Final - Resp - not meds in here

Question 1

What type of cells in the epithelial lining produce mucus?

Answer 1

Goblet cells

These cells play a crucial role in trapping particles and pathogens.

Question 2

What is perfusion?

Answer 2

The movement of blood through the pulmonary circulation

Perfusion is necessary for delivering oxygen to the tissues.

Question 3

What is a cough?

Answer 3

Involuntary response to mechanical or chemical stimulation of the bronchial tree

A cough serves to eliminate stimulants from the respiratory tract.

Question 4

What are the two types of cough?

Answer 4

Productive and non-productive

A productive cough brings up mucus, while a non-productive cough does not.

Question 5

What is hemoptysis?

Answer 5

Coughing up blood

Hemoptysis can be associated with conditions such as tuberculosis, lung cancer, or infection.

Question 6

What is atelectasis?

Commonly occurs?

Answer 6

Collapse of alveoli, resulting in decreased gas exchange

Commonly occurs post-op and can also occur due to compression by a mass.

Question 7

What are the common causes of atelectasis?

Answer 7

• Post-operative complications
• Compression by a mass

Question 8

What is hypoxia?

Answer 8

Oxygen level in blood inadequate to meet needs of the tissue

Question 9

What is hypoxemia?

Answer 9

Insufficient amount of oxygen in blood

Question 10

Rhinosinusitis: Antitussives

Robutussin- DM

Answer 10

Used to suppress non-purposeful cough
-Depresses the cough receptors in brain, throat, trachea, or lungs

Drugs in Class:
Benzonate (Tessalon Perles)

Codeine
Hydrocodone bitartrate

Dextromethorphan (Delsym) -Adverse effects: nausea, drowsiness, rash, and difficulty breathing *No alcohol/psych drugs

Adverse effects: Drying of mucus membranes, headache, drowsiness, dizziness

All Drugs are Pregnancy Category C(D during labor)

Question 11

How do antitussives work?

Answer 11

Used to suppress non-purposeful cough
-Depresses the cough receptors in brain, throat, trachea, or lungs

Question 12

Side effects of antitussives?

Answer 12

Adverse effects:
Drying of mucus membranes, headache, drowsiness, dizziness
Dextromethorphan – nausea, drowsiness, rash, and difficulty breathing

Question 13

Nursing considerations for antitussives?

contraindications/dont use for longer than…?

Answer 13

Contraindications:
History of allergy to drugs, those with a head injury, or could be impaired by CNS depression
Caution in those with asthma and COPD (difficulty breathing)
Caution in children with atopic syndrome (rash)
Dextromethorphan – Avoid use with alcohol and several psych drugs

Dont use for more than 5 days unless specified

Question 14

Medications in antihistamines class

BV ZACA

ONLY THE BOLD ONES ON POWER POINT

Answer 14

First Gen: Diphenhydramine(Benadryl)**
Hydroxyzine (Vistaril

Second Gen: Certirizine (Zyrtec)**
Loratadine (alavert, claritin)

Third Gen: Fezofenadine (allegra)

Question 15

Indications for antihistamines?

Answer 15

Used for the relief of symptoms associated with allergic responses (i.e. seasonal allergies, angioedema, motion sickness, allergic reactions)

Question 16

How do antihistamines work?

also have what effects? (2)

Answer 16

Block the release or action of histamine at the histamine-1 receptor sites

Also have anticholinergic and antipruritic effects

Question 17

Side effects of antihistamines?

Answer 17

May cause dryness of mucus membranes and thickening of secretions
drink plenty of fluids

Question 18

Nursing considerations for antihistamines?

Answer 18

• May cause drowsiness, dizziness, or impaired mental alertness
• Do not smoke
• Do not drive or operate heavy equipment after taking
• Avoid other medications that also cause sedation
• Do not take more than one antihistamine at a time
• Many otc cold and “nighttime” or “PM” sinus and allergy medications contain an antihistamine
• Also otc sleep aids contain Diphenhydramine (Benadryl)
• Avoid prolonged exposure to sunlight

**Take with meals to avoid GI upset

Question 19

Medications in expectorants class

only 1!

Answer 19

Guaifenesin (Mucinex)
Onset: 30 minutes
Duration: 4-6 hours

Question 20

How do the expectorants work?

Answer 20

Increase productive cough to clear the airway by:
Liquify lower respiratory tract secretions
Decrease the viscosity of secretions

Question 21

Side effects of expectorants?

Answer 21

rash, headache, nausea/vomiting, dizziness

Question 22

Nursing considerations of expectorants?

Answer 22

Contraindications:
History of allergy to drugs
Persistent cough due to smoking, asthma, emphysema
Productive cough lasting more than 1 week

Question 23

Medications in mucolytics class?

Pulverize mucus

Answer 23

Acetylcysteine (Acetadote, parvolex)
Fast onset via nebulizer
Dornase alfa (Pulmozyme

Question 24

Indications for mucolytics?

Answer 24

Used to treat cystic fibrosis, asthma, bronchiectasis, COPD, and chronic bronchitis

Question 25

How do mucolytics work?

Answer 25

Breakdown and liquefy of respiratory tract secretions

Question 26

Side effects of mucolytics?

Answer 26

GI upset, stomatitis, rhinorrhea, Bronchoconstriction, bronchospasm, urticaria, ras

Question 27

Nursing considerations for mucolytics? | contraindications/ can be given what form?

Answer 27

History of allergy to drugs Presence of acute bronchospasm - Can be given in nebulizer form- pt should know how to use one

Question 28

Respiratory: herbal meds | Cold remidies

Answer 28

* Echinacea different preparations no better that a placebo * Vitamin C decrease incidence and severity of colds and influenza Regular used appears to play a role in the defense mechanisms of the respiratory system * Zinc Sulfate decrease incidence and severity of cold symptoms in adults Can lead to loss of smell with nasal zinc *

Question 29

Role of histamine r/t the respiratory system?

Answer 29

First chemical mediator releases in immune and inflammatory responses

Question 30

Asthma (pathophy) | overtime what can happen?

Answer 30

There are 3 major components: Bronchoconstriction – in response to a trigger Airway inflammation – due to t-helper cells and ige-mediated pathways Bronchial hyperresponsiveness –due to activated mast cells which lead to the release of inflammatory mediators (Histamine, prostaglandins, and leukotrienes) ## Footnote Overtime, Airway thickening and hyperplasia of the smooth muscle may lead to remodeling of lung tissue

Question 31

Exercise-induced asthma: Treatment (3)

Answer 31

*Short-acting beta-agonists (SABAs) -**take before exercising.** include albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA) and levalbuterol (Xopenex HFA). are inhaled medicines that help open airways. Should not be used every day As it can make them less effective. *Ipratropium (Atrovent HFA) is an inhaled medicine that relaxes the airways 

Question 32

Nocturnal asthma ## Footnote You cant go to the MALL at night

Answer 32

symptoms: wheezing, chest tightness, difficulty breathing at night Treatment: montelukast (Singulair) (leukotriene) Albuterol Long-Acting-beta agonists (salmeterol + steroid) ## Footnote Worse at night and may disrupt sleep

Question 33

Status asthmaticus

Answer 33

**Acute, Severe asthma that is refractory to treatment. Can be life threatening** Patient may have no wheezing or cough

Question 34

Adrenergic meds: Short-acting Beta-Agonists (SABA) | bronchodilator 3 types PRO VENT PROVENT ## Footnote How do use?

Answer 34

Known as "rescue drug" Always used first to treat an acute attack Meds: Albuterol (proair, ventolin, proventil) Administration Shake the inhaler before use 2-4 puffs every 20 minutes, up to 3 doses No relief, call the physician

Question 35

How do adrenergic medications work | SABA

Answer 35

Causes Smooth muscle relaxation in the lungs, muscles, and liver; vasodilation of the bronchial passage; release of insulin

Question 36

Side effects of adrenergics? | SABA

Answer 36

Side effects: Tachycardia, tremors/shakiness, palpitations, anxiety, sweating, and arrhythmias, and insomnia

Question 37

Nursing considerations for adrenergic medications | avoid using with

Answer 37

Avoid use with Beta-blockers and Nsaids

Question 38

How do anticholinergics work? ## Footnote aka- muscarinics

Answer 38

Blocks muscarinic cholinergic receptors by antagonizing the neurotransmitter acetylcholine in smooth muscle ## Footnote USED AFTER SABA

Question 39

Side effects of anticholinergics?

Answer 39

Local: dry mouth, hoarseness Systemic: dizziness, headache, fatigue, palpitations, urinary retention

Question 40

Medications in muscarinic receptors class | aka anticholinergic ## Footnote Short/Long

Answer 40

-Ipratropium Bromide (Atrovent) *Short acting* -Tiotropium Bromide (Spiriva) *Long acting*

Question 41

Muscarinic Antagonists: Ipratropium (Atrovent) | allergies?

Answer 41

Short-acting (SAMA) Can cause anticholinergic side effects NOT FOR ACUTE BRONCHOSPASM Can not use if allergic to peanuts or SOY products

Question 42

Muscarinic Antagonists: Tiotropium Bromide (Spiriva)

Answer 42

Long-Acting (LAMA) Inhibits the muscarinic M3 receptors in the lungs Can cause a cough/dry mouth Not for acute bronchospasm

Question 43

Methylxanthines: General info | Bronchodilator

Answer 43

THEOPHYLLINE Bronchodilator **Current asthma guidelines do not support it's use ** May be used at second-line treatment Narrow therapuetic range Several drug interations **DO not use if breastfeeding or pregnant**

Question 44

Side effects/Nursing considerations of Methylxanthines?

Answer 44

Side effects: N/v, irritability, tremors, insomnia, tachyarrhythmias Requires drug monitoring due to very narrow therapeutic range Avoid caffeine Avoid smoking

Question 45

Corticosteroids: Meds

Answer 45

Beclomethasone (Qvar) Fluticasone (Flovent)

Question 46

Indications/ how do they work: corticosteroids? | How much makes it into the lungs? Use in combo with? ## Footnote When youre on steroid your dick gets..

Answer 46

Mainstay of asthma treatment and advanced COPD Suppress airway inflammation Decrease mucus secretions Suppress the release of histamines by mast cells Increase sensitivity of beta-2 adrenergic receptors **only about 10-30% make it into the lungs** | USED IN COMBINATION WITH LABA (Salmeterol) ## Footnote Qvar and Flovent

Question 47

Corticosteroids: Flovent | QUIETLY FLOppy

Answer 47

May be used alone or in combination with other bronchodilators - Caution with hepatic patients

Question 48

Side effects of corticosteroids (flovent)?

Answer 48

Side effects: headache, dry mouth, cough, hoarseness, candida infection, adrenal insufficiency, hyperglycemia

Question 49

Nursing considerations for corticosteroids (flovent)?

Answer 49

Teach patient to rinse mouth after use Inhaled steroids are not for emergency use

Question 50

Leukotriene modifiers: singulair - when is it taken

Answer 50

Taken at night | Montelukast

Question 51

Indications for Leukotriene modifiers (singulair)?

Answer 51

Asthma (rarely used) Exercise-Induced Bronchoconstriction Allergic rhinitis

Question 52

Side effects of Leukotriene modifiers (singulair)? | any SINGle guy will make you...

Answer 52

Headache, GI symptoms, liver dysfunction Generally, well tolerated Neuropsychiatric: agitation, aggression, depression, sleep disturbances, suicidal thoughts & behavior

Question 53

Nursing considerations for Leukotriene modifiers (singulair)? | Reduced effect if taken with..

Answer 53

Age limitations (Exercise-induced) - 1 tablet at least 2 hours before exercise for patients 6 years and older. Seasonal allergic rhinitis: Daily, age 2 and older Asthma – age 12 months and older ## Footnote Reduced effect if taken with phenytoin

Question 54

Any black box warnings for Leukotriene modifiers (singulair)?

Answer 54

black box warning: psychiatric side effects such as aggression, depression, agitation, sleep disturbances, suicidal thoughts, and suicide.

Question 55

Immunosuppressant monoclonal antibodies: Xolair

Answer 55

Adjunctive therapy for moderate to severe asthma | omalizumab

Question 56

Indications for immunosuppressant monoclonal antibodies (xolair)?

Answer 56

Used in children 6+ years

Question 57

Side effects of immunosuppressant monoclonal antibodies (xolair)?

Answer 57

pain at injection site, headache, nausea, fatigue

Question 58

Any black box warnings for immunosuppressant monoclonal antibodies (xolair)?

Answer 58

<0.1% anaphylaxis

Question 59

Mast cell stabilizers: Cromolyn

Answer 59

Prevent bronchoconstriction by preventing the release of chemical mediators from mast cells - Effective long-term therapy - - Not for treatment of asthma attacksd

Question 60

Side effects of mast cell stabilizers (cromolyn)?

Answer 60

Side effects: hypotension, sore throat, taste changes, bronchospasm, chest pain, restlessness, nausea, dizziness

Question 61

How to use an inhaler? | what to do after??

Answer 61

* Shake canister before each use * Breath out steadily * Place mouthpiece between lips * Tilt head back slightly * Depress the inhaler while taking a slow, deep breath in * Hold breathe for about 10 seconds then exhale slowly * Repeat after 5 minutes, if needed * Clean mouthpiece ## Footnote Rinse mouth after

Question 62

Rhinitis | *Rhinosinusitis- Path. of both are similar but affects diff structures

Answer 62

Inflammation and congestion of the nasal mucosa - Seasonal (hay fever) Inflammatory response to a specific allergen -Symptoms: Nasal congestion, sneezing, stuffiness, watery eyes

Question 63

Common Clinical manifeststions- Rhinosinusitis

Answer 63

Nasal Congestion Cough Bronchial Secretions

Question 64

Sinusitis | *Rhinosinusitis- Path. of both are similar but affects diff structures ## Footnote Timing, causes, symptoms

Answer 64

Inflammation of the mucus membranes lining the para sinuses Can be acute, subacute, or chronic -Viral (7-10days) - Allergies -Bacterial (up to 4 weeks) -Symptoms: Headache, pain over sinus area, pressure, nasal congestion, purulent discharge

Question 65

Pharmacological management of Rhinosinusitis

Answer 65

Treatment of nasal congestion and cough -May be OTC/prescriptions -Analgesics (acetaminophen/ibuprofen)

Question 66

Rhinosinusitis Med classes: | Treatmeant for nasal congestions/cough

Answer 66

Nasal decongestants Anittussives Antihistamines Expectorants Mucolytics

Question 67

Nasal Decongestants: General info

Answer 67

Used to relieve nasal obstruction and discharge -decreases inflammation of nasal membranes Adverse effects: local stinging and burning Rebound congestion SNS symptoms: increased HR and BP, Urinarty retention Pt education: dont use for more than 5 days unless instructed otherwise ## Footnote All drugs are category C pregnancy

Question 68

Nasal Decongestants: Drugs in class

Answer 68

Pseudoephedrine (Sudafed) Oxymetazoline (Afrin) Phenylephrine (Vazculep; Neo-synephrine) Fluticasone (Flonase) Triamcinolone (Nasacort)

Question 69

Asthma- Clinical Manifestations

Answer 69

Dyspnea, wheezing, cough, prolonged expiration Chest tightness Accessory muscle use

Question 70

Types of Bronchodilators

Answer 70

Beta 2 adrenergic agonists (short/Long) Muscarinic (anticholinergic) antagonists(short/long) Leukotriene Receptor Antagonists Methylxanthines

Question 71

Short acting- Albuterol Administration, contraindications, side effects

Answer 71

Administration: Exercise-induced – 2 puffs 15 to 30 minutes before exercising Bronchospasm/Constriction Inhaler solution – 3 to 4 times a day Inhaled powder – 3-4 times a day Contraindications: CAD, HTN, Diabetes, Seizure disorder Side Effects: Muscle tremors Cardiac: Angina, tachy, palpitations CNS: agitations, anziety, insomnia, seizures

Question 72

Adrenergics- Long-acting Beta Agonists ## Footnote LABA

Answer 72

Maintenece Drug- allows airway to stay open -Seen as inhaler-metered dose or dry powder -**used in combination with steroid** Meds: Salmeterol (serevent)

Question 73

Long- acting Beta Agonist: Black-box warning and information

Answer 73

**salmeterol (Serevent) and formoterol (Foradil) should not be used without a steroid in asthma for all ages Need to weigh the risk vs benefitsalmeterol (Serevent) and formoterol (Foradil) should not be used without a steroid in asthma for all ages Need to weigh the risk vs benefit** NEVER USE AS A RESCUE INHALER - SHOULD NOT BE USED IN CHILDREN LESS THAN AGE 4 and NEVER WITHOUT A STEROID ## Footnote USE WITH A STEROID!!