Pharmacology Exam 2–UT Tyler Nursing Spring 16 – Flashcards
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What is the most prevalent type of Upper Respiratory Infection?
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Common cold
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More than 40 billion dollars is spent each year in the USA on what?
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OTC cold and cough preparations
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What usually accomanpies the common cold?
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Acute Rhinitis (inflammation of the mucous membranes of the nose)
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What is the difference between acute rhinitis and allergic rhinitis?
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Allergic Rhinitis is called HAY FEVER and caused by pollen or a foreign substance
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Name the groups of drugs created to manage cold symptoms? (4)
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1. antihistimines 2. decongestants 3. antitussives 4. expectorants
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Watery nasal discharge is a symptom of the common cold and can be desribed as what?
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rhinorrhea
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Which drug group is being described? --H1 blockers, or H1 antagonists, compete with histamine for receptor sites, preventing a histamine response.
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Antihistimine
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What are the 2 types of histamine receptors?
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H1 and H2 (DIFFERENT)
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Which histamine receptor is responsible for constricting the extravascular smooth muscles, including the ones lining the nasal cavity?
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H1
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Which histamine receptor is responsible for increasing gastric secretions and can cause a peptic ulcer?
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H2
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Antihistimines block the _____ histamine receptor.
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H1
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Antihistimines are not useful in emergency situations like Anaphylaxis because..?
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antihistimines are rapidly absorbed in 15 minutes, but they are NOT potent enough to combat anaphylaxis
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What is the difference between first-generation antihistamines and second-generation antihistamines?
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-1st gen cause dry mouth, drowsiness, and other anticholinergic symptoms -2nd gen have fewer anticholinergic effects and lower incidence of drowsiness
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Many OTC meds contain (1st or 2nd) generation antihistamines?
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1st!!! (thats why ppl who take them are advised not to operate machinery when taking 1st generation antihistamines bc drowsiness is a side effect)
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The anticholergic properties of most antihistamines help in treating rhinitis because of what?
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They cause dryness of the mouth and decreased secretions..they also decrease nasal itching which causes sneezing
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Name the most common side effects of first-generation antihistamines.
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drowsiness, dizziness, fatigue, and disturbed coordination
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Which generation of antihistamines are commonly called "nonsedating antihistamines" because they have little to no effect on sedation?
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2nd generation
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Which first-generation antihistamine has been available for years and is frequently combined with other ingredients in cold remedy preparations. It is commonly used to treat RHINITIS.
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diphenhydramine (Benadryl)
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Nasal decongestants are administered by what forms?
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Nasal spray or drops or in tablet, capsule, or liquid form
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Frequent use of decongestants, or nasal sprays can result in tolerance, and _____ ______ ______.
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Rebound nasal congestion (rebound vasodilation instead of vasoconstriction)
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This medication is used for allergic rhinitis and urticaria. Has few anticholinergic effects. ???
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Zyrtec
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Systemic decongestants (alpha-adrenergic agonists) are used to treat allergic rhinitis, and examples of these are what meds?
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Sudafed, ephedrine
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Why did the FDA remove OTC cold remedies and weight loss agents?
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Reports suggested the drugs may cause stroke, hypertension, renal failure, and cardiac dysrhytmias
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What is the advantage of a systemic decongestant like Sudafed?
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relieve congestion for longer that nasal decongestants do
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The incidence of side effects is low with what form of decongestants?
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topical preparations such as nose drops
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Pseudophedrine may decrease the effect of what t,ype of drugs?
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beta blockers
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Intranasal Glucocortocoids are effective for treating ________ _______...why? (these drugs can be used alone or combined with an H1 antihistamine)
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Allergic Rhinitis...bc they are steroids, so the have an inflammatory action, by decreasing symptoms such as rhinorhhea, sneezing, and congestion
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______________ act on the cough control center in the medulla to supress the cough reflex.
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Antitussives
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______________, is a nonnarcotic antitussive that is widely used OTC drug for cold remedies.
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Dextromethorphan (Robitussin DM)
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What are the 3 types of antitussives?
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1. nonnarcotic 2. narcotic 3. combo preparations
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__________ loosen bronchiol secretions so they can be eliminated by coughing. They are found in may OTC cold remedies along with analgesics, antihistamines, decongestants, and antitussives. a. antitussives b. decongestants c. expectorants d. antihistamines
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c
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The most common expectorant drug?
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guaifenesin (Robitussin)
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What is the best natural expectorant?
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Hydration
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NCLEX STUDY QUESTIONS ARE HELPFUL FOR UPPER RESP--PG. 582
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NCLEX STUDY QUESTIONS ARE HELPFUL FOR UPPER RESP--PG. 582
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What are the 2 major categories of lowere respiratory disorders?
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1. COPD 2. Restrictive Pulmonary Disease
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COPD is caused by what?
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air way obstruction and increased airway resistance of airflow to lung tissues
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4 major pulmonary disorders that cause COPD:
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1. chronic bronchitis 2. bronchiectasis 3. emphysema 4. asthma
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What disease is described as: -a decrease in total lung capacity as a result of fluid accumulation or loss of elasticity of the lung
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Restrictive Lung Disease
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Drugs used to treat COPD include: ???
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bronchodilators (primarily beta2-adrenergic Agonists)
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Medications frequently prescribed for COPD?
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-bronchodilators to open narrowed airways -glucocorticoids to decrease inflammation -leukotrine modifiers to reduce inflammation in the lungs, and cromolyn and nedocromil act as antiinflammatory agents by supressing release of histamines and other mediators -expectorants to loosen mucus -antibiotics to prevent serious complications from bacterial infections
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__________ asthma is a COPD characterized by periods of bronchospasm resulting in wheezing and difficulty breathing.
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Bronchial Asthma
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________________ increase cAMP, causing dilation of the bronchioles.
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Sympathomimetics
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For bronchospasm associated with chronic asthma or COPD, selective beta2 adrenergic agonists are given in what form?
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aerosol or tablet
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Which drug is a selective beta2 drug that is effective for treatment and control of asthma by causing bronchodilation with long duration of action.
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Albuterol
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What are the 2 lower respiratory meds given by aerosol inhaler or nebulizer?
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1. metaproterenol 2. isoprotenerol
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What is the chemical mediator that can cause inflammatory changes in the lungs?
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Leukotriene
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____________ is an anticholinergic drug used for maintenance treatment of bronchospasms associated with COPD.
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tiotropium (Spiriva)
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tiotropium is only administered by inhalation from what kind of device?
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HandiHaler device (dry powder capsule inhaler)
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Which medication for lower respiratory relaxes the smooth muscles of the bronchi, bronchioles, and pulmonary blood vessels by inhibiting the enzyme phosphodiesterase, resulting in an increase in cAMP promoting bronchodilation?
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theophylline
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which drug was once used as the first-line drug for treating pts with chronic asthma and other COPD's?
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theophylline
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__________, members of the corticosteriod family, are used to treat respiratory disorders, particularly asthma.
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glucocorticoids (steroids)
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Glucocorticoids have a synergistic effect when given with what kind of agonist?
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beta2
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3 ways glucocorticoids can be administered?
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MDI inhaler, tablet, IV
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How long may it take an inhaled steroid to reach it's full effect?
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1-4 wks
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Are side effects of orally inhaled glucocorticoids usually local or systemic?
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local ( throat irritation, hoarseness, dry mouth, coughing)
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__________ is used for prophylactic treatment of bronchial asthma and must be taken daily. NOT used for acute asthma attacks.
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Cromolyn
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How does cromolyn work?
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does not have bronchodilation properties, but instead acts by inhibiting histimine release to prevent asthma reaction
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Name a serious side effect of Cromolyn.
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rebound bronchospasm
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_________ act like detergents to liquefy and loosen thick mucus secretions so they can be expectorated.
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mucolytics
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Which 2 drugs are used to treat the inflammatory effects of asthma in children?
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cromolyn and nedocromil
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A pt with copd is taking a leukotriene agonist, Singulair. The nurse is aware that this med is given for what purpose?
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maintenence trx of asthma
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Major adverse reaction of theophylline?
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increased heart rate
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Digitalis preparations treat what?
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congestive heart failure
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3 effects that digitalis has on the heart muscle:
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1. positive inotropic action (increases myocardial contraction stroke volume) 2. negative chronotropic action (decreases heart rate) 3. negative dromotropic action (decreases conduction of heart cells)
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_________ is a secondary drug for HF.
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Digoxin
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Cardiac Glycosides are used to correct what2 complications?
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atrial fibrillation and atrial flutter
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When digoxin cannot convert atrial fibrillation to normal heart rhythm, the goal is to slow the heart rate by decreasing....?
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electrical impulses through the AV node
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What is the therapeutic serum level for Digoxin?
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0.8-2.0
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Diuretics such as feuromeside and hydrochlorothiazide promote the loss of ....?? resulting in what??
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potassium...increased effect of digoxin causing digitalis toxicity
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How do vasodilators treat heart failure?
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decrease venous blood return to the heart resulting in a decrease in cardiac filling, ventricular stretching, and O2 demand
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_________ are the first line drug treatment for reducing fluid volume
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diuretics
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_________ is a potassium sparing diuretic used to treat moderate to severe HF
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spironolactone
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which drugs are used to treat angina pectoris?
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antianginal drugs
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These drugs are prefereed to thiazides only in the treatment of malignant HTN and concominant kidney disease... -they are a sulfonamide loop diuretic--inhibits co transport system (Na, K, and 2 CL) of thick ascending limb of henle loop
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Furosemide (lasix)
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This drug is used in the tratment of HTN due to hyperaldosteronism...K sparing diuretic that is competitve aldosterone receptor antagonist in corticol collecting tubule
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spironolactone
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2nd choice antihypertensive agent typically given with a diuretic?
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clonidine
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Second choice HTN drug used in combo with other HTN drugs...selective blockade of a1 adrenoceptors; dilation of both resistence and capacitance vessels
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prazosin
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3 types of angina:
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1. classic (occurs with predictable stress or exertion) 2. unstable (unpredictable) 3. variant (during rest)
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What were the first agents created to relieve angina?
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nitrates
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What do nitrates do?
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Relaxation of coronary arteries which
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What is the most commonly used nitrate?
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sublingual nitroglycerin
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Which type of drugs are used to treat stable and variant angina, certain dysrhythmias, and HTN?
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calcium channel blockers
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What is the desired action of antidysrhythmic drugs?
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to restore cardiac rhythm to normal
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What is the major systemic effect of Nitrates?
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coronary vasodilation
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What is the antidote for Digoxin?
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digoxin immune Fab
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therapeutic serum level of Digoxin:
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0.8-2.0 ng/mL
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The antidysrhythmic drug Lidocaine is used to treat..?
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digoxin-induced ventricular dysrhythmias
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Digitalis toxicity may result in what?
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first degree, second degree, or complete heart block
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Which potent diuretics promote the loss of potassium from the body?
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-furosemide -hydrochlorothiazide
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Hypokalemia increases the effect of Digoxin, and results in what?
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digitalis toxicity
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Which drugs may be used to treat HF?
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-ACE inhibitors -beta blockers -calcium channel blockers -diuretics -angiotensin 2 receptor agonists -vasodilators
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Arteriolar dilators work in what 3 ways?
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1. reduce cardiac afterload 2. dilate arterioles of the kidneys 3. improves circulation to the skeletal muscles
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How do ACE inhibitors treat HF?
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dilate venules and arterioles, improving renal blood flow and decreasing blood fluid volume
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Name a potassium sparing diuretic:
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Spironolactone
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For HF pt's that cannot take ACE inhibitors, what should they be given?
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Angiotensin 2 receptor blocker
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Your pt is complaining of chest tightness, pressure in center chest, and pain radiating down their left arm. What is your pt suffering from?
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Angina pectoris
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What do antianginal drugs do to treat anginal pain?
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increase blood flow by increasing O2 supply or by decreasing O2 demad by the myocardium
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3 types of antanginal drugs:
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1. Nitrates 2. Beta blockers 3. calcium channel blockers
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Nitrates and calcium channel blockers are effective in treating _______ angina pectoris.
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variant
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What were the first agents created to treat angina?
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nitrates
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Nitrates reduce myocardial ischemia, but can cause ______.
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hypotension
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What is the avg prescribed dose of SL nitroglycerin?
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0.4 mg
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How long do the effects of SL Nitroglycerin last?
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10 mins
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What is the most common side effect of nitroglycerin?
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headache
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What is the most commonly used nitrate?
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SL nitroglycerin
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If a nitrate is given too rapidly, what may occur?
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reflex tachycardia, and myocardial ischemia
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Beta blockers are used as _______, ________, and _________ drugs.
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antianginal, antidysrhytmic, antihypertensive
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Beta blockers are most useful for which type of angina?
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classic
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Beta blockers should never be abruptly discontinued because what may occur?
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reflex tachycardia, and recurrence of anginal pain
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What pt's should never take beta blockers?
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pt's with 2nd or 3rd degree AV block
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Describe a cardioselective beta blocker..
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they ac more strongly on the beta1 receptor, which decreases HR but avoids bronchoconstriction
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Examples of cardioselective beta blocker meds: (2)
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-atenolol -metoprolol
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Which group choice is the most common for controlling angina pectoris?
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selective beta blockers
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Which drug group is used for the treatment of stable and variant angina, certain dysrhythmias, and HTN?
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Calcium channel blockers
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How do Calcium channel blockers work?
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they relax coronary arteries, and peripheral arterioles, and decrease cardiac demand
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Name the calcium channel blocker that is used for long term treatent of angina and has the side effect of bradycardia:
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Verapamil
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When giving a pt a calcium channel blocker, which serum levels should be closely watched?
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liver enzymes
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What is a deviation from the normal rate or pattern of a heartbeat?
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cardiac dysrhythmia
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In an ECG, the P-R interval indicates the ____ ______ _____, and the Q-T interval reflects the ________ ______ ______ _______.
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-AV conduction time -ventricular action potential duration
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When do cardiac dysrhythmias occur?
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after an MI, or from hypoxia or hypercapnia
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What is the desired action of antidystrhythmic drugs?
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restore cardiac rhythm to normal
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4 classes of antidysrhythmic drugs:
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1.Na (fast) channel blockers IA, IB, and IC 2. beta blockers 3. Prolonged repolarization 4. Calcium (slow) channel blockers
