Respiratory Drugs

Question 1

guaifenesin

Answer 1

Therapeutic Class: expectorant

Vandermeer: loosen and thin mucous by “increasing respiratory fluid”

Client Teaching:

• avoid CNS depressants or alcohol
• no eating or drinking 30 min after syrup
• stay hydrated
• encourage cough and deep breath
• notify HCP: fever or worsen cough may indicate development of pneumonia

Question 2

oxymetazoline (Afrin)

Answer 2

Classes/Mechanism

• Therapeutic Class: nasal decongestant
• Pharmacologic class: sympathomimetic; (activate alpha-adrenergic receptors in the sympathetic nervous system)
• (Vasoconstriction) causes arterioles in nasal passages to constrict, thus drying mucous membranes.

Adverse Effects and Patient Teaching:

• Rebound congestion common if used for longer than 3 - 5 days (do not use more than 7 days).
• Minor stinging and dryness in nasal mucosa may be experienced.

Interactions:

• Use caution with herbal supplements such as St. John’s wort that have properties of MAOIs

Question 3

pseudophedrine (Sudafed)

Answer 3

Classes/Route/Mechaism:

• Route: PO
• Therapeutic Class: nasal decongestant, (others)
• Pharmacologic class: sympathomimetic (Adrenergic drug); acts on alpha and beta receptors

Precautions: cardiovascular diseases

ADR of PO nasal decongestants:

• ​HTN, dysrhythmias
• dizziness, headache
• nervousness, insomnia
• dry mouth

Interactions: MAOIs (cause HTN crisis)

Question 4

Intranasal corticosteroids

flunisolide

fluticasone (Flonase, Veramyst)

beclomethasone

budesnoide (Rhinocort Aqua)

triamcinolone (Nasacort)

Answer 4

• intranasal corticosteroids
• ADR:
  
  • dry mucous membranes, epistaxis, sore throat
    
    • provide comfort measures
  • transient nasal irritation, burning, sneezing, or dryness; nasopharyngitis
  • hypercorticism (only if large amounts are swallowed)

Question 5

Antihistamines

Answer 5

Antihistamines

• mild cholinergic blockers -
  
  • drying effects (dry mouth), tachycardia, and mild hypotension occur in some pts
  • urinary retention
• sedation, drowsiness
• H1-receptor ANGTAGONIST
• Contraindications: narrow-angle glaucoma, BPH, GI obstruction
• Precaution: asthma, hyperthyroidism
• Teaching:
  
  • don’t use with alcohol; sedative effects
  • increase fluid intake to 2L/day
  • do not use alcohol
  • operating machine and driving may be dangerous
  • paradoxical CNs stimulation and excitability may occur
  • may cause photosensitvity
• d/c at least 4 days prior to skin allergy tests

1st generation

• diphenhydramine (Benadryl)

2nd generation

• cetirizine
• therapeutic effects last longer
• may cause drwosiness, fatigue - but less than 1st gen antihistamine

Question 6

(Inhaled) Anticholinergic

Answer 6

• bronchodilator and also dries you out
  
  • used in COPD patients to reduce secretions in pts
• ??slower onset of action - not used for acute bronchospasm??

ADR:

• dry mouth, urinary retention, dry eye, and increase intraocular pressure
• produces bitter taste - may rinse the mouth after use

Precaution: careful BPH, glaucoma

Contraindication: CHECK FOR SOY/SOYBEAN AND PEANUT ALLERGIES

Administration Alerts:

• proper use of MDI
• wait 2 - 3 minutes between dosages

Misc.

• Oten combined with other drugs (combo inhaler)

Question 7

methylxanthines

Answer 7

Pharmacologic Class: methylxanthines

• theophylline
• aminophylline

Therapeutic Class: bronchodilator?

Route: PO, IV (not inhalation)

Use: today, primarily used for long-term management/oral prophylaxis of asthma that is unresponsive tobeta agonists or inhaled corticosteroids

• chemically-related to caffeine
  
  • avoid caffeine - potentiates…
• significant interactions with numerous other drugs
• have narrow safety margin so infrequently prescribed
  
  • therapeutic index 10 - 20 mcg/mL
  • toxicity over 20 mcg/mL
  • s/s toxicity
    
    • n/v (assess for other signs of toxicity, last blood draw)
    • restless, tremors, insomnia
    • seizure
• ADR:
  
  • n/v
  • CNS stimulation
    
    • ​like caffeine, can cause nervousness and insomnia
  • dysrhythmias at high doses

Question 8

Inhaled corticosteroid

Answer 8

give beta 2 adrenergic agonist inhaler first

use spacer

swish and spit

Question 9

oral steroid

Question 10

other types of antiinflammatory drugs

Answer 10

• leukotriene modifier - montelukast (Singulair)
• mast cell stabilizer - cromolyn

Question 11

Asthma

Quick-Relief Medications

Long-term Control Medications

Answer 11

Quick-Relief Medications

• SABA
• Inhaled anticholinergic
• systemic corticosteroids - although not rapida cting, these oral drugs are used for short periods to reduce frequency of acute exacerbation

Long-term Control Medications

• inhaled corticosteroids
• mast cell stabilizers
• leukotriene modifiers
• LABA
• methylxanthine

Question 12

COPD med management

Answer 12

• bronchodilators
  
  • both short-acting and long-acting bronchodilators
  • beta-2-agonist
  • anticholinergics
• mucolytic and expectorants sometimsed used to reduce viscocity of bronchial mucus and to aid in its removal
• long-term O2 therapy (precaution greater than 4L)
• abx if infection

Avoid:

• COPD pts should not receive beta blockers (beta-adnergic antagonist activity) or otherwise cause bronchoconstrictionrespiratory derpssants uch as opioids and barbiturates should be avoided
• does not cure, only tx symptoms
• encourage soking cessation - slow progression of COPD and result in fewer respiratory symptoms