Drugs for Upper Respiratory Disorders Chapter 40 Drugs for Upper Respiratory Disorders Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Upper Respiratory Disorders Upper respiratory infections Common cold Etiology: rhinovirus Affects nasopharyngeal tract Acute rhinitis Inflammation of nasal mucous membranes Sinusitis Inflammation of mucous membranes of sinuses Acute pharyngitis Inflammation of throat Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Upper Respiratory Disorders (Cont.) Contagious period of common cold 1 to 4 days before onset of symptoms During first 3 days of cold Transmission Touching contaminated surfaces, then touching nose or mouth Viral droplets from sneezing Symptoms of common cold Nasal congestion, nasal discharge, cough, increased mucosal secretions Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Antihistamines H1-blockers (H1 blockers or H1 antagonists) can cause drowsiness, dizziness, fatigue, and disturbed coordination First-generation antihistamines Diphenhydramine (Benadryl) Second-generation antihistamines Nonsedating antihistamines Cetirizine (Zyrtec) Fexofenadine (Allegra) Loratadine (Claritin) Azelastine (Astelin) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Antihistamines (Cont.) Diphenhydramine (Benadryl) Action Competes with histamine for receptor sites preventing a histamine response Reduces nasopharyngeal secretions, itching, sneezing Use Treats acute and allergic rhinitis, antitussive Contraindications/cautions Severe liver disease, narrow-angle glaucoma, urinary retention Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Antihistamines (Cont.) Diphenhydramine (Benadryl) Administration: oral, IM, IV Interactions Increases CNS depression with alcohol and other CNS depressants Avoid use of MAOIs Side effects Drowsiness, dry mouth, dizziness, blurred vision, wheezing, photosensitivity, urinary retention, constipation, GI distress, blood dyscrasias Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Diphenhydramine (Benadryl) Assessment Nursing diagnoses Planning Nursing interventions Patient teaching Cultural considerations Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Diphenhydramine (Benadryl) (Cont.) Nursing interventions Obtain list of environmental exposures, drugs, recent foods eaten, stressors. Give with food to decrease GI distress. Avoid operating motor vehicles if drowsiness occurs. Avoid alcohol and other CNS depressants. Use sugarless candy or gum or ice chips for temporary relief of mouth dryness. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Second-Generation Antihistamines Nonsedating antihistamines Fewer anticholinergic symptoms Cetirizine (Zyrtec) Cexofenadine (Allegra) Loratadine (Claritin) Azelastine (Astelin) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nasal Congestion Nasal congestion Dilation of nasal blood vessels Due to infection, inflammation, allergy Transudation of fluid into tissue spaces Leads to swelling nasal cavity Nasal decongestants: Systemic decongestants Stimulate alpha-adrenergic receptors Produces nasal vascular vasoconstriction Shrinks nasal mucous membranes Reduces nasal secretion Rebound nasal congestion Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nasal Congestion (Cont.) Systemic decongestants Used primarily for allergic rhinitis, including hay fever and acute coryza Ephedrine (Ephedrine), Phenylephrine (Neo-Synephrine) Pseudoephedrine (Sudafed) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nasal Decongestants (Cont.) Ephedrine HCl (Primatene) Naphazoline HCl (Privine) Oxymetazoline (Afrin) Phenylephrine HCl (Neo-Synephrine Nasal) Pseudoephedrine (Sudafed) Tetrahydrozoline (Tyzine) Administration Nasal spray, nasal drops, tablet, capsule, liquid Interactions Refer to Table 40-2, Systemic and Nasal Decongestants (Sympathomimetic Amines). Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nasal Decongestants (Cont.) Side effects Nervousness, restlessness, “jitters” Alpha-adrenergic effect (hypertension, hyperglycemia) Frequent use May lead to tolerance May lead to rebound nasal congestion Should not use more than 5 days Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Intranasal Glucocorticoids Beclomethasone (Beconase, Vancenase, Vanceril) Budesonide (Pulmicort, Rhinocort) Dexamethasone (Decadron) Flunisolide Fluticasone (Flonase, Flovent) Triamcinolone (Nasacort) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Intranasal Glucocorticoids (Cont.) Action Antiinflammatory Use Treat allergic rhinitis May be used alone or in combination with H1 antihistamines Dexamethasone should not be used longer than 30 days to avoid systemic effects. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Expectorants Guaifenesin (Robitussin) Action Use Side effects Loosens bronchial secretions by reducing surface tension of secretions Use Dry, nonproductive cough Side effects Drowsiness, nausea Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Antitussives Act on the cough-control center in the medulla to suppress the cough reflex Three types of antitussives are nonnarcotic, narcotic, or combination preparations. Dextromethorphan (Benylin) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nursing Process: Common Cold Assessment Nursing diagnoses Planning Nursing interventions Patient teaching Cultural considerations Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Sinusitis and Pharyngitis Treatment Decongestant, acetaminophen, fluids, rest, antibiotics Acute pharyngitis Saline gargles, lozenges, increased fluid intake, acetaminophen Antibiotics with bacterial infection Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #1 A patient is receiving dextromethorphan (Benylin). The nurse knows the drug is exerting its therapeutic effect when the patient experiences thinning of secretions. bronchodilation. decreased coughing. relief of nasal congestion. Answer: C Rationale: Dextromethorphan (Benylin) is an antitussive which acts on the cough-control center in the medulla to suppress the cough reflex. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #2 The nurse is teaching an older adult patient about guaifenesin (Robitussin). Which information is appropriate to include in this teaching? (Select all that apply.) Take the drug with a glass of water. Read labels on over-the-counter drugs and check with health care provider before taking cold remedies. Take the drug at bedtime. Advise patient 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 be read, and the health care provider should be checked with, to avoid conflict with other medications the patient is taking. Cold remedies should not be taken at bedtime. The health care provider should be notified if the cough lasts for 1 week. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #3 A patient has been diagnosed with the common cold. The nurse should question if which drug is ordered to treat this patient? Antihistamines Antitussives Expectorants Antibiotics Answer: D Rationale: The common cold is caused by the rhinovirus. Antibiotics would not be used to treat a virus. Groups of drugs used to manage cold symptoms include antihistamines (H1 blockers), decongestants (sympathomimetic amines), antitussives, and expectorants. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #4 Which medication is a first-generation antihistamine? Cetirizine (Zyrtec) Fexofenadine (Allegra) Diphenhydramine (Benadryl) Loratadine (Claritin) Answer: C Rationale: Diphenhydramine (Benadryl) is a first-generation antihistamine. Most first-generation antihistamines cause drowsiness, dry 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. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #5 When teaching a patient about use of nasal decongestant sprays, the nurse informs the patient that they are most effective when administered for how many days? 4 days 10 days 14 days 20 days Answer: A Rationale: Use of nasal decongestants for longer than 5 days could result in rebound nasal congestion. Instead of the 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. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #6 Before administering diphenhydramine (Benadryl) to a patient, it is most important for the nurse to assess the patient for a history of allergy to penicillin. hypertension. diabetes mellitus type 2. narrow-angle glaucoma. Answer: D Rationale: Diphenhydramine (Benadryl) has anticholinergic effects and should not be used by patients with narrow-angle glaucoma. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #7 Which statement about dextromethorphan does the nurse identify as being true? It is a narcotic antitussive. It suppresses the cough center of the medulla. It suppresses respirations. It causes physical dependence. Answer: B Rationale: Dextromethorphan, a nonnarcotic antitussive, suppresses the cough center in the medulla but does not depress respiration. It causes neither physical dependence nor tolerance. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.