C5- Resiratory Medications Flashcards
What are the two components of the respiratory system?
Upper respiratory system
Lower respiratory system
What are some of the functions of the respiratory system?
Brings air into the body and expels CO2 and other waste
What are two common upper respiratory disorders?
Common cold
Allergic rhinitis
Common cold cause:
Rhinovirus
CONTAGIOUS BEFORE SYMPTOMS
Common cold symptoms
Nasal congestion
Cough
Increased mucosal secretions
Rhinorrhea/rhinitis
Allergic rhinitis cause
Pollen or foreign substances
Allergic rhinitis symptoms:
Acute inflammation of the nasal mucosa
Antihistamine action in upper respiratory:
Competes with histamine for receptor sites
Prevents histamine response
Tissue engorgement/inflammation of mucosal linings
Antihistamines are treatment of which conditions?
Mild allergic reactions
Anaphylaxis
Anxiety
Motion sickness
Nausea treatment
Insomnia
** DOES NOT REDUCE CONGESTION**
Antihistamine 1st generation
Diphenhydramine (Benadryl)
Antihistamine 2nd generation
Cetirizine (Zyrtec)
-non-sedating
Side effects of antihistamines for upper respiratory:
Sedation (1st generation only)
GI upset
Anticholinergic effects
-dry mouth
-constipation
-urinary retention
Use caution with antihistamines if:
3rd trimester and breastfeeding
In children and older adults
Asthma
Prostatic hypertrophy/urinary retention
Open angle glaucoma
Major difference between 1st and 2nd antihistamines:
NO SEDATION with 2nd generation
CNS/Alcohol with antihistamines
Additive effect
Antihistamine administration guidelines:
For motion sickness
-give 30 minutes before motion
Administer with food or milk
Caution client about drowsiness
-don’t drive or operate heavy machinery
Antihistamine nursing teaching:
Advise clients to avoid medications causing CNS depression (additive effect)
-alcohol
-opioids
-barbiturates
-benzodiazepines
Action of decongestants:
Stimulate alpha1 adrenergic receptors causing vasoconstriction and reduction in inflammation of the nasal membranes (decreases stuffy nose)
Systemic decongestant
Pseudoephedrine
Local (nasal drops/spray) decongestants
Phenylephrine
Decongestant therapeutics
Allergic rhinitis
Sinusitis and common cold
Systemic vs. Local decongestants:
Local =
-more effective and work faster
-shorter duration
-vasoconstriction and CNS stimulation uncommon
Systemic=
-Don’t cause rebound congestion
What are two therapeutics associated with decongestants?
Allergic Rhinitis
Sinusitis and common cold
Decongestant side effects: (Rebound Congestion occurs in?)
Only with local decongestants
Decongestant side effects (what happens with the CNS stimulation)
Nervousness
Agitation
Palpitations
Decongestant side effects (Vasoconstriction concerns?)
Hypertension
Decongestant side effect voiding/elimination?
Difficulty voiding
Decongestant side effect teaching (rebound congestion)
Advise client to use LOCAL DECONGESTANT for no more than 3-5 days
Decongestant side effects teaching (CNS stimulation)
Advise client to observe for signs of CNS stimulation and notify PCP if symptoms occur
Decongestant side effects teaching (Vasoconstriction)
Advise client with HTN and CAD to avoid using these medications
Decongestant side effects teaching elimination/ voiding
Monitor urine output/flow
Contraindication/cautions of decongestants
Glaucoma
Benign Prostatic Hypertrophy (BPH)
Difficulty voiding
Decongestant drug interactions
Caffeine
-restlessness
-palpitations
(Decongestants) report symptoms of
Eye pain
Difficulty voiding
Palpitations
Intranasal glucocorticoids (ACTION)
Prevent inflammation
Suppress airway mucus
Promote responsiveness of beta2 receptors in bronchial tree
Action is not immediate
-it does work long term
Intranasal glucocorticoids example:
Fluticasone (Flonase)
Intranasal glucocorticoids therapeutics:
Decreasing allergic rhinitis symptoms
Suppress
-congestion
-rhinorrhea
-sneezing
-nasal itching
Steroids have an anti-inflammatory action
Intranasal Glucocorticoids initial response
May be seen within 2-3 hours
Intranasal glucocorticoids maximal effect
May require a week
Antitussives (Action)
Suppress cough reflex in the medulla
Antitussives (therapeutics) ((BEST USE FOR))
Dry, non-productive cough relief
Antitussives (opioid like)
Codeine
Antitussives (Non-opioid)
Dextromethorphan (robitussin DM)
Antitussives (Local anesthetic)
Benzonatate (Tessalon)
Antitussives adverse effects of CNS:
Drowsiness
Suppress respirations (opioid)
Antitussives GI distress (opioid) adverse effects:
Nausea
Constipation
Antitussives adverse effects (possible abuse) common in which category?
Both
-opioid
-non opioid
-in high doses can produce euphoria “robo-tripping” or “Lean”
Expectorants action:
Loosen bronchial secretions
Expectorants example:
Guaifenesin (Mucinex)
Expectorants teaching:
Hydration is the best expectorant!
Mucolytics action:
Break down the chemical structure of the mucus molecules
Mucolytics uses:
CF (cystic fibrosis)
Chronic bronchitis
Rx ONLY
Mucolytics example
Acetylcysteine (mucomyst)
-Nebulizer
-Sulfer smell
Mucolytics administration
Inhalation
** produces sulfur smell **
Mucolytics off label uses
Tylenol overdose
Renal protection with contrast dye
Chronic Obstructive Pulmonary Disease:
COPD
COPD pathophysiologic changes:
Airway obstruction with increased airway resistance to airflow
COPD root causes
Chronic bronchitis
Bronchiectasis
Emphysema
Asthma
Asthma definition
Broncho-constriction & inflammation
(Narrow airway)
Types of asthma:
Acute
Chronic
Acute Asthma goal of therapy
Terminate bronchi-spasm in progress
Chronic asthma goal of therapy:
Reduce the frequency of asthma attacks
Management of A.S.T.H.M.A:
A- adrenergics (beta 2 agonists) (albuterol)
S- Steroids
T- Teophylline
H- Hydration (IV) (oral)
M- Mask O2
A- Anticholinergics
Bronchodilators Beta2 adrenergic agonists
Inhaled short acting
- Albuterol (Proventil)
Inhaled long acting
-Salmeterol (Serevent)
Bronchodilators (Anti-cholinerics) Parasympathetic antagonist
Inhaled maintenance (DRY SIDE EFFECTS)
-Ipatropium (Atrovent)
-Tiotropium (Spiriva)
** ALLERGY CAUTION (SOY, PEANUTS, ATROPINE) **
Bronchodilators Methyl xanthine
Oral long acting medications (emergency occasional IV)
-theophylline (Theo-dur)
Beta adrenergic agonists side effects:
Minimal when inhaled
- increased risk with more use
-tachycardia
-angina
-tremors
Pregnancy category C
Beta Adrenergic Agonists Medication interactions
Beta blockers
-non selective
MAOIs, TCA
-increased risk of tachycardia and angina
Beta adrenergic agonists teaching
Use of inhalers
Take adrenergic PRIOR to inhaled steroid
Glucocorticoids Action
Suppress immune response
Prevents inflammation
Decreases mucous production
Glucocorticoids help with? (Long term? Short term?)
Long term prophylaxis of asthma
Short term treatment after asthma attack
Not for rescue during asthma attack
Glucocorticoids examples
Methylprednisolone
Prednisone (deltasone)
Triamcinolone (Azmacort)
Glucocorticoids side effects: (what happens in the mouth? How does it effect blood glucose? Bone density? Muscles?)
Hoarseness
-yeast infection in mouth/throat
Hyperglycemia (diabetes?)
Infection (suppress immune system)
Bone density loss
Muscle wasting
Glucocorticoids Teaching
Rinse mouth after using inhaler
Do not stop treatment abruptly
-taper dose
Monitor blood glucose
Advise to report early signs of infection
-sore throat
-weakness
-malaise
Glucocorticoids interactions:
Potassium wasting diuretics
-additive K+ loss
NSAIDS
-increase risk of peptic ulcers
Insulin and oral hypoglycemic drugs
Nursing interventions of glucocorticoid interactions
Monitor K+ levels and administer supplements
Advise client to avoid NSAIDS
Monitor glucose levels
-might want to increase dose of DM med
Nursing teaching glucocorticoid interactions
-advise client to inhale beta 2 agonist before glucocorticoid
Methylxanthines/Thophylline action
Relaxation of bronchial smooth muscle causes dilation
Methylxanthines/Theophylline example
Theophylline
Theophylline/methylxanthine therapeutics:
Long term control of chronic asthma
Methylxanthines/Theophylline Narrow therapeutic range:
Want less than 20mcg - anything above 20mcg is toxic
Toxicity signs
-GI distress
-nervousness
-seizures
Methylxanthines/Theophylline Interactions (increases levels of what? Decreases levels of what?)
Increases levels of
-caffeine
-fluoroquinolones
Decreases levels of
-Phenobarbital
-phenytoin
-Cigarette smoking
Leukotriene Modifiers/Montelukast (singulair) ACTION (prevents effects of? What does it suppress?)
Prevents effects of leukotrienes
-suppressing:
-inflammation
-airway edema
-mucous production
Leukotriene Modifiers/Montelukast (Singulair) examples:
Montelukast (Singulair)
Leukotriene Modifiers/Montelukast (Singulair) Therapeutics:
Long term control of asthma
Exercise induced asthma
Allergic rhinitis
Leukotriene Modifiers/Montelukast (Singulair) Side effects:
Headache
Drowsiness
Mood changes
Suicidal thoughts
Antitussives
Codeine
Dextromethorphan
Expectorants
Guaifenesin
Antihistamines
Diphenhydramine (1st)
Cetirizine (2nd gen)
N/A
