Upper Respiratory Flashcards
Upper Respiratory Infections (URIs) Symptoms
- Sneezing
- Watery Eyes
- Nasal Congestion
- Runny Nose
- Sore Throat
- Cough
What most often causes a URI?
A viral infection, like
- Rhinovirus
- Influenza
A URI can also be caused by an allergic reaction to an antigen…
… (allergic rhinitis)
inflammation of mucus membranes of nose, throat, upper airways
In a URI, the viruses invade tissues of the upper respiratory tract…
…Nose, pharynx, larynx
-Stimulates excessive mucus production
Basic way to treat URIs?
Use of multiple agents = relief of symptoms = no cure
*Unless bacterial infection; then treat with antibiotics
Antihistamines are also known as?
histamine antagonists
The histamine response is?
Another immunologic response to a foreign invader
*So it’s there to help us, but sometimes gets out of control
What are the 5 Histamine Effects?
- Immune
- Smooth muscle
- Skin
- Cardiovascular
- Pulmonary
In the histamine effect, what does the Immune response do?
Inflammatory substances released from mast cells.
In the histamine effect, what does the Smooth Muscle response do?
Secretions from salivary, gastric, lacrimal and bronchial stimulation.
In the histamine effect, what does the Skin response do?
Puritis (itching) from stimulation of nerve endings (development of hives)
In the histamine effect, what does the Cardiovascular response do?
Redness, fluid leaking edema, decreased BP from dilation/increased permeability of blood vessels.
In the histamine effect, what does the Pulmonary response do?
Bronchoconstriction from smooth muscle contraction.
What are the two types of cellular receptors in the histamine effect?
- H1
- H2
*H = histamine
What does the H1 cellular receptor do?
Mediate smooth muscle contraction and dilation of capillaries.
What does the H2 cellular receptor do?
Increase acceleration of heart rate and increase gastric secretion.
Is mucus good for you?
Yes, mucus is good for you!
H1 blockers are also known as?
histamine 1 antagonists
What is the Action of H-1 Blockers?
Histamine 1 antagonists
Compete with histamine for receptor sites resulting in constriction of nasal lining, decreased secretions, dry mouth, easier breathing.
Decreased secretions = no runny nose or teary eyes = dry mouth
What are the Indications of H-1 Blockers?
Histamine 1 antagonists
- Cold and flu symptoms
- Nasal allergies
- Allergic reactions (NOT anaphylaxis)
- Motion sickness and vertigo
- Parkinson’s disease
What are H-1 Blockers not used for anaphylactic reactions?
Anti-histamines take 20-40 minutes to start working; take TOO long!
Engerged
Congested, traffic
What does an anti-histamine do to histamine receptors?
An anti-histamine blocks histamine receptors, stops it from working.
What are the Contraindications of H-1 Blockers?
- Allergy (to the medications)
- Acute Asthma attacks (not an emergency medicine)
What are the Side Effects of H-1 Blockers?
EACH AGENT DIFFERS in its histaminic, anticholinergic, and sedative effects, but all have:
- Drowsiness
- Dry mouth; changes in vision, difficult urination, constipation (continued long-term use; drying effect)
- Hypertension (restricting vessels)
What are the 2 types of H-1 Blocker medicines?
- Traditional
2. Non-sedating
What are the Traditional H-1 Blockers known for?
Sedating properties
What are the Non-Sedating H-1 Blockers known for?
Non-sedating
*All the other side effects, except the drowsiness
Examples of Traditional H-1 Blockers?
- Bendaryl (diphenhydramine)
- Chlor-Trimetron (chlorpheniramine)
- Dramamine (dimenhydrinate) - motion sickness, vertigo
- Atarax, Vistaril (hydroxyzine)
- Antivert (meclizine) - vertigo
- Phenergan (promethazine) - anti-nausea, but technically it’s antihistamine
Examples of Non-Sedating H-1 Blockers?
- Zyrtec (cetirizine)
- Claritin (loratadine)
- Allegra (fexofenadine)
Nursing Considerations for H-1 Blockers?
- First generation antihistamines can be sedating, caution not to drive or use heavy machinery until patient knows how it will effect them. (Warm Them!)
- Monitor side effects, specifically those “drying” effects. (May want to increase water consumption)
- Caution patients with asthma, hypertension, glaucoma (because of anticholinergic effects).
Another treatment for URIs, besides Antihistamines?
Nasal Decongestants
Nasal Decongestants are broken down into 3 categories.
- Adrenergics
- Anticholinergics
- Corticosteroids
What do Adrenergics in the Nasal Decongestants category do?
Adrenergics (sympathomimetics) which are the largest group.
- No congestion
- Constricts vessels
What do Anticholinergics in the Nasal Decongestants category do?
Anticholinergics (parasympatholytics) less commonly used.
-Drying
What do Corticosteroids in the Nasal Decongestants category do?
Corticosteroids (intranasal steroids) used to prevent congestion; treat allergic rhinitis.
-Anti-inflammatories
What are the Actions of Nasal Decongestants?
Shrink engorged nasal mucus membranes and relieve nasal stuffiness.
What are the Actions of Adrenergics of the Nasal Decongestants?
(Adrenergics): constrict small arterioles = nasal secretions better able to drain.
What are the Actions of Anticholinergics of the Nasal Decongestants?
(Anticholinergics): drying side effects
What are the Actions of Corticosteroids of the Nasal Decongestants?
(Corticosteroids): decrease inflammatory process; used mostly for allergic rhinitis
What are the Indictions of Nasal Decongestants?
Nasal congestion due to colds or allergies
What are the Contraindications of Nasal Decongestants?
-Allergy
With adrenergics: glaucoma, uncontrolled CV disease
-Thyroid dysfunction
Nasal Decongestants contraindications scenario…
You take an anti-hypertensive and you’re on 2-3 of them, you may want to stay away from antihistamines. Just on 1, you’re fine.
What are the Side Effects of Nasal Decongestants?
- Usually well tolerated
- Overdosages = systemic effects like other sympathomimetics, anticholinergics or steroids.
- Rebound congestion
Rebound Congestion
Can develop if you over use, always worse the second time around.
What are the Interactions of Nasal Decongestants?
- Few significant
- Other sympathomimetic drugs
What are the ways Nasal Decongestants can be administered?
-Orally - produce prolonged effect; onset is delayed; effect
less potent.
*Rebound congestion almost non-existent
-Inhaled (steroids & anticholinergics) - used prophylactically
in chronic URI.
*Usually no rebound congestion
-Inhaled (adrenergics) - potent effect with prompt onset
*Sustained use = rebound congestion
Nursing Considerations for Nasal Decongestants?
- Limit use of intranasal preparations to 3-5 days to prevent rebound congestion
- Pseudoephedrine is a main ingredient in methamphetamine; have patient note any palpitations, chest pain, dizziness, confusion, insomnia, restlessness, etc.
Why can Sudafed not be sold OTC?
Can make methamphetamine.
Another treatment for URIs, besides antihistamines and nasal decongestants?
Antitussives
anti-cough
“tuss”
cough
What kind of cough are antitussives used for?
Only non-productive coughs
What are the Two Main Types of Antitussives?
- Narcotic (opioid)
- Non-narcotic (non-opioid)
What is the Action of Antitussives?
Suppress cough control center in the medulla
What is the Use of Antitussives?
Only if cough is unproductive and irritating (dry cough) or if a cough is contraindicated (after hernia)
Narcotic Antitussives are what type of substance?
Controlled substances
What are 2 examples of Narcotic Antitussives?
Codeine
Hydrocodone
*All the same precautions as with narcotics
Codeine and Hydrocodone, Narcotic Antitussives info?
- Usually mixed with antihistamine, decongestant, or expectorant in syrup
- Problems with drowsiness and constipation in adults and kids
- Can lead to abuse and potentiate effects of other opiate and CNS depressants
Non-narcotic Antitussives are sold?
Over the counter
An example of a Non-narcotic Antitussive?
Dextromethorphan (DMX)
Action of Dextromethorphan (DMX)
*Non-narcotic Antitussive
Non-narcotic inhibits cough center which results in suppression of nonproductive cough and reduce viscosity of secretions.
Indication of Dextromethorphan (DMX)
*Non-narcotic Antitussive
Cough
Contraindications of Dextromethorphan (DMX)
*Non-narcotic Antitussive
- COPD
- With productive cough or MAOIs
Side Effects of Dextromethorphan (DMX)
*Non-narcotic Antitussive
- Nausea
- Dizziness
- Drowsiness
Interactions of Dextromethorphan (DMX)
*Non-narcotic Antitussive
Get increased effect with MAOIs, narcotics, sedatives, antidepressants, and alcohol.
What is the discussion with Dextromethorphan (DMX)?
Lot of discussion if it really works.
Why are antitussives not used with a productive cough?
We don’t want to use an antitussive on a productive cough, because the mucus stays there and is a great place for bacteria.
Nursing Considerations with Antitussives?
- Do not encourage the use of antitussives if the cough is productive. The body needs to use the cough reflex to eliminate the accumulation of sputum possibly filled with bacterial organisms. Without expectoration, the URI could lead to diseases such as pneumonia.
- Abuse and associated deaths are increasing. Households should be cautious, monitor use of medications containing DMX.
Can get high from DMX…
… Can lead to death.
The last type of treatment for URIs?
Expectorants and Mucolytics
*Both about mucus
Expectorants and Mucolytics info?
Aid in the expectoration of excessive mucus that has accumulated in the respiratory tract
When do you use Expectorants and Mucolytics?
Use when you have a productive cough.
Actions of Expectorants?
-Reflex Stimulation = loosening and thinning of the respiratory tract secretions in response to an irritation of the GI tract.
-Actual clinical effectiveness is highly questionable
*Placebo controlled studies fail to prove expectorants
reduce viscosity
*Still very popular, found in many cold preparations
Actions of Mucolytics?
Breakdown chemical structure of mucus molecules, thinning mucus, and then helps it expel
Increasing fluids with mucolytics will…
Increase fluids to thin secretions
What is the difference between Expectorants and Mucolytics?
Expectorants = hopefully, making you cough will cough up mucus Mucolytics = Thinning mucus
Contraindications of Expectorants and Mucolytics?
Allergy
Side Effects of Expectorants and Mucolytics?
Minimal
Interactions of Expectorants and Mucolytics?
Use with potassium containing drugs or potassium sparing drugs may lead to development of hyperkalemia = cardiac dysrhythmias or arrest.
Example of an Expectorant?
Guaifenesin
Examples of a Mucolytic?
- Mucomyst (acetlycysteine) - given in nebulizer
- Mucinex
Nursing Considerations for Expectorants and Mucolytics?
Always encourage patients to increase fluid intake; helps to liquefy secretions.
