Drug Therapy for the Respiratory System Flashcards
Common Cold
affects the upper respiratory tract (clavicles up)
Occurs when viruses or bacteria invade our system and get past our general defense mechanisms
Viral Cold
2-4 occurrences every year typical in adults; up to 10 occurrences a year for children.
Viruses invade via mucous membranes
Can survive for several horse on skin and hard surfaces
Sinusitis
When the sinus cavities become inflamed or infected and it blocks the fluid that drains out of the sinuses
Rhinitis
(running nose) is the most common cause of sinusitis because your nose is running and you are blowing it constantly and it gets swollen which blocks off the sinuses
Signs and Symptoms of colds and sinusitis
Nasal congestion
Cough: protective defense
Productive vs. non-productive
Increased secretions: they run down your throat and into your bronchi. You can get these from irritations like allergies, smoking, or surgery
Nasal Decongestants Example
pseudoephedrine
Oxymetazoline
Phenylephrine
Nasal Decongestants Action
relieve nasal obstruction and discharge by producing vasoconstriction. Decreases nasal blood vessels and increase blood flow for breathing.
Nasal Decongestants Contraindications
Anything that is dangerous with SNS/vasoconstriction
Severe HTN, CAD, narrow angle glaucoma, antidepressants
Nasal Decongestants Patient teaching
Encourage adequate fluid intake (thin secretions)
Humidification (moisture is good for GI tract and respiratory tract)
Do not take longer than package recommendation (3-5d. Could cause rebound congestion. It is going to overpower the medication)
Avoid caffeine (increased vasoconstriction)
Avoid accidental OD (be careful when taking with other cold medicine)
Avoid HTN
Proper use of nasal spray
Take with or without food
Antitussive Examples
Cough Medicine
Dextromethorphan
Antitussive Action
Suppresses dry, hacking, non-productive cough
Centrally Acting Antitussive
Narcotic and non-narcotic
Taken orally
Acts on whole body
Cough syrup (DM)
Locally Acting Antitussive
Throat lozenges
Cough drops
Nursing considerations for Antitussives:
Don’t eat or drink after a syrup (30 min)
Drug-to-drug interactions with antidepressants
Fluid intake and humidification
Expectorant Examples
Guaifenesin (mucinex)
Expectorant Action
Liquify respiratory secretions and allow for easier removal.
Used in a productive cough (tenacious sputum)
Expectorant Considerations
Do not crush or chew (extending release)
Adequate hydration and fluid intake.
Don’t take longer than 1 week w/o seeing a doctor.
Avoid accidental OD
Encourage coughing and deep breathing
Mucolytic Examples
Acetylcysteine
Mucolytic Action
highest power expectorant
Used with chronic respiratory issues
Used in the event of an acetaminophen overdose
Liquifies the mucous in the respiratory tract and is given via inhalation
Nursing considerations for Mucolytic
Given inhalation so monitor airways because the are going to cough out their secretions
Encourage coughing and deep breathing
Don’t leave the acetylcysteine on the person’s face (it smells like rotting eggs)
Pseudoephedrine
Vasoconstrictor that was used in meth so it is no longer OTC. Phenylephrine replaced it. Good for people with cardiac issues. It is in all of the cold medicine that you can buy in the OTC aisle.
OTC Cold Medicine
Vicks NyQuil
Pseudoephedrine
Phenylephrine
Histamine
the 1st chemical mediator released in an allergic reaction. Found in mast cells and basophils.
What happens when Histamine is released
Constriction of smooth muscle in R tract
Bronchoconstriction
Stimulation of the Vagus nerve
Increased permeability of veins and capillaries
Increased secretion from mucus glands
Stimulation of peripheral nerve endings
Dilation of capillaries in the skin
Increase secretion of gastric acid
Increased heart rate and force of contraction
Hypersensitivity Reactions
Memory B cells (antibodies) in the immune system mark something as harmful that isn’t actually harmful and whenever it sees it, it attacks it like crazy
Involves an exaggerated allergic response
Type 1 Hypersensitivity
Immediate hypersensitivity
Occurs within minutes
Type 1 Hypersensitivity enzyme and cell activation
IgE induced Mast cells activation. Usually after 2nd or later exposure
Mast Cells and Basophils
Type 2 Hypersensitivity
Much less common
Cytotoxic
Generates direct damage to cell surface
Blood transfusion reactions
Hemolytic disease of newborns, hemolytic anemia
Seen as reactions to penicillin and heparin
Type 2 Hypersensitivity Enzyme
Mediated by IgG or IgM
Type 3 hypersensitivity
Immune Complex
Serum sickness
Rare: seen in an antibody transfusion or in a response to some medications
Type 3 hypersensitivity Enzyme and action
Mediated by IgG or IgM
Forms antigen(badguy)-antibody(goodguy) complexes and causes acute inflammatory reaction in tissue
Type 4: Delayed hypersensitivity
Happens after exposure to an antigen
We don’t have the antibodies already looking for it, so it is a delayed response.
Tuberculin test
Contact Dermatitis
Graft rejection, poison ivy
Type 4: Delayed hypersensitivity
Cells activated
T cells reacts and causes a reaction
Sensitized T lymphocytes react with antigen to cause inflammation
Allergic Rhinitis
Inflammation of nasal mucosa caused by type 1 reaction to inhaled allergens
Allergic Rhinitis Symptoms
Nasal congestion
Itching, sneezing
Watery drainage
Itching or throat, eyes, and ears.
Seasonal Disease
Response to airborne pollens (spring, or fall)
Perennial Disease:
Response to nonseasonal allergies (happen all year round)
Dust Mites, molds
Animal dander
Allergic food reactions
Immune response to ingestion of a protein
Higher risk of triggering anaphylaxis
Common Food Allergies
Shellfish, fish, corn, seeds, bananas, eggs, milk, soy, peanuts
Contact Dermatitis
(Type 4–delayed reaction)
Poison Ivy, cosmetics, metals, tattoo dye
Affected skin: Inflamed, warm, swollen, itchy Blisters may form, drain, and become infected
Allergic Reactions from medications
Symptoms vary but may include:
Skin rash, fever, itching, hematologic reaction
May be from a preservative or a dye or a coating and NOT from the drug
May occur 7-10 days after starting the medication
Antihistamines
Stop the allergic cascade from the histamine. Stops histamine from binding.
Relieve symptoms but do not relieve hypersensitivity
Antihistamine Indication
Allergic Rhinitis
Anaphylaxis
Allergic conjunctivitis
Drug allergies, pseudoallergies
Blood/blood product transfusion
Dermatologic conditions
First Generation H1 Receptor Antagonists Example
Diphenhydramine
First Generation H1 Receptor Antagonists Action
Prevents/reduces most physiologic effects that histamine produces at receptor sites
Decreases capillary permeability
Decreases salivation and tear formation
First Generation H1 Receptor Antagonists Adverse Effects
CNS depression
Anticholinergic effects
(avoid giving to glaucoma, BPH, or constipation)
Make old adults confused.
Thickens secretions
Take med before exposure to the allergen.
Makes people TIRED
First Generation H1 Receptor Antagonists Indication for Use
Treats allergic reactions, motion sickness, and insomnia
**Children may experience paradoxical effect and might be very energetic
Second Generation H2 Receptor Antagonists Example
Fexofenadine, Loratadine, Cetirizine
Second Generation H2 Receptor Antagonists Action
occupy the same receptors as histamine which prevents histamine from reaching the target receptor sites. Bind preferentially to peripheral rather than central H1 receptors
Second Generation H2 Receptor Antagonists Considerations
Safer for older adults because it does not mess with CNS
Does not readily enter the brain from the blood
Be careful in patients with renal failure because they are at a higher risk of overdosing on this medication
Lower respiratory system
bronchia, lungs, and trachea
Common symptoms of Lower tract
excessive mucus production
Airway hyperresponsiveness
Swelling
Common Conditions with the Lower Tract
Asthma, emphysema and chronic bronchitis
Asthma
Caused by an IgE hypersensitivity reaction (type 1 sensitivity)
Can occur at any age
Asthma is Stimulated by
Viral infections
Environmental irritants
stress/emotion
Strenuous activity
temperature/weather changes
***This is why it is different than an allergy
Asthma Pathophysiology
Muscle constriction narrows airways
Inflammatory response
Mast cells release Cytokines which increase inflammation
Mild to moderate asthma
Recurrent and reversible
Advanced to severe Asthma
Less reversible, chronic inflammation, structural changes
Can lead to structural changes and long term structural changes known as remodeling
Manifestations of Asthma
dyspnea, wheezing, chronic cough, peak expiratory flow rate decrease (how much air you are able to breathe out), vary moderate to severe symptoms
Status Asthmaticus
Acute severe asthma, does not respond to usual treatments, severe respiratory distress, life threatening
Air Trapping
Hard to EXHALE
Chronic Bronchitis
Frequent productive cough more than 3 months/year x2 years
Increased mucus leads to airway narrowing. Chronic changes
Bronchitis s/sx
Blue Bloater:
Airway flow problems
Cyanosis
Hypoxia
Increased Hgb
Emphysema
Enlargement and destruction of Alveoli r/t long term lung damage
Loss of elasticity and surface area
Carbon dioxide trapping
Emphysema s/sx
Pink Puffer:
Increased CO2 retention
Pink
Pursed lips
Barrel Chested
Chronic Obstructive Pulmonary Disease
Chronic bronchitis and Emphysema together
Usually develops with long standing exposure to airway irritants
COPD S/sx
Symptoms are more consistent and less reversible
Dyspnea
Activity intolerance
Air trapping
Goal for Broncocogestive disorders
prevent airway inflammation
Minimize the use of “rescue drugs”
Maintenance drug: everyday prevention of congestion
Bronchodilators
Andrenergics
Anticholinergics
Xanthines
Anti-Inflammatories
Corticosteroids
Leukotriene modifiers
Mast cell stabilizers
Immunosuppressants
first choice to relieve acute asthma
Administering bronchodilators by inhalation is most effective and the treatment of first choice to relieve acute asthma
Two general types of inhaled B2 adrenergic agonists
Rescue inhalant
Maintenance inhalant:
Maintenance inhalant:
long term control drugs used to achieve and maintain prophylactic control of persistent asthma
Salmeterol
Rescue inhalant
quick relief short acting drugs used during periods of acute symptoms and exacerbations
Albuterol
Beta 2 Adrenergic Agonists
beta 2 receptors in the smooth muscle of bronchi and bronchioles and open up the bronchioles
The receptors, in turn, stimulate the production of cyclic AMP
The increased cyclic AMP produces bronchodilation
Beta 2 Adrenergic Agonists Considerations
Can be used in children and older adults
Large doses used in critical care short term
Available as nebulizer, MDI, or oral
Beta 2 Adrenergic Agonists Adverse Effects
Muscle Tremor
Cardiac stimulation
CNS stimulation
Beta 2 Adrenergic Agonists Contraindications
Dysrhythmias
CAD
HTN
With Beta Blockers, it may cause bronchospasm
Thyroid hormones, theophylline, cold med, caffeine increase stimulatory effects
Beta 2 Adrenergic Agonist Patient Teaching
Use bronchodilator inhaler first
Wati 5 minutes between inhalers
Use steroid inhaler second
Do not overuse the rescue inhaler or it will not work as well when you really need it!
Do not skip or overuse maintenance inhalers
Proper use of a MDI
Anticholinergics Examples
Ipratropium
Anticholinergic Action
blocks the action of acetylcholine in the bronchial smooth muscle, inhibiting bronchoconstriction and mucus secretion
Maintenance therapy for bronchoconstriction r/t asthma, chronic bronchitis, and emphysema
Anticholinergic Uses
Available in nebulizer or MDI
Usually used in combination with other bronchodilators
Prevent bronchoconstriction.
Maintenance
Don’t skip a dose
These do NOT have cardiac stimulation like B2
Anticholinergics Adverse Effects
Cough, Dry Mouth, GI upset
Anticholinergic Contraindications
Narrow angle glaucoma
BPH
Xanthines Examples
Theophylline
Xanthines Action
Works by relaxing the smooth muscle, which promotes bronchodilation.
Suppresses airway responsiveness
Xanthines Uses
Used as second line treatment in SEVERE cases of chronic bronchoconstriction
Xanthine Considerations
Monitor lab values for dosing because it can be very toxic (which is why it is only used in emergencies)
**Smoking Cigarettes can increase metabolism. Call dc. if quitting smoking
s/sx of Xanthine overdose
anorexia, N+V, tachycardia, convulsions
Xanthine Contraindications
Gastritis
PUD
Seizure disorder
Corticosteroid Examples
Beclomethasone
Corticosteroid Action
Suppress airway inflammation by blocking the cytokines
Results in
Blocks mucus secretion
Blocks airway mucosal edema
Repaired epithelium damage
Reduced airway reactivity
Corticosteroid Use
Prevention (low dose) and treatment (high dose) of asthma and COPD
Long term can be used in combination
Inhaled for local effect to lungs only
Corticosteroid Adverse effects
HA
Dry mouth, cough
Fungal infection (candidiasis/thrush)
Corticosteroid Contraindications
Recent nasal/oral surgery because it slows down the healing process
Leukotriene Modifier Example
Montelukast
Leukotriene Modifier Action
Prevents leukotrienes from binding to receptors reducing bronchoconstriction and inflammation
Leukotriene Modifier Use
Long term treatment of asthma
Not effective in relieving acute attacks
PO
Maintenance
prevent acute asthma attack from allergens, exercise, cold air, irritants, hyperventilation
Leukotriene Modifier BLACK BOX
Neuropsychiatric events (vivid dreams)
Mast Cell Stabilizer Example
Cromolyn
Mast Cell Stabilizer Action
Prevent release of bronchoconstrictive and inflammatory substances from mast cells
Mast Cell Stabilizer Use
Second line treatment option
Used in prophylaxis of acute asthma in mild, persistent asthma
Not effective in acute bronchospasm or status asthmaticus
Monoclonal Antibodies Example
Omalizumab
Monoclonal Antibodies Action
Binds with IgE blocking receptors so there is less IgE available to start allergic reactions
Adjunct therapy for severe allergic asthma not well controlled
BLACK BOX WARNING Monoclonal Antibodies
only give this drug under medical supervision risk of life-threatening anaphylaxis
Relievers
acute problems: albuterol
Controller
Maintenance: salmeterol, Ipratropium
Preventers
Prevent the problems: Theophylline, Beclomethasone, Montelukast, Cromolyn, and Omalizumab
