N365 Exam #3

mucolytics

break up mucus into smaller units

classification of acetylcysteine (Mucomyst)

mucolytic

action of acetylcysteine (Mucomyst)

breaks up bonds/linkages of mucus into smaller, more soluble and less viscous strands

what pH is acetylcysteine most effective at

pH 7-9

why is it easier for people to cough out when acetylcysteine is used

it is less viscous and sticky

what form is acetylcysteine given in

nebulized form, puts it right into the respiratory tract

ADRs of acetylcysteine

few ADR; people with asthma can develop bronchospasm in reaction to this drug

why might N/V occur in a patient being treated with acetylcysteine?

it has an unpleasant rotten egg odor

acetylcysteine is an antidote for ___ overdose

acetaminophen overdose

expectorants

help liquefy secretions

bronchomucotropics

make mucus in large airways

classification of guaifenesin (Robitussin)

expectorant, bronchomucotropic

action of guaifenesin (Robitussin)

it works by irritating the gastric mucosa, stimulates the nerve endings where the gastropulmonary reflex action occurs. it lubricates your airway to help loosen up the mucus

what is the gastropulmonary reflex action

natural response to alert itself & rest of body to get rid of the medicine, body makes greater volume of super watery secretions which makes it easier to expectorate

guaifenesin has nothing to do with how often you cough. t or f

true

ADRs of guaifenesin

• rare

• occasional GI irritation

why is hydration important with expectorants?

expectorants pull fluids that’s already in the body which will dehydrate you

classification of epinephrine

bronchodilator, sympathomimetic (non-selective)

how do nonselective bronchodilators work

it hits all receptors

what is sympathomimetics

it activates all the major sympathetic receptors

action of epinephrine

very potent and rapid bronchodilator that has significant cardiac effects. it stimulates all receptors; alpha - vasoconstriction; beta-1: stimulates HR, force of contraction and irritability; beta-2: induces bronchial relaxation

why can’t we give epinephrine orally?

it gets destroyed by the digestive enzymes

ADRs of epinephrine

• nervousness

• insomnia

• fear

• tremors

• tachycardia

• palpitations

• headache

• dyspnea

• (think SNS “fight or flight” effects)

why should we avoid giving epi to a patient with CAD?

• epi stimulates beta-1 receptors, so it’ll increase BP and the heart might be too weak to tolerate that

why should we use epi with caution on a patient w HTN?

• it causes vasoconstriction, so might raise BP even more

why must we be careful giving epi to a patient w hyperthyroidism?

everything gets shifted into high gear

when educating a patient about the use of epinephrine, we should ask if they are taking ___ because ___

MAO inhibitors, it will precipitate severe hypertension

in the case of an emergent allergic reaction, the nurse should use

epinephrine

classification of isoproterenol (Isuprel)

non selective beta stim sympathomimetic, bronchodilator

action of isoproterenol (Isuprel)

it stimulates ONLY beta receptors (stimulates heart, causes bronchodilation & decreases tone and motility of GI tract and uterus)

ADRs of isoproterenol

• tachycardia

• palpitations (d/t stimulation of b-1 receptors)

• sympathetic ADRs

isoproterenol is not a strong bronchodilator. t or f

false, this is one of the most powerful bronchodilators

classification of albuterol

selective beta-2 stimulator, relatively selective beta stim

actions of albuterol

stimulates beta-2 which causes relaxation of smooth muscles of bronchial tree and peripheral vasculature

ADRs of albuterol

• few

• peripheral dilatation can cause decreased BP leading to tachy

  • this is really only a problem if given too often or dose is too high

albuterol has two types:

• SABA

• LABA

difference between LABA and SABA

• SABA — short acting nature, considered a “rescue” inhaler because it works quickly

• LABA — lasts longer than epi, but is slower

who must we use SABA with caution in?

pts who have diabetes, HTN, cardiac disorders

classification of ipratorium (Atrovent)

anticholinergic bronchodilator

action of ipratropium (Atrovent)

stimulates PNS, anticholinergic would open up the bronchi —> cholinergic receptors are blocked, bronchial tone reduced

ADRs of ipratropium

• no big ADRs because there is no systemic absorption

• dry mouth

• pharyngeal irritation

what is ipratropium mostly used for

maintenance therapy, it’s prevention. this is taken everyday so they dont get constriction in their airways

when educating pts about spiriva, what should you tell them to do

they need to put a capsule into the chamber and then inhale it that way, make sure they don’t forget to poke a hole in it

what is special about aminophylline (theophylline)?

it acts like caffeine, so it gives you caffeine-like SEs

classification of aminophylline (theophylline)

methylated xanthine, bronchodilator

action of aminophylline

has increased cAMP which leads to relaxation of smooth muscle, stimulates heart and CNS. and renal excretion

what is the therapeutic level of aminophylline

8-15mcg/mL

ADRs of aminophylline

• severe hypotension

• urinary frequency

• N/V because it stim. vomiting center

half life of aminophylline is shorter in non-smokers. t or f

false, shorter if you smoke

why is aminophylline taken with food

to decrease GI irritability

classification of cromolyn sodium (Intal)

antiallergic (Histamine inhibitor)

action of cromolyn sodium

this is a mast cell stabilizer; when mast cells burst it releases histamine, but this prevents that from happening

cromolyn sodium can be used on a patient who is already having an allergic reaction. t or f

false, histamine is already out so can’t use this. this cannot be used for acute attack

ADR for cromolyn sodium

throat irritation

a child is having an allergic reaction, but there is a respiratory component to it. what medication can we prescribe him?

cromolyn sodium

what is cromolyn sodium used for

asthma prophylaxis and to prevent exercise-induced asthma attack

what is different about zafirlukast (Accolate)

it is a leukotriene receptor antagonist, it blocks INFLAMMATORY response because it is a competitive antagonist that blocks receptors for leukotriene

what is zafirlukast used for

for prevention, not when you’re already having inflammation.

why shouldnt zafirlukast be taken food

its bioavailability gets decreased by 40%, so make sure not to lump food together in the morning

ADRs of zafirlukast

• liver damage

• GI

• headache

why can’t we take zafirlulast with warfarin

it causes an increased warfarin concentration and elevated PT, causes increased plasma levels of zafirlukast

classification of beclomethasone (Vanceril)

inhaled corticosteroid

what is one of the most effective anti-inflammatory drugs we have

beclomethasone (Vanceril)

what medication causes hoarseness, dry mouth and localized thrush infection as your ADRs?

beclomethasone

what is beclomethasone most effective for

long-term control treatment, used for precention

dextromethorphan (DM) classification

antitussibe, nonopioid

why do we want to avoid giving patients w respiratory disorders dextromethorphan?

it suppresses cough reflex, we want to avoid this because we need to keep their airways clean

action of dextromethorphan

it acts centrally in the medulla and has no analgesic or addictive properties

ADRs for dextromethorphan

infrequent, can cause GI distress and drowsiness though

what does dextromethorphan contain

alcohol

classification of pseudoephedrine (Sudafed)

decongestant

what is a deognestant

helps to shrink BV in the airway to help it open up more

actions of pseudoephedrine

causes release of norepinephrine, may incr BP because of vasoconstriction and cardiac stimulation

ADRs of pseudoephedrine

• adrs are minimal though it can cause tachycardia, flushing and palpitations

why is pseudoephedrine behind the counter?

it used to be OTC, but bow you’re limited in how much you can buy because this is one of the ingredients used to make meth

when should pseudoephedrine NOT be taken

avoid taking near bedtime bc stimulaiton can occur

classification of diphenhydramine (Benadryl)

antihistamine

what is benadryl used for

helps people sleep

actions of diphenhydramine

decreases allergic reactions by inhibiting vasoconstrictor effects of histamine, strongly antagonizing action of histamine, inhibiting release of acetylcholine and is a SEDATIVE

ADRs of diphenhydramine (Benadryl)

• rarely serious

• sedation

the patient should not drive when taking benadryl. t or f

true

why shouldn’t you take benadryl concurrently with alcohol

it enhances sedative effect, alcohol is a CNS depressant

tolerance cannot occur with benadryl. t or f

false

why is an expectorant drug like guaifenesin used to relieve chest or upper airway congestion

1. easier to cough out secretions since it liquefies them

2. no secretions from post nasal drip

Which of the following is indicated for treatment of an acute asthma attack?

1. beclomethasone

2. zafirlukast

3. ipratropium

4. albuterol

albuterol

Inhaled steroids should be given cautiously to patients with

active respiratory infection

Pseudophedrine works by

mimicking the SNS system

what is a major cause of atherosclerosis

excess plasma levels of lipoproteins

what are lipoproteins

contain a protein shell with core lipid

how can we modify lipoproteins in the blood?

modify diet and drug therapy

what is the difference between LDL and HDL

LDL — bad cholesterol; gets delivered to liver and tissues

HDL — removes cholesterol from tissues; has a good protective effect

what are non-pharmacologic ways to alter plasma lipoproteins

diet modification, weight loss, exercise and cessation of smoking

what is the goal of drug therapy in treating hyperlipidemia

goal is to decrease LDL without decreasing HDL (LDL below 100, HDL @ 40-60)

classification of atorvastatin (Lipitor)

anti-lipid (HMG-CoA reductase inhibitor)

action of atorvastatin

• increases HDL modestly

• decrease LDL, total cholesterol, VLDL, and trigyclyerides over all

• it inhibits the very same enzyme that controls the rate at which your body makes cholesterol

• this is a HIGHLY EFFECTIVE LIPID REDUCING AGENTS

ADRs of atorvastatin

• mild transient GI disturbances

• muscle pain

• increase in serum transaminase levels

• severe myalgia

• myositis

• muscle weakness

• rhabdomyolysis muscle death/necrosis

what should the nurse monitor to check for serum transaminase levels in a patient taking lipitor

liver function tests

what are the big ADRs the nurse should be concerned about when giving atorvastatin

• liver and muscle effects

• myopathies

• elevations in liver enzymes

• peripheral neuropathy