Loss of elasticity, increased secretions, narrowed airways and inflammation can result in?
CAL (chronic airflow limitation)
Mucolytics do what?
Liquefy and remove secretions.
CNS depressants and drugs that stimulate a parasympathetic response are referred to as?
"unkind drugs"
Drugs causing a parasympathetic response may cause what adverse reaction on the respiratory system?
bronchospasm
What are the five main categories of respiratory drugs?
1-bronchodilators
2-antihistamines
3-anti-inflammatories
4-mucolytics
5-antitussives
What are three common types of bronchodilators?
1-beta-adrenergic agonists
2-anticholinergics
3-xanthines
Beta-1 receptors are primarily found where?
in the heart
Beta-2 receptors are primarily found where?
in the bronchi
Epinepherine and Afrin are examples of what kind of drugs?
non-selective adrenergic
Caution: The use of serevent (Servent Diskus) has been associated with fatal ______ ______.
asthma attacks
What is a beta-adrenergic agonist?
A respiratory drug that acts on beta receptors to produce a sympathetic response.
Beta-2 agonists should be used with caution in the ______ and ______ women.
elderly, pregnant
Albuterol (Proventil) and Formoterol (Foradil) are approved for use in children __ and older.
five
Metaproterenol (Alupent) and pirbuterol (Maxair) are approved for use in children __ and older.
12
What is an MDI?
Metered dose inhaler
What are non-selective adrenergics?
Give two examples.
Beta-adrenergic agonists that act equally on beta-1 and beta-2 receptors.
Epinepherine and Afrin
What do selective beta-adrenergic drugs primarily effect?
bronchi (and they exert a lesser degree of influence on beta-1 receptors)
_______ agonists can be used more safely than non-selective adrenergics in a variety of clients.
Beta-2
Anticholinergenics do what?
Block the parasympathetic neurotransmitter, acetylcholine.
The most common anticholinergic bronchodilator is _________.
Ipratroprium bromide (Atrovent)
Ipratropium has the greatest theraputic effect if taken?
consistently, rather than as needed.
Ipratropium peaks in?
1.5 hrs.
Is Ipratropium effective in emergency situations? why or why not?
no, b/c it take 1.5 hrs to peak.
Ipratropium should be used with caution in patients with:
1-
2-
3-
4-
1-glaucoma
2-myasthenia gravis
3-obstructive or infectious GI diseases
4-prostatic hypertrophy
_________ type side effects occur when a client uses anticholinergenics.
sympathetic
Xanthines, anticholinergenics and beta-adrenergic agonists three common types of?
bronchodilators
Some common Xanthines are?
aminophylline, theophylline
The long half-life of xanthines can be dangerous because?
the drug can build up in the body and cause toxicity.
Effective client education for xanthines must include:
1-
2-
3-
4-
5-
1-Take the med at same time every day 2-take w/plenty of fluids to thin
secretions.
3-limit caffeine and smoking
4-Learn toxicity manifestations
5-report toxicity manifestations to PCP
immediately.
Manifestations of xanthene toxicity are:
1-CNS stimulation (tremors, headache..)
2-GI distress
3-Cardiac stimulation (palpatations,
tachycardia, dysrhythmias)
4-Hyperglycemia and hyperkalemia
Xanthines are chemically related to _________.
caffeine
Some side effects of Xanthines are (xanthines are chemically related to caffeine):
1-tachycardia
2-insomnia
3-diuresis
4-restlessness
5-epigastric pain
Side effects of xanthines are increased by?
1-caffeine
2-beta-adrenergic bronchodilators
Clients on _______ therapy require blood levels to be drawn periodically to make sure their therapy is in a safe, theraputic range.
xanthine
Severe xanthine toxicity can result in
1-
2-
1-seizures
2-ventricular fibrillation
Glucocorticoids have these three important actions:
1-
2-
3-
1-anti-inmlammatory
2-anti-allergic
3-anti-stress
Acetylcystine can cause bronchospasm and the concurrent use of ______________ is often recommneded.
bronchodilators
_________ smells and tastes like rotten eggs, often causing nausea in patients.
Acetylcysteine (Mucomyst)
Cromolyn sodium (intal) has a very _____ onset and is used __________.
slow, prophylactically
Paradoxial restlessness can occur in the elderly and children when administered ____________.
antihistamines
The nurse is reviewing a client's medical history, which disease would contraindicate the use of antihistamines?
A) angina
(fatal arrythmeas with prolonged QT interval)
Cromalyn sodium (Intal) is most effective when used ?
prophylactically
Rebound congestion is?
tolerance
A patient newly prescribed theophylline will be instructed to have ______ levels checked regularly.
blood (theophylline has a narrow theraputic range)
Beclomethasone (Beclovent) is what type of bronchodillator?
Corticosteroid
List 3 important instructions for a patient prescribed Beclomethasone (Beclovent) for long-term use.
1-Use a spacer during admininstration by MDI.
2-Rinse and gargle after inhaling to prevent candidiasis
3-engage in weight bearing excercises and ensure adequate intake of calcium and vitamin D since steroids promote bone loss.
When prescribed both Albuterol (Proventil) and beclomethasone dipropionate (QVAR) inhalers for asthma, when, how and why should the patient use these in a special sequence?
Use the albuterol inhaler 5 min before using the beclomethasone inhaler because the beta-2 agonist (Albuterol) promotes bronchodillation and enhances the absorption of the glucocorticoid (beclamethasone).
Albuterol is used for asthma treatment to?
promote bronchodilation
Glucocorticoids and cromolyn decrease?
inflammation
Montelukast (Singular) a leukotriene modifier decrease _______ _______ production and supress the effects of ________ _________.
airway mucus, leukotriene compounds
Glucocorticoids can result in weight _____ and fluid ______.
gain, retention
Subcutaneous needles are between ___ and ___ in. long.
1/4 to 5/8 in. long
Sites for subq injections are:
1-
2-
3-
4-
5-
1-upper arm
2-upper back
3-abdomen
4-thighs
5-top of buttocks
A nurse is preparing to give an obese patient a subq injection. She knows which angle is best?
90
The two angles for giving subcutaneous injections are?
45 and 90
Subcutaneous syringes are no more than __mL.
1mL
IM deltoid needles are __in. long?
1inch
IM Deltoid syringes are up to __mL?
3mL
Where are four IM injection sites?
1-Deltoid
2-Ventrogluteal
3-Dorsogluteal
4-Vastus Lateralis
Mucolytics work on the ______.
cilia
Surfactants work in the _______?
alveoli
Antitussives ______ the cough reflex.
supress
The antitussive Benzonatate (Tessalon) acts like a _________ _________ for a _________ cough.
numbing agent, non-productive.
Dextromethorphan (Benylin) belongs to which class of drugs?
Antitussives
Sally is walking through the perfume department at her favorite departments store as another customer sprays several perfumes. The correct antitussive for this kind of non-productive cough due to irritation of the throat would be? And why?
Benzonotate (Tessalon) because it's a numbing agent.
If a patient has a severe, non-productive cough that just won't go away and is causing irritation, the nurse would administer which antitussive and why?
Either Dextromethorphan (Benylin) or Hydrocodone (Hycodan) because they supress the cough reflex in the brain.
Adverse reactions associated with antitussives are (3):
Decongestants cause vasoconstriction or vasodilation of upper airway?
vasoconstriction (to allow drainage)
Topical decongestants are _____________, meaning that they imitate the effects of the sympathetic nervous system.
sympathomimetics
Oxymetazoline (Afrin) and Ephedrine (Pretz-D) are examples of what class of respiratory drugs?
Decongestants
_______ decongestants are not absorbed into the blood stream.
Topical
Describe the rebound effect:
After taking Afrin for several weeks you suddenly stop and the symptoms are worse than before. You have built up a tolerance for the drug and need more each time for it to work.
Steroids should be avoided for patients that have vasoconstriction. Give some examples:
Glaucoma, CV, thyroid, HTN
Is the decongestant Ephedrine (Pretz-D) topical or oral?
topical
Is the decongestant pseudoephedrine (Sudafed) topical or oral?
Oral
Beclomethasone (Beclovent) and flunisolide (Aerobid) are examples of what class of respiratory drugs?
Topical steroids can cause an overgrowth of ______________.
candida
Diphenhydramine (Benadryl) and Promethazine (Phenergen) belong to which class of respiratory drugs?
Antihistamines
True or False:
The nurse knows Benadryl can be used to treat, prophylactically or for it's sedation qualities.
True
Promethazine (Phenergen) is used as (2 things)?
antihistamine or nausea
Antihistamines can cause a __________ _________.
fatal interval.
This classification can cause ______ ______ with prolonged QT interval.
fatal arrythmeas
A very serious drug interaction for antihistamines is?
MSO inhibitors (anti-depressant)
It's very important to assess the _____ and the ___ when administering an antihistamine.
heart, GI
A glaucoma patient complains of irritation to their eyes after taking a Sudafed for 3 days. What is this patient at risk for? and why shouldn't they be taking this?
blindness, b/c decongestants are vasodilators.
Guaifenesin (Mucinex) is?
an expectorant
Acetylcysteine (Mucomyst) is?
Mucolytic
Because mucolytics and expectorants liquify secretions, it is always important to teach the patient to?
drink fluids
What is the antidote for acetaminophen poisoning?
Acetylcysteine (Mucomyst)
Be aware of _______ when administering mucomyst via nebulizer.
skin excoriation
Antitussives and decongestants affect which part of the respiratory tract, upper or lower?
upper
ARDS & RDS stand for?
Acute respiratory distress syndrome and Respiratory distress syndrome
RDS refers to?
any obstructrions at the alveoli
The progressive loss of lung compliance and hypoxia refers to?
ARDS
The nurse has control over RDS or ASRDS?
ARDS
ARDS can happen within __ hours.
24
RDS or ARDS is completely preventable?
ARDS
Xanthines, enzyme therapy, sympathomimetics and anticholinergenics are all examples of?
Bronchodilators/Antiasthmatics
Caffeine, aminophylline and theophylline are all examples of what group of bronchodilators?
Xanthines
Common side effects of xanthines are:
tachycardia, jitters
The nurse is concerned because her smokes and is taking a __________.
xanthine
Alpha1-protease inhibitor treats a __________ deficiency?
protease
An emphysematic patient in their 30's or 40's is most likely to be prescribed this therapy.
Alpha1-protease inhibitor (enzyme therapy)
Alpha1-protease inhibitor is specifically for treatment of ________ deficiency.
protease
Smokers who have the protease deficiency are at risk for severe _____ destruction.
lung.
Albuterol (Proventil), Epinepherine and Salmeterol (Serevent) are all?
Sympathomimetics
Sympathomimetics work by _______ the bronchi.
dilating
Sympathomimetics work by _________ rate amd depth of respiration.
increasing
Sympathomimetics act on ______ receptors.
Beta-2
A patient taking a sympathomimetic may feel ________ or ________ because everything is speeding up.
restless or anxious
What is imperative to monitor on a patient taking a sympathomimetic?
telemetry
Epinepherine is the __________ drug of choice.
anaphylactic shock
Sympathomimetics can cause these two serious adverse reactions:
