Pharm week 11 Respiratory drugs

Guaifenesin (expectorants) mechanism of action

Expectorants help thin the secretions in your airway and loosen up mucus, so you can make your cough more productive, it does this by reducing the adhesiveness and surface tension of these fluids, this makes it easier for patient to excrete it.

prototype of expectorants

Guaifenesin (Robitussin, Mucinex)

Mechanism of action of pseudoephedrine (decongestants)

Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes

A nurse is teaching a client about the use of a mucolytic to treat a cough. The nurse should include that a mucolytic has which of the following therapeutic effects? a. Suppresses the cough stimulus b. Reduces inflammation c. Thins and loosens mucus d. Dries secretions

Thins and loosens mucus Mucolytics make mucus less viscous to increase a cough's productivity.

For which of the following reasons should a client attach a spacer to a metered dose inhaler? ​a. To increase the amount of drug delivered to the lungs b. To increase the amount of drug delivered to the oropharynx c. To increase the amount of drug delivered on exhalation d. To increase the speed of drug delivery into the mouth

​To increase the amount of drug delivered to the lungs - he spoke on this during class, A spacer increases the amount of drug that reaches the lungs.

pseudoephedrine contraindication

hypertension (HTN)

Budesonide (inhaled coriticoid steroids) adverse effects

immunosupression

What is pruritus?

itching

What advantage does Ipratropium have over albuterol

less tachycardia, anxiousness as side effects as compared to albuterol, LESS but not completely absent.

what are the proper nursing interventions for budesonide (inhaled steroids)

monitor for immunosupression; watch out for fever, sore throat which would indicate compromised immunity

what dictates the adverse effects of Aminophylline (xanthines) and what is the proper nursing interventions

monitor theophylline levels, normal is 10-20, if greater notify provider and hold xanthine do not give

what is dextromethorphan used for? (indications)

non productive cough (dry cough)

Cromolyn (Mast cells stabilizer) mechanism of action

prevents mast cells from bursting, which would result in inflammation, if there is no inflammation of airways, there is no broncho constriction and no asthma.

prototype of oral decongestants

pseudoephedrine

Zafirlukast (Leukotriene Receptor Antagonists) adverse effects

said don't memorize, but GI symptoms, headaches, dizziness just in case

what is rebound congestion?

worsening of congestion due to overuse of nasal decongestants with prolonged daily use, rendering it useless

Prototype Leukotriene Receptor Antagonists

zafirlukast, or Montelukast

indications of acetylcysteine (mucolytics)

- cystic fibrosis, there is high production of mucous - Patients who have difficulty coughing up secretions - conditions where there are high production of mucous - atelectasis (partial lung collapse) - antidote for acetaminophen (Tylenol) toxicity

Dextromethorphan adverse effects

- drying effect on mucous membranes - causes sedation, drowsiness

Cromolyn (Mast cells stabilizer) used for (indications)?

- exercise induced asthma

pseudoephedrine adverse effect

- hypertension - Rebound congestion

Guaifenesin (expectorants) adverse effects

- relatively safe, just nausea, vomiting

Drug prototype for sympathomimetics

- Albuterol B2 specific - epinephrine acts on both alpha and beta receptors, which means it increases BP via vasoconstriction (A1 receptor), increases heart rate (B1 receptor) and causes broncho dilation (B2 receptor) - epinephrine has more to do with anaphylactic shock in an allergic reaction

List of all the drugs used for treatment of Asthma, COPD, any disease that obstructs lower airways

- Aminophylline (xanthines) - Albuterol, epinephrine (sympathomimetics) - Ipratropium (anticholinergic) - budesonide (inhaled steroids) - Zafirlukast, or Montelukast (Leukotriene Receptor Antagonists) - cromolyn (mast cell stabilizer)

ipratropium used for

- Asthma, COPD, Maintenance treatment of bronchospasm

What are oral decongestants used for? (indications)

- Decrease nasal congestion related to the common cold, sinusitis, and allergic rhinitis - Promotion of drainage in the sinuses and improving air flow

budesonide mechanism of action

- Decrease the inflammatory response in the airway and will decrease airway hyperactivity to stimulant, allowing increased air flow. MEMORIZE

Aminophylline (xanthines) adverse effects

- Narrow therapeutic index; this means a small differences in dose or blood concentration may lead to serious therapeutic failures and/or adverse drug reactions that are life-threatening or result in persistent or significant disability or incapacity, not much room for error - Nausea/vomiting

Inhaled steroids vs albuterol

- albuterol only used as needed, when you cannot breath. USED IN EMERGENCY - inhaled steroids used as maintenance, used to prevent asthma attacks, NOT USED IN EMERGENCY - if he asks us a question and you see both options, the answer will be based on situation, if person cannot breath and its an emergency, albuterol is the better answer, If the situation is just talking about preventing attacks, and daily use, inhaled steroids is the better answer

What are the 5 different types of drugs used to treat upper respiratory tract infections?

- antitussive - decongestants - antihistamines - expectorants - mucolytics

Dextromethorphan nursing interventions

- drink more fluid (to combat the drying effect of mucous membranes) KNOW THIS! - advise to not operate machinery or drive vehicle, avoid hazardous activities (due to sedative effects)

What is the difference between 1 gen and 2 gen histamine

2nd Gen has less sedative effects, this is advantageous because you can take them and still continue to do work and be productive throughout the day

The nurse is caring for a patient taking Budesonide. What would be an appropriate nursing diagnosis for this patient? A. Risk for injury related to immunosuppression B. Risk for injury related to CNS effects C. Risk for injury related to CVS effects D. Risk for injury related to age and risk of infection

A. Risk for injury related to immunosuppression this is adverse effect, we must watch for sore throat, fever, which indicates immune system has been suppressed

Xanthines prototype

Aminophylline

Which of the following is an adverse reaction to topical nasal steroids? A. Increased nasal drainage B. Rebound effect C. Suppression of healing D. Local ulceration

B. Rebound effect this is an adverse effect associated with the overuse of nasal sprays, you end up with nasal congestion as a result of using nasal sprays too much

acetylcysteine (mucolytics) mechanism of action

Breaks down mucous in order to aid the high-risk respiratory patient in coughing up thick, tenacious secretions, clears airways

Mast cells stabilizer prototype

Cromolyn

A nurse is teaching a client about the use of beclomethasone to treat asthma. The nurse should explain that the drug has which of the following therapeutic effects? a. Thins mucus b. Relaxes bronchial smooth muscle c. Decreases inflammation d. Increases the cough threshold

Decreases inflammation he mentioned Beclomethasone on a practice question about inhaled steroids during lecture

Prototype Antihistamine

Diphenhydramine (Benadryl)

Aminophylline (xanthines) mechanism of action

Direct effect on the smooth muscles of the respiratory tract, producing broncho dilation which in turn relieving and/or preventing bronchial asthma

A nurse is teaching an adult client about diphenhydramine. The nurse should inform the client to expect which of the following adverse effects while taking this drug? a. Muscle tremors b. Drowsiness c. Excitation d. Insomnia

Drowsiness The most common adverse effect of diphenhydramine, a first-generation antihistamine, is drowsiness.

Prototype anticholinergic

Ipratropium

What is a leukotriene?

Leukotriene are substances released by mast cells during inflammatory responses.

For which of the following reasons should a nurse instruct a client to avoid guaifenesin with combination over the counter products? a. Over-the-counter cold products can also contain guaifenesin. b. Blood glucose levels are increased. c. Rebound congestion is likely. d. Drug tolerance is likely.

Over-the-counter cold products can also contain guaifenesin. - Many combination over-the-counter cold products contain guaifenesin. A client taking both might be taking excessive amounts of the drug.

A nurse should identify that dextromethorphan can have which of the following effects when combined with morphine? a. Reduced antitussive effect of dextromethorphan b. Potentiation of depression of CNS actions c. Increased renal reabsorption of the dextromethorphan d. Delayed analgesic effect of the opioid

Potentiation of depression of CNS actionsCombining dextromethorphan with an opioid, such as morphine, increases the risk for decreased respirations and other depressed CNS responses. - i think the same applies for alcohol, it would exacerbate sedative effects, not 100% sure tho, he mentioned alcohol increasing sedative effects of antihistamines, im sure same applies here

A nurse is teaching a client about the use of antihistamines to treat allergic rhinitis. The nurse should explain that these drugs are effective because they perform which of the following actions? a. Decrease viscosity of nasal secretions b. Block H2 receptors c. Prevent histamine from binding to receptors d. Reduce nasal congestion

Prevent histamine from binding to receptors - the class of the drug is ANTI-histamine. It tells us the action of the drug, it blocks action of histamine. They block H1 receptors not H2

A nurse is teaching a client about the use of cromolyn sodium to prevent bronchospasm. The nurse should explain that the drug has which of the following therapeutic effects? a. Increases leukocyte activity b. Blocks muscarinic receptors c. Causes bronchodilation d. Reduces inflammation

Reduces inflammation Cromolyn sodium is a mast cell stabilizer, it keeps mast cells from bursting and releasing their inflammatory by products, therefore inflammation of airways is prevented and bronchospasm is inhibited

A nurse is teaching a client about the use of an expectorant to treat a cough. The nurse should include that an expectorant has which of the following therapeutic effects? a. Suppresses the cough stimulus b. Reduces surface tension c. Reduces inflammation d. Dries mucous membranes

Reduces surface tension Expectorants act by reducing the surface tension and viscosity of respiratory secretions. This results in thinning thick mucus, making it easier to cough out of the lungs and drain out of the nose and sinuses.

True or False The adverse effects of the Xanthines are related to theophylline levels in the blood and include brain damage.

TRUE, Adverse Effects related to theophylline levels in the blood; GI upset, nausea, irritability, and tachycardia to seizure, brain damage, and even death.

Albuterol is given for acute exacerbation of CAL or asthma. True or False?

True - albuterol opens up airways

What is a mast cell?

a large cell that contains many inflammatory cells in it.

What drug enhances the output of respiratory tract fluid by reducing the adhesiveness and surface tension of fluids? a. Guaifenesin b. Diphenhydramine c. atorvastatin d. dextromethorphan

a. Guaifenesin this is expectorants mechanism of action

A nurse is monitoring plasma drug levels in a client who is taking theophylline. Which of the following findings should the nurse expect to see if the clients drug level indicates toxicity? a. Seizures b. Constipation c. Normal sinus rhythm d. Somnolence

a. Seizures Seizures are likely when plasma drug levels of theophylline, a methylxanthine, are higher than 30 mcg/mL, which indicates toxicity.

acetylcysteine is the antidote for which drug

acetaminophen (tylenol) he mentioned this like the 3rd week of classes, i think this will be on quiz MEMORIZE

prototype of mucolytics

acetylcysteine

What are antihistamines used for? (indications)

allergies, pruritus associated with allergies

albuterol is used for? (indications)

asthma - used for emergency only, as needed - immediately opens up airways

albuterol mechanism of action

beta 2 adrenergic agonist, meaning it stimulates beta 2 receptors, leading to bronchodilation - also increases BP remember that

Zafirlukast (Leukotriene Receptor Antagonists) mechanism of action

blocks Leukotriene Receptors, inhibiting release of leukotrienes and inhibiting inflammation associated with asthma, therefore there is no asthma

ipratropium (anticholinergic) mechanism of action

blocks acetylcholine, inhibiting its action, thereby producing bronchodilation

mechanism of action of dextromethorphan

blocks cough reflex, preventing patient form coughing

antihistamine (Diphenhydramine) mechanism of action

blocks histamine 1 receptor, decreasing allergic response

Prototype inhaled steroids (inhaled corticoid steroids)

budesonide

A nurse is caring for a client who is having difficulty mobilizing thick respiratory secretions. Which of the following drugs should the nurse expect to administer to the client? a. Ipratropium b. Beclomethasone c. Acetylcysteine d. Azelastine

c. Acetylcysteine Acetylcysteine is a mucolytic that loosens thick respiratory secretions.

What does CAL mean?

chronic airflow limitation

popular antitussive that requires prescription

codeine

what does the word tussive mean

cough, antitussive means anti cough

A nurse should recognize that using pseudoeephdrine to treat allergic rhinitis requires cautious use with clients who have. which of the following conditions? a. Peptic ulcer disease b. A seizure disorder c. Anemia d. Coronary artery disease

d. Coronary artery disease Because pseudoephedrine, an oral sympathomimetic, can cause systemic vasoconstriction, it requires cautious use with clients who have severe hypertension or coronary artery disease. He mentioned that hypertension was an adverse effect so we have to be careful giving to patients who are already hypertensive

Prototype of antitussive

dextromethorphan (over the counter)

nursing interventions for antihistamines

do not drive, do not operate machinery, avoid hazardous activities (due to sedative effects)

ipratropium adverse effect

dry mouth, sore throat, headaches, dizziness, nervousness

Prototype Topical Nasal Steroid Decongestant

flunisolide, same stuff as oral decongestant, although im unsure if it causes hypertension, im like 80% leaning towards no it does not because exact mechanism of action is unknown, therefore it cannot be said it stimulates adrenergic receptors like oral decongestants do

albuterol adverse effects

he didn't mention in class but its on slides - tachycardia, tremor, restlessness, anxiety, hypertension - remember it will exhibit effects based on receptor it acts on

adverse effects for acetylcysteine (mucolytics)

he said don't memorize because different for every patient, but most common is GI upset just in case

A nurse is teaching a client about albuterol. The nurse should instruct the client to monitor for and report which of the following as an adverse effect of this drug? a. Fever b. Bruising c. Polyuria d. Palpitations

Palpitations didnt really mention adverse effects of albuterol during class

what are Zafirlukast (Leukotriene Receptor Antagonists) used for (indications)?

- Prophylaxis (used as prevention) - bronchial asthma

A nurse is teaching a client about the adverse effects of pseudoephedrine. Which of the following should the nurse include (Select all) a. Restlessness b. Bradycardia c. Insomnia d. Muscle pain e. Anxiety

- Restlessness is correct. Restlessness is an adverse effect of pseudoephedrine, an oral sympathomimetic. - Bradycardia is incorrect. Pseudoephedrine is more likely to cause tachycardia, not bradycardia. - Insomnia is correct. Insomnia is an adverse effect of pseudoephedrine. - Muscle pain is incorrect. Muscle pain is not an adverse effect of pseudoephedrine. The drug is more likely to cause numbness of the extremities. - Anxiety is correct. Anxiety is an adverse effect of pseudoephedrine.

adverse effects of antihistamines

- sedation, drowsiness - do NOT drink alcohol, exacerbates sedation, can be fatal

what is more detrimental to a patients health, nasal congestion or hypertension, how does this apply clinically with regards to pseudoephedrine?

hypertension, if a patient has nasal congestion and hypertension, do not give pseudoephedrine as this will exacerbate hypertension, which is more deadly. Noone has ever died of a stuffy nose according to my knowledge

What effect does pseudoephedrine have on blood pressure?

increases blood pressure, it stimulates alpha-adrenergic receptors, remember this increases BP, careful not to give to ppl who are already hypertensive

what are the two important characteristics of asthma?

inflammation and bronchoconstriction present, seen also in COPD

Guaifenesin (expectorants) is used for? (indications)

- symptomatic relief of viral infection which usually starts with dry cough, expectorant allows for you to get rid of sputum from respiratory tract