ENT Medications & Nursing Considerations

• Focus on identifying medication classes, their potential side effects, nursing considerations for administration and monitoring
• Be prepared to apply knowledge to specific patient scenarios using resources like ATI, texts, and the Pharmacology Study Guide

Ear / Nose / Throat Medications

• Decongestants: Monitor for adverse effects such as hypertension, tachycardia, and palpitations
• Antihistamines: Can cause dry sedation, dry mouth, urinary retention, and dizziness
• First-generation antihistamines have a greater risk of these side effects
• Second-generation antihistamines still pose a risk but to a lesser extent
• Antitussives: Suppress cough, may cause sedation, especially opioid-based ones, also constipation with opioids
• Expectorants: Loosen secretions, require good hydration to loosen mucus
• Guaifenesin: Common in OTC medications, may cause GI upset or dizziness
• Acetylcysteine: Has a sulfur smell and is used in nebulizers and orally, also used for APAP overdose

Asthma / COPD Medications

• SABA (Short-Acting Beta Agonist): Rescue inhaler for shortness of breath, cough, and wheeze that can cause tachycardia and anxiety
• Albuterol: Inhaled or liquid form, a major rescue medication also used for exercise-induced asthma
• Levalbuterol: Inhaled only, carries less risk of tachycardia/palpitations, beneficial for CHF patients
• LABA (Long-Acting Beta Agonist): Not a rescue medication but helps with cough, wheeze, and shortness of breath, used as a controller
• Salmeterol and terbutaline are common in this class
• Anticholinergics: Drying agents that clear up thick secretions and are often used in COPD with SABA/LABA
• Risk of urinary retention, dry mouth, dizziness, and tachycardia, ipratropium ("atropine")
• Leukotriene Inhibitor: Anti-inflammatory controller medication, not an emergency medication
• Montelukast (Singulair): Used for rhinitis, be aware of muscle pain, and liver function tests
• Corticosteroids: Potent anti-inflammatories used in severe exacerbations
• Inhaled forms(fluticasone, beclomethasone) are controllers, risk of thrush so rinse mouth after use
• Systemic forms (PO or IV): Adverse effects include hyperglycemia, hypertension, decreased immunity, and osteoporosis, posing a risk of adrenal crisis
• Nasal forms generally safe and carry risks like nosebleeds and potential slight glaucoma risk with long-term use
• Example: Flonase (fluticasone)
• Mast Cell Stabilizers: Old-school controller with better adverse effect profile than steroids
• Cromolyn: Used for exercise-induced asthma, administered 30 minutes before exercise
• ALL Inhaled asthma medications are better absorbed if SABA is administered 20 minutes before
• Methylxanthines (theophylline): Risk of tachycardia and nervousness so avoid other stimulants and seizure risk
• MDI (Metered Dose Inhaler): Proper inhaler technique is crucial for effective medication delivery

Review Medications

• Cardiac Medications: Loop diuretics, anti-dysrhythmics (lidocaine), diuretics (consider labs), cardiac glycosides, and beta-adrenergic blockers
• Emergency Medications: Lidocaine (Vfib/Vtach), epinephrine (hypotension, shock, allergic reaction), and diphenhydramine for allergic reactions