Upper Respiratory Agents Flashcards
Upper Respiratory Agents
In Children
- Caution due to adverse effects: sedation, confusion, dizziness
- DO NOT give UNDER 4 years old
- Caution in 4-6 years old
- Non-Drug Measures first: oral fluids, cool humidifier, control exposure to smoke, allergens, irritants
- Wash hands to prevent infection
Upper Respiratory Agents
In Adults
- Potential Accidental Overdose
- Non-drug measures
- No established safety in pregnancy and lactation
Upper Respiratory Agents
In Older Adults
- More Likely to develop adverse effects: sedation, confusion, dizziness
- Renal and hepatic impairment
- START LOW, GO SLOW
Antitussives
Drug Names
- Benzonatate
- Codeine and Hydrocodone
- Dextromethorphan
Antitussives
MOA
Codeine, Hydrocodone, Dextromethorphan:
* Acts directly on the medullary cough center of the brain to depress the cough reflex
Antitussives
Benzonatate
MOA
Local anesthetic on the respiratory tract
Need to know cause of cough first
Antitussives
Contraindications
Absolute:
* Allergy
* Patients who need to cough to maintain the airway
Relative:
* Head injury or impaired CNS
* Serious respiratory conditions like asthma or emphysema
Caution:
* History of narcotic addiction
* If they need to be alert
Antitussives
Adverse Effects
- Drying effect on the mucus membranes
- GI upset from drying effects
- CNS effects
Antitussives
Drug Interactions
Drug:
* MAOIs - taken for depression
* Opiods/CNS depressants - including alcohol
Antitussives
Assessment
History:
* Contraindications, cautions, pregnancy, lactation
Physical:
* Lung sounds & respiratory rate
* Temperature
* Orientation and affect
Antitussives
Nursing Conclusions
- Ineffective airway clearance
- Altered sensory perception
- Knowledge deficit
Antitussives
Implementation/Patient Teaching
- Do not take longer than prescribed or needed
- Further medical evaluation if needed
- Comfort measures: Resting, lozenges, cool humidifier, avoiding irritants, oral fluids
- Patient Teaching: avoid other opiods and CNS depressants
Topical Nasal Decongestants
MOA
Sympathomimetic => local vasoconstriction => decreased edema and inflammation
Topical Nasal Decongestants
Indications
- Relieve the discomfort of nasal congestion (cold, allergies)
- Dilate the nares (nostrils) for medical exams or to relieve middle ear pressure
Topical Nasal Decongestants
Drug names
“-zoline”
* Oxymetazoline
* Tetrahydrozoline
* Xylometazoline
Phenylephrine
Topical Nasal Decongestants
Contraindications
Absolute:
Allergy
Caution:
* Lesion or erosion in the mucus membranes (can lead to systemic absorption)
* Conditions that might be exacerbated by sympathetic activity: Glaucoma, HTN
Topical Nasal Decongestants
Adverse Effects
- Local stinging and burning (Usually goes away after a few uses)
- Rebound congestion (after 3-5 days)
- Sympathomimetic effects
Topical Nasal Decongestants
Drug Interactions
Drug:
* Other sympathomimetic drugs (Toxic effect)
* Sympathomimetic blocking drugs (less effective)
Topical Nasal Decongestants
Assessment
History:
* Contraindications or cautions
Physical:
* Nasal mucus membranes
* Cardiac
* Urinary Status (elimination patterns)
Topical Nasal Decongestants
Nursing conclusions
- Impaired comfort
- Knowledge deficit
Topical Nasal Decongestants
Implementation/Patient Teaching
- Administer correctly
- Drug not taken longer than 1 week
- Further medical evaluation for persistent symptoms
- Comfort measures (ie. cool humidifier)
- Patient Teaching: overdose prevention
Topical Nasal Decongestants
How to administer
- Sit upright, close one nostril
- Hold the bottle upright and insert the tip (about 1/2 inch) into the open nostril
- Firmly squeeze the bottle
- Repeat with other nostril
- Refrain from blowing nose after administration
Oral Decongestants
MOA
- Vasoconstricts small blood vessels of the nasal membranes
- Stimulates the alpha-adrenergic receptors in the nasal mucus membranes to shrink them
- Leads to promotion of drainage in the sinuses and improving air flow
Oral Decongestants
Indications
Decrease nasal congestion due to:
* common cold
* sinusitis
* allergic rhinitis
Relieves pressure in the middle ear:
* ear infections
Oral Decongestants
Drug Names
- Pseudoephedrine
- Phenylephrine