Lewis 29 - Upper Respiratory Problems Flashcards
MOA/Class
diphenhydramine, hydroxyzine – 1st generation
cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra) – 2nd generation
Block histamine from binding to H1 histamine receptors on basophils and mast cells (thus preventing the release of additional histamine and other inflammatory mediators).
Antihistamine
Tucker 54
Side effects
diphenhydramine, hydroxyzine – 1st generation
cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra) – 2nd generation
Anticholinergic effects
Drowsiness (1st generation drugs) especially when combined with other CNS depressants; also prolonged QT interval and urinary retention
Tucker 54
Nursing Considerations
diphenhydramine, hydroxyzine – 1st generation
cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra) – 2nd generation
Stop several days before allergy testing. Manage anticholinergic (drying) effects. Most beneficial when given early in histamine-induced reactions.
Tucker 54
Indications
diphenhydramine, hydroxyzine – 1st generation
cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra) – 2nd generation
Allergic rhinitis, adjuct for anaphylaxis, pruritis, motion sickness, *insomnia (use with caution especially in older adults).
Tucker 54
MOA/Class
montelukast
Leukotrienes are produced in leukocytes such as mast cells. Once released from the mast cell during an inflammatory response, leukotrienes mediate additional responses such as bronchial constriction
LTRAs prevent leukotrienes from attaching to receptors on lymphocytes and alveolar macrophages thus reducing the inflammatory response thus preventing smooth muscle contraction (bronchi), decreasing mucus secretion, decreasing vascular permeability
Leukotriene Receptor Antagonist (LTRA)
Tucker 55
Side Effects
montelukast
Headache, nausea, diarrhea, cough, elevated LFTs, myalgia, neuropsychiatric events
Tucker 55
Nursing Considerations
montelukast
Tablets contain lactose (monitor patients for lactose intolerance)
Maintenance therapy
Safe for young children (used in ages 2 years and older)
Tucker 55
Indications
montelukast
Asthma, seasonal allergic rhinitis
Tucker 55
MOA/Class
pseudoephedrine, phenylephrine
pseudoephedrine (alpha-adrenergic); phenylephrine (alpha- and beta-adrenergic)
Vasoconstriction of blood vessels specifically in the nasal passages and sinuses
Adrenergic - Oral decongestant
Tucker 30
Side Effects
pseudoephedrine, phenylephrine
HTN, nervousness, insomia, vision changes/light sensitivity
Tucker 30
Nursing Considerations
pseudoephedrine, phenylephrine
May worsen narrow angle glaucoma.
Use cautiously with other cardiac or CNS medications.
Tucker 30
Indications
pseudoephedrine, phenylephrine
Cold/allergy congestion, otitis media, hypotension, pupil dilation
Tucker 30
MOA/Class
cromolyn sodium
Suppresses release of histamine and other inflammatory mediators from mast cells
Mast-Cell Stabilizer
Tucker 55
Side Effects
cromolyn sodium
Nasal irritation (when administered as a nasal spray)
Tucker 55
Nursing Considerations
cromolyn sodium
Usually started 1 week before pollen season starts and use throughout pollen season
Tucker 55
Indications
cromolyn sodium
Allergic conditions (usually reserved for those whose symptoms are not managed well with other therapies).
Tucker 55
MOA/Class
fluticasone
Intranasal
Steroids stabilize leukocytes (WBCs) preventing the release of intracellular chemical/inflammatory mediators
Restore/increase bronchial responsiveness to beta-adrenergic receptor stimulation
Glucocorticoid/steroid
Tucker 36, 54
Side Effects
fluticasone
Intranasal
Localized dryness; limited/few systemic adverse effects
Tucker 36, 54
Nursing Considerations
fluticasone
Intranasal
May be used prophylactically.
Tucker 36, 54
Indications
fluticasone
Intranasal
Allergic rhinitis, inflammation after removal of nasal polyps
Tucker 36, 54
MOA/Class
ipratropium
Intranasal
Decreased secretions due to anti-SLUDGE effects
Anticholinergic
Tucker 33
Side Effects
ipratropium
Intranasal
Localized dryness; limited/few systemic adverse effects
Tucker 33
Nursing Considerations
ipratropium
Intranasal
May be used prophylactically.
Tucker 33
Indications
ipratropium
Intranasal
Allergic rhinitis
Tucker 33
MOA/Class
oxymetolazine (Afrin); phenylephrine
Intranasal
Vasoconstriction of blood vessels specifically in the nasal passages and sinuses
Adrenergic/topical decongestant
Tucker 54
Side Effects
oxymetolazine (Afrin); phenylephrine
Intranasal
Nasal dryness
Tucker 54
Nursing Considerations
oxymetolazine (Afrin); phenylephrine
Intranasal
Use for more than 3-5 days can result in rebound congestion; Do not use for patients with HTN or other conditions that may be worsened by systemic absorption (glaucoma, coronary disease, etc.)
Tucker 54
Indications
oxymetolazine (Afrin); phenylephrine
Intranasal
Nasal congestion
Tucker 54
MOA/Class
dextromethorphan; benzonatate, codeine
Dextromethorphan – suppresses cough reflex in CNS
Benzonatate – numbs stretch receptors in the respiratory tract, thus prevent stimulation of the cough center
Codeine – CNS depressant/opioid – suppress cough reflex in CNS; drying effect
Antitussive
Tucker 54
Side Effects
dextromethorphan; benzonatate, codeine
Drowsiness, dry mouth , dizzy/lightheadedness
Tucker 54
Nursing Considerations
dextromethorphan; benzonatate, codeine
Consider benefit of expectorant for productive cough instead of cough suppressant
Encourage other measures to help cough - humidity, cool temperatures, fluids, topical lozenges, etc.
Tucker 54
Indications
dextromethorphan; benzonatate, codeine
Dry cough; persistent cough
Tucker 54
MOA/Class
echinacea
Thought to be immunostimulant
Herbal
Tucker 60
Side Effects
echinacea
N/V, dizziness, headache
Tucker 60
Nursing Considerations
echinacea
Consider potential for drug interactions
Tucker 60
Indications
echinacea
Colds, flu, viral infections
Tucker 60
MOA/Class
acetaminophen
Acts on the hypothalamus to decrease fever.
Inhibits prostaglandin synthesis.
Analgesic/antipyretic
Tucker 16
Side Effects
acetaminophen
Generally well-tolerated. Hepatotoxicity.
Tucker 16
Nursing Considerations
acetaminophen
Maximum dose 4g/day for most patients; May be reduced to 2-3 g/day for patients with hepatic impairment.
Combined hepatotoxic effects with alcohol.
Be aware of OTC drugs that may also contain acetaminophen (daily limit).
Acetylcystine may be used for acute hepatotoxicity/overdose.
May alter metabolism of drugs requiring liver biotransformation.
Tucker 16
Indications
acetaminophen
Mild pain and fever
Tucker 16
MOA/Class
oseltamivir (Tamiflu)
Prevents synthesis of viral DNA/release of viral particles.
Antiviral
Tucker 10
Side Effects
oseltamivir (Tamiflu)
Generally well-tolerated.
Tucker 10
Nursing Considerations
oseltamivir (Tamiflu)
Most effective when started within 48 hours of symptom onset.
Tucker 10
Indications
oseltamivir (Tamiflu)
Influenza (treatment or prophylaxis)
Tucker 10
MOA/Class
penicillin; amoxicillin; amoxicillin/clavulanic acid (Augmentin)
Binds to bacterial cell wall causing cell death.
PCN/Beta-lactam antibiotic
Tucker 09
Side Effects
penicillin; amoxicillin; amoxicillin/clavulanic acid (Augmentin)
Urticaria, pruritis, angioedema, SJS, GI upset, c. diff
Tucker 09
Nursing Considerations
penicillin; amoxicillin; amoxicillin/clavulanic acid (Augmentin)
Potential cross-allergy with cephalosporins; monitor for hypersensitivity
Tucker 09
Indications
penicillin; amoxicillin; amoxicillin/clavulanic acid (Augmentin)
Bacterial infections - group A strep infections
Tucker 09
MOA/Class
nystatin
Disrupts fungal cell membrane altering cell metabolism
Tucker 11
Side Effects
nystatin
Generally well-tolerated
Tucker 11
Nursing Considerations
nystatin
May be administered as swish-and-swallow or swish-and-spit
Tucker 11
Indications
nystatin
Oral candida infections
Tucker 11
