PHARM 2 - RESPIRATORY

Antitussive

"Drugs that block the cough reflex"

Chronic Airway Limitation: cause, symptoms and results

"Gradually progressive, degenerative diseases such as chronic bronchitis, emphysema, or repeated, severe asthma attacks." Bronchioles become thick & edematous Defense mechanisms destroyed Constant irritation and inflammation of lower respiratory tract Results in: Air trapping in lung Increased energy to move air End Result: Lungs overinflate and efficiency of gas exchange is lost Other terms: chronic obstructive pulmonary disease (COPD) and chronic obstructive lung disease (COLD)

The client has been prescribed cromolyn (Intal) for the treatment of asthma, and the nurse is evaluating the client's understanding of the medication. Which of the following statements by the client indicate the need for further education? "I will use this medication when I am having an asthma attack." "This medication may also be used for allergy disorders." "This medication may cause my throat to become dry." "I may experience wheezing with this medication."

"I will use this medication when I am having an asthma attack." not a bronchodilator. it is not going to relieve an acute asthma attack.

flunisolide - max/min and pt edu

Daily use, **despite absence of symptoms** BID dosing as maintenance dose teach patients how to use inhaler spacer: a way to make sure that the patient is inhaling and its not sitting in their mouth..to prevent fungal infections and help prevent systemic absorption an helps promote getting medication directly absorbed into the lungs/can alleviate hoarse voice

Influenza

A VIRAL infection: NOT TREATABLE WITH ANTIBIOTICS; caused by several strains of myxoviruses; as virus enters body it selectively attacks and destroys epithelial cell that line upper respiratory tract; epithelial cells usually provide protection and influenza breaks down this protective mechanism; transmitted person to person through inhalation of infected droplets.

acute bronchitis and chronic bronchitis - characteristics

ACUTE: think of as an extension of the common cold Cause: Virus, BacteriaOther agents Symptoms: Fever, productive cough purulent mucus (with pus) Treatment: Bronchodilators, Expectorants antibiotics (+/-) +/- depending on if its viral or bacterial if its viral its self-limiting and doesn't very last long Course: short, 2-4days CHRONIC: not an extension of acute they are totally separate chronic that is life-long and is irreversible you don't want to suppress the cough because its a protective mechanism Irreversible inflammation of bronchial tree Symptoms: Chronic, deep productive cough Contributing factors: Tobacco use Risk for: Acute bronchitis Pneumonia

EMPHYSEMA

Abnormal distention of the lungs with air Loss of elastic tissue Disappearance of capillary walls Breakdown of alveolar walls Cause: tobacco use Symptoms: DOE (dysspnea or excursion) Weight loss Swelling in extremities Bluish color of skin Chest pain Wheezing muscle wasting low cardiac output hyperventilation occurs as an overcompensation mechanism to try and blow off more of the accumulating gas purssed lip breathing

Katlin, age 5, has a history of cystic fibrosis. What would be the drug of choice to decrease the amount of secretions associated with this disease? Guaifenesin Acetylcysteine Dextromethorphan pseudoephedrine

Acetylcysteine

Epithelial lining of nasal pasage

Air filtration: warms and humidifies air, produces mucus, purifies air and increases efficiency of gas diffusion in lower respiratory tract

A patient with COPD presents at the Emergency Department (ED) in acute respiratory distress. The patient's family tells the nurse that the patient just started taking atrovent. They deny any drug allergies, but report she does have some food allergies, but the family cannot remember what it is. What would the nurse suspect is the problem? An allergy to milk Over-exertion by the patient Patient is not taking the medication correctly An allergy to soy products

An allergy to soy products

Prototype antitussive

Dextromethorphan (DMX)

DMX: dynamics

Directly affects cough center in the medulla: works because (similar to an opiate agonist in chemical structure) - suppresses a cough as well as a narcotic drug suppresses a cough

pseudeophrine

Do not take if they have ever had a reaction to it, have high blood pressure or are breast-feeding Avoid taking at bedtime because of possible adverse effect of insomnia **Do not take pseudoephedrine for more than 4 days, contact health provider if respiratory symptoms do not resolve in this time** Avoid excessive use to prevent rebound congestion and potential overdose Implement safety measures in case of CNS effects Report excessive dizziness, weakness, palpitations, and sleeplessness Keep out of reach of children

The asthmatic client is being treated with two inhalers, albuterol and flunisolide. The nurse teaches the client that the two medications should be administered in what order? Flunisolide first, wait five minutes and then follow with albuterol Albuterol first, wait five minutes and then follow with flunisolide Flunisolide followed immediately by albuterol Albuterol followed immediately by flunisolide

B albuterol is fast acting its rapid will cause rapid bronchodilation - give it some time to work. let it open up the airways so that when u use inhaled corticosteroid you can get it all into the open airways that are ready

cystic fibrosis

Hereditary disease Affects exocrine glands Flawed protein lacks phenylalanine Causes: Dehydration of mucous Abnormally thick, sticky, and concentrated secretions Accumulates in lungs, plugging up bronchi and making breathing difficult Results in: Chronic respiratory infections Manifestations: Chronic cough Recurrent pneumonia Progressive loss of lung function effects mostly the lungs but can affect other organs that have protective mucus like pancreas liver kidneys and intestine Goals: Keep secretions fluid and moving Maintain airway patency

Zafirlukast - CIs, ADRs and drug interactions

Hypersensitivity to povidone, lactose, titanium dioxide or cellulose derivatives Pregnancy category B Not for use with acute asthma Adverse effects: Common: headaches Serious: liver dysfunction Drug interactions: Theophylline, warfarin, aspirin, erythromycin Food decreases bioavailability

pseudophendrine: CI's ADRs, drug interactions

CI: Pregnancy Category C Severe HTN and coronary artery disease Special caution: DM, thyrotoxicosis, coronary artery disease, BPH, and increased intraocular pressure (stop taking drug if adverse effects occur) ADR Related primarily to its sympathomimetic effects on the CNS and CV systems Extreme dryness of mucous membranes Rebound congestion more serious ADRS: hallucionations, delusions, convulsions, tachychardia, HTN dysrrithmea DRUG INTERACTIONS Urinary alkalinizers Urinary acidifiers MAOI's - interaction with can cause hypertensive crisis

fexofenadine - CIs, ADRs, and Drug interactions

CIs Children < 2 y/o Pregnancy Category C Elderly * used with caution in patients with renal impairment * ADRs most common = flu-like symptoms, nausea and vomitting, dysmenorrhea and drowsiness most serious = potential for QT interval prolongation Drug interactions - apple, grapefruit, orange juice cfinfluenza

when the walls of the nasal cavity are stimulated

CNS reflex is initiated and a sneeze results

acetylcysteine: CI's and ADRs

Caution in any condition that compromises ability to cough IV: caution with liver disease PO: causes vomiting Pregnancy category B Common: bronchospasm, bronchoconstriction, chest tightness, burning feeling in upper airway, rhinorrhea Serious: anaphylactoid reaction (IV) Nausea/ vomiting (IV and PO)

guaifenesin: CIs, ADRs, health status?

Contraindications & Precautions: Hypersenstivity Pregnancy Category C Adverse Effects: Most common: GI symptoms, headache/dizziness, occasionally a rash Health Status: Cause of the cough? - prolonged used of the OTC preparation could result in masking important symptoms of a serious underlying disorder, so the drug **should not be used for more than ONE WEEK** and patient should contact prescriber if cough persists. Also, if a rash or fever develops, prescriber should be contacted because maybe there is an underlying bacterial cause that needs to be addressed

ipratropium bromide - CIs and ADRs

Contraindications and Precautions: Hypersensitivity to ipratropium and atropine or any of its derivatives Caution: BPH patients use caution: patients cannot urinate, and an anticholinergic will cause more urinary retention which is very bad for someone with BPH - they would need a catheter anticholinergics increase interocular pressure - so in someone with glaucoma you would need to use caution Pregnancy Category B Adverse Effects: Paradoxic acute bronchospasm: usually seen if inhaler is brand new and hasn't been primed - PRIMING IS IMPORTANT Anaphylactoid reaction: *if patient has allergy to SOYBEANS OR LEGUMES* Classic Anticholinergic effects: More common: dry mouth, urinary retention, blurred vision more common ADRs: hoarse voice, throat irritation dry mouth urinary retention blurred vision

theophyline - CIs and ADRs and drug interactions

Contraindications and Precautions: Hypersensitivity to xanthines Status asthmaticus: omeone who is having a severe life threatening asthma attack Peptic Ulcer (no detailed reason given) Caution: caution with any disorders (like pulmonary edema, shock states) that decrease the clearance of theophyline has a very narrow therapeutic range / blood levels need to be drawn theophyline toxicity: causes a bunch of problems the effects of theophylline and how well it works is related to drug serum level - the greater the drug level in the body, the greater the risk of adverse effects -- between 20-25: some CNS (headache, etc) and GI symptoms greater than 30: can cause death, hypotension, seiuzre, brain damage Pregnancy category C Adverse Effects: Directly related to serum drug level - MONITOR SERUM LEVELS AND DO NOT INFUSE RAPIDLY Drug Interactions: Many Tobacco use**may decrease potency

flunisolide: CIs, ADRs, life span

Contraindications and precautions Active systemic fungal infection:chronic steroid use decreases your immune system - someone who has a systemic fungal infection, make people very ill and very difficult to treat - the last thing we want is to decrease their immune system Caution: active respiratory tract infection, other untreated infections: chronic steroid use decreases immune system Pregnancy category C Adverse effects: Most common: hoarse voice and fungal infections in the mouth fungi like to grow on the steroid that sits in the oral cavity - very common reaction when using inhaled steroids - oral thrush HPA (hypothalamic-pituitary-adrenal)axis suppression-- point: *TAPER DOWN - NEVER STOP STEROIDS SUDDENLY* Life span and gender: Children > 6 y/o

cromolyn sodium - CIs and ADRs

Contraindications: Hypersensitivity --> anaphylaxis Aerosol preparation Oral: contains lactose Pregnancy Category B Adverse Effects: Oral inhalation: bronchospasm, throat irritation, cough Intranasal: sneezing, nasal irritaion (transient)

our patient is prescribed pseudoephedrine to relieve his nasal congestion. What should the nurse include in patient and family education. a. Advise him to avoid excessive and frequent use of the drug b. Advise him not to take other OTC drugs c. Advise him to avoid direct sunlight d. A and B

D the reason for b is that sudafed, like DMX, often comes as a combo medication with many other medications/ingredients in it.

Your patient is 45 y/o and is being seen in the physician's office today for a cough that is keeping her up at night. The physician prescribes DMX for the cough. Which statement is true about DMX? a. DMX works by relaxing the smooth muscles in the bronchioles b. DMX works by inhibiting allergen response c. DMX works on the receptors in the throat to prevent a cough d. DMX works in the medulla to suppress the cough reflex

D - DMX acts on opiate receptors directly in medulla to suppress cough reflex

Mr. Lou, 68 years old, is prescribed zafirlukast drug therapy. The nurse is aware that due to his age, he may experience decreased renal clearance of zafirlukast. What measure is the nurse expected to take? Advise increased fluid intake Monitor the serum zafirlukast levels carefully Advise a quiet environment or exercise Arrange for frequent follow-up appointments

D - to test heaptic funtion Arrange for frequent follow-up appointments

flunisolide

Inhibit production of leukotrienes and prostaglandins Reduce activity of inflammatory cells Increase number of beta receptors (and enhance their responsiveness) Decrease production of mucus

protects the upper res. tract from foreign bodies

Larynx

albuterol - max/min

Life Span and Gender: PO tablets and ER: not < 6 y/o Liquid form: not < 2 y/o Maximizing Therapeutic Effects: Proper use of MDI: - prime inhaler 1-2 times a day, hold 1-2 inches from mouth, use a spacer, breathe in for 3-5 seconds patient needs to know how to use device properly this is a hUGE PART OF ASTHMA MANAGEMEN _ MDI is different that DPI: in DPI, hold breath for 10 seconds to allow drug to reach deep into lungs Minimizing Adverse Effects: How to avoid rebound bronchoconstriction Educate on frequency of administration *this rescue drug should be first for ALL ACUTE symptoms of shortness of breath or wheezing*

DMX: lifestyle and max/min

Lifestyle, Diet and Habits: Need to drive? * think of this med as similar to an opiate - sleepiness, drowsy, less alert etc Assess patient's typical intake of alcohol Grapefruit or orange juice? Can increase the potency Maximizing Therapeutic Effects: Environmental controls Minimizing Adverse Effects: Safety precautions Asses respiratory status

zafiruklast - max/min

Maximizing therapeutic effects: BID dosing *despite the absence of symptoms* Take 1 hour before or 2 hours after a meal Minimizing adverse effects: Take the drug only as prescribed - this is not a rescue drug

acetylcysteine: manx/min

Maximizing Therapeutic Effects: Inhaled beta agonist first: stimulating the beta-2 receptors to cause bronchodilaiton - open up airways first and then you will give acetylcysteine which will make it easier for them to breathe medication in Dilute PO with diet soda to mask the taste Minimizing Adverse Effects: Nebulizer: odor Keep suction equipment available Monitor for anaphylactoid reaction Diphenhydramine

guaifenesin: max/min

Maximizing Therapeutic Effects: Non pharmacologic pulmonary hygiene techniques (deep breathing, drinking water) Minimizing Adverse Effects: Give with meals to avoid GI upset

fexofenadine: max/min and pt edu

Maximizing Therapeutic Effects: Prevent thick respiratory secretions via humidifiers and increasing fluid intake MIN: adhere to safety precautions Patient Education: Avoid use of other OTC drugs Take with food to prevent GI upset Sugarless lozenges if dry mouth is a problem Take with a full glass of water

ipratropium bromide - max/min and pt edu

Maximizing Therapeutic Effects: Take daily Correct use of the MDI Minimizing Adverse Effects: Use MDI as prescribed to avoid systemic absorption Patient and Family Education: Used prophylactically to reduce the frequency and severity of future asthma attacks Avoid using drug if history of allergy to soybeans, legumes, or soya lecithin Take drug daily there are certain medications that need to be taken every day, regardless of if you are symptomatic or not - atrovent is one of these medications. because its meant to prevent you from having an attack - tell patient to take every day, regardless of symptoms Teach patient proper use of MDI If continues to need beta agonists >2x/week refer to HCP for additional assessment

DMX: kinetics

PO; rapidly absorbed in GI tract; has antitussive activity within 15-30 minutes; metabolized liver and excreted kidneys

DMX: ADRs

Rare if you take as prescribed. Toxicity is characterized by nausea and vommitting; drowsy sleepy less alert (like an opiod OD). Excessive doses: may induce symptoms similar to those associated with PCP: dissociative effects, can last up to 6 hours.

ASTHMA

Recurrent episodes of bronchospasm Intrinsic or Extrinsic Symptoms: Bronchoconstriction --> wheezing Pharmacotherapy dependent on classification: *intrinsic: asthma where there is not an identifiable cause usually associated with exercise or emotional stress *extrinsic: usually as a result of an environmental allergen something that is irritating their airway s

theophyline: pt edu

Report to HCP all other drugs being used along with theophylline Schedule routine check-ups and blood tests If a dose is missed, take as soon as it is remembered UNLESS it is almost time for the next dose—NEVER take 2 doses at the same time Avoid consuming large amounts of caffeine *IV theophylline may only be used for an acute attack Urge patients to report adverse effects

guaifenesin: TX, kinetics, dynamics

TX respiratory conditions characterized by non productive cough in order to make the cough more productive common cold patients, influenza, bronchitis - all these patients would benefit typically in combination with antihistamines and decongestants KINETICS PO Duration of action: 4-6hrs DYNAMICS Reduces the adhesiveness and surface tension of secretions --> thinned secretions

thehophyline - tx, kinetics, dyamics

TX used for symptomatic relief of bronchoconstriction and bronchospasm associated with CAL KINETICS PO or IV (iv only in acute attack) Metabolized: liver Excreted: urine DYNAMICS Direct effect on the smooth muscles of the respiratory tract Bronchodilation caused by inhibiting phosphodiesterase Increases force of contraction of diaphragmatic muscles

fexofenadine - TX, kinetics, dynamis

TX - best if taken before onset of symptoms used to treat symptoms of allergies; works by blocking action of histamine when it gets released in response to an antigent. blocks swelling and congestion that follow histamine release effective for allergies or allergic rhinitis helps restore normal airflow through the URS two classess first generation (sedating) are much older benadryl is an example of first generation second (non sedating) claritin, zyrtec, allegra KINETICS PO, nasal or topical DYNAMICS MOA: selectively blocks the effects of histamine at H1 receptor sites --> decreasing the allergic response Anticholinergic and Antipruritic effects - anti cholinergic effects = decreased gland secretion; urinary retention; decreased swettig; dry as a bone watch for anticholinergic OD antipruritic = anti-itch

pseudoephedrine: TX, kinetics, dynamics

TX: reduces volume of nasal congestion and is used for *TEMPORARY* relief of nasal congestion related to common cold, allergic rhinitis, and sinusitis. also beneficial in somebody who has an ear infection that is caused by fluid/ear effusion Kinetics: oral drug readily absorbed from the GI tract, onset within 30 minutes. oral - gets absorbed systemically- ADR profile is increased topical - usually in a nasal spray; same therapeutic effect but don't get absorbed systemically therefore decreasing likelihood of ADR Dynamics: mimics SNS: works by causing vasoconstriction in the nasal arterioles so therefore the swelling of the nasal passages is decreased

The nurse is caring for a 38-year-old patient who is beginning treatment with albuterol. Which of the following should the nurse identify as a potential adverse effect of the drug? Polydipsia Tachycardia Hypotension Diarrhea

Tachycardia

acetylcysteine : TX kinetics dynamics

Uses: to liquify thick, tenacious secretions used for patients that have a MAJOR problem mobilizing and coughing up secretions this is NOT USED for patients have a cold or chronic bronchitis or pneumonia you would never go to your doctor and be prescribed mucomyst (if you had trouble coughing up stuff you'd be given an expectorant) Other uses: acetaminophen OD, contrast induced renal complications receiving IV contrast dye Kinetics - nebulizer or direct instillation (if someone is intubated) dynamics plits bonds that holds mucus together and thus decreases the viscosity of the secretions ** also has other two important uses ** - used in tylenol overdose: what happens with tylenon overdose is the liver is affected - helps the liver produce what it needs to to excrete the extra tylenol to protect the liver from toxicity of the overdose - but has to be given within 8-10 hours other use: someone who receives an IV contrast die for a cat scan or some sort of imaging.. IV contrast can be toxic to the kidneys... mucomyst will reduce the cell damage in the kidneys and acts as a renal vasodilator to help more oxygenated blood flow into the kidney to help prevent extra damage in this tylenol overdose sistuation, it could be given IV. during treatment, monitor for anaphylactoid reactions and serial LFTs. successful treatment if patient recovers without permanent hepatic dysfunction

Common Cold

VIRAL infection; absence of fever and mild symptoms: sneezing, headaches, rhinitis, sore throat, nasal discharge

Influenza - hallmark symptoms

abrupt onset. a high fever (>101); generalized body aches/everything hurts; some sort of respiratory symptom (sore throat, cough, runny nose)

albuterol - CIs, ADRs, drug interactions

absolute: absolute CI: the only absolute would be an allergy to it or an allergy to any part of the delivery system. if you have a medication that requires a device to administer it, we have to consider allergens that are within that dose relative/precautions: this is a relatively selective drug meaning it trie as hard as it can to stimulate the beta-2 receptors but it also has potential to stimulate beta-1 receptors. so this might not be good for patients with CV issues. hyperthroidism patients, they already have tachycardia: drug interactions: Other sympathomimetic agents (Additive effect) Example: Caffeine beta-adrenergic blocking agents (Opposite effect)

what drug is used to manage cystic fibrosis?

acetylcysteine

Allergic or seasonal Rhinitis

aka hay fever. Cause = upper airways responding to a specific antigen. Symptoms = nasal congestion, sneezing, stuffiness and watery eyes; an allergic-in-nature condition, producing a very vigorous allergic response

prototype beta 2 agonist bronchodilator?

albuterol albuterol stimulates the beta 2 - dilation of bronchi - increased rate and depth of respiration

DMX: precaution in OD situation

any of theses combo products can have 3 or 4 active ingredients in it so anytime you are dealing with a patient who is overdosing, you need to know exactly which kind of DEX product they took/other ingredients in that kind. some combos (the DEX with sudafed as an ingredient) will cause restlessness and irritability in overdose

Your patient is prescribed fexofenadine for relief of symptoms associated with allergic rhinitis. Which feature of the patient's medical history would be of concern? a. She has been diagnosed with asthma in the last year b. She has increased BUN and Cr levels c. She has a history of excessive alcohol use d. She is also taking pseudoephedrine

b. She has increased BUN and Cr levels this suggests impaired kidney function and this med is to be used in caution with patients who have renal failure

zafirkulast: tx, kinetics and dynamics

blocks leukotrienes - therefor no inflammatory response used to treat again, chronic asthma PO Peak effects: 2 weeks Food reduces bioavailability not used for acute attacks Blocks receptors for leukotrienes bound to amino acid cysteine (potent vasoconstrictor)

flunisolide - tx, kinetics, dynamics

bronchospasm associated with asthma or any of the CAL disorders used as a maintenance drug do not act quickly are not helpful during acute attack intransal: to decreasee inflammation in the nasal passages do not work quickly will start working within about 6 hours but takes 1-2 weeks of regular use

Your patient is 65 y/o, admitted to the hospital for cough, fever, chill, malaise, and headache. He is diagnosed with influenza. Examination reveals SOB at rest, course crackles throughout the lung fields, and cough productive of thick yellow sputum. The MD has prescribed guaifenesin (Robitussin) to help the patient mobilize secretions in the lungs. What would be an important nursing intervention to enhance the guaifenesin drug therapy? a. Discourage the use of a humidifier b. Advise the patient not to use the medication for longer than 2 weeks c. Suggest drinking one glass of water with every dose d. Advise the use of chest percussion

c. Suggest drinking one glass of water with every dose

The client's theophylline levels are increased. The nurse questions the client about his intake of which of the following? Caffeine Tea Carrots Cheese

caffeine is also a xanthine derivative

cromolyn sodium - tx kinetics and dynamics

can be used as prophylactic agents that can be used for asthma patients that get attacks around certain **allergens** also good for people that have exercise-induced bronchoconstriction PO: systemic absorption Improvement of symptoms requires several weeks of therapy (nasal and ophthalmic options too) Pharmacodynamics: Anti-inflammatory agent

prorotype mast cell stabilizer

cromolyn sodium MCS are vasocative substances like histamine, leukotrian when the mast cell ruptures in an airway, it causes bronchiole constriction and precipitates an asthma attack mast cell stabilizers stabilize mass cell membrane so that it when it coes into contact with an allergen or antigen, it prevents it from rupturing **used for patients that get asthma attacks due to allergens THEY ARE NOT BRONCHODILATORS***

What drug is known to be effective in treating acute bronchospasm? Ipratropium bromide (Atrovent) Epinephrine (Adrenalin) Cromolyn (Intal) ephedrine

epinpherine acute bronchospasm acute allergic reaction as well as cardio/pulmoar - one of the most potent drugs to treat bronchospasm

prorotype antihistamine and general function

fexofenadine: "Drugs that block the release or action of histamine, a chemical released during inflammation, which increases secretions and narrows airways." (histamine increases secretions and narrows arrows/cases us to feel more congested)

anti-inflammatory/inhaled steroid prototype

flunisolide Uses: manage respiratory disorders Glucocorticoid steroids PO, parenterally, inhalation ICS (inhaled corticosteroid) agents 1st line treatment for persistent asthma (*their asthma is not controlled with a short acting bronchodilator like albuterol*)

cromolyn sodium: max/min

for Exercise induced bronchospasm: take 15-20min before exercise Minimizing Adverse Effects: Use caution in patients who have lactose intolerance while taking oral cromolyn sodium due to GI effects Consider changing to a different route

prorotype expectorant drug and general function

guaifenesin: "Drugs that increase productive cough to clear the airways." Liquefy lower respiratory tract secretions Why does this help? decreases the viscosity of secretions makes it easier for the patient to cough them up improves airflow Available in many OTC preparations

other non pharmacologic treatment for nasal congestion?

humidifier, drink plenty of fluids, and avoid smoke-filled rooms - increase in fluid helps to liquify secretions

laryngitis

inflammation of larynx; caused by chemical/mechanical irritation OR viral OR bacterial infection. most commonly comes in a viral form and is associated with the common cold

prototype anticholinergic

ipratropium bromide 1st-line treatment for patients with CAL with persistent symptoms Bronchodilator MOA: decrease effect of Ach Result: Stop bronchoconstriction

Sinusitis

lining of sinus cavity becomes inflamed; bacterial OR viral infection. most are caused by viruses so antibiotics don't treat. Danger: if untreated, causative agents can move up sinus passages to brain

move freely throughout the epithelium to destroy foreign invaders

macrophage scavengers

release histamine and other chemicals to ensure a rapid and intense inflammatory reaction to any cell injury

mast cells

A client with COPD takes theophylline. The nurse identifies that the client is still experiencing severe dyspnea. Upon review of labs, the theophylline level remains nontherapeutic. The nurse evaluates the client for which of the following drugs that may cause decreased theophylline levels? Allopurinol Nicotine Cimetidine Corticosteroids

nicotine is a drug interaction for theophylline

DMX: used to treat?

non-productive cough and it's used ash OTC medication - in many cough and cold medication

ipratropium bromide - tx, kinetics, dynamics

one of the first line drugs for \patients have CAL - these patients have persistent symptoms used as a MAINTENANCE treatment for someone with cal: the patient takes this every day, regardless of if they have symptoms or not, to prevent bronchoconstriction inhalation or intransal spray blocks uptake of acetylcholine at muscarinic cholinergic receptors: decreases contractility of smooth muscle and therefore decreases bronchospasm

DMX: drug interactions

other CNS depressants; MAOIS. opiates produce CNS depression - drowsy, less alert. so if DMX is similar to opiates, need o be careful about other CNS depressants like alcohol, sedatives etc. MAOIs are the antidepressant drugs that basically interact with everything serotonin syndrome: the effect of DEX and MAOI, is when the body's serotonin receptors are s nausea hypotension restlessness and excitability increase temperature coma and death.

DMX: CI's

people with chronic coughs caused by other diseases (emphysema or asthma or ACE cough); caution in patients with hepatic impairment;

prototype decongestant and general function

pseudoephedrine: "Drugs that decrease the blood flow to an area and thus decrease overproduction of secretions."

DMX: pt edu

sedation, drowsiness and impaired orientation can occur: take only as directed, avoid driving or other tasks that require alertness Do not take dextromethorphan if patient ever had a reaction to it, are pregnant or breast-feeding (use with caution if pregnant), or have a history of liver problems Caution about drug-drug interactions if taking certain antidepressants or drugs for obesity Avoid alcohol as it could increase sedation Immediately report any chest tightness, difficulty breathing, noisy breathing or shortness of breath, or if cough does not resolve Caution parents of adolescents about the potential for abuse Keep out of reach of children

prototype xanthine derivative

theophyline Bronchodilator Not rapid acting- a maintenance drug * Come from naturally occurring sources Other examples: aminophylline and caffeine

Pneumonia

this is NOT CAL Inflammation of the lungs Cause: Bacterial Viral Aspiration Symptoms: Difficulty breathing Fever Productive cough Shortness of breath Chest pain typically occur when the immune system gets compromised or when u have an URS that is not effectively protecting

Pharyngitis

throat infection; bacterial OR viral infection. sore throat, redness, white spots on tonsils, swelling of lymph nodes, fever - these are all symptoms, whether viral or bacterial. strep is the most common bacterial agent that causes throat infection

what are the 3 classes of bronchodilators? *

used to facilitate respiration because they dilate the airways - there are 3 classes 1. sympathomimetic (beta 2 agonists) 2. anticholinergics 3. xanthine derivatives

albuterol - tx, kinetics, dybamics

uses: prototype beta agonist: a bronchodilator used to treat airway disorders that fall under umbrella of CLA as well as asthma **considered a RESCUE DRUG for patients that are asthmatic - it should be the first drug that an asthmatic goes to when they are having symptoms of an acute asthma attack** more often inhaled than orally dynamics: relaxed bronchiole musculature to relieve the spasm associated with in during asthma and reduces airway resistance - moderately selective beta-2 agonist

prototype leukotriene receptor antagonist - what are leukotrienes and relation to asthma

zafirkulast Leukotrienes as inflammatory mediators Asthma = airway inflammation Leukotriene release: Airway hyper-reactivity Brochoconstriction Hypersecretion Manifested by: wheezing, coughing, and dyspnea