Lewis 29 - Upper Respiratory Problems Flashcards by Miss Elizabeth Stille

MOA/Class

diphenhydramine, hydroxyzine – 1st generation
cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra) – 2nd generation

Block histamine from binding to H1 histamine receptors on basophils and mast cells (thus preventing the release of additional histamine and other inflammatory mediators).

Antihistamine

Tucker 54

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Side effects

diphenhydramine, hydroxyzine – 1st generation
cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra) – 2nd generation

Anticholinergic effects
Drowsiness (1st generation drugs) especially when combined with other CNS depressants; also prolonged QT interval and urinary retention

Tucker 54

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Nursing Considerations

diphenhydramine, hydroxyzine – 1st generation
cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra) – 2nd generation

Stop several days before allergy testing. Manage anticholinergic (drying) effects. Most beneficial when given early in histamine-induced reactions.

Tucker 54

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Indications

diphenhydramine, hydroxyzine – 1st generation
cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra) – 2nd generation

Allergic rhinitis, adjuct for anaphylaxis, pruritis, motion sickness, *insomnia (use with caution especially in older adults).

Tucker 54

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MOA/Class

montelukast

Leukotrienes are produced in leukocytes such as mast cells. Once released from the mast cell during an inflammatory response, leukotrienes mediate additional responses such as bronchial constriction
LTRAs prevent leukotrienes from attaching to receptors on lymphocytes and alveolar macrophages thus reducing the inflammatory response thus preventing smooth muscle contraction (bronchi), decreasing mucus secretion, decreasing vascular permeability

Leukotriene Receptor Antagonist (LTRA)

Tucker 55

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Side Effects

montelukast

Headache, nausea, diarrhea, cough, elevated LFTs, myalgia, neuropsychiatric events

Tucker 55

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Nursing Considerations

montelukast

Tablets contain lactose (monitor patients for lactose intolerance)
Maintenance therapy
Safe for young children (used in ages 2 years and older)

Tucker 55

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Indications

montelukast

Asthma, seasonal allergic rhinitis

Tucker 55

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MOA/Class

pseudoephedrine, phenylephrine

pseudoephedrine (alpha-adrenergic); phenylephrine (alpha- and beta-adrenergic)
Vasoconstriction of blood vessels specifically in the nasal passages and sinuses

Adrenergic - Oral decongestant

Tucker 30

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Side Effects

pseudoephedrine, phenylephrine

HTN, nervousness, insomia, vision changes/light sensitivity

Tucker 30

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Nursing Considerations

pseudoephedrine, phenylephrine

May worsen narrow angle glaucoma.
Use cautiously with other cardiac or CNS medications.

Tucker 30

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Indications

pseudoephedrine, phenylephrine

Cold/allergy congestion, otitis media, hypotension, pupil dilation

Tucker 30

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MOA/Class

cromolyn sodium

Suppresses release of histamine and other inflammatory mediators from mast cells

Mast-Cell Stabilizer

Tucker 55

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Side Effects

cromolyn sodium

Nasal irritation (when administered as a nasal spray)

Tucker 55

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Nursing Considerations

cromolyn sodium

Usually started 1 week before pollen season starts and use throughout pollen season

Tucker 55

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Indications

cromolyn sodium

Allergic conditions (usually reserved for those whose symptoms are not managed well with other therapies).

Tucker 55

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MOA/Class

fluticasone

Intranasal

Steroids stabilize leukocytes (WBCs) preventing the release of intracellular chemical/inflammatory mediators
Restore/increase bronchial responsiveness to beta-adrenergic receptor stimulation

Glucocorticoid/steroid

Tucker 36, 54

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Side Effects

fluticasone

Intranasal

Localized dryness; limited/few systemic adverse effects

Tucker 36, 54

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Nursing Considerations

fluticasone

Intranasal

May be used prophylactically.

Tucker 36, 54

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Indications

fluticasone

Intranasal

Allergic rhinitis, inflammation after removal of nasal polyps

Tucker 36, 54

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MOA/Class

ipratropium

Intranasal

Study These Flashcards

Decreased secretions due to anti-SLUDGE effects

Anticholinergic

Tucker 33

Side Effects

ipratropium

Intranasal

Study These Flashcards

Localized dryness; limited/few systemic adverse effects

Tucker 33

Nursing Considerations

ipratropium

Intranasal

Study These Flashcards

May be used prophylactically.

Tucker 33

Indications

ipratropium

Intranasal

Study These Flashcards

Allergic rhinitis

Tucker 33

# MOA/Class oxymetolazine (Afrin); phenylephrine | Intranasal

Vasoconstriction of blood vessels specifically in the nasal passages and sinuses | Adrenergic/topical decongestant ## Footnote Tucker 54

# Side Effects oxymetolazine (Afrin); phenylephrine | Intranasal

Nasal dryness ## Footnote Tucker 54

# Nursing Considerations oxymetolazine (Afrin); phenylephrine | Intranasal

Use for more than 3-5 days can result in rebound congestion; Do not use for patients with HTN or other conditions that may be worsened by systemic absorption (glaucoma, coronary disease, etc.) ## Footnote Tucker 54

# Indications oxymetolazine (Afrin); phenylephrine | Intranasal

Nasal congestion ## Footnote Tucker 54

# MOA/Class dextromethorphan; benzonatate, codeine

Dextromethorphan – suppresses cough reflex in CNS Benzonatate – numbs stretch receptors in the respiratory tract, thus prevent stimulation of the cough center Codeine – CNS depressant/opioid – suppress cough reflex in CNS; drying effect | Antitussive ## Footnote Tucker 54

# Side Effects dextromethorphan; benzonatate, codeine

Drowsiness, dry mouth , dizzy/lightheadedness ## Footnote Tucker 54

# Nursing Considerations dextromethorphan; benzonatate, codeine

Consider benefit of expectorant for productive cough instead of cough suppressant Encourage other measures to help cough - humidity, cool temperatures, fluids, topical lozenges, etc. ## Footnote Tucker 54

# Indications dextromethorphan; benzonatate, codeine

Dry cough; persistent cough ## Footnote Tucker 54

# MOA/Class echinacea

Thought to be immunostimulant | Herbal ## Footnote Tucker 60

# Side Effects echinacea

N/V, dizziness, headache ## Footnote Tucker 60

# Nursing Considerations echinacea

Consider potential for drug interactions ## Footnote Tucker 60

# Indications echinacea

Colds, flu, viral infections ## Footnote Tucker 60

# MOA/Class acetaminophen

Acts on the hypothalamus to decrease fever. Inhibits prostaglandin synthesis. | Analgesic/antipyretic ## Footnote Tucker 16

# Side Effects acetaminophen

Generally well-tolerated. Hepatotoxicity. ## Footnote Tucker 16

# Nursing Considerations acetaminophen

Maximum dose 4g/day for most patients; May be reduced to 2-3 g/day for patients with hepatic impairment. Combined hepatotoxic effects with alcohol. Be aware of OTC drugs that may also contain acetaminophen (daily limit). Acetylcystine may be used for acute hepatotoxicity/overdose. May alter metabolism of drugs requiring liver biotransformation. ## Footnote Tucker 16

# Indications acetaminophen

Mild pain and fever ## Footnote Tucker 16

# MOA/Class oseltamivir (Tamiflu)

Prevents synthesis of viral DNA/release of viral particles. | Antiviral ## Footnote Tucker 10

# Side Effects oseltamivir (Tamiflu)

Generally well-tolerated. ## Footnote Tucker 10

# Nursing Considerations oseltamivir (Tamiflu)

Most effective when started within 48 hours of symptom onset. ## Footnote Tucker 10

# Indications oseltamivir (Tamiflu)

Influenza (treatment or prophylaxis) ## Footnote Tucker 10

# MOA/Class penicillin; amoxicillin; amoxicillin/clavulanic acid (Augmentin)

Binds to bacterial cell wall causing cell death. | PCN/Beta-lactam antibiotic ## Footnote Tucker 09

# Side Effects penicillin; amoxicillin; amoxicillin/clavulanic acid (Augmentin)

Urticaria, pruritis, angioedema, SJS, GI upset, *c. diff* ## Footnote Tucker 09

# Nursing Considerations penicillin; amoxicillin; amoxicillin/clavulanic acid (Augmentin)

Potential cross-allergy with cephalosporins; monitor for hypersensitivity ## Footnote Tucker 09

# Indications penicillin; amoxicillin; amoxicillin/clavulanic acid (Augmentin)

Bacterial infections - group A strep infections ## Footnote Tucker 09

# MOA/Class nystatin

Disrupts fungal cell membrane altering cell metabolism ## Footnote Tucker 11

# Side Effects nystatin

Generally well-tolerated ## Footnote Tucker 11

# Nursing Considerations nystatin

May be administered as swish-and-swallow or swish-and-spit ## Footnote Tucker 11

# Indications nystatin

Oral candida infections ## Footnote Tucker 11

Lewis 29 - Upper Respiratory Problems Flashcards

(52 cards)