Drugs for Respiratory System Study Guide PDF

**Antihistamines** - **Actions:** Antihistamines block histamine from attaching to H1 receptors, reducing inflammatory and allergic symptoms. They do not prevent histamine release, but rather block the receptors. This limits vasodilation, capillary leak, swelling, and bronchoconst...

**Antihistamines** - **Actions:** Antihistamines block histamine from attaching to H1 receptors, reducing inflammatory and allergic symptoms. They do not prevent histamine release, but rather block the receptors. This limits vasodilation, capillary leak, swelling, and bronchoconstriction. - **Uses:** Treat various allergic reactions including allergic rhinitis. - **First-generation:** Available OTC, cross the blood-brain barrier causing sedation, and have anticholinergic effects. They are effective for short-term relief of sneezing, itching, and runny nose. - **Second-generation:** Newer, with faster onset, less sedation as they don\'t cross the blood-brain barrier. Some are prescription and some are OTC. Generally, less effective against nasal congestion than first-generation. - **Side Effects:** Drowsiness, dry mouth, increased heart rate, increased blood pressure, dilated pupils, and urinary retention. - **Adverse Effects:** Severe anticholinergic effects (cardiac dysrhythmias, high BP), increased intraocular pressure in glaucoma. Overdose symptoms include nervousness, anxiety, agitation, progressing to confusion, delirium and hallucinations. Paradoxical reactions like hyperexcitability, agitation, or confusion can occur in children and older adults. - **Life Span Considerations**: Older adults may experience pronounced anticholinergic effects, such as constipation, dry mouth, and urinary retention. They are also at risk for dizziness, syncope, and confusion. - **Examples:** diphenhydramine (Benadryl), fexofenadine (Allegra), loratadine (Claritin). - **Drug Interactions:** Increased sedation with other CNS depressants, enhanced anticholinergic effects with other anticholinergic drugs, and may mask ototoxicity symptoms. - **Nursing Implications/Patient Teaching:** - Caution patients about drowsiness and activities requiring alertness. - Advise increased fluid intake, unless contraindicated. - Tell patients not to increase dose or drink alcohol. - Instruct them to report skin reactions. - Inform patients about tolerance to the medication. - Advise patients not to take other medications, especially sedatives, without talking to their healthcare provider. - Monitor for side effects like dizziness, syncope, and confusion in older adults. - Patients with thyroid disease or migraines may not be able to take antihistamines because of tachycardia. **Leukotriene Inhibitors** - **Actions**: Blocks leukotriene response, reducing allergy and asthma symptoms. Some block production, others block receptors. Both actions reduce inflammation. - **Uses**: Allergic rhinitis, relaxes respiratory smooth muscle, increases airflow, prevents and treats asthma. - **Side Effects:** Headache, nausea, diarrhea. - **Adverse Effects:** Rare, but liver dysfunction is possible with long-term use. - **Life Span Considerations:** None noted. - **Examples:** montelukast (Singulair), zafirlukast (Accolate). - **Drug Interactions:** Interact with drugs that stimulate liver metabolism (phenytoin, phenobarbital, carbamazepine, and rifampin). Montelukast has the least interactions. - **Nursing Implications/Patient Teaching:** - These are not for acute asthma attacks because of slow onset. - Teach patients to report increased asthma or allergy symptoms. - Caution use in pregnancy/breastfeeding. - Advise not to stop taking these drugs suddenly. - Teach patients to report signs of liver impairment such as yellowing of the skin or eyes, darkening of urine, or white/gray stools. - Monitor and report changes in behavior or mood. **Mast Cell Stabilizers** - **Actions:** Prevents mast cells from releasing inflammatory mediators. - **Uses:** Nasal allergies and asthma. Used as inhaled drugs. - **Side Effects:** Headache, unpleasant taste, nosebleed, temporary nasal stinging. - **Examples:** cromolyn sodium (NasalCrom), nedocromil sodium. - **Nursing Implications/Patient Teaching:** - Mild stinging or burning is expected. - Advise patients to rinse mouth and gargle after use to minimize dry mouth, throat irritation, and hoarseness. - These drugs must be used daily as prescribed, not rapid acting. **Decongestants** - **Actions:** Reduce swelling of nasal passages by shrinking blood vessels. - Sympathomimetics mimic the body\'s adrenaline. - **Uses:** Relieves nasal congestion due to stuffiness and pressure. Can also be used to decrease congestion around the eustachian tubes. - **Side Effects:** Local irritation and dryness of mucous membranes. Systemic effects can occur with overuse, leading to nervousness, insomnia, tremors, and heart palpitations. Oral decongestants may cause headache, nervousness, dizziness, insomnia, and tremors. - **Adverse Effects:** Can cause cardiac dysrhythmias, hypertension, and palpitations, potentially leading to a heart attack. Rebound congestion can occur with overuse of nasal sprays. - **Examples:** oxymetazoline (Afrin), pseudoephedrine (Sudafed). - **Drug Interactions:** Interact with caffeine, MAOIs, amphetamines, ergotamine, selegiline, and linezolid. - **Nursing Implications/Patient Teaching:** - Relief is immediate with sprays/drops. - Use nasal sprays for only a few days to prevent tolerance and rebound congestion. - Caution patients not to swallow the spray. - Advise caution for patients with hypertension, heart disease, glaucoma, or prostate enlargement. - Take oral forms at least 4 hours before bed to prevent insomnia. - Monitor heart rate and blood pressure. **Mucolytics** - **Actions:** Decrease thickness of respiratory secretions, aiding in their removal. They increase fluid in the respiratory tract, which helps break down mucus. - **Uses:** Treat productive cough, useful in COPD, and with coughs associated with viral upper respiratory infections. - **Side Effects:** GI upset, dizziness, headache, and rash. - **Life Span Considerations:** Not for children younger than 2 years or 6 years for some products, due to overdosage risk. - **Examples:** guaifenesin (Mucinex). - **Nursing Implications/Patient Teaching:** - Monitor for thinner secretions. - Ask about dosage if side effects occur. - Ask about back pain and difficulty urinating, as high dosages can cause kidney stones. - Tell patients to seek care if symptoms do not improve within a few days. - Instruct patients that the mucolytic makes sputum easier to expectorate, but will not stop coughing alone. - Advise using a humidifier and drinking at least 2 quarts of water daily. - Instruct patients to take the drug with a full glass of water. - Advise patients to avoid driving or activities requiring alertness until they know how they respond to the drug due to dizziness. **Antitussives** - **Actions:** Relieve or suppress coughing by acting centrally on the cough center in the brain, peripherally by anesthetizing stretch receptors in the respiratory tract, or locally by soothing irritated areas in the throat. - **Uses:** Reduce coughing. - **Side Effects:** Drowsiness, dry mouth, nausea, postural hypotension, and constipation with codeine. - **Adverse Effects:** Opioid antitussives have additive effects with other CNS depressants. - **Life Span Considerations:** Not for children younger than 2 years or 6 years for some products, due to overdosage risk. - **Examples:** benzonatate (Tessalon Perles), dextromethorphan (Delsym). - **Caution:** Opioid antitussives should be used with caution in patients with COPD. - **Nursing Implications/Patient Teaching:** - Instruct patients to take the drug as prescribed. - Advise caution when doing tasks that require alertness while taking an opioid antitussive. - Advise patients about constipation with codeine containing antitussives. - Tell patients not to take opioid antitussives with alcohol or other CNS depressants. - Advise patients to change positions slowly when getting up. **Bronchodilators** - **Actions:** Relax airway smooth muscles, widening the airways by stimulating beta2-adrenergic receptors. - SABAs rapidly bind to beta2 receptors for quick relief. - LABAs bind to beta2 receptors over time for continuous relaxation. - Cholinergic antagonists prevent nervous system from releasing acetylcholine, allowing the body\'s own adrenaline to activate beta2 receptors. - **Uses:** Asthma and COPD, prevent or treat bronchospasms, and other respiratory infections. - SABAs: Reliever/rescue drugs for acute attacks. - LABAs: Controller/prevention drugs, not for rescue. - Cholinergic antagonists: Controller/prevention drugs. - **Side Effects:** Hypertension, tachycardia, headache, insomnia, nervousness, tremors, dry mouth, bad taste. - **Adverse Effects**: Heavy use can cause constriction of heart vessels, leading to chest pain or myocardial infarction. - **Examples:** albuterol (ProAir HFA), salmeterol (Serevent), ipratropium (Atrovent), theophylline. - **Drug Interactions:** MAOIs, tricyclic antidepressants, beta-blockers, other antihypertensives, digoxin, potassium-losing diuretics, and caffeine-containing herbs. - **Nursing Implications/Patient Teaching:** - Take baseline vital signs, and assess for cardiovascular disease. - Teach patients to take the drug as directed and not change the dose. - Advise patients that overuse can result in severe side effects. - Contact healthcare provider if the drug is not helping breathing. - Report any bronchial irritation, dizziness, chest pain, insomnia or changes in symptoms. - Advise patients to drink lots of fluids, especially water. - Do not take any OTC drugs without checking with the healthcare provider. - Use the reliever inhaler 15-30 minutes prior to exercise to prevent exercise-induced bronchospasm. - Shake the inhaler well before using. - Follow the instructions for correct use of the inhaler. - Rinse mouth with water after using inhaler. - Keep count of sprays used, and replace inhaler as needed. - Clean the mouthpiece at least once per week. - Use SABA inhaler before a corticosteroid inhaler when using them both. - Teach patients with asthma to always have their SABA reliever drug with them. **Corticosteroids** - **Actions:** Prevent or limit inflammation and allergy by slowing or stopping production of histamine and leukotriene. They decrease inflamed airways by preventing mast cells and WBCs in the respiratory mucosa from releasing inflammatory mediators, but do not cause bronchodilation. - **Uses:** Allergic reactions, allergies and asthma. Nasal corticosteroids decrease inflammation and swelling in nasal membranes. - **Side Effects:** Sodium retention, hyperglycemia, increased blood pressure, weight gain, bruising, and reduced immunity. - **Drug Interactions:** Increase the effects of barbiturates, sedatives, narcotics, and anticoagulants, and decrease the effects of insulin, oral hypoglycemics, isoniazid, and broad-spectrum antibiotics. - **Examples:** beclomethasone (Qvar), fluticasone (Flovent), fluticasone (Flonase). - **Nursing Implications/Patient Teaching:** - Do not use in patients with sputum containing Candida or who have systemic fungal infections. - Advise patients to rinse their mouths after each use to prevent fungal infection. - Inhaled corticosteroids are not used to treat an acute asthma attack because they are not bronchodilators. - Teach patients to use these drugs daily as prescribed, even when no symptoms are present. - Advise patients to notify the healthcare professional if white patches in the mouth or throat appear. - Teach patients how to properly use the MDI and DPI devices. **Antitubercular Drugs** - **Actions:** Bactericidal and bacteriostatic, control TB organisms. - **Uses:** Direct treatment of TB infection and for prophylaxis in people heavily exposed to the organism. - **First-Line Drugs:** Isoniazid (INH), rifampin (Rifadin), pyrazinamide, and ethambutol (Myambutol). - **Isoniazid (INH):** Kills active mycobacteria and inhibits growth of dormant bacteria. - **Nursing Implications:** Avoid antacids, take on empty stomach, supplement with B-complex vitamins or vitamin B6, avoid alcohol, report signs of liver toxicity, be aware of drug interactions. - **Rifampin:** Kills slower-growing organisms. - **Nursing Implications:** Avoid antacids, take on empty stomach, expect reddish-orange staining, avoid soft contact lenses, avoid alcohol and acetaminophen, report signs of liver toxicity, check blood glucose in diabetic patients, be aware of drug interactions. - **Pyrazinamide:** Kills organisms in acidic environments. - **Nursing Implications:** Ask about gout history, drink at least 8 oz. of water with the tablet, increase fluid intake, avoid sunlight, avoid alcohol, report signs of liver toxicity. - **Ethambutol:** Inhibits bacterial RNA synthesis. - **Nursing Implications:** Take with food to avoid stomach irritation, report changes in vision, avoid alcohol, ask about history of gout, increase fluid intake. - **Second-Line Drugs:** Aminoglycosides such as kanamycin (Kantrex) and capreomycin (Capastat). \* **Nursing Implications:** Monitor for nephrotoxicity, ototoxicity, and respiratory depression. Monitor liver function, vitamin B6 and B12 levels, and drug levels. - **General Nursing Implications/Patient Teaching:** - Do not drink alcohol during treatment. - Set a regular time to take anti-TB drugs. - Take drugs exactly as directed, and what to do if a dose is missed. - Report new symptoms promptly (bruising, fever, sore throat, unusual bleeding, rashes, mental confusion, headache, tremors, severe nausea, vomiting, diarrhea, malaise, yellowish discoloration, visual changes, excessive drowsiness, changes in personality or affect and severe pain). - Normal reddish orange color of urine while taking rifampin. - Do not wear soft contact lenses. - Do not take other drugs without permission. - Take rifampin and isoniazid 1 hour before or 2 hours after meals or antacids. - Take ethambutol with food. - Keep all appointments and laboratory tests.