pharm test 3

chapter 36

Benzonatate

indication

drug class

Contraindications

cautions

drug interaction

common adverse effects

Anesthetizes (numbs) cough receptors to suppress cough

indication: cough suppress (dry)

drug class: Nonopioid antitussive

Contraindications: hypersensitivity

drug interactions: Very few significant interactions

cautions: Pregnancy Category C

common adverse effects: Dizziness, headache, sedation, nausea, constipation, pruritus, nasal congestion

Codeine

indication

drug class

Contraindications

cautions

drug interaction

common adverse effects

Suppresses cough through CNS opioid activity

indication: cough suppression

drug class: Opioid antitussive

Contraindications: Opiate allergy, respiratory depression, increased ICP, seizure disorders, severe respiratory disease

cautions: Pregnancy Category C; respiratory depression; addictive (controlled substance)

drug interaction: Potentiates opioids, anesthetics, tranquilizers, sedatives, hypnotics, tricyclic antidepressants, alcohol, other CNS depressants

common adverse effects: Sedation, nausea, vomiting, lightheadedness, constipation

Dextromethorphan

indication

drug class

Contraindications

cautions

drug interaction

common adverse effects

Suppresses cough without respiratory or CNS depression at recommended doses

indication: cough suppression

drug class: Nonopioid antitussive

Contraindications: Drug allergy, asthma, emphysema, persistent headache

cautions: Pregnancy Category C; commonly abused

drug interaction: None listed in provided material

common adverse effects: Dizziness, drowsiness, nausea

Diphenhydramine (Benadryl)

indication

drug class

Contraindications

cautions

drug interaction

common adverse effects

Blocks histamine receptors; works peripherally and centrally; anticholinergic and sedative effects

indications: Allergies, motion sickness, insomnia, Parkinson disease, anaphylaxis (with epinephrine), acute dystonic reactions

drug class: Traditional antihistamine

Contraindications: drug allergy

cautions: Use cautiously in nursing mothers, neonates, patients with lower respiratory disease; avoid in older adults due to falls and anticholinergic effects

drug interaction: Should not exceed recommended doses; FDA warning: overdose may cause seizures, coma, death

common adverse effects: Sedation, dry mouth, anticholinergic effects

Guaifenesin (Mucinex)

indication

drug class

Contraindications

cautions

drug interaction

common adverse effects

Increases hydration of respiratory tract, maintains ciliary clearance, decreases mucus viscosity

indications: Productive cough, chronic sinusitis-related cough

drug class: Expectorant

Contraindications: drug allergy

Cautions: Pregnancy Category C

drug interaction: No significant interactions

common adverse effects: Nausea, vomiting, gastric irritation

Loratadine (Claritin)

indication

drug class

Contraindications

cautions

drug interaction

common adverse effects

Blocks histamine receptors with minimal CNS penetration

indication: Seasonal allergic rhinitis, urticaria

drug class: Nonsedating antihistamine

Contraindications: drug allergy

Cautions: High doses may cause drowsiness, headache, fatigue; Pregnancy Category B

drug interaction: Do not use with aclidinium, azelastine, ipratropium, orphenadrine, potassium chloride, tiotropium, umeclidinium

common adverse effects: High-dose: drowsiness, headache, fatigue

Oxymetazoline (Afrin)

indication

drug class

Contraindications

cautions

drug interaction

common adverse effects

Constricts nasal arterioles, reducing swelling and congestion

indication: Nasal congestion from colds, sinusitis, allergies, rhinitis

drug class: Alpha-adrenergic nasal decongestant

contraindications: Drug allergy; narrow-angle glaucoma; uncontrolled cardiovascular disease; hypertension; diabetes; hyperthyroidism

cautions: Use no longer than 3 days (rebound congestion); Pregnancy Category C

Drug Interactions: Sympathomimetics increase toxicity; MAOIs increase pressor effects

common adverse effects: Nervousness, insomnia, palpitations, tremor; excessive use: hypertension, headache, dizziness, rebound congestion

Easy Memory Tricks

Drug	Memory Trick
Benzonatate	Benzo = Benzocaine → numbs cough receptors
Codeine	Codeine = CNS depression + constipation
Dextromethorphan	DXM = OTC cough suppressant, abuse potential
Diphenhydramine	Benadryl = Bedtime (sedation)
Guaifenesin	Guaifenesin = Get mucus out
Loratadine	Claritin = Clear allergies with less drowsiness
Oxymetazoline	Afrin = 3 days only → rebound congestion if longer

identify the definition

Adrenergics

Sympathomimetics are drugs that trigger the "fight or flight" response. They either copy the action of natural chemicals like epinephrine (adrenaline) or force the body to release them. These drugs speed up your heart rate, open your airways, and increase your energy

• neurotransmitters

Drugs that stimulate the sympathetic nerve fibers of the autonomic nervous system that use epinephrine or epinephrine-like substances as neurotransmittersd

Antagonists

Antagonists are drugs that block or undo the effects of other substances in the body. They do this by attaching to the exact same cell "locks" (receptors) as other drugs or natural chemicals. Once attached, they do not trigger a reaction; instead, they act as a shield to keep other chemicals out

drugs that exert an action opposite to that of another drug or compete for the same receptor sites

Anticholinergics

Parasympatholytics (also known as anticholinergics) block the action of a brain chemical called acetylcholine. Because acetylcholine normally triggers your "rest and digest" state, blocking it stops involuntary muscle movements and gland secretions. This causes your heart rate to speed up and muscles to relax

• block the "rest and digest

• effectively allowing the sympathetic nervous system ("fight or flight") to take the upper hand

Parasympatholytics drugs that block the action of acetylcholine and similar substances at acetylcholine receptors, which results in inhibition of the transmission of parasympathetic nerve impulses

Antihistamines

Substances that reduce the effects of histamine are called antihistamines. Histamine is a natural body chemical released during allergic reactions that causes swelling, itching, and acid reflux. Antihistamines block histamine from attaching to cell receptors, stopping these symptoms before they happen

Substances capable of reducing the physiologic and pharmacologic effects of histamine.

Antitussive

a drug that reduces coughing by slowing down the cough center in the brain is called an antitussive (or cough suppressant

A drug that reduces coughing, often by inhibiting neural activity in the cough center of the central nervous system

Corticosteroids

Any of the hormones produced by the adrenal cortex, either in natural or synthetic drug form. They control many key processes in the body, such as carbohydrate and protein metabolism, the maintenance of serum glucose levels, electrolyte and water balance, and the functions of the cardiovascular system, skeletal muscle, kidneys, and other organs

Decongestants

Drugs that reduce congestion or swelling, especially of the upper or lower respiratory tract

Expectorants

Drugs that increase fluid flow in the respiratory tract and thin mucus to help you cough are called expectorants. They turn thick, sticky mucus into a wetter, looser liquid. This makes it much easier to clear your airways by coughing

Drugs that increase the flow of fluid in the respiratory tract, usually by reducing the viscosity of secretions, and facilitate their removal by coughingd

Histamine antagonists

Drugs that compete with histamine for binding sites are called antihistamines. They bind to histamine receptors (the "locks") to block histamine (the "key"). This prevents your body from having allergic reactions or making excess stomach acid

Drugs that compete with histamine for binding sites on histamine receptors

Sympathomimetic drugs

These drugs are called sympathomimetics. They imitate the "fight-or-flight" response of the body. This means they raise your heart rate, increase your blood pressure, open up your airways, and give you more energy

A class of drugs whose effects mimic those resulting from the stimulation of the sympathetic nervous system.

Upper respiratory tract (URT

Any infectious disease of the upper respiratory tract, including the common cold, laryngitis, pharyngitis, rhinitis, sinusitis, and tonsillitis.

The division of the respiratory system composed of organs located outside the chest cavity (thorax

memory trick

Term	Think...

Adrenergics

Fight or Flight

Sympathomimetics

Mimic adrenaline

Antagonists

Block

Anticholinergics

Dry everything

Antihistamines

Allergy medicine

Histamine antagonists

Same as antihistamines

Antitussives

Stop coughing

Expectorants

Get mucus out

Decongestants

Unstuff the nose

Corticosteroids

Reduce inflammation

Upper respiratory tract

Nose and throat

chapter 37

albuterol

indication

drug class

Contraindications

cautions

drug interaction

common adverse effects

Stimulates β₂ receptors in the lungs causing bronchodilation and relaxation of bronchial smooth muscle.

drug class: SABA

indications: Acute asthma attacks, bronchospasm, COPD (rescue inhaler

Contraindications: Hypersensitivity

Cautions: Frequent use decreases β₂ selectivity and stimulates β₁ receptors, increasing cardiac effects

drug interactions: None specifically

Common Adverse Effects: Tachycardia, palpitations, tremors, anxiety, nausea, increased heart rate

Salmeterol

indication

drug class

Contraindications

cautions

drug interaction

common adverse effectsd

Long-acting β₂ agonist (LABA) producing prolonged bronchodilation ≈12 hr

drug class: LABA

indication: Maintenance treatment of asthma and COPD

Contraindications: Not for acute asthma attacks.

cautions: Never use alone in asthma; use with an inhaled corticosteroid. Do not exceed 1 puff twice daily

drug interactions: Commonly combined with fluticasone (Advair)

Common Adverse Effects: Headache, hypertension, hypersensitivity reactions, neuromuscular pain, skeletal pain

Ipratropium

indication

drug class

Contraindications

cautions

drug interaction

common adverse effects

Anticholinergic that blocks acetylcholine receptors, preventing bronchoconstriction and relaxing airway smooth muscle.

drug class: Anticholinergic

indications: COPD, asthma, bronchospasm

contraindications: hypersensitivity

cautions: Often used with albuterol for greater bronchodilation

drug interactions: Combination products: Combivent, DuoNeb, or given with albuterol

common adverse effects: Dry mouth, dry throat, cough, bitter taste

Theophylline

Xanthine bronchodilator that relaxes bronchial smooth muscle and promotes bronchodilation

indications: Chronic asthma, bronchospasm; IV aminophylline for status asthmaticus

drug class: Xanthine bronchodilator

contraindications: Hypersensitivity

cautions: Narrow therapeutic index; monitor serum drug levels (goal 5–15 mcg/mL)

drug interactions: None specifically listed in your notes

common adverse effects: Toxicity: tachycardia, tremors, restlessness, arrhythmias, seizures

montelukast

Blocks leukotriene D4 receptors, decreasing airway inflammation and preventing bronchoconstriction

indications: Asthma maintenance, allergic rhinitis

drug class: Leukotriene receptor antagonist

contraindications: Hypersensitivity

cautions: Not for acute asthma attacks. Pregnancy Category B

drug interactions: Fewer interactions than zafirlukast

common adverse effects: Generally well tolerated; fewer adverse effects than zafirlukast

fluticasone

Reduces airway inflammation and mucus

indication: Asthma prophylaxis and maintenance, seasonal allergic rhinitis

drug class: inhaled corticosteroid

contraindications: Hypersensitivity

cautions: Not for acute attacks. Rinse mouth after each use to prevent thrush

drug interactions: Often combined with salmeterol (Advair)

common adverse effects: Hoarseness, oral candidiasis (thrush), throat irritation

Methylprednisolone

Suppresses inflammation and immune response

indication: Asthma exacerbations, COPD exacerbations

drug class: systemic corticosteroids

contraindications: Hypersensitivity

cautions: Used short-term for acute flare-ups; monitor glucose and infection risk

drug interactions: None specifically listed in your notes

common adverse effects: Hyperglycemia, increased infection risk, fluid retention, mood changes, GI irritation

memory tips

• Albuterol = Acute attack (A = Acute/Rescue)

• Salmeterol = Scheduled maintenance (S = Slow onset)

• Ipratropium = Inhaled antIcholinergic → dries secretions

• Theophylline = Test blood levels (therapeutic range 5–15 mcg/mL)

• Montelukast = Blocks Leukotrienes → Less inflammation

• Fluticasone = Flush (rinse) your mouth after use

• Methylprednisolone = Major flare-up steroid (systemic corticosteroid

Allergic asthma

Bronchial asthma caused by hypersensitivity to an allergen or allergens

Antibodies

Immunoglobulins produced by lymphocytes in response to bacteria, viruses, or other antigenic substances

Antigen

A substance (usually a protein) that causes the formation of an antibody and reacts specifically with that antibody

bronchial asthma:

The general term for recurrent and reversible shortness of breath resulting from narrowing of the bronchi and bronchioles; it is often referred to simply as asthma. Key characteristics are inflammation, bronchial smooth muscle spasticity, and sputum production; inflammation is the most important

Bronchodilators

Medications that improve airflow by relaxing bronchial smooth muscle cells (e.g., xanthines, adrenergic agonists).

Chronic bronchitis

Chronic inflammation and low-grade infection of the bronchi. This term is now included into chronic obstructive pulmonary disease diagnosis

Chronic obstructive pulmonary disease (COPD

A lung disease depicted by chronic obstruction of lung airflow that interferes with normal breathing. COPD is not fully reversible. The terms “chronic bronchitis” and “emphysema” are no longer used, but are now included within the COPD diagnosis

Emphysema

A condition of the lungs characterized by enlargement of the air spaces distal to the bronchioles. This term is now included into chronic obstructive pulmonary disease diagnosis

Status asthmaticus:

A prolonged asthma attack.

Upper respiratory tract (URT

The division of the respiratory system composed of organs located outside the chest cavity (thorax

Lower respiratory tract (LRT):

The division of the respiratory system composed of organs located almost entirely within the chest

Normal ABG Values

Value	Normal Range
pH	7.35–7.45
PaCO₂	35–45 mmHg
HCO₃⁻	22–26 mEq/L

Easy Memory Trick

• pH = Overall problem

• CO₂ = Respiratory (Lungs)

• HCO₃ = Metabolic (Kidneys

Respiratory Acidosis

The lungs retain too much carbon dioxide (CO₂), making the blood acidic.

Causes: Hypoventilation (not breathing enough)

Examples: COPD, Asthma attack, Respiratory depression from opioids

Airway obstruction, Pneumonia

ABGs: pH ↓ (<7.35), PaCO₂ ↑ (>45), HCO₃⁻ normal initially (or increased if compensated)

Signs & Symptoms: Confusion, Drowsiness, Hypoventilation, Warm, flushed skin, Respiratory depression

Interventions: Improve ventilation, Administer oxygen as prescribed, Bronchodilators, Mechanical ventilation if needed, Monitor ABGs

Respiratory Acidosis = CO₂ Acid Goes Up

Respiratory Alkalosis

Too much CO₂ is blown off through excessive breathing.

Cause: Hyperventilation

Examples:Anxiety, Panic attack, Pain, Fever, Early sepsis

ABGs: pH ↑ (>7.45), PaCO₂ ↓ (<35) , HCO₃⁻ normal initially (or decreased if compensated)

Signs & Symptoms: Dizziness, Tingling of fingers, mouth, Lightheadedness

Tetany, Anxiety

NCLEX Interventions: Treat underlying cause, Slow breathing, Pain management, Anxiety reduction

Memory Trick

Respiratory Alkalosis = CO₂ Too Low

Metabolic Acidosis

The body has too little bicarbonate or too much acid.

Causes: Diabetic ketoacidosis (DKA), Kidney failure, Severe diarrhea, Lactic acidosis, Shock

ABGs: pH ↓ (<7.35), HCO₃⁻ ↓ (<22), PaCO₂ normal initially (or decreased if compensated)

Signs & Symptoms: Kussmaul respirations, Confusion, Weakness, Headache, Nausea

NCLEX Interventions: Treat underlying cause, IV fluids, Insulin for DKA, Sodium bicarbonate if indicated, Monitor electrolytes

Memory Trick

Metabolic Acidosis = Low Bicarb

metabolic alkalosis

Too much bicarbonate or loss of acid.

Causes: Vomiting, NG suction, Diuretics, Excess antacids

ABGs: pH ↑ (>7.45), HCO₃⁻ ↑ (>26)

Signs & Symptoms: Muscle cramps, Weakness, Tetany, Confusion, Dysrhythmias

NCLEX Interventions: Stop GI losses, Replace fluids, Replace potassium, Treat underlying cause

Memory Trick

Metabolic Alkalosis = High Bicarb

compensation

the body attempts to return the pH towards normal

Partially Compensated (Uncompensated) Respiratory Acidosis

ABGs

• pH ↓

• PaCO₂ ↑

• HCO₃⁻ ↑ or beginning to rise

The kidneys are beginning to compensate

Fully Compensated Respiratory Acidosis

ABGs

• pH normal (7.35–7.45)

• PaCO₂ ↑

• HCO₃⁻ ↑

The kidneys have completely compensated

Partially Compensated (Uncompensated) Respiratory Alkalosis

ABGs

• pH ↑

• PaCO₂ ↓

• HCO₃⁻ ↓ or beginning to decrease

The kidneys are beginning to compensate

Fully Compensated Respiratory Alkalosis

ABGs

• pH normal

• PaCO₂ ↓

• HCO₃⁻ ↓

Compensation is complete

Partially Compensated (Uncompensated) Metabolic Acidosis

ABGs

• pH ↓

• HCO₃⁻ ↓

• PaCO₂ ↓ (lungs compensate by hyperventilating

Fully Compensated Metabolic Acidosis

ABGs

• pH normal

• HCO₃⁻ ↓

• PaCO₂ ↓

Compensation is completed

Partially Compensated (Uncompensated) Metabolic Alkalosis

ABGs

• pH ↑

• HCO₃⁻ ↑

• PaCO₂ ↑ (lungs compensate by hypoventilating

Fully Compensated Metabolic Alkalosis

Fully Compensated Metabolic Alkalosis

• pH normal

• HCO₃⁻ ↑

• PaCO₂ ↑

Compensation is complete.