RESPIRATORY SYSTEM

funds lab ambience (im good !)

albuterol (beta-2 agonist)

used in asthma; receives bronchospasm and prevents exercise induced bronchospasm. can be long or short acting. stimulates beta 2 receptors, causing bronchodilation. also have a minor role in increasing ciliary motility and depressing histamine release. ADRs include tachycardia, palpitations, and tremors via SNS/possible beta 1 stimulation. can also cause angina in those with vascular disease and paradoxical bronchospam. monitor for all ADRs and possible chest pains. also monitor for increased bronchoconstriction. client should not use short acting form, avoid caffeine, and notify if any ADRs are experienced. is given before glucocorticoids are administered.

ipratopium (short acting muscarinic antagonists)

provides relief of bronchoconstriction and reduces secretions in those with COPD. works on PNS, which causes constriction via Ach, by inhibiting action of Ach at receptor resulting in bronchodilation. not a rescue med; only a preventative medication. ADRs include local reactions (dry mouth, itchy throat), increased intraocular pressure in clients w/ hx of glaucoma, urinary retention, tachycardia, headache, bloody nose, and hypotension. monitor for ADRs and provide water or hard candy for dry mouth. not recommended for those with hx of glaucoma, BPN, bladder obstruction, or urinary retention. give 5 min between other inhalants.

anticholinergics

drugs that block Ach. ADRs can include blurred vision or dry eyes, dry mouth, constipation, skin-flushing, overheating, urine retention, tachycardia, hallucinations, confusion, drowsiness, and dizziness

theophylline

blocks PDE to relax smooth muscle of bronchi; is a preventative way to treat chronic stable asthma. ADRs include CNS effects like restlessness and insomnia, nausea, vomiting, diarrhea/GI issues, palpitations, and muscle twitching. toxic levels are above 20 mcg/mL; exceeding this level can lead to seizures and dysrhythmias. monitor blood levels of med along with HR and rhythm. client should reduce or eliminate their caffeine intake. not recommended for smokers or for clients receiving meds for seizures, TB, PUD, or certain bacterial infections.

cromolyn (mast cell stabilizer)

prevents release of inflammatory mediators (leukotriene and histamine) while also keeping leukocytes and eosinophils from stimulating inflammatory response, all decreasing edema of the airways. used as preventative care in mild to moderate asthma. ADRs are minimal but can consist of cough or bronchospasm. admin 10-15 minutes prior to exposure for EIB. not effective in acute asthma attacks. may take weeks to show effects.

montelukast/zafirlukast

a leukotriene antagonist that decreases inflammation by preventing activation of leukotrienes (inflammatory mediators)

zileuton

decreases # of leukotrienes available to cause inflammation

montelukast ADRs

slight risk of suicidal thoughts or behaviors, give 2 hours prior to activity help prevent EIB.

zafirlukast/zileuton ADRs

may cause liver damage and suicidal thoughts. monitor liver function tests and give 2 hours prior to activity for EIB. client should report any s/s of liver damage (abdominal pain, nausea, and anorexia). can increase effects of warfarin.

diphenhydramine (Benadryl)

binds to H1 receptors, blocking release of histamine. treats allergic/anaphylactic reactions, motion sickness, and insomnia. ADRs include drowsiness and dizziness, dry mouth, constipation, and urinary hesitancy. monitor clients when ambulating for drowsiness and have them suck on candy or sip water to combat dry mouth. client should take at bedtime, report any ADRs, and refrain from any activity requiring mental alertness. not recommended for children under 2, glaucoma, breastfeeding, urinary retention, or acute exacerbation of asthma. activated charcoal and laxatives can help with toxicity.

glucocorticoids (-sone; belcomethasone, prednisone, fluticasone)

prevents release of inflammatory mediators to decrease inflammation and edema of airways. not a rescue medication or a bronchodilator, just reduces swelling. ADRs include thrush if inhaled, adrenal suppression, osteoporosis, hyperglycemia, PUD, immunosuppression, electrolyte imbalances, and epistaxis in IN form. use spacer and rinse mouth if inhaling, give w/ food if oral. monitor wt, electrolytes, glucose, s/s of infection, GI bleeds, or adrenal suppression. client should avoid NSAIDs and report s/s of infection as they are opportunistic. taper client off.

cetrizine (zyrtec)

antagonizes histamine effects at H1 receptor sites without binding or inactivating histamine. treats allergic rhinitis and chronic idiopathic urticaria. available OTC. ADRs include drowsiness, fatigue, dry mouth, and dry throat; all ADRs are less severe than effects of diphenhydramine. assess clients during ambulation for drowsiness/fatigue, ensure water is available, and maintain fluid intake (1500-2000ml/day). lower dose if patient has compromised kidney/liver function. not recommended for infants under 6 months or those breastfeeding. can interact with theophyline to produce toxicity.

phenylephrine (neo-synephrine)

mimics SNS by activating alpha 1 receptors in the nose to shrink nasal turbinates and open nasal passages/relieve congestion. used in allergic rhinitis, sinusitis, and common cold. ADRs include CNS stimulation leading to agitation, anxiety, and insomnia. can also cause systemic vasoconstriction leading to HTN, palpitations, and dysrhythmias. clients should not overuse med so that they can prevent rebound congestion, not use for longer than 3-5 days, and notify provider of excessive CNS stimulation. prolonged tachycardia and palpitation can indicate OD. MAOIs (antidepressants) and beta agonists can potentiate effects. taper when discontinuing.

codeine (opioid)/dextromorphan (nonopioid)

suppresses the cough reflex in the brain that’s usually due to allergies or upper respiratory infections. treats nonproductive cough. ADRs include drowsiness, sedation, nausea, vomiting, dizziness, constipation, and respiratory depression. ADRs usually only occur in opioid form unless non opioid form is given in high doses or w/ other depressant meds. client should change positions slowly, have a high fiber diet, and increase fluids. given PRN in a short time frame. not recommended for men with BPN as they can develop urinary retention. monitor RR in patient.

guaifenesin (Mucinex)

reduces surface tension of secretions, thinning out mucous making it easier to cough out or drain out via nose. treats colds, upper respiratory infections, and bronchitis. assists with productive coughs. ADRs are not common but can manifest as dizziness, drowsiness, headache, GI stress, and rash. encourage patient to change positions slowly and increase fluid intake. notify provider if fever or worsening cough occur, use caution in diabetes, cough longer than 1 week, and disulfiram use. given PRN; can be tablets or extended release.

acetylcysteine

breaks disulfide of proteins in mucus to decrease viscosity of mucus to expectorate it easier. can also treat acetaminophen toxicity. ADRs include GI distress, nausea/vomiting, and rotten egg smell. monitor clients RR and breathing sounds and encourage them to not swallow their mucus. do not use with GI bleeds. not recommended for those w/ asthma, bronchospasm, and severe respiratory insufficiency. monitor possible anaphylaxis.

beta 1 receptors

increase HR, contractility, AV conduction, renin, and BP

beta 2 receptors

cause bronchodilation, vasodilation, an increase in insulin, a decrease in GI motility, and an inhibition of labor.

beta 3 receptors

cause an increase in lipolysis and relaxation of the bladder