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Flashcards in Resp System(Pharm) Deck (67):
1

Dextromethorphan

Generic Name: Dextromethorphan
Trade Name: Romilar
-Antitussive(central acting)(non narcotic)
most commonly used for nonproductive, dry cough
-working in CNS(central acting non-narcotic)
-non narcotic
-cause hypotension, decrease resp.drowsiness(not as severe), increase risk of tolerance/abuse, euphora,misused by adolescents
-not for children under 4
-caustion 4-12
-adolescents can abuse

2

Guaifenesin

Generic Name: Guaifenesin
Trade Name: Robitussin
-rarely has adv reaction
-is expectorant
-10ml/2tsp q4hr
side effect:
-hypersensitvity
-gastrotoxivity
-drowsiness
nursing implication:
-give meals(after meal), do not follow by water
-position in high fowlers
-teach deep breathing cough
-humidification
-increase fluids
-temp control
-suction as needed

3

Acetylcysteine

Generic Name: Acetylcysteine
Trade Name: Mucomyst
-Mucolytic
-liquify thick tenacious secretion, breaks down mucous
-break down mucous
-antidote to tylenol
-indication-emphysema,copd,
-smells like rotten egg

4

Albuterol

Generic Name: Albuterol
Trade Name: Proventil
Sympathomimetics(drug)
bronchodilator(anti-asthmatic drug)
-short acting beta agonist(drug)
PO/Inhalation-q6h

5

Theophylline

Generic Name: Theophylline
Trade Name: Elixophyllin/Theo-Dur/Unipyhyl
Methyl-Xanthine
Xanthinal/Xanthine Derivatives-Theophylline(Theo-Dur/Uniphyl)
-300-800mg
-start of with theophylization
-10-20mcg per ml(therapeutic level)action: act directly to relax the smooth muscle of the bronchus to increase the size and lumen of the bronchioles
-they are mild diuretics(remove fluid)
-indicated for pulmonary edema=dilate bronchi,get rid of fluid

6

Diphenhydramine

Generic Name: Diphenhydramine
Trade Name: Benadryl
-25-50mg 3x day, po,im
indication:
-seasonal allergy
-Hypersensitivity=from medication,blood products,seasonal allergies
-N&V,motion sickness
-Parkinsons-have anticholegerin like effect=decrease in strength/muscle tone
-adjucts to anesthesia-drying,prevent nausea
-allergy to drugs and blood products

7

Phenylephrine

Generic Name: Phenylephrine
Trade Name: Neosynephrine
-Nasal Decongestant
-Sympathomimetics/Ageneric
-Topical, Local

8

Beclomethasone

Generic Name: Beclomethasone
Trade Name: Beclovent/Vanceril
-Beconase/Vancenase
-Corticosteroid nasal decongesant

9

Dexamethasone

Generic Name: Dexamethasone
Trade Name: Decadron
-corticosteroid/antiinflammatory/antiasthmatic
--po, 3-5days, ac exacerbation

10

Ipratropium Bromide

Generic Name: Ipratropium Bromide
Trade Name: Atrovent
-Anticholinergic/Broncodilator
inhalation-short term relief of symptoms-last 4hrs

11

Triamcinolone

Generic Name: Triamcinolone
Trade Name: Azmacort, Nasocort
Corticosteroid nasal decongesant

12

Isoproterenol

Generic Name: Isoproterenol
Trade Name: Isuprel
-bronchodilator
-sympathomimetic
-short acting beta 2 agonist
-subcut,inhal,iv
-cause pink coloration of mucus

13

Loratadine

Generic Name: Loratadine
Trade Name: Claritin
-Anti histamine
-2ng gen
-10mg daily,Tab,liq,and peds dose

14

Zafirlukast

Generic Name: Zafirlukast
Trade Name: Accolate
-bronchodilator
-Leukotrine antagonist

15

Histamine

-substance found in various body tissue
-highest concentration in the mast cells and basophils
-produced in response to injury and released in allergic and hypersensitivity reaction
-forms in foundation for many cold remedies

16

Antihistamine/Driers

action: blocks the action of histamine at the H1 receptor site and prevent histamine from entering the receptor site
-H1 receptor blocker
-H1 receptor antagonist
-more effective in prevention
-best given at early sign and symptoms
-better at preventing than reversing effect
-pallitive treatment(makes feel better)

17

Antihistamine/Driers(Indication)

-seasonal allergy
-Hypersensitivity=from medication,blood products,seasonal allergies
-N&V,motion sickness
-Parkinsons-have anticholegerin like effect=decrease in strength/muscle tone
-adjucts to anesthesia-drying,prevent nausea
-allergy to drugs and blood products

18

Antihistamine/Driers(First Generation s/s)

-works centrally at the brain
-works periphally at the site
-have anti-cholegernic effect(drying,decrease muscle tone,decreased mobility,dilated pupils,cause drowsiness(sedation)
-fast onset(30min), short duration=taken more frequetly
-decrease muscle strength, urinary retention,constipation,dilated pupils, blurry vision, hypotension, monitor BP

19

Antihistamine/Driers(First Generation Drugs)

Diphenhydramine(Benadryl)
-25-50mg 3x day, po,im
Hydroxyzine(Atarax Vistaril)
-25-50mg 3x day, po,im

20

Antihistamine/Driers(Second Generation s/s)

-slower onset: 1hr or more
-dont have to take as often
-less effective in drying
-less sedating/drowsiness
-Anticholinergic like effect
-sedation, hypotension
-gastrotoxicity
-hypersensitivity
-photosensitivity
-paradoxical excitement-some pt may have insomnia-elderly
-tolerance-w/ prolonged use-less drowsy as continue to take medication

21

Antihistamine/Driers(Second generation drugs)

-Loratadine(Claritin)-10mg daily,Tab,liq,and peds dose
-Cetirizine(Zyrtec)
-Fexofenadine(Allegra)- 2x day dose, 60mg cap, BID, po, not to be used by anyone under the age of 12,pt should not be drinking fruit juice, decrease absorbtion

22

Antihistamine/Driers(contraindication)

-asthma,copd=b/c drying effect=mucous harde to expel
-glaucoma=b/c dilates pupil
-prostate=b/c decreae unrinary output/retention
-pregnant and lactating women
-interaction-MAOI

23

Antihistamine/Driers(Nursing implication)

-take with meal, parental deep IM(exception allegra(fruit juice)
-for motion sickness 30min to 1hr before traveling
-stop 4 days before allergic testing: b/c can mask allergic response
-watch for degree of drowsiness
-provide safety: decrease bp: orthostatic hypotention-watch for hot showers
-relieve drynes
-alcohol and other CNS depressants increase drowsiness
-can cause resp difficulty

24

Nasal Deocongestants(action/indication)

shrink engorged mucous membrane in the nose to relive stuffiness
-constrict blood vessels in the nose to decrease the formation of mucous and increase drainage to lessen swelling

indication: drain sinuses/adjunct in middle ea infectino, cold

-increase drainage
-decrease swelling
-decrease formation of mucous
-adjunct for common cold/ear infection/pre op med for balance anesthesia

-systemic last longer
-topical works faster
-locally/systemic
-topical/ by mouth

25

Nasal Deocongestants(Drugs)

-Sympathomimetics/Ageneric
-Phenylephrine Hcl(Neo synephrine)

Corticosteriods
-Flucticasone
-Tramcinolone
-Beclomethasone

26

Nasal Deocongestants(side effects)

-local-use topically
-cns stimulation
-cardiac stimulation
-gastrotoxicity
-rebound congestion-no more than 3-5days-overuse of medication, more frequently than they should
-contrainfication: MAOI(hypertensive crisis), pregancy,lactating women
-caution HTN, Heart disease,diabetes(hyperglycemia)
-systemic-cns stimulation,cardiac,gastrotoxity
-local: burning, rebound congestion

27

Nasal Deocongestants(Nursing implications)

-caution in htn, heart disease and diabetes
-burning or stinging discontinue
-do not giver for more than 4 days can cause rebound congestiion
-monitor bp and heart rate/apical pulse
-assess nasal mucosa
-d/c if burning/stinging occur

28

Antitussive

-action: suppress cough reflex center located in the medulla in the brain
-there are two types central and peripheral(affecting receptor sites) acting
-central acting directly on the cough reflex center in the medulla. There are two types of central acting(narcotics and non-narcotics)
-suppresses cough reflex center in medullar
-drowsiness
-decrease resp. decrease bp

29

Antitussive

1)Narcotics:
-Morphine
-Codeine-most effective antitussive
-Hydrocodone-most effective antiitussive

2)Non-Narcotics:
-Dextromethorphan(Romilar)

30

Dextromethorphan(Romilar)

-Antitussive
most commonly used for nonproductive, dry cough
-working in CNS(central acting non-narcotic)
-non narcotic
-cause hypotension, decrease resp.drowsiness(not as severe), increase risk of tolerance/abuse, euphora,misused by adolescents
-not for children under 4
-caution 4-12
-adolescents can abuse

31

Peripheral Acting

-works at receptor site
-peripheral acting act directly on the cough receptor in the trachea,pharynx,and lung for a demulcent(soothing) or local anesthetic effect(dulling irritation)

31

Peripheral Acting

-works at receptor site
-peripheral acting act directly on the cough receptor in the trachea,pharynx,and lung for a demulcent(soothing) or local anesthetic effect(dulling irritation)

32

Antitussive(indication)

-relieve dry hacking cough non productive cough
side effects:
-all antitussive can cause some drowsiness
-central active have more degree drowsiness
-opiate like
-cns depression
central side effect:
-resp depression
-euphora
-dependency
-n/v
-constipation
peripheral side effect:
-cardiovasuclar collapse

32

Peripheral Acting(Drug)

Benzonatete(Tessalon):
-has cain substance,
-anesthetic like effect,
-must swallow whole,
-can cause arrhythmia,
-spasm in bronchi
-cardiovascular collapse,
-allergy to cain products,
-teach pt to swallow whole(gel like substance)

Diphenhydramine(Benylin)
-related to benadryl
-drowsiness,dizziness

33

Antitussive(indication)

-relieve dry hacking cough

33

Antitussive(indication)

-relieve dry hacking cough non productive cough
side effects:
-opiate like
-cns depression
central side effect:
-resp depression
-euphora
-dependency
-n/v
-constipation
peripheral side effect:
-cardiovasuclar collapse

34

Mucolytic(action)

-action:liquify thick tenacious secretion, breaks down mucous
indication: emhysema-copd-part of treatment for pulmonary diseases

35

Expectorants

-reduce the viscosity and help raise thick tenacious secretions making expulsion of the sputum easier. act directly on the bronchial glands
-loosen and thin the sputum

36

Expectorants(drug)

-Guaifenesin(Robitussin)
-rarely has adv reaction
-is expectorant
-10ml-2tsp q4hr
side effect:
-hypersensitvity
-gastrotoxivity
-drowsiness
nursing implication:
-give meals(after meal), do not follow by water
-position in high fowlers
-teach deep breathing cough
-humidification
-increase fluids
-temp control
-suction as needed

37

Mucolytic

-action:liquify thick tenacious secretion, breaks down mucous
indication: emhysema-copd-pulmonary diseases

38

Mucolytic(drug)

-acetylcystein(mucomyst)-antidote/tylenol
-tyloxapol(alevaire)

39

Mucolytic(side effect)

-N/V
-smells like rotten egg
-stomatitis,bronchospasm
-interaction: tetracycline,erythromycin H202

40

Mucolytic(Nurising Implication)

-given instilled or by nebulizer
-assess mucus membrane in mouth
-cough patient or suction before and after
-store in fridge discard after 96hrs

41

Asthma

-inflammatory respiratory condition characterized by recurrent attack of dysnea, wheezing and bronchospasm
-various combination of drugs are used to treat asthma
-the objective is to give the smallest dose and to decrease the number and frequency

42

Bronchodilator(Antiasthmatic drug)(indication)

-relieve bronchospasms associated with respiratory disorders such as asthma,emphysema,and chronic bronchiits
Four types:
-Sympathomimietics
-Methyl Xanthine compounds
-Anticholinergics
-Leukotrience Receptors Antagonist

43

Sympathomimetics

-Broncodilator/Antiasthmatic drug
-dilate the bronchus by stimulating the sympathetic nervous system
-most stimulate beta 2 receptor site
-drugs divided into short acting and long acting

44

Sympathomimetics(drug)
bronchodilator(anti-asthmatic drug)
-short acting beta agonist(drug)

-rescue inhaler/meds
-Albuterol(Proventil)-PO/Inhalation-q6h
-Epinephrine(Adrenalin)-via inhalation-
1-1000(0.5mg-1mg)-tuberculin syringe-side effect: tremors

45

Sympathomimetics(drug)
bronchodilator(anti-asthmatic drug)
-long acting beta agonist

-symptom control
-Salmeterol
-Formoterol fumarate
-sustained released albuterol

46

Side effect(Sympathomimetic)

-CNS stimulation
-cardiac stimulation
-gastrotoxicity
-endrocrine
-prolonged used lead to tolerance

47

Methyl-Xanthine
Xanthinal/Xanthine Derivatives
(Action/Indication)

action: act directly to relax the smooth muscle of the bronchus to increase the size and lumen of the bronchioles
-they are mild diuretics(remove fluid)
-indicated for pulmonary edema=dilate bronchi,get rid of fluid

48

Methyl-Xanthine
Xanthinal/Xanthine Derivatives
(Drugs)

-Theophylline(Theo-Dur/Uniphyl)
-300-800mg
-start of with theophylization
-10-20mcg per ml(therapeutic level)

49

Methyl-Xanthine
Xanthinal/Xanthine Derivatives
(interaction)

-beta blocker,erythromycin and cimetidine: cause increase theophylline toxicity, decrease effect allupurinol, anticonvulsant, oral contraceptive

50

Methyl-Xanthine
Xanthinal/Xanthine Derivatives
(Nursing implication)

-Xanthine products increase toxicity like chocolate and soda
-given with food if nausea
-monitor site/peri care
-educate to protect from UV light(photosensitivity)
-monitor for theophyline toxicity: N/V, anorexia, arrthymia, seizure

51

Anticholinergic(action)
bronchodilator

-most useful longterm treatment with COPD
-or for asthma not able to tolerate beta 2 agonist

52

Methyl-Xanthine
Xanthinal/Xanthine Derivatives
(side effects)

-similar to beta 2 agonist(review A part of map)
-increase hypotension and N/V
-iv: bp drop(hyp0tension), pump mlxhr

53

Anticholinergic(drug)
bronchodilator

-Inpratropium Bromide(Atrovent)-inhalation-short term relief of symptoms-last 4hrs
-Tiotropium Bromide(Spiriva)-long term, last about 24hrs-maintain airway, not as drying

54

Anticholinergic(side effect)

-atropine like, cough, nervousness, headache, and dizziness
-dilation of pupils=glaucoma(blurry vision)
-tachycardia, N/V, headache, dizzy, cough,
-best taken when they wake in the morning

55

Leukotriene Antagonist(Action)

-action: antagonize leukotriene which is a bronchoconstrictor to dilate the bronchus and decrease mucus secretion
indication: prophylactic long-term
-good for asthma patient,prophalatic,long term management

56

Leukotriene Antagonist(Drug)(Only PO routes)

Zafirlukast(Accolate)-5yrs and older
Montelukast-1yr and above, tab,chewable,granules
Zileuton-12 yrs and older

57

Leukotriene Antagonist(side effect)

-drowsiness, headache, dizziness, dyspepsia, abdominal pain, myalgia, hepatoxicity, and increased incidence of resp tract infection
-monitor liver enzymes and s/s of infection
-interaction-potentiate: NSAIDS, ASA, Theophyline and erythromycin decrease levels infection
-contraindicated in pregnancy and lactation and an acute asthmatic attack
-used to prevent not to treat acute attack

58

Bronchodilators(Nursing Implication)

-dose by number of puffs
-vital signs
-auscultate lungs
-give oral with food
-space dose at equal interval
-if symptoms increase do not increase dose
-IV rate monitor closely

-wait one min to recharge
-in more that one drug inhaled wait 5min
-rinse mouth and spit out
-check dose counter or indicator
-check empty full if no indicator
-if more than one drug inhaled wait 5 min
-avoid smoking, OTDC, caffeine and beta blockers
-increase fluids
-sympathomimetic-epinephringe drug of choice for an acute attack asthma

-isuprel and epinephrine should never be given together
-methylxanthine: bp: hypotension
-watch for theophylline toxicity
-monitor blood levels
-watch for seizures

-inhalation puffs equally spaced
-mdi wait 1 min to recharge
-hold breathe for long as possible 10 seconds
-use bronco dilator first than steroids to decrease inflammation
-avoid smoking no OTC,caffeine
-increase fluids


59

Anti-Inflammatory
Corticosteroids

-used prophylactic treatment of bronchial asthma
-decrease inflammatory process
-least amount of drug small dose

60

Anti-Inflammatory
Corticosteroids(Drugs)

Beclomethasone:
-Beclovent-inhalation
-Beconase-decongestion
-maintanece

Dexamethasone(Decadron):
-po, 3-5days, ac exacerbation

Triamcinolone(Azmacort/Nasort):
Azmacort=for asthma
Nasocort=nasal decongestion
-maintenance

61

Corticosteroids(side effect)

-require tappering, give body time to release own steroids
-can cause addison crisis
-throat irritation-rinse mouth/throat
-hoarsenss
-cough
-oral fungal infection
-vertigo
-headache
-steroids effect calcium levels decrease(hypocalcemia)-take calcium supplements
-increase Blood sugar
-stunt growth in child
-increase BP(hypertension)

62

Mast Cell Stabilizer(action)

-decrease secretion of histamine by the mast cells

63

Mast Cell Stabilizer(indication)

-prophylatic treatment of mild bronchial asthma especially in children when growth retardation is concern
-exercise induced bronchospasm
-need 2 to 4 weeks for optimal

64

Mast Cell Stabilizer(Drugs)(side effect)

-cromolyn and nedocromil
side effect:
-N/V/D
-headache
-fatigue
-hypotension
-joint swelling
-dysuria
-rash
-sneezing
-cough,hoarseness,burning,stinging, bad taste in mouth
-rinse after use and spit out

Nursing implication:
-teach mdi
-teach spacer
-humdifier
-teach peak flow