Pharm II: Exam #3

Glucocorticoids Class

anti-inflammatory

Glucocorticoid Action

1. decrease release of inflammatory mediators
2. block the production of cytokines
3. decrease the recruitment of eosinophils

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Glucocorticoids Use

* asthma
* COPD
* COVID

Glucocorticoids Route

* inhaled
* IV
* Intranasal
* Eye drops
* Ear drops
* Topical (cream)

Glucocorticoids Prototypes

* Beclomethasone (inhaled)
* Prednisone (PO/IV)
* Methylprednisone (PO/IV)
* Dexamethasone (PO/IV)

Beclomethasone Use

* daily preventative along with other asthma meds (long-term)
* used to treat an acute illness or exacerbation of COPD/asthma
* could be part of a nebulizer treatment for either of the above uses (acute/preventative)
* part of nebulizer treatment for either of the above uses (acute/preventative)
* NOT USED FOR ACUTE ATTACKS (no immediate relief)

Beclomethasone Side Effects

* less systemic effects because drug is delivered to target tissue
* less adrenal insufficiency risk

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Beclomethasone Admin

* can cause oral candidiasis so have pt rinse mouth after
* use a spacer for better drug delivery and absorption

Inhaled Steroids

* better long-term control of disease by decreasing inflammation
* improved lung sounds/function/breathing over time
* not used for acute asthma attacks where the patient is having trouble breathing or SOB

Oral/IV

* prednisone (PO), methylprednisone (PO/IV), Dexamethasone (PO/IV),
* same effect as inhaled but faster response due to systemic (in blood stream) administration (IV/PO)
* each med has a different potency and rate of action

Prednisone Side Effects

* adrenal insufficiency
* red/thin skin
* mood changes/mania
* HTN
* delayed healing
* impaired growth
* hyperglycemia
* increased risk for infection
* dysrhythmias
* impaired growth
* osteoporosis
* cataracts/glaucoma
* cushingoid features

Prednisone Expected Outcomes

* inflammation relief
* improved breathing
* decreased SOB
* reduced swelling of airways
* regime to treat anaphylaxis

Prednisone Adverse Effect

* should not be used for long periods of time unless there is no other alternative (best for short-term effects)
* Cushing’s Syndrome

Hydrocortisone

* weakest (1)
* rapid-acting

Prednisone

* most common
* less weak (4)
* intermediate-acting

Methylprednisone

* moderate (5)
* intermediate-acting

Dexamethasone

* strongest (25)
* long-acting

Montelukast Class

leukotriene modifier

Montelukast Action

* leukotriene receptor blocker
* leukotrienes are released during trauma, infection, and inflammation

Montelukast Use

* reduces bronchoconstriction and inflammation caused by leukotrienes
* long-term treatment of asthma in children/adults
* decreased beta-2 agonist meds
* improves nighttime symptoms

Montelukast Admin

* take in evening or at night when asthma symptoms worsen
* NOT effective for treating acute asthma attacks but can still be taken while treating an acute issue

Montelukast BBW

* neuropsychiatric events
* agitation
* aggressive behavior
* depression
* disorientation
* suicidal ideation
* dream abnormalities

Montelukast Expected Outcomes

* improved asthma symptoms
* relief of allergic rhinitis
* absence of exercise induced symptoms

Albuterol Class

short-acting beta-2 adrenergic agonist

Albuterol Action

stimulates beta-2 receptors in smooth muscle of bronchi and bronchioles which produces bronchodilation

Albuterol Use

can be used as a rescue inhaler for SOB, dyspnea, asthma, and COPD

Albuterol Side Effects

* jitteryness
* tachycardia
* tremor
* shakiness
* agitation/anxiety

Albuterol Admin

* 1-2 puffs
* 5min between each puff

Albuterol Contraindications

* HTN
* seizure disorder
* diabetes mellitus

Salmeterol Class

* long-acting maintenance beta-2 adrenergic agonist
* bronchodilator

Salmeterol Admin

* usually taken as part of daily regimen to control asthma symptoms
* not effective for treating acute asthma attacks

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Salmeterol Side Effects

* jitteryness
* tachycardia
* tremor
* shakiness
* agitation/anxiety

Salmeterol BBW

* use in pts with worsening or acutely deteriorating asthma may be life-threatening
* not for acute symptoms

Ipratropium Class

bronchodilator, anticholinergic

Ipratropium Action

blocks muscarinic acetylcholine receptors in smooth muscles of bronchi, inhibiting bronchoconstriction and mucous secretion

Ipratropium Use

* asthma
* chronic bronchitis
* emphysema

Ipratropium Admin

* improves pulmonary function within a few minutes
* NOT effective for treating acute asthma attacks however it can be used with other adrenergic bronchodilators

Ipratropium Expected Outcomes

* reduced rate and improved quality of respirations and pulmonary function
* improved breathing
* reduced anxiety

Isoniazid Class

antitubercular

Isoniazid Action

inhibits cell wall synthesis

* most common anti-TB drug
* bactericidal
* used alone for latent TB but used with others for active TB

Isoniazid Adverse Effects

* hepatotoxicty
* peripheral neuropathy (give with vitamin B6 to prevent)

Isoniazid Contraindictaions

* liver disease
* chronic alcoholism
* elderly
* no ETOH

Isoniazid Nursing Considerations

* observe for signs of active TB
* report increased liver enzymes
* bilirubin
* numbness/tingling

Rifampin Class

antitubercular

Rifampin Action

inhibits RNA synthesis

Rifampin Uses

* used alone for latent TB infections
* used for INH resistant TB
* can also be used as prophylaxis for exposure to meningococcal meningitis

Rifampin Adverse Effects

* GI upset
* hepatotoxicty
* acute renal failure
* skin rashes
* prolonged use can lead to C.diff
* many drug interactions

Rifampin Contraindications

* use cautiously in those with liver disease or those with a history of alcoholism

Rifampin Nursing Considerations

* observe for signs of active TB
* report increased liver enzymes
* bilirubin
* numbness/tingling
* monitor liver function

Pyrazinamide Class

anti-tubercular

Pyrazinamide Action

* bactericidal
* exact mechanism unknown

Pyrazinamide Uses

part of a multi-drug anti-TB regimen used with INH, RIF, and ethambutol during first two months of active TB care

Pyrazinamide Side Effects

* GI upset, can inhibit uric acid excretion → gout
* hepatotoxicity
* pts with pre-existing liver impairment should not take drug unless its essential

Diphenhydramine Class

histamine antagonist

Diphenhydramine Action

blocks effects of histamine (H1 receptors) in the brain

Diphenhydramine Uses

* allergy treatment (runny nose, itchy eyes, congestion)
* used for sleep (side effects of drowsiness)
* pre medication for blood transfusion that can cause reactions

Diphenhydramine Adverse Effects

* drowsiness
* dry mucous membranes

Diphenhydramine Contraindications

HTN

Diphenhydramine Pt Education

* do not drive or operate heavy equipment

Loratadine Class

antihistamine

Loratadine Action

* second generation antihistamine (non-drowsy)
* sold OTC

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Loratadine Uses

* seasonal allergies
* chronic itching (urticaria)

Loratadine Side Effects

* dry mucous membranes
* drowsiness in some

Loratadine Contraindications

* asthmatics (careful use b/c dries membranes)
* hepatic/renal impairment

Pseudoephedrine Class

decongestant

Pseudoephedrine Action

* sympathomimetic
* reduces nasal congestion by constricting vessels
* buy OTC as phenylephrine but can get from pharmacist
* can be used to make meth

Pseudoephedrine Uses

* congestion during URI

Pseudoephedrine Side Effects

* tachycardia/palpitations


* HTN (fight or flight)
* CNS stimulation
* inability to sleep
* feeling “wired”

Pseudoephedrine Contraindications

* cardiac arrhythmias
* HTN
* diabetes (masks symptoms of hypoglycemia)

Dextromethorphan Class

cough suppressant, antitussive

Dextromethorphan Action

NMDA agonist, but not well understood, works in brain to suppress cough

Dextromethorphan Uses

cough due to common cold (not nearly as effective as codeine)

Dextromethorphan Side Effects

* few
* hallucinogen at high doses
* nausea
* vomiting
* constipation

Acetylcysteine Class

mucolytic (mucous buster)

Acetylcysteine Action

* splits disulfide bonds in mucoproteins
* lowers mucus viscosity resulting in larger volume of sputum

Acetylcysteine Uses

* emphysema
* bronchitis
* cystic fibrosis
* asthma
* acetaminophen overdose

Acetylcysteine Side Effects

* nausea
* vomiting
* chest pain
* trouble breathing

Fluticasone Therapeutic Class

drug for allergic rhinitis, asthma, and skin inflammation

Fluticasone Pharmacologic Class

* corticosteroid

Fluticasone Actions/Use

* used to decrease local inflammation in nasal passages, thereby reducing stuffiness.


* Some new formulations that combine antihistamine with corticosteroid in a nasal spray (Dymista)

Fluticasone Adverse Effects

adverse effects are rare. Nasal irritation and epistaxis (nose bleeds)

Fluticasone Forms

* Cream
* Nasal Spray
* Inhaler

Fluticasone Contraindications

known hypersensitivity pts w/ known viral, fungal, bacterial, or parasitic infections should not receive drug

Metoprolol Class

beta blocker

Metoprolol Action

bind to B1 and B2 adrenoceptors (predominantly B1) in cardiac tissue; bind norepinephrine released from sympathetic adrenergic nerves

Metoprolol Use

treatment of HTN, MI, angina, a-Fib

Metoprolol Side Effects

* **bradycardia**
* **postural hypotension**
* **bronchospasm**
* heart block
* cold extremities
* dizziness
* CHF

Metoprolol Nursing Care

* **Contraindicated with HR < 60 bpm or SBP

Diltiazem Class

calcium channel blocker

Diltiazem Action

* relaxes the muscle of heart and blood vessels
* inhibit the influx of calcium ions during membrane depolarization of cardiac and vascular smooth muscle
* decreases myocardial demand and dilates coronary arteries
* Suppression of dysrhythmias by blockage of calcium channels – slows conduction velocity and stabilizes dysrhythmia
* 1) slowing of SA node automaticity
* 2) delay of AV nodal conductivity
* 3) reduction of myocardial contractility

Diltiazem Use

* HTN
* angina

Diltiazem Side Effects

* edema
* nausea
* constipation
* headache
* drowsiness
* fatigue
* URI
* dizziness
* hypotension

Diltiazem Nursing Care

* monitor BP, pulse, cardiac rhythm
* do not crush ER or SR preparations
* teach to take radial pulse
* limit alchohol anf caffeine
* may elevate ALT, AST, LDH, CPK, and Alk Phos

Verapamil Class

calcium channel blocker

Verapamil Action

* relaxes the muscle of heart and blood vessels
* inhibit the influx of calcium ions during membrane depolarization of cardiac and vascular smooth muscle
* decreases myocardial demand and dilates coronary arteries
* Suppression of dysrhythmias by blockage of calcium channels – slows conduction velocity and stabilizes dysrhythmia
* 1) slowing of SA node automaticity
* 2) delay of AV nodal conductivity
* 3) reduction of myocardial contractility

Verapamil Use

* HTN
* angina

Verapamil Side Effects

* edema
* nausea
* constipation
* headache
* drowsiness
* fatigue
* URI
* dizziness
* hypotension

Verapamil Nursing Care

* monitor BP, pulse, cardiac rhythm
* do not crush ER or SR preparations
* teach to take radial pulse
* limit alchohol anf caffeine
* may elevate ALT, AST, LDH, CPK, and Alk Phos

Lisinopril Class

ACE Inhibitor

Lisinopril Action

* inhibits angiotensin converting enzyme (ACE); prevents conversion of angiotensin I to angiotensin II.
* Increases plasma renin activity
* Reduces aldosterone secretion to lower BP