Upper Respiratory Drugs PDF

Drugs for Upper Respiratory Disorders NUR 210/BSL 101 Unit 8  Common cold Etiology: Rhinovirus Upper Respiratory Affects nasopharyngeal tract Disorders Acute rhinitis Inflammation...

Drugs for Upper Respiratory Disorders NUR 210/BSL 101 Unit 8  Common cold Etiology: Rhinovirus Upper Respiratory Affects nasopharyngeal tract Disorders Acute rhinitis Inflammation of nasal mucous membranes Allergic rhinitis Hay fever due to pollen or foreign substance  First-generation antihistamines ◦ Diphenhydramine ◦ Action ▪ Blocks histamine, which decreases allergic response. ◦ Uses ▪ Treat allergic rhinitis, itching (allergic reaction), prevent motion sickness, sleep aid, antitussive Antihistamines Second-generation antihistamines Nonsedating antihistamines ◦ Loratadine ◦ Action ▪ Work similarly to first-generation but without the drowsiness and anticholinergic side effects ◦ Uses ▪ Allergic rhinitis, itching (allergic reaction). ◦ Long acting medications – longer half-life  Side effects Anticholinergic - Drowsiness, dry Antihistamines – mouth, decreased secretions, dizziness, blurred vision, urinary diphenhydramine retention, constipation & loratadine Photosensitivity Excitability in children Loratadine Less drowsiness Fewer anticholinergic side effects  Diphenhydramine Contraindications/cautions Acute asthma attack Severe liver disease Antihistamines – Caution diphenhydramine narrow-angle glaucoma BPH, urinary retention Pregnancy Interactions Other CNS depressants – more with diphenhydramine  Assessment Nursing Process: Baseline VS Antihistamines Medical/medication history S/S of urinary dysfunction Cardiac and respiratory status Environmental exposures for allergy  Nursing interventions/Teaching ◦ Administer in large muscle IM ◦ Diphenhydramine-Dilute and IV push over several minutes as it can cause burning ◦ Avoid operating motor vehicles if drowsiness occurs. Nursing Process: ◦ Avoid alcohol and other CNS depressants. Antihistamines ◦ Take as prescribed ◦ Use sugarless candy or gum or ice chips for temporary relief of mouth dryness. ◦ Instruct to use caution when giving to children – can cause excitability ◦ Older adult can be more sensitive and can cause confusion  Nasal congestion Dilation of nasal blood vessels ◦ Due to infection, inflammation, allergy Transudation of fluid into tissue spaces ◦ Leads to swelling nasal cavity Nasal Nasal decongestants: Systemic and Nasal Decongestants decongestants 1 Stimulate alpha-adrenergic receptors ◦ Produces nasal vascular vasoconstriction ◦ Shrinks nasal mucous membranes ◦ Reduces nasal secretion ◦ Rebound nasal congestion can occur with overuse Uses ◦ Nasal congestion  Fluticasone Action Intranasal ◦ Steroidal action decreases inflammation Glucocorticoids Uses ◦ Allergic rhinitis Short term use during “allergy season” No rebound congestion with this drug  ▪ Side effects/Adverse reactions ▪ Nervous, jittery, restless Nasal Decongestants - ▪ Hypertension Oxymetazoline ▪ Hyperglycemia HCL & ▪ Tachycardia Pseudoephedrine 1 Frequent use May lead to tolerance May lead to rebound nasal congestion Should not use more than 3 days  ▪ Contraindications/caution ▪ Hypertension Nasal Decongestants - ▪ Cardiac issues Oxymetazoline ▪ Diabetes HCL & Pseudoephedrine 1 ▪ Interactions ▪ Caffeine ▪ Antihypertensive medications ▪ Antidysrhythmic medications  Act on the cough-control center in the medulla to suppress the cough reflex Three types of antitussives are Antitussives - nonnarcotic, narcotic, or combination Dextromethorphan preparations. hydrobromide Dextromethorphan – non-narcotic Use Provide temporary suppression of nonproductive cough, to reduce viscosity of tenacious secretions  Contraindications Antitussives - COPD Dextromethorphan Chronic productive cough hydrobromide Children under 2 Interactions ◦ Other CNS depressants ◦ Grapefruit juice  Guaifenesin Action ◦ Loosens bronchial secretions so they can be coughed up Expectorants Use ◦ Common cold, flu, respiratory illnesses Side effects ◦ Nausea/vomiting, drowsy, headache  Assessment Cold medication Vital signs – check for tachycardia, care plan hypertension Medication/medical history Cardiac and respiratory status Allergies  Interventions/teaching Monitor vital signs Monitor secretions Monitor for cough suppression & resp status with narcotics Teach proper use of nasal spray Cold medication Increase fluids – especially with expectorant care plan Don’t drive until action is known Decongestants can cause insomnia Take early decongestants in the day Decongestants can lead to rebound congestion for overuse Read labels to know what medications are in multiple symptom control medication Contact HCP if cough lasts longer than one week  A client is receiving dextromethorphan (Benylin). The nurse knows the drug is exerting its therapeutic effect when the client Practice Question experiences #1 1 A. thinning of secretions. B. bronchodilation. C. decreased coughing. D. relief of nasal congestion.  Answer: C Practice Question Rationale: Dextromethorphan (Benylin) is #1 1 an antitussive which acts on the cough- control center in the medulla to suppress the cough reflex.  The nurse is teaching an older adult client about guaifenesin (Robitussin). Which information is appropriate to include in this teaching? (Select all that apply.) Practice Question A. Take the drug with a glass of water. #2 1 B. Read labels on over-the-counter drugs and check with health care provider before taking cold remedies. C. Take the drug at bedtime. D. Advise client to contact health care provider if cough persists more than 2 days.  Answer: A, B Rationale: Taking the drug with a glass of water can help loosen mucus. Labels should Practice Question be read, and the health care provider should #2 1 be checked with, to avoid conflict with other medications the client is taking. Cold remedies should not be taken at bedtime. The health care provider should be notified if the cough lasts for 1 week.  A client has been diagnosed with the common cold. The nurse should question if which drug is ordered to treat Practice Question this client? #3 1 A. Antihistamines B. Antitussives C. Expectorants D. Antibiotics  Answer: D Rationale: The common cold is caused by the Practice Question rhinovirus. Antibiotics would not be used to #3 1 treat a virus. Groups of drugs used to manage cold symptoms include antihistamines (H1 blockers), decongestants (sympathomimetic amines), antitussives, and expectorants.  Which medication is a first-generation antihistamine? Practice Question #4 A. Cetirizine (Zyrtec) 1 B. Fexofenadine (Allegra) C. Diphenhydramine (Benadryl) D. Loratadine (Claritin)  Answer: C Rationale: Diphenhydramine (Benadryl) is a first-generation Practice Question antihistamine. Most first-generation antihistamines cause drowsiness, dry #4 1 mouth, and other anticholinergic symptoms. The other options are drugs that are second-generation antihistamines. These drugs have fewer anticholinergic effects and a lower incidence of drowsiness.  When teaching a client about use of nasal decongestant sprays, the nurse informs the client that they are most effective when Practice Question administered for how many days? #5 1 A. 3 days B. 10 days C. 14 days D. 20 days  Answer: A Rationale: Use of nasal decongestants for longer than 3 days could result in Practice Question rebound nasal congestion. Instead of the #5 1 nasal membranes constricting, vasodilation occurs, causing increased stuffy nose and nasal congestion. The nurse should emphasize the importance of limiting the use of nasal sprays and drops.  Before administering diphenhydramine (Benadryl) to a client, it is most important for the nurse to assess the client for a Practice Question history of #6 1 A. allergy to penicillin. B. hypertension. C. diabetes mellitus type 2. D. narrow-angle glaucoma. Practice Question Answer: D Rationale: Diphenhydramine (Benadryl) has #6 1 anticholinergic effects and should not be used by clients with narrow-angle glaucoma.  Which statement about dextromethorphan does the nurse identify as being true? Practice Question #7 1 A. It is a narcotic antitussive. B. It suppresses the cough center of the medulla. C. It suppresses respirations. D. It causes physical dependence.  Answer: B Practice Question Rationale: Dextromethorphan, a nonnarcotic #7 1 antitussive, suppresses the cough center in the medulla but does not depress respiration. It causes neither physical dependence nor tolerance.