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MSII Medication Review > Lewis 29 - Upper Respiratory Problems > Flashcards

Lewis 29 - Upper Respiratory Problems Flashcards

1
Q

MOA/Class

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

A

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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2
Q

Side effects

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

A

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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3
Q

Nursing Considerations

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

A

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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4
Q

Indications

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

A

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

Tucker 54

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5
Q

MOA/Class

montelukast

A

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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6
Q

Side Effects

montelukast

A

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

Tucker 55

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7
Q

Nursing Considerations

montelukast

A

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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8
Q

Indications

montelukast

A

Asthma, seasonal allergic rhinitis

Tucker 55

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9
Q

MOA/Class

pseudoephedrine, phenylephrine

A

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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10
Q

Side Effects

pseudoephedrine, phenylephrine

A

HTN, nervousness, insomia, vision changes/light sensitivity

Tucker 30

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11
Q

Nursing Considerations

pseudoephedrine, phenylephrine

A

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

Tucker 30

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12
Q

Indications

pseudoephedrine, phenylephrine

A

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

Tucker 30

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13
Q

MOA/Class

cromolyn sodium

A

Suppresses release of histamine and other inflammatory mediators from mast cells

Mast-Cell Stabilizer

Tucker 55

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14
Q

Side Effects

cromolyn sodium

A

Nasal irritation (when administered as a nasal spray)

Tucker 55

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15
Q

Nursing Considerations

cromolyn sodium

A

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

Tucker 55

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16
Q

Indications

cromolyn sodium

A

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

Tucker 55

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17
Q

MOA/Class

fluticasone

Intranasal

A

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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18
Q

Side Effects

fluticasone

Intranasal

A

Localized dryness; limited/few systemic adverse effects

Tucker 36, 54

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19
Q

Nursing Considerations

fluticasone

Intranasal

A

May be used prophylactically.

Tucker 36, 54

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20
Q

Indications

fluticasone

Intranasal

A

Allergic rhinitis, inflammation after removal of nasal polyps

Tucker 36, 54

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21
Q

MOA/Class

ipratropium

Intranasal

A

Decreased secretions due to anti-SLUDGE effects

Anticholinergic

Tucker 33

22
Q

Side Effects

ipratropium

Intranasal

A

Localized dryness; limited/few systemic adverse effects

Tucker 33

23
Q

Nursing Considerations

ipratropium

Intranasal

A

May be used prophylactically.

Tucker 33

24
Q

Indications

ipratropium

Intranasal

A

Allergic rhinitis

Tucker 33

25
Q

MOA/Class

oxymetolazine (Afrin); phenylephrine

Intranasal

A

Vasoconstriction of blood vessels specifically in the nasal passages and sinuses

Adrenergic/topical decongestant

Tucker 54

26
Q

Side Effects

oxymetolazine (Afrin); phenylephrine

Intranasal

A

Nasal dryness

Tucker 54

27
Q

Nursing Considerations

oxymetolazine (Afrin); phenylephrine

Intranasal

A

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.)

Tucker 54

28
Q

Indications

oxymetolazine (Afrin); phenylephrine

Intranasal

A

Nasal congestion

Tucker 54

29
Q

MOA/Class

dextromethorphan; benzonatate, codeine

A

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

Tucker 54

30
Q

Side Effects

dextromethorphan; benzonatate, codeine

A

Drowsiness, dry mouth , dizzy/lightheadedness

Tucker 54

31
Q

Nursing Considerations

dextromethorphan; benzonatate, codeine

A

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

Tucker 54

32
Q

Indications

dextromethorphan; benzonatate, codeine

A

Dry cough; persistent cough

Tucker 54

33
Q

MOA/Class

echinacea

A

Thought to be immunostimulant

Herbal

Tucker 60

34
Q

Side Effects

echinacea

A

N/V, dizziness, headache

Tucker 60

35
Q

Nursing Considerations

echinacea

A

Consider potential for drug interactions

Tucker 60

36
Q

Indications

echinacea

A

Colds, flu, viral infections

Tucker 60

37
Q

MOA/Class

acetaminophen

A

Acts on the hypothalamus to decrease fever.
Inhibits prostaglandin synthesis.

Analgesic/antipyretic

Tucker 16

38
Q

Side Effects

acetaminophen

A

Generally well-tolerated. Hepatotoxicity.

Tucker 16

39
Q

Nursing Considerations

acetaminophen

A

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.

Tucker 16

40
Q

Indications

acetaminophen

A

Mild pain and fever

Tucker 16

41
Q

MOA/Class

oseltamivir (Tamiflu)

A

Prevents synthesis of viral DNA/release of viral particles.

Antiviral

Tucker 10

42
Q

Side Effects

oseltamivir (Tamiflu)

A

Generally well-tolerated.

Tucker 10

43
Q

Nursing Considerations

oseltamivir (Tamiflu)

A

Most effective when started within 48 hours of symptom onset.

Tucker 10

44
Q

Indications

oseltamivir (Tamiflu)

A

Influenza (treatment or prophylaxis)

Tucker 10

45
Q

MOA/Class

penicillin; amoxicillin; amoxicillin/clavulanic acid (Augmentin)

A

Binds to bacterial cell wall causing cell death.

PCN/Beta-lactam antibiotic

Tucker 09

46
Q

Side Effects

penicillin; amoxicillin; amoxicillin/clavulanic acid (Augmentin)

A

Urticaria, pruritis, angioedema, SJS, GI upset, c. diff

Tucker 09

47
Q

Nursing Considerations

penicillin; amoxicillin; amoxicillin/clavulanic acid (Augmentin)

A

Potential cross-allergy with cephalosporins; monitor for hypersensitivity

Tucker 09

48
Q

Indications

penicillin; amoxicillin; amoxicillin/clavulanic acid (Augmentin)

A

Bacterial infections - group A strep infections

Tucker 09

49
Q

MOA/Class

nystatin

A

Disrupts fungal cell membrane altering cell metabolism

Tucker 11

50
Q

Side Effects

nystatin

A

Generally well-tolerated

Tucker 11

51
Q

Nursing Considerations

nystatin

A

May be administered as swish-and-swallow or swish-and-spit

Tucker 11

52
Q

Indications

nystatin

A

Oral candida infections

Tucker 11

MSII Medication Review (13 decks)

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