1. Drugs for Upper Respiratory Disorders
Chapter 40
Drugs for Upper Respiratory Disorders
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2. 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
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3. 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
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4. 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)
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5. 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
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6. 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
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7. Nursing Process: Diphenhydramine (Benadryl)
Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
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8. 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.
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9. Second-Generation Antihistamines
Nonsedating antihistamines
Fewer anticholinergic symptoms
Cetirizine (Zyrtec)
Cexofenadine (Allegra)
Loratadine (Claritin)
Azelastine (Astelin)
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10. 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
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11. Nasal Congestion (Cont.)
Systemic decongestants
Used primarily for allergic rhinitis, including hay fever and acute coryza
Ephedrine (Ephedrine),
Phenylephrine (Neo-Synephrine)
Pseudoephedrine (Sudafed)
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12. 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).
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13. 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
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14. Intranasal Glucocorticoids
Beclomethasone (Beconase, Vancenase, Vanceril)
Budesonide (Pulmicort, Rhinocort)
Dexamethasone (Decadron)
Flunisolide
Fluticasone (Flonase, Flovent)
Triamcinolone (Nasacort)
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15. 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.
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16. Expectorants Guaifenesin (Robitussin) Action Use Side effects
Loosens bronchial secretions by reducing surface tension of secretions
Use
Dry, nonproductive cough
Side effects
Drowsiness, nausea
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17. 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)
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18. Nursing Process: Common Cold
Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
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19. Sinusitis and Pharyngitis
Treatment
Decongestant, acetaminophen, fluids, rest, antibiotics
Acute pharyngitis
Saline gargles, lozenges, increased fluid intake, acetaminophen
Antibiotics with bacterial infection
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20. 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.
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21. 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.
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22. 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.
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23. 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.
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24. 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.
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25. 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.
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26. 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.
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