Respiratory Drugs Flashcards
Diphenhydramine
*DRUG:
* 1st generation antihistamine
* Targets H1 and H2 receptors
Therapeutic use:
* seasonal allergic rhitinis
* cold symptoms
* allergic reactions
* sleep aid
Side effects:
* anti-cholinergic adverse effects i.e
* dryness–> nose, eyes and mouth
* urinary retention
* constipation
* drowsiness
Fexofenadine (Allegra)
&
Loratadine (Claritin)
peripheral acting
Drug:
* 2nd generation antihistamine
* targets only H1 receptors
Therapeutic use
* seasonal allergic rhinitis
* cold symptoms
side effects
* limited
* non-sedating
Drug-interaction
* Fexofenadine toxicity with ketoconazole and erythromycin
oral antihistamines
MOA & nursing implications
* Diphenhydramine
* Fexofenadine
* Loratadine
MOA
- blocks the action of histamine throughout the body
- Histamine receptors are throughout the body and contract smooth mm tissue, dilate blood vessles, stimulates gastric acid secretion & serves as neurotransmitters
- H1 receptors are located throughout the body but also in the CNS
- H2 receptors are not located in the CNS
nurse teaching// pt. edu
* 1st line drug for allergic rhinitis
* take b4 symptoms being
BENIFITS
* bronchial relaxation
* decrease hypersecretions (salivary, lacrimal, bronchial, gastric)
* alleviates itching
* prevents vasodilation
* prevents capillary
* permibilty
* prevents further vasodilation but does not promote vasoconstriction (DOES NOT REDUCE NASAL CONGESTION)
1ST GENERATION ANTIHISTAMINES:
* warn about alcohol and CNS depressants when taking
* caution in the use in the elderly pt due to urinary retention
* increase fluid intake
glucocorticoids
Drug
* Beclomethasone (Vancenase)
* Fluticasone (Flonase
* Budesonide (Rhinocort)
MOA
* produce an anti-inflammatory response
* stabilizes cell membranes
* prevents the release of histamine
* interferes with the normal actions of white blood cells that stops the inflammatory process
Therapeutic use
* Allergic rhinitits
* most effective for prevention and treatment of seasonal and perennial rhinititis
* considered the first line therapy
* cold symptoms
* sinusitis
* diagnostic and surgical procedures
Adverse effects
* nasal irritation
* Epistaxis, nasal lesions & sores
* dry, burning itching nose
* decrease nasal passage healing
* sore throat, HA
* adrenal suppression & decrease in linear growth in children
Nursing implications
* can take 3-4 weeks for maxium strength
* educate on rare side effects
Mast cell stabilizers
Drug
* Cromolyn
MOA
* blocks mass cell degranulation, stabilizing the cell and preventing the release of histamine and allergy related mediators
Therapeutic use
* allergic disorders
* works best if taken 15 min before excersise
* therapeutic effects can take weeks to work
Adverse effects
* Nasal irritation
* Epistaxis, nasal lesions, nasal sores
* Dry, burning, itching nose
* Decrease nasal passage healing Due to the blocking of the immune response
* Sore throat, headache
intranasal antihistamine
Drug
* Azelastine
MOA
* antihistamines
* blocks the action of histamine throughout the nasal cavity
Therapeutic effects
* seasonal allergic rhinitis
* cold symptoms
Adverse effects
*Epitaxis
*HA
* unpleasant taste
Nasal sprays
Sympathomimetic (adrenergic decongestants)
Drugs:
* Phenylephrine
* Oxymetazoline
* Pseudoephedrine (oral)
MOA
* Activates alpha 1 adrenergic receptors on blood vessels
* causes vasoconstriction of small blood vessles
* reduces blood flow to nasal mucosa
* reduces nasal congestion
* allows nasal secretions to drain
Adverse effects
sprays
* nasal mucosal irritation and sryness
* CNS-HA, irritability
* rebound congestion
* CV-increases blood pressure, palpation
ORAL
* less potent
* delayed effects but longer acting
* more systemic effects
* CV- increases blood pressure, palpations
contraindications
* pts with CV disease (HTN)
Nursing education
* do not use spray longer than 2-3 days
* abuse risk: CNS stimulation (pseudoephedrine and Ephedrine)
opioids
Anti-tussive
DRUGS:
* codeine
* hydrocodone
NON-OPIOID
* DEXTROMETHORPHAN
* BENZONATATE
MOA
* suppresses the cough reflex directly in the center of the medulla oblongata
Therapeutic effects
* cough suppressant
* relieves pain
* promotes sedation
Adverse effects of opioids
* N/V, sedation, decreases respiratory drive
* Addictive potential
Adverse effects of non-opioids
* nausea, drowsiness, dizziness
* mild sedation
* abuse risk
* mild inebriation, mind/body disassociation
Pt teaching
* Avoid drinking and operating heavy equipment
* call HCP IF:
* cough lasts longer than 1 week
* severe HA occurs
* chest pain occurs
* fever occurs
Expectorants
DRUG: Guaifenesin
MOA: stimulates mucus reduction by irritating the stomach lining
* thins the respiratory tract secretions
* creates a more productive cough
* increases the production of the RT secretions
Therapeutic use
* relief of non-productive cough
* bronchitits
* laryngitits & sinitus
Adverse effects
* N//V// gastric irritation
Nursing education
* pt has to be drinking water in order for the drug to work
* effectiviess is questionable
Asthma
types of inhalers
* metered dose inhaler (MDI): 10% delivered to lungs without spacer
- dry powered inhaler: 20% delivered to lungs
- Nebulizers: drug solution that converts to mist and is delivered over several minutes (used in the ER)
Beta 2 Adrenergic agonists in asthma
DRUGS:
Inhaled Short Acting (SABAs)
- Albuterol (Proventil)
- Levalbuterol (Xopenex)
Inhaled Long Acting (LABAs)
* Salmeterol
* Formoterol
Oral Agent
* Terbutaline (Brethine)
* Albuterol – Same action as above with different route
Therapeutic use:
* relive from acute bronchospasms and prevention of exercise induced bronchospam
SABA: 1-2 puffs, 3-4 x/day for PRN use
- Rescue inhaler used in both COPD and Asthma
- LABA: used BID, everyday
- Fixed schedule, not PRN
- Monotherapy in COPD
- Used with inhaled glucocorticoids in asthma (never used alone in Asthma)
Side effects
* Inhaled preparations
* System effects: tachycardia, angina, and tremor
Oral preparations:
* Excessive dosage: angina pectoris, tachydysrhythmias
- Tremor
- High enough dose will hit the Beta 1 receptors
- Never use in combination with Beta Blockers
pt. teaching
* Education on use of MDI, DPI, or nebulizer
- may need spacer with one way valve
- One minute between puffs
- Do not exceed recommended dosage
- Inhaled long acting beta2 agonists (Salmeterol) & Oral beta2 agonists (Terbutaline) should be taken on a fixed schedule; not PRN
Glucocorticoids inhaled
Drugs:
* Beclomethosone
MOA: suppressess inflammation and mucus production
Therapeutic use
* Asthma
* anti-asmathic #1
* prophylaxis for chronic asthma on fixed schedule
* NOT PRN
Adverse effect
* Oropharyngeal candidiasis
* Dysphonia
* hoarseness & speaking difficulty
* Promotes bone loss (bones break easily)
* Prolonged use increases risk of Cataracts & Glaucoma
pt teaching
* Inhaled glucocorticoids are intended for preventive therapy, not PRN.
- Gargle & spit after each administration
- Inhaled corticosteroids can cause thrush
- Use a spacer
- Monitor growth charts in children
- Routine eye exams
- Minimize bone loss by taking lowest dose possible, take a calcium
- supplement and perform weight bearing exercise
Glucocorticoids oral
Drugs
* prednisone
* prednisolone
Theapeutic use
* exacerbations of asthma and COPD
* diseases r/t inflammation
Adverse effects
* Adrenal supression
* wt gain and fluid retention
* osteoporosis
* hyperglycemia
* peptic ulcer disease
contridictant in
* live viruses
* lowered immue system
* systemic fungal infectio n
pt teaching
* taper oral steroids if taking for longer than 10 days
* can cause acute respiratory exacurbation or adrenal crisis
Glucocorticoid/LABA combinations
Drugs
* Fluticasone/ Salmeterol
* Budesonide/ Formoterol
Therapeutic use
* Asthma and COPD
pt. teaching
* if using seperate inhaler, use BETA 2 agonist 1st, wait 5 min, then deliver glucocorticorticoids
Methylxanthines
Drugs
* Theophylline
MOA
* smooth mm relaxation (bronchodilation)
* suppression of the response of the airwaus to stimuli
Therapeutic effects
* long-term control of chronic asthma
* best for nocutnal asthma attacks * COPD
* Decreases the frequency of asthma attacks
Adverse effects
* Narrow therapeutic index
* toxicity: N/V/D
* Severe dysrhythmias @ high levels > or equal to 30
pt education
* Monitor therapeutic index closely Plasma levels 10-20 mcg/mL
- Never double up after missed dose
- Antidote to Toxicity: Activated Charcoal
- Caffeine increases the plasma levels & increases CNS excitation
- NO caffeine
- Do Not crush
Anticholinergic
Drug:
* Ipratropium Bromide
MOA
* blocks muscarinic receptors in the bronchi= bronchial dilation
Therapeutic use
* Allergic Rhinitis
* cold symptoms
* COPD
Adverse effects
* Dry mouth
* hoarsness
* unpleasant taste
Rinse mouth after use
Leukotriene receptor antagonist
Drug
* montelukast sodium
MOA
* blocks the action of leuktriene resulting in decreased inflammation and relaxation of smooth mm
* reduction of mm constriction, mucus and inflammation
Therapeutic use
* Asthma
* excercise induced asthma symptoms
* allergic rhinitis–maintance therapy
Adverse effects
* CNS, neuro: mood changes, HA, fatigue and tremors
* if mood changes occur the drug should be stopped immediately
* GI: N/V/D, stomach pain
* SKIN: rash
Bronchoconstricors (Drugs)
- SABAS
- LABAS
- METHLYXANTHINS
- ANTICHOLINERGICS
INFLAMMATION (DRUGS)
- INHALED GLUCOCORTICOIDS
- MAST CELL STABLILIZERS
- igE antagonists
- Anti-leukotrine
