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51 Cards in this Set

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➢Widely used to treat allergic rhinitis
➢MOA: compete with histamine for binding to H1 receptors after histamine released due to allergen stimuli
➢Most beneficial when given early before the release of histamine (prophylaxis)


located in the Respiratory system and the CNS

Antihistamines (H1 Antagonists)

1._______


➢Prototype: Diphenhydramine (___2___)
➢MOA: acting centrally and peripherally
➢Cross blood brain barrier
➢More significant central adverse effects such as drowsiness and sedation
➢Tolerance develops after a few doses
➢Excessive anticholinergic adverse effects such as dry mouth and urine hesitancy

1. 1st generation H1 antagonists


2. Benadryl


(*diphenhydramine (Benadryl) can also help when you have a sleep problem)

1._______


➢Prototype: Loratidine (__2___), Cetirizine (___3___), Fexofenadine (___4___)
➢MOA: acting peripherally to bind to Histamine 1 receptors
➢Not cross blood brain barrier
➢Less significant central adverse effects
➢Less anticholinergic side effects


1. 2nd generation of H1 Antagonists


2. Claritin


3. Zyrtec


4. Allegra


Parkinson’s disease (central and anticholinergic effects,______

1st generation

_______OTC sleep aids, 1st generation but tolerance, less than 2 weeks)

Insomnia

__________and other skin rashes (1st and 2nd generation, oral and tropical creams)

Urticaria

STUDY CARD FYI!!!!!!!!Vertigo and motion sickness (Promethazine (Phenergan) discussed in GI drugs)

FYI STUDY CARD !!!!

➢Prototype: Pseudoephedrine (Sudafed)
➢MOA
➢Activate alpha1 adrenergic receptors which causes (vasoconstriction) in nasal mucosa
➢Stimulate beta2 adrenergic receptors of respiratory tract, which may result in some


(bronchodilation)
➢Oral or Intranasal Spray


Decongestants


➢Headache
➢Nervousness and tremors
➢Tachycardia, palpitations, hypertension
➢Rebound effects
➢Often occur after taken too long
➢Worsen symptoms when drug discontinued
➢A result of a tissue dependence


OTC drugs

Adverse effect of decongestants

What are the rebound effects for decongestants

➢Use no longer than 3-5 days
➢Patients with dependence need a gradual switch to intranasal corticosteroids
➢Oral drugs eliminate rebound effects but slower onset and less effective

1._________


➢Used to suppress cough reflex
➢Two types
➢Opioids vs Nonopioids
➢Opioid (__2____)
➢Suppress cough reflex center in medulla
➢Non-opioid (3)


➢Inhibit cough reflex in the throat, trachea, or lungs


1. Antitussives


2. Codeine


3. Dextromethorphan

what are the adverse effects,interactions, and the precautions for anti-tussives

***Adverse effects
➢Dizziness
➢Sedation
➢Abuse causing CNS toxicity (limit use < a week)
***Interaction
➢Alcohol
➢Other CNS drugs
***Precaution
➢Fever and productive cough
➢Pre-existing pulmonary disease

1.______


➢Prototype: Guaifenesin (Robitussin, ___2___)
➢MOA: reduce thickness or viscosity of bronchial secretions
➢Commonly used OTC drug
➢No smoking or 2nd hand smoke


NOT and ANTI-TUSSIVE


Lose sputum not direct act of cough reflux

1. Expectorants


2. Mucinex

Lower Respiratory Tract


Autonomic Control


_________ ,Beta 2 adrenergic receptors, Bronchodilation,& needs agonist


Sympathetic system

Lower respiratory tract


Autonomic Control


_______, Muscarinic receptor, Bronchoconstriction, and needs antagonists


➢Parasymphathetic system


_____is a common indication of pharmacotherapy

Bronchoconstriction

1._______


-Bronchospasm


Sudden contraction bronchus causing acute __2____
Bronchodilators
-Chronic inflammation
Thick, viscous secretions
Block __3___
Antibiotics or mucolytics
-Edema
Engorgement of pulmonary blood vessels
____4___

1. Brochoconstriction


2. dyspnea


3.airways


4. Diuretics



What are the 3 types of bronchodilators?

➢Beta2 adrenergic agonists
➢Methylxanthines
➢Anticholinergics

what is the indication for bronchodilators

➢Chronic Obstructive Pulmonary Disease (COPD)
➢Emphysema
➢Chronic bronchitis
➢Asthma


1.______


➢Prototype: ___2____ (Proventil)
➢MOA
➢Activate selective beta2 adrenergic agonists in bronchus resulting in bronchodilation
➢Inhalation – short acting as rescuer
➢Oral – long acting
➢Adverse effects – tachycardia, angina, tremors
➢Levalbuterol (__xopenex_____) – expensive but less cardiac adverse effects


1. Beta 2 Adrenergic Agonists


2. albuterol

➢Prototype: theophylline (Theolair)
MOA :Increase cyclic adenoside monophosphate (cAMP) to dilate bronchial smooth muscle
➢Suppress airway responsiveness to stimuli that promote bronchospasm
➢Not available for inhalation – long term management
➢Risk of toxicity (drug level monitor)


Methylxanthines

➢Increased cAMP
➢Cerebral stimulation (restlessness, insomnia, dizziness)
➢Skeletal muscle stimulation (restlessness)
➢Bronchodilation
➢Pulmonary vasodilation
➢Cardiac stimulation (Palpitation, tachycardia)
➢Diuretics (Urinary frequency)
➢Multiple drug-drug interactions and contraindications


Adverse effects of methylxanthines

1.__________


➢Prototype: Ipratropium (____2___)
➢MOA
➢Block cholinergic receptors in bronchial smooth muscle
➢Intranasal administration reduces nasal hypersecretion
➢Available for inhalation and nasal spray
➢Indication
➢Bronchospasm associated with COPD
➢Used for allergen- or exercise-induced asthma


1. Anticholinergic drugs


2. Atrovent

What are the nursing concerns for anticholinergic drugs?

➢Complete respiratory history
➢Respiratory signs assessment including dyspnea, orthopnea, cyanosis, nasal flaring, wheezing
➢Vital signs
➢Pulse Oximetry
➢Peak Flow (usually >=6yr)
➢Arterial blood gas
➢Pulmonary Function Test (PFT)

________________ - a test in which a device that clips on the finger measures the saturation of hemoglobin in the blood

Pulse Oximetry

______ the maximum speed that air is exhaled from the lungs; used to determine the effectiveness of asthma medications

Peak flow measurements


(* Green is ok/Yellow needs rescue treatment/Red urgent go to the ER or call 911it means you don't have enough air exchange in the lungs )

Inhaled Corticosteroids as controller


Anti inflammatory drugs



__1___-cost effectiveness, most prescribed


__2___- expensive with nebulizer


Beclomethasone (Qvar)


1.Fluticasone (Flovent)


2. Budesonide (Pulmicort)

STUDY CARD FYI


Anti inflammatory drugs


➢Mast Cell Stabilizers
➢Cromolyn (Intal)
➢Leukotriene Modifiers as controller
➢Montelukast (Singulair)


STUDY CARD FYI

Reduces inflammation and immune response thus reducing frequency of asthma attacks

➢Inhaled Corticosteroids


Stabilizes mast cells thus preventing inflammatory response

➢Mast Cell Stabilizers


Blocks leukotriene receptors in airways thereby preventing airway edema and inflammation

➢Leukotriene Modifiers


➢Infectious disease caused by Mycobacterium _____
➢System/organ affected
➢Lungs/pulmonary ___
➢Extrapulmonary ______
➢Community disease with incidence of 10 to 15 million people in US
➢Might be asymptomatic and activate when immune system compromised (HIV-AIDS, transplant, steroid users, chemotherapy)

Tuberculosis (TB)

_________________the presence of T memory cells but can not determine active or latent (48 to 72 hr)

Tuberculin skin test (Mantoux/purified protein derivative (PPD)

True /False 15% of TB infected people develop active TB

False: ➢Only 10% of TB infected people develop active TB


True/False: People with healthy immune system fight off the infection and TB dormant (inactive) in lungs


True

what are thee other tools used to diagnose TB

➢Sputum culture/acid fast bacilli (several weeks)
➢Chest radiology (not specific but helpful with PPD+)
➢Amplified DNA/RNA tests (expensive)

what are the signs and symptoms of TB

➢Coughing
➢Chest pain with breathing and cough
➢Cough with sputum or blood
➢Weight loss
➢Fatigue
➢Malaise
➢Fever
➢Night sweats

1.____


➢Kill or inhibit mycobacterial organism
➢Often given in combination
➢Decrease drug resistance (mutation)
➢Increase adverse effects
➢Long and complex
➢6 months to 2 years
➢Directly observed therapy (____2___)
➢Health care provider directly observe patient swallowing pills everywhere all the time and provide education


1. Anti-TB agents


2. DOT


1.______


➢Prototype: Isonizid (___2__)
➢MOAs
➢Inhibits synthesis of mycolic acid on cell wall
➢Bacteriocidal for rapidly dividing organisms
➢Bacteriostatic for dormant mycobacteria
➢Most effective and safest (1st line ___1___drugs)
➢Prophylaxis and active treatment
➢Monitor therapeutic effectiveness in first 2-3 weeks. Chest x-ray and sputum culture

1. Anti-TB drugs


2. INH

➢Bacteriocidal by inhibiting RNA synthesis
➢Flulike hypersensitivity, potent CYP450 inducer


Rifampin (other anti-tb drug)


*1st line tb drug

➢Inhibiting synthesis of mycolic acid
➢Old drug, easily to develop resistance when used alone, gout or arthralgia


➢Pyrazinamide (PZA) (other anti-tb drug)


1st line


➢Unclear but bacteriostatic by inhibiting cell wall and RNA synthesis
➢Active against TB resistance, short half life (1 to 4 hr), optic neuritis to affect visual acuity for distinguishing red and green


➢Ethambutol (Myambutol)


other anti-tb drug

The nurse teaches the client that which type of over-the-counter cough preparations is not effective with coughs associated with the common cold and allergic rhinitis?
1.Dextromethorphan
2.Diphenhydramine
3.Mucolytics
4.Pseudoephedrine


4. Pseudoephedrine

The nurse knows that sympathomimetic decongestants should be avoided by people with which conditions or situations?
1.Hypertension and coronary artery disease
2.Wide-angle glaucoma
3.Breast-feeding women
4.Elderly clients


1. Hypertension and coronary artery disease

A client is prescribed beclomethasone (Beclovent), a glucocorticoid inhaler. Education by the nurse will include:
1.“Check your heart rate because this may cause tachycardia.”
2.“Limit your coffee intake while on this drug.”
3.“Rinse your mouth out well after each use.”
4.“You may feel shaky and nervous after using this drug.”


3 Rinse your mouth out well after each use

A client with asthma asks which of the prescribed medications should be used in the event of an acute episode of bronchospasm. The nurse will instruct the client to use:
1.Albuterol, a beta agonist bronchodilator, by inhalation.
2.Beclomethasone, a glucocorticoid anti-inflammatory drug, by inhalation.
3.Ipratropium, an anticholinergic bronchodilator, by inhalation.
4.Zafirlukast, a leukotriene modifier, by mouth.


1. Albuterol, a beta agonist bronchodilator, by inhalation.

The nurse should inform the client who is prescribed a nebulizer treatment with a bronchodilator agent that a common adverse effect is:
1.An increased heart rate with palpitations.
2.Predisposition to infection.
3.Sedation.
4.Temporary dyspnea.


1.An increased heart rate with palpitations.






Question 6
A 4-year-old child with respiratory distress secondary to asthma has an order for a nebulizer treatment. The type of medication most likely to be given for asthma management is a:
1.Beta agonist.
2.Beta antagonist.
3.Corticosteroid.
4.Leukotriene modifier.

1.Beta agonist.


A client who is receiving antituberculosis therapy is complaining of tingling and numbness of the fingers and toes. The nurse knows that these symptoms are most likely due to the drug’s ability to:
1.Increase the sensitivity of nerve endings.
2.Decrease the activity of pyridoxine (vitamin B6).
3.Accelerate the excretion of neurotransmitters.
4.Enhance skin receptors to ascorbic acid (vitamin C).


2.Decrease the activity of pyridoxine (vitamin B6).

A client’s family asks the nurse to explain the most common cause for treatment failure in pulmonary tuberculosis. The nurse knows that treatment failure is most often caused by the client’s:
1.Inability to pay for the medication.
2.Poor nutritional intake of complex proteins.
3.Inability or unwillingness to adhere to the therapeutic regimen.
4.Inability to restrict intake of calcium-enriched foods.


3.Inability or unwillingness to adhere to the therapeutic regimen.


Which of the following clients receiving isoniazid (INH) is most likely to experience hepatotoxicity?
1.A 42-year-old housewife
2.A 22-year-old postpartum female
3.An 82-year-old farmer
4.A 42-year-old marketing executive

3.An 82-year-old farmer