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PEDS A. > KARCH: CH. 54 - Drugs Acting on the Upper Respiratory Tract > Flashcards

KARCH: CH. 54 - Drugs Acting on the Upper Respiratory Tract Flashcards

1
Q

_____: drugs that block histamine release/action.

A

Antihistamines

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2
Q

_____: drugs that block the cough reflex.

A

Antitussives

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3
Q

_____: drugs that ↓ blood flow to the URT & ↓ overproduction of secretions.

A

Decongestants

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4
Q

_____: drugs that ↑ productive cough to clear airways.

A

Expectorants

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5
Q

_____: drugs that ↑ or liquify respiratory secretions to help clear airways.

A

Mucolytics

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6
Q

_____: as a decongestant drug wears off, the nasal passage becomes congested.

A

Rebound congestion

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7
Q

_____: an adverse effect of excessive or long-term decongestant use causing a reflex reaction (rebound congestion) to vasoconstriction.

A

Rhinitis medicamentosa

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8
Q

_____: a chemical released d/t inflammation; its causes ↑ secretions & narrows airways.

A

Histamine

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9
Q

Antitussives

A

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).
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10
Q
A
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11
Q

What drug class should be used with caution in patients who have a history of addiction.

A

Antitussives (codeine, hydrocodone).

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12
Q

Topical Nasal Decongestants

A

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)
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13
Q

Oral Decongestants

A

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
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14
Q

Topical Nasal Steroid Decongestants

A

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.
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15
Q

Antihistamines

A

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
    *
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16
Q

Expectorants

A

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
17
Q

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

A

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.

18
Q

Mucolytics

A

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
19
Q

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

A

C. Acetylcysteine

20
Q

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

A

d. a decongestant

21
Q

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.

A

c. patients with a dry, irritating cough.

22
Q

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.

A

d. topical nasal steroids.

23
Q

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.

A

b. restlessness and palpitations.

24
Q

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. a history of arrhythmias or prolonged QT intervals.

25
Q

A patient is not getting a response to the antihistamine that was prescribed. Appropriate action might include

a. switching to a decongestant.
b. stopping the drug and increasing fluids.
c. trying a different antihistamine.
d. switching to a corticosteroid.

A

c. trying a different antihistamine.

26
Q
  • *Dornase alfa (Pulmozyme), because of its mechanism of action, is reserved for use in**
    a. clears secretions before diagnostic tests.
    b. facilitates the removal of secretions postop.
    c. protects the liver from acetaminophen toxicity.
    d. relieves the buildup of secretions in cystic fibrosis.
A

d. relieves the buildup of secretions in cystic fibrosis.

27
Q

Select all that apply.

Common adverse effects of Topical Nasal Steroids would include which of the following:

a. Local burning and stinging
b. Dryness of the mucosa
c. Headache
d. Constipation and urinary retention
e. Fungal infections
f. Osteonecrosis

A

a. Local burning and stinging
b. Dryness of the mucosa
c. Headache
e. Fungal infections

28
Q

Select all that apply.

An antihistamine would be the drug of choice for treating which of the following?

a. Itchy eyes
b. Irritating cough
c. Nasal congestion
d. Runny nose
e. Idiopathic urticaria
f. Thick, tenacious secretions

A

a. Itchy eyes
c. Nasal congestion
d. Runny nose
e. Idiopathic urticaria

29
Q

Select all that apply.

  • *Nursing interventions for PTs receiving antihistamines include:**
    a. Using a humidifier
    b. Sugarless lozenges, candy, gum (for dry mouth)
    c. Limiting fluid intake to decrease swelling
    d. Provide safety measures to prevent falls or injury
    e. Encourage fluids
    f. Leave bowls of water around the house to increase humidity.
A

a. Using a humidifier
b. Sugarless lozenges, candy, gum (for dry mouth)
d. Provide safety measures to prevent falls or injury
e. Encourage fluids
f. Leave bowls of water around the house to increase humidity.

30
Q
A

PEDS A. (3 decks)

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