Ch. 40 & 41 - Upper & Lower Respiratory Flashcards
Antihistamines - Action:
blocks action of histamine at H1 histamine receptor site
Tx: Allergic Rhinitis
1st Generation Antihistamines:
Cause anticholinergic symptoms:
- ) Dry mouth
- ) Constipation
- ) Blurred vision
- ) Urinary retention
Ex: diphenhydramine (Benadryl)
diphenhydramine (Benadryl):
- ) PO, IM, IV
- ) Allergic rhinitis
- ) Prevents motion sickness
- ) Active ingredient in OTC sleep aids
diphenhydramine (Benadryl) - SE (anticholingeric effects):
- *1.) Drowsiness
2. ) dizziness, fatigue, urinary retention, constipation
3. ) dry mouth, blurred vision
*Should NOT take with alcohol or other CNS depressants
diphenhydramine (Benadryl): contraindications (1):
Acute asthma:
-Drying effect on resp tract = may thicken secretions = more difficulty breathing
diphenhydramine (Benadryl): contraindications (2):
- ) Narrow-angle glaucoma
- ) BPH, urinary retention
- ) Pregnant/Nursing mothers
2nd Generation Antihistamines:
- ) Little to no effect on sedation
- ) More specific to H1 histamine receptor
- ) Fewer anticholingeric symptoms
2nd Generation Antihistamines - Examples:
- ) cetirizine (Zyrtec)
- ) fexofenadine (Allegra)
- ) loratadine (Claritin)
**Tolerance may develop over time
Nursing Diagnoses (1):
- ) Ineffective airway clearance r/t nasal congestion
2. )Sleep deprivation r/t frequent coughing
Nasal Decongestants (sympathomimetic amines):
Stimulate alpha-adrenergic receptors =vasoconstriction in nasal mucosa
Nasal mucous membranes shrink=decrease fluid secretion
Nasal Decongestants:
Adm:
-Nasal spray/drops
Nasal Decongestants With Frequent Use:
1.) Tolerance
- ) Rebound congestion
- Nasal vasodilation instead of vasoconstriction
3.) Shouldn’t use more than 3-5 days
Examples (sprays/drops):
oxymetazoline HCl (Afrin)
Systemic Decongestants (alpha-adrenergic agonists):
1.) Po
- ) Tx: allergic rhinitis
- Hay fever
- Acute coryza
Examples (systemic):
ephedrine (Ephedrine)
phenylephrine (Neo-synephrine)
pseudoephedrine (Sudafed)
Systemic Decongestants SE:
Jittery, nervous
-Disappear as tolerance develops
Alpha-adrenergic drug
- Increase BP - Increase glucose levels
Systemic Decongestants - Contraindications:
Hypertension
Cardiac disease
Hyperthyroidism
DM
Nasal / Systemic Decongestants –>
Not for:
- Infants
- Young children (
Drug Interactions (2):
Decongestants with MAO inhibitors:
-Increased chance of hypertension & cardiac dysrhythmias
Avoid:
Large amts coffee / tea (caffeine) = increase restlessness & palpitations
Intranasal Glucocorticoids (steroids):
Antiinflammatory action decreases symptoms of:
1. ) Rhinorrea 2. ) Sneezing 3. ) Congestion
Intranasal Glucocorticoids (steroids) - Ex:
dexamethasone (Decadron)
Intranasal Glucocorticoids - SE:
- ) Continuous use = dryness of nasal mucosa
- ) Usually no systemic side effects
- ) Should not use for > 30 days
Antitussives (1):
Act on cough control center in medulla =suppresses cough reflex
Antitussives (2):
Cough:
- Physiological mechanism
- Productive or nonproductive
Antitussives (3):
Involuntary cough should not be suppressed unless:
- Resp discomfort
- Cant sleep
3 Types of Antitussives:
- ) Narcotic
- ) Nonnarcotic
- ) Combination
Narcotic Antitussives:
codeine
hydrocodone
-Direct action on cough center in medulla
Major Problems With Narcotic Cough Suppressants:
- ) Risk for dependence
- ) Resp depression
- ) Bronchial constriction
- ) CNS depression
- ) Constipation
Nonnarcotic Antitussives:
Dextromethorphan HBr:
1. ) Most common nonnarcotic cough suppressant 2. )Chemical derivative of opiates 3. ) Acts on cough center
Dextromethorphan HBr (1):
- DOES NOT cause: :)
- Dependence
- Resp depression
- Analgesia
PO , IV
Dextromethorphan (DM) HBr – Ex:
Robitussin DM
Benylin DM
Dextromethorphan – Side Effects:
CNS depression =
-Nausea, dizziness, drowsiness, sedation
Expectorants:
1.) Stimulate flow of secretions in resp tract –>
2.) Decrease viscosity of secretions & phlegm –>
3.) Easier to remove by coughing
Guaifenesin:
- *Most popular expectorant
- Well tolerated
May cause :
-Stomach upset / nausea
Goal:
- ) Client will be free of nonproductive cough
2. ) Client will be free of a secondary infection
Seek Medical Attention:
Cough > 1 week
High fever, rash
HA
Nursing Interventions (1):
Assess cough:
- Frequency
- Productivity
Nursing Interventions (2):
-Cough syrups = local, soothing effect
–Do not give water, food, after admin.
—If giving several meds = give cough syrup last
Nursing Interventions (3):
Should not suppress:
- Productive cough
- Post-op clients
Nursing Interventions (4):
Teach to cough effectively:
- Upright
- Deep breaths before coughing
- Dispose of secretions
Nursing Interventions (5):
Encourage fluids
Humidify dry air
-clean regularly
Sympathomimetics – epinephrine (Adrenalin):
Nonselective sympathomimetic
Tx:
-Acute bronchospasm d/t anaphylaxis from allergic reaction = bronchodilation, increases BP (bee sting or peanut allergy)
epinephrine (Adrenalin) SE:
- ) Tremors, dizziness
- ) Increase BP, tachycardia, heart palpitations
- ) Cardiac dysrhythmias
Sympathomimetics (1):
Beta2 adrenergic receptors = control bronchiol smooth muscle tone
Sympathomimetics (2):
**Stimulate Beta2 adrenergic receptors = increase formation of cyclic adenosine monophosphate (cAMP)
cAMP:
Causes:
-Smooth muscle relaxation & bronchodilation
Drugs Affecting Both Beta1 & Beta2 Receptors:
Will also have cardiac SE:
- Tachycardia
- Increase BP
Sympathomimetics (3):
Other Side Effects:
- ) CNS stimulation
- ) Insomnia
- ) Nervousness, anxiety, tremor
- ) GI distress
Sympathomimetics (4):
Po
Inhalation
Parenteral (some)
Extender device (spacer):
are long tubes that slow the delivery of medication from pressurized MDIs
should always be used with MDIs that deliver inhaled corticosteroids
make it easier for medication to reach the lungs, and also mean less medication gets deposited in the mouth and throat
INHALE very SLOWLY — if whistle heard, inhale slower!
Theophylline:
- ) Therapeutic range:
- 10-20mcg/mL - ) Above 20 = toxicity
- ) Peak / trough levels
Theophylline – Monitor for toxicity:
- ) N/V, GI distress
- ) Restless
- ) Convulsions
- ) Irregular heartbeat
Theophylline — Avoid:
Xanthine-containing beverages or foods:
-Caffeine
Theophylline — Smoking:
Increases metabolism of drug
-May need to increase dosage
Examples: —–
Aminophylline – IV
Theophylline (Theo-Dur, Theobid Duracaps) – time-released capsules
Oral, rectal, IV
Aminophylline:
controls symptoms of asthma and other lung diseases but does not cure them
usually is taken every 6, 8, or 12 hours
take with a full glass of water on an empty stomach, at least 1 hour before or 2 hours after a meal. Do not chew or crush the long-acting tablets; swallow them whole.
Meter Dose Inhaler (MDI) inhaler:
Not for severe attack
May take 1-4 weeks for full effect
MDI inhaler:
MORE EFFECTIVE for controlling symptoms than Beta-2 agonists
Beclomethasone (Vanceril, Beclovent)
MDI inhaler –Side Effects: with long term use
- ) GI irritation
- ) HA, confusion
- ) Sweating
- ) Insomnia
Orally Inhaled SE:
Throat irritation, hoarseness, dry mouth
Oral, laryngeal, pharyngeal fungal infections may occur
Spacer may help
Cromolyn Sodium (Intal):
- ) Prophylactic tx
- ) Taken daily
- ) NOT for tx:
- Acute asthma attacks
- Status asthmaticus
4.) Antiinflammatory drug
Cromolyn Sodium (Intal) cont….
- ) No bronchodilator activity
- ) Inhibits release of histamine
- ) Inhalation ONLY (not well absorbed in GI tract) — (Spinhaler)
Cromolyn Sodium (Intal) ==Serious Side Effect
Rebound bronchospasm = do not discontinue abruptly
acetylcysteine (Mucomyst) (1):
Breaks apart muco-proteins contained in respiratory mucous secretions
acetylcysteine (Mucomyst) (2):
Nebulization
Directly into intratracheal catheter
Do not mix with any other drugs
Acetylcysteine (Mucomyst) cont…
May lead to = large amt of liquefied secretions
Able to cough or have suction available
montelukast (Singulair):
in a class of medications called leukotriene receptor antagonists (LTRAs)
works by blocking the action of substances in the body that cause the symptoms of asthma and allergic rhinitis
PO & w/o food
if used to treat asthma, take in evening
used to prevent breathing difficulties during exercise, it should be taken at least 2 hours before exercise
Nebulizer:
a drug delivery device used to administer medication in the form of a mist inhaled into the lungs
commonly used for the treatment of cystic fibrosis, asthma, COPD and other respiratory diseases
