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Pharm 2
| Question | Answer |
|---|---|
| Drugs that work on liver | Biguanides TZDs big thick liver |
| Drugs that work on pancreas | SulfonylureasMeglitinides S&M |
| Drugs that work on kidneys | sodium glucose transport inhibitors flow through the kidneys |
| Drugs that work on GI tract | alpha glucosidase inhibitors and incretins |
| Drugs that work on inflammation | antipyreticsNSAIDSH1 antihistamines |
| H1 antihistamines ending | -ineexamples: diphenhydramine, hydrOXYzine, cetirizine, loratadine |
| H1 antihistamines | H1 receptors found in vascular smooth muscle, bronchi, and sensory nerveshas first and second generation |
| diphenhydramine more common name | benadryl |
| Second generation H1 antihistamines | newer, specifically target receptors in periphery, and tend to be less sedating that first generation |
| H1 antihistamines mechanisms of action | blocks action of histamine at H1 receptors CANNOT be used for anaphylaxis |
| why can’t H1 antihistamines be used for anaphylaxis? | anaphylaxis overwhelms all H1 receptors |
| H1 antihistamine indications | allergies, inflammation, pruritus (itchy skin) |
| pruritus | itchy skin |
| H1 antihistamine side effects | anticholinergic effects (drying of mucous membranes in mouth/nose) sedation of paradoxical excitation |
| paradoxical excitation | insomnia, nervous tremors, and irritability |
| H1 antihistamine nursing implications | monitor response and excess sedationmonitor elderly especially because it inc. fall risks |
| H1 antihistamine pt education | safety concerns and possible paradoxical excitation |
| NSAIDS most common drugs | aspirin and ibuprofen |
| aspirin is the prototype of what drug? | NSAIDS |
| NSAIDS | blocks COX-1 and COX-2 |
| NSAIDS effect on COX-1 | GI upset, ulcer risk, inc. bleeding risk, vaso/bronchiconstriction, |
| NSAIDS effect on COX-2 | decreases inflammation and pain |
| NSAIDS selective COX-2 inhibitor | celecoxib |
| NSAIDS mech of action: COX-1 | PROTECTIVEreduce gastric blood flow, promotes renal blood flow, and regulate smooth muscle tone in blood vessels |
| NSAIDS mech of action: COX-2 | formed after tissue injury and promote inflammation |
| aspirin mech of action | inhibits COX 1&2prevents platelet aggregation (for life of platelet)analgesic, anti-inflammatory, antipyretic, anti-platelet aggregation |
| Ibuprofen, naproxen (OTC), indomethacin and ketorolac (prescription) | prevents formation of prostaglandins analgesic, anti-inflammatory, antipyreticrheumatoid arthritis |
| selective COX-2 inhibitors: mech of action | inhibit only COX-2analgesic, anti-inflammatory, and pyretic effects without causing serious adverse effects Does not produce adverse effects on digestive system |
| side effects of aspirin | GI distress/bleeding, heartburn, salicylism |
| salicylism | toxic levels of salicylic acid s/sx: tinnitus, dizziness, headache, and excess sweating |
| ibuprofen and others side effects | less GI/bleeding issues than ASA contraindicated for pt with hx of bleeding gastric ulcersmost common side effects are nausea and vomiting |
| COX-2 inhibitors side effects | risk of allergy |
| NSAIDS nursing implications | bleeding risk (monitor color/quality of stool and emesis)hemoccult testing |
| NSAIDS hemoccult melena: | upper GI bleeding, dark stool |
| NSAIDS hemoccult hematochezia: | indicator of lower GI bleeding, bright red bleeding |
| aspirin nursing implications: | not used in hospital/with kidsif given to kids: at risk for Reye’s syndrome protective effect on cardiovascular system and is taken daily in small doses to prevent abnormal clot formationmonitor for salicylate toxicity |
| exception for aspirin use in kids | 325 mg q day to reduce risk of heart attack or stroke |
| ibuprofen nursing implications | renal assessments (for nephrotoxicity)increased risk of thromboembolic events/worsen HTN |
| celecoxib nursing implications | used to reduce number of colorectal polyps in adults |
| NSAIDS pt education | do not use aspirin on kids <19 for Reye’s conditionringing in ears and dark/bloody stools for GI bleedingtake with food |
| colorectal polyps | clump of cells on rectal or colon; most are harmless but can turn into cancer |
| antipyretics examples: | NSAIDS (ibuprofen)Acetaminophen (APAP) |
| Acetaminophen (APAP) | most common fever reducer, has direct action on hypothalamus and dissipates heat |
| Acetaminophen (APAP) mech of action: | direct action on hypothalamus peripheral dilation and diaphoresis |
| Acetaminophen (APAP) indications: | fever and painno anti-inflammatory properties |
| Acetaminophen (APAP) side effects | potential liver damage (avoid taking on regular basis) |
| Acetaminophen (APAP) nursing implications | T > 100contraindicated with liver disease |
| Acetaminophen pt education | max 4 g per day |
| Immunoglobulin examples: | IVIG, HBIG, Tetanus immune globulin (TIG), varicella immune globulin (VariZIG), and RhoGAM (RhoD) |
| IVIG | gamma globulin, used to protect pt with immunodeficiencies or autoimmune disorders |
| HBIG | immunoglobulin after pt is exposed to HIV |
| Tetanus immune globulin (TIG) | immunoglobulin after pt is exposed to tetanus |
| Varicella immune globulin (VariZIG) | immunocompromised pts who are exposed to chickenpox |
| RhoGAM (RhoD) | administered to RH neg moms |
| immunoglobulins mech of action | passive immunity after exposure (only lasts a few weeks) |
| Immunoglobulin indications | immune deficienciespost exposure |
| immunoglobulin side effects: | anaphlylaxis |
| immunoglobulin nursing implications | give ASAP after exposure and assess for reactions (pt should stay for 30 min - like COVID) |
| immunoglobulin pt education | teach pt s/sx of active disease |
| Vaccines mech of action | active acquired immunity (long term protection) |
| Types of vaccines | inactivated microbes, attenuated microbes, toxoid, recombinant, conjugates, and nucleic acid |
| inactivated microbes | microbes have been inactivated by heat or chemicals and unable to replicateexample: flu, rabies, polio |
| attenuated vaccine | alive, but weakened microbe so they are unable to produce diseasesubclinical s/sx of the disease (like rash after MMR vaccine) |
| toxoid vaccine | Contains bacterial toxins that have been modified to be incapable of causing disease example: diptheria and tetanus |
| recombinant vaccine | Contains partial viral subunits or bacterial proteins that are generated using biotechnologyexamples: Hep B, HPV |
| Conjugates vaccine | antigens attached to a protein carrier that heightens an immune responseexample: pneumococcal, HPV |
| nucleic acid vaccine | newest; uses genetic material from microbe to initiate immune responseexample: COVID |
| vaccine side effects | pain at injection sitefever, chills, malaise, or fatigue, allergy/anaphylaxis risk |
| vaccine nursing implications | assess vaccination risk titer levels to determine immunity |
| vaccine pt education | recommend schedule and follow-up vaccinesteach mothers to give acetaminophen for fever |
| Colony-stim factors (synthetic growth factors) examples | -stimfilgrastim/tbo-filgrastim: daily dosingpegfilgrastim: prolonged action, once a week |
| Colony-stim factors (synthetic growth factors) mech of action | stim production of leukocytes |
| Colony-stim factors (synthetic growth factors) indications | neutropenia |
| Colony-stim factors (synthetic growth factors) adverse reactions | bone pain |
| Colony-stim factors (synthetic growth factors) nursing implications | contraindicated with hypersensitivity or hx leukemiamonitor WBC and differential (only administered when counts are below normal)in hospitals: hand hygiene and temp Q4 and notify MD if >100.5 |
| Colony-stim factors (synthetic growth factors) pt education | acetaminophen for bone painprecautions at home |
| glucocorticosteroids (immunosuppressants) | -oneshort: cortisone, hydrocortisoneintermediate: prednisone, methylprednisolonelong: betamethasone, dexamethasone |
| glucocorticosteroids mech of action | anti-inflammatory and immunosuppression (suppresses histamines, prostaglandin, leukocytes, lymphocytes, cytokines) |
| glucocorticosteroids indications for use | severe chronic inflammatory processes, prevent organ transplant rejections, cancer, cerebral edema, endocrine disorders |
| glucocorticosteroids side effects | cataracts, ulcers, GI bleeding, skin (striae, thinning, bruising), HTN, hirsutism, infection, necrosis of femoral head, glycosuria, obseity, osteoporosis, immunosuppression, diabetes |
| hirsutism | dark or coarse hair in females |
| glucocorticosteroids nursing implications | give in morning (mimic body)assess s/sx of infectiontaper dose to D/C to prevent adrenal gland atrophyintranasal and topical have less standard of errorcontraindicated with active infectionlong term → Cushing’s Syndrome |
| Cushing’s Syndrome | too much cortisol (stress) over time and no treatment |
| glucocorticosteroids pt education | take oral doses in morning with foodinfection may be maskedreport black, tarry stooltake exactly as prescribed |
| calcineurin inhibitors | immunosuppressant; calcineurin is a intracellular messenger that activates T-cells |
| cyclosporine | binds to calcineurin and disrupts ability to bind to T-cells, used to treat autoimmune disorders and transplant surgeries |
| Monoclonal antibodies - immunosuppressants | -mabexamples: adalimumab, infliximab, ustekinumab |
| other suppressants side effects | bone marrow suppression and infection |
| other immunosuppressant nursing implications | monitor VS and labs with neutropenic precautions (hand washing, avoid crowds/kids/fresh fruit, temp Q4, assess for infections) |
| other immunosuppressants to pt education | report elevated temp and other s/sx of infectionsavoid others report unusual bleeding due to immunosuppressive effect on platelets |
| stevens-johnson syndrome | separates dermis from epidermis treat: IVF and wound carepain meds, antihistamines, corticosteroids |
| type 1 hypersensitivities - immediate, anaphylaxis | treat with epinephrine, antihistamine, corticosteroids |
| type 2 hypersensitivities - Cytotoxic Ag-Ig rxn | D/C drug and time |
| type 3 hypersensitivities - immune complexes | antihistamines, corticosteroids, plasmapheresis |
| plasmapheresis | take plasma out, filter, and return |
| type 4 hypersensitivities - cell mediated | avoid exposureantihistamines, corticosteroids, report +PPD |
| insulin adverse effects | hypoglycemia (carbs intake following)hyperglycemia → lead to metabolic disturbanceinsulin resistance → antibodies formed against exogenous insulinallergic rxn to preservative |
| rapid insulin examples | lispro (Humalog) and Aspart (Novolog) |
| lispro (Humalog) | 15-30 min onset1-3 hr peak3-5 duration |
| Aspart (Novolog) | 10-20 min onset30-1 hr peak3-5 duration |
| rapid insulin indications | synthetic analogclear solutionused for sliding scalecan mix with NPHs |
| sliding scale | PRN dose of insulin based on pt BS reading |
| short insulin examples | Regular insulin or R (Humulin R, Novolin R) |
| Regular insulin or R (Humulin R, Novolin R) | 30 min onset2-4 peak5-8 duration |
| short insulin indications | natural insulin (can give SQ/IV) clear solutionused for sliding scale/insulin dripscan mix with NPH |
| intermediate insulin examples | insulin isophane (NPH, Humulin N, Novolin N, ReliOn N) |
| insulin isophane (NPH, Humulin N, Novolin N, ReliOn N) | 1-2 onset4-12 peak12 hr duration |
| intermediate insulin indications | reduces frequency of injections |
| long/basal insulin examples | glargine, detemir, degludec |
| glargine | crystallizes and dissolves as absorbed24 hr duration |
| detemir | tends to stick together and dissolve24 hr duration |
| degludec | forms a string of pearls and dissolves from both sides48 hr duration |
| long/basal insulin indications | usually administered once a day, commonly at bedtimeno significant peakCANNOT be given IV or mixed |
| insulin pens | prime with two or three unitsabdomen is preferred, fastest absorbedimportance of rotating sites and inject at 90 degrees |
| mixing insulin | cloudy before clear regular before the NPH Newly Registered, Registered Nurse |
| combination insulin | first number = percentage of intermediate insulinsecond number = percentage of rapid acting insulin |
| insulin pt education | teach BS monitoring/target goalsteach s/sx of hypoglycemiamedical alert braceletexercise, diet, equipementrotate injection sites to prevent lipoatrophy |
| OHA nursing implication | BS monitoring, flow sheet, assessment of hypo/hyperglycemia, I/O, labs |
| OHA pt education | BS monitoring, s/sx of hyper/hypoglycemia, dietary teaching (alc), carrying fast-acting agents for BS, med alert bracelet |
| Biguanides example | Metformin |
| Biguanides | works on liver, decreases hepatic production of glucoseDOES NOT cause hypoglycemia |
| biguanides side effects | GI related: n & v, abdominal discomfort, diarrhea, anorexia |
| biguanides nursing implications | monitor BS before giving, drugs are stopped before radiation (can cause renal impairment) and does not cause hypoglycemia |
| Thiazolidinediones examples | -glitazones or TZDspioglitazone, resiglitazone |
| Thiazolidinediones mech of action | works on liver; reduces BS by decreasing insulin resistance and inhibiting hepatic gluconeogenesisdec. hepatic production of glucosemetabolized by liver via CYP enzymes |
| Thiazolidinediones side effects | liver dysfunction and fluid retention |
| Thiazolidinediones nursing implications | monitor fluid status and liver function; contraindicated in pts with serious heart failure or pulmonary edema |
| Thiazolidinediones pt education | report signs of fluid retention (swelling, weight gain, shortness of breath) |
| Sulfonylureas examples | -ideglyburide, glipizide |
| Sulfonylureas mech of action | works on pancreas; releases insulin from pancreatic islets and increases sensitivity of insulin receptors on target cells |
| Sulfonylureas side effects | hypoglycemia (not eating enough after meds) |
| Sulfonylureas nursing implications | check BS before administering |
| Sulfonylureas pt education | No alcohol (cause disulfiram reaction), eat meals regularly, and carry fast-acting carbs |
| Meglitinides examples | -ide repaglinide, nateglinide |
| Meglitinides mech of action | works on pancreas; releases insulin from pancreatic islets cells (like sulfonylureas) short duration of action (2-4 hrs) |
| Meglitinides indications | DM2 with postprandial spikes (BS spikes after eating) |
| Meglitinides side effects | hypoglycemia |
| Meglitinides nursing implications | similar to other OHAs |
| Alpha-Glucosidase inhibitors examples | acarbose (without carbs) |
| Alpha-Glucosidase inhibitors mech of action | works on small int; blocks enzymes in small int. that are responsible for breaking down complex carbs into monosaccharides |
| Alpha-Glucosidase inhibitors indications | DM2 with postprandial spikes |
| Alpha-Glucosidase inhibitors side effects | GI related; bloated, excess gas, nauseahypoglycemia (when used with insulin or sulfonylurea) |
| Alpha-Glucosidase inhibitors nursing implications | monitor liver function, dietary restrictions, increase activity |
| Incretin agents | protein hormones released by int; signals pancreas to secrete insulin and liver to STOP producing glucagon |
| GLP-1 agonist examples | -tideexenatide, liraglutide |
| GLP-1 agonist mech of action | stimulates release of insulin and suppresses glucagon |
| GLP-1 agonists side effects | pancreatitis and increased cancer risk, n & v, diarrhea |
| GLP-1 agonists nursing implications | same as other OHAs |
| DPP-4 inhibitors examples | -gliptinsitagliptin, saxagliptin, linagliptin |
| DPP-4 inhibitors mech of action | slows breakdown of incretin, allowing natural incretin levels to rise and produce greater response |
| DPP-4 inhibitors nursing implication | PO medicine |
| incretin agent examples | GLP-1 agonists, DDP-4 inhibitors, SGLT-2 inhibitors, amylin analog |
| SGLT-2 inhibitors examples | -gliflozin dapagliflozin, canagliflozin |
| SGLT-2 inibitors mech of action | increases excretion of glucose in urine and decreases reabsorption of glucose in renal tubules |
| SGLT-2 inhibitors side effects | increases risk of UTI |
| amylin analog | pramlintide |
| amylin analog mech of action | synthetic amylin; amylin is usually secreted from insulin from beta cells in pancreas to promote satiety |
| amylin analog indications | adjuvant (after initial) therapy for DM1 or DM2 |
| amylin analog side effects | hypoglycemia and allergic reactions |
| amylin analog nursing implications | SQ pen injection in mcg |
| thrombopoietic growth factors examples | eltrombopag |
| thrombopoietic growth factors mech of action | increase production of platelets by stimulating thrombopoietin receptors |
| thrombopoietic growth factors indications | thrombocytopenia, used to treat ITP(immune thrombocytopenia)/aplastic anemia |
| thrombopoietic growth factors adverse effects | thromboembolism and liver dysfunction |
| thrombopoietic growth factors pt education | take on EMPTY stomach, bleeding risk, dose and duration based on platelet counts, avoid aspirin and NSAIDS, use electric razor to shave, avoid enemas/suppositories/unnecessary trauma |
| antiplatelet agents | inhibit aggregation and adhesion |
| antiplatelet examples that inhibit aggregation | aspirindipyridamolecilostazol (prevents intermittent claudication for pts with PVD due to vasodilation) |
| claudication | pain in extremities brought by movement because of ischemia |
| antiplatelet examples that inhibit aggregation AND adhesion | clopidogrel (blocks ADP receptors on platelets to prevent adhering to damaged tissue) |
| antiplatelet indications | prevent thrombus formation |
| antiplatelet side effects | abnormal bleeding |
| antiplatelet nursing implications | bleeding risk |
| antiplatelet pt education | D/C 3-5 days before surgery/invasive procedure because they irreversibly alter platelets |
| anticogulants examples | -arin or -abanheparin, warfarin, enoxaparinnew drugs: dabigatran and rivaroxaban |
| Low molecular weight heparin (LMWH) | longer duration of action, causes less thrombocytopenia, and needs less monitoring |
| Heparin mech of actions | inhibits specific clotting factors, slowing formation and enlargement of fibrin clots |
| LMWH mech of action | inhibits active factor X |
| Warfarin mech of action | inhibits action of vitamin K (liver synthesis) |
| Dabigatran mech of action | irreversibly binds to active site of thrombin, preventing formation of fibrin clots |
| Rivaroxban mech of action | inhibit factor Xa directly in clotting cascade |
| anticoagulation indication | thrombus prophylaxis (SQ), thromboembolism disorders, IV hep for existing blood clot, lower dose for prevention route is determined by reason ordered |
| anticoagulation side effects | bleeding, heparin induced thrombocytopenia |
| anticoagulation nursing implications | PINCH, assess for bleeding, monitor PTT for heparin or PT/INR for WarfarinFactor Xa does not monitoring Do NOT aspirate or massage, NEEDS AIRLOCK |
| anticoagulation pt education | aspirin and NSAIDS inc. bleeding riskreport bleeding |
| heparin bolus v. flush | bolus: 500-1000 units (loading dose)flush: 100 (maintain patency of IV lines) |
| oral anticoagulants examples | -abanvit K clotting factors and newer drugs (Rivaroxaban or Dabigatran) |
| warfarin | not suitable for emergencies because delayed onset of 1-3 days |
| Factor Xa inhibitors (rivaroxaban and apixaban) - oral anticoagulant | inhibit factor X in common pathway, alternative for stroke prevention, safe during pregnancy, and doesn’t require INR |
| thrombin inhibitor - oral anticoagulants | dabigatran has antidote (same as monoclonal antibody) |
| oral anticoagulants indications | prevents thrombi/emboli from forming or enlarging |
| oral anticoagulants side effects | bleedingwarfarin can cause birth defects |
| oral anticoagulants nursing implication | monitor labs and bleeding |
| oral anticoagulants pt education | take at same time everyday (best @ bedtime), report s/sx of bleeding, what to avoid for warfarin (leafy green veggies) |
| Heparin and LMWH antidote | protamine sulfate |
| Warfarin antidote | phytonadione (vit K) usually given SQFFP (dire need) |
| Heparin lab tests | aPTT or PTT: want between 60-70 secsplatelet count: risk of HIT (hep. induced thrombocytopenia) |
| warfarin lab tests | PT and INR (2-3 goal) |
| thrombolytic agents (clot busters) examples | -plasealteplase, reteplase, tenectplase |
| thrombolytic agents (clot busters) mech of action | dissolve clots via TPA (tissue plasminogen activors)promote process of fibrinolysis |
| thrombolytic agents (clot busters) primary use | disorders with intravascular clot already MI, ischemic stroke, PE, DVT |
| thrombolytic agents (clot busters) adverse effects | excessive bleeding |
| thrombolytic agents (clot busters) nursing implications | contraindicated in SNATCH (surgery in past month, neoplasia, allergy, traumatic injury in past month, CVA, HTN) |
| Iron def. anemia examples | ferrous sulfate, iron dextran |
| iron def. anemia mech of action | replacement therapy |
| iron def. anemia adverse effects | ferrous sulfate: nausea, heartburn, constipation, GI upset |
| iron def. anemia nursing implication | test dose prior to IV/IM, Z-track for IM, vit C enhances absorption, contraindicated for hemolytic anemia and hemochromatosis, and dark stool is normal |
| iron def. anemia pt education | best with food and OJ, increases fluid and fiber to prevent constipation |
| Vit B12 deficient anemia examples | Cyanocobalamin (vit B12) can be IM, SQ, intranasal and PO for vitamin supplement |
| Vit B12 deficient anemia mech of action | replacement therapy |
| Vit B12 deficient anemia indications | used to trate pernicious anemia (IM) and megablastic anemiapost gastrectomy needs parenteral route, nutritional deficits |
| Vit B12 deficient anemia adverse reactions | allergy, dizziness, headache, joint poain (arthralgia), hypokalemia |
| Vit B12 deficient anemia nursing implications | monitor for reactions, contraindicated in pts with severe pulmonary disease |
| Vit B12 deficient anemia pt education | teach importance of diet and rest (helps heal anemia) |
| folate def. anemia example | folate (vit B9) |
| folate def. anemia nursing implications | alcoholic vitamin deficiencies, prevent neural tube defects |
| RBC production anemia examples | Epoetin alpha and darbepoetin |
| RBC production anemia mech of action | stimulates BM production of erythrocytes |
| RBC production anemia indications | anemia from drugs, renal disease, chronic illness |
| RBC production anemia adverse effects | HTN (higher risk when IV) |
| RBC production anemia nursing implications | labs (when H/H is low) and BP |
| RBC production anemia pt education | nutrition and activity |
| sickle cell crisis | teach pts to prevent sickling event from occurring (physical exertion, illness, infection, dehydration, high alt, cold, stress, vasoconstriction) |
| hydroxyurea | prevention of sickle cell crisis |
| metered dose inhaler | inhalation route for pulmonary disorder; use propellent to deliver measured dose with each puff and best used with spacer |
| Nebulizer | inhalation route for pulmonary disorder; uses small machine to vaporize meds into mist and then inhaled |
| Dry powder inhaler (DPI) | inhalation route for pulmonary disorder; fine powdered drugs using devices that deliver a set amount |
| Disadvantages of inhalation route for pulmonary disorder | hard to get precise dose with MDI, potential side effects if drugs are swallowed and need to rinse out mouth |
| inhalation route for pulmonary disorder for nursing implication | shake canister and use spacer |
| asthma therapy goals | terminate acute attacks and prevent attacks |
| terminate acute attack examples | bronchodilators, corticosteroids, and oxygen |
| how to prevent asthma attacks | LABA- long acting beta agonists like Metrol, inhaled steroids, antileukotrienes, and monitor peak flow meter readings |
| Inhaled Adrenergic (bronchodilators) examples | -terolalbuterol, metaproterenol, levalbuterol |
| Inhaled Adrenergic (bronchodilators) systemic adrenergic | epinephrine (SC, IV) |
| Inhaled Adrenergic (bronchodilators) mech of action | relaxes smooth muscles of airway, increases airflow |
| Inhaled Adrenergic (bronchodilators) indications | Rapid acting (SABA- short acting beta agonists): rescue inhalersintermediate: rescue or preventionLABA (long acting beta agonists): prevention |
| Inhaled Adrenergic (bronchodilators) side effects | tachycardia and restlessness |
| Inhaled Adrenergic (bronchodilators) nursing implications | V/S and respiratory (retraction, nasal flaring, wheezing), O2 sat, lung sounds before or after, ABC- airway, breathing, circulation |
| Inhaled Adrenergic (bronchodilators) pt education | acute vs prevention management, bronchodilator first, rinse mouth after use |
| Inhaled anticholinergics (examples) | -tropiumipratropium, tiotropium |
| Inhaled anticholinergics mech of action | blocks parasympathetic NS and activates bronchodilationIpratropium has slower onset and less bronchodilation Tiotropium has longer duration |
| Inhaled anticholinergics side effects | similar to adrenergic, but less intense dry mouth, headache, cough, GI distress, anxiety |
| Inhaled anticholinergics nursing implication | combination products (ipratropium and albuterol) used to rapidly open airway (better together b/c of different peaks) |
| Inhaled anticholinergics pt education | can leave bitter taste in mouth so rinse after using |
| Methylxanthines examples | -ophylline Theophylline (PO)Aminophylline (IV or PO) |
| Theophylline | blood levels need to be drawn and monitored |
| Methylxanthines mech of action | relax bronchial muscles, bronchodilation, and improve air flow |
| Methylxanthines indication for use | status asthmaticus when unresponsive to other tx; reserved for pts who do NOT respond to anticholinergics or adrenergics |
| status asthmaticus | when unresponsive to other tx; beta 2 agonist → anticholinergic → epinephrine → glucocorticosteroids IV → Methylxanthines |
| Methylxanthines side effects | CNS stim (anxiety, hand tremors, insomnia) and indicators of toxicity (tachycardia, nausea, vomiting, seizures) |
| Methylxanthines nursing implications | VS and respiratory assessments; drug levels leading to risk of toxicity of ineffective dose |
| Methylxanthines pt education | avoid caffeine and other stimulants due to effect on CNS, teach signs of toxicity |
| Corticosteroids inhaled agent examples | -sone/-lone beclomethasone, fluticasone, traimcinolone - used to prevent asthmatic attacks |
| Corticosteroids systemic agent examples | prednisone, methylprednisone, prednisolone - usually reserved for acute and severe exacerbation of asthma for short-term management |
| Corticosteroids mech of action | prevents release of chemical mediatorsdampen activation of inflammatory cells and inc production of anti-inflammatory mediators |
| Corticosteroids side effects of inhaled agents | oropharyngeal candidiasis (rinse mouth out after use), hoarseness, dry mouth, cough, sore throat |
| Corticosteroids inhaled pt education | dec. unwanted side effects with long term steroid use, rinse mouth after use, report white patches, use bronchodilators first |
| Corticosteroids systemic steroids | monitor for infection and blood sugar (immunosuppressive quality and hyperglycemia), taper before D/C to prevent adrenal gland atrophytake in am with food to prevent GI upset |
| Anti-leukotrienes examples | -lukastmontelukast, zafirlukast |
| Anti-leukotrienes mech of action | block leukotriene receptors in airwayprevent inflammation and mucus production |
| Anti-leukotrienes indications | prevent inflammation from asthma |
| Anti-leukotrienes side effects | CNS stimulation, headache, cough, nasal congestion, GI upset |
| Anti-leukotrienes nursing implication | monitor respiratory status and CNS stimulation |
| Anti-leukotrienes pt education | take daily |
| expectorants examples | guaifenesin (common in OTC meds) |
| expectorants mech of action | stimulate bronchial gland secretion, thins and liquifies respiratory secretions, inc. ease of coughing and eliminating sputum, and eliminates pathogen before reaching lower respiratory structures |
| cough medications | expectorants, mucolytic, antitussives |
| expectorants indications for use | ONLY if pt can cough |
| expectorants side effects | nausea and sedative |
| expectorants nursing implications | monitor for fever or signs of active infection |
| expectorants pt education | increase fluid intake to have productive cough |
| mucolytic examples | acetylcysteine |
| mucolytic mech of action | breaks chem bonds of mucus molecules |
| mucolytic indications for use | viscous mucus (thick) and tenacious (tight), administered with nebulizer |
| mucolytic side effects | bronchospasms, stomatitis, nausea (smells bad) |
| mucolytic nursing implications | never use for acute asthma attack, pt rinse mouth after treatment (prevent stomatitis)encourage coughing and expectorate secretionsrespiratory assessments (determine if they can eliminate secretions)antidote for acetaminophen overdose (protecting liver) |
| antitussives examples | opoid (hydrocodone and codeine) or non-opoid (benzonatate/Tessalon Perles or dextromethorphan) |
| antitussives mech of action | both opioid and non-opioids raise threshold in CNSbenzonatate suppresses rough reflex by anesthetizing stretch receptors in lungs |
| antitussives side effects | opioid: dependence, fall risk (sedating effect), constipation |
| antitussives nursing implication | avoid fluids x 30 min, safety precautions, give benzonatate whole (could anesthetize throat and risk of choking), check respiration rate |
| antitussives pt education | safety precautions, avoid alcohol (inc sedation), inc fluid and fiber to prevent constipation |
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AV25
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