects to be seen; fluticasone, budesonide, beclomethasone, fluticosone/salmeterol (corticosteroid and LAMA for a more powerful effect); thrush, dry mouth coughing; if given PO used to treat acute exacerbations or severe asthma for a short period of time with a prednisone taper side effects include hyperglycemia and mood changes, if used with SAMAs: SAMA will first open lung up then several minutes later use corticosteroid

Question 61

What is roflumilast? Use? Side effects?

Answer 61

a phosphodiesterase-4 inhibitor that prevents coughing and excess mucus; used to decrease frequency of life-threatening COPD exacerbations; nausea, diarrhea, headache, insomnia, dizziness, weight loss

Question 62

What is hydralazine? Side effects?

Answer 62

vasodilator; dizziness, tachycardia, headache, edema

Question 63

What is minoxidil? Additional use?

Answer 63

vasodilator; promote hair growth

Question 64

What is nitroprusside? Route? Side effects?

Answer 64

vasodilator; IV only therefore causes rapid onset; will be given only during hypertensive emergency; brachycardia, decreased platelet aggregation, hypotension, headache

Question 65

What is tuberculosis? Cause? Types? Risk factors?

Answer 65

respiratory tract infection; mycobacterium tuberculosis; latent: don't develop symptoms and cannot spread it but will have a positive TB skin/blood test, if untreated may get active TB active: symptomatic TB; typically those who become infected are able to fight it off but young children, older people, and immunocompromised

Question 66

What is the mantoux test?

Answer 66

purified TB protein derivative test delivered intradermally to detect exposure, induration if positive

Question 67

What is bacille calmette-guerin vaccine? Interaction with test?

Answer 67

vaccine for TB that reduces active TB by 60-80% and prevents severe cases, does not prevent infection, not typically administered in US, can cause false positive on mantoux test

Question 68

What drugs are given to those exposed to TB or have latent? Treatment plan?

Answer 68

isoniazid for 6-9 months daily (most common) rifampin for 4 months daily (given for those who have reaction to isoniazid or contraindications) Isoniazid and rifampentine: 3 months once a week

Question 69

What are the first line drugs for those with active TB? MOA? Side effects? Treatment plan?

Answer 69

RIPE rifampin: inhibits RNA synthesis, can cause tears, urine, and sweat to turn orange/red isoniazid: effects cellular activity and cell wall synthesis, most common used, can cause: vitamin B6 deficiency and peripheral neuropathy pyrazinamide: action not completly understood (bacterialcidal or static), hyperuricemia or gout like symptoms ethambutol: effects lipid synthesis, can cause effects with eyes take four drugs for eight weeks daily and then isoniazid and rifampin daily for 18 weeks, total of 6 months of treatment

Question 70

What is MDR-TB? What are drugs for it? Side effects? Interactions?

Answer 70

TB resistant to isoniazid adn rifampin; bedaquiline: ATP synthase inhibitor, should be taken with food and avoid alcohol, interaction with certain heart medications could cause QT prolongation, side effects: headache, chest pain, nausea. Streptomycin: aminoglycoside antibiotic, side effect: ototoxicity

Question 71

What are nursing considerations for TB drugs?

Answer 71

patient education is critical: side effects, length of treatment, strict adherence, need for multiple medications, cultural considerations, monitor labs