Respiratory Drugs Flashcards
What is the pathophysiology of viral rhinitis?
The virus invades mucosa of the upper respiratory tract to cause URI (upper respiratory tract infection)
What are the parts of the upper respiratory system?
Nose
Pharynx
Larynx
What are the symptoms of viral rhinitis?
Sneezing Runny nose Sore throat Congestion Coughing
How can viral rhinitis be managed?
Combined use of antihistamines, nasal decongestants, antitussives, and expectorants
Do not give OTC cough and cold products to children younger than 2
DANGER, DUDES!
What are some antihistamine drugs?
Diphenhydramine - Benadryl
Fexofenadine - Allegra
What is the mechanism of action of antihistamines?
Blocks histamine from binding to H1 receptor sites, preventing the adverse consequences of histamine binding including runny nose and sneezing
What is the drug effect of antihistamines?
Decreased symptoms of rhinitis (runny nose and sneezing)
What are the indications of antihistamines?
Nasal allergies
Typical symptoms of the common cold
Allergic reactions
Motion sickness
Vertigo
Sometimes used as sleep aids
What are the contraindications of antihistamines?
Allergy Glaucoma Cardiac disease Kidney disease Hypertension Asthma, COPD Peptic ulcer disease
What are the adverse effects of antihistamines?
Drowsiness Anticholinergic effects: -Dry mouth -Difficulty urinating -Constipation -Changes in vision
What are nursing implications of antihistamines?
Possibility of sedation
Avoid driving or operating heavy machinery while sedated
Avoid alcohol and CNS depressants
Caution in asthma, glaucoma, and benign prostatic hyperplasia
What are the two types of antihistamines?
First-generation (centrally acting)
Second-generation (peripherally acting)
What are the differences between the two types of histamines?
First-generation: -Centrally acting -More sedating -Benadryl (diphenhydramine) Second-generation: -Peripherally acting -Less sedating -Longer duration of action -Allegra (fexofenadine)
What is nasal congestion?
The blockage of nasal passages due to membranes lining the nose becoming swollen from inflamed blood vessels
What are the primary causes of nasal congestion?
Allergic rhinitis
Viral rhinitis
What are some nasal decongestants?
Pseudoephedrine - Sudafed (oral)
Oxymetazoline - Afrin (topical)
Triamicinolone - Nasocort
What are the main classes of decongestants?
Adrenergic: -Largest group -Systemic -Topical Glucocorticoids: -Topical -Intranasal steroids
What is the mechanism of action of adrenergic decongestants?
Adrenergic/sympathomimetic decongestants stimulate alpha1-adrenergic receptors on nasal blood vessels which causes vasoconstriction and shrinkage of swollen vessels
What is the drug effect of adrenergic decongestants?
Relief of nasal stuffiness
What are some adrenergic decongestants?
Oral - Pseudoephedrine (Sudafed)
Topical - Oxymetazoline (Afrin)
What are the differences between oral and topical adrenergic decongestants?
Oral: -Prolonged decongestant effects -Delayed onset -PRO: No rebound congestion Topical: -Prompt onset with potent effect -CON: Sustained use over several days causes rebound congestion, making condition worse
What is the mechanism of action of steroid decongestants?
Steroids exert their antiinflammatory effect and reduces inflammation of swollen nasal passages
What is the drug effect of steroid decongestants?
Decreased inflammation
Decreased congestion
Relief of nasal stuffiness
What are some steroid decongestants?
Nasal spray - Fluticasone (Flonase)
Nasal spray - Triamicinolone (Nasocort)
What are indications for nasal decongestants?
Rhinitis
Common cold
Sinusitis
Allergies
What are contraindications for nasal decongestants?
Allergy Glaucoma Uncontrolled cardiovascular disease Hypertension Diabetes Hyperthyroidism
What are the adverse effects of adrenergic decongestants?
Nervousness
Insomnia
Palpitations
Tremor
What are the adverse effects of steroid decongestants?
Mucosal irritation and dryness
What are nursing implications for nasal decongestants?
Systemic adrenergic decongestants may cause hypertension, palpitations, and CNS stimulation
Patients on medication therapy for hypertension or hyperthyroidism should check with their physician before taking OTC adrenergic decongestants
What are antitussives?
Drugs used to stop or reduce cough
What are the categories of antitussives?
Opioid
Nonopioid
What is the mechanism of action of opioid antitussives?
Suppresses the cough reflex by direct action on the cough center in the medulla
What is the drug effect of opioid antitussives?
Suppresses cough
What are some opioid antitussives?
Codeine - Robitussin-AC, Dimetane-DC
Hydrocodone cough syrup - Hycodan
What is the mechanism of action of nonopioid antitussives?
Suppresses cough reflex by numbing the stretch receptors in the respiratory tract
What is the drug effect of nonopioid antitussives?
Prevents the cough reflex from being stimulated
What are some nonopioid antitussives?
Dextromethorphan - Robitussin-DM
Benzonatate - Tessalon, Zonatuss
What are the indications for antitussives?
Nonproductive cough
What is a productive cough?
Cough that expels sputum from the respiratory tract
What is a nonproductive cough?
Dry cough with no sputum production
What are the adverse effects of opioid antitussives?
Sedation Respiratory depression Lightheadedness Nausea Vomiting Constipation
What are the adverse effects of nonopioid antitussives?
Dizziness
Drowsiness
Headache
What are the contraindications of antitussives?
Allergy
Opioid dependency for opioid antitussives
High risk for respiratory depression
What are nursing implications for antitussives?
Avoid driving or operating heavy equipment
Patients taking chewable tablets or lozenges should not drink or eat for 15 - 30 minutes afterwards
What are the differences between opioid and nonopioid antitussives?
Opioid:
-Anaglesic effect
-Has drying effect on mucosa of respiratory tract
Nonopioid:
-No analgesic effect
-Does not cause CNS depression
-Numbs stretch receptor cells in respiratory tract
What is expectoration?
Coughing up and spitting out excessive mucus that has accumulated in the respiratory tract
What is the mechanism of action of expectorants?
Reflex stimulation, which is the loosening and thinning of respiratory tract secretions
Direct stimulation of secretory glands in respiratory tract
What is the drug effect of expectorants?
Cold and cough symptom relief
What is the indication of expectorants?
Productive cough
What is the contraindication of expectorants?
Allergy
What is an example of expectorants?
Guaifensin - Mucinex
What are the adverse effects of expectorants?
Guaifensin (Mucinex) may cause:
Nausea
Vomiting
Gastric irritation
What are nursing implications for expectorants?
Patients taking expectorants should receive more fluids (if permitted) to help loosen and liquefy secretions
Report a fever, cough, or other symptom lasting longer than a week
What is asthma?
A chronic respiratory disorder in which there is recurrent and reversible airflow obstruction (bronchoconstriction, inflammation and edema of bronchial mucosa, production of viscid mucus)
What causes asthma?
Allergen
Cold air
Exercise
Emotional stress
What are the symptoms of asthma?
Wheezing
Shortness of breath
Chest tightness
Coughing
Which drugs are used to manage asthma?
Bronchodilators
Corticosteroids
Leukotriene receptor antagonists
What are the classifications of bronchodilators?
Beta-adrenergic agonists
Anticholinergics
Xanthine derivatives
What are the types of medication used to manage asthma?
Quick relief (rescue medication):
-Short-acting inhaled beta2-agonists (albuterol inhaled)
Long-term control:
-Long-acting beta2-agonists (salmeterol inhaled)
-Inhaled glucocorticoids
-Leukotriene receptor antagonists (LTRA)
What is chronic bronchitis?
A continuous inflammation and low-grade infection of the bronchi, leading to airflow obstruction
Involves excessive secretion of mucus and certain pathologic changes in bronchial structure
What is emphysema?
Condition in which air spaces enlarge as a result of the destruction of alveolar walls, which reduces surface area available for oxygen and CO2 exchange, impairing effective respiration
What is the mechanism of action of beta2-adrenergic bronchodilators?
Stimulates beta2-adrenergic receptors on bronchial smooth muscles
What is the drug effect of beta2-adrenergic bronchodilators?
Muscle relaxation
Bronchodilation
What are examples of beta2-adrenergic bronchodilators?
Short-acting - Albuterol inh (Proventil, Ventolin)
Long-acting - Salmeterol inh (Serevent), Formoterol (Foradil)
What is the indication of beta2-adrenergic bronchodilators?
Bronchoconstriction
What are the adverse effects of beta2-adrenergic bronchodilators?
Insomnia Restlessness Tachycardia Palpitations Vascular headache Tremor
What are contraindications for beta2-adrenergic bronchodilators?
Allergy
Uncontrolled hypertension
Cardiac dysrhythmias
High risk for stroke
What is the mechanism of action of anticholinergic bronchodilators?
Anticholinergics bind to acetylcholine (ACh) receptors to prevent bronchial constriction and narrowing of airways from occuring
What is the drug effect of anticholinergic bronchodilators?
Airway relaxation and dilation
What are indications of anticholinergic bronchodilators?
Bronchocostriction
What are examples of anticholinergic bronchodilators?
Ipratropium bromide inh - Atrovent
Tiotropium inh - Spiriva
What are contraindications of anticholinergic bronchodilators?
Allergy (atropine)
Caution:
-Glaucoma
-Prostate enlargement
What are the adverse effects of anticholinergic bronchodilators?
Dry mouth/throat Nasal congestion Heart palpitations GI distress Urinary retention Glaucoma Headache Coughing Anxiety
What is the mechanism of action of inhaled glucocorticosteroids?
Stabilizes the membranes of cells that normally release bronchoconstricting substances
What is the drug effect of inhaled glucocorticosteroids?
Works to continuously decrease inflammation in airways
What are the indications for inhaled glucocorticosteroids?
Prevent asthma symptoms
Does NOT relieve symptoms of acute asthamtic attacks
Primary treatment of bronchospastic disorders
What are examples of inhaled glucocorticosteroids?
Fluticasone - Advair
Triamcinolone acetonide - Azmacort
What are the contraindications of inhaled glucocorticosteroids?
Allergy
Systemic fungal infection
What are the adverse effects of inhaled glucocorticosteroids?
Pharyngeal irritation
Coughing
Dry mouth
Thrush (oral fungal infection)
What are nursing implications for inhaled glucocorticosteroids?
Patients should gargle and rinse mouth with lukewarm water after to prevent thrush
Bronchodilator should be used several minutes before corticosteroid if ordered together
What is the mechanism of action of leukotriene receptor antagonists (LTRAs)?
Blocks leukotrienes from attaching to receptors that would cause inflammation, bronchoconstriction, and mucus production that results in coughing, wheezing, and shortness of breath
What is the drug effect of leukotriene receptor antagonists?
Alleviating asthma symptoms
Reduce inflammation
Prevent constriction of airways
Decrease mucus secretion
What are examples of leukotriene receptor antagonists?
Montelukast - Singulair
Zafirlukast - Accolate
What are indications for leukotriene receptor antagonists?
Long-term treatment and prevention of asthma
What are adverse effects of leukotriene receptor antagonists?
Headache Nausea Dizziness Insomnia Diarrhea
What are nursing implications of leukotriene receptor antagonists?
Prophylaxis and chronic treatment of asthma in adults and children older than 12
Not meant for acute asthmatic attacks
Improvement seen in about 1 week
Take medication every night on a continuous schedule, even if symptoms improve
