Lecture One Part Two: Respiratory Medications (Vocabulary Flashcards)

Vocabulary flashcards covering key respiratory medications, their mechanisms, uses, and nursing considerations from the notes.

Antihistamines

Drugs that antagonize H1 receptors to prevent histamine release in allergic reactions, relieving symptoms such as itching, increased mucus secretions, and runny nose.

Histamine

Chemical mediator of the inflammatory response released from mast cells and basophils; causes allergic symptoms and can trigger bronchoconstriction in severe allergic states.

H1 receptors

Receptors responsible for allergic symptoms and the primary target of antihistamines.

H2 receptors

Receptors in the gastric mucosa responsible for peptic ulcers; a separate histamine receptor not targeted for allergic symptoms.

First-generation antihistamines

More sedating antihistamines (e.g., diphenhydramine, dimenhydrinate, cyproheptadine) with stronger anticholinergic effects.

Diphenhydramine (Benadryl)

A first-generation antihistamine; sedating; used for mild allergic reactions and motion sickness; pronounced anticholinergic effects.

Dimenhydrinate (Dramamine)

A first-generation antihistamine; sedating; used for allergy symptoms and motion sickness; anticholinergic effects.

Cyproheptadine

A first-generation antihistamine; sedating; used for allergic symptoms noted in notes.

Second-generation antihistamines

Less sedating antihistamines (e.g., loratadine, fexofenadine, cetirizine); levocetirizine placement varies by source.

Loratadine (Claritin)

A second-generation antihistamine with relatively low sedative effects.

Fexofenadine (Allegra)

A second-generation antihistamine with low sedation potential.

Cetirizine (Zyrtec)

A second-generation antihistamine; generally less sedating than first generation.

Levocetirizine

Antihistamine; placement in second or third generation varies by source.

Third-generation antihistamines

Subset of antihistamines described as the least sedating.

Therapeutic uses of antihistamines

Mild allergic reactions; prophylaxis against allergic symptoms; motion sickness; common cold; anaphylaxis with bronchospasm or laryngeal edema; insomnia; often combined with decongestants/antitussives in OTC products.

Decongestants

Agents that stimulate alpha-1 adrenergic receptors to reduce nasal membrane inflammation and congestion.

Phenylephrine

A decongestant that stimulates alpha-1 receptors to relieve nasal congestion.

Phenylpropanolamine

A decongestant that stimulates alpha-1 receptors to relieve nasal congestion.

Pseudoephedrine

A decongestant that stimulates alpha-1 receptors to relieve nasal congestion; often combined with antihistamines.

Rebound congestion

Worsening nasal congestion after prolonged use of intranasal decongestants due to mucosal rebound.

Oxymetazoline

Intranasal decongestant associated with rebound congestion with prolonged use.

Intranasal vs oral decongestants

Topical decongestants act faster but have shorter duration; oral agents have longer duration and different side effects.

3–5 day rule (intranasal)

Intranasal decongestants should be limited to 3–5 days to minimize rebound congestion.

Nursing considerations for decongestants

Contraindicated in chronic rhinitis; avoid in hypertension; caution with prostatic enlargement, CNS/psychiatric disorders, thyroid disorders, and diabetes; assess nasal history; educate about rebound effects.

Antitussives

Cough suppressants used to treat nonproductive cough; suppress the cough reflex.

Codeine

Opioid antitussive; effective for suppressing nonproductive cough but with risks of sedation, respiratory depression, and abuse potential.

Hydrocodone

Opioid antitussive; similar risks to codeine (drowsiness, dependence, respiratory depression).

Benzonatate (Tessalon Perles)

Non-opioid antitussive; suppresses cough reflex without opioid side effects.

Dextromethorphan (OTC)

Non-opioid antitussive; suppresses cough with fewer opioid-related risks but potential for abuse in some forms.

Opioid/non-opioid combinations (Tussionex, Robitussin AC)

Combination antitussives that pair opioid and non-opioid components for cough suppression.

Nonproductive cough

Cough not ending with mucus production; antitussives are used to suppress it.

Abuse and dependence risk (antitussives)

Opioid antitussives carry abuse potential and dependence risk; use short-term as prescribed.

Expectorants

Agents that decrease mucus viscosity to help coughing up secretions.

Guaifenesin (Robitussin)

An oral expectorant that reduces mucus viscosity to facilitate clearance.

Mucolytics

Agents that directly loosen and thin mucus to enhance clearance by coughing.

Acetylcysteine (Mucomyst)

A mucolytic (inhalation) used for conditions with thick secretions; antidote for acetaminophen poisoning; has rotten egg odor.

Inhalation route; not OTC (Mucomyst)

Mucomyst is administered by inhalation and is not available OTC.

Common therapeutic use of mucolytics/expectorants

Acute and chronic respiratory disorders with excessive secretions and cystic fibrosis.

Airway management – two groups

Bronchodilators (beta-2 agonists, anticholinergics, methylxanthines) and anti-inflammatories (leukotriene antagonists, mast cell stabilizers).

Bronchodilators

Drugs that relax smooth muscles to dilate airways and relieve bronchospasm.

Beta-adrenergic agonists

Drugs that activate beta-2 receptors in bronchial smooth muscle, causing bronchodilation.

Beta-1 vs Beta-2 selectivity

Some agents activate both beta-1 and beta-2; selective beta-2 agonists cause fewer cardiac side effects.

-terol/-terenol suffix

Nomenclature cue: drugs ending in -terol or -terenol are beta-adrenergic agonists.

Ultra-short-acting beta-adrenergic agonists

Act immediately but last 2–3 hours (e.g., isoproterenol) for rapid relief.

Short-acting beta-adrenergic agonists (SABA)

Last about 5–6 hours; examples include pirbuterol (Maxair) and terbutaline (Brethine) for quick relief.

Intermediate-acting beta-adrenergic agonists

Last about 8 hours; example: albuterol. Used for quick relief and some control.

Long-acting beta-adrenergic agonists (LABA)

Last at least 12 hours; example: salmeterol (Serevent); used for long-term control, not for acute relief.

Inhaled long-acting agents – onset

Inhaled long-acting agents have a slower onset (~20 minutes) and are not for immediate relief.

MDI/DPI/nebulizer administration

Common inhalation routes; proper technique essential for effective delivery of beta-agonists.

Bronchodilator timing with corticosteroids

If used with inhaled corticosteroids, bronchodilator is often given first to improve steroid absorption.

Beta-adrenergic agonist side effects

Tachycardia, palpitations, angina; tremors and nervousness; may cause hypertension and hyperglycemia.

Drug interactions with beta-agonists

Adrenergic blockers (e.g., propranolol) can negate effects; MAOIs and TCAs increase tachycardia/HTN risk.

Nursing considerations for beta-agonists

Contraindicated in pregnancy/breastfeeding; tachydysrhythmias; hypertension; teach proper inhaler use; monitor vitals.

Anticholinergics (Bronchodilators)

Block parasympathetic activity to produce bronchodilation; alternative for COPD and some asthma cases.

Ipratropium (Atrovent)

An anticholinergic bronchodilator; often combined asipram. Provides bronchodilation with fewer systemic effects.

Tiotropium (Spiriva)

A long-acting anticholinergic bronchodilator for maintenance in COPD and some asthma cases.

Combivent (ipratropium + albuterol)

Combination anticholinergic and beta-agonist providing greater, prolonged bronchodilation.

Anticholinergic therapeutic uses

Relieve bronchospasm in COPD; allergen-induced and exercise-induced asthma; maintenance therapy.

Anticholinergic side effects

Dry mouth, hoarseness, urinary retention; often avoided in peanut/soy allergies; caution with narrow-angle glaucoma and BPH.

Methylxanthines

Bronchodilators related to caffeine with a narrow safety margin and significant drug interactions.

Theophylline

A methylxanthine used for long-term asthma control; requires monitoring of blood levels.

Aminophylline

A methylxanthine used for asthma control; monitored for therapeutic range and toxicity.

-phylline naming cue

Drugs ending with -phylline are methylxanthines (theophylline/aminophylline).

Methylxanthine therapeutic use

Long-term control of asthma; status asthmaticus (IV) in severe cases.

Methylxanthine side effects

Nervousness, tachycardia, irritability, insomnia; GI distress; tremors; severe toxicity includes dysrhythmias and seizures.

Methylxanthine monitoring

Therapeutic range typically 10–20 mcg/mL; toxicity risk rises above 20 mcg/mL; monitor levels.

Methylxanthine drug interactions

Caffeine increases CNS/cardiac effects; phenobarbital/phenytoin decrease levels; cimetidine/fluoroquinolones increase levels.

Methylxanthine nursing considerations

Contraindicated in pregnancy, heart disease, hypertension, seizures; advise caffeine limitation; monitor for toxicity.

Inhaled Corticosteroids (ICS)

Anti-inflammatory agents that prevent inflammation, reduce mucus production, and enhance beta-2 receptor response; not immediate-acting.

Beclomethasone dipropionate (QVAR)

An inhaled corticosteroid used for long-term asthma prophylaxis.

Budesonide (Pulmicort)

An inhaled corticosteroid used for long-term asthma prophylaxis.

Fluticasone (Flovent)

An inhaled corticosteroid used for long-term asthma prophylaxis.

Oral corticosteroids (long-term)

Used for chronic asthma; side effects include bone loss, hyperglycemia, immunosuppression; usually tapered.

ICS side effects

Oral candidiasis, sore throat, hoarseness; rinse mouth after use; spacer recommended.

ICS nursing considerations

Take daily; use spacer; rinse mouth after use; if combined with a beta-agonist, use bronchodilator first.

Corticosteroids and infection risk

Inhibits inflammation and may mask signs of infection; monitor for infections and wound healing; monitor glucose in diabetics.

Leukotriene Modifiers

Block leukotriene mediators to reduce inflammation, bronchoconstriction, edema, and mucus production.

Montelukast (Singulair)

A leukotriene receptor antagonist for long-term asthma maintenance; not for acute attacks.

Zafirlukast (Accolate)

A leukotriene receptor antagonist for maintenance therapy; not for acute attacks.

Zileuton (Zyflo)

A leukotriene synthesis inhibitor for maintenance therapy; not for acute attacks.

-lukast naming cue

Leukotriene receptor antagonists often end in -lukast (montelukast, zafirlukast).

Leukotriene modifiers therapeutic use

Maintenance therapy for asthma; daily use; not for acute attacks.

Leukotriene modifiers side effects

Headache, cough, nasal congestion, GI upset, pain, fever; monitor for liver toxicity.

Leukotriene modifiers drug interactions

Warfarin may increase INR/bleeding; theophylline may increase levels.

Leukotriene modifiers contraindications

Liver disease, pregnancy, and breastfeeding; avoid during an acute attack.

Mast Cell Stabilizers

Prevent release of histamine and other mediators; suppress inflammatory cells; not bronchodilators.

Cromolyn sodium (Intal)

A mast cell stabilizer used for chronic asthma and allergic rhinitis; inhalation.

Cromolyn nasal spray (Nasalcrom)

Intranasal mast cell stabilizer for allergic rhinitis.

Mast cell stabilizers therapeutic use

Prevention of exercise- or allergen-induced bronchospasm; long-term control of asthma.

Mast cell stabilizers side effects

Irritation of throat or nasal mucosa, nasal congestion, unpleasant taste, headache; generally safest.

Mast cell stabilizers contraindications

Pregnancy; fluorocarbons in aerosol may be contraindicated in CAD/dysrhythmias/status asthmaticus.

Mast cell stabilizers dosing note

Take 15 minutes before exercise or allergen exposure; several weeks for full effect; not for acute attack.

Mast cell stabilizers nursing considerations

Prevention-focused; monitor effectiveness; educate on non-acute use.