Respiratory Medication Guide

• Codeine antitussives can cause drowsiness, so avoid driving while taking it.
• Cetirizine requires avoiding driving as well.
• Severe nasal congestion a week after starting OTC nasal decongestant spray use is likely rebound congestion.
• Expectorants work by thinning respiratory secretions.
• For a cough treated with guaifenesin, instruct the patient to call the HCP if the productive cough continues after one week.
• For an acute asthma attack, use a beta-2 agonist.
• Anticholinergic medication therapy will provide relaxation of smooth muscle for respiratory distress related to bronchi constriction.
• Evaluate effectiveness of leukotriene receptor antagonist medication therapy based on long-term management of asthma symptoms.
• Inhaled steroids decrease release of inflammatory mediators to treat asthma and COPD.
• When providing education to a patient with an acute asthma attack, note a high coffee intake.

Antitussives

• Risk of central nervous system effects.
• Used to treat non-productive coughs.
• Can cause urinary retention in men with BPH.

Oral Decongestants (Sympathomimetics)

• Examples include pseudoephedrine and phenylephrine.
• Can cause hypertension, anxiety, and arrhythmias.
• Caution is advised for patients with glaucoma, hypertension, diabetes, thyroid disease, prostate problems, and coronary artery disease (CAD).
• As systemic medications, they do not have sympathetic nervous system effects.
• Use should be limited to 3-5 days and not for chronic rhinitis.

Topical Nasal Decongestants (Nasal Sympathomimetics)

• Example: Oxymetazoline (Afrin).
• Contraindicated if lesions or erosions exist in the nares before administration.
• May cause nose bleeds and erosions.
• Teach proper administration techniques to patients.
• Mimic sympathetic nervous activity, potentially increasing heart rate, blood pressure, and causing respiratory agitation.
• Caution in patients with a history of hypertension, anxiety, arrhythmia, or insomnia.
• Limit use to 3-5 days to avoid rebound vasodilation, known as rhinitis medicamentosa.
• Avoid use with cyclopropane or halothane due to major cardiovascular effects.

Expectorants

• Example: Guaifenesin (Mucinex).
• Contraindicated for clients with diabetes due to sugar content.
• Limit use to less than one week.
• Increase fluid intake to aid in liquefying secretions.
• It is the only expectorant on the market.

Antihistamines (1st Generation)

• Have anticholinergic properties.
• Examples: diphenhydramine (Benadryl), hydroxyzine (Restoril), meclizine (Antivert), promethazine (Phenergan).
• Contraindicated for those with narrow-angle glaucoma due to the risk of increased intraocular pressure.
• Do not mix with alcohol due to potentially life-threatening CNS depression.
• May cause QT elongation and sedation.

Antihistamines (2nd Generation)

• Used for seasonal allergies.
• Examples: cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra), azelastine (spray).
• Non-sedating.
• Do not give to infants younger than 6 months.
• Use with caution in patients with renal or liver problems.
• May cause urinary retention, confusion, and overdrying; encourage drinking 8oz of water.
• Theophylline can have reduced clearance, increasing the risk of toxicity.
• Do not take with CNS depressants.

Methylxanthines

• Acts as a bronchodilator, an example is theophylline.
• Has a narrow therapeutic range (10-20).
• Take with food and avoid caffeine.
• Presents lots of interactions caution with a lot of history of diseases.

Beta2-Adrenergic Agonists

• Examples: albuterol, levalbuterol.
• Short-acting helps airways stay open with bronchodilation.
• Relaxes smooth muscle cells; used as emergent medication.

Anticholinergics

• Ipratropium is an example of a bronchodilator.
• Relaxes smooth muscle, leading to bronchodilation
• Not for emergency use.
• Has fewer systemic effects than short-acting beta-agonists; not as effective.

Inhaled Steroids

• Examples: beclomethasone.
• Used for long-term management of asthma or COPD.
• The patient needs to wash out mouth well after use to prevent thrush.
• Have fewer systemic effects than oral steroids.
• Contact the MD with the presence of respiratory infection signs and symptoms.

Oral Steroids

• Example: Prednisone.
• Suppress inflammation.
• Can decrease the infiltration of inflammatory cells and edema of airways.
• Long-term use requires tapering the dose to avoid adrenal crisis.
• Increase intake of calcium and vitamin D.
• Report hyperglycemia, weight gain, edema, and generalized weakness; monitor blood glucose.
• Be aware of the risks of hypokalemia with furosemide and gastro intestinal bleeding with NSAIDs.
• Can reduce effectiveness of insulin and oral hypoglycemics.

Leukotriene Receptor Antagonists

• Examples: montelukast, zafirlukast.
• Block receptors for the production of leukotrienes D4 and E4 (components of asthma).
• Not to be used for an emergency asthma attack - this is a maintenance drug.
• Caution should used with pts with hepatic or renal impairment

Mast Cell Stabilizers

• Example: Cromolyn.
• Not to be used for emergent situations.
• Used for prophylaxis in mild persistent asthma, exercise-induced bronchospasm (EIB), intranasal can relieve allergic rhinitis.
• Suppresses inflammation, does not cause bronchodilation.
• Effects are less than steroids, so not a preferred drug alone for asthma, but can be useful if issues tolerating steroids.

Inhalers

• Wait at least 1 minute bewteen medications.
• Wait at least 5 minutes between 2 inhaled medications.

Nebulizer

• Uses compressed air to change liquid druginto fine mist for inhalation.
• Using hand-held device- sit upright or Semi-Fowler position.
• Breathe slowly and deeply during the treatment.
• Rinse out mouth and clean device when treatment is over.

Rescue and Maintenance Inhalers

• Promotes bronchodilation and enhances absorption of the glucocorticoid.

Mucolytics

• P - Acetylcysteine (Mucomyst).
• Increases/liquefy respiratory secretions to aid clearing of the airways in high risk respiratory patients.
• AE: bronchospasm and rotten egg smell.
• Caution w/ acute bronchospasm, peptic ulcer or esophageal varices as it could make these things worse.
• Administer w/ nebulizer (inhaled aerosol) to high-risk resp patients.
• Monitor respiratory status frequently (auscultation of lungs) and encourage to cough up secretions.
• Have suction equipment available.

First-generation antihistamines

• Have many uses attributed to drying and sedation effects.

• Used in antianxiety, urinary incontinence, benign positional vertigo, and sleep disturbance.

• Dependency on nasal decongestant sprays is very common because of the rebound effect, which occurs after 3 to 5 days of use.

• Antitussives should not be used longer than a week.

• Seek eval if patients have a persistent cough.

• Decongestants are drugs that cause local vasoconstriction, decreasing blood flow to the irritated and dilated capillaries of the mucous membranes lining the nasal passages and sinus cavities.

• An adverse effect of frequent or prolonged use of decongestants is rebound vasodilation, called rhinitis medicamentosa; as well as the reflex reaction to vasoconstriction, which often leads to prolonged overuse of decongestants.

• Topical nasal decongestants are preferable in patients who need to avoid systemic adrenergic effects.

• Oral decongestants are associated with systemic adrenergic effects and require caution in patients with CV disease, hyperthyroidism, or diabetes mellitus.

• Topical nasal steroids block occurring inflammatory responses. These drugs, which take several days to weeks to reach total effectiveness, are preferred for patients with allergic rhinitis who need to avoid the complications of systemic steroid therapy.

• Antihistamines selectively block histamine's effects at the histamine-1 receptor sites, decreasing allergic response.

• Antihistamines are used for relief of seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria, or angioedema.

• The nurse should encourage to drink plenty of fluids, use a humidifier if possible, avoid smoke-filled rooms, and use good skin care/moisturizers.

• Antihistamines should be avoided with any patient who has a prolonged QT interval, can cause serious cardiac complications and death.

• Mucolytics are to aid high-risk respiratory patients in coughing up thick, tenacious secretions and reduce mucus.

• Many drugs that act on the upper respiratory tract are in various OTC cough and allergy preparations, patients need to always read the labels carefully to avoid inadvertent overdose and toxicity.

• Theophylline relieves asthma by causing bronchodilation.

• Theophylline has a narrow therapeutic range and can cause serious adverse effects, it has been largely replaced by safer and more effective medications.

• Beta2 agonists promote bronchodilation by activating beta2 receptors in bronchial smooth muscle.

• Inhaled short-acting beta2 agonists (SABAs) are the most effective drugs for treating acute bronchospasm and preventing exercise-induced bronchospasm.

• For therapeutic purposes drugs can be classified as long-term control medications and quick-relief medications.

• Intermittent asthma is treated PRN, using an inhaled SABA to abort the few acute episodes that occur.

• For persistent asthma, daily inhalation of a glucocorticoid is the foundation of therapy, an inhaled LABA is added to the regimen when asthma is more severe, a SABA is inhaled PRN to suppress breakthrough attacks.

• In the stepwise approach to asthma therapy, treatment becomes more aggressive as impairment or risk becomes more severe.

• The goals of stepwise therapy are to prevent symptoms, maintain near-normal pulmonary function, maintain normal activity, prevent recurrent exacerbations, minimize the need for SABAs, minimize drug side effects, minimize ED visits, prevent progressive loss of lung function, and meet patient and family expectations about treatment.

• To prevent exercise-induced bronchospasm, patients can inhale a SABA just before strenuous activity.

• Glucocorticoids are the most effective anti-inflammatory drugs for asthma management.

• Glucocorticoids reduce symptoms of asthma by suppressing inflammation.

• Inhaled and systemic glucocorticoids are used for long-term prophylaxis of asthma, not for aborting an ongoing attack they are administered on a fixed schedule, not PRN.

• Unless asthma is severe, glucocorticoids should be administered by inhalation.

• Inhaled glucocorticoids are generally very safe, their principal side effects are oropharyngeal candidiasis and dysphonia (hoarseness).

• Minimize the effects by employing a spacer device during administration and by rinsing the mouth or gargling after use. Prolonged therapy with oral glucocorticoids can cause serious adverse effects, including adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, and growth suppression.

• You must taper an extended dose of oral steroids due to adrenal suppression.

• Cromolyn is an inhaled anti-inflammatory drug used for prophylaxis of asthma.

• Cromolyn reduces inflammation primarily by preventing the release of mediators from the mast cells.

• Pharmacologic management of stable COPD relies primarily on bronchodilators and glucocorticoids, use SABA for acute COPD exacerbation.

• Low Cortisol Symptoms: fatigue, dizziness, weight loss, muscle weakness, mood changes, and the darkening of regions of the skin.

• Often, as many as 3-4 different medications are needed to keep BP between acceptable limits

• AE: angioedema (because of buildup of bradykin, which is life threatening), bone marrow suppression (neutropenia), and weird hacking cough.

• ACE Inhibitors P: Captopril is used for hypertension treatment (suppress RAAS), kidney protection in diabetes mellitus (DM), heart failure protectant, and MI prevention.

• Don't combine with potassium-sparing diuretics or dietary salt substitute, can cause hyponatremia.

• For Angiotensin II receptor, antihypertensives are prescribed, (P: Losartan).

• They may be severe especially in patients on diuretics if high BP; monitor sodium and potassium to confirm.

• AE: hypotension, hyperkalemia, hyponatremia, Nsaids may reduce effectiveness, Monitor: BP 2hr after initial dose, liver/kidneys, Na+ & K+, and signs of angioedema

• Aldosterone Antagonists P: Eplerenone causes hypotension, hyperkalemia diarrhea, dyspepsia, and abdominal pain.

• Cannot take if K+ > 5.0 mEq/L (dangerous hyperkalemia may occur).

• Monitor BP, K+, kidneys, lithium levels.

• Direct Renin Inhibitors P: Aliskiren causes hypotension and hyperkalemia, same contraindications as Aldosterone Antagonists.

• Calcium Channel Blockers AE: Hypotension & Bradycardia, P: Nifedipine Special: reflex tachycardia, gum hyperplasia and bleeding.

• CI: heartblock, no systolic BP < 90, no grapefruit or CYP450 drugs. Alpha1 Blockers P: Doxazosin can cause hypotension, important reflex tachycardia. Give at night to lessen change of ortho hypotension, extreme caution with ED drugs (may increase hypotension).

• Monitor: BP, ortho hypotension, HR, report headache, working on the ANS, safety related to fall, tachycardia.

• Beta Blockers P: Atenolol and Metoprolol AE: Hypotension, bradycardia, heart failure - due to reduced - CO - important: no kids < 6 yr CI if PVD or Raynaud's -Caution with DM (S&S of hypo/hyperglycemia may be sup- pressed Monitor: BP, HR (hold if <60, heart rhythm, signs of HF - don't stop abruptly.

• Centrally Acting Alpha2 Agonists P: Clonidine AE: hypotension, CNS sedation Important: drowsiness, dizziness, fall risk (take at bedtime), dry mouth Di: CNS depressants monitor: BP, heart rhythm Compliance is the main reason people won't stay on meds

Alpha/Beta Blockers

• P: Carvedilol is an Antihypertenisve.
• AE: hypotension, bradycardia, heart failure-Digoxin may cause severe effect and don't use for pregnant women
• Direct Acting Vasodilators is for acute problems with hypertensive, P: Hydralazine may or may not cause hypotension, important hypertensive crisis and tachycardia if stopped ween over 1-2 weeks A systematic lupus erythematosus (SLE)-like syndrome can occur ,REPORT: facial rash, joint pain, unexplained fever, chest pain, fatigue do not stop abruptly
• Loop Diuretics are for kidney issues P: the effects cause hypotension, hypovolemia, hypokalemia, hypercalcemia/hyperuricemia Know what hypokalemia looks like and if its K+ wasting med (will need K+ supplement) can cause ototoxicity
• Thiazides and Thiazide-like diuretics lowers BP P: Hydrochlorothiazide (HCTZ)AE: hypotension/hypovolemia, dehydration, hypercalcemia/hyperuricemia - Gout, lowers hypokalemia Important: The kidneys are more frequent and worse, hypokalemia can cause potassium-sparing ,don’t use salt substitutes , causes hormonal changes Hyperkalemia, hypotension/hypovolemia, dehydration treat HF, heart beats more. cardiac glycosites: treats all but cures nothing, Quality life drug, slows HR, no beta blockers. Chest pain, dizziness, everything goes down! Hypokalemia reversal: digibind sympathomimetics: increases BP AE: tachydysrhythmias, hypertension, and angina opposite of sympathetic phosphodiesterase inhibitors =AE , cardio and hyerpten IV never Angiotensin P: Valsartan AE: Angioedema, hyperkalemia, hypt tension, renal fail SGLT2s: new. Only used for kidney, AE: diabetic ketoacidosis, increase UTI because of sugar. P: ivabradine: lethral ventral disrythmia, need interaction. P: Epi- Adrenergic: if your dying, NO CONTRAINDICATIONS, AE tissue of death, and arrythmias.

HMG-CoA Reductase Inhibitors (Statins) may show muscle ache, tea urine and high LDL levels in the steam and more liver damage, P: Atrovastatin monitor: patient education, do not take with vitamin X, digioxins and warfarin, also experiences large pass effect.

• Cholesterol Absorption Inhibitors may show abdominal pain, and diarrhea, increase gall stones, monitor : bowel patterns with wafarin, P: Eztimibe,DI: risk increase with fibrate when working with warfarin levels

• Bile Acid Sequestrants may cause to stay the in intestines and abdominal discomfort , also spontaneous abortion is expected from AEDK, monitor : bowel habits with Vitamin D, P: Cholystramine Fibrates can promote abdominal pain with incresed risk with Rhaddomyolsis and is expected when warfrin P: Genfibroxil Proprotein Convertase Subtilisin/Kexin Type Common muscle joint and joint pain along with the flu like symptoms,Monitor LDL levels and only use when the state do not help.

• Short-Interfering Rna may cause Urinary infections,muscoloesital pain (SNO) needs subQ and Contranceprive

• Need to be watched for Vision changes and only by mouth ( Taper to give) Watch 1st signs in heart/artery Adenosine can cause the opposite with high dose that’s not what will happen to us. Nitrates: for anginia and close monintrg that causes ( acute angina), must start HA, not solve in angina or call 16: Antianginals will cause ear rings and liver failure and more in monitor, P: Ranzoline avoid grape fruit with alchohol liver ( monitor HR and eat ECG) Class;PQuinidine can show as wide Qrs , long tern and tox if the if report. Can’t happen Class with heart block can only monitor CNS states, P: Licolaine . - Potential First and long QT interval Thrombopyletic growth factors, need to monitor for vision and swelling, monitor platelets. monitor CBS. Feared tablets need to better with meals and the nurse states you may need efficiently of food.

• The levels can only be shown wht the nurse states ( PT, PTT), ( PT/INR), in Warfrin. If IV you need more action in IV or PTT , (4,6) hours.

• Heal with more and the clits gets and shows the hematocrit.with what he is getting.