Week 6 Upper Resp Flashcards
Antitussives are useful in blocking the cough reflex and preserving the energy associated with prolonged, nonproductive coughing. Antitussives are best used for:
A. postoperative patients
B. asthma patients
C. patients with a dry, irritating cough
D. COPD patients who tire easily
C!
- you don’t want to stop the coughing reflex for the other diseases
A patient taking a behind-the-counter cold medication and a behind-the-counter allergy medicine is found to be taking double doses of pseudoephedrine. As a result the patient might exhibit:
A. ear pain and eye redness
B. restlessness and palpitation.
C. sinus pressure and ear pain
D. an irritating cough and nasal drainage
B!
- causes SNS effect> fight/ flight
- increased HR, palpitation, jittery
Antitussives prototype drug
Dextromethorphan
Decongestants prototype drug
pseudoephedrine
Expectorant prototype drug
Guaifenesin
therapeutic action: Antitussives (dextromethorphan)
Centrally suppress the cough reflex in the medulla of the brain to control cough spasms.
Indications: Antitussives (dextromethorphan)
Treatment of a nonproductive cough
Pharmacokinetics: Antitussives (dextromethorphan)
- Rapidly absorbed, metabolized by the liver, excreted in the urine
- Cross the placenta and enter breast milk
Adverse Effects: Antitussives (dextromethorphan)
- drying effect on mucous membranes
- makes secretions thicker
- drowsiness and sedation
Contraindications: Antitussives (dextromethorphan)
- Pts who need to cough in order to maintain airways
- post-op pts, asthma, CF, emphysema
- CNS depression/ head injury
- caution use in pregnancy/ lactation
Drug-drug interaction: Antitussives (dextromethorphan)
- Avoid MAO (monoamine oxidase) inhibitors> causes severe side effects
Nursing considerations: Antitussives (dextromethorphan)
- Neuro: LOC, orientation, affect
- Resp: lung sounds, cough, secretions
- Acute medication, DO NOT use more than 1 wk
- use other measures to help relieve cough
therapeutic action: Decongestants
- Stimulates alpha-adrenergic receptors> vasoconstriction> Shrinks swollen mucous membranes and opens clogged nasal passages
- Sympathomimetic: mimics the effects of the SNS
Indications: Decongestants
- Relieves nasal congestion
- Decreases pain and congestion of otitis media
Pharmacokinetics: Decongestants
- oral: widely distributed
- metabolized in liver, excreted in urine
Adverse Effects: Decongestants
- Systemic SNS effects; Fight/ flight affect
- anxiety, hypertension, urinary retention, pallor, vision changes
Contraindications: Decongestants
- conditions that could be exacerbated by sympathetic activity
- HTN, glaucoma, coronary disease
- caution use in pregnancy/ lactation
Drug- Drug interaction: Decongestants
- Many OTC cold/ flu/ allergy contain pseudophedrines> Caution on dosages
Nursing Consideration: Decongestants
- Neuro: reflexes, orientation
- Cardiac: BP, HR
- Resp: lung sounds, congestion,
- Acute medication, DO NOT use more than 1 wk
- OTC safety w/ dosages, avoid overdose
Therapeutic action: Expectorant
Reduces adhesiveness and surface tension of resp tract fluids> thinning of secretions allows easier movement> creates more productive but less frequent cough
Indications: Expectorant
- Control of a production cough
- common cold, acute bronchitis, influenza
Pharmacokinetics: Expectorant
- oral: 30 min, 4-6hrs
- metabolism and excretion not reported
Adverse effects: Expectorant
GI: n/v/ anorexia
- Headache, dizziness, mild rash
Contraindications: Expectorant
- Allergy to drug
- caution in pregnancy and lactation
- not used for a persistent cough!
Drug-drug interaction: Expectorant
NONE!
Nursing considerations: Expectorant
- resp: lung sounds, cough, evaluate effectiveness
- Neuro: monitor CNS effects
- Skin: monitor for rash
- temp: underlying infection
- Acute medication, DO NOT use more than 1 wk
- Hydrate!
- avoid driving if dizziness occurs
- OTC safety w/ dosages, avoid overdose
Children considerations
- Do not use < 4y.o
- Caution use from 4-6 y.o.
- CNS effect more common
- In many OTC drugs> check labels
- Encourage nondrug measures
- Fluids, humidifier, avoid smoke, wash hands
Adult considerations
- In many OTC drugs> check labels
- Ask about other OTC drugs and herbals
- Encourage nondrug measures
- Saftey during pregnancy is not established
- Potential blood flow changes of fluid balance and milk production
Older Adults consideration
- Frequently prescribed
- More likely to develop CNS adverse effects
- Provide safety measures for mobility and balance> fall risks
- Impaired metabolism and excretion w/ organ dysfunction
- Dose may need to be adjusted
