1
Q
Types of Upper Airway Medications
A
- Antitussives
- Decongestants
- Expectorants
- Mucolytics
- Antihistamines
2
Q
Anti-tussives
-Overview
A
- Anti cough medication
- Reduces cough by a variety of methods
- OTC and prescription
- Reduces cough, regardless of cause / doesn’t treat underlyning issue
- Coughing is an natural part of body defense
- can be dangerous to suppress
3
Q
When to give Anti-tussives
A
Cough medication can be used when a pt is not sleeping well.
4
Q
ACE-inhibitors and Anti-tussives
A
ACE inhibitors “prils” cause a dry chronic cough. You need to deal with underlying issue instead of just treating the cough
5
Q
How do opioids work to suppress cough?
A
- Codeine / hydrocodone (hycodan)
2. Suppresses the cough center in the brain
6
Q
Non-opioid Antitussives
A
- Dextromethorphan (Robitussin DM) /
benzonatate (tessalon perles)
2.
7
Q
Antitussives
-Contraindication
A
- Asthma
- Opioid contraindications (People w/ problems with breathing or constipation) (people who need to be alert) (Pt’s with head trauma)
- Caution w/ asthma, COPD
- CNS depressants and alcohol
- MAOI’s
- NARCAN is ANTIDOTE for opioids
8
Q
Adverse Effects
-Opioid antitusives
A
- CNS depression
- Dependency
- Common: dizziness, drowsiness, N/V/C pruritus
- Life threatening: Respiratory depression, arrhythmias
9
Q
Adverse Effects
-Non-opioid antitussives
A
- Dizziness
- Drowsiness (dextromethorphan)
- N/V/stomach pain
10
Q
Anti-tussives
-Nursing implications/teaching
A
- Watch for opioid adverse effects
- Codeine intolerance (mostly stomach related)
- Notify prescriber if cough persists
11
Q
Decongestants
How it works?
A
- Sympathetic response
- Decreases congestion in the nose, several different medication types from ANTI-CHOLINERGICS TO ADRENERGIC AGONISTS
- VASOCONSTRICTION OF ARTERIOLS
12
Q
How do decongestants work?
A
Vasoconstriction of the arterioles
13
Q
Rebound Congestion
A
- Happens with sympathetic medication (adrenergic)
2. If a sympathetic med is used more than 5 days, arterioles with dilate and a rebound congestion will happen
14
Q
Decongestants
-Contraindication
A
- MAOIs (don’t eat food w/ tyramine)
2. Caution w/ HTN, cardiac Dz, DM
15
Q
Best Expectorant is?
A
hydration
16
Q
Expectorant
-Guaifenesin
A
- Well tolerated
2. watch for drowsiness
17
Q
Antihistamines
A
- Histamines vasodilator so we want to block dilation
18
Q
Benadryl
A
- 1st generation antihistamine
2. Cause drowsiness
19
Q
2nd Generation Anti-histamines
A
- Doesn’t cause drowsiness
- Used to treat allergy
- Blocks histamine receptors
Allegra, claratin
20
Q
Anti-histamines
-Contraindication
A
- Don’t take with any obstructions
- GI, Bladder neck, or BPH obstructions - Narrow angle glaucoma
- Asthma
- Bone marrow depression
- Severe CNS depression and coma
21
Q
Anti-histamines
-Adverse Effects
A
- 1st generation makes you drowsy
- 2nd generation can make people awake (hard to sleep)
3.
22
Q
Anti-histamines
-Nursing Implications/Teaching
A
- Increase fluids
- Watch for drowsiness with (generation 1)
- Don’t mix alcohol or other sedating meds
- Teach ways to relieve dry mouth
- Administer meds w/ food, except LORATADINE (CLARATIN)
23
Q
CLARITIN
A
- Anti-histamine that is NOT administered w/ food
24
Q
Lower Respiratory Medications
A
- Asthma
- COPD
- Chronic bronchitis
- Emphysema
25
Asthma and COPD cause?
1. Inflammation
| 2. Bronchoconstriction
26
Inflammation treatment
1. Corticosteroids - inhaled (nasal spray) and oral
| 2. Leukotriene receptor inhibitors
27
Bronchoconstriction Treatment
1. Beta agonist
2. Anticholinergic
3. Zanthine derivative
28
Beta Agonists
| -Examples
1. Albuterol
2. Salmeterol
Beta 2 receptors are acted on
29
Beta Agonists
| -Adverse effects
1. Increase HR
2. Tremors
3. Increased BP
4. Decreased GI motility
30
Beta Agonists
| -use
1. Used for emergency bronchoconstriction as well as prevention
Albuterol
31
Beta Agonists
| -Contraindications
1. Cardio dz
2. HTN
3. Thyroid disease use cautiously
32
How to use an inhaler (albuterol)
1. Shake it thoroughly
2. Exhale fully
3. Put mouth around mouthpiece
4. Slowly inhale when you push it down
5. Hold breath for 10 seconds
6. Rinse out mouth after treatment
7. Wait 30 seconds to a minute before puffs
33
Beta Agonists
| -Action
Quickly bronchodilates and used for emergency situations
Adrenergic meds open the door
Anticholinergics keep the door open
34
Anticholinergics
| -Example
1. Atrovent
35
Anticholinergics
| -Action
1. Inhibits muscarinic cholinergic receptors in the bronchi which inhibits bronchoconstriction
2. Slower onset than beta agonists
3. Asthma, COPD w/ airway constriction
36
Anticholinergics **TEST**
| -contraindications
1. Hypersensitivity to atropine
2. Acute bronchospasm
3. Allergy to peanuts
37
Xanthine Derivative
| -Action
1. Causes relaxation of smooth muscles of the respiratory tract, relieving bronchospasm and allowing greater airflow in and out of the lungs
38
Theophylline
1. Xanthine derivative that is a couple molecules away from Caffeine
2. can be given IV
39
```
Xanthine Derivative (theophylline)
-Contraindications
```
1. Coronary disease
| 2. Renal disease
40
```
Xanthine Derivative (theophylline)
-Drug interactions
```
1. Antibiotics
2. Beta blockers
3. Lithium
41
```
Xanthine Derivative (theophylline)
-Adverse effects
```
1. Headache
2. Nervousness
3. Tachycardia
4. N/V
5. Think effects of caffeine
42
```
Xanthine Derivative (theophylline)
-Therapeutic level
```
1. 12 micrograms/mL
43
```
Xanthine Derivative (theophylline)
-Nursing Implications/Teaching
```
1. Given orally or IV
2. Monitor levels (12 - 15)
3. Take oral on empty stomach
4. Monitor VS with IV administration
5. Avoid smoking (keep smoking constant amount)
- smoking changes blood levels of theophylline
44
Corticosteroids
| -Action
1. Anti-inflammatory effects which lead to decreased airway obstruction
2. Do not relieve symptoms of acute asthmatic attacks
3. Used prophylactically to prevent asthma attacks
45
Corticosteroids
| -Mechanism of action
1. Inhibits the body's immune response
2. Corticosteroids also restore or increase the responsiveness of bronchial smooth muscle to beta-adrenergic stimulation which results in more pronounced stimulation of the beta 2 receptors by beta agonist drugs
46
Corticosteroids
| -Examples
1. Fluticasone (Flovent)
| 2. budesonide (Pulmicort)
47
Corticosteroids
| -Contraindications
1. Oral and inhaled not used for acute attacks
2. Can be used IV
3. Caution w/ acute respiratory infection
4. Caution w/ diabetics
48
Corticosteroids
| -Adverse Effects
1. Cough
2. Pharyngeal irritation
3. Dry mouth
4. Oral fungal infections
5. Hoarseness
49
Corticosteroids
| -Nursing Implications/Teaching
1. Proper inhaler admin
2. Take it faithfully
3. Results seen in 1 to 2 weeks
4. If high dose, might need to taper off
5. Watch for systemic effects
6. Watch for fungal infection
50
Leukotriene Receptor Antagonists
| -Overview
1. Non-steroid, anti-inflammatory
2. Block leukotrienes, preventing eosinophil migration, neutrophil and monocyte adhesion, increased capillary permeability and smooth muscle contraction
51
Leukotriene Receptor Antagonists
| -Contraindications
1. LIVER problems and Renal dysfunction
| 2. Not used for acute attacks
52
Leukotriene Receptor Antagonists
| -Adverse effects
1. Headache & dizziness
2. Myalgia
3. N/V/D
4. Elevated liver enzymes
53
Leukotriene Receptor Antagonists
| -Drug implications
1. warfarin
| 2. theophylline
54
Leukotriene Receptor Antagonists
| -Pt teaching/ implications
1. Administer on empty stomach
| 2. Monitor theophylline levels, PT/INR levels if on these drugs concurrently
55
Intranasal (Topical) Decongestants
| -Pt Teaching
1. More efficacious
2. Only use for 5 days due to rebound congestion
3. Affect local action w/in minutes
4. Few systemic effects
56
1st generation antihistamine
| -adverse effects
1. DROWSINESS
2. fatigue
3. Nausea & dyspepsia
4. Throat irritation
5. Constipation & dry mouth
57
2nd Generation Antihistamine
| -Adverse Effects
1. No Drowsiness
2. Nausea & Constipation
3. Dry mouth
4. Dyspepsia
58
Bronchodilators (Beta-2)
| -How they work
1. Beta-2
- Relax muscle in the lungs allowing airways to widen
- Long acting beta-2 agonists reduce amount of mucus in lungs
- More effective at treating asthma than COPD
59
Bronchodilators (Anticholinergics)
| -How they work
1. Relax the muscles in your lungs
| 2. Mainly used to treat COPD and taken through inhaler.
60
Bronchodilators (Theophyllines)
| -How they work
1. Long acting bronchodilators used to treat COPD
| 2. Relax muscles in the lungs while reducing possible inflammation of the airways
61
Triggers for allergic Rhinitis
1. Seasonal allergies
| - ragweed / tree pollen / mold spores
62
Antitussive medication
| -Indication **TEST**
1. Not used for a productive cough / USED FOR DRY COUGH
| 2. medication is given to promote ability to sleep
63
Theophylline Toxicity
1. Therapeutic levels are 12-15 micrograms/mL
2. Diarrhea / Vomiting / Nausea
3. poor appetite & fatigue
4. headache & insomnia
5. Difficulty breathing / rapid pulse / confusion / seizures
64
Function of Upper Respiratory Tract
1. Filter, humidify and warm air
| 2. Larynx prevents food from entering lower respiratory tract
