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53 Cards in this Set
- Front
- Back
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What are histamines?
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-a chemical produced as part of a hypersensitivity reaction
-causes vasodilation, increased stomach acid secretion -smooth muscle constriction (in the bronchi) -mucus production -tissue swelling -itching **2 histamine receptors -H1 -H2 |
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What are antihistamines?
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-chemical that block or stop the reaction of histamine by blocking the histamine receptor sites
-compete w/histamine for receptor sites -used in the managment of nasal allergies, seasonal or perennial allergic rhinitis, allergic reactions, motion sickness |
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Side effects of antihistamines
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-older antihistamines have more cholinergic side effects due to receptor binding
-newer, second generation antihistamines produce less sedation due to more specific receptor binding |
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Decongestants
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-relieves nasal blood vessel dilation, which can be caused by allergies or infection
-work by stimulating alpha-adrenergic receptors, which produce constriction -decreases stuffiness....non-drying -common side effect:agitation, insomnia, potential for abuse -frequent use results in rebound congestion |
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Oral decongestants
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-prolonged effects
-less potent -no rebound congestion -exclusively adrenergics -Ex. pseudoephedrine (sudafed) |
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Client teaching for traditional, 1st generation antihistamines
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-avoid driving
-no alcohol -no central nervous system depressants |
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Commonly used decongestants
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-Afrin, nasal spray
-Neo-Synephrine -Sudafed, psuedoephedrine |
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Nasal steriods
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-anti-inflammatory
-decrease inflammation -relieve nasal decongestion |
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Nasal decongestants
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Adrenergics:
-vicks -privine -afrin -neosynephrine Intranasal steroids: -beconase -vancenase -nasalide |
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Side effects of nasal decongestants
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Adrenergics:
-nervousness -insomnia -palpitations -tremors steriods: -local mucosal dryness & irritation |
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Nasal decongestants treat?
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-acute or chronic rhinitis
-common cold -sinusitis -hay fever -other allergies |
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Nursing implications for nasal decongestants
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avoid decongestants in the following pt's:
-heart disease *hypertensive disease -respiratory disease Assess for drug allergies |
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Antitussives
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antitissive=anti-cough
-a productive cough should not be suppressed! -these act on the cold reflex -come in narcotic, non-narcotic formulations -dextromethorphan, (now a drug of abuse), found in many OTC preparations |
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Expectorants
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-these loosen bronchial secretions so they can be coughed up
-found in many OTC preparations:guaifenasin |
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Bronchodilators
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-meds used to relax & open airways
-open or maintain the bronchial airways -treat several disease syndromes: -COPD -asthma |
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Classes of bronchodilators
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-sympathomimetic agents
-xanthine bronchodilators -anticholinergics -leukotriene receptor antagonists -5-lipoxygenase inhibitors -mast cell stabilizers -corticosteriods |
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Sympathomimetics
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beta2-adrenergic receptors
-used during the acute phase of asthmatic attacks -quickly reduce airway constriction & restore normal airflow |
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Uses for sympathomimetics
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-treat actue attacks as well as to prevent attacks
-quickly reduce airway constriction & restore normal airflow -relief of bronchospasm, bronchial asthma, bronchitis, & other pulmonary diseases -treat hypotension & shock |
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Sympathomimetic agents
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non-selective adrenergics:
-stimulate alpha1, beta1, (cardiac), & beta2 (resp) receptors -ex:epinephrine nonselective beta-adrenergics: -stimulate both beta1 & beta2 receptors -ex:isuprel selective beta2 drugs: -stimulate only beta2 receptors -ex:albuteral |
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Side effects of sympathosmimetic agents
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-nausea
-increased anxiety -palpitations -tremors -increased HR *frequent use leads to beta 1 receptors stimulated: ex. albuteral loses it's action |
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Mechanism of action for anticholinergics
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-acetylcholine (ACh) causes bronchial constriction
-anticholinergics bind to the ACh receptors, preventing ACh from binding -result: bronchoconstriction is prevented, airways dilated |
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What is a leukotriene?
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-mediator of inflammation
-play a role in the inflammatory response in asthma, (& other things) -potent bronchoconstrictor & vasodilator |
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Side effects of anticholinergics
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*usually not absorbed systemically
if absorbed have potential to produce: -dry mouth or throat -GI distress -headache -coughing -anxiety |
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Leukotriene receptor antagonists
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-direcly prevent bronchoconstriction
-developed to treat asthma -popular & effective -leukotrienes are inflammatory molecules: -released by mast cells -cause the bronchials to contract -development of edema in the lungs |
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Types and actions of anticholinergic bronchodilators
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Types:
-atrovent -spiriva handihaler Actions: -local effects -slow & prolonged action -used to prevent bronchoconstriction -not used for acute asthma exacerbations |
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Side effects of leukotriene receptor antagonists
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-headache
-nausea -diarrhea -liver dysfunction |
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Patient education for leukotriene receptor antagonists
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-use for chronic management of asthma, not acute asthma
-improvement should be seen in about 1 week |
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Currently available leukotriene receptor antagonists
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-singulair
-accolate |
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By blocking leukotrienes
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-prevent smooth muscle contraction of the bronchial airways
-decrease mucus secretion -prevent vascular permeability -decrease neutrophil & leukocyte infiltration to the lungs |
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What is a mast cell?
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-like a basophil, which is essential for inflammatory reactions
-it does NOT circulate in the blood but lives in connective tissue. They are concentrated beneath the skin & the mucus membranes of the respiratory & digestive tracts -they're covered in IGe molecules, (which causes the release of histamine, prostoglandins & leukotrienes SOO, they produce hypersensitivity reactions like urticaria, allergic rhinitis, & asthma...as well as systemic anaphylaxis |
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5-lipoxygenase inhibitors
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new class of leukotriene receptor antagonist
-action: -inhibit the formation of leukotrienes -used to inhibit some cancer growth -outcome: -prevent lung inflammation Ex.zileuton, one agent |
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Mast cell stabilizers
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-used prophylactically
-no direct bronchodilator activity -indirect acting -stabilize the cell membranes of the inflammatory cells-mast cells, monocytes, macrophages -prevent release of harmful cellular contents, (that would then go on to cause inflammation) -adjuncts to the overall management of pt's w/lung disease -prevent bronchospasm when exposed to: -cold air -exercise -allergens -dry air |
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Examples of mast stabilizers
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-Nasalcrom
-intal -tilade |
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Side effects of mast cell stabilizers
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-coughing
-taste changes -sore throat -dizziness -rhinitis -headache -bronchospasm |
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Inhaled corticosteriods
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-anti inflammatory
-does not relieve acute asthma -stabilize membranes of cells that release harmful bronchocontricting substances -increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation *inhaled forms: -reduce systemic effect -used for chronic asthma |
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Examples of inhaled corticosteriods
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-beclovent
-vanceril -azmacort -aerobid **these are not for acute |
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Side effects of inhaled corticosteriods
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-pharyngeal irritation
-coughing -dry mouth -oral fungal infections -systemic effects are rare |
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Respiratory agents
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Combo product:
-advair: flutinasone propionate & salmeterol:dry powder in a circular disk salmeterol is a long acting bronchodilator -corticosteriod:anti-inflammatory agent -used daily **salmeterol is not recommended for use as a single agent, only for use in combo w/fluticasone |
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Patient education on respiratory agents
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-receive flu & pneumonia vaccination
-receive prompt treatment for any illness -check w/health care provider before taking other meds |
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Alpha & beta adrenergic agonists
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-AKA "sympathomimetics"
-an "agrenergic agonist" is an agent that mimics. or stimulates the sympathetic nervous system (fight or flight) SOO, these also use both alpha & beta receptors producing a response similar to "fight or flight" *BUT, the parts of the "fight or flight" isn't theraputic: -tremor -agitation -increased HR |
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How does the response similar to "fight or flight" brought on by alpha & beta agonists help respiratory conditions?
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-promotes bronchodilation
-elevates BP -increases airway patency |
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Anticholinergics
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*remember, a cholinergic stimulates parasympathetic nervous system SO
-anticholinergic blocks the impulses of the parasympathetic system: -making the sympathetic system more dominant -ex.:atrovent |
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What are the effects of parasympathetic stimulation?
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-pupillary constriction
-bronchial constriction -slowing of HR -increased gland secretion-but not sweat glands -contraction of muscle of ailimentary canal (digestive tract) |
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How are anticholinergics helpful?
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Because they block the impulses of the parasympathetic nervous system we see:
-bronchial dilation -relief of bronchial obstruction, (but not foreign bodies) -relief of bronchospasm |
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What is theophylline?
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-xanthine derivaties
-aminophylline, theophylline, & caffeine act similarly to: -stimulate CNS -stimulate respiration -dilate coronary vessels -dilate pulmonary vessels |
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Why do we use theophylline?
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-used when we want to relax smooth muscle of the bronchi, bronchioles, & pulmonary blood vessels. For ex in COPD & asthma
-must be monitored, by serum concentration. Optimal range determined by each lab-usually 10-20mcg/dL -in most as effective as beta agonists or glucocorticoids *used less now due to serious toxicity effects, including cardiorespiratory collapse. Also had severe drug interactions |
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Glucocorticoids
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**many, many uses!
-physiological glucocorticoids are adrenal hormones that protect us from stress, affect protein & carb metabolism (cortisol). -used also for adrenal insufficiency, inflammatory disorders, chemo-related N/V, auto-immune conditions |
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Examples of glucocorticoids and how they are administered
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Examples:
-prednisone -dexamethasone -methylprednisolone Administration: -can be administered orally, IM, IV or inhaled |
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How to glucocorticoids help respiratory disorders?
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-maintenance therapy, re:inflammation
-also plays a role in immune modulation re:allergies, asthma....reduce sensitivity to triggers |
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Side effects of glucocorticoids
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**DO NOT withdraw abruptly!!
-steriod psychosis -osterporosis -immunosuppression -appetite change -insomnia -mood swings -nausea/vomiting |
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Types of meds for daily therapy, rescue inhaler, or acute asthma attack
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rescue:
-proventil, albuterol Daily therapy: -singulair -serevent -intal -azmacort acute: -proventil -epinephrine *important: -there are short & long acting bronchodilators -if pt using rescue inhaler 2 or more times a week they need daily asthma therapy -daily asthma therapy drugs are NOT helpful in an acute asthma attack |
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A pt w/acute asthma is treated for inspiratory & expiratory wheezes & decreased expiratory volume. Which class of precribed drugs should the nurse administer 1st to this pt & why?
A. oral steriods B. bronchodilators C. inhaled steriods D. mucolytics |
B. bronchodilators
-the most immediate need is to dilate the bronchioles & promote air exchange -steriods may follow the treatment to reduce inflammation but they are not 1st. |
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A pt with asthma awakens in the middle of the night with an asthma attack. Which of the following inhaler meds should the nurse administer 1st & why?
A. albuterol (proventil) B. triamcinolone acetonide C. fluticasone propionate D. cromolyn |
A. albuterol
-the initial treatment for acute asthma is a bronchodilator. Other meds can be given after the bronchospasm is relieved. |
