Upper Respiratory Flashcards
Upper Resp Drug Classes
Made in Georgia! Mucolytics Antitussives Decongestants Expectorants
Glucocorticoids (Nasal)
Anti-Histamines H1
Mucolytics
drug names
1 acetylcysteine (Liq/Neb) 2 hypertonic saline
acetylcysteine, hypertonic saline [mucolytics]
MOA
thin + enhance the flow of secretions in the respiratory passages
acetylcysteine, hypertonic saline [mucolytics]
Tx
- acute/chronic pulmo disorders
- cystic fibrosis
- COPD
- prevent x-ray dye nephropathy
- schizophrenia
acetylcysteine, hypertonic saline [mucolytics]
A/E
- aspiration
- bronchospasm from PO
- dizzy
- drowsy
- hypotension
- tachycardia
- NV
acetylcysteine, hypertonic saline [mucolytics]
CI
- GI bleed
- caution w asthma
acetylcysteine, hypertonic saline [mucolytics]
RN/teaching
- suction setup for inhalation (Neb)
- admin PO or IV for APAP toxicity
- acetylcysteine smells bad
- have suction available (emesis/aspiratn)
acetylcysteine smells like rotten eggs, so what type of drug would you admin prior?
what would you have nearby?
,
2 categories of Antitussive
Opioid
–codeine, hydrocodone
Nonopioid
–dextromethorphan [DM], benzonatate
Antitussive-Opioid
drug names
codeine, hydrocodone
codeine, hydrocodone [anti-tuss-opd]
MOA
- brain opioid receptors (cough reflex)
- incr cough threshold
codeine, hydrocodone [anti-tuss-opd]
Tx
chronic non-productive (dry) cough
codeine, hydrocodone [anti-tuss-opd]
A/E
- CNS effects (dizzy, drowsy, RR depress)
- NV
- constipation
codeine, hydrocodone [anti-tuss-opd]
CI
- avoid ETOH
- avoid CNS depress
- no codeine for kids
- breastfeeding
codeine, hydrocodone [anti-tuss-opd]
RN/teaching
-avoid activities that require alertness
codeine for children
black box warning
-no codeine for kids
antitussive - non opioid
drug names
dextromethorphan [DM]
benzonatate
dextromethorphan, benzonatate [anti-tuss]
MOA
chemical mimic of opioids but isnt one
dextromethorphan, benzonatate [anti-tuss]
Tx
cough
dextromethorphan, benzonatate [anti-tuss]
A/E
mild nausea
sleepiness
dextromethorphan, benzonatate [anti-tuss]
CI
preg risk
cat C
dextromethorphan, benzonatate [anti-tuss]
RN/teaching
- potential for abuse
- –can still cause euphoria in high doses
- no prescription is needed
Decongestants
drug name
ephedrine
phenylephrine
pseudoephedrine
oxymetazoline
Decongestants [eph’s + o]
MOA
- sympathomimetic
- case vasoconstriction> subsequent reduction in inflammation in nasal membranes
Decongestants [eph’s + o]
Tx
rhinitis
sinustitis
Decongestants [eph’s + o]
A/E
- rebound congestion
- CNS stim (systmc): agitation, nervousness, uneasiness
- vasoconstriction
Decongestants [eph’s + o]
CI
- closed angle glaucoma
- HTN
- CVA
- CAD
- dysrythmias
Decongestants [eph’s + o]
RN/teaching
- check BP first
- short term: no more than 3-5 days
- taper; using one nostril at a time
- report CNS symptm
- instill drops in lateral head low position to prevent swallowing
pseudoephedrine + ephedrine can produce ____ like effects
amphetamine
expectorant
drug name
guaifenesin
guaifenesin [expctrnt]
MOA
expectorant w mucolytic properties
guaifenesin [expctrnt]
Tx
promotes incr cough production to spit out secretion
guaifenesin [expctrnt]
A/E
- GI upset
- drowsy
- rash
guaifenesin [expctrnt]
CI
- caution in asthma> bronchospasm
- allergy to PKU
*guaifenesin [expctrnt]
RN/teaching
drink lots of fluids
Glucocorticoids [nasal}
drug names
mometasone
fluticasone
budesonide
mometasone, fluticasone, budesonide [nasal glcrtcds]
MOA
decrease inflammation
mometasone, fluticasone, budesonide [nasal glcrtcds]
Tx
- 1st line for nasal congestion
- allergic rhinitis
- sinusitis
mometasone, fluticasone, budesonide [nasal glcrtcds]
A/E
- sore throat
- nosebleed
- headache
- burning in nose
mometasone, fluticasone, budesonide [nasal glcrtcds]
CI
preg category B + C
mometasone, fluticasone, budesonide [nasal glcrtcds]
RN/teaching
metered-dose spray to admin
–can take 7 days to get max relief for seasonal rhinitis
–use humidifier if epistaxis
clear blocked nasal passages w topical decongestant prior to glucocorticoid admin
1st Generation H1
drug names
diphenydramine
promethazine
2nd Generation H1
drug names
loratadine
cetirizine
fexofenadine
desloratadine
H1 Anti-Histamine
MOA
blocks H1 receptors
-mostly small capillaries to decr histamine
H1 Anti-Histamine
Tx
- itching
- sneezing
- seasonal allergic rxn
- rhinorrhea
- urticaria
- motion sickness
- anaphylaxis
- bronchospasm
- insomnia
- laryngeal edema
1st Gen H1 has similar A/E as 2nd Gen, except it also causes…
- CNS: tachy
- anti-ACH: drowsy, confusion, hallucination, constipation, drymouth
- GI upset
H1 Anti-Histamine
A/E
- acute toxicity
- excitation
- incoordination
- seizures in kids
H1 Anti-Histamine
CI
-3rd trimester
-breastfeeding
-promethazine if Hx of dysrhythmia
-<2YO
-BPH
glaucoma
H1 Anti-Histamine
RN/teaching
give activated charcoal + cathartic + ice packs for fever
promethazine is a __ generation H1 anti histamine
1st
promethazine
A/E
resp depress
NMS
extravasation risk
promethazine
CI
- <2YO or breastfeeding
- caution w <6YO
- caution w CNS depress
- COPD
- OSA
- no driving or machinery after
promethazine lowers the ____
seizure threshold
____ potentiates the action of opiods
benadryl
-watch out for drug seekers
____ potentiates the action of opioids
Benadryl
-watch out for drug seekers
preferred route for promethazine
IM
-monitor for burning or pain at IV site
