What causes rebound nasal congestion?
Phenlyephrine (Afrin, Neosynephrine), pseudophedrine(Sudafed) if used longer than 3-5 days or increased frequency
The patient is instructed to do what activity after acetylcysteine (Mucomyst) is administered?
coughing and postural drainage excerises
What mechanism do opiates (codeine, hydrocodone (Hycodan)) use for their anti-tussive action?
Inhibit cough refles center in the medulla of the brain
What is the drug classification of loraditine (Claritin), astmizole (Hismanal)? (Focus on the non sedating anti-histamine action.)
non sedating anti-histamine action - does not cause drowsiness
What is the drug, cromoln sodium inhaler, used for?
(Intal), giev oraly to inhibit mast cells . Doesn't bronchodilate.
List the sequence of steps for using a multidose respiratory inhaler?
1. Use a spacer device to keep inhaler one and one-half inches away from the mouth. 2. Seal mouth on mouth piece. 3. Breathe deeply once. 4. Activate the inhaler. 5. Continue breathing in for 5 seconds. 6. Hold breathe minimum of 10 seconds (or as long as possible). 7. Breathe out slowly. 8. Wait 2 minutes between doses if second dose is ordered.
What is the purpose of a spacer device on an inhaler?
to keep the inhaler 1 1/2 inches away from the mouth, helps to enhace the delivery of the medications
A pt. needs to gargle with water and spit out the water after using triancinolone(Azmacort), and belcomthasone (Vanceril) inhaler to prevent what from occurring?
To prevent fungal infection in the mouth & throat
If taking both at the same time, which should be used first, a reliever inhaler or a controller inhaler? Which meds are reliever drugs for asthma? Which meds are controller meds for asthma?
If reliever & controller inhalers are ordered, take the bronchodilator inhaler first.
Controller Drugs for Asthma:
Reliever Drugs for Asthma:
Selective Beta 2 Bronchodilators
Non Selective Beta Adrenergic Bronchodilators
-Theophylline and xanthines
Which meds are selective beta-2 bronchodilators?
albuterol(Proventil) inhaler onset in 5 minutes. Oral onset 15 mins
metaproterenol(Alupent) inhaler onset 1 min, Can be given oral
terbutaline(Brethine) inhaler, oral, injection(IM w/ onset in of 15 mins)
salmeterol(Serevent) inhaler, long acting w/ duration of 12 hrs. Onset action time too long to be used in acute asthma attack.
What is the therapeutic serum theophylline level so that time released capsules can be given?
10-20 mcg/ml serum
Aminophylline alleviates what respiratory symptoms?
Wheezing, SOB, and stimulates respiratory center in the brain.
Aminophylline is administered how most commonly?
IV infusion through IV rate control pump
*Pts. will need second IV site for other fluids and meds since amionphylline is incompatiblein the IV line other IV meds.
What is the action of of Prednisone in the treatment of asthma?
Glucocorticoids - prevent the immune system response to antigens and prevent bronchoconstriction.
Prednisone (Deltasone) - suppress an acute inflammatory process and for immunosuppression and prevents cell-mediated immune reactions (in book , I use Kee 6th edition pg 784).
* if patient requires long term glucocorticoids, given oral 20 mg or less every other day to prevent patients own adrenal gland from stopping production of cortisone
What are the side effects of Predinsone? Why should Prednisone not be stopped suddenly?
-cause elevation in serum glucose
-cause overproduction of gastrin & can cause development of gastric ulcers
Book says on pg 784, side effects of prednisone are nausea,diarrhea, abdonminal distention, inceased appetite,sweating,headache, depression, fush, mood changes.
if stop suddenly it can cause severe changes in b/p and glucose levels
Surfactant is given to prevent what occurrence in the lung?
-to prevent respiratory distress syndrome (hyaline membrane disease in newborns)
-collapse of tine airsacs in lung from deficiency of surfactant
What are the causes of Hypofunction of glands which requires replacement hormones be given?
cancer, congenital absent gland, infection, pituitary insufficiency, surgical removal of gland, radiation
What is the protocol followed when beginning to give Synthroid? (Focus on small dose initally and gradual increase in dosage.)
Before breakfast daily. Small dose initally and gradual increase in dosage
What is the desired outcome of giving the hormone replacment drug, Synthroid? (Focus on restoration of normal hormone levels.)
to restoration of normal hormone levels
What is the effect on pulse when a patient receives too much Synthroid?
rapid,irregular pulse & angina pain indicate toxicity
What are the toxic effects of Tapazole or Propacil?
Soe throat, fever, rash, leukopenia (monitor CBC)
What are the sleeping precautions for 48 hrs someone who has received radioactive iodide
sleep alone and avoid embracing or close contact with others
Why is replacement hormone, cortisone, prescribed: 2/3 dose in the AM and 1/3 dose in the PM?
to refrain from disturbing sleep (circadian cycle)
Oral contraceptive drugs provide birth control by suppressing what function?
given oral to stop ovulation and provide reversible prevention of pregnancy.
What is the action of Histrlin and why is it given in Hyperfunction of the anterior pituitary?
Given parenterally until puberty to block gonadotropin production & prevent premature sexual development in children
What is the desired growth when a child is given Humatrope?
(HGH) Humatrope given SubQ 3 times/week to promote one inch growth every 6 months in 2-13 years
When a pt has SIADH what drug blocks the action of anitdiuretic hormone (ADH) on the kidneys?
What is the action of Glucotrol?
increase beta cell activity in pancreas to release the already formed insulin into circulation
increase the insulin cell receptor responsiveness
What is the action of Gluocophage?
lowers blood glucose by increasing the receptiveness for insulin on the peripheral insulin receptor sites
How is cloudy insulin in suspension properly mixed before administeriong to a pt?
rotate or gently roll the bottle, do not shake (this will cause bubbles to draw up in syringe)
Why are insulin injection sites rotated?
prevents development of fatty tissue fibrosis which hinder absorption
Why is the sequence of drawing regular and intermediate actiong insulins into the same syringe not varied? (Focus on maintaining consistent onset times.)
because it can cause changes with the onset time from injection to injection. onset times must be kept constant.
What does peak onset time mean?
how many mins after receiving the insulin, the most ability to lower blood glucose from the circulation is occuring.
What are the signs and symptoms of hypoglycemia?
headache, dizziness, difficulty problem solving, restlessness, hunger, tachycardia, cold & clammy skin, sweating, decreasing LOC, seizure, coma
What behaviors by the pt cause episodes of hypoglycemia?
Too much insulin, too little food (missed meals), insulin peak activity and too little food, increased exercise with the same food and insulin, decreased food absorption (vomiting, diarrhea)