Pharm V

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mowgli
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150766
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Pharm V
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2012-05-04 09:40:10
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respiratory diuretics Immunological modifiers
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  1. what are the 2 types of histamines?
    • H1
    • H2
  2. What do H1 recepters do?
    }H1 receptors mediate smooth muscle contraction (allergic symptoms) }Dilation of capillaries
  3. What do H2 recepters do?
    • Accelerate HR
    • Accelerate gastric acid secretion
  4. what can excessive amount of histamine released lead to?
    can lead to allergic reaction and even anaphylaxis

    Both H1 and H2 dilate vessels
  5. what happens when Both H1 and H2 dilate vessels?
    inflammitory response

    There can be an in crease in body secretions

    There can be dilation of the vessels causing fluid to move OU OF the vessels and into the tissue causing a drop in the Bp and excessive
  6. What are antihistamines?
    “antagonists”
  7. What do antihistamines do?
    }Those that compete with histamine for the H2 receptors are “ H2 antagonists” or H2 BLOCKERS

    }Think about cimetadine and rantadine- they act on the GI system
  8. what do H1 blockers do?
    compete with histamine for the H1 receptors

    help out with environmental allergies
  9. how do H1 BLOCKERS work?
    will block histamines attempting to bind to receptor sites- that is why early treatment is needed!
  10. what happens if there is histamine already attached to the receptor sites?
    the H1 blockers can’t help
  11. what are environmental allergies
    Allergies due to- molds, mold spores, dust, etc…

    can cause hay fever, ithy eyes, uticaria, sneezing, cough, etc…
  12. what kind of effect do H1 blockers have?
    • an anticholinergic effect- so they DRY secretions
    • (Think about the opposite of SLUDGE
  13. how do histamines cause pruritis in the skin?
    Histamines bind to nerve endings causing pruritis
  14. what do histamines do in an allergic reaction?
    Binds and activates specific receptors in the eyes, nose, skin, resp. tract
  15. What causes an allergic reaction?
    Histamines and other substances are released by mast cells, basophils b/c they are reacting to the circulating antingens( foreign substances) in the blood.
  16. What are some Non-sedating Antihistamines?
    • 1) FEXOFENADINE-
    • 2) Claritin
  17. What are some FEXOFENADINE drugs?
    Allegra and Seldane*
  18. What are some properties of seldane?
    Seldane has serious interactions- off market.
  19. What can taking EES & seldane at the same time lead to?
    EES- antibiotic and Ketokonozole (antifungal)- can lead to Seldane build-up in the blood- can cause cardiac dysrythmias and can be life-threatening }
  20. What is Allegra used for?

    How is it available?
    the relief of symptoms of seasonal allergic rhinitis-

    OTC
  21. what ages is allegra safe in?
    children 12 and older
  22. What kind of antihistamine is Claritin
    non-sedating antihistamine
  23. What pt's is claritin not used in?
    those with lower resp-tract diseases

    • those with an acute asthma attack
    • Why
  24. how is claritin available?
    • Also now available OTC
    • Fairly inexpensive
  25. What are some Traditional Antihistamines?
    • 1) Diphenhydramine-
    • 2) Meclizine
    • 3) Promethazine- Phenergan
    • 4) Astelin-
    • 5) Zyrtec-
    • 6) Chlor-trimeton-
    • 7) Dramamine-
    • 8) Unisom-
    • 9) Atarax/Vistaril
    • 10) Antivert-
  26. what is another name for Diphenhydramine?
    Benadryl
  27. What is diphenhyramine used for?
    • Used for allergies
    • motion sickness
    • a sleep aid (think safety ed.)

    Commonly used for allergies and pruritis
  28. How safe is diphenhyramine?
    Very safe (few s/e’s)
  29. What kind of s/e or properties does diphenhyramine have?
    • Anticholinergic properties
    • dries secretions so educate

    These still act on CNS so educate about safety
  30. what pt's is diphenhyramine contraindicated for?
    • in nursing mothers
    • neonates
  31. What forms does diphenhyramine come in?
    PO (tabs, elixir and topical)
  32. how is topical diphenhyramine available?
    • alone
    • in combo with other drugs- calamine, camphor
  33. What is Benadryl- Diphenhydramine ?
    antihistamine
  34. What is Meclizine used to treat?
    • vertigo
    • dizziness
    • motion sickness
  35. What can meclizine cause?

    what do you need to worry /do about this?
    • May cause sleepiness
    • Safety if sleepiness

    EducateRx.
  36. What is another name for Promethazine?
    Phenergan
  37. What is promethazine
    Antihistamine, used basically for antiemetic
  38. How is promethazine available/in what forms?
    • Rx only-
    • may be po, IV, IM, and rectal formula
  39. how is promethazine usually ordered?
    Uusually ordered q4-6 hours prn for nausea
  40. When is promethazine given in conjunction with Demerol?
    if Demerol is the drug of choice for pain

    How does this work as an antiemetic?
  41. WHat is Phenergan (promethazine) often given for?
    for nausea Will dry secretions- educate and assess
  42. What is a s/e of Phenergan (promethazine)?
    Will dry secretions- educate and assess
  43. in what form is Astelin available?
    Only nasal spray antihistamine
  44. what age groups is Asteline used for?
    for adults and children over age 12
  45. What is a possible s/e of Asteline?
    May have rebound effect-

    educate
  46. what is Zyrtec used for?
    for year round allergy sufferers

    for chronic uticaria also
  47. how is Chlor-trimeton available?
    Available OTC in tab form
  48. What is Dramamine used for?
    Used for motion sickness
  49. At what age can pt's start taking Dramamine?
    Can be used starting at age 6 and greater
  50. What is a s/e of Dramamine?
    Causes sleepiness
  51. What is Unisom?
    OTC for sleep aid
  52. how should Unisom be taken?
    Take with a full glass of water
  53. What is a s/e of Atarax/Vistaril
    Has sedative and mild antianxiety properties
  54. What is Antivert used for?
    the treatment of vertigo
  55. What are some adverse reactions of antihistamines?
    • dysrythmias/palpitations
    • Hypotension, syncope
    • Dizziness, blurred vision
    • Sedation
    • Paradoxical excitement,
    • insomnia
    • Nervousness,
    • headache
    • Seizure
    • N/V/D/anorexia
  56. Rarely-
    • Leukopenia,
    • pancytopenia
  57. What are Decongestants used for?
    to decrease the nasal mucosa inflammation
  58. What are three types of Decongestants?
    • a) Adrenergics
    • b) Anticholinergics
    • c) Corticosteroids-
  59. what forms do Decongestants come in?
    • orally,
    • inhaled,
    • topical
  60. What are some Oral/Inhaled Decongestants?
    • Neo-synephrine
    • Sudafed
  61. What kind of effect do Oral/Inhaled Decongestants give?
    These give the longest effect because they are distributed systemically
  62. What is the onset of action for Oral/Inhaled Decongestants ?
    Onset is delayed
  63. Sudafed
    Caution in handing out sudafed- why?
  64. what should pt's taking oral/inhaled decongestants have?
    ID
  65. What are some Inhaled decongestants?
    • Vicks inhaler,
    • Benzedrex
  66. What are some Topical Decongestants?
    • Adrenergics
    • intranasal steroids
  67. what kind of onset do Topical Decongestants have?
    Prompt onset
  68. what can several days of use of Topical Decongestants cause?
    “rebound congestion”
  69. What kind of education do you need to provide for topical Decongestants
    adverse effects on nasal mucosa are more likely to occur with excessive or long term use

    can produce rebound effect w/ long term use (usually longer than 3 days) or in excess

    use only meds labeled for intranasal use
  70. what are some ADRENERGICS?
    • Ephedrine- Vicks
    • Afrin
    • Neo-senephrine
  71. What is an adverse effect to adrenergics?
    cardiac stimulation
  72. in what pt's are adrenergics contraindicated?
    • cardiac tachdysrhythmias
    • w/ severe CAD
  73. What are some INTRA-NASAL STEROIDS?
    • Beconase
    • Decadron Phosphate Turbinase
  74. What do topical decongestants do?
    They relieve nasal stuffiness (vasocinstrict)

    Shrink engorged nasal mucous membranes
  75. What happens if topical decongestantd inadvertently enter the blood stream?
    • they can cause
    • Hypertension
    • Palpitations
    • HA,
    • dizziness
  76. What do Andrenergics do?
    specifically constrict the small blood vessels that supply the UR tract- especially those around the sinus cavity

    bronchodilate
  77. what can Adrenergics cause?
    • nervousness,
    • tremors,
    • palpitations,
    • insomnia
  78. What do Nasal steroids do?
    reduce inflammation
  79. What can Nasal steroids cause?
    • mucosal irritation
    • dryness
  80. What are some Nasal steroids?
    • Nasonex,
    • Flonase,
    • Nascort
  81. When is the Cough reflex stimulated?
    stimulated when the receptors in the bronchi, alveoli, and the lining of the lungs (pleura) are stretched due to excessive secretions of foreign substance invasion
  82. Where is the Cough reflex stimulated?
    in the medulla
  83. When can the Cough reflex be harmful?
    • after surgery
    • after hernia repair,
    • if there is IOP or ICP
  84. What are the two types of Antitussives?
    • Opioid
    • Non-opioid
  85. What type of antitussives is less effective?
    Non-opioid
  86. What are some non-opiod antitussives?
    Dextramethrephan / Benzonatate
  87. do non-opioids have any analgesic effects?
    no analgesic effect
  88. What are some advantages of non-opioid antitussives?
    • does not have addictive properties
    • or cause CNS depression
  89. How safe are non-opioid antitussives?
    Fairly safe to use short term
  90. WHat are Benzonatates?
    non-opioid antitussive

    but it anesthetizes the cough reflex by causing numbing of the stretch receptors
  91. What do Codiene, hydrocodone (opioids) and dextramethorephan (non-opioid) do?
    directly suppress the cough reflex
  92. What are some s/e of non-opioid antitussives?
    • Most of these drugs can cause dizziness,
    • drowsiness,
    • sedation
  93. Cause dry mouth,
    • nausea,
    • constipation
  94. What is another name for Benzonatate?
    Tesselon

    Tesselon Perle’s
  95. What does Benzonatate do?
    -Non-opioid -Numbs cough receptors
  96. How is Benzonatate available?
    • -Rx only
    • -100 mg capsules only,
    • orally-
  97. How does Benzonatate look like?
    Looks like a small vitamin E
  98. What is Codeine?
    antitussive- opioid
  99. What kind of properties does Codeine have?
    Addictive properties
  100. Wat is Codeine usually used in combo with?
    Usually in combo with a cough med- Robitussin AC
  101. What is a s/e of Codeine?
    Can depress RR and CNS
  102. How is Codeine available?
    Controlled substance- Rx only
  103. in what pt's is Codeine contraindicated for?
    • severe respiratory disorders,
    • seizures,
    • ICP
  104. What are some Detramethoraphans?
    • Vicks 44,
    • Robitussin DM
  105. What are some properties of Detramethoraphan?
    • Non-opioid
    • Safe
    • Non-addicting*
  106. In what pt's is Detramethoraphan contraindicated for?
    • with persistent head aches (why?)
    • with asthma,
    • emphysema
  107. What do Expectorants cause pt's to do?
    Cough up and out by thinning secretions
  108. What do Expectorants do?
    Reduces viscosity of secretions
  109. What are some Expectorants?
    • Commonly- Robitussin,
    • Guifenesen,
    • Guiatuss
  110. What do Expectorants help with?
    Help suppress cough b/c secretions thin
  111. What can Expectorants worsen?
    hyperkalemia with K+ sparing diuretics = cardiac dysrhythmias
  112. What pt's should use caution when taking decongestions?
    • ICP,
    • IOP,
    • Asthma,
    • Emphysema,
    • Cardiac problems,
    • HTN
  113. What do you assess with Decongestants?
    • s/s,
    • allergic reactions,
    • allergies

    • Get a really good hx.
    • drug hx
  114. What happens if pt on decongestants has renal or liver disease?
    use caution
  115. how safe are decongestants?
    • If patient has URI symptoms- many safe
    • If Lower RI- not so much! Assess and get a Dx.
  116. What can many antihisatmines interact with?

    WHat should pt's do when taking them?
    antibiotics like EES, ketokonozole

    discuss with Dr. or dentist
  117. what should pt's do if they have a fever or cough for m1 or more weeks?
    call Dr
  118. What should you avoid when on antihistamines?
    caffine
  119. What do H2 blockers do?
    Histamine blockers reduce acid like in GERD

    Allows for healing to begin
  120. How do H2 blockers reduce stomach acid?
    These all decrease stomach secretions = decrease in stomach acid = decrease in esophogeal irritation
  121. What are some H2 blocker drugs?
    • Tagamet,
    • Pepcid,
    • Zantac
  122. What are Histamine blockers used for?
    Used for URI’s and LRI’s
  123. What are some URI's?
    common cold, rhinitis, hay fever
  124. What are some LRI's
    asthma, emphysema, chronic bronchitis-So your COPD’s (LR)-
  125. What will all of the URI and LRI’s cause?
    obstruction in airflow through the airway

    -Cystic Fibrosis will also affect the LR tract as well! (FYI)
  126. what are the main s/s of Bronchial Asthma?
    Wheezing and SOB is the main complaint
  127. what are some symptoms of Bronchial Asthma?
    • Asthma attacks are sudden-
    • (status asthmaticus)*- can last days to weeks
    • Both can be deadly!
  128. What is Bronchial Asthma?
    Recurrent/reversible, bronchi and brochioles narrow, bronchospasm, inflame causing viscous mucous
  129. What is Chronic Bronchitis?
    Continuous inflammation of the brochi or bronchioles
  130. What are common causes of Chronic Bronchitis?
    • Chemicals
    • Smoke
    • Pet dander
    • Air irritants
  131. What is Emphysema?
    Enlarged air spaces in the lungs
  132. What does Emphysema result in?
    Results in destroyed alveolar walls

    O2 and CO2 exchange becomes impaired
  133. What does Emphysema effect?
    respirations
  134. What causes exacerbation of Emphysema?
    • Smoke
    • irritants
  135. What happens in Emphysema
    • Lungs become less elastic
    • SOB ensues, especially on exertion
  136. What are 2 classes of Brochodilators?
    Xanthine derivitives,
  137. Beta-agonists
  138. What are Xanthine Derivitives?

    What are some Xanthine Derivitives?
    Plant alkaloids-
  139. caffeine,
    • theophylline,
    • theobromine
  140. Which Xanthine Derivitives is the bronchodilator?
    Only theophylline
  141. What is another bronchodilator?
    aminophylline (less potent & shorter acting than theophylline)
  142. WHat are Xanthine Derivitive used primarily for?
    asthma attacks
  143. What is Amynophylline usually used for?
    status epilepticus*
  144. WHat do Xanthine Derivitives do?
    • increase cardiac contractility
    • ncreasing HR
  145. What do Xanthines cause?
    increased blood flow to kidneys
  146. what kind of effect do Xanthines have?

    WHat should you do for pt?
    diuretic effects (from increased blood flow to kidneys)
  147. Educate
  148. how effective are inhaled Xanthines?
    100% bioavailability
  149. With what meds do Xanthines have interactions?
    • Oral contraceptives
    • EES
    • Allipurinol
    • Flu vaccine
    • Cimetadine


    Often a drug-drug interaction so the drugs become less effective or ineffective
  150. What kind of s/e do Xanthines have?
    • N/V/ anorexia
    • GI reflux during sleep
    • Tachy,
    • palpitations,
    • V dysrhythmias
    • Increased urination
    • Hyperglycemia
    • Nervousness/tremors
  151. What are some Theophylline drug names?
    • Slo-bid,
    • theodur,
    • Uniphyl
  152. What is Theophylline used for?
    chronic respiratory disorders
  153. What forms is Theophylline available in?
    • Oral,
    • rectal,
    • IV,
    • topical
  154. What do you need to monitor with Theophylline?
    theo levels
  155. What are the normal limist of Theophylline?
    WNL = 10.0-20.0 mcg/ml
  156. how is Theophylline best absorbed?
    on an empty stomach
  157. what % of Theophylline is metabolized in the liver?
    about 70%
  158. Wat are some s/s of Theophylline toxicity?
    • Increased restlessness,
    • irritability,
    • N/V,
    • tremors
  159. What can Restlessness and anxiety in Theophylline toxicity be due to?

    What must you do?
    • may be due to hypoxia
    • ASSESS!!!
  160. how can one avoid Theophylline toxicity ?
    Never omit doses or double-up on doses
  161. What are elderly & pedi pt's have an increased risk for in Theophylline?
    Elderly and pedi can have increased s/e’s
  162. What are Beta Agonists?
    Smooth muscle relaxants
  163. What are Beta Agonists most commonly used for?
    an acute asthma attack to quickly reduce airway constriction
  164. How do Beta Agonists work?
    They stimulate the SNS receptors (beta and alpha adrenergic receptors)

    They imitate effects of epi and norepi in receptors

    Dilate smooth muscle and airway
  165. What do Beta Agonists do?
    vasoconstrict- reduces swelling in mucus membranes and limits secretions

    stimulates beta 1’s and 2’s
  166. What is a Beta Agonists drug?
    • terbutaline
    • (Brethine)
  167. Where are Beta 1's ?
    on the uterus
  168. What does Terbutaline (Brethine) do?
    relaxes the uterus
  169. What is Terbutaline (Brethine) used for?
    preterm labor
  170. What are some Beta Agonist drugs?
    • 1) Albuterol
    • 2) Epinephrine, ephedrine
  171. What is another name for Albuterol?
    • proventil,
    • Servent*- longer acting
  172. WHat kind of drug is Albuterol?
    Beta 2 specific bronchodilators

    short acting
  173. What does Albuterol do?
    Relieves bronchospasms
  174. What is Albuterol commonly used for?
    acute asthma attacks
  175. for what pt's is Albuterol contraindicated?
    • with tachy
    • cardiac disease
  176. What is a s/e of Albuterol?
    • increase HR
    • cause tremor
  177. What is other name for Epinephrine, ephedrine (Epi)?
    • Primatene,
    • Adrenalin,
    • Bronchaid
  178. What are some s/e of Epinephrine, ephedrine ?
    • ronchodilation
    • Can also easily cause tachy
  179. How is Epinephrine, ephedrine available
    • •Ephedrine no longer OTC
    • Rx only
  180. What is Epinephrine, ephedrine used for?
    primarily as a first line drug- code
  181. What is the only Anticholinergic used as a bronchiodialator?
    Atrovent
  182. What is COMBIVENT
    Como drug- Albuterol and atrovent
  183. What does inhalation of Atrovent cause?
    bronchodilation
  184. What is Atrovent used for?
    mainly for COPD management
  185. WHat does Atrovent not work against?
    Not for acute attacks
  186. What are some s/e of Atrovent?
    • anticholinergic s/e's
    • Dries everything
    • Cough
    • HA
    • Anxiety
  187. in what pt's is Atrovent contraindicated for
    with a hypersensitivity to atropine
  188. What is a leukotreine?
    • Substance in the body that causes
    • inflammation,
    • bronchial constriction
    • mucous
  189. What does leukotreine cause?
    • wheeze,
    • cough,
    • SOB
  190. What are Antileukotrienes?
    Newer class of asthma medication
  191. What do Antileukotrienes affect?
    primarily the lungs
  192. What do Antileukotriene agents do?
    block the effect of leukotreine
  193. What are some Antileukotriene drugs?
    • 1) Singulair
    • 2) Accolate
    • 3) Zyflo
  194. How safe is Singulair?
    Fairly safe with few side effects

    FDA ok for children 2 +
  195. How safe is Singulair?
    • Fairly safe with few side effects
    • FDA ok for children 2 +
  196. How is Accolate used?
    • asthma prophylaxis,
    • for 12 +
    • PO tabs
  197. What meds does Accolate interact with?
    • ASA,
    • EES,
    • Dilantin,
    • coumadin
  198. What is a possible s/e of Accolate ?
    can cause liver dysfunction
  199. for what age groups is Zyflo approved?

    What form does it come in?
    12 +
  200. PO tabs
  201. in what pt's is Zyflo contraindicated?
    not with liver disease
  202. What meds does Zyflo interact with?
    • inderal,
    • coumadin,
    • theophylline
  203. What are some possible s/e of Antileukotreine agents
    • All can cause N/V,
    • dyspepsia,
    • insomnia,
    • dizziness
  204. What do you do if pt gets toxicity of any antileukotreine agent?
    • Support the systems-
    • Educate to report any side effects

    do not stop abruptly
  205. What are Corticosteroids commonly used
    used for chronic asthma
  206. What are Corticosteroids?
    Potent antiinflammatories
  207. What are Corticosteroidsnot used for
    Not for acute asthma attacks
  208. What are Corticosteroids used for?
    Prophylaxis for asthma prevention
  209. What do inhaled Corticosteroids do
    decreases systemic effects
  210. What do systemic Corticosteroids do?
    - reduces immunities,

    can cause F&E imbalances, nervous system effects, dermatological effects
  211. What do you watch when giving Corticosteroids ?
    I & O's
  212. In what pt's is Corticosteroids contraidicated for?
    • immunosuppressed
    • patients with candida already,
  213. patient with any systemic fungal/yeast infections
  214. WHat can Corticosteroids exacerbate?
    Can exacerbate psychosis! FYI
  215. What can Corticosteroids cause?
    • Can cause pharyngeal irritation,
    • cough,
    • dry mouth,
    • moon face (Cushingoid symptoms*)
  216. What should you assess with corticosteroids?
    • Baseline VS and lung sounds
    • Skin color and cap refill (RR <12 or > 24 = uh oh)
    • Cough, dyspnea, SOB, orthopnea, distress?
    • Cardiac symptoms?
    • Restlessness? O2 sats…
    • Use of accessory muscles
    • Allergies?
    • Cough- color, viscosity of sputum
    • Other meds?
  217. What should pt's taking corticosteroids be educated to do?
    • Stop smoking
    • Avoid known allergens
    • Review MDI (metered dose inhaler) use (Timby)
    • OTC’s? Check with Dr. first
    • have Id card or bracelet
    • Clean mouth piece frequently
    • Wean most drugs over 1-2 weeks
  218. What should pt's not do when taking corticosteroids?
    • No doubling doses if missed
    • Never share
    • Do not run out of Rx.
  219. How should corticosteroids be stored?
    • Store upright, activate into air first…
    • Store as directed
  220. WHat should pt's taking corticosteroids watch out for?

    Why?
    Weight gain > 3-5 lbs per week

    may mean trouble
  221. What are some Corticosteroid drugs?
    • 1)Prednisone
    • 2) Hydrocortisone
    • 3) Bexamethasone
    • 4) Dexamethasone
  222. What is Prednisone?
    an immunosuppressant
  223. What is Prednisone used for?
    • many diseases
    • Inflammatory diseases-Lupus-Arthritis-Chron’s disease-

    To prevent organ rejection-
  224. What can Prednisone cause?
    Can cause cushingoid symptoms
  225. What is Hydrocortisone?
    an immunosuppresant,
  226. What can Hydrocortisone cause?
    can also treat many skin conditions
  227. What form does Bexamethasone come in?
    - topical,
  228. What is Bexamethasone used for?
    many skin conditions
  229. What kind of drug is Dexamethasone?
    antihistamine, antiinflammatory, immunosuppresant *
  230. With what other medications can Dexamethasone be given?
    Can be given with antibiotics for those with bacterial meningitis
  231. What are some Mast Cell Stabilizer drugs?
    • Chromolyn
    • Tilade
  232. What do Mast Cell Stabilizers do?
    Suppress the release of mast cells
  233. What are mast cells?
    Cells in the body rich in histamines,

    allergens can bind to them causing an allergic reaction!-
  234. What do mast cells do?
    They also release vasocontrictor’s = SOB
  235. Where in the body do most Mast Cell Stabilizer drugs go?
    Most meds here go directly to the lung and have little systemic effect
  236. What are Mast Cell Stabilizers used for?
    • used for COPD management
    • used solely for prohylaxis

    What does this mean then?•
  237. What can cromolyn be used for?
    • can be used for allergic rhinitis
    • allergic eye disorders•Used to prevent….
  238. What are Mast Cell Stabilizers used for?
    •Also used for those with Chron’s and Ulcerative colitis

    •Why?
  239. What drug is Cromolyn less potent than
    Less potent then Tilade
  240. How does Cromolyn affect pt's that are lactose intolerant?
    If patient is lactose intolerant- chromolyn can exhibit similar GI symptoms
  241. In what forms is Cromolyn available?
    • Oral
    • Opthalmic drops (Alomast, Alocril)
    • Nasal spray
    • No longer available in oral inhalation formula!
  242. How long can it take for Cromolyn to work?
    May take up to 4 weeks to start working…
  243. How do you administer nasal Pediatric Resp. drugs?
    }One spray per nostril, no more than 6 doses/24 h
  244. What kind of education needs to be done for Pediatric Resp. drugs?
    • Educate parents about the meds
    • Review inhaler/nebulizer education
    • Any capsules- not chewed
  245. How long do many Pediatric Resp. drugs take
    Many meds can take several weeks for results
  246. Pediatric considerations any Resp. drugs:
    • }
    • Can clean tubing and mouth pieces with H2O and vinegar solution
  247. What type of drug are Antiemetic Agents?
    Many are antihistamines and anticholinergics
  248. Antiemetic Agents How do they work?
    By relieveing n/v by blocking Ach receptors so nauseous stimuli is not transmitted
  249. What are some Antiemetic Agents?
    1)Scopolamine

    2) meclazine/Antivert (antihistanmines)•

    3)Compazine-

    4)Zofran-

    5) THC/Marinol
  250. What kind of properties does Scopolamine have?
    - has anticholinergic properties
  251. What does Scopolamine work on?
    Works on inner ear for balance
  252. What pt's is Scopolamine contraindicated for?
    for glaucoma patients…
  253. How is Scopolamine applied?
    • 72 h patch- behind the ear
    • Rotate patch
    • 4 hours to start working
    • Wash hands after administration
  254. what pt's is Scopolamine contraindicated for?
    • those already on anticholinergics
    • with antidepressants
  255. What is meclazine?
    H1 blockers •
  256. How safe is meclazine?
    Very safe antiemetic
  257. What does meclazine do
    Inhibits Ach by binding to histamine1 receptors
  258. What is meclazine used for?
    • motion sickness
    • vertigo
  259. What type of agent is Compazine?
    Dopamine blocking agent “neuroleptic agent’ }
  260. What type of agent is Compazine?
    Dopamine blocking agent “neuroleptic agent’
  261. What pt's is Compazine contraindicated for?
    • those with bone marrow supression
    • seizure patients or those with encephalopathy}
  262. How does Compazine interact with Parkinson's treatments?
    Levadopa effects are decreased if given with Compazine
  263. What kind of medicine is Zofran?
    Seratonin Blocker (blocks in GI tract
  264. How safe is Zofran?
    • Very safe for adults
    • No contraindications unless allergic to it specifically}
  265. What does Zofran do for Chemo pt's?
    Increases chemo tolerance
  266. What popu is - Zofran
    Not good for kids or elderly or pregnancy}
  267. What can Zofran cause?
    HA
  268. how is Zofran taken?
    Take and OTC analgesic
  269. What does THC/Marinol do?
    • marijuana
    • This alters mood and releives n/v
    • Especially in those cancer patients with chemo
  270. What can THC/Marinol cause
    • Can cause hypotensive effects
    • Better head to Cali for this one legally!
  271. What do you need to assess for respiratory drugs?
    n/v- cause & length

    • w/ oral meds-
    • monitor I & O & edu b/c They can all dry
    • Daily weights,
    • baseline vs,
    • electrolytes
  272. What is important to consider w/resp drugs?
    • have effect CNS receptors -safety very important
    • lower anxiety
  273. How should IV resp meds be given?
    SLOOOOW… the irritate the vein especially phenergan
  274. How do you start all meds?
    low & slow
  275. What can reduce n/v s/e of resp drugs?
    Peppermint and ginger can reduce n/v
  276. What does Ginger interact w/?
    • NSAIDS,
    • ASA,
    • antiplatelet drugs
    • Digoxin
  277. How soon before impending travel do you take med

    what is a precaution pt must take?
    If only taking for impending travel- take the med 30-60 hours prior

    NO DRIVING
  278. What is iron used for?
    tissue respiration
  279. What is Iron?
    a O2 carrier in Hgb & myoglobin
  280. What is Iron used in?
    many enzyme reations in the body
  281. Where is iron stored
    • liver,
    • spleen
    • bone marrow
  282. What does Iron deficiency cause?
    anemia
  283. Who requires the most iron?
    women
  284. What is iron found in?
    found in meat certain veggies grains
  285. How is iron metabolized?
    must be converted by gastric juices before they can be absorbed
  286. What foods help w/ absorption of iron?
    • OJ,
    • veal
    • fish
  287. What foods may impair absorption of iron?
    • eggs,
    • corn
    • beans
    • cereal
  288. What can Iron supplements cause?
    • Nausea
    • stomach upset
    • vomiting
    • diarrhea abd
    • cramping constipation
    • black or red tarry stools
    • can discolor tooth enamel & eyes
    • causes pain upon injection
  289. how should IM iron be givn?
    z-trackit is thick
  290. what is needed on hand for iron dextran IV?
    emer equip
  291. What is folic acid?
    water soluble B compelx vit
  292. What does Folic acid help prevent in pregnency?
    • neural tube defects
    • such as spina bifida, encephaly & enecphalocele
  293. When is it best to take folic acid for earliest ability in pregnancy?
    at least one month before pregnanay
  294. What is Folic Acid the primary treatment for?
    megaloblastic anemia-resulting from folic acid deficiency
  295. what kind of intoralake of folic acid does the body require?
    oral
  296. What are some foods with folic acid
    • dried beans,
    • peas,
    • oranges
    • green veggies
  297. What is folic acid incompatible with?
    • calc
    • iron sulf
    • vit b complex
    • vit c in same solution
  298. what do blood forming agents do?
    help raise blood cells

    often given to CA pt
  299. S/e of blood forming agents
    • gi stuff
    • constipation
  300. what are other blood forming agents?
    • vit b12
    • erythropoieten (procrit, epogen)
  301. how should liq iron be given
    • through straw
    • no teeth discolor
  302. what should pt's taking b12 eat?
    • diet high in b12
    • fish
    • oysters
    • egg yolk
    • organ meet
    • dairy
    • clams
  303. What does the immune system do?
    fights off the foreign invaders that are constantly attacking the body

    Also fights against its own cells that can become cancerous

    The system can also attack itself and cause autoimmune diseases or immune-mediated diseases
  304. What are Immunosuppressant drugs?
    Agents that decrease or prevent an immune response and suppresses the immune system

    They suppress certain lymphocyte (T-cells) cell lines
  305. What are Immunosuppressant drugs used for?
    • Used for rejection therapy after an organ transplant**
    • Used for the treatment of rheumatoid arthritis
  306. What do Cyclosporine interact with?
    • }Has a profound interaction with many drugs and GRAPEFRUIT JUICE
    • Increases serum levels
  307. What is a way to achieve therapeutic levels w/ Cyclosporine?
    May be given together to achieve therapeutic levels
  308. What are Cyclosporine used for?
    the prevention of organ rejection

    • for arthritis,
    • psoriasis,
    • IBD
  309. What are Imuran and Cellcept used for?
    Used for prophylaxis for organ rejection
  310. What can Imuran and Cellcept be given with?
    May be given in combo with cyclosporine and corticosteroids
  311. some s/e of Imuran and Cellcept
    Side effects can be numerous
  312. What can Imuran and Cellcept cause?
    As with any in this class, they suppress the immune system making the patient prone to infection
  313. What can Echinacea do to immunosuppressant drugs?
    ECHINACEA- commonly taken OTC to prevent colds, can interfere with immunosuppressant therapy
  314. What are some s/e of Imuran?
    • Leukopenia
    • Thrombocytopenia
    • Hepatotoxicity
  315. What are some s/e of CYCLOSPORINE?
    • Moderate hypertension
    • Neurotoxicity including tremors
    • Hepatotoxicity with cholelithiasis and hyperbilirubiemia
    • Nephrotoxicity
    • Gingival hyperplasia
  316. What should pt's on ORAL cyclosporines do to avoid GI upset?
    take with CHOCOLATE MILK or with MEALS!!
  317. What do you check for/assess w/ immunosuppressant therapy?
    Check labs before, during and after therapy
  318. Check renal function and urinary function
    • Liver function,- is there jaundice, edema or ascites
    • Check cardiofunction,- any history of dysrythmias, hypertension
    • CNS baseline, seizure history
    • Respiratory assessment
  319. What should be done w/ immunosuppressant drugs if WBC’s drop below 3K?
    stop medication
  320. Why should oral antifungas be given w/ immunosupressants?
    to treat oral candidiasis which is common
  321. What form of immunosuppressant drug should be given 1st?

    Why?
    Oral before IM-

    to decrease risk of infection that is common with IM injections
  322. What should pt's on immunosuppressants do?
    Avoid crowds

    Any early signs of cold or flu- call your Dr

    Women on immunosupressants- use birth control for up to 12 weeks after therapy is completed
  323. What type of medication is Methotrexate considered
    considered a cancer med,
  324. What is Methotrexate used for?
    Used for solid tumors in the breast, head, neck, lungs, and for lymphocytic leukemia

    Also has immunosuppressant activity- can be used for rheumatoid arthritis, SLE
  325. What are Diuretics?
    Drugs that accelerate urine formation-

    resulting in removal of sodium water
  326. What do diuretics do?
    • decrease extracellualar fluid volu
    • reduce plasma volu
    • reduce cardiac output


    thus decrease bp
  327. What are the Diuretic drugs?
    • 1)Carbonic Anhydrase Inhibitors
    • 2)loop diuretics
    • 3)Osmotic duiretic (manitol)
    • 4) Potassium sparing diuretic
    • 5) Thiazides & Thiazide like diuretics
  328. What are Carbonic Anhydrase Inhibitors ?
    derivatives of sulfonamide antibiotics
  329. What are Carbonic Anhydrase Inhibitors used for?
    • primarily for open angle glaucoma
    • helful in CHF
  330. What are some s/e of Carbonic Anhydrase Inhibitors ?
    • acidosis
    • hematuria
    • uticaria
    • photosensitivity
    • melena
    • hypokalemia => dig toxicity
  331. in what pt's is Carbonic Anhydrase Inhibitors contraindicated?
    w/ quinidine & oral hypoglycemic agents => can raise toxi

    kids
  332. What is the name of a Carbonic Anhydrase Inhibitor drug?
    Diamox
  333. in what pt's is Diamox contraindicated?
    w/ allergies to sulfonamides

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