KARCH: CH. 54 - Drugs Acting on the Upper Respiratory Tract Flashcards
_____: drugs that block histamine release/action.
Antihistamines
_____: drugs that block the cough reflex.
Antitussives
_____: drugs that ↓ blood flow to the URT & ↓ overproduction of secretions.
Decongestants
_____: drugs that ↑ productive cough to clear airways.
Expectorants
_____: drugs that ↑ or liquify respiratory secretions to help clear airways.
Mucolytics
_____: as a decongestant drug wears off, the nasal passage becomes congested.
Rebound congestion
_____: an adverse effect of excessive or long-term decongestant use causing a reflex reaction (rebound congestion) to vasoconstriction.
Rhinitis medicamentosa
_____: a chemical released d/t inflammation; its causes ↑ secretions & narrows airways.
Histamine
Antitussives
TRADITIONAL ANTITUSSIVES:
-
Codeine, Hydrocodone, Dextromethorphan
- MOA: Acts directly on the medullary cough center of the brain to depress the cough reflex.
OTHER DRUGS:
-
Benzonatate (Tessalone)
- MOA: Acts directly on the respiratory tract - a local anesthetic on the respiratory passages, lungs, and pleurae, by blocking the effect of stretch receptors that stimulate the cough reflex.
INDICATED TO TREAT:
- Nonproductive cough
ADVERSE EFFECTS:
- CNS depression: Dizzy & Sedation
- Respiratory depression
- Dry mouth
CONTRAINDICATIONS:
- PTs who need to cough to maintain airways (postop abdominal or thoracic sx)
- Head injury
- CNS depression
- Pregnancy & Lactation
- Hx of narcotic addiction
CAUTION IN:
- Asthma & Emphysema (b/c cough suppression may cause secretions to accumulation & loss of respiratory reserve)
- Cough that persists >1-week (b/c it may indicate underlying condition)
ASSESSMENT:
- Temp (to eval possible underlying infection)
- Respiration & lung sounds (to assess drug effectiveness & to monitor the accumulation of secretions)
- LOC (to monitor CNS depression)
PATIENT TEACHING:
- Report: a cough that persists >1-week or accompanied by fever, rash, excessive secretions.
- Other measures to relieve cough: humidity, cool temps, fluids, topical lozenges.
- NO driving & high-alert activities (for Traditional Antitussives - SE: sedation & drowsiness).
What drug class should be used with caution in patients who have a history of addiction.
Antitussives (codeine, hydrocodone).
Topical Nasal Decongestants
DRUGS:
- Oxymetazoline (Afrin, and others)
- Phenylephrine (Coricidin, and many others)
- Tetrahydrozoline (Tyzine)
- Xylometazoline (Otrivin)
MOA:
- ↓overproduction of secretions by causing local vasoconstriction to the URT.
- Sympathomimetic
- Affects SNS to cause vasodilatation
- Causing ↓ inflammation of the nasal mm
INDICATIONS:
- Relieve the discomfort of nasal congestion D/T the common cold, sinusitis, and allergic rhinitis.
- Preferred for PTs that must avoid systemic adrenergic (SNS) effects.
PHARMACOKINETICS:
- Generally, not absorbed systemically.
- If absorbed, metabolized by liver & excreted in the urine.
CONTRAINDICATIONS:
- Lesion or erosion of mm.
CAUTION IN:
- Glaucoma, HTN, DM, CAD, BPH, Hyperthyroidism (any conditions that can exacerbate SNS/adrenergic effects)
- Pregnancy & Lactation (no studies)
ADVERSE EFFECTS:
- Local stinging & burning
- Rebound congestion
- SNS effects: ↑HR & BP, urinary retention
DRUG-DRUG INTERACTIONS:
- Cyclopropane or Halothane
ASSESS:
- Glaucoma, HTN, DM, Thyroid dis., CAD, BPH.
- LOC & reflexes, VS and cardiac status
- RR & adventitious lung sounds
- Nasal mm & I&O (urinary status)
TEACH:
- DO NOT use >3-5 days (RF rebound congestion)
Oral Decongestants
MOA:
- ↓ nasal congestion R/T the common cold, sinusitis, and allergic rhinitis
DRUG:
- Pseudoephedrine (Triaminic Allergy Congestion, and many combination products)
ACTIONS:
- Shrinks nasal mm by stimulating the a-adrenergic receptors in nasal mm.
INDICATIONS:
- To drain sinuses & improving airflow
PHARMACOKINETICS:
- Well absorbed, widely distributed in the body
- Metabolized by liver & primarily excreted in urine
CONTRAINDICATIONS:
- Any condition that can ↑ SNS/adrenergic effect: Glaucoma, HTN, CAD, Hyperthyroidism, DM, BPH)
- Pregnancy & lactation
DRUG-DRUG INTERACTIONS:
- NO OTC drugs w/ Pseudoephedrine (RF unintentional OD)
ADVERSE EFFECTS:
- Rebound congestion
-
Systemic adrenergic (SNS) effects:
- Anxiety, Restless, Tremors
- HTN, HA, Dizzy, ↑HR (arrhythmias),
- N/V, Sweating, Pallor
- Urinary retention
- SOB
ASSESS:
- Pregnancy & lactation
- HTN, CAD, Hyperthyroidism, DM, BPH, Glaucoma
- LOC, reflexes, and affect
- VS and LS
Topical Nasal Steroid Decongestants
DRUGS:
- Beclomethasone (Beconase and others)
- Budesonide (Pulmicort Respules)
- Flunisolide (generic)
- Fluticasone (generic)
- Triamcinolone (generic)
ACTIONS:
- Blocks the inflammatory response from occurring (Anti-inflammatory).
- Exact MOA is unknown
INDICATIONS:
- Seasonal allergic rhinitis
- Preferred for PTs w/ Allergic rhinitis who CAN’T have Systemic Steroids.
- Inflammation after removal of nasal polyps
PHARMACOKINETICS:
- Generally, not absorbed systemically
CONTRAINDICATIONS:
- Acute infection
CAUTION:
- Active infection
- Avoid exposure to airborne infections
ADVERSE EFFECTS:
- Local burning, irritation, stinging
- Dry skin & mucosa
- HA
- Fungal & bacterial infection
- Delayed healing in PTs w/ nasal surgery or trauma
ASSESS:
- Nasal mucosa
- Temp, VS, RR & LS
TEACH:
- Takes several days to weeks to take effect.
Antihistamines
1st Gen. & 2nd Gen. Antihistamines include:
- Brompheniramine (J-Tan)
- Carbinoxamine (Histex, Palgic)
- Chlorpheniramine (Aller-Chlor) and many others
- See table 54.3
INDICATIONS:
- To relieve resp. symptoms & TX treat allergies
- Seasonal & perennial allergic rhinitis
- Allergic conjunctivitis
- Uncomplicated urticaria
- Angioedema
MOA:
- Selectively blocks the effects of histamine at the H1 receptor sites, ↓allergic response
- Anticholinergic & antipruritic effects
PHARMACOKINETICS:
- Well absorbed, metabolized in the liver, excreted in urine and feces
CONTRAINDICATIONS:
- Pregnancy & Lactation
- Renal or hepatic impairment
- Prolonged QT interval (RF death)
- HX of arrhythmias
ADVERSE EFFECTS:
- Drowsiness, Sedation, Dizzy, Bradycardia
- Epigastric distress
- Thickened bronchial secretions
- Rash
-
Anticholinergic effects:
- Dry skin, mouth, mm
- Constipation
- Urinary retention
- Blurred vision
DRUG-DRUG INTERACTIONS:
- Vary based on the drug
ASSESS:
- Pregnancy & Lactation
- Arrhythmias (prolonged QT interval)
- Skin, orientation, affect, and reflexes
- RR & LS
- LABS: Renal & Hepatic function
NURSING ACTIONS / TEACHING:
- ↑Fluids,
- Use humidifier
- Use moisturizer
- AVOID smoke-filled rooms
*
Expectorants
DRUGS:
- ONLY Guaifenesin (Mucinex, and many others).
MOA:
- Drugs that liquify the LRT secretions & ↑productive cough to clear airways.
INDICATIONS:
- Symptomatic relief of resp. conditions characterized by a dry, non-productive cough w/ presence of mucous in the resp. tract.
PHARMACOKINETICS:
- Rapidly absorbed, metabolism & excretion unknown.
ADVERSE EFFECTS:
- GI: N/V
- HA & Dizzy
- Mild rash
- Prolonged use can mask serious underlying disorders.
CONTRAINDICATIONS:
- T: NO OTC products w/ Guaifenesin (to prevent inadvertent OD)
ASSESS:
- Persistent cough d/t smoking, asthma, or emphysema
- Skin, temp., RR & LS, orientation & affect
Which of the following is an adverse reaction to topical nasal steroids?
A. Increased nasal drainage
B. Rebound effect
C. Suppression of healing
D. Local ulceration
C. Suppression of healing
Rationale: Adverse Effects: local burning, irritation, stinging, dryness of the mucosa, and headache; suppression of healing can occur in a patient who has had nasal surgery or trauma.
Mucolytics
MOA:
- Helps high-risk respiratory PTs clear airways by breaking down/liquifying thick mucous - thus easier to cough up.
- (↑ respiratory fluid O/P by ↓ its adhesiveness & surface tension of the fluid (liquefying) - making it easier to cough up)
DRUGS:
- Acetylcysteine (generic)
-
Dornase alfa (Pulmozyme)
- Specifically used to treat Cystic Fibrosis
INDICATIONS:
- PTs w/ difficulty coughing up secretions
- PTs w/ atelectasis
- PTs undergoing diagnostic bronchoscopy
- Postop PTs
- PTs w/ tracheostomies
PHARMACOKINETICS:
- Nebulization or direct instillation into trachea
CAUTION:
- Acute bronchospasm
- Peptic ulcer
- Esophageal varices
ADVERSE EFFECTS:
- N/V
- Stomatitis
- Rhinorrhea
- Bronchospasm
- Rash (Urticaria)
ASSESS:
- Presence of acute bronchospasm, peptic ulcer, and esophageal varices
- Skin, B/P, HR/pulse, RR & LS
What drug enhances the output of respiratory tract fluid by reducing the adhesiveness and surface tension of the fluid, which facilitates the removal of viscous mucus?
A. Guaifenesin
B. Flunisolide
C. Acetylcysteine
D. Dextromethorphan
C. Acetylcysteine
A patient with sinus pressure and pain related to seasonal rhinitis would benefit from taking
a. an antitussive
b. an expectorant
c. a mucolytic
d. a decongestant
d. a decongestant
Antitussives are useful in blocking the cough reflex and preserving the energy associated with prolonged, nonproductive coughing. Antitussives are best used with
a. postoperative patients.
b. asthma patients.
c. patients with a dry, irritating cough.
d. COPD patients who tire easily.
c. patients with a dry, irritating cough.
Patients with seasonal rhinitis experience irritation and inflammation of the nasal passages and passages of the upper airways. Treatment for these patients might include
a. systemic corticosteroids.
b. mucolytic agents.
c. an expectorant.
d. topical nasal steroids.
d. topical nasal steroids.
A patient taking OTC cold medication and OTC allergy medicine is found to be taking double doses of pseudoephedrine. As a result, the patient might exhibit
a. ear pain and eye redness.
b. restlessness and palpitations.
c. sinus pressure and ear pain.
d. an irritating cough and nasal drainage.
b. restlessness and palpitations.
Antihistamines should be used very cautiously in patients with
a. a history of arrhythmias or prolonged QT intervals.
b. COPD or bronchitis.
c. asthma or seasonal rhinitis.
d. angioedema or low blood pressure.
a. a history of arrhythmias or prolonged QT intervals.
