Quiz 3 - Study Guide - NURS 306

Antihistamine

Blocks histamine at H1 receptors to reduce allergic effects;

for allergies, urticaria…

drowsiness, anticholinergic effects

Decongestant

Constricts URT nasal blood vessels → shrinks swollen membranes

Antitussive

Suppresses the cough center in the medulla

Expectorant

Thins mucus so it's easier to cough up

Adrenergics (Sympathomimetics)

Drugs that mimic epinephrine by stimulating sympathetic nerve fibers

Anticholinergics (Parasympatholytics)

Block acetylcholine receptors → inhibit parasympathetic nerve impulses

Antagonist

Drug that blocks or opposes another drug's effect (competes for same receptor)

Histamine antagonist

Competes with histamine for binding at histamine receptors;

for allergies, urticaria…;

drowsiness, anticholinergic effects

Sympathomimetic drugs

Mimic stimulation of the sympathetic nervous system

Corticosteroids

Adrenal cortex hormones (natural or synthetic) that control inflammation, metabolism, and immune response

Upper Respiratory Tract (URT)

Structures outside the chest: nose, pharynx, larynx

Lower Respiratory Tract (LRT)

Structures inside the chest: trachea, bronchial tree, lungs

Allergic asthma

Asthma triggered by hypersensitivity to an allergen

Bronchial asthma

Recurrent, reversible airway narrowing from inflammation, bronchospasm, and mucus

Status asthmaticus

Back-to-back asthma attacks with no pause — medical emergency

Bronchodilators

Relax bronchial smooth muscle to open narrowed airways

COPD

Chronic, irreversible airflow obstruction — includes chronic bronchitis and emphysema

Chronic bronchitis

Chronic inflammation/infection of bronchi with excess mucus (now under COPD)

Emphysema

Destruction of alveolar walls → enlarged air spaces → poor gas exchange (now under COPD)

Antibodies

Immunoglobulins made by lymphocytes in response to bacteria, viruses, or antigens

Antigen

Protein that triggers antibody formation and reacts specifically with that antibody

Antitussives are for...

Dry, nonproductive cough

Expectorants are for...

Wet, productive cough

Diphenhydramine - type

Sedating 1st-gen antihistamine

Diphenhydramine - indications

Allergies, hay fever, urticaria (itching), cold symptoms

Diphenhydramine - side effects

Drowsiness, dry mouth, urinary retention (anticholinergic effects)

Diphenhydramine - interactions

Alcohol, MAOIs, CNS depressants → additive CNS depression

Diphenhydramine - contraindications

Known allergy to drug; caution with CNS depressant use

Loratadine - type

Non-sedating 2nd-gen antihistamine

Loratadine - indications

Seasonal/perennial allergic rhinitis, urticaria

Loratadine - vs diphenhydramine

Same uses, much less drowsiness (doesn't cross blood-brain barrier as readily)

Loratadine - interactions

Fewer CNS interactions than 1st-gen; still caution with MAOIs

Loratadine - contraindications

Known drug allergy

Oxymetazoline - type

Topical nasal decongestant (sympathomimetic)

Oxymetazoline - indications

Nasal congestion from cold, allergies, sinusitis; pre-procedure nasal visualization

Oxymetazoline - side effects

Nervousness, insomnia, palpitations, tremor; rebound congestion with prolonged use

Oxymetazoline - interactions

MAOIs → dangerous BP spike; other sympathomimetics → additive toxicity

Oxymetazoline - contraindications

Hypertension, cardiovascular disease; avoid with MAOIs

Codeine - type

Opioid antitussive

Codeine - MOA

Acts on cough center in medulla; also analgesic, dries respiratory mucosa

Codeine - indications

Dry, nonproductive or harmful cough

Codeine - side effects

Respiratory depression, CNS depression, sedation, dry mouth, dependency

Codeine - contraindications

Known drug allergy (absolute); opioid dependency; high respiratory depression risk

Codeine - interactions

Alcohol, benzos, CNS depressants → additive respiratory/CNS depression

Dextromethorphan - type

Non-opioid antitussive

Dextromethorphan - MOA

Suppresses cough center in medulla — no analgesia, no CNS depression

Dextromethorphan - vs codeine

Same cough suppression, NO analgesic effect, NO dependency risk

Dextromethorphan - contraindications

Known drug allergy; caution with MAOIs

Benzonatate - type

Non-opioid antitussive (local anesthetic MOA)

Benzonatate - MOA

Numbs stretch receptors in the airways → stops cough reflex signal to medulla

Benzonatate - indications

Dry, nonproductive or harmful cough

Benzonatate - side effects

Dizziness, drowsiness, headache, dry mouth

Benzonatate - contraindications

Known drug allergy (only absolute contraindication)

Benzonatate - WARNING

Never chew or crush capsules → oral numbness and anaphylaxis risk

Guaifenesin - type

Only FDA-approved expectorant

Guaifenesin - MOA

Thins and increases mucus volume; helps cilia sweep secretions upward

Guaifenesin - indications

Productive cough; chronic sinusitis-related cough

Guaifenesin - side effects

Nausea, vomiting, GI irritation

Guaifenesin - contraindications

Known drug allergy

Albuterol - type

SABA (short-acting beta-2 agonist) = RESCUE inhaler

Albuterol - MOA

Stimulates beta-2 receptors in lungs → relaxes bronchial smooth muscle → bronchodilation

Albuterol - indications

Acute bronchospasm: asthma, COPD, exercise-induced bronchoconstriction

Albuterol - side effects

Tachycardia, tremor, nervousness, palpitations, hypokalemia

Albuterol - contraindications

Hypersensitivity; caution in cardiovascular disease

Albuterol - interactions

Beta-blockers → block bronchodilator effect; other sympathomimetics → additive risk

Albuterol - patient ed

Rescue inhaler only; rinse mouth after use to prevent thrush

Salmeterol - type

LABA (long-acting beta-2 agonist) = MAINTENANCE only

Salmeterol - MOA

Stimulates beta-2 receptors → prolonged bronchodilation

Salmeterol - indications

Long-term maintenance of asthma and COPD

Salmeterol - NEVER for

Acute attacks, rescue, or as monotherapy for asthma

Salmeterol - must combine with

Inhaled corticosteroid for asthma

Salmeterol - side effects

Tachycardia, tremor, nervousness, palpitations, hypokalemia

Salmeterol - contraindications

Hypersensitivity; not for acute bronchospasm or status asthmaticus

Salmeterol - interactions

Beta-blockers → cancel bronchodilator effect; other sympathomimetics → additive

SABA vs LABA

SABA (albuterol) = rescue/acute. LABA (salmeterol) = long-term maintenance ONLY — never for acute attacks.

Ipratropium - type

Anticholinergic bronchodilator

Ipratropium - MOA

Blocks acetylcholine at muscarinic receptors in airways → bronchodilation

Ipratropium - indications

COPD maintenance; asthma not controlled on other meds

Ipratropium - side effects

Dry mouth, bitter taste, blurred vision, urinary retention, cough, headache

Ipratropium - contraindications

Hypersensitivity; caution with narrow-angle glaucoma, BPH, bladder obstruction

Ipratropium - interactions

Other anticholinergics → increased anticholinergic effects; caution in cardiovascular disease → may worsen tachycardia/arrhythmias

Theophylline - type

Xanthine derivative (methylxanthine) bronchodilator

Theophylline - MOA

Inhibits phosphodiesterase → raises cyclic AMP → relaxes bronchial smooth muscle

Theophylline - indications

Asthma/COPD when other bronchodilators or steroids aren't enough (adjunctive)

Theophylline - side effects

Nausea, vomiting, headache, insomnia, tachycardia, palpitations, GI upset, seizures

Theophylline - contraindications

Hypersensitivity; avoid in peptic ulcer disease, seizure disorders, arrhythmias

Theophylline - therapeutic range

5-15 mcg/mL — narrow window, must monitor plasma levels

Theophylline - toxicity signs

Nausea, vomiting, seizures, irregular heartbeat

Theophylline - interactions

Antibiotics, antifungals, anticonvulsants, CYP450-affecting drugs — many interactions

Theophylline - patient ed

Avoid caffeine (also a xanthine); don't crush extended-release capsules; keep all lab appointments; report nausea/vomiting/seizures

Montelukast - type

Leukotriene receptor antagonist (LTRA) — NOT a bronchodilator

Montelukast - MOA

Blocks leukotriene receptors → reduces airway inflammation and bronchoconstriction

Montelukast - indications

Asthma prevention (≥12 mo); allergic rhinitis (≥2 yrs); exercise-induced bronchospasm (≥6 yrs)

Montelukast - side effects

Headache, abdominal pain, nausea, diarrhea, fatigue

Montelukast - serious rare side effect

Neuropsychiatric events: agitation, aggression, suicidal ideation

Montelukast - contraindications

Hypersensitivity; NOT for acute asthma attacks

Montelukast - interactions

Anticonvulsants, rifampin, protease inhibitors

Montelukast - patient ed

Takes days-weeks for full effect; take even when feeling well; use rescue inhaler for acute attacks — not montelukast

Fluticasone - type

Inhaled corticosteroid (glucocorticoid) — long-term control, NOT rescue

Fluticasone - MOA

Binds glucocorticoid receptors → suppresses inflammatory gene expression → reduces airway swelling