Term
| Antitussives are used for? |
|
Definition
| used to stop obsessive coughing (not helping get rid of secretions or irritants in airway) |
|
|
Term
| Antitussives are contraindicate in ? Why? |
|
Definition
| COPD, asthma. these pts may need to get rid of secretions and need to cough to do this. mucus plugs could be very dangerous. |
|
|
Term
|
Definition
| act to elevate cough threshold |
|
|
Term
| What opioids are effective for cough? |
|
Definition
Codeine- a low dose (tenth the dose used for pain) is effective for cough
hydrocodone- more potent and greater chance for abuse
both of these may cause sedation |
|
|
Term
Non-opioid
Dextromethorphan: MOA |
|
Definition
(the DM part of Robitussin DM)
direct effect on cough center in medulla (slows down the amount of coughing)
has NO CNS effects |
|
|
Term
Non- opioid
Benzonate (Tessalon): used when? |
|
Definition
| used when robitussin doesn't work at home |
|
|
Term
| Benzonate (Tessalon): what does it look like and how do you take it? |
|
Definition
| round pearl like liquid filled capsules, a local anesthetic (used like lidocaine), DO NOT CHEW!!! it will numb the mouth and may cause choking. |
|
|
Term
Expectroants
Guaifenesin (Mucinex, Robitussin, Humibid): MOA |
|
Definition
does NOT stop coughing but helps mobilize secretions by pulling in fluid into resp tract and making secretions thinner and more liquefied.
COPD pts!!! |
|
|
Term
Expectroants
Guaifenesin (Mucinex, Robitussin, Humibid): Adverse effects |
|
Definition
rare
N & V, anorexia, occasional headache |
|
|
Term
Expectroants
Guaifenesin (Mucinex, Robitussin, Humibid): Interventions |
|
Definition
assess lung sounds, sputum characteristics, encourage fluid intake ( 1500-2000 mL/day ore MORE to help liquify secretions), take each dose with a full glass of water.
teach pulmonary hygeine (TCDB, percussion, postural drainage, get up and move!) |
|
|
Term
Decongestant Drugs
Pseudoephedrine used for? |
|
Definition
constricts blood vessels in nasal passageway
temporary relief of nasal congestion in cold, allergic rhinitis, and sinusitis, also in otitis media |
|
|
Term
Decongestant Drugs
Pseudoephedrine: MOA |
|
Definition
| sympathomimetic action, dries up secretions in nasal passageway |
|
|
Term
Decongestant Drugs
Pseudoephedrine: Contra/Precautions |
|
Definition
| pregnancy and lactation, HTN, CAD, BPH, glaucoma (symp change in the pupil is to dilate it and would block teh outflow of aqueous humor) |
|
|
Term
Decongestant Drugs
Pseudoephedrine: Adverse effects |
|
Definition
tachycardia, nervousness, irritability, jittery
related to sympathomimetic action |
|
|
Term
| what is rebound congestion? |
|
Definition
| vessels dilate and feel even more clogged up and the pt thinks they need to take more pseudoephedrine. they have to be weened off medication and try something else. |
|
|
Term
Decongestant Drugs
Pseudoephedrine: interventions |
|
Definition
encourage fluids to loosen up secretions
humidifier
avoid irritants
instruct pt to read over-counter labels carefully |
|
|
Term
Second Gen. Antihistamines
Flexofenadine (Allegra): indications |
|
Definition
| seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated hives and angioedema |
|
|
Term
Second Gen. Antihistamines
Flexofenadine (Allegra): pharmacokinetics |
|
Definition
oral
only SLIGHTLY metabolized in liver, mostly excreted in the feces BUT caution in pts with renal impairment |
|
|
Term
Second Gen. Antihistamines
Flexofenadine (Allegra): MOA |
|
Definition
| selectively blocks histamine at H1-receptor sites, decreases allergic response, anticholinergic effects (less sedating) and antipruritic effects (topical uses). |
|
|
Term
Second Gen. Antihistamines
Flexofenadine (Allegra): contras, precautions |
|
Definition
| hypersensitivity, not used in children <12 yr, caution in pregnancy and lactation, renal impairment |
|
|
Term
Second Gen. Antihistamines
Flexofenadine (Allegra): adverse effects |
|
Definition
viral infections
N and V
dysmenorrhea
some drowsiness (pt dependent)
dyspepsia and fatigue
may prolong QT interval - may increase risk for ventricular arrhythmia *know history* |
|
|
Term
Second Gen. Antihistamines
Flexofenadine (Allegra): interactions |
|
Definition
FRUIT JUICES
st. johns wort |
|
|
Term
Second Gen. Antihistamines
Flexofenadine (Allegra): interventions |
|
Definition
| assess for sedation, fluid intake, monitor use of other OTC drugs |
|
|
Term
Beta2-Adrenergic Agonistic
Albuterol: used for? |
|
Definition
effective in acute asthma attacks and prevents bronchospasms
sympathomimetic action in the lungs so hopefully less beta 1 effects (heart) |
|
|
Term
Beta2-Adrenergic Agonistic
Albuterol:pharmacokinetics |
|
Definition
|
|
Term
Beta2-Adrenergic Agonistic
Albuterol: MOA |
|
Definition
| activation of beta2 adrenergic receptors to promote bronchodilataion. aslo suppress histamine release in lung and increase ciliary motility (get mucous out of lungs) |
|
|
Term
Beta2-Adrenergic Agonistic
Albuterol: adverse effects |
|
Definition
|
|
Term
Beta2-Adrenergic Agonistic
Albuterol: warning!!! |
|
Definition
| treating asthma with ONLY beta2-adrenergic can increase risk of sever asthma and asthma-related death!! thats because beta2-adrenergic treats bronchoconstriction but not the other component of asthma- inflammation! |
|
|
Term
inhaled short acting beta 2-adrenergic agonist
names? |
|
Definition
albuterol (Proventil)
levalbuterol (Xopenex)- can/cant be used for pt with cardiac hx???
pirbuterol (Maxair) |
|
|
Term
inhaled short acting beta 2-adrenergic agonist
used for? |
|
Definition
used PRN for acute attacks or to prevent exercise induced asthma or bronchoconstricion
*needs to be in pts pocket at all times!!!* |
|
|
Term
inhaled long acting beta2-adrenergic agonist
prototype |
|
Definition
| sameterol (Serevent Diskus) |
|
|
Term
inhaled long acting beta2-adrenergic agonist
notes |
|
Definition
inhaled twice daily 12 hours apart
DO NOT used to treat an acute attack
DO NOT use as sole Rx!!!!!!
*maintenance inhaler!* |
|
|
Term
oral long term control beta2-adrenergic agonist
names |
|
Definition
|
|
Term
oral long term control beta2-adrenergic agonist
how many times do you take it? |
|
Definition
|
|
Term
terbutaline (Brethine)
is used for? |
|
Definition
SQ: for acute dyspnea
IV: for acute dyspnea or pre-term labor |
|
|
Term
Glucocorticoids
pharmacokinetics |
|
Definition
inhalation, oral or IV
inhaled steroids have less adverse effects |
|
|
Term
|
Definition
| suppresses inflammation reducing bronchial hyperactivity, decrease airway mucous, increases # of bronchial beta-2 receptors |
|
|
Term
|
Definition
as prophylaxis of chronic asthma
shoudl be used on fixed schedule NOT PRN
oral reserved for severe asthma and should be brief if possible or excerbations of COPD |
|
|
Term
Glucocorticoids
Adverse effects |
|
Definition
| inhaled-oropharyngeal canddidasis (trush) and dysphonia (hoarseness, diff speaking) |
|
|
Term
Glucocorticoids
long term effects of steroid use |
|
Definition
| increase BP, moon face, immunosuppresion, osteoporosis |
|
|
Term
| which do you take first? beta2 or glucocorticoid? |
|
Definition
| beta 2 then glucocorticoid |
|
|
Term
inhaled glucocorticoid
names |
|
Definition
beclomethasone (QVAR)
budesonide (Pulmicort)
flunisolide (Aerobid)
flucticasone (Flovent)
mometasone (Asmanex Twisthaler)
triamcinolone (Azmacort) |
|
|
Term
inhaled glucocorticoid
notes |
|
Definition
take scheduled and no more than ordered
teach proper use and consider a spacer
rinse mouth with water after use
if on a beta 2 med also, use it first then wait 5 mins |
|
|
Term
|
Definition
prednisone
prednisolone
"sone/solone" |
|
|
Term
|
Definition
take in morning with food
monitor for side effects with long term use: bone loss, weight gain, adrenal suppression, hyperglycemia, peptic ulcer disease and Cushings Syndrome |
|
|
Term
Parenteral glucocorticoids
names |
|
Definition
dexamethasone (Decadron)
hyrdrocortisone (Solu-Cortef)
methylprenisolone (Solu-Medrol) *most common* |
|
|
Term
parenteral glucocorticoids
notes |
|
Definition
same side effects as oral
IVE push over 1-2 mins up to doses of 125mg
Piggyback doses 250mg should be diluted and given over 15-30 mins. 500 mg or more 30-60 mins |
|
|
Term
Methylxanthines
indications |
|
Definition
| asthma, mostly used in COPD |
|
|
Term
|
Definition
| theophylline (Uniphyl, Slo-bid, Theo-dur) |
|
|
Term
Methylxanthines
parenteral |
|
Definition
IV DRIP ONLY
Aminophylline |
|
|
Term
|
Definition
| produces bronchodilation by relaxing smooth muscle of bronchi; may block the receptors for adenosine |
|
|
Term
Methylxanthines
pharmacokinetics |
|
Definition
wide fluctuation in plasma level, smoking cuts half-life by 50%, requires periodic blood levels to regulate,
*toxicity at levels >or equal to 20mcg/mL* |
|
|
Term
Methylxanthines
toxicity symptoms |
|
Definition
| N,V,D, insomina, restlessness is increased, dysrhythmias, convulsions, cardioresp collapse |
|
|
Term
Methylxanthines
drug interactions |
|
Definition
MANYYYY!!!
caffeine, cimetidine, fluoroquinolones increase effects. phenobarbital, phenytoin, rifampin decrease effects |
|
|
Term
Methylxanthines
interventions |
|
Definition
monitor VS & EKG, assess for cardiovascular dz and use with caution (xanthine type drug can be use for stress test when pt can walk on treadmil)
monitor resp assessment for therapeutic effect
monitor blood levels as ordered
oral preps may be given with food to decrease GI upset, DO NOT CRUSH TABLETs!
IV- watch for crystallization, DO NOT administer if present |
|
|
Term
|
Definition
improve lung fucntion by blockade of muscarinic receptors in bronchi-bronchial dilation *increase PO fluid to thin mucous
* |
|
|
Term
Anticholinergic Drugs
Drugs |
|
Definition
Ipratropium (Atrovent)
MDI or nebulizer (Duo-Neb)
Combivent (combo of albuterol and ipratropium)
Tiptropium (Spiriva) |
|
|
Term
Anticholinergic Drugs
Adverse effects |
|
Definition
|
|
Term
Anticholinergic Drugs
CAUTION |
|
Definition
peanut allergy!!!!
glaucoma, and bladder obstruction, BPH
teach pt to test spray MDI Atrovent when first open |
|
|
Term
Symbicort
what med category would this be? |
|
Definition
steroid
combined med- maintenance inhaler |
|
|
Term
Leukotriene Receptor Antagonists
drugs |
|
Definition
Zileuton (Zyflo)- blocks leukotriene synthesis
Zarfirlukast (Accolate)- leukotriene receptor blockers
Montelukast (Singulair)- leukotriene receptor blockers |
|
|
Term
Leukotriene Receptor Antagonists
Pharmacokinetics |
|
Definition
| all oral in either tablets or singulair comes as chewable tablet and oral granules to be mixed in food. chewable tablets MUST be chewed!!!!! |
|
|
Term
Leukotriene Receptor Antagonists
Interventions |
|
Definition
given usually in the evening
useful in allergies or allergy induced asthma
do not give if pt hypersensitive to povidone, lactose or cellulose derivatives |
|
|
Term
Histamine2-receptor antagonists
Rantidine (Zantac): MOA |
|
Definition
blocks h2 receptors in parietal cells of the stomach
reduces volume of gastric juices and hydrogen ion concentration |
|
|
Term
Histamine2-receptor antagonists
Rantidine (Zantac): indications |
|
Definition
gastric/duodenal ulcers
GERD
Zollinger-Ellison syndrome
aspiration pneumonitis
dyspepsia
indigestion
sour stomach
hiatial hernia |
|
|
Term
Histamine2-receptor antagonists
Rantidine (Zantac): interventions |
|
Definition
montor GI symptoms
monitor elderly for confusion
avoid giving antacid or sucralfate (30 mins-1hr) |
|
|
Term
Proton pump inhibitors
omeprazole (Prilosec): MOA |
|
Definition
| decrease gastric acid (up to 97%) by blocking the final pathway of gastric acid production in the partietal cell in gastric mucosa |
|
|
Term
Proton pump inhibitors
omeprazole (Prilosec): indications |
|
Definition
gastric/duodenal ulcers
GERD
Zollinger-Ellsion Syndrome
Dyspepsia, indigestion, sour stomach
H. Pylori*** decrease replication
Prophylactic to reduce GI bleed in critically ill pts. |
|
|
Term
Proton pump inhibitors
omeprazole (Prilosec): interventions |
|
Definition
monitor GI symptoms
Monitor INR in pts on warfarin
do not chew or crush!!! must be swallowed whole
hold enteral feeding 3hr prior or 1 hr after
IV check |
|
|
Term
Prokinetic
metoclopramide (Reglan): MOA |
|
Definition
suppresses emesis by blocking dopamine and serotonin in CTZ
increases GI motility by enhancing acetylcholine |
|
|
Term
Prokinetic
metoclopramide (Reglan):indications |
|
Definition
postop of chemotherapy related n/v
diabetic gastroparesis
GERD
increases gastric motility |
|
|
Term
Prokinetic
metoclopramide (Reglan): interventions |
|
Definition
monitor for redction in N/V
monitor for EPS, neuroleptic malignant syndrome &/or sedations***
CONTRAINDICATED in pts with bowel obstruction, perforation, or hemorrhage |
|
|
Term
Antiulcer agent
sucralfate (Carafate):MOA |
|
Definition
| forms a protective barrier on GI mucosa/ulcer crater |
|
|
Term
Antiulcer agent
sucralfate (Carafate): indications |
|
Definition
| acute and maintenance therapy of duodenal ulcers |
|
|
Term
Antiulcer agent
sucralfate (Carafate):interventions |
|
Definition
| give on empty stomach before meals, may affect absorption of some durgs so avoid giving within 2 hours of other drugs, may break tablet or dissolve in water, monitor for constipation, if pt has diff swallowing dissolve first |
|
|
Term
Antacids
magnesium hydroxide (Mylanta, Maalox): contraindications & ADE |
|
Definition
| can't be given to pts with renal failure- will cause diarrhea |
|
|
Term
Antacids
aluminum hydroxide (AlternaGEL, amphojel): ADE |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
peptic ulcer disease
GERD
dyspepsia
indigestion, sour stomach |
|
|
Term
|
Definition
monitor GI symptoms, may cause diarrhea or constipation
SHAKE WELL
chew tablets well
avoid taking with other drugs |
|
|
Term
|
Definition
calcium carbonate (Tums)
sodium bicarbonate (baking soda) |
|
|
Term
Serotonin antagonists
ondansetron (Zofran): MOA |
|
Definition
| blocks serotonin in the CTZ in the CNS |
|
|
Term
Serotonin antagonists
ondansetron (Zofran): indications |
|
Definition
| acute N/V following surgery or chemotherapy (give 30 mins before treatment) |
|
|
Term
Serotonin antagonists
ondansetron (Zofran): interventions |
|
Definition
with oral disintegrating tablets, do not push through the foil backing
do not touch with moist hands
IV push, undiluted over at least 30 seconds, preferably 2-5 mins |
|
|
Term
Dopamine antagonists
promethazine (Phenergan): MOA |
|
Definition
| suppress emesis by blocking dopamine2 receptors in the CTZ |
|
|
Term
Dopamine antagonists
promethazine (Phenergan): indications |
|
Definition
n/v
potentiation of pain medications (helps them to work better) |
|
|
Term
Dopamine antagonists
promethazine (Phenergan): interventions |
|
Definition
PO, IM, IV, rectal
monitor for drowsiness, *EPS* signs, hypotension
IV push-MUST be diluted in at least 10 mL NS and give very slowly in large bore IV site or running IV line as it can cause severe tissue injury and burning/pain at IV site
flush before and after!!
10-15 mins |
|
|
Term
antihistamines/muscarinic antagonists
Dramamine, Bonine, or Transderm Scop (patch): MOA |
|
Definition
| blocks acetylcholine, histamine near neuronal pathway that connects the inner ear to the vomiting center in the CNS |
|
|
Term
antihistamines/muscarinic antagonists
Dramamine, Bonine, or Transderm Scop (patch): indications |
|
Definition
| motion sickness, nausea due to vertigo |
|
|
Term
antihistamines/muscarinic antagonists
Dramamine, Bonine, or Transderm Scop (patch): interventions |
|
Definition
| monitor for sedation and anticholinergic effects (dry mouth, blurred vision, urinary retention and constipation |
|
|
Term
bulk-forming (preferred agents)
Citrucel, Metamucil, Konsyl Fiber: MOA |
|
Definition
| absorb water, softening and enlarging fecal mass with increase peristalsis |
|
|
Term
bulk-forming (preferred agents)
Citrucel, Metamucil, Konsyl Fiber: indications |
|
Definition
| correct constipation, reduce painful defection, soften stool to decrease straining esp in CV patients, increase peristalsis, bowel surgery/procedure prep |
|
|
Term
bulk-forming (preferred agents)
Citrucel, Metamucil, Konsyl Fiber: interventions |
|
Definition
ADEQUATE PO INTAKE
monitor abdominal assessment/BM's
teach non-pharmacologic means of aiding bowel elimination (inc fiber, fluid, ambulation) |
|
|
Term
surfactant or stool softeners
Colace, Surfax: MOA |
|
Definition
| alter stool consistency by lowering surface tension allowing more alter in the feces |
|
|
Term
surfactant or stool softeners
Colace, Surfax: indications |
|
Definition
| correct constipation, reduce painful defection, soften stool to decrease straining esp in CV patients, increase peristalsis, bowel surgery/procedure prep |
|
|
Term
surfactant or stool softeners
Colace, Surfax: interventions |
|
Definition
|
|
Term
Stimulant (works faster but should be sued infrequently)
Dulcolax (oral or supp), Senokot, Exlax: MOA |
|
Definition
| stimulate intestinal motility, increase amt of water and electrolytes in intestinal lumen, increase peristalsis (cramping may occur) |
|
|
Term
Stimulant (works faster but should be sued infrequently)
Dulcolax (oral or supp), Senokot, Exlax: indications |
|
Definition
| correct constipation, reduce painful defection, soften stool to decrease straining esp in CV patients, increase peristalsis, bowel surgery/procedure prep |
|
|
Term
Stimulant (works faster but should be sued infrequently)
Dulcolax (oral or supp), Senokot, Exlax: interventions |
|
Definition
monitor for abuse /dependency
bisacodyl (Dulcolax) may cause slight buring sensations
senna (exlax) may cause light yellowish-brown color of urine |
|
|
Term
osmotic or saline: MOA
magnesium hydroxide (milk of mag),
magnesium sulfate,
magnesium citrate (citrate of mag),
sodium phosphate (Fleets),
polyethylene glycol (Go lytely) |
|
Definition
| poorly absorbed from the intestianl tract, creating osmotic action that increases water in the intestinal tract, increases, softens fecal mass which increases peristalsis |
|
|
Term
osmotic or saline: indications
magnesium hydroxide (milk of mag),
magnesium sulfate,
magnesium citrate (citrate of mag),
sodium phosphate (Fleets),
polyethylene glycol (Go lytely) |
|
Definition
| correct constipation, reduce painful defection, soften stool to decrease straining esp in CV patients, increase peristalsis, bowel surgery/procedure prep |
|
|
Term
osmotic or saline: interventions
magnesium hydroxide (milk of mag),
magnesium sulfate,
magnesium citrate (citrate of mag),
sodium phosphate (Fleets),
polyethylene glycol (Go lytely) |
|
Definition
| shake milk of mag, chill citrate, mialax mix in 8oz water or juice |
|
|
Term
lactulose (Chronulac)
indicated for? |
|
Definition
| management of cirrhosis pts with portal encephalopathy by inhibiting diffusion of ammonia from colon to blood which decreases blood ammonia levels |
|
|
Term
lactulose (Chronulac)
caution in pts with ? |
|
Definition
| DM due to high sugar content in lactulose |
|
|
Term
lactulose (Chronulac)
why is it extremely important to teach pt why drug is given? |
|
Definition
| their mental status will be altered or they may not want to have to deal with the side effects |
|
|
Term
lactulose (Chronulac)
assess? |
|
Definition
| GI, neuro systems, ammonia levels and electrolyte levels |
|
|
Term
Diphenozylate HCL with atropine (Lomotil)
MOA |
|
Definition
| acts on smooth muscle in intestine to decrease motility |
|
|
Term
Diphenozylate HCL with atropine (Lomotil)
adverse effects |
|
Definition
| drowsiness, dizziness, anticholinergic effects |
|
|
Term
Diphenozylate HCL with atropine (Lomotil)
when should you NOT take this? |
|
Definition
| dont ever take with infectious diarrhea |
|
|
