Pharmacology: Upper Respiratory Drugs

• Chapter 29 discusses the drugs to treat the upper respiratory disease
• Clayton's Basic Pharmacology for Nurses, 19th edition, is the source of the information

Anatomy of Upper Respiratory Tract

• The respiratory system is the series of airways that start with the nose and mouth and end at the alveolar sacs within the lungs
• The upper respiratory tract is composed of the sinuses, nasopharynx, pharynx, tonsils, eustachian tubes, and larynx

Common Upper Respiratory Diseases

• Rhinitis involves inflammation of the nasal mucous membrane
• Acute symptoms of rhinitis are caused by the common cold, bacterial infection, presence of a foreign body, or drug-induced congestion
• Allergic rhinitis is caused by an allergic reaction to exposure to allergens such as pollens, grasses, and dust mites
• Allergic rhinitis releases large amounts of histamine
• Cold viruses are a common upper respiratory illness that are an expensive illness
• Cold viruses are most common in midwinter, spring, and fall
• There are 120 to 200 subtypes of viruses, spread by direct contact and sneezing
• Symptoms of cold viruses include clear, watery nasal discharge, sneezing, cough, mild sore throat, headache, malaise, chills, and fever
• Cold viruses should resolve over 5 to 7 days
• Complications from cold viruses include sinusitis, otitis media, and exacerbations of obstructive lung disease, and asthma.
• Sinusitis symptoms are thick, tenacious mucus obstructs sinus ducts
• Otitis media is an infection of the middle ear
• Seek medical attention if symptoms worsen or if additional symptoms appear with a cold

Treatment of Upper Respiratory Diseases

• Treatment for the common cold is limited to relieving symptoms, reducing complications, and preventing the spread of viral infection
• Allergic rhinitis treatment involves identifying allergens and avoiding exposure as well as medicines that block the allergic reaction and treat symptoms

Drug Therapy of Upper Respiratory Diseases

• Antihistamines are drugs of choice for treating allergic rhinitis
• Anti-inflammatory agents administered intranasally are used to treat nasal symptoms resulting from mild to moderate allergic rhinitis
• Nursing implications include symptoms, history of treatment and history of concurrent medical problems

Drug Class: Sympathomimetic Decongestants

• Action: Stimulates alpha-adrenergic receptors of nasal mucous membranes causing vasoconstriction
• Use: Relieves congestion associated with rhinitis
• Therapeutic outcomes: Reduced nasal congestion, easier breathing
• Common adverse effect: Mild nasal irritation
• Serious adverse effect: Hypertension
• Decongestants should be used with caution in patients with hypertension, hyperthyroidism, diabetes mellitus, cardiac disease, increased intraocular pressure, or prostatic hyperplasia
• State laws regulate the purchase of pseudoephedrine, one ingredient in methamphetamine manufacture
• Combining decongestants with MAOIs results in significant hypertension

Drug Class: Antihistamines

• Action: Competes with allergy-liberated histamine for H1 receptor sites
• Uses: Treats allergic rhinitis and conjunctivitis
• Therapeutic outcome: Reduced symptoms of allergic rhinitis
• Common adverse effects: Sedative effects, cognitive impairment, drying effects
• Anticholinergic adverse effects: dry mouth, stuffy nose, blurred vision, constipation, urinary retention, and may make respiratory mucus thicker
• Patients with a history of asthma, prostatic enlargement, or glaucoma should take antihistamines only with healthcare provider supervision

Drug Class: Respiratory Anti-Inflammatory Agents

• Drug: Intranasal corticosteroids
• Action: Reduces inflammation; mechanism of action unknown
• Use: For patients who do not respond to antihistamines or sympathomimetic agents
• Therapeutic outcomes: Reduced rhinorrhea, rhinitis, itching, and sneezing
• Common adverse effect: Nasal burning
• Drug: Cromolyn sodium (NasalCrom) stabilizes mast cells, reducing the release of histamine and other mediators
• Use: In conjunction with other drugs to treat severe allergic rhinitis
• Common adverse effect: Nasal burning
• Serious adverse effects: Bronchospasm and coughing

Use of Decongestants

• Alpha-adrenergic agents as nasal decongestants stimulate alpha receptors at other sites in the body
• Decongestants should be used only for short-term acute seasonal allergies
• Excessive use of decongestants may result in significant hypertension

Premedication and Nursing Assessments

• Assess the description of symptoms
• Assess history of treatment
• Assess history of concurrent medical problems