Comprehensive Pharmacology: Respiratory, Digestive, Reproductive, Anti-Infectives, Cancer Drugs

What are the primary functions of the upper respiratory system?

To filter, warm, and humidify incoming air, serving as the initial pathway for air entering the lungs.

What structures comprise the upper respiratory system?

Nose, nasal cavity, pharynx, and larynx.

What is the role of the epiglottis?

To prevent aspiration by covering the trachea during swallowing.

What are common conditions affecting the upper respiratory system?

Allergic rhinitis, common cold, sinusitis, pharyngitis, laryngitis.

What structures are included in the lower respiratory system?

Trachea, bronchi, bronchioles, and alveoli.

What is the function of alveoli?

They are the site of gas exchange, surrounded by capillaries.

What is the significance of type II pneumocytes?

They produce surfactant, which prevents alveolar collapse.

What are common lower respiratory conditions?

Asthma, COPD, pneumonia, pulmonary edema, pulmonary embolism.

Describe the process of external respiration.

Oxygen moves from alveoli into pulmonary capillaries, and carbon dioxide moves from capillaries into alveoli.

What is the role of hemoglobin in oxygenation?

Hemoglobin binds to oxygen in the capillary blood to transport it to tissues.

What are the indications for first-generation antihistamines?

Allergic rhinitis, urticaria, anaphylaxis (adjunct), motion sickness, insomnia, pruritus.

What are the major adverse reactions of first-generation antihistamines?

Sedation, anticholinergic effects, paradoxical excitation in children, confusion in the elderly.

What distinguishes second-generation antihistamines from first-generation?

Second-generation antihistamines have less CNS penetration and cause less sedation.

What is the action of decongestants?

They reduce nasal mucosal swelling by causing vasoconstriction via alpha-adrenergic stimulation.

What is the maximum recommended use duration for nasal decongestants?

Limit use to 3 days to avoid rebound congestion.

What are the indications for pseudoephedrine?

Nasal and sinus congestion.

What are the adverse reactions associated with pseudoephedrine?

Hypertension, tachycardia, palpitations, insomnia, anxiety.

What is the primary use of antitussives?

To suppress the cough reflex for nonproductive (dry) cough only.

What should be avoided when taking fexofenadine?

Grapefruit juice, as it can increase fexofenadine levels.

What are the nursing considerations for antihistamines?

Use caution in the elderly, avoid alcohol, and educate about drowsiness.

What is the action of oxymetazoline?

It acts as an alpha-adrenergic agonist to cause local vasoconstriction and reduce mucosal swelling.

What are the indications for cetirizine?

Allergic rhinitis and chronic urticaria.

What are the interactions to be aware of with decongestants?

MAOIs can cause hypertensive crisis; tricyclic antidepressants may interact.

What is a common side effect of nasal decongestants?

Rebound congestion if used for more than 3 days.

What is the primary indication for Codeine/Guaifenesin?

Nonproductive cough unresponsive to non-opioid therapy.

How does Codeine/Guaifenesin suppress the cough reflex?

It acts on opioid receptors in the cough center of the medulla oblongata.

What are common adverse reactions of Codeine/Guaifenesin?

Sedation, constipation, nausea/vomiting, respiratory depression (high doses), dependence potential.

What should patients avoid while taking Codeine/Guaifenesin?

CNS depressants, alcohol, and using it with a productive cough.

What is the action of Benzonatate (Tessalon Perles)?

It acts as a local anesthetic that numbs stretch receptors in the lungs and pleura.

What are the adverse reactions associated with Benzonatate?

Drowsiness, dizziness, headache, GI upset; chewing/crushing can cause serious numbness of mouth/throat.

What is a key nursing education point for Benzonatate?

Swallow capsules whole; never chew or crush.

What is the primary indication for Dextromethorphan (DXM)?

Nonproductive cough (OTC).

What is a significant risk associated with high doses of Dextromethorphan?

Dissociation and hallucinations (abuse potential).

What should patients be advised regarding Dextromethorphan and MAOIs?

Do not use with MAOIs due to the risk of serotonin syndrome.

What is the action of Guaifenesin (Mucinex)?

It increases the volume of respiratory tract secretions, reducing viscosity for easier expectoration.

What are the adverse reactions of Guaifenesin?

Nausea/vomiting, headache, dizziness (rare); generally well tolerated.

What should patients do to enhance the effect of Guaifenesin?

Increase fluid intake to 8+ glasses/day.

What is the indication for Acetylcysteine (Mucomyst)?

Thick, tenacious mucus in COPD, cystic fibrosis, post-surgical; also for acetaminophen overdose.

What is a critical nursing consideration when administering Acetylcysteine?

Have a bronchodilator available before administration.

What is the action of adrenergic bronchodilators like Albuterol?

They stimulate beta-2 receptors in bronchial smooth muscle, leading to bronchodilation.

What are the indications for Albuterol?

Acute bronchospasm in asthma and COPD; exercise-induced bronchospasm.

What are common adverse reactions of Albuterol?

Tachycardia, palpitations, tremors, hypokalemia, anxiety.

What is the action of Salmeterol (Serevent)?

It is a long-acting beta-2 agonist used for maintenance of asthma and COPD.

What is a critical warning associated with Salmeterol?

Increased risk of asthma-related death when used without an inhaled corticosteroid.

What is the indication for Epinephrine (Adrenalin)?

Anaphylaxis, severe acute bronchospasm, cardiac arrest.

What is the action of Epinephrine?

It is a potent alpha and beta agonist that causes bronchodilation and vasoconstriction.

What should patients be educated about regarding Ipratropium Bromide?

Rinse mouth after use and avoid contact with eyes.

What are common adverse reactions of Ipratropium Bromide?

Dry mouth, urinary retention, constipation, blurred vision.

What is the primary indication for Tiotropium (Spiriva)?

Maintenance treatment of COPD.

What is a key nursing consideration for Tiotropium?

Do NOT swallow capsules; they should be used in the HandiHaler device.

What is the role of corticosteroids in respiratory therapy?

They reduce airway inflammation.

What are inhaled corticosteroids (ICS) used for?

Asthma maintenance therapy and COPD (with LABA in moderate-severe cases).

Name three examples of inhaled corticosteroids.

Beclomethasone (QVAR), Fluticasone (Flovent), Budesonide (Pulmicort).

What is the primary action of inhaled corticosteroids?

Suppress airway inflammation, reduce mucosal edema, mucus production, and bronchial hyperreactivity.

What are common adverse reactions of inhaled corticosteroids?

Oral candidiasis (thrush), dysphonia (hoarseness), cough.

What should patients do after using inhaled corticosteroids?

Rinse mouth and gargle to prevent thrush.

What is the indication for oral corticosteroids like Prednisone?

Acute asthma exacerbations and severe COPD exacerbations.

What is a major adverse reaction of long-term oral corticosteroid use?

Immunosuppression, weight gain, Cushing's syndrome, osteoporosis.

What is the action of IV corticosteroids like Methylprednisolone?

Rapid systemic anti-inflammatory when the oral route is not available.

What are the indications for Xanthines like Theophylline?

Asthma and COPD, though rarely used due to narrow therapeutic index.

What is the therapeutic range for Theophylline?

10-20 mcg/mL.

What are leukotriene modifiers like Montelukast used for?

Asthma prophylaxis, seasonal allergic rhinitis, and exercise-induced bronchospasm.

What is a serious adverse reaction associated with Montelukast?

Serious neuropsychiatric events including depression and suicidal ideation.

What is the primary function of the oral cavity in digestion?

Mechanical digestion begins and salivary amylase starts carbohydrate digestion.

What condition is associated with the lower esophageal sphincter (LES)?

Gastroesophageal reflux disease (GERD).

What is the role of the stomach in digestion?

Secretes HCl and pepsinogen for protein digestion and intrinsic factor for B12 absorption.

What is the primary site of absorption in the digestive system?

Small intestine (jejunum/ileum).

What conditions are associated with the large intestine?

Ulcerative colitis, irritable bowel syndrome (IBS), constipation, diverticulitis.

What is the action of antiemetics like Ondansetron?

Blocks serotonin (5-HT3) receptors to prevent nausea and vomiting.

What are common adverse reactions of Ondansetron?

Headache, constipation, QT prolongation.

What is the action of Diphenoxylate with Atropine?

Slows peristalsis in the GI tract to treat diarrhea.

What should be monitored when using Diphenoxylate with Atropine?

Monitor for constipation and maintain hydration.

What is the indication for Loperamide?

Acute nonspecific diarrhea and traveler's diarrhea.

What is a key nursing consideration for administering Hydroxyzine?

Use IM only; safety risk due to sedation.

What is the action of Phenothiazines in treating nausea?

Block dopamine (D2) receptors in the chemoreceptor trigger zone.

What are the potential adverse reactions of Phenothiazines?

Extrapyramidal symptoms, sedation, orthostatic hypotension.

What is a key nursing action for patients on corticosteroids?

Do not stop abruptly; taper the dosage.

What is the action of Bismuth Subsalicylate?

Used for diarrhea, dyspepsia, nausea, and H. pylori treatment.

What are the properties of bismuth subsalicylate?

Antimicrobial, anti-inflammatory, and antacid properties; coats GI mucosa.

What are common adverse reactions of bismuth subsalicylate?

Dark/black stools (harmless), dark tongue, tinnitus with high doses (salicylate toxicity).

Which medications interact with bismuth subsalicylate?

Aspirin/salicylates (additive toxicity), anticoagulants (increased bleeding), tetracyclines (reduced absorption).

What should patients be warned about when taking bismuth subsalicylate?

Warn about black stools and tongue (normal); avoid in patients with aspirin allergy.

What is the action of psyllium (Metamucil)?

Absorbs water in intestine, increases stool bulk and softness, stimulates peristalsis.

What are the adverse reactions of psyllium?

Bloating, gas, abdominal cramping; bowel obstruction if inadequate fluid intake.

How should psyllium be taken?

Mix with 8 oz of water/liquid and drink immediately followed by another glass of water.

What is the onset time for psyllium?

12-72 hours.

What is the action of bisacodyl (Dulcolax)?

Irritates intestinal mucosa, stimulates peristalsis, and increases fluid secretion.

What are the adverse reactions of bisacodyl?

Abdominal cramping, diarrhea, electrolyte imbalances with frequent use.

What should be avoided when taking bisacodyl?

Antacids and milk (dissolve enteric coating prematurely).

What is the onset time for bisacodyl when taken orally?

6-12 hours; suppository onset is 15-60 minutes.

What is the action of senna (Senokot)?

Stimulates enteric nerves, increases intestinal motility.

What are the adverse reactions of senna?

Cramping, diarrhea, electrolyte imbalances, melanosis coli with long-term use.

What should patients be informed about when taking senna?

Urine may turn yellow-brown or red (harmless).

What is the action of polyethylene glycol (MiraLAX)?

Osmotically retains water in intestinal lumen, softens stool, stimulates bowel movement.

What are the adverse reactions of polyethylene glycol?

Bloating, cramping, nausea, electrolyte imbalances (with large doses).

What is the action of docusate sodium (Colace)?

Surfactant that lowers surface tension of stool, allowing water and fat to penetrate.

What are the indications for docusate sodium?

Prevention of constipation (postoperative, post-MI, in patients on opioids).

What is the onset time for docusate sodium?

1-3 days; does NOT stimulate bowel.

What is the action of calcium carbonate (Tums, Rolaids)?

Neutralizes gastric HCl, raises gastric pH.

What are the adverse reactions of calcium carbonate?

Constipation, acid rebound, hypercalcemia, nephrolithiasis with high doses.