Respiratory Medications PDF

Chapter 7 RESPIRATORY MEDICATIONS Objectives Discuss classification of respiratory drugs Distinguish the various mechanisms of action of respiratory drugs Identify drugs according to their classification Explain limitations, side effects, nursing considerations and patient teaching/education for ea...

Chapter 7 RESPIRATORY MEDICATIONS Objectives Discuss classification of respiratory drugs Distinguish the various mechanisms of action of respiratory drugs Identify drugs according to their classification Explain limitations, side effects, nursing considerations and patient teaching/education for each classification Understand the generic and trade names, administration considerations, therapeutic effects and side/adverse effects for each prototype medication. Nursing Process Assessment: ◦ Understand the MOA to guide assessment and determine effectiveness of medication Implementation: ◦ Is it safe? Evaluation: ◦ Patient response  Classification: Antihistamine Indications ◦ Allergy or cold symptom relief MOA ◦ Blocks histamine receptors, inhibits smooth muscle constriction in blood vessels and respiratory and GI tracts, decreases capillary permeability, salivation and tear formation. Considerations ◦ Not safe for children under age 2 unless prescribed by a provider Patient Teaching/Education ◦ Can cause drowsiness (ETOH and other CNS depressants) ◦ Anticholinergic effects ◦ Can cause stimulation Prototype: Diphenhydramine (Benadryl) and Cetirizine (Zyrtec) Administration Considerations Adverse/Side Effects ◦ Take as directed ◦ Diphenhydramine ◦ Avoid trigger allergens ◦ Sedation ◦ Avoid ETOH or depressants ◦ Diphenhydramine & Cetirizine ◦ Anticholinergic effects Therapeutic Effects ◦ Decreased symptoms of allergies ◦ GI: N/V ◦ Itchy watery eyes ◦ Paradoxical effects of excitation in children and elderly ◦ Runny nose ◦ Sneezing ◦ Nasal congestion ◦ Decreased symptoms of common cold (URI) ◦ Runny nose ◦ Sneezing  Classification: Decongestants Indications ◦ Nasal congestion due to inflammation MOA ◦ Produces vasoconstriction through activating alpha 1 adrenergic receptors on nasal blood vessels and enhances the release of norepinephrine to produce vasoconstriction Considerations ◦ Do not use in children less than 4 years old Teaching/Education ◦ Follow dosing ◦ Can have rebound congestion ◦ High risk for abuse Prototype: Pseudoephedrine (Sudafed) Administration Considerations ◦ Do not use for >7 days ◦ Cardiovascular disease ◦ Encourage po fluids Therapeutic Effects ◦ Relieves nasal congestion ◦ Relieves sinus congestion and pressure Adverse/Side Effects ◦ CV stimulation ◦ Rebound congestion (nasal route)  Classification: Antitussives Indications ◦ Treat cough MOA ◦ Depresses cough center in medulla oblongata or cough receptors in throat, trachea or lungs Considerations ◦ Do not use in children less than 4 years of age Patient Teaching/Education ◦ Avoid things that stimulate cough ◦ Can cause drowsiness ◦ Do not take with other CNS depressants or ETOH Prototype: Dextromethorphan Administration Considerations ◦ Do not OD ◦ Caution in ◦ Respiratory conditions ◦ MAOI’s Therapeutic Effects ◦ Decreased coughing Adverse/Side Effects ◦ CNS sedation  What is our observation???  Classification: Expectorants Indications ◦ Productive cough MOA ◦ Reduce viscosity of secretions by irritating the gastric vagal nerve receptors and stimulating respiratory tract fluid. Decrease thickness but increase in volume. Considerations ◦ Safe for all ages ◦ Not recommended for pregnant patients ◦ Not recommended for breast feeding Patient Teaching/Education ◦ Avoid irritants that stimulate cough ◦ Drowsiness ◦ Avoid CNS depressants and ETOH Prototype: Guaifenesin Administration Considerations ◦ Do not eat within 30 minutes of taking syrup ◦ Have patient cough and deep breathe Therapeutic Effects ◦ Helps patient cough up secretions Adverse/Side Effects ◦ Drowsiness ◦ N/V/D Label From an Old Cough Medication  Classification: B2 (Beta2) Agonist Indications Patient Teaching/Education ◦ Shortness of breath ◦ Take as directed ◦ Airway inflammation ◦ If no relief call 911 ◦ Prime inhaler before use MOA ◦ Rinse mouth after use ◦ Stimulate B-2 adrenergic receptors in the smooth muscle of the bronchi and bronchioles causing dilation of the bronchus. Can stimulate B-1 receptors causing tachycardia. Considerations ◦ Rapid onset (short acting) ◦ Slower onset (long acting) and will not relieve bronchospasm Prototype: SABA- Albuterol LABA- Salmeterol Administration Considerations Adverse/Side Effects ◦ SABA rapid onset- treat bronchospasm ◦ SABA ◦ LABA slow onset- prevent bronchospasm ◦ CNS stimulation ◦ CV stimulation Therapeutic Effects ◦ LABA ◦ SABA- rapid bronchodilation ◦ Tachycardia ◦ LABA- prevention of bronchospasm ◦ Dysrhythmias ◦ Hyperglycemia ◦ Hypokalemia ◦ Paradoxical bronchoconstriction ◦ Increased release for asthma related death https://www.youtube.com/watch?v=ls3zzWPFEPM Classification: Anticholinergics Indications ◦ Maintenance of asthma and COPD to prevent bronchoconstriction MOA ◦ Block acetylcholine in bronchial smooth muscle which reduces bronchoconstrictive substance release Considerations ◦ Not given with specific arrhythmias ◦ Not given in pts with hypotension Patient Teaching/Education ◦ Do not exceed dosage ◦ Not a fast-acting medication Prototype: Ipratropium (short acting) & Tiotropium (long acting) Administration Considerations: ◦ Long term management of pulmonary disease with slower onset of action Therapeutic Effects: ◦ SA: rapid bronchodilation ◦ LA: prevention of bronchospasm & reduces COPD exacerbation Adverse/Side Effects: ◦ Cough ◦ Dry mucous membranes Classification: Corticosteroids Indications Considerations ◦ Inhaler: to prevent asthma attacks ◦ PO and IV: safe for all ages ◦ PO: control reactions that do not respond to ◦ Inhalation: > 4 years old other treatments ◦ IV: rapid control Patient Teaching/Education ◦ Immunosuppression MOA ◦ Diabetic patients ◦ Inhaled: local anti-inflammatory and immune ◦ Other side effects vary according to medication modifier ◦ PO: prevents the body from responding with inflammation. Suppresses the immune system ◦ IV: same as PO Inhaled Corticosteroids  Prototype: Fluticasone (Inhaled), Prednisone (PO), Methylprednisolone (IV) Administration Considerations ◦ Inhaled: Rinse mouth after use ◦ PO: Take with food ◦ IV: Be aware of side effects Therapeutic Effects ◦ Inhaled: Nasal used for nonallergic rhinitis; Inhaler: improve asthma by reducing inflammation in the airways ◦ PO: control allergic or respiratory conditions ◦ IV: rapidly control allergic or respiratory conditions, reduce systemic inflammation and to treat adrenal insufficiency Prototype: Fluticasone (Inhaled), Prednisone (PO), Methylprednisolone (IV) cont. ◦ Adverse/Side Effects: ◦ Inhaled: hoarseness, dry mouth, sore throat and oropharyngeal candidiasis ◦ PO & IV:  CV: fluid retention, edema, hypertension.  Electrolytes:  Na, Ca, glucose,  potassium.  CNS: mood swings and euphoria.  GI: N/V, GI bleed.  MS: affects bone reabsorption.  Skin: acne, thin skin, bruising, delay healing, infections.  General: weight gain, adrenal suppression, immunosuppression, risk for Cushing’s Syndrome Corticosteroids  Classification: Leukotriene Receptor Antagonists Indications ◦ Asthma control, exercise induced asthma and allergic rhinitis MOA ◦ Blocks leukotriene receptors and reduces inflammation Routes ◦ PO Considerations ◦ Safe for children >12 months ◦ Available in granules, chewable and tablets Patient Teaching/Education ◦ Dose timing ◦ Two hours prior to exercise Prototype: Montelukast (Singular) Administration Considerations ◦ Not a rescue medication ◦ Takes 3-7 days to reach effectiveness Therapeutic Effects ◦ Prevention and treatment of asthma ◦ Prevention of exercise induced asthma Adverse/Side Effects ◦ Headache ◦ Cough ◦ Nasal congestion ◦ Hepatoxicity ◦ May cause mood swings  Classification: Xanthine Derivatives Indications ◦ Asthma treatment long term not responsive to other medications MOA ◦ Relaxes bronchial smooth muscle by inhibiting phosphodiesterase and suppresses airway response to triggers Routes ◦ PO, IV Considerations ◦ Cardiovascular disease (stimulant) ◦ Requires loading dose Patient Teaching/Education ◦ Avoid caffeine or stimulating medications ◦ Frequent blood levels  Prototype: Theophylline Administration Considerations: ◦ Other stimulants ◦ Therapeutic levels Therapeutic Effects: ◦ Long term treatment of asthma and COPD unresponsive to other treatment Adverse/Side Effects: ◦ CNS stimulation ◦ N/V ◦ Insomnia ◦ nervousness ◦ Theophylline has a very narrow therapeutic window, and its interaction with various other drugs has led to the limitation of its use Questions?