pharm 4 Respiratory
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4 antitussive meds?
- 1. dextromethorphan
- 2. codeine
- 3. hydrocodone
- 4. benzonatate/Tessalon perles
Use for dextromethorphan?
Action of dextromethorphan?
effects cough center in the medulla
2 contraindications for dextromethorphan?
emphysema & asthma b/c affects cough center & these pt need to cough stuff up
S/S of dextromethorphan toxicity?
- 1. NV
- 2. drowsiness & dizziness
- 3. irritability
- 4. restlessness
AE of dextromethorphan?
When may AE be worse?
worse if take with alcohol, MAOIs, or any other CNS depressants
How to obtain dextromethorphan?
need to show Id b/c ppl abuse it
Action of codeine?
suppresses the cough reflex
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
4 AE of codeine & hydrocodone?
- 1. sedation
- 2. dry mouth
- 3. constipation
- 4. GI upset
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
Pt education with codeine & hydrocodone?
- 1. Don't operate machinery until know effects
- 2. how to deal with constipation
Action of benzonatate/Tessalon perles?
anesthetizes stretch receptors in the resp tract -> reduces cough reflex
does not affect the resp center
What type of pt is benzonatate/Tessalon perles good for r/t not affect resp center?
- 1. emphysema
- 2. asthma
- 3. bronchitis
Prototype decongestant drug?
use for pseudoephedrine?
decreases nasal congestion r/t colds, sinusitis, and allergic rhinitis
Action of pseudoephedrine?
constricts nasal arterioles -> decreases swelling
Contraindication for pseudoephedrine?
pt with heart probs esp. severe HTN or CAD
Why is pseudoephedrine contraindicated with heart probs & HTN?
it constricts nasal arterioles and other BV
AE of pseudoephedrine?
- 1. irritability/nervousness
- 2. tachycardia
- 3. arrhythmias
- 4. palpitations
- 5. HTN
- 6. coronary vasospasm
What medication should ppl with asthma have with them at all times?
rescue inhaler - albuterol
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
What med is very likely to cause rebound congestion?
Major risk with pseudoephedrine?
could cause MI
Most imp consideration with antihistamines?
before do anything that requires concentration or operate machinery need to see how it affects you
5 second-generation antihistamines?
- 1. allegra
- 2. claritin
- 3. clarinex
- 4. zyrtec
- 5. astelin nasal spray
Use & action of allegra/antihistamines?
relieve s/s of allergies by blocking the action of histamine
2 types of antihistamine?
- 1. first generation - sedating
- 2. second generation - nonsedating
First generation antihistamine?
4 uses for benadryl?
- 1. allergies
- 2. motion sickness
- 3. induce sleep
- 4. severe allergic reactions
Why may benadryl be used prior to procedures?
induce sleep & help prevent reactions
2 nondrug interventions for thick secretions?
- 1. no milk or caffeine
- 2. cool mist humidifier
5 antihistamine nasal steroids?
- 1. Nasonex
- 2. Nasacort
- 3. Flonase
- 4. Rhinocort
- 5. Vancenase
Comparison b/t nasal and PO antihistamines?
nasal are superior b/c work directly at site & cause no systemic effects
Do inhaled nasal steroids cause immunosuppression
no b/c don't enter system
AE of nasal antihistamines?
drying of MM that can lead to epistaxis and bad tastes
Prototype expectorant med?
Use for guaifenesin?
liquefy lower resp tract secretions & decrease viscosity of secretions to aid in coughing them up in colds, acute bronchitis, & flu
3 AE of guaifenesin?
- 1. NV
- 2. anorexia
- 3. drowsiness
Pt education when taking guaifenesin?
- 1. drink lots of water
- 2. potential for drowsiness - driving etc
What may be combined with guaifenesin that gives it abuse potential?
Mucolytic prototype drug?
Action of mucomyst?
breaks down mucus and helps high-risk resp pt cough up thick, tenacious secretions to improve breathing & airflow
What med may be given prior to giving mucomyst?
may give bronchodilator before give mucomyst to open up the airway and let med in
Pt who might take mucomyst?
COPD, cystic fibrosis, bronchitis, etc
ppl who have major difficulty mobilizing and coughing up secretions
2 ways mucomyst may be given?
- 1. nebulizer
- 2. direct instillation into the trachea
What needs to be done after a pt uses mucomyst?
after removing mask need to wash off face and brush teeth to remove med
Should not take in ____ or _____ with mucomyst b/c they may thicken secretions.
milk or caffeine
What needs to be monitored if pt taking mucomyst for resp probs?
lung sounds, RR, work of breathing etc
2 uses for mucomyst besides thinning secretions?
- 1. acetaminophen antidote
- 2. protect kidneys from dye
How will mucomyst be given for antidote or kidney protection?
oral liquid that smells like rotten eggs
4 AE of mucomyst?
- 1. rhinorhea
- 2. bronchospasm
- 3. bronchconstriction
- 4. NV
- 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
Use for albuterol?
acute and chronic airway limitation & asthma
3 routes of admin for albuterol?
- 1. po
- 2. inhalation
- 3. liquid
Storage of albuterol?
if gets too hot will blow up
Precautions for use of albuterol?
- heart probs:
- 1. hypertension
- 2. cardiac disease & arrhythmias
- 3. hyperthyroidism
- 4. DM
- 5. seizures
AE of albuterol?
- 1. palpatations
- 2. sinus tachycardia
- 3. anxiety
- 4. tremor
What may occur if albuterol is used too much?
- 1. rebound bronchoconstriction
- 2. may become desensitized to the med
What does pt need to do if using albuterol too much?
go to MD
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
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
- 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
Teaching for a pt who has more than one inhaler Rx?
use bronchodilator first then others
5 short acting beta 2 agonist bronchodilators besides albuterol?
- 1. primatene mist
- 2. xopenex
- 3. alupent
- 4. maxair
- 5. Brethine
Uses for brethine?
short-acting bronchodilator & stop premature labor
2 routes of admin for brethine?
SQ or inhalation
4 AE of brethine?
- 1. tachycardia
- 2. hypertension
- 3. chest palpatations
- 4. anxiety
3 long acting beta 2 agonist bronchodilators?
All end with?
- 1. arfomoterol
- 2. formoterol
- 3. salmeterol
Can long acting bronchodilators be given during asthma attack?
What may long acting bronchodilators be used for?
to prevent excess use of albuterol
2 anticholinergic bronchodilators that may be inhaled?
Uses for anticholinergic bronchodilators?
Tx bronchospasm ass. with asthma, bronchitis, or pulmonary emphysema
AE of anticholinergic bronchodilators?
- 2. hoarseness
- 3. dysgeusia - messes with taste
- 4. anticholinergic effects
Contraindication for anticholinergic bronchodilators?
bladder or bowel obstruction r/t anticholinergic effects
- 1. constipation
- 2. decreased UO
- 3. miOsis & photophobia
- 4. increased HR & BP
- 5. agitation
2 Xanthine derivative bronchodilators?
- 1. theophylline
- 2. aminophylline
Route of admin for theophylline & aminophylline?
- theophylline - PO
- aminophylline - IV
Uses for Xanthine derivatives/theophylline?
relief of bronchial asthma and chronic airway limitation
Contraindications for Xanthine derivatives/theophylline?
- 1. status asthmaticus
- 2. peptic ulcer
AE of Xanthine derivatives/theophylline?
- 1. NV
- 2. HA
- 3. insomnia
- 4. hypertension
- 5. arrhythmias
Monitoring with theophylline?
- 1. must monitor levels - 10 to 20
- 2. BP & HR
- 3. interactions with food/drugs
- 4. caffeine & smoking
What may occur with high doses of theophylline?
Interactions with theophylline?
many food/drugs interfere with theophylline met/excretion: caffeine & smoking
monitor for toxicity
2 inhaled glucocorticoid steroids & their action?
- 1. flunsolide
- 2. budesonide
anti-inflammatory (decrease inflammatory response)
Use for glucocorticoid steroid inhalers?
Tx bronchospasm ass. with asthma, CAL, and other resp disorders
Contraindications for inhaled glucocorticoid inhalers?
active resp infection b/c can make them worse
still may be given to reduce inflammation in resp infection
2 AE of inhaled glucocorticoids?
- 1. dry mouth
- 2. dysphonia - sound funny
Serious AE of inhaled glucocorticoids?
- 1. oral candidiasis
- 2. systemic effects
How can risk for oral candidiasis and systemic effects be minimized?
- 1. use a spacer
- 2. rinse mouth after each use
Advantage for use of inhaled glucocorticoids in COPD pt?
COPD pt at risk for resp infection and inhaled steroids don't cause systemic immunosuppression
Prototype inhaled mast cell stabilizer?
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
Uses for cromolyn sodium?
allergies, mild to moderate asthma, & acute bronchospasm
Admin of cromolyn sodium?
should be taken one full week prior to coming in contact with the allergen
Anything that is sprayed in the nose can cause ______ & ______ _______.
epistaxis and mucosal irritation
2 leukotriene receptor antagonists?
End in _____.
- 1. zafirlukast/Accolate
- 2. motelukast/Singulair
What are leukotrienes?
inflammatory mediators that are powerful bronchoconstrictors & vasodilators
Action of zafirlukast & motelukast?
bronchodilation & vasoconstriction
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
Most serious AE of zafirlukast & motelukast?
- 1. hepatic failure
- 2. Churg-Strauss (autoimmune vasculitis)
Most common AE
- 1. HA
- 2. gastritis
- 3. pharyngitis
- 4. rhinitis
Major contraindiations with leukotriene receptor antagonists?
- 1. povidone (binder in some meds)
- 2. lactose
- 3. cellulose
- 4. breast-feeding
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