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RESPIRATORY MEDICATIONS Flashcards

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1
Q

METERED-DOSE INHALER (MDI)

A
  • Chemical propellant pushes medication out of inhaler
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2
Q

DRY POWDER INHALER (DPI)

A
  • Delivers WITHOUT CHEMICAL PROPELLANTS

- REQUIRES STRONG/FAST INHALATION

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3
Q

NEBULIZER

A
  • DELIVERS FINE LIQUID MISTS OF MEDICATION
  • DELIVERED THROUGH MASK OR TUBE THAT FITS OVER NOSE OR MOUTH
  • USES AIR OR OXYGEN UNDER PRESSURE
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4
Q

If two different inhaled medications are prescribed and one of the medications is a glucocorticoid (corticosteroid)what will you give first ?

A
  • ADMINISTER THE BRONCHODILATOR FIRST BEFORE THE STEROID
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5
Q

Sympatho/mimetic bronchodilator

A
  • MIMICS SYMPATHETIC NERVOUS SYSTEM IN RELAXING SMOOTH MUSCLE
  • RELAX THE SMOOTH MUSCLE OF THE BRONCHI AND DILATE AIRWAYS OF RESPIRATORY TREE
  • AIDS IN MAKING RESPIRATION AND AIR EXCHANGE EASIER
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6
Q

Methylxanthine bronchodilator

A
  • STIMULATE CNS AND RESPIRATION
  • RELAX SMOOTH MUSCLE
  • DILATE coronary and pulmonary vessels
  • CAUSE DIURESIS
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7
Q

What are bronchodilators used for ?

A
  • TREAT ALLERGIC RHINITIS AND SINUSITIS
  • ACUTE BRONCHOSPASM
  • ACUTE/CHRONIC ASTHMA
  • BRONCHITIS
  • COPD
  • EMPHYSEMA
  • OTHER RESTRICTIVE AIRWAY DISEASES
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8
Q

What are BRONCHODILATORS CONTRAINDICATED IN ?

A
  • HYPERSENSITIVITY
  • PEPTIC ULCER DISEASE
  • SEVERE CARDIAC DISEASE
  • CARDIAC DYSRHYTHMIAS
  • HYPERthyroidism
  • UNCONTROLLED SEIZURE DISORDERS
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9
Q

Bronchodilators are used with caution in patients with ?

A
  • HYPERTENSION
  • NARROW- ANGLED GLAUCOMA
  • DIABETES MELLITUS
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10
Q

Which bronchodilator increases the toxicity level of digoxin and decreases the effects of lithium and phenytoin ?

A

Theophylline

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11
Q

If Theophylline and Beta2 adrenergic agonist are taken together what will it cause ?

A

Cardiac dysrhythmias

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12
Q

Do B-blockers, Cimetidine (Tagamet), and erythromycin increase or decrease the effects of Theophylline ?

A

Increase

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13
Q

Do Barbiturates and Carbamazepine (Tegretol) decrease or increase the effects of Theophylline ?

A

Decrease

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14
Q

Side effects of bronchodilators

A
  • PALPITATIONS/TACHYCARDIA
  • DYSRHYTHMIAS
  • RESTLESSNESS/NERVOUSNESS/TREMORS
  • Anorexia, nausea, vomiting
  • Headache/dizziness
  • HYPERglycemia
  • Mouth dryness and throat irritation with inhalers
  • Tolerance and paradoxical bronchoconstriction with inhalers
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15
Q

Interventions for bronchodilators

A
  • MONITOR FOR RESTLESSNESS AND CONFUSION
  • MONITOR VITAL SIGNS AND LUNG SOUNDS
  • MONITOR CARDIAC DYSRHYTHMIAS
  • CHECK
    Cough
    Wheezing
    Decreased breath sounds
    Sputum production
  • HYDRATION
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16
Q

When/How is bronchodilators administered ?

A

ADMINISTERED AT REGULAR INTERVALS AROUND THE CLOCK TO MAINTAIN A SUSTAINED THERAPEUTIC LEVEL

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17
Q

Are oral meds administered before/after meals ?

A

Oral meds are administered WITH or AFTER MEAL to DECREASE GI IRRITATION

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18
Q

What is the therapeutic serum level for Theophylline ?

A

10 - 20 mcg/mL

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19
Q

IV administered Aminophylline or Theophylline slow or fast ?

A
  • SLOW

- VIA INFUSION PUMP (ALWAYS)

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20
Q

Client education (bronchodilators)

A
  • DO NOT CRUSH ENTERIC COATED OR SUSTAINED RELEASE TABLETS OR CAPSULES
  • AVOID CAFFEINE, PRODUCTS THAT CONTAIN IT
  • OTC MEDS
  • HOW TO MONITOR THE PULSE
  • REPORT ANY ABNORMALITIES TO THE HCP
  • HOW TO USE AN INHALER/SPACER/NEBULIZER (MONITOR AMOUNT OF MEDICATION IN INHALERS)
  • CEASE SMOKING
  • MONITOR BLOOD GLUCOSE IN DIABETIC MELLITUS PTs
  • MEDIC- BRACELET TO BE WORN (PARTICULARLY IN ASTHMATICS)
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21
Q

What is the level of toxicity for Theophylline ? And what are the early signs ?

A
  • HIGHER THAN 20 mcg/mL
  • Early signs are
    RESTLESSNESS
    TREMORS
    NERVOUSNESS
    PALPITATIONS
    TACHYCARDIA
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22
Q

What drugs are inhaled ?

A
  • B-Andrenergic bronchodilators
  • Cromolyn sodium
  • Aerosol glucocorticoids
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23
Q

How are metered dose inhalers used ?

A
  • NOT IN MOUTH

- HELD ABOUT 2 FINGER WIDTHS (1 1/2 inches) in front of mouth

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24
Q

How are inhalers with spacers used ?

A

Spacers can be put in the mouth

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25
BRONCHODILATORS ( B- ADRENERGIC AGONISTS ) INHALED
- AlbuteROL ( Proventil, AccuNeb, ProAir, Ventolin ) - ArformoteROL ( Brovana ) - LevalbuteROL ( Xopenex ) - PirbuteROL ( Maxair Autohaler ) - SalmeteROL ( Serevent Diskus )
26
How are AlbuteROL ( VoSpire, Proventil ) and Terbutaline Sulfate administered ?
- Via PO | - SubQ
27
Methylxanthine ( Bronchodilator)
- Theophylline, Oral ( Theo-24, Theochron, Uniphyl, Elixophyllin ) - Aminophylline ( SlowBid, Theo- Dur ) If IV drip for Aminophylline must have heart monitor
28
AntiCholinergics ( Bronchodilator )
- IpratroPIUM (inhaled) ( Atrovent HFA, Combivent ) | - TiotroPIUM (inhaled) ( Spiriva )
29
Glucocorticoids (corticosteroids) Inhaled
- BeclomethaSONE Dipropionate (Qvar, Beclovent) - BudesoNIDE (PulmiCORT Turbuhaler, PulmiCORT Respules, PulmiCORT Flexhaler) - CiclesoNIDE (Alvescol) - FlunisolIDE (AeroBid) - FluticaSONE Propionate (FLOVENT HFA, FLOVENT DISKUS)
30
Glucocorticoids (Oral)
- PredniSONE | - PrednisoLONE
31
Leukotriene Modifiers (oral)
- MonteluKAST ( Singular ) - ZafirluKAST ( Accolate ) - Zileuton ( Zyflo, Zyflo CR )
32
Inhaled NONsteroidal Anti-Allergy Agent
- Cromolyn sodium
33
Monoclonal Antibody
- Omalizumab (Xolair)
34
What are ANTICHOLINERGICS ?
- INHALED MEDS - IMPROVE LUNG FUNCTION - RESULT IN BRONCHODILATION
35
AntiCholinergic meds are effective for treating what ?
- COPD - ALLERGY-INDUCED ASTHMA - EXERCISE INDUCED BRONCHOSPASM
36
S/E OF ANTICHOLINERGICS
- DRY MOUTH - IRRITATION OF PHARYNX - SUCKING ON SUGARLESS CANDY WILL HELP RELIEVE SYMPTOMS
37
What can systemic anticholinergic cause ? (Rarely occur)
- Increased intraocular pressure - Blurred vision - Tachycardia - Cardiovascular events - Urinary Retention - Constipation
38
Why should clients with peanut butter allergies not take IpratroPIUM ( Atrovent HFA and Combivent) ?
CONTAIN SOY LECITHIN ( Same plant family as peanuts )
39
Glucocorticoids ( Corticosteroids )
- Glucocorticoids act as ANTI- INFLAMMATORY AGENTS - REDUCE EDEMA OF AIRWAYS - TREAT ASTHMA/ OTHER INFLAMMATORY RESPIRATORY CONDITIONS
40
Leukotriene Modifiers
- Used in prophylaxis and treatment of CHRONIC BRONCHIAL ASTHMA( NOT ACUTE EPISODES ) - Inhibits bronchoconstriction caused by specific antigens and reduce airway edema and smooth muscle constriction - CONTRAINDICATED IN HYPERSENSITIVITY AND BREASTFEEDING MOTHERS - CAUTION IN PATIENTS WITH IMPAIRED HEPATIC FUNCTION - Coadministration of inhaled glucocorticoids increase the risk if upper respiratory infection
41
Side/Adverse effects of Leukotriene Modifiers
- Headache - Nausea/Vomiting - Dyspepsia ( Indigestion ) - Diarrhea - Generalized pain, myalgia - Fever - Dizziness
42
Interventions ( Leukotriene Modifiers )/ Client education
- Monitor VS - Check lung sounds for adventitious breath sounds - Monitor liver function lab values - Monitor for cyanosis Education - Take medication 1 hour before or 2 hours after meals - Increase fluid intake - Not discontinue the medication and to take as prescribed, EVEN DURING SYMPTOM- FREE PERIODS
43
Inhaled Non-Steroidal Anti Allergy Agent
- AntiAsthmatic, AntiAllergic - Mast Cell stabilizer - Inhibits mast cell release after exposure to antigens
44
What are inhaled nonsteroidal antiallergy agents treat ?
- Allergic Rhinitis - Bronchial Asthma - Exercise induced bronchospasm - CONTRAINDICATED IN PTs with KNOWN HYPERSENSITIVITY
45
Orally administered cromolyn sodium is used in CAUTION with Pts with ?
Impaired hepatic or renal function
46
Side Effects of NONsteroidal AntiAllergy Agent/ Interventions
- Cough - Sneezing - Nasal Sting - Bronchospasm after inhalation - Unpleasant taste in the mouth Interventions - Monitor Vital Signs - Monitor Respirations and check lungs for adventitious sounds
47
Client education for NONsteroidal Anti Allergy Agent
- Administer oral capsules at least 30 min before meals - Not to discontinue the medication abruptly because a rebound asthmatic attack can occur - Medication needs to be taken as prescribed
48
What is given to the patient before and after an inhaled medication ?
Pt is given water and told to take a few sips before and after inhalation to prevent a cough and unpleasant taste in the mouth
49
Antihistamines
- Histamine Antagonists or H1 blockers - COMPETE WITH HISTAMINE FOR RECEPTOR SITES, PREVENTING A HISTAMINE RESPONSE - WHEN H1 IS STIMULATED EXTRAVASCULAR SMOOTH MUSCLES, INCLUDING THOSE LINING THE NASAL CAVITY ARE CONSTRICTED - DECREASE NASOPHARYNGEAL, GASTROINTESTINAL, AND BRONCHIAL SECRETIONS BY BLOCKING H1 RECEPTOR - USED FOR COMMON COLD, RHINITIS, NAUSEA/VOMITING, MOTION SICKNESS, SLEEP AID - CAUTION WITH PTs WHO HAVE COPD BECAUSE OF DRYING EFFECT - DYPHENHYDRAMINE (BENADRYL) HAS ANTICHOLINERIC EFFECT AND SHOULD BE AVOIDED IN CLIENTS WITH NARROW ANGLED GLAUCOMA - CAUSE CNS DEPRESSION IF TAKEN WITH ALCOHOL, OPIODS, HYPNOTICS, BARBITURATES
50
Side effects/adverse
- DROWSINESS - FATIGUE - DRY MOUTH - BLURRED VISION - WHEEZING - Constipation - GI irritation - Hearing disturbances - Photosensitivity - Nervousness and irritably
51
Antihistamine interventions
- Monitor vital signs - Monitor for signs of urinary dysfunction - Administer with food or milk
52
What administration is avoid in antihistamines ?
- AVOID SUB Q INJECTIONS | - INTRAMUSCULAR INJECTIONS IN LARGE MUSCLES ( IF PRESCRIBED)
53
Antihistamine ( MEDs )
- CetiriZINE ( Zyrtec) - ChlopheniraMINE (Chlo-Trimeton, Chlorphen, Allen- Chlor) - Dimenhydrinate ( Dramamin ) - DyphenhydraMINE ( Benadryl ) - FexofenadINE ( Allegra ) - LorataDINE ( Claritin , Alavert )
54
Nasal Decongestants
(SHRINK) NASAL MUCOSAL MEMBRANES/ REDUCE FLUID SECRETIONS - Adrenergic - Anticholinergic - Corticosteroid
55
What are nasal decongestants contraindicated in ? What are the side effects ?
- Hypertension - Cardiac Disease - Hyperthyroidism - Diabetes Mellitus S/E - Nervousness - Restlessness, insomnia - Hypertension - HYPERglycemia
56
Interventions/ Client Education for Nasal decongestants
- Assessed for existing medical disorders - MONITOR CARDIAC DYSRHYTHMIAS - BLOOD GLUCOSE LEVELS - AVOID CAFFEINE ( Cause restlessness and palpitations ) - LIMITING USE OF NASAL SPRAYS AND DROPS ( MAY CAUSE REBOUND NASAL CONGESTION )
57
What MUST you educate the Pt about NASAL DECONGESTANTS preferably NASAL SPRAYS AND DROPS
- THEY CAN CAUSE TOLERANCE AND REBOUND NASAL CONGESTION ( Vasodilation ) - IRRITATION - THESE SHOULD NOT BE TAKEN LONGER THAN 48 HRS
58
Expectorants
- LOOSEN BRONCHIAL SECRETIONS - Help in ELIMINATING WITH COUGHING, DRY/NONPRODUCTIVE COUGH - STIMULATE BRONCHIAL SECRETIONS
59
Expectorant ( MEDs)
- Guaifensin ( Humibid, Mucinex, Robitussin )
60
Mucolytic Agents
- THINS mucous secretions to help make cough more productive
61
Side/adverse effects with Expectorants and Mucolytic Agents
- GI Irritation - Skin Rash - Oropharyngeal irritation
62
Expectorant/ Mucolytic Agents Interventions
- Acetylcysteine ( Mucomyst ) Administered by NEBULIZATION SHOULD NOT be mixed with another medication - If Acetylcysteine is administered with a BRONCHODILATOR, MUST wait 5 min before administering it
63
What are side effects of acetylcysteine ?
- NAUSEA - VOMITING - stomatitis - RUNNY NOSE
64
Education for Expectorants/Mucolytic Agents
- TAKE FULL GLASS OF WATER ( Helps loosen secretions ) - Maintain adequate fluid intake - Take deep breaths periodically and cough
65
Antitussives
- Act on cough control center in medulla to SUPPRESS COUGH REFLEX - For cough that is NONproductive cough and irritating
66
Side/Adverse Effects of Antitussives
- DIZZINESS - DROWSINESS - SEDATION - GI IRRITATION - NAUSEA - DRY MOUTH - CONSTIPATION - RESPIRATORY DEPRESSION
67
Nursing Interventions for Antitussives
- Take adequate fluids with medication - Sleep with the head of bed elevated - Drug dependency can occur - DO NOT GIVE TO PATIENTS WHO HAD A CRANIAL SURGERY or HEAD INJURY - IF USING OPIODS, SEDATIVE HYPNOTICS, BARBITURATES, ANTIDEPRESSANTS IS AVOIDED ( CNS DEPRESSION CAN OCCUR )
68
Client education on antitussives
- Cough that lasts LONGER THAN 1 WEEK AND FEVER OR RASH NOTIFY HCP - AVOID HAZARDOUS ACTIVITIES - AVOID USE OF ALCOHOL
69
Opioid Antagonists
- REVERSES RESPIRATORY DEPRESSION IN OPIOD OVERDOSE IN OPIOD OVERDOSE - AVOID USE IN ( NONOPIOID RESPIRATORY DEPRESSION ) - REOCCURRENCE OF RESPIRATORY DEPRESSION CAN OCCUR IF DURATION OF OPIATE EXCEEDS DURATION OF OPIOD ANTAGONIST
70
Side/Adverse effects of opioid antagonists
- Nausea, Vomiting - Tremors - Sweating - Increased blood pressure - Tachycardia
71
Nursing Interventions for Opioid Antagonists
- Monitor vital signs - RESPIRATIONS - RN RESPONSIBLE FOR IV administration and for titrating the dose administered every 2 - 5 min as prescribed - HAVE OXYGEN AND RESUSCITATIVE EQUIPMENT AVAILABLE DURING ADMINISTRATION
72
OPIOD ANTAGONISTS
- Alvimopan (Entereg) - Methyltrexone ( Relistor) - NALOXONE (NARCAN) - NALTREXONE (VIVITROL)
73
Tuberculosis Meds
- MOST EFFECTIVE METHOD FOR TREATING DISEASE AND PREVENTING TRANSMISSION - Treatment depends on weather pt has active disease or has been exposed to disease - Use of multi drug regimen DESTROYS ORGANISMS AS QUICKLY AS POSSIBLE AND MINIMIZES THE EMERGENCE OF DRUG- RESISTANT ORGANISMS - ACTIVE TB IS TREATED WITH A COMBINATION OF MEDS TO WHICH THE ORGANISM IS SUSCEPTIBLE
74
How long are individuals with tuberculosis treated ?
6 - 9 months
75
Are clients with HIV treated for a longer period ?
Yes
76
After an individual has received medications for 2 - 3 weeks is the risk for transmission reduced ?
Yes
77
How long does it take for sputum cultures to come out negative ?
3 MONTHS OF COMPLIANCE WITH MEDICATION THERAPY
78
What are individuals with active TB treated with ? How long are they on treatment ?
They are treated with PREVENTATIVE ISONIAZID FOR 9-12 MONTHS
79
First or second line medications are more effective ?
FIRST LINE MEDICATIONS ARE MOST EFFECTIVE ANTITUBERCULOSIS ACTIVITY SECOND LINE ARE USED TO COMBINE WITH FIRST LINE MEDS BUT ARE MORE TOXIC
80
First Line Medications
- Ethambutol (Myambutol) - ISONIAZID - PYRAZINAMIDE - RIFAMBUTIN (MYCOBUTIN) - RIFAMPIN (PRIFTIN)
81
Second Line Agents
- AmikaCIN (Amikin) - CapreomCIN Sulfate (Capastat Sulfate) - CiprofloxaCIN (Cipro) - Cycloserine (SeromyCIN) - EthionaMIDE (Trecator) - KanamyCIN (Kantrex) - LevoflxaCIN (Levaquin) - MoxifloxaCIN (Avelox) - p- Aminosalicylic Acid (Pacer) - StreptomyCIN
82
Isoniazid
- ACT TO KILL ACTIVELY GROWING ORGANISMS IN EXTRACELLULAR ENVIRONMENT - ACTIVE ONLY DURING CELL DIVISION - USED IN COMBINATION WITH OTHER ANTITUBERCULAR MEDS
83
Contraindications for Isoniazid
- HYPERSENSITIVITY - ACUTE LIVER DISEASE - CAUTION WITH PATIENTS WHO HAVE CHRONIC LIVER DISEASE ALCOHOLISM RENAL IMPAIRMENT
84
What are some medications that may increase toxicity if taken with Isoniazid ?
- CarbamazePINE ( Tegretol ) | - Phenytoin ( Dilantin )
85
What are some side/adverse effects of Isoniazid
- HYPERSENSITIVITY REACTIONS - PERIPHERAL NEURITIS - NEUROTOXICITY - HEPATOTOXICITY AND HEPATITIS - INCREASED LIVER FUNCTION TEST LEVELS - PYRIDOXINE (VIT B6) DEFICIENCY - irritation at injection site ( intramuscular administration ) - nausea/vomiting - dizziness ( Safety precautions ) - hyperglycemia - VISION CHANGES ( NOTIFY RN )
86
Nursing Interventions for Isoniazid
- MONITOR HYPERSENSITIVITY - MONITOR HEPATIC DYSFUNCTION - MONITOR FOR SENSITIVITY TO NICOTINIC ACID (NIACIN) - MONITOR LIVER FUNCTION TEST RESULTS - MONITOR SIGNS OF HEPATITIS: NAUSEA VOMITING WEAKNESS FATIGUE DARK URINE JAUNDICE ( HOLD MEDS IF THESE OCCUR TELL RN ) MONITOR TINGLING/NUMBING OR BURNING OF EXTREMITIES - MONITOR CBC & BLOOD GLUCOSE LEVELS
87
How long before or after a meal would you administer Isoniazid ?
- 1 HOUR BEFORE MEAL - 2 HOURS AFTER MEAL FOOD MAY DELAY ABSORPTION
88
When to administer Isoniazid when taking antacids
- Administer at least 1 hour before taking antacids, especially those that contain aluminum
89
Why is Pyridoxine administered as prescribed with Isoniazid ?
REDUCE RISK OF NEUROTOXICITY
90
What are toxic effects that tuberculosis medications cause ?
- HEPATOTOXICITY - NEUROTOXICITY - OPTIC NEURITIS - OTOTOXICITY
91
Client education on Isoniazid
- NOT TO SKIP DOSES/ TAKE MEDICATION FOR THE FULL LENGTH - NOT TAKE ANY OTHER MEDICATIONS WITHOUT CONSULTING THE DOCTOR - IMPORTANCE OF FOLLOWING UP WITH THE DOCTOR ( VISION TESTS ) - NO ALCOHOL - TAKE MEDICATION ON EMPTY STOMACH WITH 8 oz OF WATER 1 HR BEFORE OR 2 AFTER MEALS - AVOID ANTACIDS - RECOGNIZE NEUROTOXICITY, HEPATITIS, HEPATOTOXICITY, VISUAL CHANGES

Respiratory (6 decks)

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