Respiratory and Nervous System Study Guide

Medication Considerations

  • Over-the-Counter Medications: Check guidelines for usage duration before consulting a healthcare provider.

    • Generally, advise patients to consult a medical provider if symptoms persist beyond two to three weeks.

    • Discourage self-diagnosis and self-treatment to avoid missing important underlying conditions and potential complications.

  • Dosage Calculation: Focus on understanding metric conversions, as there will only be one question on the test about that topic.

  • Abbreviations: Be familiar with abbreviations from the handout posted on Canvas.

Nervous and Respiratory System Drugs

  • Upcoming Lecture:

    • Drugs that affect the nervous system.

    • Pain medications.

    • Drugs affecting the respiratory system.

Potassium Supplementation

  • Potassium Chloride vs. Potassium Acetate:

    • Both are potassium supplementation but differ slightly in formulation.

    • Potassium acetate is used in the formulation of potassium chloride.

Exam Preparation Strategies

  • Study Habits:

    • Study regularly and consistently.

    • Use active recall techniques (e.g., writing with a pencil).

    • Realize that for the first exam, there is no need to memorize specific drug names from the example columns.

Opioids and Black Box Warnings

  • Black Box Warnings: Pay special attention to black box warnings as they indicate significant harm if the warning is ignored.

  • Boxed Warnings: They are revising it to boxed warnings because they're afraid if they call it a black boxed warning, people might not take their medicine. Same thing.

  • Patient Education: Educate patients about side effects and emphasize the precautions you are taking to ensure their safety.

  • Monitoring: Implement continuous monitoring (e.g., pulse oximetry) to allow for early intervention if complications arise.
    *If a patient starts to desaturate, intervene early

Drug Categories Overview

  • Opioid Analgesic Agonist

  • Narcotic Antagonist (reversal drug)

  • Triptans: Used for migraine

  • Salicylates: Aspirin (the grandfather of all NSAIDs)

  • NSAIDs:

    • General NSAIDs (e.g., ibuprofen)

    • Special role for ketorolac (Toradol): Need to be aware of this drug due to the strict five-day limit due to severe consequences of taking it for too long.

    • COX-2 Inhibitors: Used for arthritis (not for headaches)

  • Non-Narcotic Analgesic: Acetaminophen.

Acetaminophen

  • Not Narcotic: It is an analgesic.

  • Antipyretic: Fever-reducing, remember that pyrexia is a technical term for fever.

  • Generic Name: Tylenol.

Pain Assessment

  • Comprehensive Assessment: Before administering pain medications, assess the patient's current pain level: intensity, location, type

  • Pain Scales: Use numeric pain scales; ACES scale for those who cannot use a numerical scale.

  • Goal of Pain Management:

    • Realistic target: Aim to get their pain down to about a 3 or 4.

    • Use the least potent medication for the shortest amount of time possible.

    • Continuously reevaluate the effectiveness of pain management strategies.

Non-Pharmacological Techniques

  • Consider non-pharmacological techniques as adjuncts or alternatives to medication management.

Opioid Overdoses

  • Over the past 20 years in the USA, drug overdoses have claimed over 932,000 lives.

  • Address the need for vigilance and signing off on waste with another RN or LPN, drugs are diverted.

  • Educate patients that zero pain is not a realistic goal; avoid sending patients home with excessive amounts of opioids.

  • Most overdose deaths involve opioids.

  • There has been a rise in the usage of street drugs with synthetic versions, such as fentanyl.

    • Using elephant tranquilizers to mess around with the components of drugs is short-sighted.

Historical Perspective on Opioid Use

  • Previously opioids such as codeine were not an option for chronic pain.

  • Falsified Research: In the late 1990s falsely promoted OxyContin as safe for long-term use.

    • Lawsuits: Legal action against big pharma has revealed their knowledge of the risks.

Addressing Opioid Use

  • Need to recognize we need to be comfortable.

  • Outcome is based on how class makes decision.

  • Simulation and Lab: Being very direct about opioid agreement.

Opioid Agonists and Antagonists

  • Agonist: boosts the action of the body's normal processes.

  • Benefits opioid receptor activity in the body.

  • Used for acute or chronic moderate to severe pain. However, one must fear when using for chronic pain.

  • Side effects should be payed special attention to.

  • Boxed warnings must be acknowledged, create post it notes on where they should be memorized.
    Should Monitor, Do, and Teach

  • Respiratory Rate: Hold if respiratory rate is below 12

Medication Administration

  • Administration: Especially for oral medications, there is really not a lot of variety on how you hand them the pill.

  • Focus more on the monitor teach columns.

Antagonist

  • The opposite of an agonist is an antagonist, which is a reversal drug.

  • Naloxone or Narcan is a reversal agent for an overdose.

    • Recognize that their pain is hurting terribly as soon as it hits them because it will go in and reverse that opioid activity immediately.

    • After administration, continue to monitor their respiratory rate; if it starts to decline again, recognize that you might need to give them a second dose.

    • You have to use it, even if it is expensive.

    • Best to take the drugs at the onset of the migraine.

Triptans and Migraines

  • Drug Class: All generic names end in "triptan."

  • Mechanism: Vascular remedy.

  • Contraindications:

    • History of stroke or vascular ischemic heart disease.

    • Hypertension.

  • Side Effects/Monitoring:

    • Chest discomfort and angina (chest pain).

    • Serotonin syndrome (confusion).

    • Vertigo (spinning sensation).

Salicylates (Aspirin) and NSAIDs

  • Similarities: Study them together due to shared black box warnings and concerns.

  • Differences: Tease out individual variations in risks and uses.

  • Acetaminophen: Not an NSAID; it is a prostaglandin inhibitor.

Aspirin (Acetylsalicylic Acid or ASA)

  • Low Dose: 81 mg (used to be called children's aspirin).

  • Risks: Avoid in children due to the risk of Reye's syndrome (neurological condition).

  • Use: Contraindicated in children under 12 years; up to 19 years in those with flu-like symptoms or chickenpox.

Ibuprofen and Naproxen (Aleve)

  • Uses: Mild to moderate pain, fever reduction, and anti-inflammatory effects.

  • Considerations:

    • Ibuprofen is preferable over acetaminophen for sprained ankles due to its anti-inflammatory properties.

    • Avoid in patients with a history of ulcers due to GI irritation and increased bleeding risk.

  • Side Effects: Steven Johnson Syndrome.

Black Box Warnings: NSAIDs as a class

  • Stevens Johnson syndrome:

    • Rare but serious, a skin infection is part of it.

    • Severe rash; may require hospitalization.

  • Renal failure

Additional NSAIDs

  • Contraindicated patients with recent CABG surgery.

Toradol

  • Individual drug, due to the seriousness of its complications.

COX-Two Inhibitors

  • Treats inflammation.

Acetaminophen (Tylenol)

  • Risk: Severe liver injury (hepatotoxicity).

  • Liver Health: Liver function tests or liver enzymes are checked to see what their liver enzymes are.

  • Daily Limits:

    • Average Adult: No more than 4000 mg in 24 hours.

    • Geriatric (75+): Limit to 2000 mg; use regular strength (325 mg) instead of extra strength.

Liver Health

  • Labs:

    • Liver tests should be done often.

Respiratory System

  • Two phases of working:

    • Conducting zone.

    • Gas exchange zone.

  • Fundamentals:

    • It is an autonomic nervous system response. So as long as you got a brain stem, you can breathe independently.

  • Inflammation: Immune system drives inflammation.

    • The body just has this exaggerating response, and it's causing all these allergy symptoms.

    • Allergies, the body is thinking, and we gotta get that substance out of here.

  • Inhibitor:

    • Go back to target cell line and saying, calm yourself down. Stop coughing.

Antihistamines

  • Histamine: Chemical mediator.

  • H2 inhibitors.

First and Second Generation

  • Benadryl vs cetifazine

  • Benadryl: People are often gonna need a nap

  • cetifazine: Tends to have minimal side effects like that and only be sedating at high doses.

Special Attention

  • Afrin nasal spray can only be used for a little because of the risk of rebound congestion.

  • Limit the time frame for Afrin.

  • OTC cold remedies tend to have a warning on them about cautions for people with hypertension because they do tend to all cause some degree of vasoconstriction, kind of clamping down on things, which would help the inflammation.

OTC Meds

  • Do not allow children under 4 to take it. Because there have been cases in overdoses in children.

Decongestants

  • Cause some degree of vasoconstrict, if you decrease the amount of blood through there, then you're gonna decrease the amount of inflammation product getting delivered to trigger it

Antitussives

  • Cough medications.

  • Patients with hypertension shouldn't take any topical remedy without checking with their doctor first.

  • We can also help them understand why they can't just buy boxes of Sudafed.

Overview

  • Main thing here is to recognize some coughs are necessary, because its bringing mucus up from the lungs.

  • More for dry hacking cough.

Glyphemesis

  • Expectorants

  • Study the expectorants

Immune System

  • We said inflammation is a product of the immune system.

  • We go a little bit further.

Asthma

  • Triggered by exposure to triggers.

  • Physical changes to our airway:

    • Bronchoconstriction.

    • Inflammation.

    • Delivery of extra secretions plugging things up.

  • Managing Airways:

    • Open up bronchus to relax that muscle.

    • If they figure out the triggers, decreasing exposure to them.

Rescue Drugs vs Maintenance Drugs

  • You need to know the difference.

  • You're going to monitor and know maintenance drugs are not going to save their life.

  • Oral routes have a more potent effect.

  • Aerosal is safer to use, because it's going only to the part that they needed in: Almost immediate responses.

Devices

  • Inhaler like this first picture.

  • This one down here is also an inhaler: powdered product called sprue of that capsule goes down it that you will crushed it and then inhale the powder.

  • Nebulizer: create a little mist.

COPD

  • Chronic obstructive pulmonary disease.

  • Old air is not being let out anywhere in.

  • We break it down into emphysema and phony bronchitis, which just involves endoscope.

  • Related to tobacco use and industrial exposures.

  • Symptoms: Difficulty breathing, obstructed respiratory processes cause wheezing.

  • No cure

Regarding Asthma

  • As you get older, airways get bigger.

  • Your immune system can fluctuate in how it tolerates different things.

Neuro System

  • Driven by your neurological system

  • The emotions over here, and the body over there. And both are connected.

Triggers

  • Stress plays a role in respiratory issues

COPD Symptoms

  • As they're trying to empty the old air out, put more air in, and that is not moving

  • Chronic respiratory condition

  • Have to live with it

  • On breathing treatments

  • Daily smoking can lead to COPD

Tobacco Consumption

  • Very sensitive and compassionate tone.

  • Offer resources for quitting resources.

Patient Centered Care

  • Nicotine dependence has a physical factor.

  • Compassionate thing to do, so offer a patch.

Beta Two Agonist

  • Sympathomimetic: Boosting the beta adrenergic nervous system

  • Adrenaline: fight or flight

  • Albuterol is a poster child for it

  • Bronchodilator

  • Rescue drug

  • Go-go-go drug in spirit flight.

  • May cause tachycardia and CNS stimulant impacts

Long acting Beta Two Agonist

  • Maintenace drug

  • The scary statistics with asthma, is that some people are still seeing people die from asthma attacks often because they've self medicated with albuterol.

Concerns

  • Should be put into the system

  • Low potassium and high glucose.

  • The other time the highest time of day for deaths from asthma is like toward midnight, four AM.

Anti-Cholinergics

  • They're driving out air retention.

  • Constipation.

Bronchodilation

  • Relax those muscles and relax those muscles, result in the Bronx or dilation.

  • Tiotropium is an example listed here.

Combo Inhaler

  • This might may have an anticholinergic inhaler.

Fluticasone

  • A popular steroid inhibitor that you might see.

  • Safe, but must rinse mouth out to avoid infection of thrush.

Nasal Spray

  • Epistaxis, the word for nosebleeds, especially when using the clonase nasal spray and that's available over the counter too.

Mast Cells

  • They jump and get excited, then react to heritage and other triggers.

Leukotrines

  • Leukotriene receptor antagonist

  • Calm down these excitable cells, help them chill out, and stop reacting so dramatically here

  • Again, this is one of my mint drugs, long term control of asthma, decreasing the risk of having asthma episode.