Drugs Acting on the Upper Respiratory Tract Chapter 54

Drugs Used to Treat Upper Respiratory Infections Antitussives Block the cough reflex Decongestants Decrease the blood flow to the upper respiratory tract and decrease the overproduction of secretions Antihistamines Block the release or action of histamine that increases secretions and narrows airways

Drugs Used to Treat Upper Respiratory Infections (cont.) Expectorants Increase productive cough to clear airways Mucolytics Increase or liquefy respiratory secretions to aid clearing of airways

Sites of Action of Drugs Working on the Upper Respiratory Tract

Antitussives Actions Act directly on the medullary cough center of the brain to depress the cough reflex Indications Control nonproductive cough Pharmacokinetics Rapidly absorbed, metabolized in the liver, and excreted in the urine Contraindications Patients who need to cough to maintain the airway Head injury or impaired CNS

Antitussives (cont.) Caution Hypersensitivity or history of narcotic addiction Adverse Effects Drying effect on the mucous membranes CNS adverse effects GI upset

Topical Nasal Decongestants Actions Sympathomimetic Affects sympathetic nervous system to cause vasodilatation Causing less inflammation of the nasal membrane Indications Relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis

Topical Nasal Decongestants (cont.) Pharmacokinetics Generally not absorbed systemically Any portion of these topical decongestants that is absorbed is metabolized in the liver and excreted in the urine Contraindications Lesion or erosion in the mucous membranes Caution Any condition that might be exacerbated by sympathetic activity

Topical Nasal Decongestants (cont.) Adverse Effects Local stinging and burning Rebound congestion Sympathomimetic effects Drug-to-Drug Interactions Cyclopropane or halothane

Question Please answer the following statement as true or false. Antitussive agents should be used with caution in patients who have a history of addiction.

Answer True Rationale: Caution should also be used in patients who are hypersensitive to or have a history of addiction to narcotics (codeine, hydrocodone).

Oral Decongestants Actions Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the nasal mucous membranes Indications Promotion of drainage in the sinuses and improving air flow Pharmacokinetics Well absorbed, widely distributed in the body Metabolized in the liver and primarily excreted in urine

Oral Decongestants (cont.) Contraindications Any condition that might be exacerbated by sympathetic activity Adverse Effects Rebound congestion Sympathetic effects Drug-to-Drug Interactions OTC products that contain pseudoephedrine; taking concurrently can cause serious side effects

Topical Nasal Steroid Decongestants Actions Exact mechanism of action is not known Indications Seasonal allergic rhinitis Inflammation after the removal of nasal polyps Pharmacokinetics Generally not absorbed systemically

Topical Nasal Steroid Decongestants (cont.) Contraindications Acute infection Caution Active infection Avoid exposure to airborne infections Adverse Effects Local burning, irritation, stinging, dryness of the mucosa, and headache Suppression of healing can occur in a patient who has had nasal surgery or trauma

Antihistamines Actions Selectively block the effects of histamine at the histamine-1 receptor sites, decreasing the allergic response Anticholinergic and antipruritic effects Indications Seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria, and angioedema Pharmacokinetics Well absorbed, metabolized in the liver, excreted in urine and feces Contraindications Pregnancy and lactation

Antihistamines (cont.) Caution Renal or hepatic impairment History of arrhythmias Adverse Effects Drowsiness and sedation Anticholinergic effects Drug-to-Drug Interactions Vary based on the drug

Expectorants Actions Enhances the output of respiratory tract fluids by reducing the adhesiveness and surface tension of these fluids, allowing easier movement of the less viscous secretions Indications Symptomatic relief of respiratory conditions characterized by a dry, non-productive cough Pharmacokinetics Rapidly absorbed, metabolism and excretion has not been reported

Expectorants (cont.) Adverse Effects GI symptoms Headache Dizziness Mild rash Prolonged use may result in masking a serious underlying disorder

Question 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

C. Suppression of healing Answer C. Suppression of healing Rationale: Adverse Effects: local burning, irritation, stinging, dryness of the mucosa, and headache; suppression of healing can occur in a patient who has had nasal surgery or trauma.

Mucolytics Actions Work to break down mucous in order to aid the high-risk respiratory patient in coughing up thick, tenacious secretions Indications Patients who have difficulty coughing up secretions Patients who develop atelectasis Patients undergoing diagnostic bronchoscopy Postoperative patients Patients with tracheostomies

Mucolytics (cont.) Pharmacokinetics Nebulization or direct instillation into the trachea Caution Acute bronchospasm, peptic ulcer, and esophageal varicies Adverse Effects GI upset Stomatitis and/or rhinorrhea Bronchospasm Rash

Use of Upper Respiratory Tract Agents Across the Lifespan

Prototype Antitussives

Prototype Topical Nasal Decongestants

Prototype Topical Nasal Steroid Decongestants

Prototype Antihistamines

Prototype Expectorants

Prototype Mucolytics

Question What drug enhances the output of respiratory tract fluid by reducing the adhesiveness and surface tension of the fluid, which facilitates the removal of viscous mucus? A. Guaifenesin B. Flunisolide C. Acetylcysteine D. Dextromethorphan

Answer C. Acetylcysteine Rationale: Actions: Enhances the output of respiratory tract fluid by reducing the adhesiveness and surface tension of the fluid, facilitating the removal of viscous mucus.

Nursing Considerations for Antitussives Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation

Nursing Considerations for Topical Nasal Decongestants Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation

Nursing Considerations for Oral Decongestants Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation

Nursing Considerations for Topical Nasal Steroid Decongestants Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation

Nursing Considerations for Antihistamines Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation

Nursing Considerations for Expectorants Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation

Nursing Considerations for Mucolytics Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation

Drugs Acting on the Lower Respiratory Tract Chapter 55

Changes in the Airway With COPD

Manifestations of COPD Air is trapped in the lower respiratory tract The alveoli degenerate and fuse together The exchange of gases is greatly impaired

Prevention and Treatment for COPD Reduce environmental exposure to irritants Smoking cessation Filter allergens from the air Avoid exposure to known irritants and allergens Open the conducting airways through muscular bronchodilation Decrease the effects of inflammation on the airway lining

Adult Respiratory Distress Syndrome (ARDS) Characteristics Progressive loss of lung compliance and increasing hypoxia Causes Cardiovascular collapse; major burns; severe trauma; rapid depressurization Treatment Reversal of the underlying cause combined with ventilatory support

Xanthines Actions Direct effect on the smooth muscles of the respiratory tract, both in the bronchi and in the blood vessels Indications Symptomatic relief or prevention of bronchial asthma and for reversal of bronchospasm associated with COPD Pharmacokinetics Narrow therapeutic margin Rapidly absorbed for the GI tract Metabolized in the liver and excreted in the urine

Xanthines (cont.) Contraindications GI problems, coronary disease, respiratory dysfunction, renal or hepatic disease, alcoholism, or hyperthyroidism Adverse Effects Related to theophylline levels in the blood GI upset, nausea, irritability, and tachycardia to seizure, brain damage, and even death Drug-to-Drug Interactions Many drugs interact with xanthines Nicotine increases the metabolism

Sympathomimetics Actions Beta2 selective adrenergic agonists Indications Acute asthma attach Bronchospasm in acute or chronic asthma Prevention of exercise-induced asthma Pharmacokinetics Rapidly distributed after injection, transformed in the liver to metabolites that are excreted in the urine Contraindications Depends on the severity of the underlying condition

Sympathomimetics (cont.) Adverse Effects Sympathomimetic stimulation CNS stimulation GI upset, cardiac arrhythmias, hypertension, bronchospasm, sweating, pallor, and flushing Drug-to-Drug Interactions General anesthetics

Question Please answer the following question as true or false. The adverse effects of the Xanthines are related to theophylline levels in the blood and include brain damage.

Answer True Rationale: Adverse Effects: Related to theophylline levels in the blood; GI upset, nausea, irritability, and tachycardia to seizure, brain damage, and even death.

Anticholinergic Actions Anticholinergic that blocks vagally mediated reflexes by antagonizing the action of acetylcholine Indications Maintenance treatment of bronchospasm associated with COPD Pharmacokinetics Onset of action is 15 minutes when inhaled Peaks in 1-2 hours, duration of action is 3-4 hours

Anticholinergic (cont.) Caution Any condition that would be aggravated by the anticholinergic effects of the drug Adverse Effects Related to the anticholinergic effects of the drug Dizziness, headache, fatigue, nervousness, dry mouth, sore throat, palpitations, and urinary retention

Inhaled Steroids Actions Decrease the inflammatory response in the airway Indications Prevention and treatment of asthma Treat chronic steroid-dependent bronchial asthma Pharmacokinetics Well absorbed from the respiratory tract Metabolized by natural systems, mostly within the liver, excreted in the urine

Inhaled Steroids (cont.) Contraindications Not used for emergency during an acute attack or status asthmaticus Pregnancy or lactation Adverse Effects Sore throat Hoarseness Coughing Dry mouth Pharyngeal and laryngeal fungal infections

Leukotriene Receptor Antagonists Actions Selectively and competitively block or antagonize receptors for the production of leukotrienes Indications Prophylaxis and chronic treatment of bronchial asthma in adults and in patients younger than 12 years of age Pharmacokinetics Rapidly absorbed from GI tract, extensively metabolized in the liver and primarily excreted in feces Caution Hepatic or renal impairment Pregnancy and lactation

Leukotriene Receptor Antagonists (cont.) Adverse Effects Headache, dizziness, myalgia, nausea, diarrhea and abdominal pain, elevated liver enzyme concentrations, vomiting, and generalized pain Drug-to-Drug Interactions Propranolol, theophylline, terfenadine, or warfarin Calcium channel blockers, cyclosporine, or aspirin

Lung Surfactants Actions Replace the surfactant that is missing in the lungs of neonates with RDS Indications Rescue treatment of infants who have developed RDS Pharmacokinetics Begin to act immediately on instillation into the trachea Metabolized in the lungs

Lung Surfactants (cont.) Contraindications -Emergency drug; no contraindication Adverse Effects Patent ductus arteriosus Hypotension Intraventricular hemorrhage Pneumothorax Pulmonary air leak Hyperbilrubinemia Sepsis

Mast Cell Stabilizers Actions Works at the cellular level to inhibit the release of histamine and inhibits the release of SRSA Indications Treatment of chronic bronchial asthma Exercise induced asthma Allergic rhinitis Pharmacokinetics Contraindications

Mast Cell Stabilizers (cont.) Adverse Effects Drug-to-Drug Interactions Isoproterenol

Question Which of the following is a contraindication to using lung surfactants? A. Prematurity B. Older adult C. No contraindications D. COPD

Answer C. No contraindications Rationale: Because lung surfactants are used as emergency drugs in the newborn, there are no contraindications.

Use of Lower Respiratory Tract Agents Across the Lifespan

Prototype Xanthines

Prototype Xanthines (Continued)

Prototype Sympathomimetics

Prototype Sympathomimetics (Continued)

Prototype Anticholinergics

Prototype Inhaled Steroids

Prototype Leukotriene Receptor Antagonists

Prototype Lung Surfactants

Question The nurse is caring for a patient taking Budesonide. What would be an appropriate nursing diagnosis for this patient? A. Risk for injury related to immunosuppression B. Risk for injury related to CNS effects C. Risk for injury related to CVS effects D. Risk for injury related to age and risk of infection

Answer A. Risk for injury related to immunosuppression Rationale: Nursing diagnoses related to drug therapy might include: risk for injury related to immunosuppression; acute pain related to local effects of the drug; deficient knowledge regarding drug therapy.

Nursing Considerations for Xanthines Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation

Nursing Considerations for Sympathomimetics Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation

Nursing Considerations for Anticholinergic Bronchodilator Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation

Nursing Considerations for Inhaled Steroids Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation

Nursing Considerations for Leukotriene Receptor Antagonists Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation

Nursing Considerations for Lung Surfactants Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation

Nursing Considerations for Mast Cell Stabilizers Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation