respiratpry meds

Question 1

histamine

Answer 1

H1
H2 - GI system

Question 2

H1

Answer 2

vasodilation
*prominent in the skin of the face, can lead to hypotension

increased capillary permeability:
*produces edmea
*lead to hypotension

bronchoconstriction:
*asthma can make it severe (release of histamine)

CNS:
roles in cognition, memory and sleep/wake cycle

other:
itching, pain, secretion of mucus

Question 3

H2

Answer 3

gastric acid secretion

Question 4

Allergy

Answer 4

histamine mediates allergic reactions

mild (runny, stuffy nose)

severe (anaphylaxis)

H1 antagonist (antihistamines) used to treat

Question 5

H1 antagonists (antihistamines)
effects on the body

Answer 5

peripheral effects:
*decrease in localized flushing, edema, itching, pain, supression of mucus secretion

CNS:
*depression of the CNS with therapeutic dose leads to sedation properties
*excitation of the CNS with overdose: convulsions

others:
*blocking the muscarinic receptors lead to anticholinergic responses (SNS effects)
(dry mouth, nasal passages, and throat)
(urinary hesitancy, constipation, palpitations)

Question 6

H1 antagonists
therapeutic uses

Answer 6

mild allergic reaction
severe allergic reaction
used inly as adjunct (1st we use epinephrine)
motion sickness
insomnia
common cold
mild transfusion reactions

Question 7

H1 antagonists
SE/AR

Answer 7

sedation
dizziness
decreased coordination
confusion
N/V
diarrhea/constipation
dry mucous membranes

Question 8

frist generation H1 antagonists (antihistamines)

Answer 8

have drowsy effects

chlorpheniramine (Chlortrimeton)

diphenhydramine (Benadryl)

promethazine (Phenergan)

hydroxyzine (Vistaril)

Question 9

Second generation (less sedation)
H1 antagonists (antihistamines)

Answer 9

cetirizine (Zyrtec)

fexofenadine (Allegra)

loratadine (Claritin)

Question 10

Asthma

Answer 10

disorder that includes:

chronic inflammation
bronchoconstriction
bronchospasm

Question 11

classifcications and severity of asthma
step1 thru step5

Answer 11

step 1: mild (inhaler)

step 5: severe (need multiple meds)

Question 12

peak expiratory flow rate (PEFR)

Answer 12

max airflow during expiration

assess qAM (upon waking)

Question 13

peak expiratory flow rate (PEFR)

ZONES

Answer 13

Red zone:
*less than 50%
*seek medical tx immediately

Yellow zone:
*some symptoms
*50-80% of personal best
*control is insufficient
*f/u with PCP

Green zone:
*No symptoms
*PEFR > 80% of personal best

Question 14

asthma triggers to avoid

Answer 14

pets

cockroaches

tobacco smoke

mold

temperature extremes

aerosol

Question 15

inhalers

metered-dose inhalers (MDI)

dry powder inhalers

Answer 15

MDI:
*inhale prior to activating device
*seperate puffs by 1 min
*spacer helps deliver drug for children or pt who wont hold breath

dry powder inhaler:
*deliver more drug to lungs than MDI

Question 16

teaching points for inhalers

Answer 16

shake—
take a deep breath in and out—
on next inhale depress the med—
have pt hold breath as long as comfortable—
rinse mouth with water after —

*important if inhalation containes steroids to avoid infections

Question 17

inhalers: nebulizers

Answer 17

convert solution into a fine mist

takes several min to adminiter

aerosolized

Question 18

main classifications utulized to treat asthma

Answer 18

inhaled corticosteroids

beta2 adrenergic agonists
*inhaled and oral
*short-acting (SABA)
*long-acting (LABA)

glucocorticoids (category of corticosteroids)
*oral

leukotriene modifiers

Question 19

inhaled corticosteroids (ICS)

Answer 19

containes one of sever cotricoids designed to decrease inflammtory process with asthma

med:
fluticasone (flonase)

Question 20

ICS how to use

Answer 20

breath in and out—
on next inhale depress med—
inhale deeply

paint tip towards the ear on the side your doing it on

rinse or wipe off the tip of the applicator

2 spray per nostril

Question 21

Albuterol

Answer 21

the main short-acting Beta2 adrenergic agonist bronchodilator (SABA) inhaled med

beta2 receptors are in lungs
*stimulation of them cause bronchodilation

SABAs cause an immediate opening of the airways
*referred to as rescure inhaler

Question 22

albuterol (Proventil, Ventolin)
use and effects

Answer 22

do not change dosage without contacting provider

may cause:
paradoxical (rebound) bronchospasm
hyperactive response in children

result of taking:
*decrease in anxiety once breathing is restored

always watch for paradoxical reaction: code situation if occurs

Question 23

albuterol (Proventil, Ventolin)
route

Answer 23

inhaler
nebulizer

po via liquid
(when given po its nolonger rapid-acting)
not a resue inhaler anymore

Question 24

other B2 adrenergic agonist inhalers

Answer 24

short acting inhaled:
*levalbuterol (Xopenex)

long acting inhaled:
*salmeterol (Serevent)

Oral agents (liquid):
when given this route, no longer a rescue inhaler
*albuterol (Proventil, Ventolin, Volmax)

Question 25

SABAs SE/AR

Answer 25

minimal *tachycarida *angina pectoris *exacerbation of HF *tremors *hyperactivity

Question 26

Leukotriene Modifiers

Answer 26

added in 2nd or 3rd step asthma or if SABA and ICS are not producing needed outcomes LM are chemical mediators released within body upon the exposure to known allergens block the action of leukotrienes slow acting so not used as rescue med

Question 27

Leukotrienes ( why we use modifiers to block it) causes the following

Answer 27

bronchoconstriction excess respiratory and oral mucus production excess respiratory and mucosal fluid production

Question 28

Leukotriene Modifiers med SE/AR

Answer 28

montelukast (Singulair) flu-like symptoms nervousness HA gastric irritation N/V Nasal congestion

Question 29

glucocorticoids route uses

Answer 29

route: inhalation usually, or po, iv uses: *decrease the inflammation *used in acute situations *used for prophylaxis with asthma attack, taken on a fixed schedule

Question 30

glucocorticoids SE/AR

Answer 30

oropharyngeal condidiasis dysphonia (hoarseness) shakiness loss of appetite mood swings

Question 31

glucocorticoid meds

Answer 31

prednisone prednisolone: easier on liver for peds must taper off slowly to avoid major hormonal imbalance and mood swings add other meds very cautiously 5-7 dose pack is most common administstration schedule

Question 32

education points with inhalers

Answer 32

rinse mouth out to avoid oral fungal infection rinse mouthpiece avoid OTC inhalers due to med interactions

Question 33

decongestants

Answer 33

sympathomimtics *stimulates apha1 adrenergic receptors on nasal blood vessesl causing loacal vasoconstriction vasoconstriction takes up less space and opens the airway

Question 34

decongestants sympathomimetics meds SE/Ar

Answer 34

oxymetazoline (afrin, No-synephrine) pseudoephedrine (sudafed) epinephrine (Adrenalin) SE/AR: rebound congestion CNS stimulation Cardiovascular effects

Question 35

medications for coughs

Answer 35

antitussives expectorants mucolytic

Question 36

medications for coughs antitussives

Answer 36

opioid antitussives: effective with chronic or induced cough *codeine *low-dose morphine *hydrocodone Non-opioid antitussives: effective with acute cough due to cold, rhinitis *dextromethorphan (common) *benxonatate (Tessalon Perles)

Question 37

medications for cough Expectorants

Answer 37

gets you to cough it up Guaifenesin (used often in Robitussin) *taken with full glass of water

Question 38

medications for cough Mucolytic

Answer 38

thins mucus acetylcystine (Mucomyst)