Transcript Proteus, Klebsiella, E. coli

DRUGS FOR RESPIRATORY DISORDERS
 Upper

Common cold



Inflammation of nasal mucous membranes
Sinusitis


Etiology: rhinovirus
Affects nasopharyngeal tract
Acute rhinitis


respiratory infections
Inflammation of mucous membranes of sinuses
Acute pharyngitis

Inflammation of throat
 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,
increased mucosal secretions
cough,

H1-blockers (antagonists)
 First-generation antihistamines
 Diphenhydramine (Benadryl)

Second-generation antihistamines
 Cetirizine (Zyrtec)
 Fexofenadine (Allegra)
 Loratadine (Claritin)
Nonsedating antihistamines; little to no effect
on sedation

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

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

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.

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.
 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

Oxymetazoline (Afrin) nasal spray

Pseudoephedrine (Sudafed)
 Administration
 Nasal spray, nasal drops, tablet, capsule,
liquid

Interactions
 Sudafed may decrease effect of beta blockers
 May increase blood pressure, dysrhythmias
with MAOIs
 May increase restlessness, palpitations with
caffeine (e.g., coffee, tea)
 Oxymetazoline
(Afrin), naphazoline (Allerest),
pseudoephedrine (Sudafed)

Side effects



Frequent use



Nervousness, restlessness, “jitters”
Alpha-adrenergic effect (hypertension, hyperglycemia)
May lead to tolerance
May lead to rebound nasal congestion
Should not use more than 5 days
 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.

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
 Guaifenesin
(Robitussin; Mucinex)
 Action

Loosens bronchial secretions by reducing
surface tension of secretions
 Use

Dry, nonproductive cough
 Side
effects
 Drowsiness, nausea

Sinusitis
 Treatment
 Decongestant, acetaminophen, fluids, rest,
antibiotics

Acute pharyngitis
 Treatment
 Saline gargles, lozenges, increased fluid intake,
acetaminophen
 Antibiotics with bacterial infection
 Pathophysiologic
changes
 Airway obstruction with increased
airway resistance to airflow
 Major
disorders
 Chronic bronchitis
 Emphysema
 Asthma

Etiology
 Cigarette smoking, inflammation
 Chronic lung infections
 Allergens

Characteristic symptoms
 Dyspnea, excess mucus secretions
 Airway obstruction, bronchospasm
 Permanent, irreversible damage to the lung
tissue
Signs and Symptoms of Chronic Obstructive
Pulmonary Disease (COPD) Conditions
Factors Contributing to Bronchoconstriction
 Pathophysiologic
 Decrease in total


changes
lung capacity from:
Fluid accumulation
Loss of elasticity of the lung tissues
 Etiology
 Pulmonary fibrosis
 Pneumonitis
 Lung tumors
 Thoracic deformities
 Myasthenia gravis
(scoliosis)
 Anticholinergics



Albuterol (Proventil, ProAir)
Ipratropium bromide (Atrovent)
Ipratropium (Combivent)
Action: dilates bronchioles
 Administration: aerosol inhaler
 Caution
 Narrow-angle glaucoma


Methylxanthine (Xanthine) derivatives
 Aminophylline (Somophyllin), theophylline
(SloBid)
Action: relaxes smooth muscle of bronchi,
bronchioles increasing cAMP, promoting
bronchodilation
 Use: maintenance therapy for chronic stable
asthma
 Therapeutic range: 10 to 20 mcg/mL (toxicity
greater than 20)

 Aminophylline
(Somophyllin),
theophylline (SloBid)



Contraindications: seizure, cardiac, renal, or
liver disorders
Administration: oral, IV
Side effects: dysrhythmias, nervousness,
irritability, insomnia, flushing, dizziness,
hypotension, seizures, GI distress, intestinal
bleeding, hyperglycemia, tachycardia,
palpitations, cardiorespiratory collapse

Zafirlukast (Accolate), montelukast (Singulair)

Action: reduce inflammatory process and
decrease bronchoconstriction

Use: prophylactic and maintenance for chronic
asthma

Side effects: dizziness, HA, GI distress,
abnormal liver enzymes, nasal congestion,
cough, pharyngitis

Glucocorticoids
 Beclomethasone (Beclovent, Vanceril), dexamethasone
(Decadron), solumedrol, solucortef


Action: antiinflammatory effect
Administration
 Aerosol inhaler: fluticasone, beclomethasone – used
in long acting inhalers (budesonide/formoterol
fumarate dihydrate; fluticasone propionate and
salmeterol;
 Tablet: dexamethasone, prednisone, medrol dose
pack
 Injection: dexamethasone (Decadron), solumedrol,
solucortef

Aerosol inhaler
 Metered-dose inhaler (MDI)
 Dry powdered inhaler (DPI)

Frequent dosing
 Tremors, nervousness, tachycardia

Administration
 Teach client to use inhaler correctly and take
care of equipment correctly.
 Acetylcysteine

Action



Administer 5 minutes after a bronchodilator
Should not be mixed with other drugs
Also an antidote for acetaminophen overdose if
within 12 to 24 hours


Liquefies and loosens thick mucus secretions
Administration


(Mucomyst)
Give orally diluted in juice or soft drink
Also used to treat acetaminophen toxicity
 Etiology
 Mycobacterium

tuberculosis
Acid-fast bacillus
 Transmission
 Person to person

via droplets
Coughing, sneezing
 Clients at risk
 Alcohol addicted, debilitated
 Immunocompromised
 Homeless
 Poverty stricken populations

Symptoms
 Cough, sputum
 Fever, night sweats, weight loss
 GI distress

Prophylaxis recommended (6 months to 1 year)
 Close contact with diagnosed TB client
 HIV positive with positive TB test
 Converted from negative to positive TB test
 Contraindicated in liver disease
 Drug combinations
 Single-drug therapy


Ineffective
Multidrug therapy


Decreases bacterial resistance to drug
Treatment duration decreased
 Drug selection
 First-line drugs

Isoniazid, rifampin,ethambutol
 Treatment
 Divided
regimen
into 2 phases
 Phase
1
 Duration: 2 months
 Phase
2
 Duration: 4 to 7 month
 May
use Direct Observation Therapy

Isoniazid (INH)
 Route: Oral, IM

Inhibits bacterial cell wall synthesis

Side effects/adverse reactions
 GI distress, constipation
 Blurred vision, photosensitivity
 Tinnitus, dizziness
 Peripheral neuropathy
 Psychotic behavior, seizures
 Blood dyscrasias, hepatotoxicity

Isoniazid (INH) (cont’d)
 Drug interaction
 Increases effect of INH
 Alcohol, rifampin, cycloserine, phenytoin



Decreases phenytoin effect when concurrent
Decreases absorption
 Antacids
Alcohol
 Increases risk of neuropathy, hepatotoxicity

Isoniazid (INH) (cont’d)
 Client teaching
 Take INH 1 hour before meals or 2 hours after
meals
 Must follow complete regimen
 Collect sputum specimen in early morning
 Take pyridoxine (vitamin B6) to prevent
peripheral neuropathy
 Check liver enzymes, CBC
 Need frequent eye examinations
 Report numbness, tingling, burning
 Teach sun precautions, to avoid antacids
Rifampin
 Warn
client that body fluids
may be red-orange

Ethambutol
 Take
single daily dose to avoid
visual disturbances
 Action
 Inhibit bacterial synthesis
 Bacteriostatic
 Fights gram – bacteria

of folic acid
Proteus, Klebsiella, E. coli, Chlamydia
 Uses
 Otitis media, respiratory infections
 UTIs, prostatitis, gonorrhea
 Route
 Oral,
IV, topical, ophthalmic
 Types

of sulfonamides
Intermediate-acting


Trimethoprim-sulfamethoxazole (Bactrim)
Sulfasalazine (Azulfidine)
 Side effects/adverse reactions
 GI distress, stomatitis, photosensitivity
 Crystalluria, renal failure
 Blood dyscrasias, Stevens-Johnson syndrome
 Nursing interventions
 Increase fluid intake to at least 2000
 Monitor CBC and renal function.
 Monitor for rash, superinfection.
 Avoid during third trimester.
 Avoid antacids.
mL/day.
 Trimethoprim
 Interferes with bacterial folic
 Urinary tract antiinfective
 Effective against gram –

Proteus, Klebsiella, E. coli
acid synthesis
 TMP/SMZ
 Bactrim, Septra
 Blocks bacterial protein synthesis
 Bactericidal effect
 Treats UTI, otitis media, bronchitis,

burns
Route

Oral, IV
pneumonia,
 TMP/SMZ (cont’d)
 Drug interaction

Warfarin


Increases anticoagulation
Oral hypoglycemic

Increases hypoglycemia
 TMP/SMZ (cont’d)
 Side effects




Mild to moderate rash, photosensitivity
GI distress, stomatitis, crystalluria
Fatigue, depression, headache, dizziness
Adverse reactions



Blood dyscrasias
Stevens-Johnson syndrome
Renal failure
 TMP/SMZ
 Nursing interventions







Administer with full glass of water 1 hour before meals
or 2 hours after meals.
Increase fluid intake.
Monitor for sore throat, bruising, bleeding.
Monitor CBC.
Check for superinfection.
Advise client not to take with antacids.
Tell client to avoid direct sunlight.
 Fungal infections
 Treats superficial infections



Skin, mucous membranes
Mild
Systemic infections


Lungs, CNS
Severe
 Antifungal
 Polyenes


drug groups
Nystatin
Azoles

Fluconazole (Diflucan), miconazole (Monistat)
 Nystatin (Mycostatin)
 Methods of administration:
 Action



oral, topical
Increases permeability of fungal cell membrane
Fungistatic, fungicidal
Client teaching

Administration: Swish and swallow
 Gargle if throat affected
 Azoles
 Fluconazole
 Treat


(Diflucan)
Candidiasis, cryptococcosis, histoplasmosis
Route

oral, IV, vaginal, topical