Drugs Acting on the Upper Respiratory Tract PDF

Drugs Acting on the Upper Respiratory Tract Prepared by: Yvette M. Batar, RN, MAN, DM Source: Focus on Nursing Pharmacology by Karch (Chapter 54) Learning Objectives Upon completion of this chapter, learners will be able to: 1. Outline the un...

Drugs Acting on the Upper Respiratory Tract Prepared by: Yvette M. Batar, RN, MAN, DM Source: Focus on Nursing Pharmacology by Karch (Chapter 54) Learning Objectives Upon completion of this chapter, learners will be able to: 1. Outline the underlying physiological events that occur with upper respiratory disorders. 2. Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and important drug–drug interactions associated with drugs acting on the upper respiratory tract. 3. Discuss the use of drugs that act on the upper respiratory tract across the lifespan. 4. Compare and contrast the prototype drugs with other agents in their class and with other classes of drugs that act on the upper respiratory tract. 5. Outline the nursing considerations, including important teaching points, for patients receiving drugs acting on the upper respiratory tract.  DRUGS that affect the respiratory system work to keep the airways open & gases moving efficiently. STRUCTURES OF THE UPPER RESPIRATORY TRACT SITES OF ACTION OF DRUGS ACTING ON THE UPPER RESPIRATORY TRACT  UPPER RESPIRATORY TRACT AGENTS ACROSS THE LIFESPAN Children: Adults: o Commonly prescribed, but o Risk of accidental overdose when combining multiple OTC increased risk of adverse effects cold/flu medications. (e.g., sedation, confusion, o Always ask about OTC or herbal remedies before prescribing. dizziness). o Pregnancy and lactation safety not established—potential o Should not be used in children adverse effects on fetus or milk production. under 4 years and with caution in those aged 4-6 years. Older Adults: o Parents must be educated on o More susceptible to adverse effects (e.g., sedation, confusion, dizziness), impacting mobility. reading labels and dosing guidelines to avoid overdose. o Likely to have renal/hepatic impairment affecting drug metabolism. o Encourage nondrug remedies: fluids, humidifiers, avoiding o Start with lower doses and monitor closely. smoke/allergens, frequent o Caution against using OTC drugs without consulting handwashing. healthcare providers.  ANTITUSSIVE o Antitussives are drugs that suppress the cough reflex. o Common respiratory disorders like colds, sinusitis, pharyngitis, and pneumonia often cause unproductive coughs. o Persistent coughing can lead to muscle strain and further irritation of the respiratory tract. o Coughing without an active disease or persisting after treatment might indicate another underlying condition and should be investigated before administering medication. VARIETY OF ADVERSE EFFECTS AND TOXICITIES ASSOCIATED WITH DRUGS AFFECTING THE UPPER RESPIRATORY TRACT ANTITUSSIVE  ANTITUSSIVE o Traditional antitussives (codeine, hydrocodone, dextromethorphan) act on the brain's medullary cough center to suppress cough reflex. Therapeutic Actions & o Not recommended for patients with head injuries or CNS depression risks. Indications o Benzonatate acts locally as an anesthetic on respiratory passages, blocking stretch receptors that trigger coughing. o Used for treating nonproductive coughs. o Codeine, hydrocodone, dextromethorphan: ✓ Rapidly absorbed, metabolized in the liver, and excreted in urine. Pharmacokinetics ✓ Cross the placenta and enter breast milk. o Benzonatate: Metabolized in the liver, excreted in urine. o Not recommended during pregnancy or lactation due to risk to the fetus or baby. o Not recommended for patients who need to cough (e.g., postoperative or thoracic surgery patients). o Use cautiously in patients w/ asthma, emphysema, or a history of narcotic addiction (codeine, hydrocodone). Contraindications (C.Is) o Codeine and hydrocodone: Potential for addiction. & Cautions o Caution for those driving or needing alertness: Can cause sedation or drowsiness. o Should not be used during pregnancy or lactation due to risk of sedation and CNS depression in babies. Traditional antitussives: o Drying effect on mucous membranes, increasing respiratory secretion viscosity. o CNS effects: Drowsiness, sedation. Adverse Effects (AEs) o Other effects: Nausea, constipation, dry mouth. Locally acting antitussives: o GI upset, headache, congestion, dizziness. o Dextromethorphan: Should not be used with monoamine oxidase (MAO) inhibitors due to risk of hypotension, fever, nausea, Drug-drug Interactions myoclonic jerks, and coma.  ANTITUSSIVE Nursing Considerations Nursing Diagnosis Planning o Assess for possible contraindications or cautions: any history of allergy to any component of the drug or drug vehicle to avoid allergic reactions; cough that persists longer than 1 o The patient will receive week or is accompanied by other signs and symptoms, the best therapeutic effect which could indicate a serious underlying medical condition o Ineffective airway from the drug therapy. that should be addressed before suppressing symptoms; and clearance related to o The patient will have pregnancy or lactation because of the potential for adverse effects on the fetus or baby. excessive drug effects limited adverse effects to o Perform a physical examination to establish baseline data for o Disturbed sensory the drug therapy. assessing the effectiveness of the drug and the occurrence perception related to CNS o The patient will have an of any adverse effects associated with drug therapy. understanding of the drug o Monitor temperature to evaluate for possible underlying effects therapy, adverse effects to infection. o Deficient knowledge anticipate, and measures o Assess respirations and adventitious sounds to assess drug regarding drug therapy to relieve discomfort and effectiveness and to monitor for accumulation of secretions. o Evaluate orientation and affect to monitor for CNS effects of improve safety. the drug.  ANTITUSSIVE Implementation with Rationale Evaluation o Ensure that the drug is not taken any longer than recommended to prevent o Monitor patient response to the serious adverse effects and increased respiratory tract problems. drug (control of nonproductive o Arrange for further medical evaluation for coughs that persist or are cough). o Monitor for adverse effects accompanied by high fever, rash, or excessive secretions to detect the (respiratory depression, underlying cause of the cough and to arrange for appropriate treatment of the dizziness, sedation). underlying problem. o Evaluate the effectiveness of the o Provide other measures to help relieve cough (e.g., humidity, cool teaching plan (patient can name temperatures, fluids, use of topical lozenges) as appropriate. drug, dosage, adverse effects to o Provide thorough patient teaching, including the drug name and prescribed watch for, specific measures to avoid them, and measures to dosage, measures to help avoid adverse effects, warning signs that may take to increase the indicate problems, and the need for periodic monitoring and evaluation, to effectiveness of the drug). enhance patient knowledge about drug therapy and to promote compliance. o Monitor the effectiveness of o Offer support and encouragement to help the patient cope with the disease other measures to relieve and the drug regimen. cough.  DECONGESTANTS ANTITUSSIVE Mechanism of action: o Cause local vasoconstriction in the upper respiratory tract, shrinking swollen mucous membranes. o This opens clogged nasal passages, improving airflow and drainage of secretions, relieving blocked nose discomfort. Adverse effects: o Rebound congestion (rhinitis medicamentosa): Prolonged or frequent use can cause rebound vasodilation, leading to overuse of decongestants. Types of decongestants: o Adrenergics or sympathomimetics: Commonly used decongestants. o Topical steroids: Used for chronic rhinitis; take several weeks to become effective.  TOPICAL NASAL DENCONGESTANTS o Topical decongestants: Sympathomimetics that cause vasoconstriction, reducing nasal membrane edema and inflammation. Therapeutic Actions & o Used to relieve nasal congestion associated with cold, sinusitis, allergic rhinitis, and to facilitate medical exams or relieve otitis Indications media pain by opening the nasal passage for better drainage. o Applied topically: Immediate onset of action with minimal systemic absorption. Pharmacokinetics o Any absorbed portion is metabolized in the liver and excreted in the urine. o Caution in cases of mucous membrane lesions or erosion that may lead to systemic absorption. Contraindications (C.Is) o Use cautiously in patients with glaucoma, hypertension, diabetes, thyroid disease, coronary disease, or prostate issues due to & Cautions adrenergic properties. o Pregnancy/lactation: No studies available; use cautiously. o Local effects: Stinging and burning upon initial use. o Discontinue if persistent, as it may indicate mucous membrane lesions. Adverse Effects (AEs) o Rebound congestion: Prolonged use (over 3-5 days) can cause a cycle of congestion and drug overuse. o Systemic effects (less likely but possible): Increased pulse, blood pressure, urinary retention. o Contraindicated with cyclopropane or halothane anesthesia due to risk of serious cardiovascular effects. Drug-drug Interactions o Careful monitoring required with other sympathomimetic or sympathetic-blocking drugs to avoid toxic or ineffective responses.  TOPICAL NASAL DENCONGESTANTS Nursing Considerations Nursing Diagnosis Planning o Assess for possible contraindications or cautions: any history of allergy to the drug or a component of the drug vehicle; glaucoma, hypertension, diabetes, thyroid disease, coronary disease, and o The patient will receive prostate problems, all of which could be exacerbated by the the best therapeutic effect sympathomimetic effects; and pregnancy or lactation, which require cautious use of the drug. o Acute pain related to GI, CNS, or from the drug therapy. o Perform a physical examination to establish baseline data for local effects of drug o The patient will have assessing the effectiveness of the drug and the occurrence of any o Disturbed sensory perception limited adverse effects to adverse effects associated with drug therapy. the drug therapy. (kinesthetic) related to CNS o Assess skin color and temperature to assess sympathetic response. Evaluate orientation and reflexes to evaluate CNS effects of the drug. effects (less likely with this route o The patient will have an Monitor pulse, blood pressure, and cardiac auscultation to assess CV of administration) understanding of the drug and sympathomimetic effects. o Deficient knowledge regarding therapy, adverse effects to o Evaluate respirations and adventitious breath sounds to assess the effectiveness of the drug and potential excess effect. drug therapy anticipate, and measures Perform bladder percussion to monitor for urinary retention related to relieve discomfort and to sympathomimetic effects. improve safety. o Evaluate nasal mucous membrane to monitor for lesions that could lead to systemic absorption and to evaluate decongestant effect.  TOPICAL NASAL DENCONGESTANTS Implementation with Rationale Evaluation o Teach patient the proper administration of the drug to ensure therapeutic effect. The patient should be instructed to clear the nasal passages before use, to tilt the head back when applying the drops o Monitor patient response to the or spray, and to keep it tilted back for a few seconds after administration. This technique helps drug (relief of nasal congestion). ensure contact with the affected mucous membranes and decreases the chances of letting the Monitor for adverse effects (local drops trickle down the back of throat, which may lead to more systemic effects. burning and stinging; adrenergic o Caution the patient not to use the drug for longer than 5 days and to seek medical care if signs and effects such as increased pulse, symptoms persist after that time to facilitate detection of underlying medical conditions that may blood pressure, urinary retention, require treatment. cool and clammy skin). o Caution the patient that these drugs are found in many OTC preparations and that care should be o Evaluate the effectiveness of the taken not to inadvertently combine drugs with the same ingredients, which could lead to overdose. teaching plan (patient can name o Provide safety measures if dizziness or sedation occurs as a result of drug therapy to prevent patient drug, dosage, adverse effects to injury. watch for, specific measures to o Institute other measures to help relieve the discomfort of congestion (e.g., use of a humidifier, avoid them, measures to take to increased fluid intake, cool environment, avoidance of smoke-filled areas) as appropriate. increase the effectiveness of the o Provide thorough patient teaching, including the drug name and prescribed dosage, measures to drug, proper administration help avoid adverse effects, warning signs that may indicate problems, and the need for periodic technique). monitoring and evaluation, to enhance patient knowledge about drug therapy and to promote o Monitor the effectiveness of compliance. comfort and safety measures and o Offer support and encouragement to help the patient cope with the disease and the drug regimen. compliance with the regimen. TOPICAL NASAL DECONGESTANTS ORAL DECONGESTANTS  ORAL DENCONGESTANTS o Oral decongestants: Used to reduce nasal congestion associated with the common cold, sinusitis, allergic rhinitis, Therapeutic Actions & and otitis media. Indications o Work by stimulating alpha-adrenergic receptors in the nasal mucous membranes, causing shrinkage of the membrane and promoting sinus drainage and improved airflow. Pseudoephedrine: Pharmacokinetics o Well absorbed, reaching peak levels in 20-45 minutes. o Metabolized in the liver and excreted in urine. o Caution in patients with conditions that could be worsened by sympathetic activity: Contraindications (C.Is) & Cautions ✓ Glaucoma, hypertension, diabetes, thyroid disease, coronary disease, prostate problems. o Pregnancy and lactation: Use only if the benefits outweigh the risks. o Rebound congestion may occur. o Systemic sympathomimetic effects: Anxiety, tenseness, restlessness, tremors, hypertension, arrhythmias, sweating, Adverse Effects (AEs) pallor. o Risk of overdose when used with other OTC cold and flu medications containing pseudoephedrine. o Avoid concurrent use of multiple products containing pseudoephedrine to prevent overdose. Drug-drug Interactions o Patient education: Teach patients to read labels of OTC medications to avoid inadvertent overdose.  ORAL DENCONGESTANTS Nursing Considerations Nursing Diagnosis Planning o Assess for possible contraindications or cautions: any history of allergy to the drug and pregnancy or lactation, which are contraindications to drug use; hypertension or coronary o The patient will receive artery disease, which require cautious use; and o Acute pain related to GI, CNS, or the best therapeutic effect hyperthyroidism, diabetes mellitus, or prostate enlargement, skin effects of the drug from the drug therapy. all of which could be exacerbated by these drugs. o Increased cardiac output related o The patient will have o Perform a physical examination to establish baseline data for to sympathomimetic actions of limited adverse effects to assessing the effectiveness of the drug and the occurrence the drug the drug therapy. of any adverse effects associated with drug therapy. o Assess skin color and lesions to monitor for adverse o Disturbed sensory perception o The patient will have an reactions. Evaluate orientation, reflexes, and affect to (kinesthetic) related to CNS understanding of the drug monitor CNS effects of the drug. effects therapy, adverse effects to o Monitor blood pressure, pulse, and auscultation to assess CV o Deficient knowledge regarding anticipate, and measures stimulations. drug therapy to relieve discomfort and o Evaluate respiration and adventitious sounds to monitor improve safety. drug effectiveness. Monitor urinary output to evaluate for urinary retention.  ORAL DENCONGESTANTS Implementation with Rationale Evaluation o Note that this drug is found in many behind-the-counter products, especially o Monitor patient response to the combination cold and allergy preparations; care should be taken to prevent inadvertent drug (improvement in nasal overdose or excessive adverse effects. congestion). o Provide safety measures as needed if CNS effects occur to prevent patient injury. o Monitor for adverse effects (sympathomimetic reactions, o Monitor pulse, blood pressure, and cardiac response to the drug, especially in patients including increased pulse, blood who are at risk for cardiac stimulation, to detect adverse effects early and arrange to pressure, pallor, sweating, reduce dose or discontinue the drug. arrhythmias, feelings of anxiety, o Encourage the patient not to use this drug for longer than 1 week and to seek medical tension, dry skin). evaluation if symptoms persist after that time to encourage the detection of underlying o Evaluate the effectiveness of the medical conditions that could be causing these symptoms and to arrange for appropriate teaching plan (patient can name treatment. drug, dosage, adverse effects to o Provide thorough patient teaching, including the drug name and prescribed dosage, watch for, specific measures to avoid them, and measures to take measures to help avoid adverse effects, warning signs that may indicate problems, and to increase the effectiveness of the need for periodic monitoring and evaluation, to enhance patient knowledge about the drug). drug therapy and to promote compliance. o Monitor the effectiveness of o Offer support and encouragement to help the patient cope with the disease and the comfort and safety measures and drug regimen. compliance with the regimen.  TOPICAL NASAL STEROID DECONGESTANTS o Topical nasal steroid decongestants are used for treating allergic rhinitis and post-nasal polyp removal inflammation. Therapeutic Actions & Indications o Effective for patients who no longer respond to other decongestants. o Anti-inflammatory action through a local effect that blocks reactions involved in the inflammatory response. o The onset of action may take up to 1 week, with discontinuation recommended if no effects are seen after 3 weeks. Pharmacokinetics o Minimal systemic absorption, and pharmacokinetics are not reported unless absorbed systemically (like other steroids). o Contraindicated in the presence of acute infections due to interference with inflammatory and immune responses. o Risk of Candida albicans infection due to anti-inflammatory and anti-immune properties. Contraindications (C.Is) o Caution advised for patients with active infections (e.g., tuberculosis), and those exposed to airborne infections (e.g., & Cautions chickenpox, measles).Caution also during pregnancy and lactation, though minimal systemic absorption often allows use in these cases. o Local effects include burning, irritation, stinging, dryness of the mucosa, and headache. Adverse Effects (AEs) o Healing suppression requires monitoring in patients with recent nasal surgery or trauma. Drug-drug Interactions o No mention in the book.  TOPICAL NASAL STEROID DECONGESTANTS Nursing Considerations Nursing Diagnosis Planning o Assess for possible contraindications or cautions: any history of allergy to steroid drugs or any components of the drug vehicle, which would be a o The patient will receive contraindication, and acute infection, which would the best therapeutic effect require cautious use. from the drug therapy. o Acute pain related to local effects o Perform a physical examination to establish baseline o The patient will have of the drug data for assessing the effectiveness of the drug and limited adverse effects to o Risk for injury related to the occurrence of any adverse effects associated with the drug therapy. suppression of inflammatory drug therapy. o The patient will have an reaction o Perform an intranasal examination to determine the understanding of the drug o Deficient knowledge regarding presence of any lesions that would increase the risk therapy, adverse effects to drug therapy of systemic absorption of the drug. anticipate, and measures o Assess respiration and adventitious sounds to to relieve discomfort and evaluate drug effectiveness. improve safety. o Monitor temperature to monitor for the possibility of acute infection.  TOPICAL NASAL STEROID DECONGESTANTS Implementation with Rationale Evaluation o Teach the patient how to administer these drugs properly, which is important to ensure effectiveness and prevent systemic effects. A variety of preparations are available (e.g., sprays, aerosols, powder disks). Advise the patient about the proper administration o Monitor patient response to the technique for whichever preparation is recommended. drug (relief of nasal congestion). o Have the patient clear the nasal passages before using the drug to improve its Monitor for adverse effects effectiveness. (local burning and stinging). o Encourage the patient to continue using the drug regularly, even if results are not seen o Evaluate the effectiveness of the teaching plan (patient can name immediately, because benefits may take 2 to 3 weeks to appear. drug, dosage, adverse effects to o Monitor the patient for the development of acute infection that would require medical watch for, specific measures to intervention. Encourage the patient to avoid areas where airborne infections could be a avoid them, and measures to problem because steroid use decreases the effectiveness of the immune and take to increase the inflammatory responses. effectiveness of the drug). o Provide thorough patient teaching, including the drug name and prescribed dosage, o Monitor the effectiveness of measures to help avoid adverse effects, warning signs that may indicate problems, and comfort and safety measures the need for periodic monitoring and evaluation, to enhance patient knowledge about and compliance with the drug therapy and to promote compliance. regimen. o Offer support and encouragement to help the patient cope with the disease and the drug regimen. TOPICAL NASAL STEROID DECONGESTANTS ANTIHISTAMINES Action: o Antihistamines block the release or action of histamine, which is released during inflammation, increasing secretions and narrowing airways. Uses: o Found in many over-the-counter (OTC) preparations to relieve respiratory symptoms and treat allergies. Selection: o Choice of antihistamine depends on the patient’s reaction to the drug. o First-generation antihistamines have more anticholinergic effects, causing drowsiness. o Second-generation antihistamines are less sedating but may still cause drowsiness in some individuals. Cautions: o Care should be taken until patients know how they react to the drug. o OTC antihistamines are often misused for treating colds and flu.  ANTIHISTAMINES o Block histamine-1 receptors, reducing allergic response. o Anticholinergic (atropine-like) and antipruritic effects. o Used for: ✓ Seasonal and perennial allergic rhinitis. ✓ Allergic conjunctivitis. Therapeutic Actions & ✓ Uncomplicated urticaria (hives) and angioedema. Indications ✓ Allergic reactions to blood or blood products. ✓ Relief for dermographism discomfort. ✓ Adjunct therapy in anaphylactic reactions. ✓ Potential use in exercise-induced asthma and histamine-induced bronchoconstriction. o Most effective when used before symptoms begin. o Absorbed orally, onset in 1-3 hours. Pharmacokinetics o Metabolized in the liver, excreted via feces and urine. o Crosses placenta and enters breast milk. o Avoid use during pregnancy or lactation unless necessary. Contraindications (C.Is) o Caution in renal or hepatic impairment. & Cautions o Avoid in patients with arrhythmias or prolonged QT intervals due to risk of fatal cardiac arrhythmias. o Common: Drowsiness and sedation (less with second-generation antihistamines). Adverse Effects (AEs) o Anticholinergic effects: Drying of respiratory and GI membranes, nausea, GI upset. o Other effects: Arrhythmias, dysuria, urinary hesitancy, skin eruptions, and itching. o Anticholinergic effects may be prolonged with MAO inhibitors (e.g., diphenhydramine). Drug-drug Interactions o Fexofenadine levels may become toxic with ketoconazole or erythromycin.  ANTIHISTAMINES Nursing Considerations Nursing Diagnosis Planning o Assess for possible contraindications or cautions: any history of allergy to antihistamines; pregnancy or lactation; prolonged QT interval, which are o The patient will receive contraindications to the use of the drug; and renal or the best therapeutic effect hepatic impairment, which requires cautious use of the drug. from the drug therapy. o Perform a physical examination to establish baseline data o Acute pain related to GI, CNS, or o The patient will have for assessing the effectiveness of the drug and the skin effects of the drug limited adverse effects to occurrence of any adverse effects associated with drug o Disturbed sensory perception the drug therapy. therapy. (kinesthetic) related to CNS o The patient will have an o Assess the skin color, texture, and lesions to monitor for effects understanding of the drug anticholinergic effects or allergy. o Deficient knowledge regarding therapy, adverse effects to o Evaluate orientation, affect, and reflexes to monitor for drug therapy anticipate, and measures changes due to CNS effects. to relieve discomfort and o Assess respirations and adventitious sounds to monitor improve safety. for drug effects. o Evaluate liver and renal function tests to monitor for factors that could affect the metabolism or excretion of the drug.  ANTIHISTAMINES Implementation with Rationale Evaluation o Monitor patient response to the o Administer drug on an empty stomach 1 hour before or 2 hours after meals to increase the absorption of drug (relief of the symptoms of the drug; the drug may be given with meals if GI upset is a problem. o Note that the patient may have poor response to one of these agents but an effective response to another; allergic rhinitis). the prescriber may need to try several different agents to find the one that is most effective. o Monitor for adverse effects (skin o Because of the drying nature of antihistamines, patients often experience dry mouth, which may lead to dryness, GI upset, sedation and nausea and anorexia; suggest sugarless candies or lozenges to relieve some of this discomfort. drowsiness, urinary retention, o Provide safety measures as appropriate if CNS effects occur to prevent patient injury. thickened secretions, glaucoma). Increase humidity and push fluids to decrease the problem of thickened secretions and dry nasal mucosa. o Evaluate the effectiveness of the o Have patient void before each dose to decrease urinary retention if this is a problem. teaching plan (patient can name o Provide skin care as needed if skin dryness and lesions become a problem to prevent skin breakdown. drug, dosage, adverse effects to o Caution the patient to avoid excessive dose and to check OTC drugs for the presence of antihistamines, watch for, specific measures to which are found in many OTC preparations and could cause toxicity. avoid them, and measures to take o Caution the patient to avoid alcohol while taking these drugs because serious sedation can occur. to increase the effectiveness of o Provide thorough patient teaching, including the drug name and prescribed dosage, measures to help the drug). avoid adverse effects, warning signs that may indicate problems, and the need for periodic monitoring and o Monitor the effectiveness of evaluation, to enhance patient knowledge about drug therapy and to promote compliance. comfort and safety measures and o Offer support and encouragement to help the patient cope with the disease and the drug regimen. compliance with the regimen. ANTIHISTAMINES EXPECTORANTS  EXPECTORANTS Availability: o Purpose: o Commonly found in OTC preparations. o Increase productive cough to help clear airways. o Widely available without needing a prescription or advice from a healthcare o Liquefy lower respiratory tract secretions. provider. o Reduce viscosity of secretions, making it Common Example: easier to cough them up. o Guaifenesin (e.g., Mucinex) is the only available expectorant.  EXPECTORANTS (Guaifenesin) o Enhances respiratory fluid output by reducing adhesiveness and surface tension. Therapeutic Actions & Indications o Thins secretions, making them easier to cough up. o Leads to a more productive cough and reduced coughing frequency. o Rapid absorption with onset in 30 minutes. Pharmacokinetics o Duration of effect is 4 to 6 hours. o Sites of metabolism and excretion are not reported. o Should not be used in patients with known allergies to guaifenesin. Contraindications (C.Is) & Cautions o Use with caution during pregnancy and lactation due to potential adverse effects. o Caution with persistent coughs, which may indicate an underlying medical issue. o Common: GI symptoms (nausea, vomiting, anorexia), headache, dizziness, mild rash. Adverse Effects (AEs) o Prolonged use may mask symptoms of a serious underlying disorder. o Should not be used for more than 1 week; if the cough persists, seek medical advice. Drug-drug Interactions o No mention in the book.  EXPECTORANTS (Guaifenesin) Nursing Considerations Nursing Diagnosis Planning o Assess for possible contraindications or cautions: any history of allergy to the drug; persistent cough due to smoking, asthma, or emphysema, which would be cautions to the use of the drug; and productive cough, o The patient will receive which would indicate an underlying problem that should the best therapeutic effect be evaluated. from the drug therapy. o Acute pain related to GI, CNS, or o Perform a physical examination to establish baseline data o The patient will have skin effects of the drug for assessing the effectiveness of the drug and the limited adverse effects to o Disturbed sensory perception occurrence of any adverse effects associated with drug the drug therapy. (kinesthetic) related to CNS therapy. o The patient will have an o Assess the skin for the presence of lesions and color to effects understanding of the drug monitor for any adverse reactions. o Deficient knowledge regarding therapy, adverse effects to o Monitor temperature to assess for an underlying drug therapy anticipate, and measures infection. to relieve discomfort and o Assess respirations and adventitious sounds to evaluate improve safety. the respiratory response to the drug effects. o Monitor orientation and affect to monitor CNS effects of the drug.  EXPECTORANTS (Guaifenesin) Implementation with Rationale Evaluation o Caution the patient not to use these drugs for longer than 1 week and to seek medical attention if the cough persists after that time to evaluate for any underlying medical o Monitor patient response to the condition and to arrange for appropriate treatment. drug (improved effectiveness of cough). o Advise the patient to take small, frequent meals to alleviate some of the GI discomfort o Monitor for adverse effects (skin associated with these drugs. rash, GI upset, CNS effects). o Advise the patient to avoid driving or performing dangerous tasks if dizziness and o Evaluate the effectiveness of the drowsiness occur to prevent patient injury. teaching plan (patient can name o Alert the patient that these drugs may be found in OTC preparations and that care drug, dosage, adverse effects to should be taken to avoid excessive doses. watch for, specific measures to o Provide thorough patient teaching, including the drug name and prescribed dosage, avoid them, and measures to take measures to help avoid adverse effects, warning signs that may indicate problems, and to increase the effectiveness of the drug). the need for periodic monitoring and evaluation, to enhance patient knowledge about o Monitor the effectiveness of drug therapy and to promote compliance. comfort and safety measures and o Offer support and encouragement to help the patient cope with the disease and the compliance with the regimen. drug regimen.  MUCOLYTICS o Mucolytics: Medications that increase or liquefy respiratory secretions. o Purpose: Aid in clearing airways in high-risk respiratory patients with thick, tenacious secretions. o Common Conditions Treated: ✓ Chronic obstructive pulmonary disease (COPD) ✓ Cystic fibrosis ✓ Pneumonia ✓ Tuberculosis o Examples of Mucolytics: ✓ Acetylcysteine (generic) ✓ Dornase alfa (Pulmozyme) MUCOLYTICS  MUCOLYTICS Acetylcysteine: o Used orally to protect liver cells during acetaminophen toxicity. o Normalizes hepatic glutathione and binds with hepatotoxic metabolites. Therapeutic Actions & o Splits disulfide bonds in mucoproteins, reducing mucus tenacity and viscosity. Indications Dornase alfa: o Mucolytic created by recombinant DNA techniques. o Breaks down mucus by separating extracellular DNA from proteins. o Used in cystic fibrosis to manage thick mucus. o Administration: Nebulization or direct instillation into the trachea (via endotracheal tube/tracheostomy). Pharmacokinetics o Acetylcysteine: Metabolized in the liver, some excretion via urine. o Dornase alfa: Long duration of action, unknown fate in the body. Contraindications (C.Is) o Caution in cases of acute bronchospasm, peptic ulcer, and esophageal varices. & Cautions o No data on effects during pregnancy or lactation. Adverse Effects (AEs) o Common side effects include GI upset, stomatitis, rhinorrhea, bronchospasm, and rash. Drug-drug Interactions o No mention in the book.  MUCOLYTICS Nursing Considerations Nursing Diagnosis Planning o Assess for possible contraindications or cautions: any history of allergy to the drugs and the presence of o The patient will receive acute bronchospasm, which are contraindications to the best therapeutic effect the use of these drugs, and peptic ulcer and o Acute pain related to GI, CNS, or from the drug therapy. esophageal varices, which would require careful skin effects of the drug o The patient will have monitoring and cautious use. o Disturbed sensory perception limited adverse effects to o Perform a physical examination to establish baseline (kinesthetic) related to CNS the drug therapy. data for assessing the effectiveness of the drug and effects o The patient will have an the occurrence of any adverse effects associated with o Ineffective airway clearance understanding of the drug drug therapy. related to bronchospasm therapy, adverse effects to o Assess skin color and lesions to monitor for adverse o Deficient knowledge regarding anticipate, and measures reactions. Monitor blood pressure and pulse to drug therapy to relieve discomfort and evaluate cardiac response to drug treatment. improve safety. o Evaluate respirations and adventitious sounds to monitor drug effectiveness.  MUCOLYTICS Implementation with Rationale Evaluation o Avoid combining with other drugs in the nebulizer to avoid the formation of precipitates o Monitor patient response to the and potential loss of effectiveness of either drug. drug (improvement of o Dilute concentrate with sterile water for injection if buildup becomes a problem that respiratory symptoms and could impede drug delivery. loosening of secretions). o Note that patients receiving acetylcysteine by face mask should have the residue wiped o Monitor for adverse effects off the face mask and off the face with plain water to prevent skin breakdown. (CNS effects, skin rash, o Review use of the nebulizer with patients receiving dornase alfa at home to ensure the bronchospasm, and GI upset). most effective use of the drug. Patients should be cautioned to store the drug in the o Evaluate the effectiveness of the refrigerator, protected from light. teaching plan (patient can name o Caution cystic fibrosis patients receiving dornase alfa about the need to continue all drug, dosage, adverse effects to therapies for their cystic fibrosis because dornase alfa is only a palliative therapy that watch for, specific measures to improves respiratory symptoms and other therapies are still needed. avoid them, and measures to o Provide thorough patient teaching, including the drug name and prescribed dosage, take to increase the measures to help avoid adverse effects, warning signs that may indicate problems, and effectiveness of the drug). the need for periodic monitoring and evaluation, to enhance patient knowledge about o Monitor the effectiveness of drug therapy and to promote compliance. comfort and safety measures and compliance with the o Offer support and encouragement to help the patient cope with the disease and the regimen. drug regimen.