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VN 140 RESP PHARM
VN 40 RESP PHARM
| Question | Answer |
|---|---|
| how do you treat a common cold? | combined use of antihistamines, nasal decongestants, antitussives, and expectorants |
| Common cold treatment | it is SYMPTOMATIC only, it does not eliminate the causative pathogen. |
| empiric therapy | treating the most likely cause |
| ANTIHISTAMINES | drugs that directly compete with histamine for specific receptor sites. These are the H1 antagonists. |
| what are the effects of Antihistamines | 1) antihistaminic 2) anthicholinergic 3) sedative |
| ANTIHISTAMINES - Mechanism of Action | BLOCK action of histamine at the receptor sites. Compete with histamine for binding at unoccupied receptors. CANNOT push histamine off the receptor if already bound. |
| what do binding of the H1 blockers do to the histamine receptors when preventing the adverse consequences of the histamine stimulation? | 1) vasodilation 2) increased GI and respiratory secretions 3) increased capillary premeability |
| ANTIHISTAMINES - Histamine - cardiovascular (small blood vessels) | dilation & increased permeability (allowing substances to leak into tissues) |
| ANTIHISTAMINES - AntiHistamine - cardiovascular (small blood vessels) | 1) prevent dilation of blood vessels and 2) prevent increased permeability |
| ANTIHISTAMINES - Histamine - smooth muscle (on exocrine glands) | stimulate salivary, gastric, lacrimal and bronchial secretions |
| ANTIHISTAMINES - AntiHistamine - smooth muscle (on exocrine glands) | prevent salivary, gastric, lacrimal and bronchial secretions |
| ANTIHISTAMINES - Histamine - Immune system (release of substances commonly assoc w allergic reactions | mast cells release histamine and other substances, resulting allergic reactions |
| ANTIHISTAMINES - AntiHistamine - Immune system (release of substances commonly assoc w allergic reactions | binds to histamine receptors, thus preventing histamine from causing a response |
| ANTIHISTAMINES - OTHER EFFECTS - SKIN | block capillary permeability, wheal and flare formation, itching |
| ANTIHISTAMINES - OTHER EFFECTS - ANTICHOLIGERNIC | drying effect that reduces nasal, salivary, and lacrimal gland secretions (runny nose, tearing, and itchy eyes) |
| ANTIHISTAMINES - OTHER EFFECTS - SEDATIVE | some antihistamine cause drowsiness (ie benadryl) |
| ANTIHISTAMINES - Therapeutic uses | mgmt of nasal allergies, seasonal or perennial allergic rhinitis (hay fever) allergic reactions, motion sickness, sleep disorders |
| ANTIHISTAMINES - SIDE EFFECTS | Anticholigernic drying effects, most common dry mouth, difficulty urination, constipation, changes in vision. DROWSINESS |
| what are the two types of ANTIHISTMINES | 1) traditional 2) nonsedating/peripherally acting |
| TRADITIONAL ANTIHISTAMINE | older, work both peripherally and centrally 3) have anticholigernic efffects, making them more effective than nonsedating agents in some cases |
| TRADITIONAL ANTIHISTAMINE - drugs | diphenhydramine (BENADRYL) and chlorpheniramine (Chlor-Trimeton) |
| NONSEDATING/PERIPHERALLY ACTING ANTIHISTAMINES | developed to eliminate unwanted side effects mainly sedation. 1) work peripherally to block actions of histamine thus fewer CNS side effects 2) longer duration of action |
| NONSEDATING/PERIPHERALLY ACTING ANTIHISTAMINES - drugs | fexofenadine (Allegra) loratadine (Claritin) |
| ANTIHISTAMINE - Nursing Implication | 1) gather data abt condion or allergic reaction; assess for drug allergies. 2) contraindicated in the presence of ACUTE ASTHMA attacks and lower respiratory disease. 3) use with caution in increased intraocular pressure, hypertension |
| ANTIHISTAMINE - Nursing Implication | 4) intruct pt to report excessive sedation, confusion, hypotension, 5) avoid driving 6) do not take with with other prescribed or OTC meds without checking with prescriber |
| ANTIHISTAMINE - Nursing Implication | 7) taken with meals (reduce GI upset) 8) if dry mouth, teach pt to perform freq mouth care, chew gum |
| DECONGESTANT | 1) treat nasal congestion (excessive nasal secretions and inflammed and swollen nasal mucosa) SITE OF ACTION: BLOOD VESSELS SURROUNDING NASAL SINUSES |
| what are the primary causes of nasal congestion | 1) allergies 2) upper respiratory infections (common cold) |
| what are the 2 main types used for DECONGESTANT? | 1) adrenergics (largest grp) and 2) corticosteroids |
| what are the 2 dosage forms for Decongestant? | 1) orally and 2) inhaled/topically applied to nasal membranes |
| ORAL DECONGESTANTS | 1) prolonged decongestant effects but delayed onset 2) effect less potent than topical 3) no rebound congestions 4) EXCLUSIVELY ADRENERGICS |
| ORAL DECONGESTANTS - drugs | phenylephrine and pseudoephedrine (Sudafed) |
| TOPICAL NASAL DECONGESTANTS | both adrenergics and steroids 2) prompt onset 3) potent 4) sustained use over several days causes rebound congestion, making the condition worse |
| TOPICAL NASAL DECONGESTANTS - drugs- ADRENERGICS | ephedrine (Vicks) oxymetazline (Afrin) |
| TOPICAL NASAL DECONGESTANTS - drugs- INTRANASAL STEROIDS | beclomethasone dipropionate (Beconase, Vancenase), flunisolide (Nasalide) |
| NASAL DECONGESTANT - mechanism of action - Adrenergics | 1) constrict small blood vessels that supply URT structures, 2) result: tissues shrink and nasal secretions in the swollen mucous membranes are better able to drain 3) nasal stuffiness is relieved |
| NASAL DECONGESTANT - mechanism of action - Nasal steroids | 1) anti-inflammatory effect 2) work to turn off the immune system cells involved in the inflammatory response 3) decreased inflammation results in decreased congestion |
| NASAL DECONGESTANT -Therapeutic effects | acute or chronic rhinitis, common cold, sinusitis, hay fever, other allergies |
| NASAL DECONGESTANT -Side effects - Adrenergics | nervousness 2) insomnia 3) palpitations 4) tremors |
| NASAL DECONGESTANT -Side effects - Steroid | local mucosal dryness and irritation |
| NASAL DECONGESTANT -Nursing implications | may cause hypertension, palpitations and CNS stimulation - avoid pt with these conditions. 2) assess for drug allergies 3) avoid caffeine 4) report fever, cough or other symptoms lasting longer than a wk |
| COUGH | respiratory secretions of foreign objects are naturally removed by the cough reflex (it induces couging and expectoration; intitiated by irritation of sensory receptors in the resp tract) |
| what are the two types of Cough | productive and non productive |
| ANTITUSSIVES | drugs used to stop or reduce coughing; USED ONLY FOR NONPRODUCTIVE COUGHS!!! |
| what are the two types of Antitussives | 1) opioid (narcotic) 2) Nonopioid (non-narcotic) |
| ANTITUSSIVE - OPIOID | suppress the cough reflex by direct action on the cough center in the medulla |
| ANTITUSSIVE - OPIOID -drug | codeine (Robitussin A-C), Dimetane - DC), hydrocodone |
| ANTITUSSIVE - NONOPIOID | suppress the cough reflex by numbing the stretch receptors in the resp tract and preventing the cough reflex from being stimulated |
| ANTITUSSIVE - NONOPIOID -drug | benzonatate (Tessalon) detrmethorphan (Vicks44 and Robitussin DM) |
| ANTITUSSIVE - SIDE EFFECT - Benzonatate | dizziness, headache, sedation |
| ANTITUSSIVE - SIDE EFFECT - dextromethorphan | dizziness, drowsiness, nausea |
| ANTITUSSIVE - SIDE EFFECT - opioids | sedation, nausea, vomiting, lightheadedness, constipation |
| ANTITUSSIVE - Nursing implications | perform resp & cough assessment & allergies. 2) instruct pt to avoid driving 3) if chewing lozenges, do not drink liquids for 30 to 35 mins afterward |
| ANTITUSSIVE - Nursing implications | REPORT the following symptoms to the caregiver: 1) cough that lasts for more than a wk 2) persistent headache 3) fever 4) rash |
| EXPECTORANTS | drugs that aid in the expectoration (removal) of mucus. 2) reduce the viscosity of secretions 3) disintegrate and thin secretions |
| EXPECTORANTS - mechanism of actions | 1) Direct stimulation 2) Reflex stimulation |
| EXPECTORANTS - REFLEX STIMULATION | agent causes irritation of the GI tract 2) loosening and thinning of the resp tract secretions occur in response to this irritation |
| EXPECTORANTS - drug effect | by loosening and thinning sputum and bronchial secretions, the tendency to cough is indirectly diminished |
| EXPECTORANTS - side effect - guaifenesin | nausea, vomiting, gastric irritation |
| EXPECTORANTS - side effect - terpin hydrate | (has a high alcohol level) gastric upset, |
| EXPECTORANTS - Nursing implicatins | shld be used w caution w the elderly or with asthma or resp insufficiency 2) should receive more fluids to loosen and liquefy secretions 3) report fever cough lasting longer than a wk |
| what are the two types of BRONCHODILATORS | Xanthine derivatives and Beta - agonists |
| B - XANTHINE DERIVATIVES | 1) increase level of energing producing cAMP 2) done competitively inhibiting phosphodiesterase (enzyme that breaks cAMP) 3) result: decreased cAMP level, smooth muscle relaxation, bronchodilation and increased airflow |
| B - XANTHINE DERIVATIVES - drugs | theophylline |
| B - XANTHINE DERIVATIVES - drug effect | relief of bronhospasm and greater airflow in and out of lungs. Causes CNS stimulation and cardiovascular stimulation |
| B - XANTHINE DERIVATIVES - therapeutic uses | 1) dilation of airwas in asthmas, chronic bronchitis and emphysema 2) mild to moderate cases of asthma 3) adjunct agent in mgmt of COPD 4) adjunct therapy for the relief of pulmonary edema |
| B - XANTHINE DERIVATIVES - side effect | nausea, vomiting, anorexia, GERD during sleep, sinus tachycardia |
| B - BETA-AGONISTS | large group, sympathomimetics, used during ACUTE PHASE OF ASTHMATIC ATTACKS 3) quickly reduce airway constriction & restore normal airflow 4) stimulate beta2 adrenergic receptors throughout the lungs |
| what are the 3 types of Beta Agonists | 1) nonselective adrenergics 2) nonselective beta-adrenergics 3) selective beta2 drugs |
| B - BETA-AGONISTS - NONSELECTIVE ADRENERGICS | stimulates alpha1, beta1(cardiac), and beta2 (respiratory) receptrs |
| B - BETA-AGONISTS - NONSELECTIVE ADRENERGICS - drug | ephinephrine |
| B - BETA-AGONISTS - NONSELECTIVE BETA-ADRENERGICS | stimulate bth beta1 and beta2 receptors |
| B - BETA-AGONISTS - NONSELECTIVE BETA-ADRENERGICS - drug | isoproterenol (Isuprel) |
| B - BETA-AGONISTS - SELECTIVE BETA2 DRUGS | stimulate only beta2 receptors |
| B - BETA-AGONISTS - SELECTIVE BETA2 DRUGS-drugs | albuterol |
| B - BETA-AGONISTS - mechanism of action | begins at the specific receptor stimulated 2) ends with the dilation of airways |
| B - BETA-AGONISTS - therapeutic use | 1) relief of bronchospasm, bronchial asthma, bronchitis, other pulm disease 2) treatment of acute attacks as well as prevention 3) used in hypotension and shock 4) used to produce uterine relaxation to prevent premature labor 5) hyperkalema (stimulate pot |
| B - BETA-AGONISTS - side effect | isomnia, restlessness, hypotension, anginal pain, cardiac stimulation, vascular headaches, tremor, anorexia |
| what is the only anticholigernic used for resp disease? | Ipratroprium bromide (Atrovent) |
| ANTICHOLIGERNIC | slow and prolonged action 2) used to prevent bronchoconstriction. Acetylcholine (Ach) causes bronchial constriction and narrowing of pathways. It binds the Ach receptors preventing Ach from binding |
| ANTICHOLIGERNIC - side effect | dry mouth, GI distress, headache, anxiety, coughing |
| ANTILEUKOTRIENES | also called leukotriene receptor antagonist (LRTAs). New class of asthma med |
| what are the 3 subcategories of ANTILEUKOTRIENES | 1) montelukast (Singulair) 2) zafirlukast (Accolate) 3) zeleuton (Zyflo) |
| Leukotrienes | are substances released when a trigger, such as cat hair or dust, starts a series of chemical reactions in the body. It causes inflammation, bronchoconstriction and mucus prod |
| Leukotrienes result | wheezing, coughing and shortness of breath |
| ANTILEUKOTRIENES | prevents leukotrines frm attaching to receptors on cels in lungs and circulations. 2) inflammation in the lungs is BLOCKED and asthma symptoms are relieved |
| ANTILEUKOTRIENES - drug effect | prevent smooth muscle contraction of the bronchial airways, decrease mucus secretion, prevent vascular permeability |
| ANTILEUKOTRIENES - drug given to children | MONTELUKAST |
| ANTILEUKOTRIENES - therapeutic effect | not meant for management of acute Asthmatic attaks. Prophylaxis and chronic treatment of asthma |
| ANTILEUKOTRIENES - nursing implication | ensure that drug is being used for chronic mgmt of asthma, not acute astma. Improvement should be seen in about a wk. assess liver function. Med should be taken every night on continuous sched |
| CORTICOSTEROIDS | antiinflammatory, used for CHRONIC asthma, do not relieve symptom of acute asthmatic attacks, oral or inhaled forms, inhaled forms reduce systemic effects, may take several wks before full effects are seen |
| CORTICOSTEROIDS - inhaled drugs | beclomethane dipropionate (Beclovent, Vanceril), trimcinolone acetonide (Azmacort) dexamethason sodium phosphate (Decadron Phosphate Respihaler) |
| CORTICOSTEROIDS - mechanism f actin | stabilize membranes of cell that release harmful bronchoconstricting substances. Those cells are leukocytes or white blood cells. Also increase responsiveness of bronchial smooth muscle t beta-adrenergic stimulatin |
| CORTICOSTEROIDS - nursing implicatins | teach pts to gargle and rinse mouth afterward |
| MAST CELL STABILIZERS | indirect acting agents that prevent release of the various substances that cause bronchospasm. Stabilize the cell membranes of inflammatory cells. NO DIRECT BRONCHIDILATOR activity. Use as prevention(prophylactically) |
| MAST CELL STABILIZERS -nursing implicatins | contraindicated fr acute exacerbations, not recommended for children under age 5, therap effect may not be seen for up to 4 wks. Teach pt to gargle and rinse mouth |
| MAST CELL STABILIZERS -therapeutic uses | adjuncts overal mgmt of COPD, used to prevent exercise induced bronchospasm |
| MAST CELL STABILIZERS -drugs | cromolyn (Nasalcrm) and nedocrmil (Tilade) |
Created by:
jekjes
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