Upper respiratory Flashcards
Rhinitis
Inflammation of nasal mucous membrane
allergic rhinitis
(hay fever)
may occur alone or
along with lower respiratory disorders (asthma)
infectious rhinitis
may occur alone or
with sinusitis
(viral, bacterial)
- common cold - caused by rhinovirus - is a type of viral rhinitis
viral rhinitis
common cold- caused by rhinovirus is a type of viral rhinitis
signs and symptoms of rhinitis
- rinorrhea
- water eyes - epiphora
epiphora= abnormal secretory system - often due to inflammation- normal tear secretion - nasal congestion
- cough
- sneezing
lacrimation: excessive tear production, normal excretory system
types of drugs for upper resp - rhinitis
antihistamines
decongestants
mast cell stabilizers ~
antitussives
expectorants
intranasal corticosteroids - never during infection
inflammatory mediator
Histamine 1
histamine 1
vasodilation
increase vascular permeability
histamine side effects
swelling - congestion of airway
erythema
rinorrhea
epiphora
irratation of nerve endings–
cough
sneezing
itching
antihistamines MOA
Prevent histamine 1 release in small blood vessels and nerves - allergies
relieving:
1. itching
2. sneezing
3. rhinorrhea
4. allergic reaction
5. anaphylaxis
6. motion sickness
7. insomnia
drugs that work against histamine 1
antihistamine
Antihistamines
PRN
FIRST GEN
SECOND GEN
antihistamines first gen
ROUTES
PO, IV, IM
FIRST GEN Antihistamines
diphenhydramine
promethazine
diphenhydramine and promethazine side effects
Crossing BBB CNS depressant 1. drowsiness 2. dizziness 3. fatigue 4. disturbed coordination FALL
Secondary use of diphenhydramine and promethazine
insomnia
motion sickness
SIDE EFFECTS of diphenhydramine and promethazine under secondary use
toxicity=
excitation
hallucination
seizure
ANTICHOLINERGIC EFFECTS
PNS
PNS effects of diphenhydramine and promethazine
anti cholinergic effects
pns
SECOND GEN route
PO
nasal spray
SECOND GEN antihistamines
cetirizine
fexofenadine
cetirizine and fexofenadine
EFFECTS
little to no sedative effect
little to no anti cholinergic effect
Antihistamines first Gen effects:
diphenhydramine & promethazine
breathing
- CNS depressant = respiratory depression –> shallow diminished breathing
VS - for anticholinergic effects increase BP increase HR increase RESPIRATION
I/Os
for anticholinergic urinary retention–> shunting from kidney
First gen antihistamine CNS depression: diphenhydramine & promethazine
avoid driving or operating dangerous machinery FALL
hangover effect– residual drowsiness effect
Avoid other CNS depressants - ETOH & codeine
diphenhydramine & promethazine CONTRAINDICATIONS
pregnancy
lactation
newborns
children
older adults
diphenhydramine & promethazine contraindications due to
anticholinergic effects:
urinary retention
BPH
glaucoma
HTN
diphenhydramine & promethazine
OTHER CONSIDERATIONS
warn against:
combination medications
- decongestant alpha 1 agonist
Vesicant: ensure for IV patency
= blister agent
promethazine
is a vesicant-
causes:
blistering
tissue injury
damage to intima layer of veins
- dilute IV form in a large-bore IV and very slow IV push, deep IM if you have to give
decongestants non-specific a agonist smpathomimetic OTC PRN
ephedrine
pseudoephedrine
PRN
ephedrine & pseudoephedrine
MOA:
non-specific - a & b agonist
- when PO or large intranasal doses
ephedrine & pseudoephedrine
MOA continued:
a - peripheral vasoconstriction - decongestant effects - decreases: swelling stuffiness rhinorrhea
a & b - worsening HTN , BPH , tachycardia
CNS effect: restlessness jitteriness nervousness - avoid stimulants
decongestants
ROUTES
nasal spray
inh mist
ophthalmic
im
sub q
iv
po
ephedrine & pseudoephedrine –
ROUTES
ephedrine
PO
inh mist
pseudoephedrine
PO
limited scale with ID
naphazoline
Eye drop for redness
ephedrine NOTES
IV is used to treat low BP POST ANESTHESIA
dietary supplements containing ephedrine alkalosis is used as weight management drugs are banned for impurity side effects such as HTN, tachycardia 1005 comprehensive system of controls regarding
pseudoephedrine, ephedrine, and phenylpropanolamine distribution and sale of drugs that can be sued in the illicit production of meth
Decongestants
non- specific a agonists sympathomimetic
OTH
PRN
ephedrine & pseudoephedrine considerations:
1. Nasal spray/ drop: apply while sitting/lateral NOT SUPINE tilt head forward sniff gently - to avoid swallowing and systemic effect
- avoid frequent use of nasal spray / drop
multiple doses may cause:
paradoxical congestion by irritation on nasal mucosa NOT IN THE PO FORM - causes tolerance
must always TAPER OFF and avoid
rebound congestion
(only 3
Antitussive
“cough suppressant”
PRN
- cough lozenges
menthol : local anesthetic obtained from mint
- Non opioid
benzonatate : RX (po, soft gel)
dextromethropan : (OTC syrup, lozenges)
- opioid
codine
Antitussive indication
dry cough
to avoid further throat irritation
Cough lozenges
menthol
local anesthetic obtained from mint
- call doctor before use not given out of purse
non opioid antitussive
benzonatate
dextromethropan
benzonatate
dextromethropan
MOA
benzonatate
RX
PO soft gel
dextromethropan
OTC syrup, lozenges
benzonatate
dextromethropan
MOA
suppress the cough center in the MEDULLA
related to opoids structurally but has no analgesic properties
benzonatate
dextromethropan
SIDE EFFECTS:
drowsiness
dizziness
euphoria with high doses —- risk of abuse
opioid antitussives
codine
often in cobination with
antihistamine
decongestant
expectorant
codine
opioid antitussives
MOA:
suppress cough by increasing cough threshold in CNS -PRODRUG= usually not abuse have to drink take it to become active
codine
opioid antitussives
SIDE EFFECTS
drowsiness respiratory depression dizziness - fall, driving nausea constipation hypotension - relax bowels- falls asleep
codine
opioid antitussives
RISK OF ABUSE
risk of abuse–
short term only
reversed by naloxone - for respiratory depression
codine
opioid antitussives
REVERSAL AGENT
naloxone
respiratory depression
codine
opioid antitussives
CONTRAINDICATIONS
respriatory disease
alcohol
head trauma
expectorant
guaifenesin
guaifenesin/dextromethorphan
guaifenesin
guaifenesin/dextromethorphan
MOA
increasing respiratory tract fluid
- adds water to mucus -> no more dry cough - more productive
guaifenesin
ROUTE
PO
tab
capsule
syrup
guaifenesin
NURSING
increase hydration to promote drug action
guaifenesin
CONTRAINDICATIONS
never to children
< 4 YO
guaifenesin
COMBOS
various combinations with analgesic antihistamines decongestants antitussive (OTC cold drugs)
PATIENTS ARE AT HIGH RISK OF OD
guaifenesin/dextromethorphan
ROUTE
OTC
guaifenesin/dextromethorphan
CAUTIONS
drowsiness
dizziness
intranasal glucocorticoid
steroid- corticosteroids
budesonide
fluticasone
NASAL SPRAYSSS
budesonide
fluticasone
NURSING
SCHEDULED not prn
maintenance drug - not rescue - not designed to rescue
it takes 7-21 days for peak effect
budesonide
fluticasone
SIDE EFFECTS
dryness of nasal mucosa
epistaxis
manage dryness by saline nasal spray
budesonide
fluticasone
CONTRAINDICATIONS:
pregnancy (c)
URI - upper respiratory infections
budesonide
fluticasone
OTHER CONSIDERATIONS
must shorten the length of use TO PREVENT OPPORTUNISTIC INFECTION- CANDIDIASIS
