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Drugs Acting on the Upper Respiratory Tract
Chapter 54
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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
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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
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Sites of Action of Drugs Working on the Upper Respiratory Tract
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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
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Antitussives (cont.) Caution
Hypersensitivity or history of narcotic addiction Adverse Effects Drying effect on the mucous membranes CNS adverse effects GI upset
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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
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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
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Topical Nasal Decongestants (cont.)
Adverse Effects Local stinging and burning Rebound congestion Sympathomimetic effects Drug-to-Drug Interactions Cyclopropane or halothane
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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.
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Answer True Rationale: Caution should also be used in patients who are hypersensitive to or have a history of addiction to narcotics (codeine, hydrocodone).
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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
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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
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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
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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
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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
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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
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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
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Expectorants (cont.) Adverse Effects GI symptoms Headache Dizziness
Mild rash Prolonged use may result in masking a serious underlying disorder
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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
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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.
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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
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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
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Use of Upper Respiratory Tract Agents Across the Lifespan
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Prototype Antitussives
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Prototype Topical Nasal Decongestants
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Prototype Topical Nasal Steroid Decongestants
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Prototype Antihistamines
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Prototype Expectorants
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Prototype Mucolytics
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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
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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.
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Nursing Considerations for Antitussives
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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Nursing Considerations for Topical Nasal Decongestants
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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Nursing Considerations for Oral Decongestants
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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Nursing Considerations for Topical Nasal Steroid Decongestants
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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Nursing Considerations for Antihistamines
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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Nursing Considerations for Expectorants
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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Nursing Considerations for Mucolytics
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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Drugs Acting on the Lower Respiratory Tract
Chapter 55
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Changes in the Airway With COPD
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Manifestations of COPD
Air is trapped in the lower respiratory tract The alveoli degenerate and fuse together The exchange of gases is greatly impaired
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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
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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
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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
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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
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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
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Sympathomimetics (cont.)
Adverse Effects Sympathomimetic stimulation CNS stimulation GI upset, cardiac arrhythmias, hypertension, bronchospasm, sweating, pallor, and flushing Drug-to-Drug Interactions General anesthetics
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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.
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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.
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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
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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
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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
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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
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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
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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
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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
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Lung Surfactants (cont.)
Contraindications -Emergency drug; no contraindication Adverse Effects Patent ductus arteriosus Hypotension Intraventricular hemorrhage Pneumothorax Pulmonary air leak Hyperbilrubinemia Sepsis
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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
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Mast Cell Stabilizers (cont.)
Adverse Effects Drug-to-Drug Interactions Isoproterenol
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Question Which of the following is a contraindication to using lung surfactants? A. Prematurity B. Older adult C. No contraindications D. COPD
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Answer C. No contraindications Rationale: Because lung surfactants are used as emergency drugs in the newborn, there are no contraindications.
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Use of Lower Respiratory Tract Agents Across the Lifespan
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Prototype Xanthines
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Prototype Xanthines (Continued)
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Prototype Sympathomimetics
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Prototype Sympathomimetics (Continued)
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Prototype Anticholinergics
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Prototype Inhaled Steroids
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Prototype Leukotriene Receptor Antagonists
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Prototype Lung Surfactants
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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
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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.
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Nursing Considerations for Xanthines
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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Nursing Considerations for Sympathomimetics
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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Nursing Considerations for Anticholinergic Bronchodilator
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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Nursing Considerations for Inhaled Steroids
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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Nursing Considerations for Leukotriene Receptor Antagonists
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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Nursing Considerations for Lung Surfactants
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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Nursing Considerations for Mast Cell Stabilizers
Assessment: History and Physical Exam Nursing Diagnosis Implementation Evaluation
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