Drugs for Asthma, COPD, Allergic Rhinitis, Cough, & Cold

Question 1

Budenoside

Answer 1

Glucocorticoid
MOA: Suppresses inflammation by decreasing synthesis & release of inflammatory modulators, decreasing infiltration & activity of inflammatory cells, and decreasing edema of airway mucosa
Indications:
- Used as maintenance therapy in asthma and COPD
Adverse Effects:
- Candidiasis & dysphonia when inhaled
- Minimal adverse effects in short-term PO use
- Adrenal suppression, hyperglycemia, and osteoporosis in prolonged PO use.
Nursing Considerations:
- Do not use for acute attack!
- Patient education on inhalation drug delivery, admin with SABA, and post-admin instructions
- Tapering with long-term PO used and monitoring for adrenal suppression (chronic fatigue, anorexia, abd. pain, etc.)

Question 2

Montelukast

Answer 2

Leukotriene receptor blocker
MOA: Occupies leukotriene receptors in airway and pro-inflammatory cells to block receptor activation
Indications:
- Asthma maintenance & prophylaxis
- Prevention of exercise-induced bronchospasm (EIB)
- Relief of allergic rhinitis
Adverse Effects:
- Generally well tolerated
Nursing Considerations:
- Patient education on medication use for only maintenance; no acute tx!
- Cheaper than most inhalers; may increase adherence

Question 3

Cromolyn

Answer 3

Mast cell stabilizer
MOA: Prevents release of histamine and other mediators by stabilizing cytoplasmic membrane of mast cells
Indications:
- Maintenance of mild-moderate asthma
- Prevention of EIB
- Relief of allergic rhinitis
Adverse Effects:
- Generally well tolerated
- May cause cough or bronchospasm due to inhalation
Nursing Considerations:
- Educate on medication usage not for acute tx!
- Use 15 minutes before exposure to triggers

Question 4

Albuterol & Salmeterol

Answer 4

SABA/LABA
MOA: Activates Beta-2 receptors to cause bronchodilation
Indications:
- Relief of acute bronchospasm (SABA)
- Prevention of EIB
- Combination ICS/LABA for COPD
Adverse Effects:
- SABA: tachycardia, angina, tremor
- LABA: Severe asthma & asthma related death (rare)
Nursing Considerations:
- Patient education on how and when to use each medication
- LABA never used as monotherapy, often will used with glucocorticoid (Budenoside)
- Assess use of SABA

Question 5

Theophylline

Answer 5

Methylxanthine
MOA: Unclear; bronchodilation likely due to blockade of receptors for adenosine & anti-inflammatory effects
Indications:
- PO for asthma & COPD maintenance
- IV for asthma emergencies
Adverse Effects:
- Theophylline toxicity ranging from mild (N/V/D) to serious (v-fib & convulsions)
Nursing Considerations:
- Narrow therapeutic range; monitor serum levels regularly!
- Do not double dose if dose missed!
- Caffeine contraindicated!
- Lidocaine for v-fib & diazepam for convulsions!

Question 6

Tiotropium

Answer 6

Anticholinergic
MOA: Blocks muscarinic cholinergic receptors in bronchi to prevent bronchoconstriction
Indications:
- COPD
- Off-label use in asthma
Adverse Effects:
- Minimal, usually dry mouth and irritation of pharynx
- Systemic anticholinergic effects rare
Nursing Considerations:
- Often combined with albuterol nebulizer as PRN medication to use both mechanism for maximal relief

Question 7

Fluticasone

Answer 7

Intranasal glucocorticoid
Indications: 
- Allergic rhinitis
Adverse Effects:
- Dry nasal mucosa
- Burning or itching sensation
- Nosebleed
- Systemic effects, including adrenal suppression & slow growth in children (rare)
Nursing Considerations:
- Patient education on relief is greatest if administered daily vs. PRN
- Relief may take a week or longer

Question 8

Loratadine

Answer 8

Antihistamine
MOA: blocks histamine receptor site
Indications:
- Hay fever, seasonal allergies, etc.
Adverse Effects:
- Generally mild
- Sedation & anticholinergic effects seen more with 1st generation antihistamines (Loratadine 2nd generation)
Nursing Considerations:
- Avoid 1st gen. if requiring alertness
- Most effective if taken prophylactically vs. after symptom onset
- Intranasal preparations may cause increased drowsiness with sufficient systemic absorption

Question 9

Phenylephrine

Answer 9

Sympathomimetic decongestant
MOA: Activates alpha-1 receptors on nasal BV to cause vasoconstriction
Indications:
- Nasal congestion
Adverse Effects:
- Rebound congestion if topical agents used for more than a few days
- CNS excitation
- CV effects with PO preparations
Nursing Considerations:
- Monitor VS due to potential for increased BP, particularly those with HTN, CAD, dysrhythmias, and cerebrovascular disease
- Topical use should not exceed 3-5 days
- Commonly confused with pseudoephedrine which can be used as an ingredient for methamphetamine; this is behind the counter.
- OTC

Question 10

Dextromethorphan, diphenhydramine, benzonatate

Answer 10

Non-opioid antitussives
MOA:
- Dextromethorphan: acts on sigma opioid receptors to suppress cough reflex
- Diphenhydramine: Unclear
- Benzonatate: decreases sensitivity of respiratory tract stretch receptors (part of cough receptor pathway)
Adverse Effects:
- Dextromethorphan: High doses has potential for causing euphoria
- Benzonatate: Usually mild; can cause seizures, dysrhythmia, and dose-dependent overdose

Question 11

Codeine & Hydrocodone

Answer 11

Opioid Antitussives
MOA: Poorly understood in context of cough; thought to increase cough threshold in CNS
Adverse Effects:
- Respiratory depression
- Constipation
- Abuse
Nursing Considerations:
- Monitor respiratory status
- Use Narcan as reversal agent