pharm 4 Respiratory

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mthompson17
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225228
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pharm 4 Respiratory
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2013-06-27 19:12:08
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pharmacology nursing respiratory
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pharmacology test 4 Respiratory system drugs: Vickers
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  1. 4 antitussive meds?
    • 1. dextromethorphan
    • 2. codeine
    • 3. hydrocodone
    • 4. benzonatate/Tessalon perles
  2. Use for dextromethorphan?
    non-productive cough
  3. Action of dextromethorphan?
    effects cough center in the medulla
  4. 2 contraindications for dextromethorphan?

    Why?
    emphysema & asthma b/c affects cough center & these pt need to cough stuff up
  5. S/S of dextromethorphan toxicity?
    • 1. NV
    • 2. drowsiness & dizziness
    • 3. irritability
    • 4. restlessness
  6. AE of dextromethorphan?

    When may AE be worse?
    sedation

    worse if take with alcohol, MAOIs, or any other CNS depressants
  7. How to obtain dextromethorphan?
    need to show Id b/c ppl abuse it
  8. Action of codeine?
    suppresses the cough reflex
  9. Should use caution with codeine & hydrocodone in what pt?
    any pt that needs to cough or deep breathe b/c it suppresses cough & is a CNS depressant

    emphysema, asthma, & sleep apnea
  10. 4 AE of codeine & hydrocodone?
    • 1. sedation
    • 2. dry mouth
    • 3. constipation
    • 4. GI upset
  11. If a pt needs to cough stuff up & has Rx for codeine or hydrocodone when should they take it?
    should take hs so they can rest but cough up stuff in the day
  12. Pt education with codeine & hydrocodone?
    • 1. Don't operate machinery until know effects
    • 2. how to deal with constipation
  13. Action of benzonatate/Tessalon perles?
    anesthetizes stretch receptors in the resp tract -> reduces cough reflex

    does not affect the resp center
  14. What type of pt is benzonatate/Tessalon perles good for r/t not affect resp center?
    • 1. emphysema
    • 2. asthma
    • 3. bronchitis
  15. Prototype decongestant drug?
    pseudoephedrine
  16. use for pseudoephedrine?
    decreases nasal congestion r/t colds, sinusitis, and allergic rhinitis
  17. Action of pseudoephedrine?
    constricts nasal arterioles -> decreases swelling
  18. Contraindication for pseudoephedrine?
    pt with heart probs esp. severe HTN or CAD
  19. Why is pseudoephedrine contraindicated with heart probs & HTN?
    it constricts nasal arterioles and other BV
  20. AE of pseudoephedrine?
    • 1. irritability/nervousness
    • 2. tachycardia
    • 3. arrhythmias
    • 4. palpitations
    • 5. HTN
    • 6. coronary vasospasm
  21. What medication should ppl with asthma have with them at all times?
    rescue inhaler - albuterol
  22. What may occur with the frequent use of decongestants?
    rebound congestion - drug wears off and congestion comes back due to body overcompensating by vasodilating nasal arterioles
  23. What med is very likely to cause rebound congestion?
    Afrin
  24. Major risk with pseudoephedrine?
    could cause MI
  25. Most imp consideration with antihistamines?
    before do anything that requires concentration or operate machinery need to see how it affects you
  26. 5 second-generation antihistamines?
    • 1. allegra
    • 2. claritin
    • 3. clarinex
    • 4. zyrtec
    • 5. astelin nasal spray
  27. Use & action of allegra/antihistamines?
    relieve s/s of allergies by blocking the action of histamine
  28. 2 types of antihistamine?
    • 1. first generation - sedating
    • 2. second generation - nonsedating
  29. First generation antihistamine?
    benadryl
  30. 4 uses for benadryl?
    • 1. allergies
    • 2. motion sickness
    • 3. induce sleep
    • 4. severe allergic reactions
  31. Why may benadryl be used prior to procedures?
    induce sleep & help prevent reactions
  32. 2 nondrug interventions for thick secretions?
    • 1. no milk or caffeine
    • 2. cool mist humidifier
  33. 5 antihistamine nasal steroids?
    • 1. Nasonex
    • 2. Nasacort
    • 3. Flonase
    • 4. Rhinocort
    • 5. Vancenase
  34. Comparison b/t nasal and PO antihistamines?
    nasal are superior b/c work directly at site & cause no systemic effects
  35. Do inhaled nasal steroids cause immunosuppression
    no b/c don't enter system
  36. AE of nasal antihistamines?
    drying of MM that can lead to epistaxis and bad tastes
  37. Prototype expectorant med?
    guaifenesin
  38. Use for guaifenesin?
    liquefy lower resp tract secretions & decrease viscosity of secretions to aid in coughing them up in colds, acute bronchitis, & flu
  39. 3 AE of guaifenesin?
    • 1. NV
    • 2. anorexia
    • 3. drowsiness
  40. Pt education when taking guaifenesin?
    • 1. drink lots of water
    • 2. potential for drowsiness - driving etc
  41. What may be combined with guaifenesin that gives it abuse potential?
    dextromethorphan
  42. Mucolytic prototype drug?
    acetylcysteine/Mucomyst
  43. Action of mucomyst?
    breaks down mucus and helps high-risk resp pt cough up thick, tenacious secretions to improve breathing & airflow
  44. What med may be given prior to giving mucomyst?
    may give bronchodilator before give mucomyst to open up the airway and let med in
  45. Pt who might take mucomyst?
    COPD, cystic fibrosis, bronchitis, etc

    ppl who have major difficulty mobilizing and coughing up secretions
  46. 2 ways mucomyst may be given?
    • 1. nebulizer
    • 2. direct instillation into the trachea
  47. What needs to be done after a pt uses mucomyst?
    after removing mask need to wash off face and brush teeth to remove med
  48. Should not take in ____ or _____ with mucomyst b/c they may thicken secretions.
    milk or caffeine
  49. What needs to be monitored if pt taking mucomyst for resp probs?
    lung sounds, RR, work of breathing etc
  50. 2 uses for mucomyst besides thinning secretions?
    • 1. acetaminophen antidote
    • 2. protect kidneys from dye
  51. How will mucomyst be given for antidote or kidney protection?
    oral liquid that smells like rotten eggs
  52. 4 AE of mucomyst?
    • 1. rhinorhea
    • 2. bronchospasm
    • 3. bronchconstriction
    • 4. NV
  53. Prototype bronchodilator?
    albuterol
  54. Albuterol action?
    • short-acting selective beta-2 agonist =
    • 1. tim receptors of sm muscle in lungs, uterus, and vasculature of skel muscle
    • 2. relaxes bronchial smooth muscle & relieves bronchospasm
    • 3. reduces airway resistance
    • 4. facilitates mucus drainage
    • 5. increases vital capacity
  55. Use for albuterol?
    acute and chronic airway limitation & asthma
  56. 3 routes of admin for albuterol?
    • 1. po
    • 2. inhalation
    • 3. liquid
  57. Storage of albuterol?
    if gets too hot will blow up
  58. Precautions for use of albuterol?
    • heart probs:
    • 1. hypertension
    • 2. cardiac disease & arrhythmias
    • 3. hyperthyroidism
    • 4. DM
    • 5. seizures
  59. AE of albuterol?
    • 1. palpatations
    • 2. sinus tachycardia
    • 3. anxiety
    • 4. tremor
  60. What may occur if albuterol is used too much?
    • 1. rebound bronchoconstriction
    • 2. may become desensitized to the med
  61. What does pt need to do if using albuterol too much?
    go to MD
  62. Consideration for admin albuterol to COPD pt?
    COPD pt is hypoxic:  anxious & increased HR

    when give albuterol will become more anxious & HR will go up  - may be getting antianxiety meds also
  63. Using an MDI?
    • 1. if inhaler hasn't been used yet or in a few days need to point away from you and prime 1 to 2 times
    • 2. hold upright and shake
    • 3. tilt head back slightly
    • 4. exhale and open mouth
    • 5. position either: 1 to 2 inches from mouth, with a spacer, or with inhaler b/t lips
    • 6. start to inhale slowly and press down on inhaler
    • 7. breathe in for 3 to 5 seconds
  64. Using DPI?
    • 1. prepare med
    • 2. place mouthpiece to lips
    • 3. inhale quickly
    • 4. hold breath for 10 seconds
    • 5. do not swallow capsules
    • 6. do not place device in water
  65. Teaching for a pt who has more than one inhaler Rx?
    use bronchodilator first then others
  66. 5 short acting beta 2 agonist bronchodilators besides albuterol?
    • 1. primatene mist
    • 2. xopenex
    • 3. alupent
    • 4. maxair
    • 5. Brethine
  67. Uses for brethine?
    short-acting bronchodilator & stop premature labor
  68. 2 routes of admin for brethine?
    SQ or inhalation
  69. 4 AE of brethine?
    • 1. tachycardia
    • 2. hypertension
    • 3. chest palpatations
    • 4. anxiety
  70. 3 long acting beta 2 agonist bronchodilators?

    All end with?
    • 1. arfomoterol
    • 2. formoterol
    • 3. salmeterol

    terol
  71. Can long acting bronchodilators be given during asthma attack?
    no
  72. What may long acting bronchodilators be used for?
    to prevent excess use of albuterol
  73. 2 anticholinergic bronchodilators that may be inhaled?
    • 1. atrovent
    • 2. spiriva
  74. Uses for anticholinergic bronchodilators?
    Tx bronchospasm ass. with asthma, bronchitis, or pulmonary emphysema
  75. AE of anticholinergic bronchodilators?
  76. 1. cough
    • 2. hoarseness
    • 3. dysgeusia - messes with taste
    • 4. anticholinergic effects
  77. Contraindication for anticholinergic bronchodilators?
    bladder or bowel obstruction r/t anticholinergic effects

    and glaucoma
  78. Anticholinergic AE?
    • 1. constipation
    • 2. decreased UO
    • 3. miOsis & photophobia
    • 4. increased HR & BP
    • 5. agitation
  79. 2 Xanthine derivative bronchodilators?
    • 1. theophylline
    • 2. aminophylline
  80. Route of admin for theophylline & aminophylline?
    • theophylline - PO
    • aminophylline - IV
  81. Uses for Xanthine derivatives/theophylline?
    relief of bronchial asthma and chronic airway limitation

    causes bronchodilation
  82. Contraindications for Xanthine derivatives/theophylline?
    • 1. status asthmaticus
    • 2. peptic ulcer
  83. AE of Xanthine derivatives/theophylline?
    • 1. NV
    • 2. HA
    • 3. insomnia
    • 4. hypertension
    • 5. arrhythmias
  84. Monitoring with theophylline?
    • 1. must monitor levels - 10 to 20
    • 2. BP & HR
    • 3. interactions with food/drugs
    • 4. caffeine & smoking
  85. What may occur with high doses of theophylline?
    hypotension
  86. Interactions with theophylline?
    many food/drugs interfere with theophylline met/excretion:  caffeine & smoking

    monitor for toxicity
  87. 2 inhaled glucocorticoid steroids & their action?
    • 1. flunsolide
    • 2. budesonide

    anti-inflammatory (decrease inflammatory response)
  88. Use for glucocorticoid steroid inhalers?
    Tx bronchospasm ass. with asthma, CAL, and other resp disorders
  89. Contraindications for inhaled glucocorticoid inhalers?
    active resp infection b/c can make them worse

    still may be given to reduce inflammation in resp infection
  90. 2 AE of inhaled glucocorticoids?
    • 1. dry mouth
    • 2. dysphonia - sound funny
  91. Serious AE of inhaled glucocorticoids?
    • 1. oral candidiasis
    • 2. systemic effects
  92. How can risk for oral candidiasis and systemic effects be minimized?
    • 1. use a spacer
    • 2. rinse mouth after each use
  93. Advantage for use of inhaled glucocorticoids in COPD pt?
    COPD pt at risk for resp infection and inhaled steroids don't cause systemic immunosuppression
  94. Prototype inhaled mast cell stabilizer?

    Its action?
    cromolyn sodium OTC nasal spray

    anti-inflammatory - provides protective layer that shields mast cells lining the nasal passage and prevents them from breaking down and releasing histamine
  95. Uses for cromolyn sodium?
    allergies, mild to moderate asthma, & acute bronchospasm
  96. Admin of cromolyn sodium?
    should be taken one full week prior to coming in contact with the allergen
  97. Anything that is sprayed in the nose can cause ______ & ______ _______.
    epistaxis and mucosal irritation
  98. 2 leukotriene receptor antagonists?

    End in _____.
    • 1. zafirlukast/Accolate
    • 2. motelukast/Singulair
  99. What are leukotrienes?
    inflammatory mediators that are powerful bronchoconstrictors & vasodilators
  100. Action of zafirlukast & motelukast?
    bronchodilation & vasoconstriction
  101. Use for zafirlukast & motelukast/leukotriene receptor antagonists?
    use for Rx chronic asthma and chronic airway limitation

    used mostly in ppl with allergy problems esp. in CH
  102. Most serious AE of zafirlukast & motelukast?
    • 1. hepatic failure
    • 2. Churg-Strauss (autoimmune vasculitis)
  103. Most common AE
    • 1. HA
    • 2. gastritis
    • 3. pharyngitis
    • 4. rhinitis
  104. Major contraindiations with leukotriene receptor antagonists?
    • 1. povidone (binder in some meds)
    • 2. lactose
    • 3. cellulose
    • 4. breast-feeding

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