Drugs acting on the upper respiratory tract: antihistamines, decongestants, antitussives, and expectorants

Question 1

Histamine

Answer 1

Major inflammatory mediator in many allergic disorders

Question 2

Antihistamines

Answer 2

Drugs that compete with histamine for specific receptor sites

Question 3

H1 antagonists you need to know

Answer 3

Chlorpheniramine, fexofendaine (allegra), loratadine (Claritin), cetirizine (zyrtec), diphenhydramine (Benadryl)

Question 4

Properties of antihistamines

Answer 4

Antihistaminic, anticholinergic, sedative

Question 5

Antihistamine effects

Answer 5

Reduces dilation of blood vessels and reduces increased permeability of blood vessels; reduces salivary, gastric, lacrimal, and bronchial secretions, bind to histamine receptors thus preventing histamine from causing a response, drowsiness, anticholinergic effects,

Question 6

Antihistamine indications

Answer 6

Management of nasal allergies, season or perennial allergic rhinitis, allergic reactions, motion sickness, Parkinson’s disease, sleep disorders. Could also be used to relieve symptoms associated with the common cold- sneezing, runny nose, palliative treatment- not curative

Question 7

Antihistamine contraindications

Answer 7

KDA, Narrow angle glaucoma, cardiac disease, hypertension, kidney disease, bronchial asthma, COPD, peptic ulcer disease, seizure disorders, BPH, pregnancy

Question 8

Antihistamines adverse effects

Answer 8

Anticholinergic effects: dry mouth, difficulty urinating, constipation, changes in visions. Drowsiness

Question 9

What are the 2 types of histamine

Answer 9

Traditions and non sedating

Question 10

Tradition antihistamine drugs

Answer 10

Brompheniramine, chlorpheniramine, diiphenhydramine, meclizine, promethasine

Question 11

Nonsedating antihistamine drugs

Answer 11

Ioratadine, cetirizine, and fexofenadine

Question 12

Nonsedating antihistamines characteristics and examples

Answer 12

Developed to eliminate unwanted adverse effects, mainly sedation, works peripherally to block the actions of histamine; thus fewer CNS adverse effects, longer duration of action which can increase compliance
EX: fexofenadine (allegra), loratadine (Claritin), Cetrizine (zyrtec)

Question 13

Traditional antihistamines characteristics and examples

Answer 13

Older, work both peripherally and centrally, have anticholinergic effects, making them more effective than non sedating drugs in some cases
EX: diphenhydramine, bropheniramine, chlorpheniramine, meclizine, promethazine.

Question 14

Nursing implications for antihistamines

Answer 14

• Gather data about condition or allergic reactions that required treatment- assess for drug allergies,
• contraindicated in the presence of acute asthma attacks and lower respiratory diseases, such as pneumonia. – Instruct patients to report excessive sedation, confusion, or hypotension,
• instruct patients to avoid driving or operating heavy machinery,
• advise against consuming alcohol or other CNS depressants,
• instruct patients not to take these medications with other prescribed or OTC medications without checking with their prescribers.
• Best tolerated when taken with meals (reduces GI upset),
• If dry mouth occurs, teach patients to perform frequent mouth care, chew gum, or suck on hard candy to ease discomfort,
• monitor for intended therapeutic effects.

Question 15

Decongestants types

Answer 15

Adrenergic, corticosteroids

Question 16

Adrenergic characteristics

Answer 16

Constrict small vessels to allow mucous membranes to drain; largest group of decongestants; sympathomimetics

Question 17

Corticosteroids characteristics

Answer 17

Decreases inflammation results in decreased congestions; topical, intranasal steroids

Question 18

Oral decongestants

Answer 18

Have prolonged effects but delayed onset; effect less potent than topical, no rebound congestion, exclusively adrenergic
EX: pseudoephedrine (Sudafed)

Question 19

Topical adrenergic characteristics

Answer 19

Prompt onset,
potent,
sustained use causes rebound congestion- cycle of congestion-drug-congestion
Ephedrine, oxymetazoline, phenylephrine

Question 20

Inhaled intranasal steroids

Answer 20

Not associated with rebound congestion; often used prophylactically to prevent nasal congestion in patients with chronic upper respiratory tract symptoms

Question 21

Intranasal steroids yntk

Answer 21

Beclomethasone, budesonide (Rhinocort) ,fluticasone (Flonase), triamcinolone (nasacort)

Question 22

Nasal decongestants contraindications

Answer 22

KDA, narrow angle glaucoma, unrolled cardiovascular disease, hptn, Diabetes and hyperthyroidism, history of cerebrovascular accident or transient ischemic attacks, long-standing asthma, BPH, diabetes

Question 23

Adrenergic adverse effects

Answer 23

Nervousness, insomnia, palpitations, tremors
- Systemic effects caused by adrenergic stimulation of the hear, blood vessels, and CNS

Question 24

Steroids

Answer 24

Local mucosal dryness and irritation

Question 25

Nasal decongestants interactions

Answer 25

Systemic sympathomimetic drugs and sympathomimetic nasal decongestions are likely to cause drug toxicity when given together, monamine oxidase inhibitors and sympathomimetic nasal decongestants raise blood pressure, Methyldopa, urinary acidifiers and alkanizers

Question 26

Nursing implications for nasal decongestants

Answer 26

- Patients should avoid caffeine and caffeine-contain products, - - patients should report a fever, cough, or other symptoms lasting longer than 1 week - monitor for intended therapeutic effects, - instruct to clear nasal passages, tilt head back when applying drops or spray and keep it tilted for a few seconds - Avoid blowing nose for at least 2 minutes after administrations - periodically check the naked for erosion or lesions

Question 27

Antitussives

Answer 27

Drugs used to stop or reduce coughing- opioid and nonopioid Used only for nonproductive coughs

Question 28

Opioid Antitussives MOA

Answer 28

Suppress the cough reflex by direct action of the cough center in the medulla, analgesia drying effect on the mucosa of the respiratory tract, increased viscosity of the respiratory secretions, reduction of runny nose and postnasal drip EG: codeine, hydrocodone

Question 29

Nonopioid antitussives MOA

Answer 29

Dextromethorphan- work in same way Not an opioid, no analgesic properties, no CNS depression, EX: benzonatate Suppresses the cough reflex by numbing the stretch receptors in the respiratory tract and prevent reflex stimulation of the medullary cough center

Question 30

Antitussives contraindications

Answer 30

KDA, opioid dependency, respiratory depression

Question 31

Benzonatate adverse effects

Answer 31

Dizziness, headache, sedation, nausea, and others

Question 32

Dextromethorphan adverse effects

Answer 32

Dizziness, drowsiness, nausea

Question 33

Opioids adverse effects

Answer 33

Sedation, nausea, vomiting, lightheadedness, constipation

Question 34

Nursing implications for antitussives

Answer 34

- Report any of the following symptoms: Cough that lasts more than 1 week, persistent headache, fever, rash - NOT FOR PRODUCTIVE COUGHS - monitory for intended therapeutic effects - encourage non drug measures: fluids, humidifiers, avoid smoke-filled areas, wash hands

Question 35

Expectorants indications

Answer 35

Used for the relief of productive coughs associated with: common cold, bronchitis, laryngitis, pharyngitis, coughs caused by chronic paranasal sinusitis, pertussis, influenza, measles

Question 36

Expectorants

Answer 36

Drugs that aid in the expectation (removal) or mucus by. reducing the viscosity of secretions - Disintegrated and things secretions EX: guaidenesine Loosens and thins sputum and bronchial secretions so the tendency to cough is indirectly diminished

Question 37

Nursing implications for expectorants

Answer 37

- should be used with caution in older adults and patients with asthma or respiratory insufficiency - patients taking expectorants should receive more fluids, if permitted, to help loosen and liquefy secretions, - report a fever, cough or other symptoms lasting longer than 1 week - monitor for intended therapeutic effects