Drugs acting on Respiratory System Flashcards
Enumerate the 3 parts of the Upper respiratory tract
Nasal Cavity
Pharynx
Larynx
Enumerate the 3 parts of the Lower respiratory tract
Trachea
Primary Bronchi
Lungs
The common cold is caused by what virus
rhinovirus
- most contagious 1-4 days before the onset of symptoms, and during the first 3 days of the cold
- Transmission: touching contaminated surfaces, then touching the nose or mouth
- S/Sx: rhinorrhea, nasal congestion, cough, and increased mucosal secretions
Common Cold
Drugs used to treat common colds
antihistamines, decongestants, antitussives, and expectorants
- Inflammation of the mucuous membrane that usually accompanies the common cold
- Increased nasal secretions
Acute Rhinitis
– aka “hay fever”; caused by pollen or foreign substance
- increased nasal secretions
Allergic Rhinitis
Identify the drug…
- H1 blockers or H1 antagonists
- Compete with histamine for receptore sites
- Not useful in an emergency situation e.g. anaphylaxis
- Rapidly absorbed in 15 minutes but not potent enough to combat anaphylaxis
Antihistamines
Which Generation of Antihistamines is being described below
- Cause drowsiness, dry mouth, and other anticholinergic symptoms
- Patient should be alerted not to drive or operate machinery when taking such medications
- Decreases secretions, nasal itching and tickling that cause sneezing
First-Generation
Identify the drug…
- 1st generation Antihistamine
- Frequently combined with other ingredients in cold remedy preparations
- Can be Oral, IM, IV
- Major SE: drowsiness
DIPHENHYDRAMINE (Benadryl)
Nursing Interventions
for First-Generation Antihistamines
- Give oral form with food to decrease gastric distress
- Administer IM form in large muscle; avoid SQ injection
- Warn pt to avoid driving and performing dangerous activities after taking drug
- Advise pt to avoid alcohol and other CNS depressants
- Encourage pt to take drug as prescribed
- Teach pt on prophylaxis for motion sickness to take the drug at least 30mins before offending event, and also before meals and at bedtime during event
- Inform breastfeeding mothers that small amounts of drug pass into breastmilk
Which Generation of Antihistamines is being described below
- Fewer anticholinergic effects and lower incidence of drowsiness
- Cetirizine, Fexofenadine, and Loratadine – t1/2: 7-15hrs
- Azelastine - t1/2: 22hrs; nasal spray
Second-Generation Antihistamines
They…
- Stimulate the alpha-adrenergic receptors causing vasoconstriction (nasal mucosa) causing shrinking of the nasal mucosal membranes and reduction in fluid secretion
- Can be Nasal spray or drops, tablets, capsule, liquid
- Frequent use can result in tolerance and rebound nasal congestion
- Advantage: Fewer side effects that systemic decongestants
NASAL DECONGESTANTS
They…
- Can be Tablet, capsule, liquid form
- Used primarily for allergic rhinitis including hay fever and acute coryza
- Ephedrine, Phenylephrine, Pseudoephedrine
- Frequently combined with antihistamine, analgesic, or antitussive in oral cold remedies
- Advantage: relieve nasal congestion for a longer period that nasal decongestants
SYSTEMIC DECONGESTANTS
Side Effects and Adverse Reactions of Nasal and Systemic Decongestants
- Topical preparations have low incidence of side effects
- Jittering, nervousness, or restlessness will decrease or disappear as the body adjusts to the drug
- Nasal sprays causes rebound nasal congestion; emphasize the importance of limiting use of nasal sprays and drops
- Decongestants will increased BP and blood glucose levels
Drug Interaction of Nasal and Systemic Decongestants
- Pseudoephedrine may decrease the effect of beta blockers
- Decongestants + Monoamine oxidase inhibitors (MAOIs) – hypertension and dysrhythmias; restlessness; advice to avoid large amounts of caffeine
They are…
- Effective for treating allergic rhinitis
- Antiinflammatory action – decrease sx of rhinorrhea, sneezing, and congestion
- May be used alone or in combination with an H1 antihistamine
- Chronic use – dryness of nasal mucosa
- Dexamethasone – should NOT be used for >30 days
Intranasal Glucocorticoids
Examples of Intranasal Glucocorticoids
Beclomethasone, Budesonide, Dexamethasone, Flunisolide, Fluticasone, Triamcinolone
– naturally protective way to clear airway of secretions or any collected material
Cough
- Act on the cough control center in the medulla to suppress the cough reflex
- Indicated ONLY for nonproductive, irritating cough
- Hard candy – may decrease the constant, irritating cough
- There are 3 types – nonnarcotic, narcotic, or combination
Antitussives
3 types of Antitussives
nonnarcotic, narcotic, or combination
Theses Antitussives are
- Nonnarcotic
- OTC drug
- Syrup or liquid form, chewable, capsules, and lozenges
- Can cause neither physical dependence nor tolerance
- Fast onset of action; Duration of action: 3-6hrs; t1/2: 11hours
Dextrometorphan (Robitussin), Butamirate Citrate (Sinecod)
They…
- Loosen bronchial secretions so they can be eliminated by coughing
- Found in many OTC cold remedies along with analgesics, antihistamines, decongestants, and antitussives
- Must Instruct pt to increase fluid intake to at least 8 glasses per day to help loosen mucus
Expectorants
best natural expectorant
Hydration
An example of Expectorants
Guaifenesin
Common Cold: Nursing Interventions and Patient Teaching
- Monitor VS. Assess for hypertension and dysrhythmias
- Observe for color of bronchial secretions; yellowish-greenish mucus is indicative of a bronchial infection
- Warn pt that codeine preparation for cough suppression can lead to tolerance and physical dependence
- Tell pt that hypotension and hyperpyrexia may occur when dextromethorphan is taken with MAOIs
- Teach pt about the proper use of nasal sprays, “puff” or squeeze products
- Caution pt not to use >1-2 puffs, 4-6x a day, for 5-7 days (rebound congestion)
- Advise pt to read labels on OTC drugs and to check with physician before taking cold remedies
- Antibiotics are not helpful in treating common cold viruses
- Encourage older patients with comorbidities to contact HCP concerning selection of drug, including OTC drugs
- Instruct pt not to drive during initial use of a cold remedy
- Tell pt to maintain adequate fluid intake
- Teach pt not to take a cold remedy before or at bedtime;
- Insomnia may occur if it contains decongestant
Encourage pt to get adequate rest - Inform pt about the mode of transmission of cold and flu viruses; hand-to-hand contact or by touching contaminated surfaces
- Advise pt to avoid environmental pollutants, fumes, smoking, and dust
- Teach pt to perform 3 effective coughs before bedtime to promote uninterrupted sleep
- Instruct pt to store drug out of reach of children; request childproof caps
- Advise pt to contact HCP if cough persists for >1 week, or is accompanied by chest pain, fever, or headache
- Teach pt how to self-administer nose drops and inhalants
- Encourage pt to cough effectively; deep breaths before coughing in an upright position
- Inflammation of the mucous membrane of one or more of the maxillary, frontal, ethmoid or sphenoid sinuses
- Systemic or nasal decongestant may be indicated
- Acetaminophen, fluids, and rest ma also be helpful
- Acute or Severe may need antibiotics
SINUSITIS
- Inflammation of the throat; “sore throat”
- Can be caused by a virus, beta-hemolytic streptococci (strep throat), or other bacteria
- Can occur alone or with the common cold and rhinitis or acute sinusitis
- Sx – fever and cough
- Throat culture – to rule out B-hemolytic streptococcal infection; if (+), a 10-day course of antibiotic is prescribed
- Saline gargles, lozenges, and increased fluid intake are usually indicated
- Acetaminophen – to alleviate fever
- Antibiotics are NOT effective for viral pharyngitis
ACUTE PHARYNGITIS
Enumerate Drugs Acting on the Upper Respiratory System
- Antihistamines
- Nasal and Systemic Decongestants
- Intranasal Glucocorticoids
- Antitussives
- Expectorants
Name 3 examples of Chronic Obstructive Pulmonary Disease (COPD)
Asthma | Chronic Bronchitis | Emphysema
Identify which COPD is being described
- Inflammatory disorder of the airway associated with a varying amount of airway obstruction
- Triggers: stress, allergens, and pollutants causing inflammation and edema of bronchial airways causing constriction of air passages causing wheezing, coughing, dyspnea, chest tightnes
Asthma
Identify which COPD is being described
- Progressive lung disease caused by smoking and chronic lung infections
- Bronchial inflammation and excessive mucus secretion causing airway obstruction causing productive coughing, expiratory rhonchi, hypercapnia, hypoxemia
Chronic Bronchitis
Identify which COPD is being described
- Progressive lung disease caused by cigarette smoking, atmospheric contaminants, or lack of a1-antitrypsin protein that inhibits proteolytic enzymes that destroy alveoli
- Bacterial infection causing Release of proteolytic enzymes causing terminal bronchioles are plugged with mucus causing loss in the fiber and elastin network in the alveoli
Emphysema
They…
Increase cAMP causing dilation of the bronchioles
Bronchospasm due to anaphylaxis – epinephrine causing dilation and inc. BP
- Bronchospasm due to chronic asthma or COPD – selective B2 adrenergic agonists as aerosol or tablet
SYMPATHOMIMETICS: ALPHA- and BETA2-ADRENERGIC AGONISTS
Examples of SYMPATHOMIMETICS: ALPHA- and BETA2-ADRENERGIC AGONISTS
Albuterol/Salbutamol
Isoproterenol
Identify which SYMPATHOMIMETICS: ALPHA- and BETA2-ADRENERGIC AGONISTS is being described
- Selective B2 drug
- Effective for treatment and control of asthma
- Causes bronchodilation with long duration of action
- More rapid by inhalation (1 min) than orally (15mins)
Albuterol/Salbutamol
Identify which SYMPATHOMIMETICS: ALPHA- and BETA2-ADRENERGIC AGONISTS is being described
- First beta adrenergic agent used for bronchospasm, 1941
- Non-selective beta agonist (B1 and B2)
- B1 stimulation – inc. heart rate
- B2 stimulation – bronchodilation
- Aerosol inhaler or IV
Short duration of action
Isoproterenol
Use of an Aerosol Inhaler
- Explain correct use of meter-dose inhaler or dry-powder inhaler and dosage intervals
- Spacer may be attached to the inhaler to improve drug delivery to the lungs
- SE and AE: mouth dryness, throat irritation, tolerance, severe paradoxical airway resistance, tremors, nervousness, and increased heart rate
Side Effects and Adverse Reactions of Epinephrine
- Tremors, dizziness, hypertension, tachycardia, heart palpitations, cardiac dysrhythmias, and angina
- Close monitoring when administered
Side Effects and Adverse Reactions of Beta2-adrenergic drugs
- Tremors, headaches, nervousness, tachycardia, palpitations
- Increased blood glucose levels
DM patients should be taught to closely monitor blood glucose levels - SE may diminish after 1 week or longer
Tolerance
a class of drugs that block the action of acetylcholine, a neurotransmitter that helps you…
- Stay alert
- Maintain a steady heart rate
- Breathe
- Digest food
- Sweat
- Empty your bladder
used to treat a variety of conditions, including: Parkinson’s disease, Dystonia, especially in children, COPD, Overactive bladder, and Gastrointestinal disorders.
ANTICHOLINERGICS
used to treat a variety of conditions, including: Parkinson’s disease, Dystonia, especially in children, COPD, Overactive bladder, and Gastrointestinal disorders.
ANTICHOLINERGICS
Identify which ANTICHOLINERGICS is being described
- Used to treat asthmatic conditions by dilating the bronchioles
- Fewer systemic effects
- Aerosol
- Combined with albuterol sulfate to treat chronic bronchitis
- Administer b-agonist inhalants, 5 mins before using it
- Administer inhaled glucocorticoids or cromolyn 5 mins after using it;
Rationale: so that bronchioles can dilate so steroid or cromolyn can be deposited in the bronchioles
Ipratropium bromide (Atrovent)
- Group of bronchodilators used to treat asthma
- Stimulate the CNS and respiration, dilate coronary and pulmonary vessels, and cause diuresis
METHYLXANTHINE (XANTHINE) DERIVATIVES
Examples of METHYLXANTHINE (XANTHINE) DERIVATIVES
Aminophylline, theophylline, caffeine
first theophylline preparation produced, 1936
Aminophylline
Identify which METHYLXANTHINE (XANTHINE) DERIVATIVES is being described
- Inhibition of phosphodiesterase causing increased cAMP causing relaxation of smooth muscles of bronchi, bronchioles, and pulmonary blood vessels causing bronchodilation
- Low therapeutic index and narrow therapeutic range (10-20mcg/mL)
- Once used as a first-line drug for pts with chronic asthma and other COPDs
- Serious AEs – dysrhythmias, convulsions, cardiorespiratory collapse; should NOT be prescribed in patients with seizure d/o or cardiac, renal and liver disease
Theophylline
Drug Interactions of METHYLXANTHINE (XANTHINE) DERIVATIVES
- Beta blockers, cimetidine, propranolol, and erythromycin – decrease the liver metabolism rate and increase the half-life and effects of theophylline
- Barbiturates and carbamazepine – decreases the effects of theophylline
Increased risk of digitalis toxicity; Decreases effects of lithium - Phenytoin – decreases theophylline levels
Synergistic effect when given with B-adrenergic agonist
Bronchodilators: Nursing Interventions
- Monitor VS
- Provide adequate hydration
- Monitor drug therapy
- Observe for side effects
- Administer medication after meals to decrease GI distress
- Administer at regular intervals around the clock
- DO NOT crush enteric-coated or sustained-release tablets or capsules
- Check serum theophylline levels (10-20mcg/mL)
Bronchodilators: Patient Teaching
- Teach pt to monitor pulse rate
- Encourage pt to monitor amount of medication remaining in the canister
- Advise pt not to take OTC preparations w/o checking with HCP
- Encourage pt contemplating pregnancy to seek medical advice before taking theophylline
Advise pt to avoid smoking - Discuss ways to alleviate anxiety
- Advise pt having asthma attacks to wear an ID bracelet or MedicAlert tag
- Inform pt that certain herbal products may interact with theophylline (Ephedra, St. John’s Wort)
- Advise pt to notify HCP of aggressive or altered behavior and suicidal thoughts
- Teach pt to correctly use inhaler or nebulizer
- Advise that high-protein, low-carbohydrate diet increases theophylline elimination
- aka Leukotriene Modifiers
- Effective in reducing inflammatory symptoms of asthma triggered by allergic and environmental stimuli
- NOT RECOMMENDED for treatment of acute asthmatic attack
- Safe for >6yo
LEUKOTRIENE RECEPTOR ANTAGONISTS AND SYNTHESIS INHIBITORS
Examples of LEUKOTRIENE RECEPTOR ANTAGONISTS AND SYNTHESIS INHIBITORS
Zafirlukast, Montelukast sodium, Zileuton
- Chemical mediator that can cause inflammatory changes in the lung
- Promote an increase in eosinophil migration, mucus production, and airway wall edema causing bronchoconstriction
Leukotriene
LT Receptor Antagonists: Nursing Interventions
- Monitor respirations for rate, depth, rhythm and type
- Monitor lung sounds for rhonchi, wheezing, or rales
- Observe lips and fingernails for cyanosis
- Monitor drug therapy for effectiveness
- Observe for side effects
- Provide adequate hydration
- Monitor liver function tests (AST and ALT)
- Provide pulmonary therapy by chest tapping and positional drainage, as appropriate
LT Receptor Antagonists: Patient Teaching
- Advise pt to notify HCP once allergic reaction occurs
- Monitor periodic liver function tests
- Direct patient not to take St.
John’s wort without first checking with HCP - Warm pt that black or green tea and guarana with montelukast and zafirlukast may cause increased stimulation
- Encourage pt to stop smoking
- Discuss ways to alleviate anxiety
- Advise pt having frequent or severe asthmatic attacks to wear an ID bracelet or MedicAlert tag
- Encourage pt contemplating pregnancy to seek medical advice before taking montelikast
- Caution pt or significant other not to open oral granule packets until ready for use; Must be administered within 15mins after opening; if mixed with baby formula or approved food, do not store for future use
- Advise pt with known aspirin sensitivity to avoid a bronchoconstrictor response by avoiding aspirin and NSAIDs while taking montelukast
- Tell pt to take medication in the evening for maximum effectiveness
- Indicated if asthma is unresponsive to bronchodilator therapy or if the pt has an asthmatic attack while on maximum doses of theophylline or adrenergic drug
- Synergistic effect with b2 agonist
- Inhaler, tablet, IV
- Take with food to avoid gastric irritation and ulceration
- Combination containing fluticasone proprionate 100mcg and salmeterol 50mcg is effective in controlling asthma symptoms; 2 puffs per day
GLUCOCORTICOIDS (STEROIDS)
Examples of GLUCOCORTICOIDS (STEROIDS)
Beclomethasone, dexamethasone, prednisone, prednisolone, methylprednisone, hydrocortisone
Identify which type of GLUCOCORTICOIDS (STEROIDS) is being described below
- Not helpful in treating a severe asthmatic attack; may take 1-4 weeks before reaching full effect
- More effective for controlling sx of asthma than b2 agonist
- Minimized risk for adrenal suppression
- Preferred over oral preparations
Inhaled
Identify which type of GLUCOCORTICOIDS (STEROIDS) is being described below
- Acute asthma exacerbations
- Large doses (20-50mg prednisone for 5 days; 1-2 mg/kg/day for children for 3-5 days)
- Single dose or short-term use may be discontinued abruptly
- Prolonged glucocorticoids therapy – weaning or tapering of dose
Systemic glucocorticoids
Identify what type of commonly used drugs to treat asthma and COPD are found below
- B2 Agonist Agents (Short acting B2 Agonist Agent) (SABA)
*Salbulatamol
*Terbutaline - Anti Muscarinic agents (Short Acting) (SAMA)
*Ipratropium Bromide
Short Acting Bronchodilator
Identify what type of commonly used drugs to treat asthma and COPD are found below
- B2 Agonist Agents (Long Acting) (LABA)
*Salmeterol
*Formoterol
*Indacaterol - Anti Muscarinic Agent (Long Acting) (LAMA)
*Tioptropium
Long Acting Bronchodilator
Identify what type of commonly used drugs to treat asthma and COPD are found below
- Fluticasone
- Budesonide
- Beclomethasone
Inhaled Corticosteroid
GLUCOCORTICOIDS (STEROIDS) SE and AE
- SE are generally local rather than systemic – throat irritation, hoarseness, dry mouth, coughing
- Fungal infections may be prevented by using a spacer; instruct pt to rinse mouth and throat with water after each dose and wash the apparatus daily with warm water
- Aes – usually seen within 2 weeks of therapy
- Other SE – headache, euphoria, confusion, sweating , hyperglycemia, insomnia, nausea, vomiting, weakness, and menstrual irregularities
- Aes – depression, peptic ulcer, loss of bone density, development of osteoporosis, psychosis
- Prolonged oral and IV use – electrolyte imbalance, fluid retention, hypertension, thinning of skin, purpura, abnormal subcutaneous fat distribution, hyperglycemia, and impaired immune response
4 layers of the Adrenal Gland
Arranged From Superficial to Deep
Zona Glomerulosa
Zona Fasciculata
Zona Reticularis
Adrenal Medulla
Identify which layer of the Adrenal Gland produces the hormones described below
- Mineralocorticoids
Zona Glomerulosa
Identify which layer of the Adrenal Gland produces the hormones described below
- Glucocorticoids
Zona Fasciculata
Identify which layer of the Adrenal Gland produces the hormones described below
- Androgens
Zona Reticularis
Identify which layer of the Adrenal Gland produces the hormones described below
- Catecholamines
Adrenal Medulla
This is ….
- Used for prophylactic treatment of bronchial asthma and must be taken daily
- NOT used for asthma attacks
- NO bronchodilator properties
- Acts by inhibiting histamine release to prevent an asthma reaction
- SE: cough and bad taste; instruct pt to drink water before and after using the drug
Inhalation - Can be used with b-adrenergics and xanthine derivatives
- Should NOT be discontinued abruptly
Cromolyn sodium
This is…
- Action and uses are similar to cromolyn
- Has anti-inflammatory effects and suppress the release of histamine, LTs, and other mediators from the ,ast cells
- More effective than cromolyn
Nedocromil sodium
DRUG THERAPY FOR Young children
- Cromolyn and nedocromil – inflammatory effects of asthma
- Oral glucocorticoids – control a moderate to severe asthmatic state; 1-2 inhalations 3-4x a day or 40-80mcg 2x/day
- Oral b2-adrenergic agonist – severe attacks
DRUG THERAPY FOR
Older adults
- B2-adrenergic agonist and methylxanthines – can cause tachycardia, nervousness, and tremors in older adults esp those with cardiac conditions
- Frequent glucocorticoids – increased risk of developing cataracts, osteoporosis, and DM
They Liquefy and loosen thick mucus secretions so they can be expectorated
MUCOLYTICS
Examples of MUCOLYTICS
Acetylcysteine and Dornase alfa
Identify which Mucolytic is being described below
-Should NOT be mixed with other drugs
- May be an adjunct to bronchodilator (not mixed together)
- Give bronchodilator 5 mins before acetylcysteine
- SE: nausea, vomiting, stomatitis, and runny nose
- Antidote for acetaminophen overdose of given within 12-24h after overdose inegestion
- Inhaled, oral as effervescent tabs or powder (diluted in juice or softdrinks)
Acetylcysteine
Identify which Mucolytic is being described below
- Enzyme that digests DNA in thick sputum secretions of patients with cystic fibrosis
- Hep reduce respiratory infections and improves pulmonary function
- Improvement occur 3-7 days with its use
- SE: chest pain, sore throat, laryngitis, hoarseness
Dornase alfa
They are Used ONLY if a bacterial infection results from retained mucus secretions
ANTIMICROBIALS
An ANTIMICROBIAL that…
- aka Co-trimoxazole
- Effective for mild to moderate acute exacerbations of chronic bronchitis from infectious causes
Trimethoprim-sulfamethoxazole
