Card Set Information
respiratory diuretics Immunological modifiers
what are the 2 types of histamines?
What do H1 recepters do?
}H1 receptors mediate smooth muscle contraction (allergic symptoms) }Dilation of capillaries
What do H2 recepters do?
Accelerate gastric acid secretion
what can excessive amount of histamine released lead to?
can lead to allergic reaction and even anaphylaxis
Both H1 and H2 dilate vessels
what happens when Both H1 and H2 dilate vessels?
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
What are antihistamines?
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
what do H1 blockers do?
compete with histamine for the H1 receptors
help out with environmental allergies
how do H1 BLOCKERS work?
will block histamines attempting to bind to receptor sites- that is why early treatment is needed!
what happens if there is histamine already attached to the receptor sites?
the H1 blockers can’t help
what are environmental allergies
Allergies due to- molds, mold spores, dust, etc…
can cause hay fever, ithy eyes, uticaria, sneezing, cough, etc…
what kind of effect do H1 blockers have?
an anticholinergic effect- so they DRY secretions
(Think about the opposite of SLUDGE
how do histamines cause pruritis in the skin?
Histamines bind to nerve endings causing pruritis
what do histamines do in an allergic reaction?
Binds and activates specific receptors in the eyes, nose, skin, resp. tract
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.
What are some Non-sedating Antihistamines?
What are some FEXOFENADINE drugs?
Allegra and Seldane*
What are some properties of seldane?
Seldane has serious interactions- off market.
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 }
What is Allegra used for?
How is it available?
the relief of symptoms of seasonal allergic rhinitis-
what ages is allegra safe in?
children 12 and older
What kind of antihistamine is Claritin
What pt's is claritin not used in?
those with lower resp-tract diseases
those with an acute asthma attack
how is claritin available?
Also now available OTC
What are some Traditional Antihistamines?
3) Promethazine- Phenergan
what is another name for Diphenhydramine?
What is diphenhyramine used for?
Used for allergies
a sleep aid (think safety ed.)
Commonly used for allergies and pruritis
How safe is diphenhyramine?
Very safe (few s/e’s)
What kind of s/e or properties does diphenhyramine have?
dries secretions so educate
These still act on CNS so educate about safety
what pt's is diphenhyramine contraindicated for?
in nursing mothers
What forms does diphenhyramine come in?
PO (tabs, elixir and topical)
how is topical diphenhyramine available?
in combo with other drugs- calamine, camphor
What is Benadryl- Diphenhydramine ?
What is Meclizine used to treat?
What can meclizine cause?
what do you need to worry /do about this?
May cause sleepiness
Safety if sleepiness
What is another name for Promethazine?
What is promethazine
Antihistamine, used basically for antiemetic
How is promethazine available/in what forms?
may be po, IV, IM, and rectal formula
how is promethazine usually ordered?
Uusually ordered q4-6 hours prn for nausea
When is promethazine given in conjunction with Demerol?
if Demerol is the drug of choice for pain
How does this work as an antiemetic?
WHat is Phenergan (promethazine) often given for?
for nausea Will dry secretions- educate and assess
What is a s/e of Phenergan (promethazine)?
Will dry secretions- educate and assess
in what form is Astelin available?
Only nasal spray antihistamine
what age groups is Asteline used for?
for adults and children over age 12
What is a possible s/e of Asteline?
May have rebound effect-
what is Zyrtec used for?
for year round allergy sufferers
for chronic uticaria also
how is Chlor-trimeton available?
Available OTC in tab form
What is Dramamine used for?
Used for motion sickness
At what age can pt's start taking Dramamine?
Can be used starting at age 6 and greater
What is a s/e of Dramamine?
What is Unisom?
OTC for sleep aid
how should Unisom be taken?
Take with a full glass of water
What is a s/e of Atarax/Vistaril
Has sedative and mild antianxiety properties
What is Antivert used for?
the treatment of vertigo
What are some adverse reactions of antihistamines?
Dizziness, blurred vision
What are Decongestants used for?
to decrease the nasal mucosa inflammation
What are three types of Decongestants?
what forms do Decongestants come in?
What are some Oral/Inhaled Decongestants?
What kind of effect do Oral/Inhaled Decongestants give?
These give the longest effect because they are distributed systemically
What is the onset of action for Oral/Inhaled Decongestants ?
Onset is delayed
Caution in handing out sudafed- why?
what should pt's taking oral/inhaled decongestants have?
What are some Inhaled decongestants?
What are some Topical Decongestants?
what kind of onset do Topical Decongestants have?
what can several days of use of Topical Decongestants cause?
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
what are some ADRENERGICS?
What is an adverse effect to adrenergics?
in what pt's are adrenergics contraindicated?
w/ severe CAD
What are some INTRA-NASAL STEROIDS?
Decadron Phosphate Turbinase
What do topical decongestants do?
They relieve nasal stuffiness (vasocinstrict)
Shrink engorged nasal mucous membranes
What happens if topical decongestantd inadvertently enter the blood stream?
they can cause
What do Andrenergics do?
specifically constrict the small blood vessels that supply the UR tract- especially those around the sinus cavity
what can Adrenergics cause?
What do Nasal steroids do?
What can Nasal steroids cause?
What are some Nasal steroids?
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
Where is the Cough reflex stimulated?
in the medulla
When can the Cough reflex be harmful?
after hernia repair,
if there is IOP or ICP
What are the two types of Antitussives?
What type of antitussives is less effective?
What are some non-opiod antitussives?
Dextramethrephan / Benzonatate
do non-opioids have any analgesic effects?
no analgesic effect
What are some advantages of non-opioid antitussives?
does not have addictive properties
or cause CNS depression
How safe are non-opioid antitussives?
Fairly safe to use short term
WHat are Benzonatates?
but it anesthetizes the cough reflex by causing numbing of the stretch receptors
What do Codiene, hydrocodone (opioids) and dextramethorephan (non-opioid) do?
directly suppress the cough reflex
What are some s/e of non-opioid antitussives?
Most of these drugs can cause dizziness,
Cause dry mouth,
What is another name for Benzonatate?
What does Benzonatate do?
-Non-opioid -Numbs cough receptors
How is Benzonatate available?
-100 mg capsules only,
How does Benzonatate look like?
Looks like a small vitamin E
What is Codeine?
What kind of properties does Codeine have?
Wat is Codeine usually used in combo with?
Usually in combo with a cough med- Robitussin AC
What is a s/e of Codeine?
Can depress RR and CNS
How is Codeine available?
Controlled substance- Rx only
in what pt's is Codeine contraindicated for?
severe respiratory disorders,
What are some Detramethoraphans?
What are some properties of Detramethoraphan?
In what pt's is Detramethoraphan contraindicated for?
with persistent head aches (why?)
What do Expectorants cause pt's to do?
Cough up and out by thinning secretions
What do Expectorants do?
Reduces viscosity of secretions
What are some Expectorants?
What do Expectorants help with?
Help suppress cough b/c secretions thin
What can Expectorants worsen?
with K+ sparing diuretics = cardiac dysrhythmias
What pt's should use caution when taking decongestions?
What do you assess with Decongestants?
Get a really good hx.
What happens if pt on decongestants has renal or liver disease?
how safe are decongestants?
If patient has URI symptoms- many safe
If Lower RI- not so much! Assess and get a Dx.
What can many antihisatmines interact with?
WHat should pt's do when taking them?
antibiotics like EES, ketokonozole
discuss with Dr. or dentist
what should pt's do if they have a fever or cough for m1 or more weeks?
What should you avoid when on antihistamines?
What do H2 blockers do?
Histamine blockers reduce acid like in GERD
Allows for healing to begin
How do H2 blockers reduce stomach acid?
These all decrease stomach secretions = decrease in stomach acid = decrease in esophogeal irritation
What are some H2 blocker drugs?
What are Histamine blockers used for?
Used for URI’s and LRI’s
What are some URI's?
common cold, rhinitis, hay fever
What are some LRI's
asthma, emphysema, chronic bronchitis-So your COPD’s (LR)-
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)
what are the main s/s of Bronchial Asthma?
Wheezing and SOB is the main complaint
what are some symptoms of Bronchial Asthma?
Asthma attacks are sudden-
(status asthmaticus)*- can last days to weeks
Both can be deadly!
What is Bronchial Asthma?
Recurrent/reversible, bronchi and brochioles narrow, bronchospasm, inflame causing viscous mucous
What is Chronic Bronchitis?
Continuous inflammation of the brochi or bronchioles
What are common causes of Chronic Bronchitis?
What is Emphysema?
Enlarged air spaces in the lungs
What does Emphysema result in?
Results in destroyed alveolar walls
O2 and CO2 exchange becomes impaired
What does Emphysema effect?
What causes exacerbation of Emphysema?
What happens in Emphysema
Lungs become less elastic
SOB ensues, especially on exertion
What are 2 classes of Brochodilators?
What are Xanthine Derivitives?
What are some Xanthine Derivitives?
Which Xanthine Derivitives is the bronchodilator?
What is another bronchodilator?
aminophylline (less potent & shorter acting than theophylline)
WHat are Xanthine Derivitive used primarily for?
What is Amynophylline usually used for?
WHat do Xanthine Derivitives do?
increase cardiac contractility
What do Xanthines cause?
increased blood flow to kidneys
what kind of effect do Xanthines have?
WHat should you do for pt?
diuretic effects (from increased blood flow to kidneys)
how effective are inhaled Xanthines?
With what meds do Xanthines have interactions?
Often a drug-drug interaction so the drugs become less effective or ineffective
What kind of s/e do Xanthines have?
GI reflux during sleep
What are some Theophylline drug names?
What is Theophylline used for?
chronic respiratory disorders
What forms is Theophylline available in?
What do you need to monitor with Theophylline?
What are the normal limist of Theophylline?
WNL = 10.0-20.0 mcg/ml
how is Theophylline best absorbed?
on an empty stomach
what % of Theophylline is metabolized in the liver?
Wat are some s/s of Theophylline toxicity?
What can Restlessness and anxiety in Theophylline toxicity be due to?
What must you do?
may be due to hypoxia
how can one avoid Theophylline toxicity ?
Never omit doses or double-up on doses
What are elderly & pedi pt's have an increased risk for in Theophylline?
Elderly and pedi can have increased s/e’s
What are Beta Agonists?
Smooth muscle relaxants
What are Beta Agonists most commonly used for?
an acute asthma attack to quickly reduce airway constriction
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
What do Beta Agonists do?
vasoconstrict- reduces swelling in mucus membranes and limits secretions
stimulates beta 1’s and 2’s
What is a Beta Agonists drug?
Where are Beta 1's ?
on the uterus
What does Terbutaline (Brethine) do?
relaxes the uterus
What is Terbutaline (Brethine) used for?
What are some Beta Agonist drugs?
2) Epinephrine, ephedrine
What is another name for Albuterol?
Servent*- longer acting
WHat kind of drug is Albuterol?
Beta 2 specific bronchodilators
What does Albuterol do?
What is Albuterol commonly used for?
acute asthma attacks
for what pt's is Albuterol contraindicated?
What is a s/e of Albuterol?
What is other name for Epinephrine, ephedrine (Epi)?
What are some s/e of Epinephrine, ephedrine ?
Can also easily cause tachy
How is Epinephrine, ephedrine available
•Ephedrine no longer OTC
What is Epinephrine, ephedrine used for?
primarily as a first line drug- code
What is the only Anticholinergic used as a bronchiodialator?
What is COMBIVENT
Como drug- Albuterol and atrovent
What does inhalation of Atrovent cause?
What is Atrovent used for?
mainly for COPD management
WHat does Atrovent not work against?
Not for acute attacks
What are some s/e of Atrovent?
in what pt's is Atrovent contraindicated for
with a hypersensitivity to atropine
What is a leukotreine?
Substance in the body that causes
What does leukotreine cause?
What are Antileukotrienes?
Newer class of asthma medication
What do Antileukotrienes affect?
primarily the lungs
What do Antileukotriene agents do?
block the effect of leukotreine
What are some Antileukotriene drugs?
How safe is Singulair?
Fairly safe with few side effects
FDA ok for children 2 +
How safe is Singulair?
Fairly safe with few side effects
FDA ok for children 2 +
How is Accolate used?
for 12 +
What meds does Accolate interact with?
What is a possible s/e of Accolate ?
can cause liver dysfunction
for what age groups is Zyflo approved?
What form does it come in?
in what pt's is Zyflo contraindicated?
not with liver disease
What meds does Zyflo interact with?
What are some possible s/e of Antileukotreine agents
All can cause N/V,
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
What are Corticosteroids commonly used
used for chronic asthma
What are Corticosteroids?
What are Corticosteroidsnot used for
Not for acute asthma attacks
What are Corticosteroids used for?
Prophylaxis for asthma prevention
What do inhaled Corticosteroids do
decreases systemic effects
What do systemic Corticosteroids do?
- reduces immunities,
can cause F&E imbalances, nervous system effects, dermatological effects
What do you watch when giving Corticosteroids ?
I & O's
In what pt's is Corticosteroids contraidicated for?
patients with candida already,
patient with any systemic fungal/yeast infections
WHat can Corticosteroids exacerbate?
Can exacerbate psychosis! FYI
What can Corticosteroids cause?
Can cause pharyngeal irritation,
moon face (Cushingoid symptoms*)
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?
Restlessness? O2 sats…
Use of accessory muscles
Cough- color, viscosity of sputum
What should pt's taking corticosteroids be educated to do?
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
What should pt's not do when taking corticosteroids?
No doubling doses if missed
Do not run out of Rx.
How should corticosteroids be stored?
Store upright, activate into air first…
Store as directed
WHat should pt's taking corticosteroids watch out for?
Weight gain > 3-5 lbs per week
may mean trouble
What are some Corticosteroid drugs?
What is Prednisone?
What is Prednisone used for?
Inflammatory diseases-Lupus-Arthritis-Chron’s disease-
To prevent organ rejection-
What can Prednisone cause?
Can cause cushingoid symptoms
What is Hydrocortisone?
What can Hydrocortisone cause?
can also treat many skin conditions
What form does Bexamethasone come in?
What is Bexamethasone used for?
many skin conditions
What kind of drug is Dexamethasone?
antihistamine, antiinflammatory, immunosuppresant *
With what other medications can Dexamethasone be given?
Can be given with antibiotics for those with bacterial meningitis
What are some Mast Cell Stabilizer drugs?
What do Mast Cell Stabilizers do?
Suppress the release of mast cells
What are mast cells?
Cells in the body rich in histamines,
allergens can bind to them causing an allergic reaction!-
What do mast cells do?
They also release vasocontrictor’s = SOB
Where in the body do most Mast Cell Stabilizer drugs go?
Most meds here go directly to the lung and have little systemic effect
What are Mast Cell Stabilizers used for?
used for COPD management
used solely for prohylaxis
What does this mean then?•
What can cromolyn be used for?
can be used for allergic rhinitis
allergic eye disorders•Used to prevent….
What are Mast Cell Stabilizers used for?
•Also used for those with Chron’s and Ulcerative colitis
What drug is Cromolyn less potent than
Less potent then Tilade
How does Cromolyn affect pt's that are lactose intolerant?
If patient is lactose intolerant- chromolyn can exhibit similar GI symptoms
In what forms is Cromolyn available?
Opthalmic drops (Alomast, Alocril)
No longer available in oral inhalation formula!
How long can it take for Cromolyn to work?
May take up to 4 weeks to start working…
How do you administer nasal Pediatric Resp. drugs?
}One spray per nostril, no more than 6 doses/24 h
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
How long do many Pediatric Resp. drugs take
Many meds can take several weeks for results
Pediatric considerations any Resp. drugs:
Can clean tubing and mouth pieces with H2O and vinegar solution
What type of drug are Antiemetic Agents?
Many are antihistamines and anticholinergics
Antiemetic Agents How do they work?
By relieveing n/v by blocking Ach receptors so nauseous stimuli is not transmitted
What are some Antiemetic Agents?
2) meclazine/Antivert (antihistanmines)•
What kind of properties does Scopolamine have?
- has anticholinergic properties
What does Scopolamine work on?
Works on inner ear for balance
What pt's is Scopolamine contraindicated for?
for glaucoma patients…
How is Scopolamine applied?
72 h patch- behind the ear
4 hours to start working
Wash hands after administration
what pt's is Scopolamine contraindicated for?
those already on anticholinergics
What is meclazine?
H1 blockers •
How safe is meclazine?
Very safe antiemetic
What does meclazine do
Inhibits Ach by binding to histamine1 receptors
What is meclazine used for?
What type of agent is Compazine?
Dopamine blocking agent “neuroleptic agent’ }
What type of agent is Compazine?
Dopamine blocking agent “neuroleptic agent’
What pt's is Compazine contraindicated for?
those with bone marrow supression
seizure patients or those with encephalopathy}
How does Compazine interact with Parkinson's treatments?
Levadopa effects are decreased if given with Compazine
What kind of medicine is Zofran?
Seratonin Blocker (blocks in GI tract
How safe is Zofran?
Very safe for adults
No contraindications unless allergic to it specifically}
What does Zofran do for Chemo pt's?
Increases chemo tolerance
What popu is - Zofran
Not good for kids or elderly or pregnancy}
What can Zofran cause?
how is Zofran taken?
Take and OTC analgesic
What does THC/Marinol do?
This alters mood and releives n/v
Especially in those cancer patients with chemo
What can THC/Marinol cause
Can cause hypotensive effects
Better head to Cali for this one legally!
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
What is important to consider w/resp drugs?
have effect CNS receptors -safety very important
How should IV resp meds be given?
SLOOOOW… the irritate the vein especially phenergan
How do you start all meds?
low & slow
What can reduce n/v s/e of resp drugs?
Peppermint and ginger can reduce n/v
What does Ginger interact w/?
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
What is iron used for?
What is Iron?
a O2 carrier in Hgb & myoglobin
What is Iron used in?
many enzyme reations in the body
Where is iron stored
What does Iron deficiency cause?
Who requires the most iron?
What is iron found in?
found in meat certain veggies grains
How is iron metabolized?
must be converted by gastric juices before they can be absorbed
What foods help w/ absorption of iron?
What foods may impair absorption of iron?
What can Iron supplements cause?
black or red tarry stools
can discolor tooth enamel & eyes
causes pain upon injection
how should IM iron be givn?
z-trackit is thick
what is needed on hand for iron dextran IV?
What is folic acid?
water soluble B compelx vit
What does Folic acid help prevent in pregnency?
neural tube defects
such as spina bifida, encephaly & enecphalocele
When is it best to take folic acid for earliest ability in pregnancy?
at least one month before pregnanay
What is Folic Acid the primary treatment for?
megaloblastic anemia-resulting from folic acid deficiency
what kind of intoralake of folic acid does the body require?
What are some foods with folic acid
What is folic acid incompatible with?
vit b complex
vit c in same solution
what do blood forming agents do?
help raise blood cells
often given to CA pt
S/e of blood forming agents
what are other blood forming agents?
erythropoieten (procrit, epogen)
how should liq iron be given
no teeth discolor
what should pt's taking b12 eat?
diet high in b12
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
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
What are Immunosuppressant drugs used for?
Used for rejection therapy after an organ transplant**
Used for the treatment of rheumatoid arthritis
What do Cyclosporine interact with?
}Has a profound interaction with many drugs and GRAPEFRUIT JUICE
Increases serum levels
What is a way to achieve therapeutic levels w/ Cyclosporine?
May be given together to achieve therapeutic levels
What are Cyclosporine used for?
the prevention of organ rejection
What are Imuran and Cellcept used for?
Used for prophylaxis for organ rejection
What can Imuran and Cellcept be given with?
May be given in combo with cyclosporine and corticosteroids
some s/e of Imuran and Cellcept
Side effects can be numerous
What can Imuran and Cellcept cause?
As with any in this class, they suppress the immune system making the patient prone to infection
What can Echinacea do to immunosuppressant drugs?
ECHINACEA- commonly taken OTC to prevent colds, can interfere with immunosuppressant therapy
What are some s/e of Imuran?
What are some s/e of CYCLOSPORINE?
Neurotoxicity including tremors
Hepatotoxicity with cholelithiasis and hyperbilirubiemia
What should pt's on ORAL cyclosporines do to avoid GI upset?
take with CHOCOLATE MILK or with MEALS!!
What do you check for/assess w/ immunosuppressant therapy?
Check labs before, during and after therapy
Check renal function and urinary function
,- is there jaundice, edema or ascites
,- any history of dysrythmias, hypertension
CNS baseline, seizure history
What should be done w/ immunosuppressant drugs if WBC’s drop below 3K?
Why should oral antifungas be given w/ immunosupressants?
to treat oral candidiasis which is common
What form of immunosuppressant drug should be given 1st?
Oral before IM-
to decrease risk of infection that is common with IM injections
What should pt's on immunosuppressants do?
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
What type of medication is Methotrexate considered
considered a cancer med,
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
What are Diuretics?
Drugs that accelerate urine formation-
resulting in removal of sodium water
What do diuretics do?
decrease extracellualar fluid volu
reduce plasma volu
reduce cardiac output
thus decrease bp
What are the Diuretic drugs?
1)Carbonic Anhydrase Inhibitors
3)Osmotic duiretic (manitol)
4) Potassium sparing diuretic
5) Thiazides & Thiazide like diuretics
What are Carbonic Anhydrase Inhibitors ?
derivatives of sulfonamide antibiotics
What are Carbonic Anhydrase Inhibitors used for?
primarily for open angle glaucoma
helful in CHF
What are some s/e of Carbonic Anhydrase Inhibitors ?
hypokalemia => dig toxicity
in what pt's is Carbonic Anhydrase Inhibitors contraindicated?
w/ quinidine & oral hypoglycemic agents => can raise toxi
What is the name of a Carbonic Anhydrase Inhibitor drug?
in what pt's is Diamox contraindicated?
w/ allergies to sulfonamides