1. 1 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Chapter 40 DRUGS FOR UPPER RESPIRATORY DISORDERS

2. 2 Copyright © 2012, 2009, 2006, 2003 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

3. 3 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Upper Respiratory Disorders (cont’d)  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

4. 4 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Antihistamines  H 1 -blockers (antagonists)  First-generation antihistamines Diphenhydramine (Benadryl)  Second-generation antihistamines Cetirizine (Zyrtec) Fexofenadine (Allegra) Loratadine (Claritin) Nonsedating antihistamines; little to no effect on sedation

5. 5 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Antihistamines (cont’d)  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

6. 6 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Antihistamines (cont’d)  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

7. 7 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Antihistamines (cont’d)  Diphenhydramine (Benadryl) (cont’d)  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.

8. 8 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Antihistamines (cont’d)  Second-generation antihistamines  Differences Reduced sedation Fewer anticholinergic effects  Dry mouth, blurred vision, wheezing, urinary retention May be taken with a moderate amount of alcohol, but this is not recommended.

9. 9 Copyright © 2012, 2009, 2006, 2003 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  Stimulate alpha-adrenergic receptors Produces nasal vascular vasoconstriction Shrinks nasal mucous membranes Reduces nasal secretion

10. 10 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Nasal Decongestants  Oxymetazoline (Afrin)  Naphazoline (Allerest)  Pseudoephedrine (Sudafed)  Administration Nasal spray, nasal drops, tablet, capsule, liquid  Interactions Sudafed may decrease effect of beta blockers May increase HTN, dysrhythmias with MAOIs May increase restlessness, palpitations with caffeine (e.g., coffee, tea)

11. 11 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Nasal Decongestants (cont’d)  Oxymetazoline (Afrin), naphazoline (Allerest), pseudoephedrine (Sudafed)  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

12. 12 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Intranasal Glucocorticoids  Fluticasone (Flonase)  Triamcinolone (Nasacort)  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.

13. 13 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Antitussives  Guaifenesin and codeine (Cheratussin)  Action Suppress cough reflex by acting on cough center in the medulla Reduce viscosity of tenacious secretions  Use Nonproductive, irritating cough  Side effects Drowsiness, dizziness, nausea

14. 14 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Expectorants  Guaifenesin (Robitussin)  Action Loosens bronchial secretions by reducing surface tension of secretions  Use Dry, nonproductive cough  Side effects Drowsiness, nausea

15. 15 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Sinusitis and Pharyngitis  Sinusitis  Treatment Decongestant, acetaminophen, fluids, rest, antibiotics  Acute pharyngitis  Treatment Saline gargles, lozenges, increased fluid intake, acetaminophen Antibiotics with bacterial infection

16. 16 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Practice Question #1 Which does the nurse realize is true regarding a second-generation antihistamine, loratadine (Claritin)? A.It leads to frequent urination. B.It may cause weight loss. C.It will cause little or no drowsiness. D.It is used as a nasal decongestant.

17. 17 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Practice Question #1 (cont’d) Answer: C Rationale: Second-generation antihistamines cause little or no drowsiness. Claritin does not cause frequent urination or weight loss, nor is it a nasal decongestant.

18. 18 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Practice Question #2 The nurse is teaching an older adult client about guaifenesin (Robitussin). Which is appropriate to include in this teaching? (Select all that apply.) A. Take the drug with a glass of water. B. Read labels on over-the-counter drugs and to check with healthcare provider before taking cold remedies.. C. Take the drug at bedtime. D. Advise client to contact healthcare provider if cough persists more than 2 days.

19. 19 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Practice Question #2 Answer: A, B Rationale: Taking the drug with a glass of water can help loosen mucus. Labels should be read and the healthcare provider should be checked with, to avoid conflict with other medications the client is taking. Cold remedies should not be taken at bedtime. The healthcare provider should be notified if the cough last for 1 week.