Respiratory Flashcards
(146 cards)
1
Q
How does a metered-dose inhaler work?
A
Uses a chemical propellant to push the medication out of the inhaler
2
Q
How does a dry powder inhaler work?
A
Delivers medication without using chemical propellants but requires strong and fast inhalation
3
Q
How does a nebulizer work?
A
Delivers fine liquid mists of medication using air or oxygen under pressure
4
Q
What order do we need to administer multiple nebs/inhalers?
- How long do we wait between them?
A
We always give the bronchodilator first (opens passages to allow second med to enter farther)
- We need to wait 5 mins between meds
5
Q
What are Sympathomimetic bronchidilators?
A
Meds that relax the smooth muscle of the bronchi and dilate the airways of the respiratory tree
6
Q
What are Methylxanthine bronchodilators?
A
Meds that stimulate the CNS and respiration, dilate coronary and pulmonary vessels, cause diuresis and relax smooth muscle
7
Q
What are bronchodilators used to treat?
A
Acute bronchospasm, acute and chronic asthma, bronchitis, and restrictive airway disease
8
Q
Contraindications of bronchodilators
A
Peptic ulcer disease, severe cardiac disease, cardiac dysrhythmias, hyperthyroidism, and uncontrolled seizure disorders
9
Q
What does Theophylline increase or decrease the effectiveness of?
A
Increases the risk of digoxin toxicity.
Decreases the effects of lithium and phenytoin
10
Q
What medications increase the effect of Theophylline?
A
Beta-blockers, cimetidine and erythromycin
11
Q
What medications decrease the effect of Theophylline?
A
Barbituates and Carbamezapine
12
Q
Side effects of bronchodilators?
A
Palpitations, tachycardia, dysrhythmias, restlessnes, nervousness, tremors, anorexia, N+V, headaches, dizziness, hyperglycemia, mouth dryness, tolerance and paradoxical bronchoconstriction.
13
Q
What is the therapeutic level for serum Theophylline?
A
10-20mcg/mL (55.5-111mcmol/L)
14
Q
What are the early signs of Theophylline toxicity?
A
Restlessness, nervousness, tremors, palpitations, and tachycardia
15
Q
Name the (5) beta-adrenergic agonist bronchodilator inhalers
A
Albuterol, Arformoterol, Formoterol, Levalbuterol, and Salmeterol
16
Q
Name the (2) beta-adrenergic agonist bronchodilator orals
A
Albuterol and Terbutaline
17
Q
Name the (2) Methylxanthines bronchodilators
A
Theophylline (oral) and Aminophylline
18
Q
Name the (2) Anticholinergic bronchodilators
A
Ipratropium (inhaled) and Tiotropium (inhaled)
19
Q
Name the (6) glucocorticoid bronchodilator inhalers
A
Beclomethasone dipropionate, Budesonide, Ciclesonide, Fluticasone proprionate, Mometasone Furoate, Triamcinolone acetonide
20
Q
Name the (2) glucocorticoid bronchodilator orals
A
Prednisone and Prednisolone
21
Q
Name the (2) Leukotriene modifier bronchodilators
A
Montelukast (oral) and Zafirlukast (oral)
22
Q
Name the Inhaled Nonsteroidal Antiallergy Agent bronchodilators
A
Cromolyn sodium (inhaled)
23
Q
Name the Monoclonal Antibody bronchodilator
A
Omalizumab
24
Q
What are Anticholinergic inhaled medications?
- Uses
A
Meds that improve lung function by blocking muscarinic receptors in the bronchi, which causes bronchodilation.
- Treats COPD, asthma, exercise-induced bronchospasm
25
Adverse effects of anticholinergic inhaled meds
Dry mouth, irritation of the pharynx, increased intraocular pressure, blurred vision, tachycardia, urinary retention, constipation.
26
What kind of allergy is contraindicated with Ipatropium products?
People with peanut allergies shouldnt take certain Ipatroprium products as they are made from soy lecithin, which is the same plant family as peanuts.
27
What are inhalabe glucocorticoids?
| - Uses
Meds that act as antiinflammatory agents and reduce edema of the airways.
- Treat asthma, and other inflammatory respiratory conditions
28
What are Leukotriene Modifiers?
| - Uses
Meds that inhibit bronchoconstriction caused by specific antigens and reduce airway edema and smooth muscle constriction.
- Treatment and prophylaxis of chronic bronchial asthma
29
Contraindications of Leukotriene Modifiers
Breast-feeding mothers and impaired hepatic function
30
Adverse effects of Leukotriene modifiers
Headache, N+V, dyspepsia, diarrhea, generalized pain, fever, dizziness
31
When should we admin Leukotriene modifiers?
Either 1 hour before or 2 hours after meals
32
What are Inhaled NonSteroidal Antiallergy Agents?
| - Uses
Antiasthmatic, antiallergic, and mast cell stabilizers inhibit mast cell release after exposure to antigens
- Used to treat allergic rhinitis, bronchial asthma, and exercise induced bronchospasm
33
Contraindications of Cromolyn sodium
Impaired hepatic and renal function
34
Adverse effects of inhaled Nonsteroidal Antiallergy agents
Cough, sneezing, nasal sting, bronchospasm, unpleasant taste
35
When should Nonsteroidal antiallergy agents be admined?
At least 30 mins before meals
36
What are Monoclonal antibodies?
| - Uses
A recombinant DNA-derived humanized Immunoglobulin G murine monoclonal antibodies that selectively bind to Immunoglobulin E to limit the release of mediators in the allergic response.
- Used to treat allergy-related asthma
37
How is Omalizumab administered?
Subcutaneously every 2-4 weeks. With the dose being titrated on the basis of serum IgE and pt's weight.
38
Adverse effects of Omalizumab
Viral infections, upper respiratory infections, sinusitis, headache, pharyngitis, anaphylaxis, malignancies
39
What are antihistamines? (also called histamine antagonists or H1 blockers)
- Uses
Meds that compete with histamine for receptor sites, thus preventing a histamine response. When the histamine receptor is stimulated, the extravascular smooth muscles are constricted.
- Used to treat common cold, rhinitis, N+V, motion sickness, and urticaria
40
Contraindications of antihistamines
Co-administration with alcohol, hypnotics or barbituates. Cautiously used with COPD due to their drying effects.
41
Who shouldnt take diphenhydramine?
Pts with narrow angle glaucoma
42
Adverse effects of anthistamines
Drowsiness, fatigue, dizziness, urinary retention, blurred vision, wheezing, constipation, dry mouth, GI irritation, hypotension, hearing disturbances, confusion
43
How should antihistamines be administered?
Avoid subcutaneous injections in favour of IM injections.
44
How should antihistamines be taken for motion sickness?
Should be taken 30 mins before the event and before meals and at bedtime during the event.
45
Name the (12) antihistamines
Brompheniramine, Cetrizine, Chlorpheniramine, Clemastine, Cyproheptadine, Desloratadine, Dimenhydrinate, Diphenhydramine, Fexofenadine, Levocetirizine, Loratadine, Olopatadone
46
What are nasal decongestants?
| - Uses
Meds that shrink nasal mucosal membranes and reduce fluid secretions
- Allergic rhinitis, hay fever, and acute nasal discharge
47
What are the 3 categories of nasal decongestants?
Adrenergic, anticholinergic and corticosteroids
48
Name the (3) non-glucocorticoids (adrenergic and anticholinergic) nasal decongestants
Oxymetazoline, Phenylphrine hydrochloride, Pseudoephedrine hydrochloride
49
Name the (8) Glucocorticoid nasal decongestants
Beclamethasone, Budesonide, Ciclesonide, Flunisolide, Fluticasone proprionate, Fluticasone furoate, Mometasone, Triamcinolone
50
Contraindications of nasal decongestants
Cardiac disease, hyperthyroidism, diabetes mellitus
51
Side effects of nasal decongestants
Nervousness, restlessness, insomnia, HTN, hyperglycemia
52
What should the client taking nasal decongestants avoid in their diet?
Avoid caffeine in large amount as this increases the risk of restlessness and palpitations.
53
What are expectorants?
| - Uses
Meds that loosen bronchial secretions so that they can be eliminated with coughing.
- Used for dry unproductive coughs
54
What are mucolytic agents?
Meds that thin mucuous secretions to help make the cough more productive
55
Contraindications of Dextromethorpan
Not for clients with COPD because it suppresses the cough reflex
56
Contraindications of Acetylcysteine
Should not be used by clients with asthma as it increases the airway resistance
57
Side effects of expectorants and mucolytics
GI irritation, rash, oropharyngeal irritation
58
What are the 'need to knows' about giving Acetylcysteine nebs?
Cannot mix it with another medication.
Give any prescribed bronchodilator 5 mins before.
Take the medications with a full glass of water
59
What are antitussives?
| - Uses
Meds that act on the cough control centre in the medulla to suppress the cough reflex.
- Used for nonproductive cough
60
Side effects of antitussives
Dizziness, drowsiness, sedation, GI irritation, nausea, dry mouth, constipation, respiratory depression
61
Contraindications of antitussives
Head injury, postoperative cranial surgery, opioids, sedatives, barbituates, antidepressants
62
Name an expectorant and a mucolytic agent
Expectorant: Guaifensen
Mucolytic: Acetylcysteine
63
Name the (2) opioid antitussives
Codeine phosphatel and hydrocodone
64
Name the (3) non-opioid antitussives
Benzonatate, Dextromethorphan, Diphenhydramine hydrochloride
65
What are opioid antagonists?
Reverses respiratory depression in opioid overdose
66
Side effects of opioid antagonists
N+V, tremors, sweating, HTN, tachycardia
67
What do we monitor for IV opioid antagonists?
VS (especially resps), the dose is titrated to pt status every 2-5 mins
68
Name the (4) opioid antagonists
Alvimopan, Methylnaltrexone, Naloxone, Naltrexone
69
How long do people with active TB get treated?
6-9 months (longer if the person also has HIV)
70
How long does it take to get negative sputum cultures after the beggining of treatment?
3 months
71
How long to people take prophylacix treatment if exposed?
9-12 months
72
What is Isoniazid?
First line TB treatment
Inhibits the synthesis of mycolic acids and acts to kill actively growing organsism in the extracellular environment.
Inhibits the growth of dormant organsisms in the macrophages and caseating granulomas.
Is active only during cell division and is used in combination with other antitubercular meds.
73
Contraindications of Isoniazid
Acute liver disease, alcoholism, renal impairment, clients taking nicotinic acid, clients taking hepatotoxic meds,
74
Adverse effects of Isoniazid
Peripheral neuritis, neurotoxicity, hepatotoxicity, pyridoxine deficiency, N+V, dry mouth, dizziness, hyperglycemia, vision changes
75
Monitoring for Isoniazid
LFTs (hepatic function), signs of hepatitis (anorexia, nausea, vomiting, weakness, fatigue, dark urine, jaundice), assess LOC,
76
When do we admin Isoniazid?
1 hour before or 2 hours after meals. And 1 hour before antacids
77
What med is given with Isoniazid to reduce neurotoxicity
Pyridoxine
78
What is Rifampin?
First line TB treatment
Inhibits bacterial RNA synthesis. Binds to DNA-dependent RNA polymerase and blocks RNA transcription.
Used in combination with atleast one other TB med.
79
Contraindications of Rifampin
Hepatic dysfunction, alcoholism, use of hepatotoxic meds
80
What meds does Rifampin decrease the effects of?
Oral anticoagulants, oral hypoglycemics, chloramphenicol, digoxin, disopyramide phosphates, mexiletine, quinidine polygalacturonate, fluconazole, methadone hydrochloride, phenytoin, verapamil hydrochloride
81
Adverse effects of Rifampin
Heartburn, N+V, diarrhea, red-orange coloured body secretions, vision changes, hepatotoxicity, hepatitis, inc. uric acid levels, blood dyscrasias, colitis,
82
Monitoring for Rifampin
CBC, uric acid levels, LFTs,
83
What is Ethambutol?
First-line TB treatment
Interferes with cell metabolism and multiplication by inhibiting 1 or more metabolites in susceptible organisms.
Inhibits bacterial RNA synthesis and is active only during cell division.
Slow-acting and must be used with other meds
84
Contraindications of Ethambutol
Children under 13, Optic neuritis, renal dysfunction, gout, ocular defects, diabetic retinopathy, cataracts, pt's taking other neurotoxic medications
85
Side effects of Ethambutol
Anorexia, N+V, dizziness, malaise, mental confusion, joint pain, dermatitis, optic neuritis, peripheral neuritis, thrombocytopenia, inc. uric acid levels,
86
Monitoring for Ethambutol
CBC, uric acid level, renal and liver function tests
87
When is Ethambutol administered?
Once every 24 hours and with food to decrease GI upset
88
What is Pyrazinamide?
First line TB treatment
Exact mechanism unknown.
Used with at least one other antitubercular med
89
Contraindications of Pyrazinamide
Diabetes mellitus, renal impairment, gout, not for use in children
90
What meds does Pyrazinamide decrease the effect of?>
Allopurinol, colchicine and probenecid
91
Side effects of Pyrazinamide
Increased LFTs, inc uric acid levels, arthralgia, myalgia, photosensitivity, hepatotoxicity, thrombocytopenia,
92
Monitoring for Pyrazinamide
CBC, LFTs, uric acid levels, painful or swollen joints, blood glucose
93
When is Pyrazinamide administered?
Taken with food
94
What is Rifabutin?
Second-line TB medication
Inhibits mycobacterial DNA-dependent RNA polymerase and suppress protein synthesis.
Used to treat Mycobacterium avium complex (MAC) disease in pt's with HIV
95
Cautions for Rifabutin
Can affect blood levels of medications (hormonal contraceptives and HIV meds)
96
Side effects of Rifabutin
Rash, GI irritation, neutropenia, red-orange coloured secretions, uveitis, myositis, arthralgia, hepatitis, chest pain,
97
Assessments for Rifabutin
Painful or swollen joints, ocular pain or blurred vision, hepatotoxic signs
98
What is Rifapentine?
Second-line TB medication
| Used only to treat pulmonary TB
99
Cautions of Rifapentine
Can affet blood levels of some medications (oral contraceptives, warfarin, HIV meds)
100
Side effects of Rifapentine
Red-orange coloured secretions, hepatotoxicity
101
What is Capreomycin sulfate?
Second-line TB medication
Mechanism of action is unknown.
Given via IM injection.
102
Contraindications of Capreomycin sulfate
Renal insuficiency, acoustic nerve impairment, hepatic impairment, myasthenia gravis, parkinsons
103
Side effects of Capreomycin sulfate
Nephrotoxicity, Ototoxicity, Neuromuscular blockade
104
Monitoring for Capreomycin sulfate
Audioetric testing, renal, hepatic and electrolyte levels
105
What are Aminoglycoside antibiotics or Fluoroquinolones?
These are antibiotics used to treat TB.
| Works because receptor-binding action interfering with protein synthesis in susceptible organisms.
106
Contraindications of fluoroquinolones
Not recommended for used in children, neuromuscular disorders and eighth cranial nerve damage. Caution with renal insufficiency.
107
Adverse effects of TB antibiotics
Pain at injection site, nephrotoxicity, ototoxicity, neurotoxicity, superinfections
108
What are the signs of nephrotoxicity?
Increased BUN and serum creatinine
109
What are the signs of ototoxicity?
Tinnitus, dizziness, ringing or roaring in the ears, reduced hearing
110
What are the signs of neurotoxicity?
Headache, dizziness, lethargy, tremors, and visual disturbances
111
What is Ethionamide?
Second-line TB medication.
| Used to treat multi-drug resistant (MDR) TB
112
Contraindication of Ethionamide
Diabetes Mellitus or renal dysfunction
113
Adverse effects of Ethionamide
Anorexia, N+V, metallic taste in mouth, orthostatic hypotension, jaundice, mental changes, peripheral neuritis, rash
114
What can be administered concurrently with Ethionamide to reduce neurotoxicity
Pyridoxine
115
When should Ethionamide be administered?
With food or meals
116
What is Aminosalicylic acid?
Second-line TB medication.
| Inhibits folic acid metabolism. Used to treat MDR-TB.
117
What blocks the absoprtion of Aminosalicylate sodium?
Aminobenzoates
118
Side effects of Aminosalicylic acid
Bitter taste in the mouth, GI irritation, exfoliative dermatitis, blood dyscrasias, crytalluria, changes in thyroid function
119
When should Aminosalicylic acid be administered?
With food
120
What are signs of blood dyscrasia?
Sore throat or mouth, malaise, fatigue, bruising, and bleeding
121
What is Cycloserine?
Second-line TB medication.
Interferes with cell wall biosynthesis.
Used to treat MDR-TB.
122
Contraindications of Cycloserine
Alcohol or Ethionamide use, seizures, depression, severe anxiety, psychosis, renal insufficiency,
123
Side effects of Cycloserine
CNS reactions, neurotoxicity, seizures, heart failure, headache, vertigo, altered LOC, confusion,
124
Monitoring for Cycloserine
LOC, changes in mental status, renal and hepatic function, serum level
125
What is the peak concentration of Cycloserine be?
25-35mcg/mL (140-195mcmol/L)
| - Peak concentration should be taken 2hrs after dosing
126
When should Cycloserine be administered?
Take the medication after meals to avoid GI upset
127
What is Streptomycin?
Second-line TB medication.
Aminoglycoside antibiotic, that works because of receptor-binding action that interferes with protein synthesis in susceptible organisms
128
Contraindications of Streptomycin
Myasthenia gravis, parkinsonism, eighth cranial nerve damage. Caution with young infants.
129
Adverse effects of Streptomycin
Dec urine output, N+V, numbness, seizures, tingling, clumsiness, dizziness, hearing loss or ringing in ears
130
Monitoring for Streptomycin
Liver and kindey function, monitoring for ototoxic, neurotoxic, and nephrotoxic reactions
131
Name the (7) inactivated influenza vaccines
Afluria, Fluarix, FluLaval, Flucelvax, Flublok, Fluvirin, Fluzone
132
Name the live attenuated infuenza vaccine
FluMist
133
Who is approved to take the live nasal spray vaccine?
| - Who cant take this?
Healthy people aged 2-49 years of age
| - Should not be taken by pregnant people
134
Who is approved to take the inactivated flu shot?
Children as young as 6 months, as well as pregnant people
135
What is the advantage and disadvantage of the nasal spray vaccine?
Advantage: stronger immune response for those who have never had the flu or vaccine (think kids)
Disadvantage: May not be as protective for those who have already had the flu or other vaccines
136
Which individuals are high priority for receiving the flu vaccine?
Pregnant people, caregivers of children under 6 months old, people ages 6 months -24yrs, healthcare workers, adults aged 25-63 with a chronic medical condition
137
Contraindications of the inactive flu vaccine
Active infection, Guillain-barre syndrome, active fever, children under 6 months old
138
Contraindications of the live flu vaccine
Younger than 2, older than 50, pregnant people, people on long-term aspirin therapy, people with chronic medical conditions or organ disease
139
Side effects of flu vaccine
Genera aches and pains, malaise, fever, runny nose, cough, headache, sore throat
140
How long after getting the live vaccine is virus shed?
Up to 2 days
141
What are antiviral medications?
Medications used during outbreaks in influenz
142
Name the (4) antiviral medications
Amantadine, Oseltamivir, Rimantadine, Zanamivir
143
Side effects of antivirals
As per Saunders pg. 748. Literally anthing
144
Within how long of symptoms do antivirals need to be given?
Within 2 days of onset of symptoms
145
What is the pneumococcal conjugate vaccine?
| - Given to who
Used for the prevention of invasive pneumococcal disease in infants and children
- Given to adults and high-risk children older than 2 yrs
146
Side effects of pneumococcal vaccine
Erythema, swelling, pain at injection site, fever, irritability, drowsiness, reduced appetite
