Nurs 321 Pharmacology Upper Respiratory Su24 RV 7-14 PDF

UPPER RESPIRATORY C H A P T E R S : 5 3 ( R E V I E W O N LY ) & 5 4 UPPER RESPIRATORY Chapters 53 & 54 Objectives Outline the underlying physiological events that occur with upper respirato...

UPPER RESPIRATORY C H A P T E R S : 5 3 ( R E V I E W O N LY ) & 5 4 UPPER RESPIRATORY Chapters 53 & 54 Objectives Outline the underlying physiological events that occur with upper respiratory disorders. 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. Discuss the use of drugs that act on the upper respiratory tract across the lifespan. 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. Outline the nursing considerations, including important teaching points, for patients receiving drugs acting on the upper respiratory tract. Chapter 53: Self-Review on Introduction to Respiratory System Anatomy  CHAPTER 54: DRUGS ACTING ON THE UPPER RESPIRATORY TRACT HERE ARE SITES OF DRUG ACTION ON THE UPPER AND LOWER RESPIRATORY TRACT. Pg. 958, Figure 54.1 Copyright 2017 Wolters Kluwer All Right Reserves  Some Common Upper Respiratory Infections (URI) Upper respiratory infections (URIs) are common illnesses that affect the upper respiratory tract, which includes the nose, throat, sinuses, larynx (voice box), and trachea (windpipe). They are usually caused by viruses or bacteria but can also be caused by mycoplasma or fungi. COMMON COLD RHINOSINUSITIS LARYNGITIS OR PHARYNGITIS EPIGLOTITIS  UPPER RESPIRATORY INFECTIONS Upper Respiratory Symptoms Include: Treatment: infections include: Cough Rest Common cold Fever Fluids Epiglottis Hoarse voice OTC Medications Laryngitis Fatigue and lack Pharyngitis of energy Rhinosinusitis Red eyes Runny nose Sore throat Swollen lymph nodes  DRUGS TO TREAT THE UPPER RESPIRATORY TRACT Antitussives Expectorant Mucolytics Decongestants: Topical & Oral Decongestants Steroid Nasal Decongestants Antihistamines: First Generation (Sedating) & Second Generation (Minor to No Sedating Effect) PRODUCTIVE VERSE NON-PRODUCTIVE COUGH * UPPER Antitussives RESPIRATORY TRACT MEDICATIONS : Suppresses the cough reflex. Think common cold, sinusitis, pharyngitis, and pneumonia. The cough causes irritation and respiratory muscle strain on the external intercostal and diaphragm muscles, which can be exhausting. A: Antitussives include. B: Benzonatate have an anesthetic effect on the vagal nerve receptors in the airway. C: Codeine binds to the opioid receptors. D: Dextromethorphan suppressing the cough reflex in the Medulla. Actions: Acts directly on the medullary cough center of the brain to depress the cough reflex. Indications: Controls and reduces nonproductive cough. Pharmacokinetics: It is rapidly absorbed, metabolizes in the liver, and excreted in the urine. Contraindications: Patients who need to cough to maintain their airway, such as COPD, head injury and impaired CNS patients. It may increase the risk for developing an infection and decrease respiratory drive. Caution: Hypersensitivity or history of narcotic addiction as they can have an addictive effect. Adverse Effects: 1) Drying effect on the mucous membranes. 2) CNS adverse effects causing drowsiness and GI upset. *Drug to Drug interactions: MAOI's Antidepressant Drugs Nursing Considerations: Assess History and Physical, allergies, temperature, respirations, cough, adventitious sounds, hypotension, dry mouth, orientation, depression, constipation, CNS depression, dizziness, drowsiness. *What would you teach your patients about taking this drug? May cause drowsiness, avoid CNS depressants or alcohol, drink plenty of water, use humidity, cool temperatures, use topical lozenges, can cause constipation, and seek further medical evaluation for persistent coughs or coughs accompanied with a fever. Antitussives Pg. 959, Table 54.1 Dextromethorphan (Prototype Summary pg. 960) *Recommended Read: Nursing consideration pg. 960 & 961  EXPECTORANTS Drug: Guaifenesin Action: Increases the productive cough to clear the airway by liquefying the upper respiratory tract secretions, therefore reducing the viscosity of these secretions, and making it easier for the patient to cough up mucous. Indications: Symptomatic relief of acute respiratory conditions such as URTI's, stable bronchitis, and rhinosinusitis by thinning mucous secretions. Other patients may include: Patients who have difficulty coughing up secretions Patients who develop atelectasis Patients undergoing diagnostic bronchoscopy due to mucous plugs Postoperative patients Patients with tracheostomies Contraindications: Caution with pregnancy or lactation due to the adverse effects on the fetus and infant. If medication is used for a persistent cough lasting more than a week it could indicate or mask an underlying disease. Adverse effects: Nausea, vomiting, headache, dizziness, rash, anorexia, drowsiness Assess and Patient Teaching: Assess Lung sounds and mucous Monitor the patient's response, effectiveness, and adverse response to the drug. Take with a full glass of water Evaluate the effectiveness of the teaching plan Consult MD for a cough longer than a week Recommended Read: Nursing considerations for patients receiving expectorants pg. 974-975. Guaifenesin (Mucinex) Prototype Summary pg. 974. Table 54.4 pg. 974  MUCOLYTICS Drug: Acetylcysteine Actions:. Works by breaking down the mucous by decreasing the viscosity (thick and sticky) of the secretions to aid high-risk respiratory patients in coughing up thick tenacious secretions to clear the airways. Indications: Acute and Chronic Obstructive Pulmonary Disease COPD, Cystic fibrosis, Bronchiectasis, Pneumonia or Tuberculosis. Contraindications: Hypersensitivity reactions to the medication or components, patients who have asthma due to potential for bronchospasm, children under the age of six, pregnancy or lactating, or patients with stomach ulcers. Adverse Effects: Nausea/vomiting, stomatitis, urticaria, rash, bronchospasms, rhinorrhea Assess: Assess baseline lung assessment, history of allergies or contraindications (Asthma), drug effectiveness and presence of acute bronchospasms. Patient Teaching: Ensure drug compliancy, drink plenty of water, take with food or without, use humidifier, rhinorrhea, and notify MD with any respiratory difficulty. *Excessive thick mucus plugs can cause a lung to collapse. Acetylcysteine (Prototype Summary pg. 976. Table 54.4 pg. *What else is Acetylcysteine used for? 976)  TEST YOUR KNOWLEDGE Antitussives are useful in blocking the cough reflex and preserving the energy associated with prolonged, nonproductive coughing, which Antitussives are best used with A. Postoperative patients B. Asthma patients C. Patients with a dry, irritating cough D. COPD patients who tire easily SEE PART 2 VIDEO ON DECONGESTANTS *DECONGESTANTS DECREASE THE OVERPRODUCTION OF SECRETIONS BY CAUSING LOCAL VASOCONSTRICTION TO THE UPPER RESPIRATORY TRACT. Types of Decongestants: 1. Topical Decongestants: (Afrin, Sinex, and others) 2. Oral Decongestants: Pseudoephedrine (Sudafed), Pseudoephedrine & Phenylephrine (Sudafed PE), Loratadine (Claritin), Loratadine & Pseudoephedrine (Claritin D) 3. Topical Steroid Decongestants: aerospan (Flunisolide), fluticasone,(Flonase) mometasone (Nasonex) , Budesonide (Rhinocort Allergy), triamcinolone Nasacort Allergy 24HR) 1. Topical Decongestants (Afrin, Sinex, and others) Actions: Sympathomimetic, affecting sympathetic nervous system to cause vasoconstriction to decrease swelling in the upper respiratory tract to allow more air flow. Recall action of sympathetic Nervous System (alpha receptors) Causing less inflammation of the nasal membrane Indications: Relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis. **Topical steroids are also used as decongestants, though they take several weeks to become effective and are often used more with chronic rhinitis. Pharmacokinetics: 1) Generally not absorbed systemically. 2 Any portion of these topical decongestants that is absorbed is metabolized in the liver and excreted in the urine. Contraindications: Lesions or erosion in the mucous membranes, severe HTN, DM, CAD, Narrow angle glaucoma, and some antidepressants. Caution: Any condition that might be exacerbated by sympathetic activity Adverse Effects: 1) Local stinging and burning. 2)**Rebound congestion-Do not use for more than 5-7 days. This leads the nasal passage to become congested as the drug wears off thus initiating a cycle of congestion. 3) Sympathomimetic effects (increased HR, BP, and cardiac contraction) Drug-to-Drug Interactions: Halothane (inhalation anesthetic) *What would you teach your patient about taking these drugs? *Recommended Read Pg. 965 Nursing considerations for patients receiving Topical Nasal Decongestants 2. *Oral Decongestants Pseudoephedrine (Sudafed), Pseudoephedrine & Phenylephrine (Sudafed PE), Loratadine (Claritin), Loratadine & Pseudoephedrine (Claritin D) They decrease nasal congestion by blocking the effects of histamine at the histamine-1 receptor sites, therefore decreasing the allergic response. Actions: Is well absorbed orally with an onset action ranging from 1 to 3 hours. Indications: The common cold, sinusitis, and allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria (hives), congestions of otitis media, and angioedema. Contraindications: Any condition that might be exacerbated by sympathetic activity, alcohol, caffine, or taking MAIOs antidepressants. Adverse Effects: Anxiety, restlessness, fatigue, headache, dizziness, vision changes, seizures, hypertension arrhythmias, pallor, nausea, vomiting, urination retention, respiratory difficulty. Drug-to-Drug Interactions: OTC products that contain pseudoephedrine; taking concurrently can cause serious side effects such as overdosing, digoxin, & Hypertensive medications. Nursing considerations: Assess for: History and Physical Exam and known allergy, conditions for why they are taking the drug. Pregnancy, Lactation, Hypertension, CAD, Hyperthyroidism, Diabetes Mellitus, Glaucoma, or Prostate problems Orientation, reflexes, anxiety, tremors, seizures, trouble sleeping Vital Signs, arrhythmias, urine retention (think Prostate issues) Respiratory difficulty, tachypnea, lung sounds Do not give at night *What would you teach your patient about taking these drugs? Pseudoephedrine (Prototype Summary, pg. 965 ) *Recommended Read: Nursing Considerations for patients receiving an oral decongestant 3. *Topical Steroid Decongestants aerospan, fluticasone, mometasone, budesonide, triamcinolone Actions: Anti-inflammatory action, which results from the ability to produce a direct local effect that blocks many of the complex reactions responsible for the inflammation response. Indications: Seasonal or chronic allergic rhinitis and inflammation relief after nasal polyp removal. Contraindications: Acute infection *Why? hint: recall steroids decrease immune function…what do we need when we have an infection? Adverse Effects: Local burning, irritation, stinging, dryness of the mucosa, headache, and increased risk for infection. Suppression of healing can occur in a patient who has had nasal surgery or trauma – why? Assess: History and Physical, known allergy Drug effectiveness for decreased congestion Nasal mucosa, respiration and adventitious sounds Temperature *What would you teach your patient taking these drugs? Patient teaching: effectiveness of the drug, adherence of regimen, and adverse effects. FYI, there do not cause rebound congestion Flunisolide (Prototype Summary, pg. 966 & 967) TEST YOUR KNOWLEDGE 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 SEE PART 3 VIDEO ON ANTIHISTAMINES  Antihistamines Relieve respiratory symptoms, seasonal/allergic rhinitis, angioedema, blood reactions, motion sick ness, insomnia, and allergies. First-generation and Second- generation First Generation: Diphenhydramine (Benadryl), meclizine (A ntivert), promethazine (Phenergan). antihistamines include: Second Generation: Loratadine (Claritin ), Cetirizine (Zyrtec). The 1st generation selectively block the effects of histamine by binding to a diff erent site on the histamine-1 receptor sites, that inactive muscarinic, adrenergic, serotonin r eceptors. It passes throug h the blood brain barr ier, Actions decreasing the allergic response that increases secretions and narrows the airway. They work for 4 to 6 ho urs. The 2nd generation are specif ic H1-receptor blockers that do not cross the blood brain barrier. They work for 12 to 24 hours. The 1st generation has anticho linergic eff ects. Where as, the 2nd generation does not. Indications Seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria, and angioedema Pharmacokinetics Both are well absorbed, metabolized in the liver using the P450 cytochrome and excreted in urine and feces. Contraindications Pregnancy. Lactation, Glaucoma, Trouble urinating, Thyroid disease, High Blood Pressure. Caution Renal or hepatic impairment History of arrhy thmias (can prolong QT interval) or irreglualrities. Adverse Effects and Patient Teaching 1st Gen: A nticho linergic effects: Fatigue, dry mouth, dry ey es, s kin, dry mucous membranes, blurred vision, brady cardia rash, drowsines s, s edation, and urinary retention. 2nd Gen: Headache,Fatigue, dry mouth, cough, dr y eyes, dry skin, dry mucous membranes, tiredness, sore throat, N /V, abodomial pain or dis co nfort. Drug-to-Drug Interactions Vary based on the drug  First Generation Second Generation First generations have greater anticholinergic effects such as drowsiness due to crossing the blood brain barrier. A person that needs to be alert should take a Second generation that is less sedating and having a significant smaller extent crossing the blood brain barrier. ANTIHISTAMINES Diphenhydramine (Prototype Summary, pg. 972) Recommended Reading: Critical Thinking Scenario & Nursing Care Guide for K.E. Antihistamines pg. 972  TEST YOUR KNOWLEDGE An Antihistamine would be the drug of choice for treating which condition? A. Itchy eyes B. Irritating cough C. Nasal congestion D. Runny Nose E. Idiopathic urticaria F. Thick, tenacious secretions  FYI PATIENTS WITH HIGH BLOOD PRESSURE SHOULD TAKE OTC CORICIDIN, IT IS A COMBINATION MEDICATION *CHLORPHENIRAMINE MALEATE 4 MG ANTIHISTAMINE *DEXTROMETHORPHAN HYDROBROMIDE 30 MG COUGH SUPPRESSANT SINUSITIS X-RAYS