Timed question help - Respiratory infection drugs for upper and lower systems
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Respiratory1sthalfanimatedPPT.pptxRespiratory Drugs
ATI/ PBS Crime movie
Upper Respiratory Tract
Nares, nasal cavity, pharynx, and larynx
help trap particulate matter and pathogens
Lower Respiratory Tract
Trachea, bronchi, bronchioles, alveoli
Gas exchange occurs here.
Ventilation/Perfusion
Ventilation is the process of air movement (inspiration and expiration)
Perfusion is the blood flow to the alveolar capillary bed where gas exchange takes place.
Upper airways diseases
Which do you know?
Allergic rhinitis
Common cold
Bacterial infection (sinus infection)
clear mucoid color
Drug therapy involves antihistamines, decongestants, antitussives, expectorants, and mucolytics.
Non-Pharmacologic (drug free) Management of Upper Respiratory Disorders
Avoid known triggers.
Drink lots of fluid
Rest
Practice Breathing Exercises
Neti Pots
Hard candy for cough
Pharmacologic treatment of Respiratory Disorders
PREVENTERS
H1 receptor antagonists*
Intranasal corticosteroids
RELIEVERS
(Treat symptoms)
H1 receptor antagonists*
Decongestants
Mast cell stabilizers
Antitussives
Expectorants
Mucolytics
Antihistamine Prototypes:
1st generation agent: diphenhydramine, 2nd generation agent: cetirizine
MOA: block H1 receptors resulting in the blockage of histamine release during allergic reactions.
Therapeutic Use: Mild allergic reactions, motion sickness, insomnia, often combined with decongestants (both a preventer and reliever)
Complications:
#1 SE: Sedation (common)
#2 SE: Anticholinergic effects (dry mouth, constipation, urine retention, tachycardia, blurred vision)
#3 SE: GI upset (less common)
Diphenhydramine (Benadryl) and cetirizine (Zyrtec)
Diphenhydramine unique concerns:
Paradoxical excitation in children. More drowsiness in older adults.
Antihistamines: diphenhydramine, cetirizine
| Drug side effects | Nursing Considerations |
| Dry upper/lower airway | Contraindicated in Asthma |
| Can cause seizures | Contraindicated in Seizure disorders |
| Anti-cholinergic effects: Urine retention Pupil dilation Constipation Tachycardia Dry mouth | Contraindicated in: Urinary retention, BPH, Open angle glaucoma Teach to increase fiber/ fluid Cardiac disease Teach to sip water/ sugarless hard candy |
| Sedation | Increased CNS depression with alcohol, opioids, benzodiazepines |
Diphenhydramine (Benadryl) combinations
Nursing Process: Antihistamines
Assessment:
History of asthma, cardiac disease, BPH constipation, seizures,
Nursing Diagnosis/Problem:
Ineffective airway clearance, discomfort,
Goals:
Relief of allergic symptoms
Interventions/Education:
Patient will have decreased nasal congestion, mucosal secretions, and cough
Evaluation:
give diphenhydramine with food at bedtime, avoid driving and CNS depressants, monitor children and elderly adults for complications
Swelling (steroids decrease swelling)
Sepsis (risk of infection)
Sugar (increase blood sugar)
Slowly taper off
Steroids: “sone” drugs:
Prednisone, dexamethasone
Background info
Intranasal Meds
Nasal Glucocorticoids Prototype:
MOA: Decrease inflammation associated with allergic rhinitis
Other agents: fluticasone (flonase), triamcinolone, budesonide
Therapeutic Use: 1st line treatment for nasal congestion; reduce the effects of allergic rhinitis (sneezing, nasal itching, rhinorrhea)
Complications: minimal; most common is sore throat, nose bleed, headache, burning sensation in the nose
No significant precautions/interactions as the drug is delivered to site of action.
Administration: Teach the patient how to use metered-dose spray devices; should be taken daily with/without symptoms
May take up to 7-21 days to achieve peak response.
Client should take inhaled glucocorticoid AFTER taking decongestant in order to clear nasal passages first
mometasone (Nasonex)
Reference: PIXORIZE: https://youtu.be/9DeGX0snl0c
Dilated pupils
Vasoconstriction
Sphincter constriction (bladder)
Alpha 1 receptor effects (SNS)
Patho page
Intranasal- oxymetazoline (Afrin) Oral- pseudoephedrine (Sudafed)
MOA: stimulate the alpha-1 receptors of the sympathetic nervous system, reduction in the inflammation/ constriction of nasal blood vessels/ mucosa
Therapeutic Use: rhinitis (allergic or non-allergic), sinusitis, colds
Complications: rebound congestion (intranasal only), CNS stimulation (more common with oral agents), vasoconstriction
Contraindications/Precautions: cardiovascular disorders (due to vasoconstriction)
Administration: Teach intranasal administration, pseudophedrine requires identification at purchase as it can be converted to amphetamine (meth)
Nursing Considerations: taper use of intranasal forms over 3-5 days to avoid rebound congestion, often combined with antihistamines in cold medication preparations
Intranasal and Systemic Decongestants
Prototypes:
Ephedrine is a sympathomimetic amine and substituted amphetamine. It is similar in molecular structure to methamphetamine, and epinephrine (adrenaline). Used to make meth.
Stimulant properties
Hyperactivity
Extreme focus
Elevated heart rate
Difficulty sleeping
Pseudo- ephedrine = “Suedo- adrenalin”
Background info
Anti- tuss ives Prototypes: 1. codeine (opioid) 2. dextromethorphan (non-opioid)
MOA: suppresses the cough reflex by increasing the cough threshold in the CNS !!!!
Therapeutic Use: non-productive cough suppression (dry)
Complications: #1 SE: CNS depression (drowsiness, dizziness, respiratory depression), GI distress (N/V, constipation), opioid abuse *all complications are more common with opioid forms*
Contraindications/Precautions: Codeine is schedule II normally, but when used with other antitussives it is schedule V, respiratory depression, asthma, alcohol use, liver/kidney problems
Administration: monitor after dosage for safety (ambulation), monitor respiratory status, avoid activities that require alertness, take oral forms with food, increase fluids and fiber, use only short term, opioid concerns: overdose: naloxone, GI upset
Available forms include:
-capsules- lozenges-liquids
-syrups (may contain alcohol and glucose)
- combined in many OTC drugs
Tuss / tos= cough
Expectorants Prototype:
MOA: Increases cough secretions by thinning mucous
Makes it easy to move mucous out and up via coughing
Does not destroy mucous directly
Therapeutic Use: often combined with antitussives/decongestants for colds, rhinitis, cough
Complications: GI upset, drowsiness (no driving), allergic reaction (rash)
Contraindications/Precautions: asthma (may cause bronchospasm), some forms contraindicated in children
Administration: available in tablets (no crushing) and capsules (can sprinkle on food), report cough lasting longer than one week, take with food and a full glass of water
Nursing Considerations: Drink enough water (water is best expectorant), stop if a rash develops and notify provider, ensure client is aware of contents of all combination cold medications
guaifenesin (Mucinex)
Cool video: https://youtu.be/qT291qi6XZY
Mucolytics Prototype: acetylcysteine (Mucomyst)
MOA: directly breaks down and thins mucous to enhance the flow of secretions in the respiratory passages.
Therapeutic Use: acute and chronic pulmonary disorders, cystic fibrosis, antidote for acetaminophen overdose
Complications: aspiration/bronchospasm with oral forms, dizziness, drowsiness, hypotension, tachycardia, hepatotoxicity
Contraindications/Precautions: CNS depression, renal/liver disease
Administration: oral/inhalation/IV, this medication stinks-watch out for emesis/aspiration (stop treatment), warn patient they will cough, monitor LFT’s (AST/ALT)
**reserved for severe infections -pneumonia - cystic fibrosis **prescription drug
Actually destroys mucous
Acetylcysteine (imagine a cyst filled with mucus)
IV oral- For what type of overdose?
Respiratory use: nebulizer/ inhaler
Patient will begin coughing immediately
May cause severe bronchospasm (disease concern?)
Smells like rotten eggs
Can cause vomiting ( smell and cough) risk of aspiration
Oral: hard on liver, (labs?) CNS depression, sedation
Education: Inhaled: this is going to stink, stop if nauseous, will make you cough, but if you can’t breathe, stop
Mucolytic Prototype:
acetylcysteine
(Mucomyst)
Nursing Process: Cold Remedies
Assessment: any history of hypertension/cardiac disease, baseline vitals, cardiac/respiratory status, drug therapies
Diagnosis: hypoxemia, decreased gas exchange, airway obstruction, fatigue, discomfort
Planning: Patient’s nasal congestion will be relieved, and patient will be free from secondary bacterial infections.
Interventions/Education: monitor vitals, observe secretions, avoid activities that require alertness, limit length of use of the medications, monitor combination cold medicine use for drug overlap, drink water, rest, avoid others (infectious), avoid airway irritants
Evaluation: Free from cough, congestion, and fever. Good fluid intake and rest.
