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Respiratory Agents
Week 5
| Question | Answer |
|---|---|
| What are the structures in the upper respiratory tract? | Nose, nasopharynx, oropharynx, laryngopharynx, larynx |
| What are diseases that affect the upper respiratory tract? | Colds/coryza, hay fever/rhinitis (seasonal, perennial), pharyngitis, laryngitis, sinusitis |
| What are the types of medications used to treat colds? | Antihistamines, decongestants, antitussives, expectorants |
| What is histamine 1? | Causes allergic reactions. Smooth muscle contraction, capillary dilation |
| What is histamine 2? | Causes acceleration of HR, gastric acid secretion |
| What is the MOA of type 1 antihistamines? | They bind selectively to receptors to block action of histamine (basophils and mast cells) |
| What are type 1 antihistamines used to treat? | Allergic rhinitis, anaphylaxis, insect bite reactions, urticara (itchy hives) |
| What do antihistamines reduce? | Reduce lacrimal and nasal secretions, reduce itching of nasal passages, eyes; reduces urticaria, reduces bronchial constriction somewhat (lessens wheezing) |
| What are some side effects of antihistamines? | Anticholinergic effects: dry mouth, nose, throat, urinary hesitancy, constipation. Sedation: drowsiness, esp 1st gen. Paradoxical effects: nervousness, tremor, palpitations, low BP, arrhythmias |
| What is a prototype of 1st generation antihistamine? | Diphenhydramine (Benadryl) |
| What are some characteristics of a 1st generation antihistamine? | Intermediate antihistamine efficacy; anticholinergic and sedation effects high; good safety profile (except elderly) |
| What are some characteristics of 2nd generation antihistamine? | Intermediate/high antihistamine efficacy; anticholinergic and sedation effects very low; longer duration |
| What is a prototype of a 2nd generation antihistamine? | Loratidine (Claritin) |
| What is the MOA of decongestant adrenergics? | Adrenergic effect: constricts small blood vessels that leads to better drainage of secretions |
| What is the MOA of decongestant corticosteroids? | Anitinflammatory effects |
| What is the MOA of decongestant anticholinergics? | Less common, dries secretions |
| What are the effects of decongestants? | Reduce nasal congestion, and nasal edema |
| What are decongestants contrindicated for? | Drug allergy, narrow angle glaucoma, uncontrolled cariovascular disease, prostatitis, thyroid dysfunction |
| What are some side effects of adrenergic deongestants? | Nervousness, insomnia, palpitations, tremor |
| What are some side effects of steroidal decongestants? | Mucosal irritation and dryness |
| What are prototypes of adrenergic decongestants? | Pseudoepinephrine (Sudafed) oral, Naphazoline (Privine) nasal inhalation, may develop rebound congestion |
| What are prototypes of steroidal decongestants? | Beclomethasone (Beconase), Fluticason (Flonase) |
| What is a prototype of anticholinergic decongestant? | Ipatropium (Atrovent) |
| What do antitussives do (MOA)? | Suppress cough centers in medulla of CNS |
| What stiumlates a cough? | Bronchial, alveolar and/or pleural lining get stretched, stimulating a cough from medullary cough center. Contributes to patient discomfort |
| What are the types of antitussives? | Opioid, non-opioid |
| How do opioid antitussives work? | They have direct effect on CNS. Dries mucosa which increases viscosity. Provides analgesia, can cause dependence |
| How do non-opioid antitussives work? | No CNS depression, less drying effect |
| What are prototypes of opioid antitussives? | Codeine, hydrocodone |
| What are prototypes of non-opioid antitussives? | Dextromethorphan (Robitussin DM) |
| What are some side effects of opioid antitussives? | Sedation, n/v, lightheadedness, constipation |
| What are some side effects of non-opioid antitussives? | Dizziness, drowsiness, nausea |
| What is the MOA of expectorants? | Liquify & thin secretions to allow for easier removal |
| What is the prototype for expectorants? | Guaifenesin (potassium containing drugs are not used as much) |
| What are side effects of expectorant use? | N/v, gastric irritation |
| What are some important subjective aspects of nursing assessment? | Subjective history of nasal congestion, cough, fever/chill, pharyngitis, otalgia |
| What are some important objective assessments w/ respiratory infections? | RR, excursion, auscultation of breath sounds, oxygen saturation, skin color & capillary refill, HR and rhythm |
| What are possible respiratory nursing diagnoses? | Impaired gas exchange. Impaired removal of secretions. Deficient knowledge related to effective use of drugs. Risk for injury due to drug sedative effects. |
| What are structures of the lower respiratory tract? | Trachea, bronchi, bronchioles, alveoli |
| What are diseases that affect the lower respiratory tract? | Pneumonia, asthma, bronchitis, emphysema, cystic fibrosis, influenza, respiratory syncytial virus |
| In what population is pneumonia most common? | Highest incidence in elderly |
| How is pneumonia treated? | With antibiotics, increase in oral/IV fluids, productive cough is treated with expectorants, oxygen may be needed |
| Is oxygen a drug? | Yes |
| What are some characteristics of asthma? | Reversible bronchoconstriction. Inflammation of bronchial mucosa. Viscous mucus production |
| What are the different types of asthma? | Allergy induced (dust, molds, animals). Idiopathic (stress, exercise, resp infection). Mixed |
| What are symptoms of asthma? | Shortness of breath, wheezing (esp expiratory), cough, use of accessory muscles, exercise intolerance during attack, hypoxemia, normal or elevated CO2 if prolonged |
| What are the drugs used to treat asthma? | Bronchodilators, inhlaed corticosteroids, leukotriene inhibitors, mast cell stabilizers |
| Bronchodilators are _______ agonists | Beta-adrenergic agonists |
| Non-selective bronchodilators have what kind of effects? | Non-selective have alpha & beta effects. Epinephrine |
| What are some side effects of non-selective bronchodilators? | Insomnia, restlessness, anorexia, increased HR & BP, hyperglycemia, headache |
| What are some prototypes of bronchodilators? | Albuterol, Xopenex |
| What is the MOA of bronchodilators? | Stimulates beta2 receptors which activate adenyl cyclase, increasing production of cAMP, relaxing bronchial smooth muscle |
| What conditions are treated with bronchodilators? | asthma, bronchitis, COPD, cystic fibrosis |
| What is a short-acting selective beta2-agonist bronchodilator? | Albuterol |
| What are long-acting selective beta2-agonist bronchodilators? | Salmeterol, Xopenex |
| Side effects of selective beta2-agonist bronchodilators? | Less symtoms than non-selective. Nervousness, tremors, increased heart rate and BP |
| What are MDI’s? | Metered-dose inhalers |
| What is a spacer? | Add-on eases administering of aerosolized medication from MDI. Adds space in the form of a tube or “chamber” between the canister of medication and the mouth, allowing pt to inhale medication by breathing in slowly and deeply for five to 10 breaths. |
| What is a nebulizer? | Device used to administer medication in the form of a mist inhaled into the lungs. |
| How are respiratory medications administered? | MDI, MDI with spacer, nebulizer, oral in children |
| Bronchodilators: xanthines: MOA? | Inhibits phosphodieterase and less breakdown of cAMP |
| Xanthines include...? | Theophylline, caffeine, theobromine |
| What is xanthine prototype? | Aminoophylline- used in IV drip in acute bronchspasms, also rectal preparations |
| Side effect of xanthine prototype? | Can cause convulsions if levels get too high |
| Anti-inflammatory drugs: Corticsteroids: Indications? | Used prophylactically, important in treating chronic asthma |
| Corticosteroids: method of administration? | Orally, inhalation, intravenously |
| Corticosteroids MOA? | Stabilize membranes of neutrophils & basophils so inflammation substances are not released. Decreases activity of lymphocytes. Inhibits macrophage acumulation leading to less inflammation. Increases beta adrenergic effects |
| What is a prototype of inhaled corticosteroids? | Beclomethasone |
| What does the prototype of inhaled corticosteroids do? | Decreases mucus secretions, decreased edema of airway, repair of epithelium, decreased reactivity |
| Side effects of inhaled corticosteroids? | Pharyngeal irritation, dry mouth, fungal infections |
| What is the prototype of oral corticosteroids? | Prednisone |
| What are characteristics of the prototype of oral corticosteroids? | More potent anti-inflammatory effect, often used in short bursts of 10 days with decreasing doses |
| What are side effects of oral corticosteroids? | Change in mood, fluid retention, increased susceptibility to infection, reduced growth in children, osteoporosis |
| What is Advair Diskus? | Combination inhaler |
| What are the 2 medications in the combined inhaler, Advair Diskus? | Fluticason propionate (corticosteroid) and Salmeterol (long acting beta2 agonist) |
| Advair Diskus powder can cause what side effects? | Blisters |
| Advair Diskus: prevention very important? | Prevention of what??? |
| What are the available dosages of Advair Diskus? | 100/50, 250/50, 500/50 |
| What is important to do when using Advair Diskus? | Must rinse with alcohol based mouth wash to prevent candidiasis of the mouth |
| What are mast cells? | Stationary cells in tissue that release inflammatory mediators when antigens bind to their receptors |
| Where are mast cells located? | Nose, mouth, internal body surfaces, blood vessels |
| Mast cell stabilizers are most frequently used in ____. | Children |
| What is the MOA of mast cell stabilizers? | Drugs that stabilize the membranes of mast cells so that histamine and vasoconstrictive and bronchconstrictive substances are not released. Also stabilizes other inflammatory cells |
| What are prototypes of mast cell stabilizers? | Cromolyn (Nasalcrom), nedocromil (Tilade) |
| What are methods of administration of mast cell stabilizers? | Oral, otic drops, nebulizer, MDI (tilade) |
| Which mast cell stabilizer is administered via MDI? | Tilade |
| What are side effects of mast cell stabilizers? | Coughing, sore throat, rhinitis, bronchospasm, headache |
| What is the MOA of anti-leukotriene agents/leukotriene receptor antagonists? | Inhibits leukotriene receptors |
| What are leukotrienes? | Strong chemical mediators of bronchconstriction, inflammation and mucous production |
| Release of leukotriene mediators causes...? | Coughing, wheezing, shortness of breath |
| What are prototypes of oral prophylactics that are leukotriene receptor antagonists? | Zafirlukast (Accolate), monolukast (Singulair) |
| What are the side effects of the oral leukotriene receptor antagonist, zafirlukast (Accolate)? | Headache, nausea, diarrhea, liver dysfunction |
| What are the side effects of the oral leukotriene receptor antagonist, monolukast (Singulair)? | Fewer side effects than zafirlukast (Accolate). Still potential for liver dysfunction |
| What is COPD? | Chronic obstructive pulmonary disease. Usually compnents of chronic bronchitis and emphysema |
| What are 2 usual components of COPD? | Chronic bronchitis and emphysema |
| COPD cause what changes in the chest? | Barrel chest What is bronchitis? |
| What is emphysema? | Destruction of alveoli. Alpha-antitrypsin deficiency |
| How is COPD treated? | Bronchodilators: beta2 agonists, xanthine deriviatives, anticholinergics. Corticosteroids. Pursed lipped breathing. Sufficient fluid intake. Flu vaccines. Pneumovax. |
| What is the MOA of anticholinergic bronchodilators? | Prevents ACh from binding on bronchial tree receptors. Prevents bronchoconstriction |
| Anticholinergic bronchodilators are used to treat...? | Only used in chronic bronchitis and emphysema |
| Are anticholinergic bronchodilators used acutely? | No. Has slow and prolonged actions |
| What is an anticholinergic bronchodilator prototype? | Ipratropium bromide (Atrovent, Spiriva) |
| How is ipratropium administered? | MDI or nebulizer |
| What are side effects of ipratropium? | Dry mouth, GI distress, headache, anxiety, coughing |
| What is Combivent? | A combination drug of anticholinergic and beta2 agonist |
| What are some important patient assessment following drug administration? | Watch respirations, skin color, SaO2, breath sounds, BP & HR, use of accessory muscles, sputum production, presence of cough/dyspnea/orthopnea/restlessness/activity intolerance |
Created by:
kangaloo
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