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81 Cards in this Set
- Front
- Back
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Which bronchodilators:
stimulate an enzyme (adenyl cyclase) to increase production of cyclic AMP -> bronchodilation |
Adrenergics
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What are some side effects of Adrenergics? (try to name 5)
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- angina
- tachycardia - palpitations - agitation - anxiety - insomnia - seizures - tremors |
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True or False:
Adrenergics are ok for use in all ages. |
True (older clients may experience more cardiac stimulation)
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For which receptors is Epinephrine an agonist?
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- B1
- B2 |
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What is the drug of choice for bronchospasm?
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B2 agonist
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Which bronchodilator:
- 1st choice for status asthmaticus, acute asthma |
Short-acting B2 agonist
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Concerning short-acting B2 agonist:
- when is the onset of action? - how long is the duration? |
- 5 min
- 3-8 hours |
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How are Short-acting B2 agonists administered?
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metered dose inhalers (MDIs) or nebulizer
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The examples below are from which bronchodilator class?
- albuterol (Proventil) - levalbuterol (Xopenex) |
Short-acting B2 agonist
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What route can albuterol be given besides inhalation?
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PO
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Which bronchodilator:
- used to prevent episodes of bronchoconstriction - slower onset of action - duration up to 12 hours |
Long-acting B2 agonist
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What rule applies to the frequency of taking long-acting B2 agonist
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Never take more frequently than q12hr
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The examples below are from which bronchodilator class?
- formoterol (Foradil) - salmeterol (Serevent) |
Long-acting B2 agonist
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What long-acting B2 agonist is sometimes given to prevent preterm labor?
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terubutaline (Brethine)
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What bronchodilator:
blocks the action of aCH in bronchial smooth muscle when administered via inhalation |
Anticholinergics
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When are anticholinergics indicated?
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- long-term management of COPD
- bronchoconstriction |
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When are Anticholinergics contraindicated?
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- cautious use with narrow-angle glaucoma (increase intraocular pressure)
- BPH (causes urinary retention & anticholinergic prevents contraction of bladder :( |
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What are the side effects of Anticholinergics (try to name 5)
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- dry mouth
- urinary retention - cough - nervousness - nausea - GI upset - headache - dizziness |
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The examples below are from which bronchodilator class?
- ipratropium (Atrovent) - tiotropium (Spiriva) |
Anticholinergics
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Which bronchodilator?
- unknown method of action - 2nd line drug in asthma & COPD |
Xanthines
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When are Xanthines contraindicated?
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emergency tx of bronchospasm
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When do side effects to Xanthines usually present?
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with elevated serum levels
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What are some side effects to Xanthines? (try to name 5)
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- anorexia
- N/V - agitation - nervousness - insomnia - dysrhythmias - tonic-clonic seizures |
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The example below are from
which bronchodilator class? - theophylline (Aminophyilline, Theo-dur) |
Xanthines
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Which routes can Xanthine be administered?
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IV and PO (sustained release far more common)
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What is the therapeutic range for Xanthines?
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serume theophylline 5-15 mcg/mL (narrow range)
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When should blood be drawn after Xanthine administration?
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- 1-2 hours after immediate release
- 4 hours after SR |
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How is the dosage for Xanthines calculated?
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using lean body mass
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What is the nursing implication concerning administration if GI upset occurs with Xanthine administration?
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take with a glass of H2O or food
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What respiratory drugs suppress the inflammatory process and decrease mucus secretion, mucosal edema, repair of damaged epithelium, reduced airway reactivity. Also increased B2 receptors, enhancing responsiveness to B2 agonist
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Corticosteroids
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When are corticosteroids indicated?
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- Acute asthma (IV or PO in high/multiple doses)
- Chronic asthma (daily inhalation) |
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What are some contraindications for corticosteroid use?
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- caution with PUD
- inflammatory bowel disease - HTN - CHF - thromboembolic disorders |
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What are some side effects to corticosteroid use?
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- fewer with short-term use
- chronic use in children may retard growth & bone mass, and decrease adrenal function - avoid high doses in children - oropharyngeal candidiasis, hoarseness (rinse mouth) - adrenal insufficiency may occur with systemic use or high doses of inhalation - high dose in elderly increases risk of osteoporosis - SYSTEMIC ROUTE LIKELY TO CAUSE HYPERGLYCEMIA |
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the following are example of which respiratory drugs:
- PO - prednisone (Deltasone) - IV - hydrocortisone (Solucortef), methylprednisolone (Solu-medrol) - Inhalation - fluticasone (Flonase), triamcinolone (Azmacort), beclomethasone (Beconase) |
Corticosteroids
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Advair is a mixture of corticosteroids and what B2 agonist?
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Serevent (given q12 hours)
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When are Leukotriene modifiers indicated?
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- long-term management of asthma in adults and children
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Which Leukotriene modifier is contraindicated in liver disease?
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zileuton (Zyflo)
(increase LFT with Zyflo) |
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What are some side-effects of Leukotriene modifiers?
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- HA
- nausea - diarrhea - infection |
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the following are examples of which respiratory drugs:
- montelukast (Singulair) - zileuton (Zyflo) |
Leukotriene Modifiers
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Which respiratory drugs prophylactically stop the release of inflammatory mediators when mast cells come in contact with allergens and/or other stimuli
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Mast Cell Stabilizers
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When are Mast Cell Stabilizers indicated?
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prophylaxis for acute asthma attacks
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When are Mast Cell Stabilizers contraindicated?
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- acute bronchospasm
- status asthmaticus - caution in renal/hepatic impairment |
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What are some side effects of Mast Cell Stabilizers?
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- dysrhythmias
- hypotension - chest pain - dizziness - convulsions - anorexia - N/V - CNS depression |
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the following are examples of which respiratory drugs:
- cromolyn (Intal) - nedocromil (Tilade) |
Mast Cell Stabilizers
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What route are Mast Cell Stabilizers given?
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inhalation
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Which respiratory drugs block receptors on mast cells and basophils by binding to IgE, ultimately preventing the release of inflammatory mediators
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Immunosuppressant Monoclonal Antibodies
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When are Immunosuppressant Monoclonal Antibodies indicated?
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allergic asthma unrelieved with corticosteroids
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What are some side effects of Immunosuppressant Monoclonal Antibodies?
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- URI
- pharyngitis - sinusitis |
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the following is from which respiratory drugs
- omalizumab (Xolair) [SC route] |
Immunosuppressant Monoclonal Antibodies
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How long should one wait between MDI puffs?
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3-5 minutes
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Which respiratory drugs is caffeine associated with?
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Xanthines
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Which two vaccines are recommended to clients with respiratory difficulties?
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- flu vaccine
- pneumonia vaccine |
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What is the recommended fluid intake for clients with respiratory difficulty?
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2-3 quarts/ day
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At what times should montelukast (Singulair) be administered?
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administer in the evening or HS to increase drug concentrations during the night and early morning
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What is the first chemical mediator released from basophils & mast cells w/ immune & inflammatory disorders
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Histamine
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Which histamine receptor is located in the smooth muscle in blood vessels, respiratory tract, and GI tract
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H1
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Which respiratory drugs inhibit bronchoconstriction, decrease capillary permeability, decrease salivary & tear formation - block histamine from acting of target tissues
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H1 receptor antagonists (Antihistamine)
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When are H1 receptor antagonists indicated?
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- allergic rhinitis
- anaphylaxis - allergic conjunctivitis - drug allergies & pseudoallergies - transfusion premedication - dermatologic conditions - motion sickness - N/V |
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When are H1 receptor antagonists contraindicated?
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- pregnancy
- narrow-angle glaucoma - prostatic hypertrophy - stenosing peptic ulcer - bladder neck obstruction |
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What is the side effect of First Generation (SEDATING/nonselective) Antihistamines?
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CNS depression
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the following are examples of which respiratory drugs?
- diphenhydramine (Benadryl) - hydroxyzine (Vistaril) - promethazine (Phenergan) |
First Generation (SEDATING/nonselective) Antihistamines
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In addition to PO, both Benadryl and Phenergan can be given IV. When giving Phenergan IV, what amount of saline is used to dilute the drug?
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10mL saline
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What property causes the second generation (Nonsedating / selective) antihistamines to produce less sedation than 1st generation?
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Second Generation Antihistamines do not cross the BBB
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the following are examples of which respiratory drugs:
- loratadine (Claritin) - cetirizine (Zyrtec) - fexofenadine (Allegra) |
Second Generation Antihistamines
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Though Second Generation Antihistamines are usually better, what is the downside?
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they are more expensive
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What is the MOA of Nasal Decongestants?
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constricts arterioles and reduces blood flow to nasal mucosa thereby decreasing nasal congestion
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What are some contraindications for Nasal Decongestant use?
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- HTN
- CAD - Narrow-angle glaucoma |
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the following are examples of which respiratory drugs:
- pseudoephedrine (Sudafed) - oxymetazoline (Afrin - nasal spray - phenylephrine (Neosynephrine) |
Nasal Decongestants
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What can occur with extended use of nasal spray (> 7 days)
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Rebound nasal congestion
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Which respiratory drugs depress the cough center in the medulla oblongata, cough receptors in throat, trachea, and lungs
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Antitussives
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When are antitussives indicated?
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dry, hacking, Nonproductive cough
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Which antitussive drug is centrally active (causes drowsiness)?
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codeine
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Which antitussive drug is Non-narcotic (non drowsy)?
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dextromethorphan (Bentyl DM)
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What common antitussive drug is given locally?
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throat lozenges
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Which respiratory drugs are given to liquefy secretions?
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Expectorants
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the following is an example for which respiratory drugs:
- guaifenesin (Robitussin, Mucinex) |
Expectorants
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Which respiratory drugs are given via inhalation therapy to liquefy secretions?
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Mucolytics
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the following are examples of which respiratory drugs:
- sodium chloride & acetylcysteine (Mucomyst) |
Mucolytics
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Which respiratory drug is used in the treatment of acetaminophen overdose and in small doses with dye administration?
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acetylcysteine (Mucomyst)
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Which herb and mineral supplements are used to combat colds?
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- Echinacea
- Zinc gluconate |
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What dose of vitamin C is given to decrease incidence and severity of colds and flu?
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doses > 100mg
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