ENT & "Roids"
What is the recommended maximum use of intranasal phenylephrine?
No more than 3 consecutive days
What drug might be useful to control mucous secretions during an asthma or COPD exacerbation?
Ipratropium, a muscarinic antagonist, inhibits the action of acetylcholine at muscarinic receptors, leading to reduced bronchoconstriction and mucus secretion, thereby improving airflow.
What benefit does Guaifenesin have in chronic respiratory conditions?
Guaifenesin acts as an expectorant to thin and loosen mucus in the airways, making coughs more productive and helping clear chest congestion.
Name 3 causes of pharyngitis?
Viruses such as the common cold, influenza, and mononucleosis (Epstein-Barr virus) are the most frequent cause of pharyngitis.
Bacterial infections: Bacteria—most notably Streptococcus pyogenes, which causes strep throat—account for a smaller percentage of cases and require antibiotics.
Allergies: Allergic reactions can trigger postnasal drip, where excess mucus flows down and irritates the back of the throat.
Your patient reports they take Theophylline for severe asthma. What test should you anticipate the provider ordering?
Patients will need serum blood levels tested every six to twelve months
Why should a nurse palpate sinus passages in a patient with chronic sinusitis?
A nurse palpates the sinus passages to assess for localized inflammation, fluid accumulation, and tenderness caused by blocked or infected paranasal cavities leading to pain/pressure.
Name 3 things that improve inhaler medication delivery?
Spacers and valve holding chambers.
Proper techniques like a slow, deep inhalation and holding your breath for 10 seconds following inhalation.
Shaking the canister before use and priming new or inactive inhalers.
Your elderly patient reports they take diphenhydramine daily. What education would you provide?
Cognitive Decline and Dementia Risk with Long-term use over 3 years.
Falls and accidents due to drowsiness and psychomotor impairment.
Anticholinergic effects like urinary retention, blurred vision, constipation and dry mouth.
Tolerance and dependance.
Why is RSV dangerous for young infants?
RSV spreads easily and can lead to inflammation and heavy mucous production that block their narrow airways potentially causing respiratory distress or failure.
What findings would you anticipate in your COPD patient on (Medrol) methylprednisolone?
Gastrointestinal: Nausea, heartburn, acid reflux, and a marked increase in appetite or thirst.
Sleep and Mood: Insomnia, restlessness, anxiety, irritability, or mild mood swings.
Metabolic and Physical: Temporary fluid retention (swelling in the hands, face, or ankles), mild weight gain, temporary spikes in blood sugar or blood pressure, and minor headaches or dizziness.
Skin and Other: Acne, increased sweating, or mild skin thinning (more typical with longer use).
What are potential side effects of phenylephrine?
Rebound congestion, rapid HR, headache, nervousness, flushing, insomnia, dizziness, nausea, loss or appetite, difficulty urinating in men with enlarged prostate.
Dangerous SE include cardiovascular symptoms like chest pain, palpitations and reflex bradycardia.
Your patient reports they have been using salmeterol/fluticasone (Advair) inhaler for a wheezing exacerbation. What education would your give to the patient?
Clients should have an understanding of medication onset and use short-acting and long-acting inhalers appropriately. Using long-acting Beta-2 agonist (LABA) during acute exacerbations can lead to increased mortality.
Codeine with guaifenesin has been prescribed for your patient. What teaching would you provide your patient before discharge?
Codeine causes drowsiness and dizziness. Advise the patient to change positions slowly when standing up from a bed or chair to prevent falls. Avoid driving or operating heavy machinery until they know how the drug affects them.
Do not drink alcohol, take other central nervous system (CNS) depressants, or use sleep aids, muscle relaxers, or narcotic pain relievers while taking this medication, as severe drowsiness, slowed breathing, or death can occur.
Drink plenty of water and clear liquids throughout the day. Hydration helps the guaifenesin thin and loosen chest mucus.
What is the mnemonic for drug treatment of tuberculosis?
RIPE: Rifampin, Isoniazid, Pyrazinamide and Ethambutol
Your COPD patient developed sudden high fever, chills, muscle aches and fatigue yesterday. Are they a candidate for oseltamivir (Tamiflu)?
You must start taking Tamiflu (oseltamivir) within 48 hours (2 days) of when your flu symptoms first begin for the treatment to work best
When should the nurse expect to see improvement in airway inflammation following corticosteroids?
Oral/Systemic Corticosteroids (e.g., prednisone): Initial effects begin within 6 to 12 hours, with significant or full clinical benefits realized within 1 to 2 days. IV administration (e.g., Solu-Medrol) may begin in 2 hours.
Your patient is having persistent symptoms of asthma on most days and waking up with asthma several times per week. What therapy would you anticipate the provider to order?
Maintenance therapies like LABA combined with INH corticosteroids like formoterol daily.
Rescue SABA INH prn
Why is Acetylcysteine is administered?
Mucolytic Therapy: It thins and dissolves thick, viscid mucus in the lungs to make breathing easier. It is often used via a nebulizer or instillation for conditions like:
A nurse would anticipate a patient with active tuberculosis will need treatment for approximately how long?
Typically, 6 to 9 months for standard drug-susceptible pulmonary TB, though some short-course or alternative plans last 4 months
Your teenage asthma patient has been prescribed montelukast (Singulair), what teaching would you give the patient when they ask why they need this medication before football practice when they already use an inhaler?
Montelukast blocks leukotriene receptors and decreases inflammation and is used for the long-term control of asthma and for decreasing the frequency of asthma attacks. It is also indicated for exercise-induced bronchospasm and allergic rhinitis.
What would be the most concerning side effect of long-term corticosteroid use (e.g., prednisone).
Hypothalamic-pituitary-adrenal (HPA) axis suppression leading to adrenal insufficiency (Cushing's syndrome) AND Immunosuppression and increased risk for serious infections.
What is a serious side effect of the long-acting muscarinic antagonist (LAMA) Spiriva (tiotropium)?
Paradoxical bronchospasm is a serious adverse effect of muscarinic antagonists where the medication causes increased bronchoconstriction, necessitating immediate medical attention.
What serious syndrome can be caused by administration of dextromethorphan?
Serotonin syndrome: report high fever, agitation, tachycardia, muscle rigidity, dilated pupils and N/V/D. Combining with SSRI increases risks.
What are common symtoms of Enterovirus?
Hand, Foot, and Mouth Disease: Causes fever, painful mouth sores, and a blister-like rash on the hands, feet, and sometimes buttocks, most commonly in young children.
Respiratory Illnesses (e.g., EV-D68): Can lead to a standard cold or severe wheezing and trouble breathing, particularly in children with asthma.
Acute Hemorrhagic Conjunctivitis: Causes pink eye symptoms like eye pain, redness, swollen eyelids, and sensitivity to light.
Your patient has taken several inhaled doses of Atrovent and is exhibiting elevated blood pressure and heart rate. This response should be considered parasympatholytic?
Yes, this response should be considered parasympatholytic.
Because these drugs stimulate the sympathetic nervous system, the patient can expect a fight-or-flight response, including increased heart rate and blood pressure.