Respiratory Agents PDF
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Dr. Deanna Womble
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This presentation details respiratory agents, focusing on key terminology, objectives, and different types of medications used to treat upper and lower respiratory conditions. It covers various aspects including drug interactions, adverse effects and nursing considerations.
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Respiratory Agents DR. DEANNA WOMBLE DNP, MSN, APRN, FNP-C, CNE Objectives Define key terminology related to the respiratory system and medication management of medical conditions that affect the respiratory system Recall the anatomy and function of the respiratory system Recal...
Respiratory Agents DR. DEANNA WOMBLE DNP, MSN, APRN, FNP-C, CNE Objectives Define key terminology related to the respiratory system and medication management of medical conditions that affect the respiratory system Recall the anatomy and function of the respiratory system Recall administration of inhalers and nebulized medications and educating patients on self-administration via these routes. Differentiate between and recognize medical conditions of the upper and lower respiratory tract that necessitate treatment with a pharmacologic agent. Explain the indications, actions, contraindications, serious and most common adverse effects and nursing implications of select drugs and classifications acting on the upper and lower respiratory tract. Explain life span considerations for drugs that affect the respiratory system. Recognize drug-drug interactions, drug-food interactions and/or drug-lab interactions of select drugs that affect the respiratory system. Recognize and categorize prototype and select drugs from each classification of drugs that affect the upper and lower respiratory system Key Terminology sinusitis, pharyngitis, rhinitis, laryngitis, bronchitis, pneumonia, chronic obstructive pulmonary disease (COPD), seasonal, perennial, urticaria, bronchospasm, pruritis, epistaxis, rhinitis medicamentosa, dysphonia Need to Know Drugs Antitussives: benzonatate, codeine, dextromethorphan Decongestants (nasal and oral): oxymetazoline, phenylephrine Intranasal glucocorticoids: fluticasone Antihistamines (first & second generation): diphenhydramine, cetirizine Expectorants: guaifenesin Mucolytics: acetylcysteine Need to Know Drugs Drugs affecting inflammation Inhaled glucocorticoids budesonide (Pulmicort),fluticasone (Flovent), triamcinolone (Azmacort) Leukotriene Receptor Antagonists montelukast (Singulair) Need to Know Drugs Bronchodilators Beta 2 adrenergic agonists albuterol, formoterol, epinephrine Methylxanthines theophylline Anticholinergics ipratropium (Atrovent), tiotropium (Spiriva) Need to Know Drugs Corticosteroids- budesonide, fluticasone, triamcinolone Digging Deeper Anti-tussive-hydrocodone (scheduled)-can be combined with homatropine Decongestants-naphazoline, pseudoephedrine (Sudafed), tetrahydrozoline, xylometazoline (Otrivin) Topical Decongestants-Nasal Steroids flunisolide (Nasalide), budesonide (Rhinocort), mometasone (Nasonex), beclomethasone Antihistamines 1 st gen-brompheniramine (Dimetapp), chlorpheniramine (Chlortrimeton), clemastine (Tavist), cyproheptadine, dexchlopheniramine, promethazine (Phenergan), triprolidine 2 nd gen- acrivastine with pseudoephedrine (combo), azelastine (Astelin), cetirizine (Zyrtec), desloratadine (Clarinex), fexofenadine (Allegra), levocetirizine (Xyzal), loratadine (Claritin), olopatadine (Patanol) Digging Deeper Bronchodilators/Anti-Asthmatic Xanthines aminophylline, dyphylline, Sympathomimetics- arformoterol, indacaterol, levalbuterol, terbutaline, Anticholinergics aclidinium, tiotropium (Spiriva) Drugs affecting inflammation Leukotriene Receptor Antagonists zafirlukast (Accolate), zileuton (Zyflo CR) , roflumilast (Daliresp) Inhaled corticosteroid beclomethasone, budesonide (Pulmicort), ciclesonide (Alvesco),, mometasone (Asmanex), triamcinolone (Azmacort) Mast cell stabilizers-cromolyn, nedocromil Digging Deeper Corticosteroids-beclomethasone, ciclesonide, mometasone, flunisolide Other anti-inflammatory agents roflumilast (Daliresp)-PDE4 inhibitor umeclidinium [Incruse ellipta (long acting muscarinic)] umeclidinium/vilanterol [Anora ellipta (long acting muscarinic +long-acting beta 2 agonist)] fluticasone furoate/vilanterol [Breo ellipta (long-acting beta 2 agonist + corticosteroid), fluticasone/salmeterol (Advair) The Respiratory Tract Upper Respiratory Tract Lower Respiratory Tract Conditions of the Respiratory System Upper Respiratory System Lower Respiratory System Common Cold Pneumonia Allergic Rhinitis (seasonal and Bronchitis perennial) Obstructive Pulmonary Diseases: Sinusitis Asthma, COPD (emphysema, chronic bronchitis), cystic fibrosis, respiratory Pharyngitis and Laryngitis distress syndrome Medications LOWER AND UPPER RESPIRATORY TRACT OTC Cold Remedies Use in children should be limited or used with caution CDC no in < 2 y.o. AAP no if < 6 y.o. Cough and cold labeling: no < 4y.o. Confusing for parents Educate Avoid in children < 4-6 y.o. Use only pediatric products Consult PCP prior to using Read label and use proper measuring device Stop use and contact PCP if child worsens or doesn’t improve Avoid antihistamines to sedate children Symptomatic treatment-hydration, cool mist humidifier, avoid exposure to secondhand smoke/allergens/irritants, hand hygiene. Intranasal Glucocorticoids fluticasone (Flonase) Indications: seasonal allergic rhinitis; inflammation after removal of nasal polyps Actions: relieves inflammation; exact mechanism of action is unknown Contraindications: acute infection (if systemic absorption occurs, worsens infection) Drug interactions: systemic corticosteroid therapy Intranasal Glucocorticoids Adverse effects: local burning, irritation, stinging, dryness of the mucosa; epistaxis Nursing Considerations: Assess for intranasal lesion before administering, administer properly and educate patient on proper administration; if nasal decongestant-give before intranasal glucocorticoid; respiratory and ENT assessment Antihistamines First Generation: diphenhydramine (Benadryl) Second Generation: cetirizine (Zyrtec) Indications: allergic rhinitis, uncomplicated urticaria, allergic rxn to blood and blood products and adjunctive tx with anaphylaxis, some used for motion sickness and insomnia Actions: selectively block the effects of histamine-decreasing the allergic response and results in decreased sneezing, rhinorrhea and itching (does not help with nasal congestion); anticholinergic (1 st gen. mainly) and antipruritic effects Contraindications: other CNS depressants (alcohol), anticholinergics and drugs with anticholinergic properties, glaucoma, BPH Adverse reactions: drowsiness, sedation, anticholinergic effects (dryness, urinary retention), excitation (children) Nursing Considerations: minimize symptoms of side effects (dry mouth/mm-lozenges, sugarless candy, oral care, humidifier, push fluids; urinary retention-void frequently; Educate-OTC meds, avoid alcohol and other sedating medications; avoid driving if CNS side effects occur; more effective if started before symptoms; if GI upset give with food; no in infants < 6 mo. (caution if older because of risk of sedation and respiratory depression); older adults more affected by CNS and anticholinergic adverse effects; educate pt.. not to use for longer than recommended, OTC education; respiratory and ENT assessment Decongestants Can be topical (nasal, ophthalmic) or systemic (oral) Nasal: oxymetazoline (Afrin), phenylephrine, Oral: phenylephrine (Sudafed) Decongestants Topical Nasal Decongestants: oxymetazoline (Afrin), phenylephrine Oral Decongestants: phenylephrine (Sudafed)-alpha specific adrenergic agonist Indications: relieve discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis Actions: vasoconstriction and less inflammation to the nasal mucus membrane; decreases overproduction of secretions Contraindications: lesion or erosion in the mucus membranes (nasal); HTN, cardiac conditions (oral) Adverse effects: Nasal [local stinging and burning, rebound congestion (rhinitis medicamentosa); if absorbed systemically or excessive dosage may see elevated HR, BP (CNS stimulation-restless, insomnia, anxiety)]; oral (CNS stimulation, elevated HR and BP) Decongestants Nursing Considerations Monitor for signs of systemic absorption, assess nasal mucosa prior to administration and throughout treatment for lesions Administer properly and educate in proper administration Do not use for more than 5 days Very effective at relieving congestion short term Educate pt.. not to use for longer than recommended, OTC education Respiratory and ENT assessment Antitussives codeine (scheduled), dextromethorphan (Delsym), benzonatate (Tessalon) Indications: controls nonproductive cough; suppresses the cough reflex Actions: acts directly on the medullary cough center of the brain to depress the cough reflex, *benzonatate (local anesthetic on respiratory passages) Contraindications: patients who need to cough to maintain an open airway; CNS depression; children 20mcg/mL) restlessness, insomnia, seizures; tachycardia; death Nursing Considerations: Assess CV, pulse, BP; assess serum theophylline levels or compare to previous levels; Educate smokers and importance of timely follow up for blood levels; drug level affected by pt.. factors that affect metabolism; po or IV in an emergency; monitor for toxicity; resp assessment before and throughout ipratropium (Atrovent)-also topical nasal Anticholinergics spray, tiotropium (Spiriva) Indications: maintenance treatment of bronchospasm associated with COPD (off label for asthma); nasal spray (allergic rhinitis and common cold) Actions: block muscarinic receptors in lungs decreasing bronchoconstriction Caution: any condition that would be aggravated by the anticholinergic effects of the drug (narrow angle glaucoma, bladder neck obstruction, BPH) Anticholinergics Adverse effects: systemic absorption rare - if occurs see usual anticholinergic effects (increased i.o.p, tachycardia, urinary retention, constipation, etc.); dry mouth/throat (general AE and if anticholinergic effects) Drug interactions: other anticholinergics Nursing Considerations: educate about inhaler use; resp. assessment before and throughout; DuoNeb (albuterol/ipratropium); monitor for anticholinergic effect Combination therapy Glucocorticoid/LABA (budesonide/formoterol- Symbicort) Beta 2 adrenergic agonist/Anticholinergic Nebulizer (DuoNeb-albuterol and ipratropium) Concurrent Drug Therapy Corticosteroids- budesonide, fluticasone, triamcinolone Po, IM or IV Anti-infective- antibiotics, antivirals, antifungals, antimycobacterial Consider possibility of OTC, herbal, homeopathic treatments General Patient Education Smoking cessation and dangers of smoking Asthma-avoid triggers and allergens Proper use of medication delivery device SABA only for acute attack (bronchoconstriction) SABA prn If using SABA more than twice a week, see provider Regular follow-up How to monitor for worsening of condition (asthma-peak flow meter), increased use of SABA, worsening of symptoms References Burchum, J. R. & Rosenthal. L. D. (2022). Lehne’s pharmacology for nursing care (11th ed.). Elsevier. Colgrove, C. & Doherty, C. (2019). Pharmacology success: NCLEX style Q & A review. (3rd edition). F.A. Davis Craig, G. P. (2020) Clinical calculations made easy: Solving problems using dimensional analysis (7th ed.). Wolters Kluwer. Ignatavicius, D.D., Workman, M. L., Rebar, C. R. & Heimgartner, N. M. (2021). Medical-Surgical nursing : Concepts for interprofessional collaborative care (10th ed.). Elsevier. Lynn, P. (2023). Taylor’s clinical nursing skills (6th ed.). Wolters Kluwer. Taylor, C., Lynn, P. & Bartlett, JL. (2023 ). Fundamentals of nursing: The art and science of person-centered care (10th ed.). Lippincott, Williams and Wilkins Vallerand, A. H. & Sanoski, C. A. (2021). Davis drug guide for nurses (17th ed.). F.A. Davis Image References American Academy of Pediatrics. (n.d.). How to use an MDI closed mouth inhaler. Retrieved on 11/7/23 from https://www.youtube.com/watch?v=_euQJqoD120 American Lung Association. (n.d.). How to properly use a nebulizer. Retrieved on 11/7/23 from https://www.youtube.com/watch?v=pEKFKZiLNaA Boston Children's Hospital. (n.d.). How to use the respimat inhaler. Retrieved on 11/7/23 from https://www.youtube.com/watch?v=Joe8iZxr_w0 Centers for Disease Control. (n.d.). Using a metered dose inhaler with a spacer. Retrieved on 11/7/23 from https://www.youtube.com/watch?v=_euQJqoD120 Image References Lung Foundation Australia. (n.d.). Inhaler device technique: Accuhaler. Retrieved on 11/7/23 from https://www.youtube.com/watch?v=9gZAl5q-XnE Socratic Q & A. (2017). Anatomy & physiology: What structures are in the upper respiratory tract? And lower?. Retrieved on 11/7/23 from https://socratic.org/questions/what-structures-are-in-the-upper- respiratory-tract-and-the-lower Photos or pictures without a source are from creative commons or are personal photos of the author