M6-7

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Author:
TomWruble
ID:
160740
Filename:
M6-7
Updated:
2012-07-23 23:40:08
Tags:
nur119 mod6 respitatory ch40 ch41 exam3
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Description:
respitatory drugs
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  1. Effects of h1 stimulation:
    • → Bronchoconstriction & cough
    • → Pain - stimulation nerve endings
    • → Contraction of smooth muscle
    • → Increased permeriability of capillaries - edema
  2. Effects of h2 stimulation:
    • → Increased secretion of gastric acid and pepsin
    • → Increased rate/force of cardiac contraction
    • → Decreased release of histamine
  3. Stimulation of Both h1 and h2:
    • → Peripheral vasodilation
    • → Hypotension, headache, skin flushing
    • → Increased secretion of bronchial, intestinal, & salivary secretions
  4. Stimulation of h3 receptors:
    • → Inhibits histamine
    • → Inhibits vasoconstriction & slows HR
  5. How do adrenergic bronchodilators work?
    • allergens attach to Mast cells & basophils
    • → Mast cells stim rel of histamines & eosinophil chemotactic factor of analphylaxis (ECF-A)
    • → which are stong bronchoconstrictors
    • → cyclic adenosine monophosphate (cAMP), a bronchodilator (relaxed smooth muscle) is inhibited by histamines & ECF-A
    • → adrenergic bronchodilators inc amount of cAMP 
  6. Blockage of b1 receptors:
    • → Decreases HR
    • → Reduces force of contration
  7. Blockage of b2 receptors:
    • → Constricts bronchioles
    • → Inhibits glucogenolysis, which can dec blood sugar
  8. Norepinephrin (adrenalin) does?
    • → Agonist of:
    • → a1: Vasoconstriction - inc BP & mydriasis(dilate)
    • b1: Inc HR & force of contract - could turn sinus rhythm into tachy @ > 100 BPM
    • → b2: dilates bronchioles
  9. beta adrenergic agonists
    • → albuterol - b2 only, no tachy
    • → isoproterenol (Isuprel) - b1 & b2 (increased sputum, O2 @ 2L, will not withhold O2 in emergency) 
    • → Alupent - some b1 & b2
    • → Serevent - b2 only, maintenance
    • → Brethine - b2 only

    • → a1: Vasoconstriction - inc BP & mydriasis(dilate)
    • → b1: Inc HR & force of contract - could turn sinus rhythm into tachy @ > 100 BPM
    • → b2: dilates bronchioles
  10. alpha & beta adrenergic agonists
    • → ephedrin sulfate - a1, b1, b2
    • → epinephrin (Bronkaid Mist) - a1, b1, b2

    • → a1: Vasoconstriction - inc BP & mydriasis
    • → b1: Inc HR & force of contract - could tuen sinus rhythm into tachy @ > 100 BPM
    • → b2: dilates bronchioles
  11. beta adrenergic agonists side effects
    • b1
    • → inc HR, possible tachy

    • b2
    • → palpitations at high doses
    • → may inc blood glucose levels, so...
  12. Antocholinergic Bronchodilators
    • → ipratropium bromide (Atrovent) - few systemic sides effects but still not for glaucoma pts
    • → Combivent (ipratropium & albuterol) - long term COPD, longer acting
  13. When are anticholinergic bronchodilators used?
    Long term COPD Tx beause they are longer acting.
  14. Theophylline Bronchdilators
    • → aminophylline-theophylline - for acute asthmatic attack
    • → theophylline

    • → low therapeutic index andnarrow therapeutic range (10-20 mcg/dL)
    • → risks for cardiorespiratory collapse
    • → NOT for pt w/ seizure disorders
    • → above 20 mcg/dL: hyperglycemia, dec clotting time, and rarely, inc WBC count (leucosytosis)
    • → because of diuretic effect of xanthines, avoid caffein and inc fluids. (NBote "mild" diuretic effect results from increased cardiac output.)
    • no faster than 25 mg/min IV
    • → Seperate line bx incompatibility
    • Toxicity signs: Palp, insomnia, nervousness

    • → Anxiety & tachycardia are not a contraindication - these symptoms are experienced related tohypoxia.
    • → dec theophylline dose for patients taking Erythromycin
    • → Inc dose for smokers
  15. Give 2 examples of corticosteroid inhalers.
    • → Vanceril
    • → Azmacort
  16. Antiinflammatory COPD drugs
    • → work by reducing inflammatory response caused by Mast cells
    • → for exercise-induced asthma NOT acute asthma
    • → Accolate - for chronic asthma, not a rescue drug
    • → Vanceril
    • → Azmacort
    • → Intal (glucosteroid)
  17. Mast cells stabilizer?
    • Not for tx of asthma or acute bronchitis
    • → cromolyn sodium (Intal)
    • → Prophylactic use - prevents release of histamines
    • → If no resp w/in 1 mo, doc likely dc's
    • → Watch for chest pain
    • → Bronchospasms if overuse
    • → OD - sedation & coma
  18. To use glucocorticoids (steroids) to prevent asthma attacks.
    • → Administer bronchodilator first
    • → Wait 5 minutes
    • → Then administer the steroid inhaler

    • Actions
    • Dec inflammation & mucus sec
    • → Inc blood sugar
    • → Inc # & sensitivity of b2 receptors

    • Sides
    • → Hoarsness
    • → White spots in mouth (infec)
  19. Correct Steps for Inhaler Usage
    • 1: Cleansing breath
    • 2: Shake inhaler
    • 3: Remove cap
    • 4: Breathe out through mouth
    • 5: Hold inhaler 1-2" from mouth unless spacer is used, 9% v 21% w/ spacer
    • 6: Slow deep breath, held for 10 seconds
    • 7: 1 to 2 minutes betwwe doses or
    • 8: 5 minutes between bronchodilator and steroid
    • 9: Monitor pulse
    • 10: Caution overuse because of side effects & tolerance
    • 11: Rinse mouth
    • 12: Avoid smoking
    • 13: Clean equipment
  20. At what flow rate is supplemental humidity necessary for oxygen therapy? and why?
    • → Above 4 L/min
    • → Dry gasses dehydrate respiratory mucus membranes
  21. At what flow rate is supplemental humidity NOT necessary for oxygen therapy? and why?
    • → From 1-2 L/min via cannula
    • → There is sufficient humidity inhaled from the atmospheric air.
  22. List the safety precautions for oxygen therapy safety precautions
      • "No smoking, Oxygen in Use" signage
      • Adherence to no smoking
      • Instruct client and visitors to hazards of smoking with oxygen use
      • Make sure all electrical devices are in good working order to prevent sparks.
      • Avoid wool and synthetics that can create static discharge. Wear cotton clothes and use cotton bed clothes
      • Avoid alcohol, acetone, and nail polish in Pt room.
      • Make sure all electrical medical equipment is grounded.
      • Know location and use of fire extinguishers.
  23. A Simple oxygen mask delivers...
    5-8 L/min @ 40-60%
  24. Partial rebreather mask delivers...
    6-10 L/min @ 60-80%
  25. Non rebreather mask delivers...
    10-15 L/min @ 95-100%
  26. Venturi mask delivers...
    4-10 L/min @ 24-50%
  27. Nasal Cannula delivers...
    1-6 L/min @ 24-45%

    • O2 in room air is 21%
    • 2L is 28%
  28. Face tent provides...
    4-8 L/min @ 30-50%
  29. Tx motion sickness with?
    Benadryl
  30. How do 1st gen antihistamines work?
    • → They do not prevent histamine release.
    • → They do prevent a histamine response by occupying the receptors.
    • → Only blocking the h1 receptor will decrease nasopharyngeal secretions.
    • → They also cause CNS depression, e.g. drowsiness.
    • → Anticholinergic effects: observe for urinary retention esp in elderly men.
  31. 1st gen antihistamines
    • → diphenhydramin (Benadryl)
    • → Chlor-Trimeton

    → Give w/ meals
  32. 2nd generation antihistamines
    • → Zyrtec
    • → Allegra
    • → Claritin

    • → Nonsedating antihistimines
    • → Fewer antoicholinergic effects
  33. Antihistimine Contraindications:
    • → GLAUCOMA
    • → BLADDER OBSTRUCTION

    → CAUTION WITH ENLARGED PROSTATE
  34. Indications for antihistimines:
    • → Allergy
    • → Allergic rhinitis
    • → Acute urticaria(hives)/pruritis(itch)
    • → Angioedema (edema of the dermis, subcutaneous tissue, mucosa and/or submucosal tissues)
    • → Motion sickness
    • → Vomiting
    • → Sleep disorders
    • → Prior to blood therapy
  35. Nasal & systemic decongestants Contraindications?
    • → Glaucoma
    • → HTN
    • → CAD
  36. How do nasal & systemic decongestants work?
    • → alpha-adrenergic e.g. Vasoconstriction - inc BP(bad) & mydriasis(dilate)
    • → The vasoconstriction of the capillaries in the nasal mucosa shrinks them and reduces fluid secretion
    • → Because of rebound effect from overuse, use not more than 7 days.
    • → Watch for hypertension
    • → Watch for tachy
    • → Watch for elevated blood sugars

    Common adverse effect: dry mouth
  37. Nasal & systemic decongestants
    • → ephedrine
    • → Neo-Synephrine
    • → Sudafed
  38. Are antitussives appropriate for pneumonia Pt? Why/Why not?
    No. You want the Pt to have a productive cough and get the infectious byproducts out.
  39. Cough suppresion via the ?
    Medulla
  40. How to administer cough suppressant?
    Make sure Pt has quenched thirst before taking drug because they should avoid food & fluids for 30 minutes afterward.
  41. Aids to productive cough
    • → Deep breathing
    • → Ambulation
    • → Chest physiotherapy
    • → Force fluids
  42. Mucomyst?
    • → Not indexed as mucomyst or Acetylcysteine
    • → "thin" mucus, i.e. inhalation to liquify secretions.
    • → Remember, it is the antidote for Tylenol OD 
  43. Narcotic Antitussives
    • → centrally acting (medula?)
    • → codeine
    • → guaifenesin aned codeine
  44. Non-narcotic Antitussives
    • → Tessalon Perles
    • → Benylin DM
  45. Expectorants
    guaifenesin (Robitussin)
  46. Antitussive/Expectorant
    guaifenesin and dextromethorphan (Robitussin DM)
  47. What are symptoms of asthma?
    They are the same as Emphysema and Chronic Bronchitis:

    • → Bronchoconstriction
    • → Dyspnea
    • → Mucus secretions
  48. What is the prototype HI antagonist?
    diphenhydramine (Benadryl)
  49. What anticholinergic effects should the nurseobserve the patient for on h1 antagonists?
    • → CNS depression resulting in drowsiness
    • → Urinary retension
    • → Hypotension
    • → Hearing disturbances
  50. How should antihistimines be administered?
    With food

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