Term
| Antitussives (what are they?) |
|
Definition
| Drugs that suppress the cough reflex. Relieves unproductive coughs for the common cold, sinusitis, pharyngitis, and pneumonia. (Coughs that occur without presence of any active disease process or persists after treatment may be a symptom of another disease) |
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Term
Codeine, hydrocodone, and dextromethorphan
Therapeutic actions an indications |
|
Definition
| act directly on the medullary cough center of the brain to depress the cough reflex. Because they are centrally acting, they are not the drugs of choice for anyone who has a head injury or who could be impaired by central nervous system depression. |
|
|
Term
Codeine, hydrocodone, and dextromethorphan
Pharmacokinetics |
|
Definition
| are rapidly absorbed, metabolized in the liver, and excreted in urine. |
|
|
Term
Benzonatate
Therapeutic actions an indications |
|
Definition
| acts as a local anesthetic on the respiratory passages, lungs, and pleurae, blocking the effectiveness of the stretch receptors that stimulate a cough reflex. |
|
|
Term
Benzonatate
Pharmacokinetics |
|
Definition
| Benzonatate is metabolized in the liver and excreted in urine. |
|
|
Term
Antitussives
Nursing considerations |
|
Definition
-Make sure the drug is not taken longer than needed to avoid adverse effects
-Arrange for further medical evaluation for coughs that persist or are accompanied by high fever, rash, or excessive secretions to detect underlying cause of the cough and arrange for appropriate treatment
-Provide other measures to help relieve cough (ie. humidity, cool temperatures, fluids, use of topical lozenges)
-Provide patient teaching (dose, name, avoid adverse affects)
-Offer support and encouragement tohelp the patient cope with the disease and the drug regimen |
|
|
Term
Antitussives
Adverse effects |
|
Definition
-Dryin effect on muscous membranes
-Increase the viscosity of the resp. tract secretions
-CNS effects: Nausea, Constipation, and complaints of dry mouth
-GI upset, headache, feelings of congestion, and dizziness(sometimes) |
|
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Term
| Dextromethorphan should not be used with |
|
Definition
| monoamine oxidase (MAO) inhibitors, could result in hypotension, fever, nausea, myoclonic jerks, and coma. |
|
|
Term
Decongestants
(What are they) |
|
Definition
| Decrease the overproduction of secretions by causing local vasoconstriction to the upper respiratory tract. It decreases the shrinking of the swollen mucous membranes and tends to open clogged nasal passages, providing relief from the discomfort of a blocked nose and promoting drainage of secretions and improved airflow. |
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|
Term
Decongestants
Adverse effects |
|
Definition
| -Frequent use can reslult in in rebound congestion (rhinitis medicamentosa) which is a reflex reaction to vasoconstriction is a rebound vasodilation, which often leads to prolonged overuse of decongestants. |
|
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Term
| Decongestants are usually |
|
Definition
| adrenergics or sympathomimetics |
|
|
Term
| Topical nasal decongestants |
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Definition
| Many available OTC. The choice of a topical nasal decongestant varies with the individual. Some patients may have no response to one and respond very well to another. |
|
|
Term
| Topical Nasal Decongestants*** |
|
Definition
|
|
Term
| Expectorants (What are they) |
|
Definition
| they increase productive cough to clear the airways. They liquefy lower respiratory tract secretions, reducing the viscosity of these secretions and making it easier for the patient to cough them up. Expectorants are available in many OTC preparations making them widely available to the patient without advice from a health care provider. Only expectorant is Guaifenesin (Mucinex) |
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|
Term
Expectorants
Therapeutic Actions and Indications |
|
Definition
| enhances the output of respiratory tract fluids by reducing the adhesiveness and surface tension of these fluids, allowing easier movement of the less viscous secretions. The result of this thinning of secretions is a more productive cough and thus decreased frequency of coughing. |
|
|
Term
Expectorants
Pharmacokinetics |
|
Definition
| Rapidly absorbed, with an onset of 30 minutes and a duration of 4 to 6 hours. Sites of metabolism and excretion have not been reported. |
|
|
Term
Expectorants
Adverse Effects |
|
Definition
-GI (nausea, vomiting, anorexia)
-headaches, dizziness, or both
-occasionally, a mild rash develops.
-Prolonged OTC prep. could result in the masking of important symptoms of a serious underlying disorder
-Drug should not be used for over 1 week |
|
|
Term
|
Definition
-Allergies
-Persistant cough due to smoking, asthma, or emphysema
-Establish baseline data for assessing drug efficiency
-Assess the skin for the presence of lesions and color to monitor for any adverse reactions
-Monitor temperature to assess for an underlying infection
-Assess respirations and adventitious sounds to evaluate the respiratory response
-Monitor patient's orientation (CNS) |
|
|
Term
Expectorants
Nursing diagnosis |
|
Definition
-Acute pain related to GI, CNS, or skin effects
-disturbed sensory perception related to CNS effects |
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|
Term
Expectorants
Implementations |
|
Definition
-use drug no longer than a week
-advise patient to eat small, frequent meals (To avoid GI discom.)
-Avoid driving (causes dizziness and drowsiness)
-Can be found OTC-avoid excessive doses
-Patient teach
-offer support! |
|
|
Term
|
Definition
| skin, temperature (For underlying infection), if cough lasts longer than 1 week (could be another serious disease) |
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|
Term
mucolytics
(What is it used for?) |
|
Definition
| increase or liquefy respriatory secretions to aid the clearing of the airways in high-risk repsiratory patients who are coughing up thick, tenacious secretions.Patients who suffer from COPD, Cystic fibrosis, pneumonia, or tuberculosis. |
|
|
Term
|
Definition
| Acetylcysteine (Mucomyst) |
|
|
Term
Mucolytics
Therapeutic actions and indications |
|
Definition
| Acetylcysteine is used orally to protect liver cells from being damaged during episodes of acetaminiphen toxicity because it normalized hepatic glutathione levels and binds with a reactive hepatotoxic metabolite of acetaminophen. It also affects the mucoproteins in the resp. secr. by splitting apart disulfide bonds that are responsible for holding the mucus material together. Results in a decrease in the tanacity and viscosity of the secretions. |
|
|
Term
Acetylcysteine (Mucomyst)
Pharmokinetics |
|
Definition
administered by nebulization or by direct instillation into the trachea via an endotracheal tube or tracheostomy.
It is metabolized in the liver and exreted somewhat in urine. |
|
|
Term
Acetylcysteine (Mucomyst)
Caution |
|
Definition
| in cases of acute bronchospasms, peptic ulcer, and esophageal varices because increased secretions could aggravate the problem. |
|
|
Term
Acetylcysteine (Mucomyst)
Adverse Effects |
|
Definition
| Most commonly-GI UPSET, Stomatitis, rhinorrhea, bronchospams, and occasionally a rash. |
|
|
Term
|
Definition
Allgery
-acute bronchospam, peptic ulcer and esophageal varices (May require careful monitoring)
-establish baseline
-assess skin color and lesions
-Take blood pressure and pulse (eval. cardiac respon)
-Evaluate respiratory |
|
|
Term
| Nursing Diagnosis Mucolytics |
|
Definition
-Acute pain GI, CNS, or skin
-disturbed sensory perception (Kinesthetic) related to CNS
-Ineffective Airway Clearance related to bronchospasm |
|
|
Term
|
Definition
Avoid combing with other drugs in the nebulizer to avoid formation of precipitates and potential loss of effectiveness of either drug
-Dilute concentration with sterile water for injection if build up could impede drug delivery.
-if using mask for Acetylcysterine wipe reside of facemask and face to prevent skin breakdown.
-Review nebulizer with patients
-Provide thorough patient teaching |
|
|
Term
|
Definition
Block the release or action of histamine, a chemical released during inflammation that increases secretions and narrow airways. Found in mulitple OTC
Used to relieve respiratory systems and treat allergies. |
|
|
Term
| 1st generation antihistamines |
|
Definition
| greater anticholinergic effects effects with resultant drowsiness |
|
|
Term
| 2nd generation antihistamines |
|
Definition
| a person who needs to be alergy should be given this-less-sedating antihistamines. |
|
|
Term
| Pseudoephedrine (Sudafed) |
|
Definition
Oral Decongestant
Decreases nasal congestion associated with the common cold, allergic rhinitis; relief of pain and congestion of otitis media. |
|
|
Term
Oral Decongestant (Pseudoephedrine (Sudafed)
Assess |
|
Definition
-Allergy
-establish baseline
-skin color\lesion
-Evaluate orientation (CNS)
-Blood pressure, auscultation, pulse (Cardio. stim)
-Monitor urinary output |
|
|
Term
Oral Decongestant (Pseudoephedrine (Sudafed)
Nursing Diagnosis |
|
Definition
Acute pain related to GI, CNS, or skin
-increase cardiac output (sympathomimetic)
-disturbed sensory |
|
|
Term
Oral Decongestant (Pseudoephedrine (Sudafed)
Implementation |
|
Definition
-be careful of OD (B\c of OTC)
-Provide safety measures (CNS affected)
-Monitor pulse, blood pressure, and cardiac response to the drug
-use no longer than 1 week
-Patient teaching
-offer support |
|
|
Term
Diphenhydramine (Bendaryl)
Indication |
|
Definition
| Symptomatic relief of perennial and seasonal rhinitis, vasomotor rhinitis, allergic conjunctivitis, urticaria(hives), angioedema (rapid edema). Also used for treating motion sickness and parkinsonism and as a nighttime sleep aid to suppress coughs! |
|
|
Term
Diphenhydramine (Bendaryl)
Action |
|
Definition
| competitively blocks the effects of histamine at H1-receptor sites; had atropine-like antipruritic and sedative effects |
|
|
Term
Diphenhydramine (Bendaryl)
Adverse effects |
|
Definition
| Drowsiness, sedation, dizziness, epigastric distress, thickening of bronchial secretions, urinary frequency, rash, bradycardia |
|
|
Term
|
Definition
| an Xanthines. Come from a variety of naturally occuring sources. Main treatment for asthma and broncho spasms. They have relatively narrow margin of safety and interact with many other drugs, they are no longer considered the 1st choice brachodialators. |
|
|
Term
Theophylline
Therapeutic action |
|
Definition
Have direct effect on smooth muscles of respiratory tracts.
-mechanism of action not known
-inhibit the release of slow reacting substance of anaphylaxis (SRSA) and histamine, decreasing bronchial swelling and narrowing that occurs as a result of these two chemicals. |
|
|
Term
| Cheyne-Stokes respiration |
|
Definition
| an abnormal pattern of breathing characterized by apneic periods followed by periods of tachypnea that may reflect delayed blood flow through the brain. Xanthines are used for this. |
|
|
Term
Xanthines (Theophylline)
Pharmacokinetics |
|
Definition
rapidly absorbed from the GI when given orally, reaching peak in 2 hours.
Given IV reaching peak within minutes.
Distributed and metabolized in the liver and excreted in urine. |
|
|
Term
Xanthines (Theophylline)
Caution |
|
Definition
| In patients with GI problems, coronary disease, respiratory dysfunction, renal or hepatic disease, alcoholism, or hyperthyroidism (symptoms can be made worse with this medication) |
|
|
Term
Xanthines (Theophylline)
Adverse Effects |
|
Definition
| GI Upset, nausea, irritability, and tachycardia to seizures, brain damage, and even death! |
|
|
Term
Xanthines (Theophylline)
Drug interactions |
|
Definition
met. in the liver results in many drugs interacting with xanthines.
Nicotine increases the metabolism of xanthines in the liver, so the dose must be increased for patients who smoke. Be careful-incase they decide to decrease smoking or discontinue (results in Theophylline toxicity) |
|
|
Term
Xanthines (Theophylline)
Assess |
|
Definition
-Skin, establish base, allergies,
-blood pressure, pulse, cardiac auscultation, peripheral perfusion, and electrocardiogram
-assess bowel sounds and do a liver evaluation and monitor liver and renal function tests
Evaluate serum theophylline levels to provide base reference |
|
|
Term
Xanthines (Theophylline)
Diagnosis |
|
Definition
Acute pain in headaches and GI Tract
Disturbed sensory perception |
|
|
Term
Xanthines (Theophylline)
Implementation |
|
Definition
Administer drug with milk of food to relieve GI Upset
-monitor patient response to drug (adjust dose if needed)
-provide comfort measures, including rest periods, quiet environment and dietary control of caffeine, and headache therapy as needed
-provide follow up blood tests
-provide teaching |
|
|
Term
|
Definition
|
|
Term
| Sympathomimetric (Albuterol) |
|
Definition
drugs used to mimic the effects of the sympathetic nervous systems.
ex) dilation of the bronchi with increased rate and depth of respiration. This is desired effect when selecting a sympathomimetric as a bronchodialtor. |
|
|
Term
Sympathomimetric (Albuterol)
Therapeutic Actions |
|
Definition
used as bronchodilators. They are beta2 selective adrenergic agonists. At therapeutic levels their actions are specific to beta 2 receptors found in bronchi.
-increased blood pressure, increased heart rate, vasoconstriction, and decreased renal and GI blood flow |
|
|
Term
|
Definition
prototype drug of sympathomimetric
-drug of choice in adults and children for the treatment of acute bronchospasm, including that caused by anaphylaxis, it is also available for inhalation.
Not choice for patients with cardiac conditions. |
|
|
Term
Sympathomimetric (Albuterol)
Pharmacokinetics |
|
Definition
Inhaled or oral.
Transformed in the liver to metabolites that are excreted in urine. Inhaled drugs are rapidly absorbed into the lung tissue. |
|
|
Term
Sympathomimetric (Albuterol)
Contraindications |
|
Definition
| Cardiac disease, arrhythmias, diabetes, and hyperthyroidism |
|
|
Term
Sympathomimetric (Albuterol)
Adverse effects |
|
Definition
| CNS stimulation, GI upset, cardiac arrhythmias, hypertension, bronchospasm, sweating, pallor, and flushing. |
|
|
Term
Sympathomimetric (Albuterol)
Drug interactions |
|
Definition
| avoid combination with general anesthetic yclopropane and halogenated hydrocarbons. These drugs sensitize the myocardium to catecholamines, serious cardiac complications could occur. |
|
|
Term
Epinephrine
Summary
Indication |
|
Definition
| Treatment of anaphylactic reactions, acute asthmatic attacks; relief from respiratory distress of chronic obstructive pulmonary disease and bronchial athma |
|
|
Term
|
Definition
| Reacts at alpha and beta-receptor sites in the sympathetic nervous system to cause bronchodilation, increased heart rate, increased respiratory rate, and increased blood pressure |
|
|
Term
Epinephrine
Adverse effects |
|
Definition
| Fear, anxiety, restlessness, headache, nausea, decreased renal formation, pallor, palpitation, tachycardia, local burning and stinging, rebound congestion with nasal inhalation |
|
|
Term
Sympathomimetric (Albuterol)
Assessment |
|
Definition
Allergies, skin, baseline,
-assess reflexes and orientation(CNS)
-monitor respirartions and adventitious sounds (drug's effectiveness)
-pulse, blood pressure, and electrocardiogram
-evaluate lier function tests to assess for changes |
|
|
Term
Sympathomimetric (Albuterol)
Nursing diagnosis |
|
Definition
increased cardiac output
-acute pain CNS, GI, or cardiac effects of drug
-disturbed though processes related to CNS |
|
|
Term
Sympathomimetric (Albuterol)
Implementation |
|
Definition
-drug choice varies per individual
-advise patient to use minimal amount needed
-use 30-60min before exercise
-alert patient that long-acting adrenergic blockers are not for use during acute attacks (slower acting)
-Provide CNS safety measures
-provide small, freq. meals to avoid GI upset
-Patient teaching and encouragement |
|
|
Term
|
Definition
|
|
Term
Atrovent & Spiriva
Therapeutic actions and indications |
|
Definition
| used as bronchodilators because of their effect on the vagus nerve, which is to block or antagonize the action of the neurotransmitter acetylcholine at vagal-mediated receptor sites |
|
|
Term
| Normally vagal stimulation results in a |
|
Definition
| stimulating effect on smooth muscle, causing contraction. |
|
|
Term
| Blocking the vagal effect, |
|
Definition
| relaxation of smooth muscle in the bronchi occurs, leading to bronchodilation. |
|
|
Term
Atrovent & Spiriva
Pharmacokinetics |
|
Definition
inhalation
Ipratropium (atrovent)O-15 minutes. peak effects 3-4 hrs. Not absorbed systemically.
Tiotropium (Spiriva)-rapid onset of action and a long duration with a half life of 5 to 6 days. Excreted in urine. |
|
|
Term
Atrovent & Spiriva
Contraindications |
|
Definition
caution in any conidtion that can be aggravated by the anticholinergic or atropine like effects of the drugs (ex. narrow angle glaucoma, bladder neck obstruction or prostatic hypertrophy, and conditions aggravated by dry mouth and throat)
Allergy to drug or to soy products or peanuts. |
|
|
Term
Atrovent & Spiriva
Adverse Effects |
|
Definition
| dizziness, headache, fatigue, nervousness, dry mouth, sore throat, palpitations, and urinary retnetion |
|
|
Term
Atrovent & Spiriva
drug-drug |
|
Definition
| increased risk of adverse effects if these drugs are combined with any other anticholinergics |
|
|
Term
|
Definition
Indications-maintenance treatment of bronchospasm associated with COPD; treatment of seasonal allergic rhinitis as a nasal spray
Actions: Anticholinergic that blocks vagally mediated reflexes by antagonizing of acetylcholine |
|
|
Term
Atrovent & Spiriva
assessment |
|
Definition
allergy, baseline, skin, pulse, blood pressure
-respirations and adventitious sounds
-urinary output and prostate palpation (Monitor anticholinergic effects) |
|
|
Term
Atrovent & Spiriva
Nursing Diagnosis |
|
Definition
Acute pain related to CNS, GI, or respiratory effects of the drug
-Imbalanced Nutrition: Less than body requirements
-Deficient knowledge regarding drug therapy |
|
|
Term
Atrovent & Spiriva
Implementation |
|
Definition
-adequate hydration and enviro. control
-humidifier
-Encourage patient to void before medication
-provide small, frewuent meals and sugarless lozenges to relieve dry mouth and and GI upset
-Advise patient not to drive or use use haardous machinery if nervousness, dizziness, and drowsiness occur with this drug to prevent injury
-provide patient teaching
-review use of inhaler (do not exceed 12 inhalations in 24 hours) |
|
|
Term
| Inhaled steroids as a class of medicines |
|
Definition
| effective for treating bronchospasms. Type of drug depends on patient's response. |
|
|
Term
Inhaled steroids
Therapeutic Action |
|
Definition
| to decrease the inflammatory response in the airway. Airway is swollen and narrowed by inflammatino and swelling, this action will increase air flow and facilitate respirations. Inhaling steroid tends to decrease the numerous systemic effects that are associated with steroid use. It decreased inflammatory response. Promotes smooth muscle relaxtion and inhibit bronchoconstriction |
|
|
Term
Inhaled steroids
Pharmacokinetics |
|
Definition
rapidly absorbed from the respo. tract
But take 2-3weeks to reach effective levels
Metabolized in natural systems
Mostly in liver and excreted in urine |
|
|
Term
|
Definition
Not for emergency use or acute asthma attack.
Caution used in patients with active infection of the respiratory system (depression of resp. could result in serious illness) |
|
|
Term
Inhaled steroids
Adverse effects |
|
Definition
| Sore throat, hoarseness, coughing, dry mouth, and pharyngeal and laryngeal fungal infections are the most common side effects. If not properly administered it could result in lesions |
|
|
Term
|
Definition
allergy, baseline,
Temperature, blood pressure, pulse, auscultation
assess respirations and adventitious sounds to monitor drug effectiveness
-examine the nares to evaluate for any lesions that might lead to systemic absorption |
|
|
Term
Inhaled steroids
Nursing Diagnoses |
|
Definition
Risk for injury related to immunosuppression
acute pain related to local effects of the drug
knowledge (on all) |
|
|
Term
| Inhaled steroids Implementation |
|
Definition
-do not use to treat acute asthma attack
-taper systemic steroids during transfer to inhaled ones (deaths have occurred)
-have patient rinse mouth after use (decrease syst. absorp. and GI upset)
-monitor the patient for any sign of respiratory infeciton
-teaching |
|
|
Term
|
Definition
| Leukotriene receptor antagonists |
|
|
Term
Montelukast (Singulair)
Leukotriene receptor antagonists |
|
Definition
| A newer class of drugs that was developed to act more specifically at the site of the problem associated with asthma. |
|
|
Term
Montelukast (Singulair)
Leukotriene receptor antagonists
Therapeutic |
|
Definition
| selectively and competitively block receptores for the production of leukiotrienes D4 and E4, components of SRSA. These drugs block many of the signs and symptoms of asthma, such as neutrophil and eosinophil migration, neutrophil and monocyte aggregation, leukocyte adhesion, increased capillary permeability, and smooth muscle contraction. |
|
|
Term
Montelukast (Singulair)
Leukotriene receptor antagonists
Pharmacokinetics |
|
Definition
Orally
rapidly absorbed GI tract
met in liver
ex in feces |
|
|
Term
Montelukast (Singulair)
Leukotriene receptor antagonists
Caution |
|
Definition
in patients with renal or hepatic damage.
Do not use for asthma attacks |
|
|
Term
Montelukast (Singulair)
Leukotriene receptor antagonists
Adverse Effects |
|
Definition
| headache, diiness, nausea, diarrhea, abdominal pain, elevated liver enzyme concetrations, vomiting, generalized pain, fever, and myalgia. |
|
|
Term
Montelukast (Singulair)
Leukotriene receptor antagonists
Drug |
|
Definition
| Be careful with Theophylline it can cause toxicity. |
|
|
Term
Montelukast (Singulair)
Leukotriene receptor antagonists
Assess |
|
Definition
allergy, baseline, temp,
-Orientation CNS
-Resp and adventitious breath sounds
-liver and renal function
-abdominal evaluation for (GI) effects |
|
|
Term
Montelukast (Singulair)
Leukotriene receptor antagonists
Nursing Diagnosis |
|
Definition
Acute pain-headache, GI upset, myalgia
Risk injury-CNS |
|
|
Term
Montelukast (Singulair)
Leukotriene receptor antagonists
implementation |
|
Definition
administer on empty stomach, 1 hr before or 2 hours after
-not used for asthma attack
-take drug continuously-don't stop cause ya feel good!
-Dizziness-provide safety
-Patient teaching |
|
|
Term
|
Definition
|
|
Term
Cromolyn (Nasalcrom)
Mast cell stabilizer |
|
Definition
| prevents the release of inflammatory and bronchoconstricting substances when the mast cells are stimulated to release these substances because of irritation or the presence of an antigen (Only available OTC) |
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|
