URI and Drugs

Question 1

Two main types of Bronchitis

Answer 1

Simple (acute) bronchitis
-No airflow obstruction
-Defined: Inflammation of the bronchi and bronchioles
-Etiology: bacterial or viral (majority)
-Presentation: usually mild and self-limited/requires only supportive care
Prognosis: good, usually better in 3-4 weeks

Chronic Bronchitis
-Airflow obstruction=form of COPD
-Bronchitis for 3 months out of the year
-Etiology: cigarettes (90%)
-Presentation: May have acute exacerbation of chronic bronchitis= AECB (known as acute or chronic)
-Prognosis: Premature morbidity and mortality

Question 2

Acute bronchitis:
Clinical presentation, Diagnosis, and treatment

Answer 2

Clinical Symptoms:
-Often begins as a common cold
-Sore throat-pharyngeal erythema
-Nasal discharge: rhinorrhea
-Muscle aches
-PERSISTENT COUGH-can last 3 weeks
-Wheezing in severe cases
-Sputum production in most patients
-Enlarged lymph nodes

Diagnosis
-Mostly based on symptoms and physical assessment
-CBC to distinguish bacterial from viral infection

Treatment
-Broad spectrum antibiotics for bacterial infection
-Expectorants
Cough suppressants

Question 3

Influenza

Answer 3

Viral infection
-A,B,C
-Type can mature

Vaccine-prevents people from getting VERY sick. Does not prevent infection altogether

Rapid onset
-Fever
-Chills
-Body aches

SECONDARY PNEUMONIA can be deadly-can get additional bacterial infection

Question 4

Histamines

Answer 4

Stored in the mast cells and basophils
-Found in skin and soft tissue

When activated can cause:
-Hives and itching:skin
-Dilation of blood vessels and resulting in erythema and hypotension
-Bronchoconstriction-SOA
-Affect sleep/wake cycles
Increase the secretion of acid in the stomach

Question 5

What causes the majority of symptoms associated with allergic reactions?

Answer 5

Histamine

-Can be drug induced, food, contacts
Hives or urticaria can develop

Question 6

Allergic Rhinitis

Answer 6

Inflammatory disorder

-Involves: Upper airway, lower airway, and eyes
-CM: sneezing, rhinorrhea, pruritis, nasal congestion, watery, itchy eyes
-Triggered by allergens: bind to IgE antibodies on mast cells-release inflammatory mediators
-Environmental triggers: dust mites, mold, etc. (avoid contact as part of treatment)

Question 7

Acute Sinusitis

Answer 7

Defined: Infection of the facial sinuses and membranes of the nose
-Inflammation causes the sinus cavity to become obstructed by fluid accumulation and edema allowing for bacterial growth and infection

Etiology:
-May be accompanied by a URI, nasal polyps, deviated septum, or allergic reaction (rhinitis)
-Viral sinusitis: duration 5-7 days
-Bacterial sinusitis: duration up to 4-6 weeks

Sx:
-Headache, facial pain or pressure over the sinus area, nasal obstruction, fatigue, purulent nasal discharge, ear pain, dental pain, cough, decreased sense of smell, sore throat

Tx: antibiotics, decongestants, antihistamines, mucolytic agents to decrease secretions

Question 8

Which infection is difficult to treat with antibiotics?

Answer 8

Sinusitis

-Hard for drugs to get into the sinus
-7 or more days
Decongestants

Question 9

Pharyngitis

Answer 9

Infection of the:
palate, tonsils, uvula

Diagnosis: culture and rapid strep test

Question 10

What is the difference between bacterial and viral pharyngitis?

Answer 10

Bacterial:
-Swollen uvula, whitish spots, red swollen tonsils, throat redness, gray furry tongue

Viral:
-Red swollen tonsils, throat redness

Question 11

Laryngitis

Answer 11

Inflammation of the larynx
-around the vocal chords

Croup (laryngotracheobronchitis)
-Barking cough

Question 12

Epiglottis (clinical diagnosis)

Answer 12

Clinical diagnosis:
-inspiratory stridor and retractions
-rapid onset of fever, pain, difficulty swallowing
-Drooling (absence of barking cough differentiates from croup)

Question 13

Epiglottis (definition)

Answer 13

Rare, but potentially life-threatening
-Causes sudden swelling of the epiglottis, which often worsens rapidly, sometimes within hours
-Without timely treatment, the epiglottis can become so large that it block the windpipe making it hard to breathe

With the development of a vaccine against Haemophilus influenzae type b (Hib) in 1985, epiglottis is now increasingly rare in vaccinated children

Question 14

Epiglottis (symptoms)

Answer 14

-Severe sore throat that come on suddenly
-Fever
-Shortness of breath or difficulty breathing, especially when lying down
-DROOLING and difficulty managing saliva in the mouth
-A loud sound heard when breathing in (stridor)
-Difficulty swallowing
-Muffled voice
-Preference for sitting upright with neck extended and face tilted slightly upward in a “sniffing” position to be able to breathe

Question 15

Bronchospasm

Answer 15

Sudden constriction of the bronchial muscles making it hard to breathe

-Sx: trouble breathing, SOA, and wheezing

-Can be triggered by family history of asthma, upper respiratory infection

Medications:
-Bronchodilators
-Inhaled steroids
-Anticholinergics

Question 16

Histamine (definition)

Answer 16

Substance involved in nerve transmission, capillary dilation, smooth muscle contraction, gastric acid secretion and HR control

Release of excessive amounts of histamine can lead to anaphylactic and severe allergic symptoms

Question 17

2 Types of Histamines

Answer 17

H1: receptors which mediate smooth muscle contraction and capillary dilation (target for traditional “allergy” medications)

H2: mediation of heart rate and gastric acid secretion

Question 18

Antihistamines MOA

Answer 18

Bind to H1 receptors and BLOCK histamine release
-Have a mild anticholinergic effect

Question 19

Antihistamines (contraindications)

Answer 19

Closed angle glaucoma, cardiac disease, kidney disease, hypertension, bronchial asthma, COPD, Peptic ulcer disease, seizures, BPH and pregnancy

*depends on the patient

Question 20

Sedating Antihistamines: 1st gen

Indications, Route, SE, Considerations

Answer 20

Drug: diphenhydramine

Indications: mild allergic reactions, motion sickness, insomnia

Given: PO or IV

SE; drowsiness, dizziness, dry mouth, urinary retention, constipation=DRY

NSG implication: monitor closely for dizziness when ambulating, monitor for urinary retention and constipation

Avoid driving and activities that require mental alertness. Take at night

Question 21

Non-sedating Antihistamines

Answer 21

Drugs: Loratidine, fexofenadine, cetirizine

Indications: allergic rhinitis, chronic idiopathic urticaria

Route: All given PO

SE: Fewer SE, less drowsiness and fatigue

Also called 2nd gen antihistamine

Question 22

Sympathomimetics (Decongestant)

Answer 22

Drug: phenylephrine, pseudoephedrine

Indications: reduce nasal congestion, allergic rhinitis, sinusitis, and the common cold

MOA: mimics the action of SNS, and activates, alpha 1-adrenergic receptors (causes vasoconstriction of blood vessels) which causes nasal turbinates to shrink and opens the nasal passages

SE: all related to the CNS stimulation (agitation, insomnia, anxiety, tachycardia, heart palpitations

Patient Education: Do not use for more than 4 days (rebound nasal congestion occurs if the drug is abruptly stopped after prolonged use)
-Tapering off recommended

Pseudoephedrine
-Potential for abuse
-One of the active ingredients in methamphetamine (meth)
-OTC, but must get at the pharmaceutical counter, states have different requirements as far as age
-Limits on how much people can get

Question 23

Antitussives

Answer 23

Drug: Dextromethorphan, codeine, benzonatate

Indication: Cough suppressant (acute or chronic)

MOA: directly suppresses the cough reflex in the brain

Route: PO (syrups), sprays, lozenges

SE: CNS depressant (do NOT take with other CNS depressants)

Potential for abuse (dextromethorphan is over the counter)

Question 24

Expectorant

Answer 24

Drug: guaifenesin

Indication: decrease mucus in colds, bronchitis, etc.

MOA: reduction in surface tension of secretion helping thing the mucus making it easier to expectorate

SE: Few, mild GI distress

ENCOURAGE fluid to help thin secretions as well
* Be careful in patients with chronic
cough/asthma

Question 25

Mucolytics

Answer 25

Drug: acetylcysteine

Indications:bronchopulmonary disease, cystic fibrosis

MOA: decreases the viscosity of mucus making it easier to cough

SE: few, BRONCHOSPASM may occur, SMELLS TERRIBLE

Monitor lung sounds closely

Given via nebulizer or through tracheostomy