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rsp meds
respiratory meds
| Question | Answer |
|---|---|
| What is the primary function of the respiratory system? | bring oxygen into the body and remove carbon dioxide |
| What is the process by which gasses are exchanged called? | respiration |
| What is the process of moving air in and out of the lungs called? | ventilation |
| What is inhalation called? | inspiration |
| What is exhalation called? | expiration |
| When the diaphragm contracts, is air drawn in or let out of the lungs? | drawn in |
| When the diaphragm contracts what kind of pressure is created? | negative |
| When the diaphragm relaxes it raises in position and air: | leaves the lungs passively |
| How many times per minute does respiration occur? | 12-18 |
| What controls the rate of respiration? | neurons in brain stem (medulla and pons) |
| Respiration is modified by what? | emotions, fever, stress, pH of blood |
| What pathway does air take entering the respiratory system? | nose-pharynx-trachea-bronchi-bronchioles-alveoli |
| What separates alveoli and pulmonary capillaries? | thin membrane |
| What does the membrane between the alveoli and pulmonary capillaries do? | allow gasses to move between blood and inspired air |
| Oxygen moves from _______to _______, passing through the membrane. | air;blood |
| Carbon dioxide moves from ________to___________ through membrane. | blood;air |
| What is blood flow through the lung called? | perfusion |
| Bronchioles can do what in order to meet the needs of the body? | change in diameter |
| What kind of muscle is in the wall of bronchioles? | smooth |
| Smooth muscle is controlled by what? | ANS |
| In “flight or fight” response, beta2 receptors of sympathetic nervous system are stimulated. What happens to bronchiolar smooth muscle? | relaxes causing the lumen to widen |
| Bronchodilation occurs causing what? | more air to enter alveoli and increases the oxygen to the body |
| What is stimulated when at rest? | parasympathetic nervous system |
| What happens to the lumen when bronchiolar smooth muscle contracts? | narrows |
| How fast is the action of inhaled substances? | almost immediate |
| Why are drugs administered by the inhalation route? | local effect:immediate relief of bronchospasm, loosen thick mucus in the bronchial tree, drug delivered directly where it is needed |
| What small machine vaporizes a liquid drug into a fine mist to be inhaled? | nebulizer |
| What device is activated by inhalation and used to inhale a powdered solid? | dry powder inhaler (DPI) |
| What device uses a propellant to deliver a measured dose of drug during inhalation? | metered dose inhaler (MDI) |
| What should a patient use with a metered does inhaler to make sure they get the medication into the lungs instead of the nasopharynx? | chamber/spacer |
| What is a common chronic condition in the U.S. that affects 15 million people? | asthma |
| What can acute bronchospasm during asthma cause? | dyspnea, coughing, gasping for air |
| During asthma an acute inflammatory response is activated causing what? | mucus secretion, edema of airway |
| What causes asthmatic attacks? | chronic airway inflammation |
| What is a severe, prolonged form of asthma that is unresponsive to drug treatment? | status asthmaticus |
| What can status asthmaticus lead to? | respiratory failure |
| What is the goal of drug therapy for asthma? | terminate acute bronchospasms in progress, reduce frequency of acute asthma attacks |
| Beta adrenergic agonists are what? | sympathomimetrics |
| Beta adrenergic agonists are selective for what? | beta2 receptors in lungs |
| There are fewer what with selective beta2 adrenergic agonists? | cardiac side effects |
| When beta adrenergic agonists are inhaled, what happens to bronchiolar smooth muscle? | relaxes, producing rapid bronchodilation |
| What risk for toxicity do beta adrenergic agonists produce? | little systemic toxicity |
| What are the frequent side effects of oral beta-adrenergic agonists? | tachycardia, tremor |
| What route of beta adrenergic agonist has a longer duration of action? | oral |
| What may develop to therapeutic effects of beta agonists? | tolerance |
| What do you want to assess in patients on beta adrenergics? | adherence to medicine regimen, side effects, medical history |
| What problems can arise from patients with history of cardiac dysrhythmias or MI who take beta adrenergics? | inc demand on heart, risk for hypokalemia, inc risk for dig toxicity |
| What kind of thyroid issue do you want to assess for in patients taking beta adrenergics? | hyperthyroidism |
| What can happen to diabetics on beta adrenergics? | hyperglycemia |
| What should patients limit the intake of when taking beta adrenergics? | caffeine |
| What should be reported immediately when patients are taking beta adrenergics? | dyspnea, palpitations, tremor, vomiting, nervousness, vision changes |
| What kind of drug is salmeterol (Serevent) | beta adrenergic agonist |
| What does salmeterol (Serevent) bind to? | beta2 adrenergic receptors in bronchial smooth muscle |
| What is the duration of action of salmeterol (Serevent) | 12 hours |
| What is the onset of action of salmeterol (Serevent) | 15-25 minutes |
| What is salmeterol (Serevent) used for? (prevention or treatment of acute attack) | prevention |
| What are possible side effects of salmeterol (Serevent)? | HA, nervousness, restlessness, tachycardia |
| What two drugs are methylxanthines (aka xanthines), the drugs of choice for bronchoconstriction 20 years ago, and chemically related to caffeine? | theophylline (Theo-dur) and aminophylline (Somophylline) |
| What is theophylline primarily used for? | long term oral prophylaxis of persistent asthma; low doses in conjunction with other meds |
| What are the side effects of theophylline? | nausea and vomiting, CNS stimulation, dysrhythmias at high doses, interacts with many drugs, narrow margin of safety |
| What should you avoid when taking theophylline? | caffeine |
| What are the side effects of methylxanthines? | dysrhythmias (usually tachycardia), nausea and vomiting (usually getting close to toxic), cough and drying mucous membranes (keep well hydrated) |
| What do anticholinergic drugs do? | block parasympathetic nervous system |
| What do anticholinergic drugs cause? | bronchodilation |
| What do anticholinergic drugs prevent? | bronchospasm |
| What are the most widely used anticholingeric drugs? | ipratropium (Atrovent, Combivent) |
| What route is ipratropium (Atrovent, Combivent) taken by? | inhaled |
| Ipratropium (Atrovent, Combivent) has few system side effects, but is less effective than what type of drug? | beta-agonists |
| What do you want to assess before and after dosing a client with anticholinergics? | respiratory rate |
| What do you want to monitor on patients on anticholinergics? | VS, I&O |
| Who is at risk for toxicity with anticholinergics? | the elderly |
| Cautious us of anticholinergics in patients with a history of what? | BPH or glaucoma |
| What should patients immediately report when on anticholinergics? | imability to urinate or have a BM, severe HA, palpitations, SHOB, vision changes or eye pain |
| How does ipratropium (Atrovent, Combivent) work? | blocks cholinergic receptors in bronchial smooth muscle which causes bronchodilation |
| What does ipratropium (Atrovent, Combivent) relieve? | acute bronchospasm |
| What else is ipratropium (Atrovent, Combivent) prescribed for? | chronic bronchitis |
| Adverse effects and interactions of ipratropium (Atrovent, Combivent): | proper use of inhaler is essential, avoid contact with the eyes |
| Administration alert of ipratropium (Atrovent, Combivent): | few systemic effects, cough, dry mucous membranes, hoarseness, bitter taste |
| Patient goals and expected outcomes with ipratropium (Atrovent, Combivent): | exhibit adequate oxygenation, reduction in subjective symptoms, report at least 6 hours of uninterrupted sleep, demonstrate an understanding of drug effects and precautions |
| How would you determine if the goal was met for patients on ipratropium (Atrovent, Combivent): | they can tell you about it |
| When should patients use ipratropium (Atrovent, Combivent)? | even if asymptomatic (it is a preventative drug) |
| What should patients on ipratropium (Atrovent, Combivent) be taught? | proper use of inhaler, controlled breathing technique (ie pursed lip breathing), relaxation techniques, avoid respiratory irritants (second hand smoke) |
| Nutritional interventions for patients on ipratropium (Atrovent, Combivent): | small freq meals, 3-4 L of fluid a day, avoid caffeine |
| What are glucocorticoids used for? | long term prophylaxis of asthma |
| What is the most effective drug available for prevention of acute asthmatic episodes? | glucocoritcoids |
| Are glucocorticoids effective in stopping episodes of acute asthma while they are in progress? | no |
| Sometimes what else is prescribed with glucocorticoids? | beta-adrenergic agonists |
| Glucocorticoids suppress inflammation without major side effects but can contribute to what? | osteoporosis, growth retardation |
| If patient is on bronchodilator and steroid, which should be administered first? | bronchodilator (always administer bronchodilator before other meds to open the airways) |
| What are oral glucocorticoids prescribed for? | severe, persistent asthma unresponsive to other treatments |
| How are oral glucocorticoids usually taken? | as a “burst” |
| What significant adverse effects can be produced if oral glucocorticoids are taken longer than 10 days? | adrenal gland suppression, peptic ulcers, hyperglycemia (whether diabetic or not) |
| What patient history should be assessed for glucocorticoids? | asthma, seasonal rhinitis, HTN (use cautiously), CV disease (CHF), blood clots, VS, body weight, signs of infection |
| What should be monitored daily and reported if any elevations for the patient on glucocorticoids? | temp and BP |
| If diabetic and on glucocorticoids, what should be monitored more closely? | blood sugar |
| What should be reported for the patient on glucocorticoids? | tarry stools, edema, dizziness, dyspnea |
| What should patients do after using inhaled glucocorticoids? | rinse mouth to avoid thrush |
| What kind of drug is beclomethasone (Beclovent, Beconase, Vancenase, Vanceril)? | glucocorticoid |
| How is beclomethasone (Beclovent, Beconase, Vancenase, Vanceril) prescribed for asthma? | aerosol inhalation |
| How is beclomethasone (Beclovent, Beconase, Vancenase, Vanceril) prescribed for allergic rhinitis? | nasal spray |
| How does beclomethasone (Beclovent, Beconase, Vancenase, Vanceril) work to decrease asthma attacks? | reduces inflammation |
| Will beclomethasone (Beclovent, Beconase, Vancenase, Vanceril) stop acute asthma attacks? | no it’s preventative |
| SE of beclomethasone (Beclovent, Beconase, Vancenase, Vanceril): | hoarseness, candidiasis/thrush, can mask an infection |
| What are the two mast cell stabilizers? | cromolyn and nedocromil |
| What are mast cell stabilizers used for? | asthma prophylaxis |
| How do mast cell stabilizers work? | prevent mast cells from releasing histamine and other chemical mediators of inflammation |
| What do mast cells release? | histamine and “other stuff” |
| What kind of drug is cromolyn (Intal)? | anti-inflammatory drug |
| What is the intranasal form of cromolyn (Intal) used for? | treat seasonal allergies |
| How is cromolyn (Intal) administered for asthma? | MDI or nebulizer |
| Cromolyn (Intal) is a safe alternative to: | glucocorticoids |
| Is cromolyn (Intal) used to stop acute attacks or prevent asthma attacks? | prevent |
| What is another anti-inflammatory drug with similar actions and uses as cromolyn? | nedocromil (Tilade) |
| What are leukotriene modifiers used for? | athma prophylaxis (prevention) |
| What do leukotriene modifiers prevent? | airway edema, inflammation, bronchoconstriction |
| What route are the three leukotriene modifiers taken by? | PO |
| What are the three leukotriene modifiers? | zileuton (Zyflo), zafirlukast (Accolate), montelukast (Singulair) |
| Leuotriene modifiers are not effective for acute asthma attacks. Why? | They are not bronchodilators |
| What are the adverse effects of leukotrienes? | HA, cough, nasal congestion, GI upset, increased risk of infection for patients >55, contraindicated w/hepatic dysfunction or in alcoholics |
| What is a normal reflex to forcibly remove excess secretions and foreign material from bronchial tree called? | cough |
| What do antitussives do? | control cough |
| What kind of cough are antitussives used for? | dry, hacking, nonproductive |
| Why should you not use antitussives on clients who have emphysema and bronchitis? | do not want to suppress cough |
| What are the most effective class of antitussives? | narcotic analgesics |
| What schedule is codeine cough mixtures? | schedule V drug |
| What is the most frequently used OTC antitussive? | drextromethorphan (DM) |
| What kind of drug is benzonatate (Tessalon)? | non-opioid antitussive |
| What happens if you chew benzonatate (Tessalon)? | numbing of the mouth |
| What are possible side effects of benzonatate (Tessalon)? | sedation, nausea, HA, dizziness |
| What do you want to monitor in a patient taking drugs containing codeine? | drowsiness |
| Patient education regarding codeine antitussives: | avoid driving or operating machinery, avoid alcohol (CNS depression), store all meds away from children |
| Where does dextromethorphan (Benylin, DM) work? | the medulla |
| How faxt does dextromethorphan (Benylin, DM) work? | 15-30 minutes |
| What do you do if dextromethorphan (Benylin, DM) is ineffective? | consult HCP |
| Adverse effects and interactions of dextromethorphan (Benylin, DM): | avoid resp irritants, avoid MAOIs, avoid alcohol |
| Administration alert for dextromethorphan (Benylin, DM): | dizziness, drowsiness, GI upset |
| What are expectorants and mucolytics used for?: | removing thick bronchial secretions |
| How do expectorants and mucolytics work? | reduce thickness (viscosity) of bronchial secretions (increase mucus flow, remove more easily by coughing) |
| What is the most effective OTC expectorant? | guaifenesin (Mucinex, Humibid) |
| How is acetylcysteine (Mucomyst) administered? | inhalation |
| What drug is used in cystic fibrosis or other diseases that produce large amounts of thick bronchial secretions? | acetylcysteine (Mucomyst) |
| What drug is an antidote to acetaminophen toxicity? | acetylcysteine (Mucomyst) |
| What are the two primary disorders classified as COPDs? | chronic bronchitis, emphysema |
| What is excessive mucus produced in bronchial tree due to inflammation and irritation called? | chronic bronchitis |
| Signs of chronic bronchitis: | dyspnea, wheezing, coughing |
| In what condition are the airways partially obstructed with mucus (productive cough in the morning)? | chronic bronchitis |
| Exchange of what is impaired with chronic bronchitis? | gasses |
| With what condition are pulmonary infections common? | chronic bronchitis |
| What is the terminal stage of COPD? | emphysema |
| What happens in emphysema? | bronchioles loose elasticity |
| Why do alveoli dilate to maximum size with emphysema? | to get more air into the lungs |
| What is a sign of emphysema? | extreme dyspnea with slightest physical activity |
| Goals of drug therapy for COPD: | treat infections, control cough, control bronchospasm |
| What do pharmacological therapies for COPD do? | only treat symptoms (do not cure it) |
| What drugs are used in COPD? | bronchodilators, mucolytics, expectorants |
| During a visit a patients asks the nurse if it matters which inhaler he uses first, the albuterol or the ipratroprium. How would you respond? | use the albuteral first to open the airways and allow the ipratroprium to enter more easily |
| Glucocorticoids are a natural hormone. What secretes it? | the adrenal cortex |
| Action of glucocorticoids: | affect almost every cell, suppress histamine and prostaglandin, inhibit immune system |
| Uses of glucocorticoids: | reduce inflammation, short term treatment |
| Adverse effects of steroids: | suppression of adrenals, hyperglycemia, mood changes, cataracts, peptic ulcers, electrolyte imbalances, osteoporosis, mask infections |
| Physical changes associated with steroids: | moon face, acne, buffalo hump |
| What should you screen for in patients who are going to use steroids? | screen for existing infections |
| What should patients be monitored for on steroids? | electrolyte imbalance (Na retention), mental and emotional status, hyperglycemia, mania (in bipolar patients) |
| Monitor for Cuhsing’s syndrome for patients on steroids. What are signs of Cushing’s syndrome? | bruising, abnormal fat distribution (moon face, buffalo hump, abd) |
| What drug can exacerbate myasthenia gravis? | steroids |
| What drug can cause gastric ulcers? | steroids |
| Patient education related to steroid use: | consult with HCP prior to immunizations, report dizziness, palpitations, HA, fever, cough, sore throat, joint pain, weakness, excess wt gain, thirst, copious urine, insatiable appetite, GI SE |
| Who should patients on steroids avoid? | people with infections |
| What kind of food should people on steroids eat? | high protein, Ca, K, low fat, avoid simple carbohydrates |
| What type of drug is prednisone (Meticorten)? | steroid |
| How long should prednisone (Meticorten) be used? | 4-10 days; alternate dosing for long term therapy |
| Alerts for prednisone given IM: | give deep |
| How should prednisone be stopped? | not abruptly (taper off) |
| What should people on prednisone be monitored for? | monitor vigilantly for systemic infection |
| Many drug interactions with prednisone are potentiated with: | licorice |
| What is allergic rhinitis also called? | hay fever |
| Causes of inflammatory response: | hyper/over reaction of body defenses |
| What is released in action to an antigen during an inflammatory response? | histamine |
| Antigen = what? | allergen |
| What is an antigen? | anything recognized as foreign by the body |
| Examples of potential antigens: | food, chemicals (tobacco smoke), drugs, pollen (weeds, grass, trees), animal proteins (dander, insulin derived from animals, dust mites, dust) |
| Symptoms of antigens: | similar to inflammation because the body reacts the same way, tearing eyes, sneezing, nasal congestion, post nasal drip, itching throat, urticaria |
| Preventer drugs for allergic rhinitis: | prophylaxis, antihistamines, glucocorticoids, mast cell stabilizers |
| Drugs for allergic rhinitis give what kind of relief? | temporary |
| What kind of drugs are h-1 receptor antagonists? | anticholinergics; antihistamines |
| When are h-1 receptor antagonists most effective? | when taken to prevent symptoms |
| What does the ‘h’ im h-1 receptor antagonist stand for? | histamine |
| First generation anti-histamines have a significant side effect. What is it? | drowsiness |
| Examples of first generation anti-histamines: | Dimetapp, chlor-trimeton, tavist, benadryl |
| What route is benadryl available in? | PO, IM, IV, topical |
| Second generation anti-histamines have less sedation. What are some examples of these drugs? | Claritin, zyrtec, clarinex, allegro |
| Which OTC cold and sinus medicines are combined with decongestants and antitussives? | ”D”, usually pseudoephedrine and behind the counter |
| What should the elderly be monitored for with first generation H-1 receptor antagonists? | profound sedation and altered consciousness |
| Contraindications for first generation H-1 receptor antagonists: | hx of dysrhythmias, CHF, CNS depression, depression, sleep disorders, glaucoma, pregnancy, breast feeding |
| What should patients immediately report whne taking first generation H-1 receptor antagonists? | wheezing, dyspnea, HA, dizziness, palpitations, seizures, chest arm or back pain with nausea vomiting and sweating, nervousness, insomnia, thirst, mood changes, visual changes, reduced U.O., sx of hypoglycemia |
| Instruct patients on first generation H-1 receptor antagonists to do what? | wear dark glasses, use sunscreen, avoid driving or operating heavy equipment, hard candy will relieve dry mouth |
| Contraindications for second generation H-1 receptor antagonists: | dysrhythmias (prolong QT interval), asthma, nicotine dependence |
| Precautions for second generation H-1 receptor antagonists: | liver or renal impairment |
| How should loratadine (Claritin) be given? | on an empty stomach |
| Examples (trade names) of intranasal glucocorticoids: | Beconase, Vancenase, Rhinocort, Nasarel, Flonase, Nasonex, Nasacort AQ |
| What replace antihistamines for chronic allergic rhinitis? | intranasal glucocorticoids |
| What is intranasal glucocorticoids applied to? | nasal mucosa |
| Intranasal glucocorticoids are administered with what? | metered spray device |
| What are the side effects of intranasal glucocorticoids? | temporary burning/stinging sensation in the nose after spraying; drying of nasal mucosa |
| Before starting therapy with intranasal glucocorticoids, what should the nurse assess? | nares for excoriation or bleeding, mouth and throat for infection |
| What are the contraindications for intranasal glucocorticoids? | excoriation and bleeding of mucous membranes; infection in mouth, throat, sinuses; hypersensitivity to ingredients |
| After starting intranasal glucocorticoids, what should be monitored? | changes in nasal and oral mucosa, signs of upper respiratory infection, signs and symptoms of GI distress, signs of Cushing’s syndrome |
| Patient education for intranasal glucocorticoids: | if prescribed use decongestant first, shake before spraying, may take 2-4 weeks for full effect, avoid swallowing meds, clear nose before use, rinse mouth/throat after using, wash dispenser after use, alleviate dryness by humidifier/saline spray |
| Prototype drug of intranasal glucocorticoids: | fluticasone (Flonase) |
| What are Primatene, Afrin, pseudoephedrine (Sudafed)? | sympathomimetics for treating nasal congestion |
| What do sympathomimetics stimulate to relieve nasal congestion? | SNS |
| Action of sympathomimetics: | alpha-adrenergic activity |
| Routes of administration for sympathomimetics: | intranasal, OTC sprays or drops, oral |
| How long should sympathomimetics be used? | no longer than 3-5 days |
| What can prolonged or overuse of sympathomimetics cause? | rebound congestion (inc secretion of mucous) |
| Patient education for OTC cold and allergy medicines should include what? | limit use to 3-5 days, avoid using more than 1 product at a time, report SE |
| What side effects should be reported by patients on OTC cold and allergy medicines? | palpitations, chest pain, fever, vision changes, confusion, numbness or tingling, severe HA, insomnia, restlessness, nosebleed |
| What is a serious and often fatal allergic response called? | anaphylaxis |
| Anaphylaxis is what kind of response to an antigen? | hyper-response |
| First exposure to an antigen, what happens? | no reaction, body becomes highly sensitized |
| Second exposure to an antigen, what happens in anaphylaxis? | response within minutes, histamine released |
| What are the symptoms of anaphylaxis? | Inc pulse, dec BP, dec cardiac output; dyspnea; edema; itching, hives; bronchospasm |
| What do symptomatic meds for anaphylaxis do? | support cardiovascular system, prevent further response |
| What drugs are used for anaphylaxis? | Oxygen, sympathomimetics (epinephrine), antihistamines (Benadryl), bronchodilators (albuterol), systemic glucocorticoids (hydrocortisone) |
| Nursing considerations for epinephrine include: | monitor patient’s condition |
| Precautions for epinephrine: | cardiac disease, cerebral circ problems, hyperthyroidism |
| If it is a life threatening situation, what kind of contraindications exist for using epinephrine? | none |
| Resuscitation: continuous… | VS and EKG |
| Resuscitation: IV sites… | treat extravasation |
| Resuscitation:Visual changes… | may exacerbate glaucoma |
| Patient drug education for anaphylaxis: | use of Epi-pen, seek medical attention immediately (EMS), report burning, irritation at injection sites |
| What should patients report during anaphylaxis? | change in LOC, palpitations, chest pain, N, V, sweating, blurred vision, HA, anxiety, sense of impending doom |
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