URI and Drugs Flashcards
Two main types of Bronchitis
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
Acute bronchitis:
Clinical presentation, Diagnosis, and treatment
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
Influenza
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
Histamines
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
What causes the majority of symptoms associated with allergic reactions?
Histamine
-Can be drug induced, food, contacts
Hives or urticaria can develop
Allergic Rhinitis
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)
Acute Sinusitis
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
Which infection is difficult to treat with antibiotics?
Sinusitis
-Hard for drugs to get into the sinus
-7 or more days
Decongestants
Pharyngitis
Infection of the:
palate, tonsils, uvula
Diagnosis: culture and rapid strep test
What is the difference between bacterial and viral pharyngitis?
Bacterial:
-Swollen uvula, whitish spots, red swollen tonsils, throat redness, gray furry tongue
Viral:
-Red swollen tonsils, throat redness
Laryngitis
Inflammation of the larynx
-around the vocal chords
Croup (laryngotracheobronchitis)
-Barking cough
Epiglottis (clinical diagnosis)
Clinical diagnosis:
-inspiratory stridor and retractions
-rapid onset of fever, pain, difficulty swallowing
-Drooling (absence of barking cough differentiates from croup)
Epiglottis (definition)
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
Epiglottis (symptoms)
-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
Bronchospasm
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
Histamine (definition)
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
2 Types of Histamines
H1: receptors which mediate smooth muscle contraction and capillary dilation (target for traditional “allergy” medications)
H2: mediation of heart rate and gastric acid secretion
Antihistamines MOA
Bind to H1 receptors and BLOCK histamine release
-Have a mild anticholinergic effect
Antihistamines (contraindications)
Closed angle glaucoma, cardiac disease, kidney disease, hypertension, bronchial asthma, COPD, Peptic ulcer disease, seizures, BPH and pregnancy
*depends on the patient
Sedating Antihistamines: 1st gen
Indications, Route, SE, Considerations
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
Non-sedating Antihistamines
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
Sympathomimetics (Decongestant)
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
Antitussives
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)
Expectorant
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
Mucolytics
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
