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Pharmacology Exam #1 > Upper Respiratory Agents > Flashcards

Upper Respiratory Agents Flashcards

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1
Q

Upper Respiratory Agents
In Children

A
  • Caution due to adverse effects: sedation, confusion, dizziness
  • DO NOT give UNDER 4 years old
  • Caution in 4-6 years old
  • Non-Drug Measures first: oral fluids, cool humidifier, control exposure to smoke, allergens, irritants
  • Wash hands to prevent infection
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2
Q

Upper Respiratory Agents
In Adults

A
  • Potential Accidental Overdose
  • Non-drug measures
  • No established safety in pregnancy and lactation
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3
Q

Upper Respiratory Agents
In Older Adults

A
  • More Likely to develop adverse effects: sedation, confusion, dizziness
  • Renal and hepatic impairment
  • START LOW, GO SLOW
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4
Q

Antitussives
Drug Names

A
  • Benzonatate
  • Codeine and Hydrocodone
  • Dextromethorphan
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5
Q

Antitussives
MOA

A

Codeine, Hydrocodone, Dextromethorphan:
* Acts directly on the medullary cough center of the brain to depress the cough reflex

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6
Q

Antitussives
Benzonatate
MOA

A

Local anesthetic on the respiratory tract

Need to know cause of cough first

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7
Q

Antitussives
Contraindications

A

Absolute:
* Allergy
* Patients who need to cough to maintain the airway

Relative:
* Head injury or impaired CNS
* Serious respiratory conditions like asthma or emphysema

Caution:
* History of narcotic addiction
* If they need to be alert

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8
Q

Antitussives
Adverse Effects

A
  • Drying effect on the mucus membranes
  • GI upset from drying effects
  • CNS effects
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9
Q

Antitussives
Drug Interactions

A

Drug:
* MAOIs - taken for depression
* Opiods/CNS depressants - including alcohol

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10
Q

Antitussives
Assessment

A

History:
* Contraindications, cautions, pregnancy, lactation

Physical:
* Lung sounds & respiratory rate
* Temperature
* Orientation and affect

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11
Q

Antitussives
Nursing Conclusions

A
  • Ineffective airway clearance
  • Altered sensory perception
  • Knowledge deficit
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12
Q

Antitussives
Implementation/Patient Teaching

A
  • Do not take longer than prescribed or needed
  • Further medical evaluation if needed
  • Comfort measures: Resting, lozenges, cool humidifier, avoiding irritants, oral fluids
  • Patient Teaching: avoid other opiods and CNS depressants
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13
Q

Topical Nasal Decongestants
MOA

A

Sympathomimetic => local vasoconstriction => decreased edema and inflammation

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14
Q

Topical Nasal Decongestants
Indications

A
  • Relieve the discomfort of nasal congestion (cold, allergies)
  • Dilate the nares (nostrils) for medical exams or to relieve middle ear pressure
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15
Q

Topical Nasal Decongestants
Drug names

A

“-zoline”
* Oxymetazoline
* Tetrahydrozoline
* Xylometazoline

Phenylephrine

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16
Q

Topical Nasal Decongestants
Contraindications

A

Absolute:
Allergy

Caution:
* Lesion or erosion in the mucus membranes (can lead to systemic absorption)
* Conditions that might be exacerbated by sympathetic activity: Glaucoma, HTN

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17
Q

Topical Nasal Decongestants
Adverse Effects

A
  • Local stinging and burning (Usually goes away after a few uses)
  • Rebound congestion (after 3-5 days)
  • Sympathomimetic effects
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18
Q

Topical Nasal Decongestants
Drug Interactions

A

Drug:
* Other sympathomimetic drugs (Toxic effect)
* Sympathomimetic blocking drugs (less effective)

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19
Q

Topical Nasal Decongestants
Assessment

A

History:
* Contraindications or cautions

Physical:
* Nasal mucus membranes
* Cardiac
* Urinary Status (elimination patterns)

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20
Q

Topical Nasal Decongestants
Nursing conclusions

A
  • Impaired comfort
  • Knowledge deficit
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21
Q

Topical Nasal Decongestants
Implementation/Patient Teaching

A
  • Administer correctly
  • Drug not taken longer than 1 week
  • Further medical evaluation for persistent symptoms
  • Comfort measures (ie. cool humidifier)
  • Patient Teaching: overdose prevention
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22
Q

Topical Nasal Decongestants
How to administer

A
  • Sit upright, close one nostril
  • Hold the bottle upright and insert the tip (about 1/2 inch) into the open nostril
  • Firmly squeeze the bottle
  • Repeat with other nostril
  • Refrain from blowing nose after administration
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23
Q

Oral Decongestants
MOA

A
  • Vasoconstricts small blood vessels of the nasal membranes
  • Stimulates the alpha-adrenergic receptors in the nasal mucus membranes to shrink them
  • Leads to promotion of drainage in the sinuses and improving air flow
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24
Q

Oral Decongestants
Indications

A

Decrease nasal congestion due to:
* common cold
* sinusitis
* allergic rhinitis

Relieves pressure in the middle ear:
* ear infections

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25
**Oral Decongestants** Drug Names
* Pseudoephedrine * Phenylephrine
26
**Oral Decongestants** Contraindications
**Absolute:** * Allergy **Caution:** * Any conditions that might be exacerbated by sympathetic activity (Alpha-adrenergic receptors => sympathetic activity)
27
**Oral Decongestants** Adverse Effects
* Rebound congestion * Sympathetic effects *(restlessness, anxiety, sweating, etc)*
28
**Oral Decongestants** Drug Interactions
Other OTC products that contain the same ingredients (Increased toxicity)
29
**Oral Decongestants** Interventions/Patient Teaching
* Don't take drug more than one week * Further medical evaluation for persistent symptoms * Monitor vitals (Pulse, BP) to detect adverse effects * Safety and comfort measures * Patient teaching - read drug labels to prevent overdose
30
**Steroid Nasal Decongestents** MOA
* Blocks inflammatory response to relieve inflammation * Exact mechanism of action is NOT known * Minimal systemic absorption * Takes 1-3 weeks to be effective *(because it is TOPICAL, not oral)*
31
**Steroid Nasal Decongestents** Indications
* Seasonal allergic rhinitis * Nasal congestion * Inflammation after the removal of nasal polyps
32
**Steroid Nasal Decongestents** Drug names
**"-one"** * Beclomethas**one** * Fluticas**one** * Triamcinol**one** **"-ide"** * Budeson**ide** * Flunisol**ide**
33
**Steroid Nasal Decongestents** Contraindications
**Absolute:** * Allergy **Relative:** * Acute infection *(because it suppresses immune function)* * Recent nasal surgery or trauma *(can interfere with healing)* **Caution:** * Active infection *(because it suppresses immune function)*
34
**Steroid Nasal Decongestents** Adverse Effects
* Local burning, irritation, stinging, drying of the mucosa * Headache * Suppression of healing/immune function * Nausea
35
**Steroid Nasal Decongestents** Assessment
**History:** * Allergy * Acute/Active Infection * Nasal trauma/surgery **Physical:** * Nasal mucosa *(lesions)* * CNS *(headache)* * Temperature *(infection)*
36
**Steroid Nasal Decongestents** Nursing Conclusions
* Impaired comfort *(r/t local effects)* * Infection risk *(r/t immune suppression)* * Knowledge deficit
37
**Steroid Nasal Decongestents** Implementation/Patient Teaching
* Monitor for acute infection * Safety measures: avoid areas with airborne infections * Comfort measures: cool environment, humidification, oral fluids) * Patient teaching: how to administer, follow up, takes 1-3 weeks to work
38
**Antihistamines** MOA
* Blocks release or action of histamine at histamine-1 receptor sites * Decreases allergic response * Anticholinergeric and antipruritic effects * 1st generation: greater anticholinergic effects * 2nd generation: less sedating
39
**Antihistamines** Indications
* Allergic rhinitis and conjunctivitis * Urticaria * Angioedema
40
**Antihistamines** Drug names
**"-amine"** or **"-ine"** * Diphenhydramine * Hydroxyzine * Meclizine * Promethazine * Azelastine * Cetirizine * Fexofenadine * Levocetirizine * Loratadine
41
**Antihistamines** Contraindications
**Absolute:** * Allergy **Caution:** * Renal or hepatic impairment * History of arrhythmias or prolonged QT intervals *(1st gen can result in fatal arrhythmias)*
42
**Antihistamines** Drug Interactions
* Varies based on the drug * CNS depressants * Any drug that increases QT intervals
43
**Antihistamines** Adverse Effects
* CNS: drowsiness and sedation * Anticholinergic: respiratory, skin, GI/GU *(urinary retention)*
44
**Antihistamines** Assessment
**History:** * Allergy, pregnancy/lactation, prolonged QT interval/arrhythmias * Renal or hepatic impairement **Physical:** * heart and lung sounds * skin * CNS * Urinary status, orientation, affect and reflexes
45
**Antihistamines** Nursing Conclusions
* Impaired comfort *(r/t adverse effects)* * Altered sensory percepetion *(r/t CNS effects)* * Knowledge deficit
46
**Antihistamines** Implementation/Patient Teaching
* Administer on an empty stomach to increase absorption * Sugarless candy/lozenges for dry mouth * Skin Care * Void before administration * Most effective before onset of symptoms * Comfort and safety measures * Patient Teaching: Read labels to avoid overdose, avoid alcohol
47
**Expectorants** MOA
Enhances the output of respiratory tract fluids by reducing the adhesiveness and surface tension of these fluids, allowing easier movement of the less viscous secretions
48
**Expectorants** Indications
Increase productive cough to expel mucus to clear the airway therby relieving respiratory congestion
49
**Expectorants** Drug name
Guaifenesin
50
**Expectorants** Contraindications
**Absolute:** * Allergy **Cautions:** * Persistent cough: unknown underlying problem
51
**Expectorants** Drug Interaction
NONE/Unknown
52
**Mucolytics** Drug Interaction
NONE/Unknown
53
**Expectorants** Adverse Effects
* GI Symptoms: nausea * Headache, dizziness * Mild rash * Prolonged use may mask serious underlying condition
54
**Expectorants** Assessment
**History:** * Allergy, pregnancy, lactation, persistent cough **Physical:** * Respiratory * Skin * CNS * Abdomen * Vital Signs
55
**Expectorants** Nursing Conclusions
* Impaired comfort *(r/t adverse effects)* * Altered sensory percetion *(r/t CNS effects)* * Knowledge Deficit
56
**Expectorants** Implementation/Patient Teaching
* Small frequent meals to prevent GI effects * Safety * patient teaching
57
**Mucolytics** MOA
Works to break down mucus in order to aid the high-risk respiratory patient in cougning up thick. tenacious secretions
58
**Mucolytics** Drug Names
* Acetylcysteine * Dornase alfa *(for cystic fibrosis symptomatic relief)*
59
**Mucolytics** Contraindications
**Absolute:** * Allergy **Caution:** * asthma *(potential for bronchospasm)*
60
**Mucolytics** Adverse Effects
* GI upset * Stomatitis *(inflammation in mouth)* * Rhinorrhea * Bronchospasm * Rash
61
**Mucolytics** Assessment
**History:** * Allergy, asthma **Physical:** * Respiratory * skin * abdomen * Vital signs
62
**Mucolytics** Nursing Conclusions
* Impaired comfort *(r/t adverse effects)* * Ineffective airway clearance *(r/t bronchospasm)* * Knowledge deficit
63
**Mucolytics** Implementation/Patient Teaching
* DO NOT COMBINE in a Nebulizer: *(prevents precipitation)* * Wipe face and mask with water after nebulizer *(prevent skin breakdown)* * Patient Teaching *(what to take, when, and why) * Keep Dornase alfa in fridge
64
**Mucolytics** Indications
* Pts. with difficulty coughing up secretions * Pts. with atelectasis * Pts. undergoing diagnostic bronchoscopy * Postoperative pts. * Pts. with tracheostomies * Illnesses such as: COPD, cystic fibrosis, pneumonia, TB

Pharmacology Exam #1 (10 decks)

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