Drugs Acting On The Upper Respiratory Tract PDF

Drugs Acting on the Upper Respiratory Tract Chapter 54 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Drugs Used to Treat Upper Respiratory Infections Antitussives – Block the cough reflex Decongestants – Decreas...

Drugs Acting on the Upper Respiratory Tract Chapter 54 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Drugs Used to Treat Upper Respiratory Infections Antitussives – Block the cough reflex Decongestants – Decrease the blood flow to the upper respiratory tract and decrease the overproduction of secretions Antihistamines – Block the release or action of histamine that increases secretions and narrows airways Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Drugs Used to Treat Upper Respiratory Infections (cont.) Expectorants – Increase productive cough to clear airways Mucolytics – Increase or liquefy respiratory secretions to aid clearing of airways Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Sites of Action of Drugs Working on the Upper Respiratory Tract Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Antitussives Actions – Act directly on the medullary cough center of the brain to depress the cough reflex Indications – Control nonproductive cough Pharmacokinetics – Rapidly absorbed, metabolized in the liver, and excreted in the urine Contraindications – Patients who need to cough to maintain the airway – Head injury or impaired CNS Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Antitussives (cont.) Caution – Hypersensitivity or history of narcotic addiction Adverse Effects – Drying effect on the mucous membranes – CNS adverse effects – GI upset Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Topical Nasal Decongestants Actions – Sympathomimetic – Affects sympathetic nervous system to cause vasodilatation – Causing less inflammation of the nasal membrane Indications – Relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Topical Nasal Decongestants (cont.) Pharmacokinetics – Generally not absorbed systemically – Any portion of these topical decongestants that is absorbed is metabolized in the liver and excreted in the urine Contraindications – Lesion or erosion in the mucous membranes Caution – Any condition that might be exacerbated by sympathetic activity Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Topical Nasal Decongestants (cont.) Adverse Effects – Local stinging and burning – Rebound congestion – Sympathomimetic effects Drug-to-Drug Interactions – Cyclopropane or halothane Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Question Please answer the following statement as true or false. Antitussive agents should be used with caution in patients who have a history of addiction. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Answer True Rationale: Caution should also be used in patients who are hypersensitive to or have a history of addiction to narcotics (codeine, hydrocodone). Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Oral Decongestants Actions – Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes Indications – Promotion of drainage in the sinuses and improving air flow Pharmacokinetics – Well absorbed, widely distributed in the body – Metabolized in the liver and primarily excreted in urine Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Oral Decongestants (cont.) Contraindications – Any condition that might be exacerbated by sympathetic activity Adverse Effects – Rebound congestion – Sympathetic effects Drug-to-Drug Interactions – OTC products that contain pseudoephedrine; taking concurrently can cause serious side effects Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Topical Nasal Steroid Decongestants Actions – Exact mechanism of action is not known Indications – Seasonal allergic rhinitis – Inflammation after the removal of nasal polyps Pharmacokinetics – Generally not absorbed systemically Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Topical Nasal Steroid Decongestants (cont.) Contraindications – Acute infection Caution – Active infection – Avoid exposure to airborne infections Adverse Effects – Local burning, irritation, stinging, dryness of the mucosa, and headache – Suppression of healing can occur in a patient who has had nasal surgery or trauma Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Antihistamines Actions – Selectively block the effects of histamine at the histamine-1 receptor sites, decreasing the allergic response – Anticholinergic and antipruritic effects Indications – Seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria, and angioedema Pharmacokinetics – Well absorbed, metabolized in the liver, excreted in urine and feces Contraindications – Pregnancy and lactation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Antihistamines (cont.) Caution – Renal or hepatic impairment – History of arrhythmias Adverse Effects – Drowsiness and sedation – Anticholinergic effects Drug-to-Drug Interactions – Vary based on the drug Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Expectorants Actions – Enhances the output of respiratory tract fluids by reducing the adhesiveness and surface tension of these fluids, allowing easier movement of the less viscous secretions – Indications – Symptomatic relief of respiratory conditions characterized by a dry, non-productive cough Pharmacokinetics – Rapidly absorbed, metabolism and excretion has not been reported Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Expectorants (cont.) Adverse Effects – GI symptoms – Headache – Dizziness – Mild rash – Prolonged use may result in masking a serious underlying disorder Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Question Which of the following is an adverse reaction to topical nasal steroids? A. Increased nasal drainage B. Rebound effect C. Suppression of healing D. Local ulceration Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Answer C. Suppression of healing Rationale: Adverse Effects: local burning, irritation, stinging, dryness of the mucosa, and headache; suppression of healing can occur in a patient who has had nasal surgery or trauma. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Mucolytics Actions – Work to break down mucous in order to aid the high-risk respiratory patient in coughing up thick, tenacious secretions Indications – Patients who have difficulty coughing up secretions – Patients who develop atelectasis – Patients undergoing diagnostic bronchoscopy – Postoperative patients – Patients with tracheostomies Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Mucolytics (cont.) Pharmacokinetics – Nebulization or direct instillation into the trachea Caution – Acute bronchospasm, peptic ulcer, and esophageal varicies Adverse Effects – GI upset – Stomatitis and/or rhinorrhea – Bronchospasm – Rash Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Use of Upper Respiratory Tract Agents Across the Lifespan Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Prototype Antitussives Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Prototype Topical Nasal Decongestants Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Prototype Topical Nasal Steroid Decongestants Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Prototype Antihistamines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Prototype Expectorants Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Prototype Mucolytics Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Question What drug enhances the output of respiratory tract fluid by reducing the adhesiveness and surface tension of the fluid, which facilitates the removal of viscous mucus? A. Guaifenesin B. Flunisolide C. Acetylcysteine D. Dextromethorphan Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Answer C. Acetylcysteine Rationale: Actions: Enhances the output of respiratory tract fluid by reducing the adhesiveness and surface tension of the fluid, facilitating the removal of viscous mucus. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Nursing Considerations for Antitussives Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Nursing Considerations for Topical Nasal Decongestants Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Nursing Considerations for Oral Decongestants Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Nursing Considerations for Topical Nasal Steroid Decongestants Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Considerations for Antihistamines Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Considerations for Expectorants Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins  Nursing Considerations for Mucolytics Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins