Lilley Ch. 36 & 37

Which statement by the patient demonstrates understanding of action or use of beclomethasone diproprionate (Beconase)?

"This medication will help prevent the inflammatory response of my allergies."

Beta-agonists Nursing Implications

- Avoid allergens, smoke, air and stress - Adequate fluid intake - Treatment compliance - Avoid temperature extremes and fatigue - Obtain prompt treatment for respiratory illness - Teach inhalers and MDIs - Track number of doses in inhaler

Antihistamine Nursing Implications

- CAUTION with increased intraocular pressure (glaucoma), cardiac or renal ds, HTN, asthma, COPD, peptic ulcer ds, BPH, or pregnancy. - Avoid ETOH and other CNS depressants - Oral care for dry mouth: gum, hard candy, water - Take with meals to avoid GI upset - Don't take OTCs without checking with MD

Corticosteroids Nursing Implications

- Contraindicated with AIDS, TB, fungal infections, and psychosis - Rinse mouth after use - Use peak flow meter - Use spacer to ensure better delivery - Clean equipment after use - If ordered with a bronchodiator use that first!

Antitussives Nursing Implications

- For non-productive cough - Report to MD cough lasting > 1wk or fever

Decongestants Nursing Implications

- May cause HTN, palpitations, and CNS stimulation - Avoid caffeine - Patients on antihypertensives shouldn't take unless approved by MD - Report fever, cough, or respiratory symptoms >1 week in duration - Rebound congestion may occur - Do not use steroids if patient has mucosal infection

Expectorant Nursing Implcations

- Use with caution in elderly and patients with asthma or respiratory insufficiency - Increase fluid intake to help liquefy secretions - Report to MD cough lasting > 1wk or fever

Wait for __ - __ mins in between puffs of inhalers.

1-2

Both aminophylline and theophylline must have rt blood levels. what is therapeutic range?

10-20 mics/mL

Decongestants and expectorants are recommended to tx cold sx, but pt must report to prescriber a fever of >____ degrees, cough, or other sx lasting longer than 3-4 days.

100.4 (38C)

Long acting anticholinergic bronchodilators begin to work more slowly and last _____ hrs.

12

Children younger than ___ yrs old should not take loratadine.

2

If two different inhalers are ordered, how much time should be put in between administration of the second one after the first is given?

2-5 mins

Short acting inhalers have immediate effect and peak in ___ - ____ mins. They last ___-___ hrs.

30-60 mins 3-5 hrs

Contraindications to use of antihistamines is hypersensitivity, pregnancy (avoid ____ trimester), _________, and newborns.

3rd, breast-feeding

Decongestants

Act to shrink nasal mucosa and relieve stuffiness allowing for better drainage of secretions.

Drugs that stimulate the sympathetic nerve fibers of the ANS that use epinephrine or epinephrine-like substances as neurotransmitters.

Adrenergics (sympathomimetics)

Expectorants

Aid in the removal of mucous bystimulating secretory glans to produce respiratory fluids that thin secretions and reduce viscosity. Cough is indirectly diminished. The most commonly used drug is guaifenesin which is often found in combo with other drugs. Side effects are N/V and gastric irritation.

Bronchial asthma caused by hypersensitivity to an allergen.

Allergic asthma

Microscopic sacs in the lungs where O2 is exchanged for CO2; also called air sacs.

Alveoli

Name 2 common Xanthine derivatives.

Aminophylline, theophylline

Drugs that exert an action opposite to that of another drug or compete for the same receptor sites.

Antagonist

______ drugs are used for mait.

Anticholinergic

_________ like Spiriva prevent broncho constriction, which relaxes muscles in airway and increases airflow to lungs.

Anticholinergics

Drugs that block the action of acetylcholine and similar substances, which result in inhibition of the transmission of parasympathetic nerve impulses.

Anticholinergics (parasympathetic)

Substances that are capable of inducing specific immune responses and reacting with the specific products of those responses, such as antibodies and specifically Tlymphocytes.

Antigens

A patient is making an appointment for allergy testing. The nurse instructs the patient not take what class of medications at least 4 days before allergy testing?

Antihistamines

Substances capable of reducing the physiological and pharmacologic effects of histamine.

Antihistamines (histamine antagonists)

The nurse is discussing management of symptoms of an upper respiratory tract infection. Which classes of medications are often used in treating the symptoms of upper respiratory tract infections?

Antihistamines, Nasal decongestants, Antitussives, Expectorants

A drug that reduces coughing, often by inhibiting neural activity in the cough center of the CNS.

Antitussin

__________ are used to suppress coughing.

Antitussives.

Antihistamines must be given cautiously to ppl with (specific resp disorder) ________ because it thickens secretions and dries them up.

Asthma

The onset of wheezing together with difficulty breathing.

Asthma attack

The nurse would question an order for pseudoephedrine in a patient with a history of which condition?

Atrial fibrillation

Epinephrine

Beta-agonist that stimulates alpha, beta-1 and beta-2 receptors. Side effects include restlessness, agitation, anorexia, vascular headache, hyperglycemia, tremor and cardiac stimulation.

Metoproterenol

Beta-agonist that stimulates beta-1 and beta-2 receptors. Side effects include tremor, angina pain, vascular headache, hypotension and cardiac stimulation.

Albuterol

Beta-agonist that stimulates beta-2 receptors. Side effects include hypotension or hypertension, vascular headache and tremor. At high dose and/or frequency the drug will lose its beta-2 specificity and acts on beta-1 receptors as well, causing anxiety, palpitations, tremors, tachycardia, and nausea.

The gen term for recurrent and reversible sob resulting from the narrowing of the bronchi and bronchioles. Key characteristics are inflammation, bronchial smooth muscle spasticity, and sputum production.

Bronchial Asthma

Medication that improves airflow by releasing bronchial smooth muscle cells. Also called Xanthines, adrenergic agonists.

Bronchodilators

Do not take antihistamines with other ____ depressants such as drugs and alcohol.

CNS

Histamine

Chemical mediator of inflammatory response. Causes vasodilation, increased GI and respiratory secretions, and increased capillary permeability.

Chronic inflammation and low-grade infection of the bronchi.

Chronic bronchitis

Any of the hormones produced by the adrenal cortex, either in natural or synthetic form.

Corticosteroids

Drugs that reduce congestion or swelling, esp of the resp tract.

Decongestants

When providing general education on use of over-the-counter medications for allergies, which is the highest priority for the nurse to include?

Do not use in patients younger than 2 years of age, unless prescribed

The nurse is discussing use of antitussive medications with a patient. What common side effect does the nurse include in the patient teaching?

Drowsiness and dizziness

Antihistamines

Drugs that compete with histamine for receptor sites to block inflammatory response. More effective at preventing a response, not reversing, therefore give early in treatment for best results. Used for nasal or seasonal allergies, allergic reactions, motion sickness, and sleep disorders. Adverse effects include dry mouth, difficulty urinating, constipation, vision changes and drowsiness.

Xanthine derivatives

Drugs that increase levels of cAMP by inhibiting the enzyme that breaks it down which leads to bronchodilation. Used in chronic bronchitis, emphysema, and mild-moderate asthma attacks. Plant alkaloids are caffeine and theophlyline; synthetic is aminophylline. Contraindicated in peptic ulcer ds and other GI disorders. Multiple drug interactions and a narrow therepeutic index lead to infrequent use. Side effects are increased HR, CO and force of heart contractions, diuresis due to increased blood flow to kidneys, CNS stimulation, N/V, anorexia, GERD, tachycardia, palpitations, dysrhythmias, and transient, increased urination.

Decongestants

Drugs that reduce congestion or swelling, especially of the upper or lower respiratory tract

Emphysema

Ds in which alveolar walls are destroyed, air spaces enlarge and there is reduced surface area for gas exchange. Patients will have increased compliance due to loss of tissue but SOB.

A method of treating disease based on observations and experience rather than a knowledge of the precise cause for the disorder.

Empiric therapy

Drugs that increase the flow of fluid in the respiratory tract, usually by reducing the viscosity of secretions, and facilitate their removal by coughing.

Expectorants

__________ break down and thins out secretions making for a more productive cough.

Expectorants

First/Second generation antihistamines are very sedating.

First

Beta-2 receptors

Found in lungs; cause bronchodilation.

Histamine 1

Found in smooth muscle of vascular system and bronchial trees. Causes many of the symptoms of allergic rhinitis.

Histamine 2

Found in stomach. Responsible for peptic ulcers.

If both an inhaled beta2 agonist and an inhaled corticosteroid are ordered, which should be given first?

Give the inhaled beta 2 agonist first to provide bronchodilator before the administration of the anti-inflammatory drug. The bronchodilator drug is usually taken 2-5 mins before the corticosteroid drug.

Caution giving antistamines to folks with the following conditions because it can aggrevate said conditions.

Good Protestants Have urinary retention very young. Glaucoma Prostate Hypertrophy HTN Urinary retention Very young

Most common expectorant is _______.

Guafenison

Echinacea

Herbal product that reduces cold symptoms. Side effects include dermatitis, GI upset, dizziness and headache.

Drugs that compete with histamine for binding sites on histamine receptors.

Histamine antagonists

Proteins belonging to any of 5 structurally and antigenically distinct classes of antibodies present in serum and external secretions of the body; they play a major role in immune responses.

Immunoglobulin

Beta-1 receptors

In heart.

Patient teaching regarding expectorants should instruct the patient to perform which action?

Increase fluid intake to decrease viscosity of secretions

Chronic Bronchitis

Inflammation of bronchioles causes obstruction of airway which often develops as a result of prolonged exposure to irritants.

A highly contagious infection of the resp tract caused by a myxovirus and transmitted by airborne droplets.

Influenza

The nurse is providing education to a patient with a history of chronic nasal congestion secondary to allergic rhinitis. Which class of medications would the nurse anticipate the provider would recommend for the patient to use on a long-term basis?

Intranasal steroids

Leukotriene Receptor Antagonists

LTRAs are a newer class of meds that prevent leukotrienes, which are released by exposure to certain substances and cause inflammation, muscous production and bronchoconstriction, from attaching to receptors. Used for treatment of chronic asthma in patients >12yoa and for allergic rhinitis in patients >2yoa. Drugs include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo). Singulair has few sides effects but Accolate and Zyflo may cause headache, N/D, liver dysfunction and insomnia.

Anticholinergics

Long-acting bronchodilators used to prevent bronchconstriction. Acts by binding to Ach receptors which brevents Ach from causing constriction. Drugs include ipratropium bromate (Atrovent) and tiotropium (Spiriva). Side effects include dry mouth, palpitations, GI distress, nasal congestion, headache, cough, and anxiety.

Asthma

Lower airway ds manifested as recurrent, reversible SOB. Can be caused by bronchospasm, bronchial mucosa inflammation or edema, or production of viscous mucous. Alveoli remain open but airflow is obstructed. Can be allergic, idiopathic or mixed. S/S include wheezing, difficulty breathing and dropping O2 sats.

Do not give sympathomimetics with ___ drugs because it causes additive pressor effects and may raise b/p.

MAOIs

Beta-agonists

Medications used during acute asthma attack to reduce airway restriction by binding to Beta-2 receptors which causes smooth muscle relaxation and subsequent bronchodilation. Drugs include albuterol and epinephrine.

Give one example of a Leukotriene receptor antagonist.

Montelukast (singulair)

What system assessment will the nurse monitor in a patient due to a known common side effect of traditional antihistamines?

Neurologic status

Medications that called second generation antihistamines and peripheral antihistamines because they have fewer CNS effects than first generation

Non-sedating antihistamines

Antitussives

Opioid or non-opioid drugs used to stop or reduce coughing. Don't suppress productive cough unless it is contraindicated in the patient's condition (IICP or hernia surgery) or is affecting patient's sleep. Okay to suppress dry, wheezy cough.

Name a commonly used OTC decongestant.

Phenylephrine (neosynephrine) is a sympathomimetic drug, which means that it mimics the actions of epinephrine (commonly known as adrenaline) or norepinephrine. Phenylephrine selectively binds to alpha receptors which cause blood vessels to constrict. Phenylephrine may cause side effects such as headache, reflex bradycardia, excitability, restlessness and cardiac arrhythmias. Phenylephrine is not suggested for use in patients with hypertension

______ ________ occurs because of the very rapid absorption of drug thru mucous membranes followed by a more rapid decline in therapeutic activity. Typically this can cause overuse and dependence on the nasal spray.

Rebound congestion

Name 3 desired effects of antihistamines.

Reduced localized flushing. Reduced edema Reduced itching and pain Suppresses secretion of mucus.

An irritation of the resp tract occurring in response to an irritation of the GI tract.

Reflex stimulation

Any of about 100 serologically distinct RNA viruses that cause about 40% of the acute resp illnesses.

Rhinovirus

Omalizumab is a monoclonal antibody antiasthma drug and is given by what route?

SC--given for moderate to severe asthma and not for aborting acute attacks.

Opioid antitussives

Suppress cough reflex by direct action on the cough center in medulla. Drugs include codeine and hydrocodone. Side effects are sedation, N/V/C, lightheadedness

Non-opioid antitussives

Suppress cough reflex by numbing stretch receptors in the respiratory tract and preventing stimulation of the cough reflex. Drugs include dextromethorphan (most commonly used OTC med) and benzonatate (Tessalon-Pereles: prescription pills). Side effects are dizziness, drowsiness, headache, nausea, and sedation (with Tessalon-Pereles).

A class of drugs whose effects mimic those resulting from the stimulation of the SNS.

Sympathemimetic drugs.

Nasal decongestants that work by constricting the sm arterioles that supply the structures of the upper resp tract, primarily the blood vessels surrounding the nasal sinuses. Once these blood vessels are stimulated, they constrict and this allows the blood vessels to shrink and nasal secretions can then better drain. What type of nasal decongestant?

Sympathomimetics aka adrenergics (works like epinephrine)

Common H2 antagonists.

Tagamet, zantac, etc. Decreases H2 effect on smooth muscle of the stomach.

Any infectious disease of the URI.

Upper resp infection.

Corticosteroids

Used as an antiinflammatory for chronic asthma treatment, NOT in acute attacks. Act to stabilize leukocytes that cause bronchoconstriction and increase smooth muscle response to beta-adrenergic stimulation. Can be oral or inhaled and effects may not be seen for days or weeks after start of treatment.

Sympathomimetic drugs

a class of drugs whose effects mimic those resulting from the stimulation of the sympathetic nervous system

Antitussive

a drug that reduces coughing, often by inhibiting neural activity in the cough center of the central nervous system

influenza

a highly contagious infection of the respiratory tract caused by a myxovirus and transmitted by airborne droplets

Empiric therapy

a method of treating disease based on on observations and experience, rather than knowledge of the precise cause for the disorder

After a neb tx with beta agonist albuterol, the pt c/o feeling shaky and exhibits hand tremors. HR is 98. The nurse knows this reaction is a. expected adr of drug b. allergic reaction c. indication of overdose

a. expected adr of drug

When assessing a pt who is to rec a decongestant, the nurse will recognize that a potential contraindication to this drug would be which condition? a. glaucoma b. fever c. peptic ulcer disease d. allergic rhinitis

a. glaucoma

Long-acting inhalers cannot be used for chronic/acute attacks.

acute

Monitor for ________ crisis during tapering of long-term systemic corticosteroid use.

addisons

Name the 3 different groups of nasal decongestants.

adrenergics anticholinergics corticosteroids

Name the correct side effects of antihistamines. a. HTN b. dizziness c. hangover effect d. drowsiness e. tachycardia f. dry mouth

all are side effects except for a and e

Any substance that evokes an allergic response.

allergen

reflex stimulation

an irritaion of the respiratory tract occurring in response to an irritation of the GI tract

Common adverse cardiac reactions of bronchodilators are _____ and ______.

angina and dysrhythmias

Immunoglobulins produced by lymphocytes in response to bacteria, viruses, or other antigenic substances.

antibodies

During allergic reactions, histamine and other substances are rel'd from mast cells, basophils, and other cells in response to _________ circulating in the blood.

antigens

Upper respiratory tract infection (URI)

any infectious disease of the upper respirtatory tract, including the common cold, laryngitis, pharygitis, rhinitis, sinustis, and tonsillitis

Rhinovirus

any of the 100 serologically distinct ribonucleic acic virus that cause 40% of acute respiratory illness

Corticosteroids

any of the hormones produced by the adrenal cortex, either in natural or synthetic drug form. They control many key processes in the body, such as carbohydrate and protien metabolism, the maintence of serum glucose levels, electrolyte and water balance, and the functions of the cardiovascualr system, skeletal muscle, kidneys, and other organs.

A pt who has a hx of asthma is having acute sob attack and needs immediate relief. what med should be given? a. montelukast b. albuterol c. ipratropium

b. albuterol

After pt takes a dose of inhaled corticosteroid, what is the most important action for pt to do next? a. hold breath 60 secs b. rinse out mouth with water c. follow with a bronchodilator inhaler if ordered d. repeat the dose in 15 mins if feels sob

b. rinse out mouth with water

A pt has been receiving aminophylline IV for 24 hrs. The nurse should asses for what during infusion? a. CNS depression b. Sinus tachycardia c. increased appetite d. urinary retention

b. sinus tachycardia

Corticosteroid drugs

beclomethasone (Beclovent), fluticasone (Flovent, Flonase), triancimilone acetonide (Azmacort), dexamethasone sodium phosphate (Decadron Respihaler). Side effects include pharyngeal irritation, cough, dry mouth, and oral fungal infection.

Inhaled decongestants

beclomethasone (Beconase), fluticasone (Flonase), triamcinolone (Nasocort), ipratropium (Atrovent). Corticosteroids and cholinergics that are used prophylactically to prevent nasal congestion.

Drugs, like albuterol, that primarily stimulate ____- have more specific drug effects and cause less adverse effects.

beta 2

Name the 3 types of bronchodilators.

beta agonists anticholinergic xanthine deriviative

Which drug group is commonly used for acute asthma attacks?

beta-adrenergic agonists. They stimulate the adrenergic receptors in the sympathetic nervous system and mimic effect of norepinephrine.

Nonselective adrenergic agonist drugs such as epi do the trick, but they also stimulate ____ which results in adverse cardiovascular effects as well as CNS effects.

beta1

When teaching about beta agonists, educate the pt to not overuse the medication due to risk of rebound _______.

bronchospasm

Name 3 examples of inhaled corticosteroids.

budesonide (pulmocort) Dexamethasone (decadron) fluticasone (Flovent) triamcinolone acetonide (azmacort)

The nurse knows than an antitussin cough med would be best choice for which pt? a. pt with productive cough b. pt with chr paranasal sinusitis c. pt with recent abd surg d. pt with influenza

c. pt with recent abd surg

During teaching session for montelukast, how will nurse describe therapeutic effect? a. improves resp drive b. loosens and removes thickened secretions c. reduces inflammation in airway

c. reduces inflammation in airway

Instruct pts taking xanthines to avoid taking ________.

caffeine because can exacerbate CNS stimulation

Name 3 examples of second generation antihistamines.

cetirizine (Zyrtec) fexofenadine (Allegra) LORATADINE - (Claritin)

Name two narcotic antitussives.

codeine and hydrocodone

What is s/s toxic levels of xanthine derivative?

convulsions and dysrhythmias

Educate the pt that excess levels of systemic corticosteroids may lead to _______ syndrome with moon face, acne, and increase in fat pads/swelling.

cushings

Name 2 common nonopioid antitussins.

dextromethorphan and benzonatate

Xanthine meds are used to constrict/dilate airways in pts with asthma, chronic bronchitis, or emphysema.

dilate

____ has the greatest range of therapeutic indications of any of antihistamines.

diphenhydramine (Benadryl)

________ can be given in adjunct with epinephrine to treat anaphylaxis.

diphenhydramine (Benadryl)

Name 3 examples of first generation antihistamines.

diphenhydramine (Benadryl) hydroxyzine (Vistaril) promethazine (Phenergan) brompheniramine chlorpheniramine (Chlor-Trimeton)

Common H1 antagonists aka H1 blockers aka antihistamines.

diphenhydramine, chlorpheniramine, etc. Affects the smooth muscle of the resp tract.

Traditional Antihistamines

diphenhyramine (Benadryl) or chlorpheniramine (Chlor-Trimeton). Work both peripherally and centrally and have cholinergic effects, making them more effective than non-sedating drugs in some cases.

Most common side effect of antihistamines is ______ and _______.

drowsiness and sedation.

Name 3 contraindications with use of Xanthine meds.

drug allergy uncontrolled cardiac dysrhythmias hyperthyroidism peptic ulcers seizure disorders

Anticholinergics

drugs that block the action of accetylcholine and simular substances at accetylcholine receptors, which results in inhibition of the transmissions of parasympathetic nerve impulses

Histamine antagonists

drugs that compete with histamine for binding sites on a histamine receptor

Antagonist

drugs that exert an action opposite to that of another drug or compete for the same receptor sites

Expectorants

drugs that increase the flow of fluid in the respiratory tract, usually by reducing the viscosity of secretions, and facilitate their removal by coughing

Adrenergics

drugs that stimulate the sympathetic nerve fibers of the autonomic nervous systemthat use epinephrine or epinephrine-like substances as neurotransmitters

Which type of inhaler does not require hand-lung coordination?

dry powder inhalers

A condition of the lungs characterized by enlargement of the air spaces distal to the bronchioles.

emphysema

The nurse is discussing use of antihistamines for allergic rhinitis. Which medications would be included in the list of H1 antagonists used in the treatment of allergic rhinitis?

fexofenadine (Allegra), loratadine (Claritin), cetirizine (Zyrtec)

Non-sedating Antihistamines

fexofenadrine (Allegra), loratidine (Claratin), or cetirizine (Zyrtec). Work peripherally to block histamine reactions resulting in reduced CNS side effects (mainly sedation); longer duration of action increases compliance.

Anticholinergic bronchodilators must be used with caution in pts with __________, prostate enlargement and allergies to _____ or ________.

glaucoma atropine soybean, peanut (soy lecithin)

Benadryl can have paradoxal effect on children causing them to be _____.

hyperactive.

Name the 2 most common anticholinergic drugs used in tx of COPD. They prevent bronchospasms. Their actions are long and slow so are not for the management of acute symptoms.

ipratropium tiotropium

The only intranasal anticholingergic drug in use is _______ nasal spray.

ipratropium (atrovent)

Theophylline is/isn't compatible with many drugs.

isn't

Loratadine (Claritin) has an advantage over traditional antihistamines such as diphenhydramine (Benadryl) in that loratadine has

less sedative effect.

Leukotriene receptor antagonists (LTRAs) prevent ______ from binding with the receptors located on the circulating immune cells. This alleviates asthma sx in lungs by reducing inflammation and prevents smooth muscle contraction of the bronchial airways.

leukotrienes

The division of the resp tract composed of organs located almost entirely within the chest.

lower resp tract

The beta 2 agonists work specifically on the _____.

lungs

Nonsedating antihistamines

medications that primarily work peripherally to block the actions of histamine and therfore do not generally have the central nervous system effects of many of the older antihistamines

Name 3 common adverse effects of Xanthine meds.

nausea vomiting anorexia gastric reflux during sleep.

Mixed alpha/beta drugs produce the most adverse effects because they are ________.

nonselective.

Educate pt to only take ____ type of antihistamine at a time.

one

LTRAs are usually dosed only ____ time per day and are not used for acute asthma attacks.

one

Expectorants should not be used longer than ________.

one wk.

A _______ is a handheld device used to monitor a pts ability to breath out air and reflects the airflow thro the bronchi and thus the degree of obstruction in the airways.

peak flow meter

Topical or spray decongestants

phenylephrine (). Rapidly absorbed with a fast onset, but may cause rebound congestion after discontinuing.

Oral decongestants

pseudophedrine (Sudafed). Delayed onset, but prolonged action.

Antihistamine work by competing with histamine for the limited number of histamine ______ available on the surface of the mast cells and basophils.

receptors

Bronchodilators relax/constrict smooth muscle, which causes dilation of the bronchi and bronchioles that are narrowed as a result of disease process.

relax

Antitussins commonly cause drowsiness, _______, and _______.

sedation, and dizziness

Antihistamines should/shouldn't be given with food.

should to decrease GI distress

Theophylline can be given IV in emergencies, but must be given slowly/quickly to avoid severe hypotension and even death.

slowly

A prolonged asthma attack.

status asthmaticus

Antihistamines

substances capable of reducing the physiologic and pharmacologic effects of histamine

Antigens

substances that are capable of inducing specific immune responses and reacting with the specific products of those responses. such as antibodies and specifically sensitized T lymphocytes. Antigens can be soluble or particulate or insoluble

A patient complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2 to 4 hours for the past 5 days. The nurse's response is based on knowledge that

sustained use of nasal decongestants over several days may result in rebound congestion.

what is the most common Xanthine meds?

theophylline

The _______ is composed of the structures that are located outside of the chest cavity or thorax.

upper resp tract

Use of a spacer is indicated esp for what two groups of ppl?

very young and very old

Advise pt taking nasal decongestants to report to prescriber what 5 sx.

weak sedation dizziness heart palpitations excessive irritability

How is overdose of Xanthine meds usually treated?

with charcoal

what is main undesired side effect of inhaled corticosteroids?

yeast and fungal growths