Pharmacology Fall 2012 Unit 4

Front 1

What do antitussives do?

Back 1

Suppress chronic, nonproductive cough

Front 2

What are some side effects of antitussives?

Back 2

-CNS depression (drowsiness, sedation)
...-Common with opioid antitussives
...-Only occurs in nonopioid antitussive when given in large doss or with concurrent use of other CNS depressant drugs
-Dizziness and lightheadedness (more common with opioid antitussives)
-Gastrointestinal distress (nausea, vomiting)
-Constipation (opioids only)
Respiratory depression (opioids only)
Potential for abuse (both opioids and nonopioids)

Front 3

Interventions for Antitussives:

Back 3

-Monitor patients when changing positions or amubulating
-Administer drug with food or milk
-Give drug only when needed
-Encourage diet high in fluids and fiber

Front 4

What are contraindications to the use of Antitussives?

Back 4

acute asthma
liver or renal disease
acute alcoholism
head trauma

Front 5

Precautions for antitussives

Back 5

reduced respiratory reserve (emphysema, chronic asthma)
history of substance abuse
prostatic hypertrophy
children and older adults (opioid antitussives)

Front 6

Inform men with prostatic hypertrophy that opioid and nonopioid antitussivess may cause what?

Back 6

urinary retention

Front 7

What are interactions of antitussives?

Back 7

*With opioids, alchohol and other CNS depressants icrease CNS depression
*Nonopioid antitussives increase the analgesic effects of opioids
*Fever an hypotension may occur if nonopioid antitussives are taken with MAOI antidepressants
*St. John's wort may increase sedation

Front 8

What are expectorants used for?

Back 8

* Colds and other upper respiratory infections
* Bronchitis

Front 9

What is the pharmacologic action of expectorants?

Back 9

* Reduce surface tension of secretions
* Thin mucus
* Makes it easure to cough secretions out of the lung
* Helps secretions drain out of the nose and sinuses

Front 10

What are some side effects of expectorants?

Back 10

* Dizziness
* Drowsiness
* Gastrontestinal distress (nausea, diarrhea)
*Allergic reaction (rash)

Front 11

What are some intervetions to use for a patient on expectorants

Back 11

* monitor patients when changing positions or ambulating
* give drug with food or 8 oz of water
* if allergic reaction occurs, stop drug and recommend alternative drug

Front 12

What are contraindications for expectorants?

Back 12

* cough due to heart failure
* ACE inhibitor therapy

Front 13

What are some precautions when using expectorants?

Back 13

* chronic cough
* asthma

Front 14

What are some interactions with expectorants?

Back 14

increased risk of hemorrhage with heparin (guaifenesin inhibits platelet function)

Front 15

What is the pharmacologic action of glucocorticoids?

Back 15

Suppress inflammation by:
*- Prevent release of inflammation mediators (leukotrienes, prostaglandins, histamine)
*- Prevent action of cells responsible for inflammation (leukocytes, eosinophils)
*- Decrease edema of airways

Front 16

Side effects of inhaled glucocorticoids

Back 16

oral candidiases
hoarseness
difficulty speaking

Front 17

side effecs of oral glucocorticoids

Back 17

supression of adrenal function
muscle wasting and bone demineralization (osteoporosis)
hyperglycemia
peptic ulcer disease
infection
fluid/electrolyte imbalances

Front 18

Side effects of nasal glucocorticoids:

Back 18

dry mucous membranes
epistaxis
sore throat
headache

Front 19

Interventions for inhaled glucocorticoids

Back 19

- attach a spacer to the inhaler
- initiate antifungal therapy when indicated

Front 20

interventions for oral glucocorticoids:

Back 20

- monitor plasma drug levels to determien adrenal function suppression
- recemmend lowest possible effective dose and alternative-day dosing to minimize bone demineralization, muscle wasting,and gastrointestinal bleeding
- implement gastric protective measures such as:
*- take drug with food or meals
*- recommend analgesic substitute (acetaminophen) if NSAID is prescribed
- monitor blood glucose levels for hyperglycemia, especially in patients with diabetes mellitus
- observe for signs of infections such as:
*- fever, inflammation, sore throat, fatigue, tachycardia, or discharge fom a wound
*- initiate appropriate antimicrobial
- monitor for sodium retention or hypernatremia, and potassium loss or hypokalmia
- monitor for signs of electrolyte imbalance such as:
*- abnormal lab values, weight gaine, edema, and generalized weakness
*- initiate appropriate fluid and electrolyte replacement therapy

Front 21

Interventions for nasal glucocorticoids

Back 21

- provide comfort measures (fluids, throat lozenges, hard candy, humidified air)
- administer non-NSAID analgesic, such as acetaminophen, for headache

Front 22

Patient instructions for inhaled glucocorticoids

Back 22

- use a spacer to deposit less drug in the oropharynx
- rinse mouth and gargle after use to prevent candidiasis

Front 23

patient instructions for oral glucocorticoids

Back 23

- explain the schedule of alternate-day therapy
- taper the dose before discontinuing it - never stop abruptly
- increase intake of calcium and vitamin D; perform weight-bearing exercises daily
- report polyphagia, polydipsia, an polyuria
- report weight gain, edema, and generalized weakness

Front 24

Instruct patients to take gastric-protective measures when taking an oral glucocorticod to prevent the development of ______ _____.

Back 24

gastric ulcers

Front 25

Patients should avoid taking _____ and use _________ instead for mild pain.

Back 25

- NSAIDs
- acetaminophen

Front 26

Patient instructions for nasal glucocorticoids

Back 26

- for dry muscous membranes, epistaxis, and sore throat
*- use a humidifier when sleeping
*- increase fluid intake
*- suck on hard candy or lozengers
- take over-the-counter non-NSAID analgesics as needed for headaches

Front 27

Contraindications for glucocorticoids

Back 27

- recent live virus immunization (oral)
- systemic fungal infection (oral)
- oral candidiasis (inhaled)

Front 28

precautions for glucocorticoids

Back 28

- peptic ulcer disease
- diabetes mellitus
- hypertension
- renal dysfunction
- use of NSAIDs

Front 29

Glucocorticoids interactions

Back 29

- potassium-depleting diuretics (furosemide [Lasix]) increase the risk of hypokalemia when used concurrently with glucocorticoids
- NSAIDs increase the risk o gastsrointestinal bleeding when used concurrently with glucocorticoids
- effects of insulin and oral hypoglycemics are decreased when used concurrently with glucocorticois

Front 30

What are glucocorticoids used for?

Back 30

- inhaled: Long-term management of chronic asthma

- oral: Short-term management of post-exacerbation symptoms

- Nasal: reduce inflammation and pevent and treat rhinitus

Front 31

What are leukotriene modifiers used for?

Back 31

- long-term treatment of chronic asthma
- propylaxis for exercise-induced bronshospasm (EIB)
- management of allergic rhinitus

Front 32

what is the pharmacologic action of leukotriene modifiers?

Back 32

suppresse inflammation by inhibiting the release of leukotrienes

Front 33

side effects of Zileuton (Zyflo) (a leukotriene modifer)

Back 33

Liver damage

Front 34

what is a side effect of Zafirlukast (Accolate) (a luekotriene modifier)

Back 34

liver damage

Front 35

What is a side effect of Montelukast (Singulair) (a leukotriene modifier)?

Back 35

headache

Front 36

Interventions for leukotriene modifiers

Back 36

- monitr liver funciton with periodic testing (zileuton and zafirlukast)

- give mild analgeic for headache

Front 37

Administration of leukotriene modifiers?

Back 37

- schedule montelukast one daily in the evening

- mix oral granules with applesauce, carrots, rice, or ice cream or place directly on the tongue

- to prevent EIB, take at least 2 hr before exercising and do not repeat the dose for 24 hrs

Front 38

what would you instruct for a patient using leukotriene modifiers?

Back 38

if on zileuton or zafirlukast, report abdominal tenderness, nausea, or anorexia

Front 39

contraindications for leukotriene modifiers

Back 39

~ liver dysfunciton (zileuton, zafirlukast)
~ acute asthma exacerbations
~ status asthmaticus

Front 40

precautions for leukotriene modifiers

Back 40

severe asthma

Front 41

Interactons of leukotriene modifiers

Back 41

~ Phenobarbital (Luminal) and phenytoin (Dilantin) may necessitate higher dosages of montelukast

~ Zileuton can increase levels of warfarin (Coumadin), theophylline (Theo-24), and propranolol (Inderal)

~ Zafirlukast can increase levels of warfarine, tolbutamide (Orinase), carbamazepine (Tegretol), and phenytoid (Dilantin).

~ Aspirin can increase zafirlukast levels

Front 42

What is the pharmacologic action of mucolytics?

Back 42

break disulfide linkages of proteins in mucus. doing this:

~ decreases viscosity of mucus
~ allows mucus to expectorate

Front 43

side effects of mucolytics

Back 43

~ bronchospasm
~ aspiration of excessive secretions
~ gastrointestinal distress (drug's rotten egg smell, ingestion of secretions)

Front 44

intervetions for mucolytics

Back 44

~ monitor respiratory status (auscultation of the lungs for adventitious breath sounds)

~ administer a bronchodilator as needed

~ give patient tissues and a disposable bag, and encourage pateint to expectorate secretions

Front 45

Administration of muolytics

Back 45

~ give via nebulizer that does not contain metal or rubber parts. Instill directly into tracheostomy tube
~ clear the airway and assess the patient's abiliy to cough prior to administration
~ have suction equipment available
~ clean equipment after treatment
~ expect a sulfur-lie (rotten egg) odor
~ for acetaminophen overdose, giv acetylcysteine (Acetodote)
~ for acetaminophen toxicity, dilute oral acetylcysteine with juice or soft drinks

Front 46

patient instructions for mucolytics

Back 46

~ report any difficulty breathing or worsenig cough
~ expectorate secretions instead of swallowing them
~ take antemetic as needed

Front 47

contraindications of mucolytics

Back 47

risk of or actual gastric bleeding

Front 48

precautions for mucolytics

Back 48

~ weak or ineffective cough
~ peptic ulcer disease
~ esophageal varices
~ severe liver disease
~ asthma
~ anaphylactic reaction (when given IV)

Front 49

What are mast cell stabilizers for?

Back 49

~ long-term treatment of allergy-related asthma

~ prophylaxis for exercise-induced bronchospasm

~ prophylaxis for seasonal allergy symptoms

~ management of allergic rhinitis (intranasally)

Front 50

what is the expected pharmalogical action of mast cell stabilizers?

Back 50

Suppresses inflammation (similar to corticosteroids) by:

~ prevent the release of inflammation mediators (leukotrienes, histamine)
~ inhibit activity of cells responsible for inflammation (leukocytes, eosinophils)

Front 51

side effects of mast cell stabilizers

Back 51

~ allergic reaction
~ dry mouth
~ headache
~ bitter aftertaste
~ cough, tingling, or burning of the throat and trachea after inhalation

Front 52

interventions for mast cell stabilizers

Back 52

~ if anaphylaxis occurs, administer epinephrine or antihistamines
~ encourage patient to gargle, drink sips of water, or suck on hard candy or throat lozenges after inhalations
~ administer mild analgesic as needed for headache

Front 53

administration of mast cell stabilizers

Back 53

~ use with a nebulizer or a metered-dose inhaler
~ administer 2-4 times daily on a fixed schedule
~ clear mucus from airways prior to inhalation
~ expect several weeks of use for full effects to become apparent
~ use the inhaler 15 minutes prior to exercising to prevent exercise-induced bronchospasm
~ do not use to relieve acute asthma attacks

Front 54

contraindications for mast cell stabilizers

Back 54

~ allergy to cromolyn
~ coronary artery disease
~ cardiac dysrhythmias
~ status asthmaticus

Front 55

precautions for mast cell stabilizers

Back 55

~ liver disease
~ kidney disease

Front 56

what are nonsedating antihistamines used for?

Back 56

~ allergic rhinitis
~ chronic idiopathic urticaria

Front 57

what is the pharmacologic action of nonsedating antihistamines?

Back 57

binds to H1 receptors: blocks release of histamines

Front 58

side effects of nonsedating antihistamines

Back 58

~ drowsiness and fatigue
~ mild anticholinergic effects (dry mouth, nose, and throat)

Front 59

interventions for nonsedating antihistamines

Back 59

~ monitor patient when ambulating
~ provide water, and encourage frequent sips
~ provide hard candy to suck on

Front 60

contraindications for nonsedating antihistamines

Back 60

~ infants under 6 months
~ breastfeeding women

Front 61

precautions of nonsedating antihistamines

Back 61

impaired kidney or liver function

Front 62

interactions with nonsedating antihistamines

Back 62

~ Theophylline can reduce clearance and lead t toxicity
~ Atropine may cause anticholinergic effects

Front 63

what are sympathomimetics used for?

Back 63

reduction of nasal congestion:

~ allergic rhinitis
~ sinusitis
~ common cold

Front 64

expected pharmalogic action of sympathomimetics?

Back 64

activate alpha1-adrenergic receptors in the nose (sympathomimetic)

~ vasoconstriction of blood vessels
~ turbinates shrink, which opens nasal passages

Front 65

side effects of sympathomimetics

Back 65

~ CNS stimulation with oral agents such as agitation, anxiety, insomnia

~ systemic vasoconstrction, tachycardia, and heart palpitations with oral agents

~ rebond nasal congestion with abrupt stoppage of polonged use of topical agents

~ abuse potential (pseudophedrine, ephedrine)

Front 66

Sympathomimetic drugs can cause an increase in heart rate, palpitations, and blood pressure. So, it is important to monitor patients who have a history of _______ ________, _____________, or __________ ________ _________.

Back 66

~ cardiac dysrhythmias
~ hypertension
~ coronary artery disease

Front 67

patient instructions for sympathomimetics

Back 67

~ notify provider of symptoms of excessive CNS stimulation such as agitation, anxiety, inability to fall asleep

~ report prolonged tachycardia or heart palpitations

~ avoid using nasal preparations for more than 3-5 days

~ taper and discontinue the drug using one nostril at a time

Front 68

contraindications of sympathomimetics

Back 68

~ chronic rhinitis
~ narrow-angle glaucoma
~ uncontrolled heart disease
~ hypertension
~ dysrhythmia

Front 69

Precautions for sympathomimetics

Back 69

~ coronary artery disease
~ hypertension
~ older adults

Front 70

interactions wtih sympathomimetics

Back 70

~ MAOI antidepressants potentiate effects so don't use within 3 weeks of each other

~ Beta2-adrenergic agonists and oteh stimulants potentiate hypertensive effecs

Front 71

What are sedating antihistamiens used for?

Back 71

Management of mild allergic reactions
~ seasonal allergic rhinitis
~ mild transfusion reaction
~ urticaria (hives)

Management of severe anaphylactic reactions
~ hypotension
~ acute laryngeal edema
~ bronchospasm

Treatment of motion sickness and insomnia

Front 72

what is the expectd pharmalogical action for sedating antihistamines

Back 72

~binds to H1 receptors: blocks release of histamines
~ mild cholinergic blocker: acts lie anticholinergic (dry mout, constipation, urinary hesitancy)

Front 73

side effects of sedating antihistamines

Back 73

~ drowsiness and dizziness
~ anticholinergic effects (dry mouth, constipation, urinary hesitancy)
~ gastrointestinal discomfort such as nausea and vomiting
~ acute toxicity in adults: flushed face, high fever, tachycardia, dry mouth, urinary retention, and pupil dilation
~ acute toxicity in children: excitation, hallkucinations, and seizures

Front 74

interventions for sedating antihistamines:

Back 74

~ monitor patient when ambulating
~ recommend a nonsedating antihistamine if sedation is excessives
~ encourage sips of water or sucking on hard candy
~ recommend selecting high fiber foods
~ provide fiber supplement or laxative as needed
~ monitor for urinary retention
~ give drug with food

Front 75

if acute toxicity develops with sedating antihistamines:

Back 75

~ administer activated charcoal and athartics
~ administer acetaminophen
~ apply ice packs or give sponge baths
~ anticipate teh need for phenytoin IV if patient experiences seizures

Front 76

contraindications for sedating antihistamines

Back 76

~ newborns and children under 2 years old
~ breastfeeding women
~ narrow-angel glaucoma
~ prostatic hypertrophy
~ acute asthma exacerbation

Front 77

Precautions for sedating antihistamines

Back 77

children and older adutls
patients with a history of:
~ asthma
~ urinary retention
~ open-angle glaucoma
~ hypertension
~ impaired kidney of lver function

Front 78

Instruct patients with ______ to avoid taking diphenhydramine.

Back 78

glaucoma

Front 79

why should patients with glaucoma avoid diphenhydramine?

Back 79

it can potentially cause a sudden and painful increase in intraocular pressure that could damage the optic nerve

Front 80

interactions with sedating antihistamines

Back 80

alcohol and other CNS depressants increase depressant effects of antihistamines

Front 81

expected pharmacologic action of beta2-adrenergic agonists?

Back 81

~ promote bronchodilation
~ relieve bronchospasm
~ valuable in treatment of asthma because they help airways stay open

Front 82

side effects of beta2-adrenergic agonists

Back 82

~ tachycardia
~ heart palpitations
~ tremors
~ angina for patients with cardiac blood vessels already compromised by vascular disease
~ angina for patient who experience significant vasospasm of the cardia vessels in response to the drug

Front 83

interventions for beta2-adrenergic agonists

Back 83

monitor and report
~ tachycardia
~ heart papitations
~ chest pain

Front 84

patient instructions for beta2-adrenergic agonists

Back 84

avoid caffeine
notify provider of signs of exacerbations:
~ keep a log of frequency and intensity
~ notify provider of changes
~ it is important for patients to notify provider if they experience chest pain, heart palpitations, or increase in pulse rate when taking these drugs, especially if they have a history of cardiovascular disease, hypertension,or are taking a digitalis-type drug

Front 85

contraindications for beta2-adrenergic agonists

Back 85

~ allergy
~ tachydysrhythmia
~ tachycardia due to digitalis toxicity

Front 86

Precautions for beta2-adrenergic agonists

Back 86

~ diabetes millitus
~ hypethyroidism
~ cardiovascular disease
~ hypertension
~ angina pectoris

Front 87

Interactions of beta2-adrenergic agonists

Back 87

~ beta-adrenergic blockers reduce the effectiveness of beta2-adrenergic agonists
~ Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants increase the risks of hypertension, tachycardia, and angina
~ hypoglycemic (antidiabetic) drugs require increased dosing due to hyperglycemic effects

Front 88

what are inhaled anticholinergics used for?

Back 88

~ relief of bronchospasm in patients who have chronic obstructive pulmonary disorder (COPD)
~ treatment of allergen- and exercise-induced asthma

Front 89

what is the expected pharmacologic action of Inhaled Anticholinergics

Back 89

Blocks muscarinic receptors in the bronchi causing bronchodilation

Front 90

side effects of inhaled anticholinergics

Back 90

Occur secondary to decreased stimulation of parasympathetic nervous system

Effects include:
~ dry mouth
~ hoarseness
~ increased intraocular pressure
~ urinary retention

Front 91

interventions for inhaled anticholinergics

Back 91

~ provide patient with water and hard candy
~ schedule routine testing for glaucoma
~ monitor urinary elimination patterns, especially in older adults

Front 92

Due to the delay of the onset of action and the time it takes for the drug to reach its peak effects, don't use _____________ for acute episodes of asthma. Use a ______-_______ _______ instead.

Back 92

~ anticholinergics
~ beta2-adrenergic agonist

Front 93

Contraindications for inhaled anticholinergics

Back 93

allergies to soya lecithin, soybean, or peanuts

Front 94

precautions for inhaled anticholinergics

Back 94

~ glaucoma
~ prostatic hypertrophy
~ bladder neck obstruction

Front 95

interactions with inhaled anticholinergics

Back 95

beta2-adrenergic agonists enhance bronchodilaton

Front 96

Methylxanthines are used for:

Back 96

Long-term management of:
~ chronic asthma
~ chronic bronchitis
~ emphysema

Front 97

expected pharmacologic action of Methylxanthines

Back 97

relaxes smooth muscles in bronchi and pulmonary blood vessels

Front 98

side effects of Methylxanthines

Back 98

Rare at therapeutic levels

When blood level exceeds therapeutic level:
~ restlessness and insomnia
~ nausea, vomiting, and diarrhea

When blood level reaches toxic level:
~ life-threatening seizures
~ dysrhythmias

Front 99

interventions for Methylxanthines

Back 99

monitor blood level

if drug levels rise:
~ notify provider who may adjust dosage or discontinue the drug
~ give activated charcoal to decrease absorption
~ monitor heart rate and rhythm

If life-threatening cardiac dysrhthmias occur, antidysrhythmics may be necessary to restore heart rate adn rhythm. If the patient experiences a seizure, initiate anticonvulsant therapy per the provider's prescription, and institute the seizure precautions.

Front 100

contraindications for Methylxanthines

Back 100

cardiac disorders that cannot withstand myocardial stimulation

Front 101

precautions for Methylxanthines

Back 101

~ heart disease
~ liver or renal dysfunction
~ acute pulmonary edema
~ hyperthyroidism
~ diabetes mellitus
~ peptic ulcer disease

Front 102

Interactions with Methylxanthines

Back 102

Increase risk of toxicity:
~ Cimididine (Tagamet)
~ some fluoroquinnolones
~ caffeine

Decrease in blood level
~ nicotine
~ Phenobarbital
~ Phenytoin (Dilantin)

Front 103

cause of hypovolemic shock?

Back 103

dehydration and/or loss of blood

Front 104

treament for hypovolemic shock

Back 104

fluid replacement such as:
~ blood products (whole blood, plasma protein fraction, fresh/frozen plasma)
~ colloids (plasma protein fraction, normal serum albumin, dextran 40, hetastarch)
~ crystalloids (normal saline,lactated ringer's plasmalyte, hypertonic saline)
~ 5% dextrose in water (D5W)

Front 105

cause of septic shock?

Back 105

infection that has gotten into the blood stream and become systemic

Front 106

treatment of septic shock?

Back 106

treated with antibiotics

Front 107

Fat soluble vitamins:

Back 107

~ A, D, E, K
~ relatively stable during cooking
~ get from animal and plant sources
~ stored in fat

Front 108

Water soluble vitamins:

Back 108

~ C, B complexes
~ excreted in urine
~ dailly doses must be obtained

Front 109

Shock:

Back 109

Assess for reason of shock.
Types of shock:
~ hypovolemic
~ neurogenic
~ cardiogenic
~ septic
~ anaphylaxis

Front 110

Treatment of shock:

Back 110

~ place victim in shock positon: supine with legs & feet elevated
~ keep victim warm & comfortable
~ turn victim's head to 1 side if neck injury is not suspected because victim may vomit
~ maintain adeuate blood pressure
~ treatment with meds such as: Epinephrine and Dopamine which workn instantanious; or with dobutamine

Front 111

what is the main goal when treating someone in shock and why is it?

Back 111

main goal is to maintain adequate blood pressure
because blood pressure can drop too low to push blood through to the brain

Front 112

kidney failure:

Back 112

~ kidneys have decreased ability to maintain electrolyte and fluid balance and to excrete waste products
~ tend to have generalized edema b/c kidneys are retaining sodium
~ excess ammonia, nitrobumin, and blood urea
~ blood pressure lowers b/c kidneys are secreting less renin
~ anemia results b/c kidneys are secreting less EPO

Front 113

diuretics are used to treat:

Back 113

hypertension
heart failure
fluid retention disorders

Front 114

loop diuretics

Back 114

work in the loop of Henle
need potassium supplements

Front 115

loop diuretic meds:

Back 115

Furosemide (Lasix)
Torsemide (Demadex)
Bumetanide (Bumex)

Front 116

Thiazide meds:

Back 116

Hydrochorothiazide
Metolazone (Zaroxolyn

Front 117

Potassium Sparing Diuretics meds:

Back 117

`Spironolactone (Aldactone)
Triamterene (Dyrenium)

Front 118

What should potassium levels be?

Back 118

<5 and > 3.5

Front 119

if hyperkalemia occurs:

Back 119

~ restrict major dietary sources of potassium
~ kaexelate binds with potassium and allows it to be defecated

Front 120

If hypokalemia occurs

Back 120

~ increase intake of dietary sources of potassium
~ give potassium supplements (take oral with food or watch IV site closely)